Monday, April 21, 2008
Go on; do it.
It's only five minutes... what else are you gonna do?
I'm on an education day today, so non-clinical... supposed to be in work anyway, but since I've been awake all night (pacing, mostly) and the wonders of the Internet envelop my house, I've kinda taken an executive decision to stay at home. I imagine I'll get a bollicking for it, but what can ye do?
In fact I'm becoming mildly concerned about my inability to adjust from nights, which seems to be getting worse weekly, but not sure what i can do, without resorting to pills - either sleepers to send me into the arms of Morpheus, or some sort of upper to get me goin' in the morning. I am reluctant to go down this road... so i guess I'll just have to slug it out. Ain't that so?
(Etymology note - I think 'ain't' dates from early 18th Century English, exported to the Americas. I have it in mind that it was used throughout the classes until popularised by e.g Dickens in the 19th Century, and vulgarised...)
The Department continues busy... we move onward, ever onward and upward. BBP has suggested we're getting extra staff, footprint and cash. I'll believe it when I see it. On a personal note, I need to overcome my Resus addiction. My minors experience is suffering. But I can't help it... I am, unashamedly, an adrenaline junkie.
Sometimes, it seems genuinely hard to get out; but I guess that's always the way of addiction. I need to trust the SHOs a bit more.
Achieved highs and lows last week:
---Having staff ask me for 'second opinions' on my colleagues cases... while it rankles a bit - it is a bit disrespectful - it at least means they trust me, which helps my psyche at a time when I'm feeling like my ability is being called into question.
---Treating a young lad presenting de novo in DKA, and having him give me a sticker to say thanks. (It read 'Please hug me, I've been brave'. No-one hugged me. They knew I hadn't really been brave)
--- Accidentally squirting ethyl chloride into the eye of one of my SHOs. It's all funny until someone gets hurt... how right they are. Sorry
---Blowing my top in a most childish manner. Shouting at all and sundry ain't cool, and i think I'm lucky enough to have enough credit at the Nurse Bank that they have accepted my apology. Maybe. Sorry, again.
I also had a pretty good run personally. For the record, she ain't in Cleveland. That was just an example, back-linking to a previous post. I do have an old friend in Cleveland, a high-falutin' gas-passer, but fate has seen fit to throw me together with someone a lot closer.
They know who they are, and that's pretty much all I can say, really.
Le silence du p'tit singe.
Tuesday, April 15, 2008
The Dept was, again, a Monday Night NightMare. The Hospital being really full didn't help. And, strange enough, sick people kept showing up. The audacity of it... BBP wasn't on, which aided my quest to be serious, as he always makes me feel jovial, and shares my sense of humour (I think - he may just be humouring me, until it's my round on the peanuts) which tends to encourage me to joke about a little. But another of my favourite nurses was on - The Great I Am - and he's equally partial to a bit of light heartedness. This, coupled with the presence of yet another of my fave staff - Queen of The Black Smoke - combined to make us busy, and me just a bit silly. But not hypomanic enough to warrant the Vitamin H. Yet.
But, still, I defined finite interaction with my patients. So, you, who were short of breath as your lungs clogged with fluid, and you, who were bleeding yourself pale, you joined the throng who I spent a little less time with. Less time holding your hands, explaining what I was doing; less time talking to your families, less time making sure you were warm and comfortable. You were all pushed, filed, indexed, briefed, debriefed and numbered.
Cautiously, as I may once again be on thinnish ice, I'm contemplating fate. I'm never quite sure how much of a fatalist I am. I'm pretty sure there's something in it, but I'm never quite sure how much I could, or should attribute to the will of a higher power. Either way, I most often contemplate it in terms of mortality, or soul mates.
Mortality? Is it ever someone's time? Well, yes. When you go, it's your time. I've presided over this hundreds, if not thousands of times. Some of you know when it's coming; some of you don't. Is it meant to be? Does that make it easier. I genuinely don't know; I suspect the idea that something was 'meant' to be is extraordinarily cold comfort to someone who has lost a loved one.
