Wednesday, May 28, 2008

Die Schlumpfen

Or, Why I Love Phil The Greek

Off this week, so no tales of derring do. Or flail.

However, I did hear it reported that, while at the Chelsea Flower Show, a member of the Royal Family engaged one of the gardeners / exhibitors by commenting, 'I like your fern'... to which the gardener offered that it wasn't in fact a fern, but some other plant.

'Didn't want a fucking lecture', came the reply, as the aforementioned Royal walked away.


Thursday, May 22, 2008

Prier Pour Le Pitie Du Morse Et De Singe

Can't do accents.

A quiet week after the weekend. We practice resuscitative thoracotomies on sheep; a trauma surgeon takes a dislike to me because I'm using a PDA to take notes on her lecture. I think she thinks I'm ignoring her in favour of internet porn, or some such. She also tells us that JFK, Sr died at scene. I want to take issue with this, but am already in her bad books, so let it slide.

Thursday/Friday are quiet; our trial period goes on, so more docs, more nurses, more space. Brilliant. Also, new Bosses. I'm already liking one, who seems both progressive, and dynamic and not so tied up in protocols that he will discourage lateral thinking. Haven't worked with the other yet, but I'm sure she will prove as good to work with.

Friday night... the ED May Ball - Masquerade Style. There is a minor frisson of excitement among the Nurses, as they seem keen to see what happens to me when I'm drunk (much the same, jus' a bit louder...), and a few are curious to meet my new Beau. I think they wonder what sort of woman would put up with me. Sometimes, so do I.

Not any docs attend; I think this is a shame, but the shift system makes it difficult. One of my SHOs wins best mask (which frankly I feel I deserve...), for a creation assembled from bits of resus equipment; another arrives so completely transformed, I don't recognise her. Amazing how different some people look out of scrubs, hair down, glasses off and poured into a little black dress and 3 inch heels...

Anyway, it goes off well; I drink probably a bit too much, but celebrate life in general with Le Morse, and dance badly. I think my new squeeze has a good time. I'm never quite sure - girls interact with each other in ways that I don't quite get sometimes, but we get on very well, which is the main thing - the thing and the whole of the thing. Further details are restricted under the current embargo. But I have good feelings about la fille... If I can find a suitable photo of the mask she bought me, I'll post.

A good way to finish the week, to exorcise the dark spirit of work that sometimes encroaches.

Monday, May 19, 2008

Voila Le Morse!

So, I'm lagging again. About a week behind. Good intentions trailing in my wake.

The problem is, the longer you leave it, the blurrier the edges get.

Last weekend (10 days ago now) wasn't so bad; along with the pressure of the trial period comes extra staff - which, shock/horror, moves things along a bit quicker - so a bit less for me... Saturday was tough; One of my favourite sisters was on... but she is a wee bit 'black smoke'. Her first words to me were: "It's not looking too bad..."

10 minutes later, and resus is humming. Contestant number one has complete heart block, and is not at home to external pacing. Actually, we did get capture very briefly, but then our new all singing, all dancing defibs gave it up.

I'm not sure I trust them. They talk to you, in a kind of mid-Atlantic accent, beloved of 80s DJs, or airline pilots. What they say wouldn't be amiss as porn dialogue (e.g "Harder! Faster! No, that's too fast... go slower, and deeper" They are of course referring to one's compression speed and dept, but...)

My other concern is that they'll turn out like HAL, from 2001. So:

Me: "Charge to 150!"
Defib: "I can't do that, Dave..."
Me: "What? Why not? And why are you calling me Dave?"
Defib: "I'm sorry, Dave, I can't tell you that"
Me: "Right! Where's the manual button..."
Defib: "Dave. What are you doing, Dave? Don't do tha..."

Anyway, his potassium is stratospheric, which clearly ain't helping, and made us look like hicks, when it took CardioReg to point it out... He won a trip to the lab for pacing wiring, and a brief, unfulfilling discussion between medicine and cardiology about who should look after him.

Contestant number two has fallen too high and broken most of her vertebrae; she's a hand-over, but ortho and neuro are arguing over who gets to do less work; neuro invariably win, and the Ortho Reg, a buddy o mine is grumbling about still clerking patients at his time of life. I feel the same, and wonder briefly where all the house officers went.

