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.

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