Wednesday, August 13, 2008

Hard Done By

Self deprecating... maybe; it's almost a requirement of the Citizenship exam these days. "Hard-done-by"..? Not really, and we all know it... but it does make for better copy.

For most of you, this will make precious little sense... but you know who you are.

Sometimes you see people get sicker before your eyes. I know that sounds somewhere between common sense and bollocks, but it fits, if you think about it. I've blogged about it before, but can't quite remember when; no bother. What I bring to the table tonight is the opposite. Which is always better. Almost by default, we of God's Children in the ED tend to assume the worst, and work backwards. You miss less that way. And when BatPhone goes, you prepare for the worst.

For example: the call comes in, warning of an adult male, stabed in the leg, in the thigh. Pale sweaty, tachycardic. The thought that flickers in to view, that crawls out of the back of the subconscious is the Butcher's Cut. Well, that's what Pa Shroom called it. KnifeMan slang for the wound that cuts BigRed, BigBlue and BigRed again. One cut, in the groin; the unkindest cut, the Butcher's knife slipping past the apron...

Plenty of claret, difficult to stem.

So you prepare for it, steel yourself and in rolls a very healthy looking fella with a wee knife in the front of his thigh, minimal bleeding. And he's waving. A jaunty smile, God love 'im. He has the decency to look slightly embarrassed, but by now, you don't care, because the patient just got better in front of your very eyes.

Last night: the call is worse. A young 'un, a tweenager, found down, unresponsive, no blood pressure... no more details, but what you have is bad enough. Late at night, it's just you; you hurry to guess-timate their weight, prepare the drugs you hope you won't need, gather your wits.

The Ambos roll up, and already its better. They're older, more responsive and obs sit on the normal. You take a breath, but still have a vomiting comatose teenager to deal with; this is still not an happy combo. They have definitely NOT been drinking you hear as you offload onto the trolley. They heave, determinedly, and you do the gallant thing, and roll them onto their side, but ensuring it's the side that faces Sister.

In the vomitus? Vodka. Sister has a nose for it. I can't smell it, but she assures me it's there. I learned early not to doubt Sister.

So, in about 30 seconds, my patient has transformed, from one with no blood pressure, and no neurological function, to one who just had a bit too much fun.

Now, granted, people still die from drinking too much, but rarely, and here is something we can deal with, something significantly more benign. Drunk teenagers? It's virtually our speciality...

The same patient provides us with the best quote of the year a little later. Sister, while assessing our patient's response to pain, employs a technique not unlike Mr Spock's Vulcan nerve grip. As well as confirming our ability to wake this patient from the alcohol induced slumber she presented with, it elicits a response that draws heavily on an epithet that might derive from instructions to procreate issued by a monarch.*

Sister is not keen on bad language. "Don't say that!", she implores. "Couldn't you say something else? Something like: 'Oh, Fairies!'"

*Fornication Under Command of the King since you were wondering....


Elaine said...

I think the best bit was that you rolled the vomiting patient over so that the vomitus would hit Sister rather than you.


or, depending on Sister,very, very brave!

Chrysalis Angel said...

Didn't care to be bathed in vomit, Shroom? You know I'm teasing...just popping in to say hello.

DrShroom said...

I have achieved something of a reputation among the nursing staff for the gallant way I roll patients toward them / away from me when vomit looks likely...

SeaSpray said...

Never dull in the ED.

Being vomited on would ruin my night.

I briefly entertained the notion that I might want to become a nurse until I actually began working with the ER (registration) and realized there were projectile body fluids to deal with. ;)

If I worked with you I'd quick roll her back like a fast game of Hot Potato. ;)

Anonymous said...

It's not always /our/ fault. I was found down, incoherent and covered in my own vomit. Why did my friends call an ambulance instead of schleping me home? I'll never know. :(