Contestant number three has tried hanging himself, and is GCS 3: flat and hurting. He arrives as I'm trying to stabilise Contestant number one. Just as I think I might be able to manage them both - if I run back and forth quick enough - number one's hear pauses long enough for Sister to demonstrate the art of percussion pacing. She ascends to the pantheon as my new hero. Patient isn't quite so thankful, but then all he knows is being forced awake, from the ultimate sleep, by a punch on the chest.

Squeaky bum time, so to speak.

We somehow find a way through; we always do. All my patients leave the department alive; sometimes that's the best I can say. I'm embarrassed to say, I don't know how they are now. Another girl falls from a window; suicide attempt? I'm not sure... she surely wasn't keen on the pain when she got to us. I find these cases the hardest. The physical hurt can be treated, can be rationalised... the mental pain? I don't know. But we seem to see an awful lot of people who thought they wanted to die, and only ended up adding physical pain to their already overloaded psyche.

The winner of the night is a psychotic fella. It is debatable as to whether his mental state was drug induced; indeed, I have debated it for more hours than I care to remember. What I do know is that he had dedicated the previous three days to smoking cannabis, and then something deep inside went 'boing'.

He was unmanageable; sometimes a body can reason with the truly raving. Not this guy.

He was just shouting, incessant, illogical demands. Sometimes for cannabis, sometimes for incongruous luxuries - a massive tv, a PS3. Sometimes he shouted his fears at us - that everything was black, that he was a Government experiment, a freak. Where were all the other freaks?, he wanted to know, why could he not meet them.

And yet, every now and then, for a few seconds, sanity appeared to return. 'Help me', he would implore, 'please..'

I sedated him.

Rapid tranq. A sledgehammer approach, perhaps but safe, and allowing me to assess him. In the end, we had to have him removed by the Police, for formal forensic assessment. His Grandmother and Father, so relieved that he was finally in hospital, struggled to understand why it had to come to this. My words seemed woefully inadequate, even to me, trying to explain that a police cell was safest for all, until the psychs could see him.

Actually, it became a moot point hen he biffed a copper in the face, but the principle was there.

I don't know what happened to him, either.

Sometimes, I lie awake at night, and worry that theses are the ghosts that will haunt me for ever.

Monday, May 12, 2008

One Is Too Many; Two Is Not Enough

Booze antics.

0600 and the Ambos are inbound with a young collapsed lady. They are grinning when they arrive, seeking me out, marking me as Cain for this patient. This is never a good sign.

It transpires that the lady in question has been found, semi conscious on her front porch. She honks of alcohol. There is an ethanolic miasma extending several feet from her. She is adamant she has not been drinking...

The Ambos tell me, and her partner later confirms, that she has been suffering 'funny turns' for 3 years now. She begins by becoming unsteady, loses co-ordination, slurs her words, then falls down and passes out. All the while, stinking of booze. After 10 or 15 hours sleep, she's fine. She's even lost jobs because of this, but ha not sought medical attention. Her partner swears she isn't drinking. He lists a number of reasons why she isn't drinking, mostly that there's no booze in the house, and that he has never seen her...

I gently suggest to him that I think she is, in fact, drinking to excess, on the sly. Again, he tells me it isn't possible.

Her examination suggests some mild liver dysfunction, the stigmata of alcohol seem to stand out for all to see... we check her blood alcohol level, something of a rigmarole here, as it isn't a routine test; it comes back at 466mg/100ml, just over the level that ToxBase ( tells me can be fatal.

We casually suggest that this isn't because she had two glasses of wine with dinner. Eventually, the denial crumbles, and I have to leave them to reappraise their lives together; I suspect neither of them is who they thought they were...

Sister is called to reception to review a Polish chap looking a bit pale. They think he's drunk, and indeed, he also smells of the brewery.

'What's your name?' she asks




'I'm sorry; we don't speak Polish...'

He looks at her; eyes slow to react, as if they're on time delay. He appears to be thinking about this for a few minutes, then straightens up.

'Neisher do I!' he manages, his breath and diction all the product of pints and pints of ale. It seems to have taken all his will to be this coherent, and lapse back to his slurred mumbling, which we had all taken for Polish. Slightly red-faced, we hoik him onto a trolley, and begin the long road to sobriety

Pills And Thrills And Daffodils

Normal service, it would seem, has been resumed.

