Thursday, January 10, 2008


I'm due a few weeks off; I'm beginning to think it couldn't come too soon. Off the back of a few nights, I worked a single day. It was not a good shift. Busy busy busy.

This is not unusual these days, with the hospital running at 98% occupancy most days. But I did not comport myself well. Over excited, showing off?

i don't know. In the final analysis, it doesn't matter much, but I was in a stroppy mood. Thankfully, no-one takes me very seriously, and they were more understanding of my temper than I deserve.

My last patient on nights was a three week old baby. One so very, very new to the world, but already too much medical history. Today's problem: vomiting. The little fella wasn't clearing his own airway, and for a few minutes I thought he was going to plug off completely. Actually for about 5 seconds, I thought he had. But a little soft suction, and I have never been so pleased to hear a baby scream. In fact, I've never been so glad to hear any sound.


Last shift. Busy, busy, busy. But I told you that already.

Mostly in resus. Strokes, trauma, stabbings. Fractures, dislocations, head injuries.

The first was the hardest. A young woman, who had a 'minor' TIA middle of last year. All the right things were done. The proper work up.

None of which prevented a large, disabling stroke in November. Worse today. What little function she had had... gone. She came to us fitting. Easily treated.

The old routine, tourniquet on, hunt the vein. If you can't see it, feel it. A zen thing. It doesn't matter. I never miss these days. (Arrogant, moi?) The cannula slides in, almost a reflex after all these years, and a lorazepam chaser.

The fits stop; I told you that part was easy.

But she doesn't get better, she can't get better, she won't get better.

She gets worse.

I have to preside over it; the MC of this horror show. Her husband knows; he can't bring himself to say it; he tells me over and over how she was, how alive, how vital.

He's trying to do the terminal illness split. To distance himself from what his beloved has become, while staying true to her. When he looks at her, he still sees the love of his life, but he knows it's not her.

He can't do it, and we both have to take a few minutes out.


If all I have is being good at my job, and I'm not doing that well anymore, what's left?

I hope the break will do me good.


the little medic said...

Sounds like you're well in need of a break - enjoy it.

View from the Trekant said...

These TIA work ups are scary. Go on a thorough source of embolism safari and still miss the patient who will have a recurrent event.

ps -Doubt the bit about 'not good at my job' - sounds like you care much and are very good. EchoDoc

cherrypicker said...

Antiphospholipid syndrome for the TIA. Previous history of migraines or miscarriage. Polycythemia I suppose could be a consideration as could paraneoplastic along with the usual haem differntials.

Obviously could have been inherited structural weakness as well. Can you let us know diagnosis please. Anyway back to my monoclonals!!