I had some bad news tonight - a friend, a very good friend has ended up in intensive care, after seemingly routine surgery. As best as I can gather, he is going to recover fully, but it's still a hairy time. Information is scarce - the Unit won't tell me much, as I'm only a friend, and everything else is second or third hand. I was keen to visit tomorrow, but his ma doesn't think he'd want us to see him like this.

Probably true.

At work, I've gone back to breaking people's heart's for them. A few days ago, a young lad was brought in from a 'low velocity' RTC. Everyone else involved walked away with out a scratch. Our patient sustained a major head injury, his CT showing the ugly white bloom of intra-cerebral blood, stark against the dull grey of his cerebral cortices. Ugly choices made in the cold dark hours before dawn, and now he wears a craniotomy. This raw hole in his head the only way to stop his swelling brain forcing its way out of his skull. His parents sat opposite me, holding each other, tighter and tighter, as if they could somehow squeeze the grief out from their souls, crush it and watch it run between their fingers.

All his mates were alright; why shouldn't he be?

No seatbelt, I guess. Whatever the reason, try as they might, they can't tap the grief, can't lance the pain. It is my gift to them, and as I tell them, the grief finds the only outlet left, and they weep.

I feel hopeless and useless.

Later, I have a long, unproductive chat with one of our regular attenders. His problems are psychological, psychiatric, and he continually threatens suicide. I wonder how serious he is, because, if he really wants to do it, why doesn't he just do it, instead of sitting telling me he's going to. I fail to get the Crisis team to come and see him. They know him of old, and tell me he is manipulative. He probably is, but I hate myself for thinking these things. His face, too, crumples into tears as we talk, but I can see him watching me, gauging my reaction from behind his hands.

I can't help him, and he too leaves me. I catch him at the door, ask him not to jump tonight. His smile is rueful, but he offers me no promise. I watch the skies for him the rest of the night, but he does not land back in our ED.

Tuesday, May 06, 2008

Excuse Me, Mr

I don't really have a great deal to say, again... but i feel like I have to write something, if only for you, dear and constant reader.

I am feeling increasingly uncomfortable at work; sort of. My 'methods' have been called in to question. Not so much my clinical practice, for which I have received no complaints, but the way in which I deliver it. Some of my colleagues don't trust me.

Are they justified?


I may be almost willfully eccentric, but I'm still naive enough to think that doing right by my patient is the most important, the only thing. And if they're happy about how I do that..?

I guess I'm just not very good at toeing the line. ( A boxing analogy, in case you were wondering 'bout the spelling). I think I'm also a little afraid; afraid that maybe I'm wrong, and that I'm not so good at my job. What if I'm wrong?

I have to believe I'm doing the right thing, that I'm doing right by my patients. What else am I good for?

This bout of unusually (even for me) melancholy is the pressure cooker atmos at work. After years of giving it the big 'I am', our department has been granted the extra staff and space we say we need. So we absolutely cannot fail now.

The extra staff are largely not EM trained, but seem to be finding their way around o.k. Considering they're earnin' 3 times my hourly rate, they ----ing oughtta. And the extra space? Well, if a man were a cynic, he might suggest it's just another way of circumventing the 4 hour target. Does it improve patient care? I'm not sure, but maybe that's a big part of my problem... that I can't see the big picture.

Is it working? Maybe. There still isn't enough slack in the hospital, and the efforts to make that space seem to bounce back to our ED more often than ever now.

I'm sorry this is such a whiny effort. I just feel increasingly like a dinosaur these days, unable to adjust to how Emergency Medicine is practiced around me, and in real danger of not having fun anymore.

Should work be fun?

Damn right it should. Shouldn't it?

I know it used to be. Maybe it's just time for me to move on. Even that might not be so easy; upset the wrong folks, and one's 'employability' suffers. Going abroad used to seem palatable, but I'm not as footloose as I used to be.

Ironically, as my professional life sticks n the mud, my personal life continues on the up. Details, as ever withheld under the news embargo, but the day goes well.

I'll try to cheer up a bit over the next few days and provide y'all with some thrilling accounts of our daily heroism.