Nonetheless, sometimes, I think it is your time, whether you like it or not. I'm not sure what that means. Maybe it's the whiskey talking. The philosopher Izzard has commented that Hitler lived longer than his mother. (Izzard's, not Hitler's) His point being that shit happens; is that fate?
Soulmates. A happier subject? Not necessarily. Is there someone for everyone? Maybe, but what if they're on another continent? Or in Cleveland? Then is that fate telling you they ain't the one for you?
I've mostly encountered this is the negative sense; people who one meets, who, if fate had dictated a different time, a different place... well, who knows?
But never before, encountered a situation wherein now seems to be the right time. Is that a sign? Would that be fate?
Time, as ever, will tell.
Monday, April 14, 2008
Pa Shroom has also pointed out that we're more or less 99% fruitfly, but I'm having less fun with 'Voila le fruitfly...'
As for my 'hypomania'... while I accept I sound a bit hypomanic from time to time, I'm happy that I ain't clinical. I'm a firm believer in people being allowed to be happy, and miserable, sometimes excessively so, without it being a clinical phenomenon. Anyway, I haven't been wrestled to the ground and sedated yet, but stay tuned.
However, I have to accept that I have been, perhaps, overly jocular at work, and a failure to adjust one's attitude for circumstances might well be straying over the boundary a bit. So, this week I shall try to forgo the fun part of my job; I'm not sure I can curtail the streak of black humour that courses thru my veins; that might send me mad. But I feel like I've been challenged, accused, of not doing the job.
So, serious Shroom. Game face, kow-tow to the managers, allow my spirit to be subverted. Maybe it'll make me a better doc. It sure as hell won't make me a better person, but that's not the point, eh?
Updates to follow.
Saturday, April 12, 2008
In fact, I continue to have a shit-eating grin on my face. The reasons are subject to the current embargo, but I feel... electric. As a young 'un, I used to get hyper during thunder-storms. The warning grey-yellow bruising of the sky, the smell of ozone, the feeling of the wind, as it changes carrying first the promise of, and then the reality of rain... it all combines to fire me up in a truly elemental way. I can't really explain it, but I guess it is elemental, more or less. Anyway, that's how I feel.
I need to calm down.
My mood was damped slightly by receiving a missive from a friend, also serving his time in the ED. He, too, is being squashed by time pressures. His boss delivered him a 3 line whip today, about the 'big picture' (read: 'spend less time with patients') He, as I, feels that this makes sense in theory - doing the most, for the most; but it is difficult in reality. Sick patients need re-assessment. We can't just leave them. Can we? He got a rollicking for going back to take an history from a non-English speaker. Told he had spent enough time with that patient. Refer and move on. And there was barely a flicker in response to the explanation, that the treatment had been empiric, until the translator arrived, and even we can't justify not taking an history in the name of targets.
Further criticism handed out for going back to talk to a patient's daughter, and explain what was happening. Limits must be placed. Aside from anything else, I think he feels the pain inherent in this, the unspoken criticism, that he is not doing his job properly anymore. I'm not sure either of us know what that is anymore sometimes.
Glad that couldn't happen to me.
And lastly, a rant about private medicine. When you decide to go private, if you don't agree with the care, it will not endear you to your local ED, if you pitch up, demand what you think is the right treatment (because that's what your friend got), complain when we have to repeat your investigations because the ones you had yesterday (privately) are not available to us, and then, after a 4 hour work up, demand that we admit you to the private hospital, so you can 'have a telly in your room'
Friday, April 11, 2008
I am, unusally, pretty happy. I can't really say why - certain details o my life have been embargoed, but ha'e a guess. It'll do ya good.
Hopefully, I'll be able to carry my mood to work, where our lives have become more complex as a film crew try to capture our every move, so now we have to worry about looking good while serving the Public... I am NOT ready for my close up.
Anyway... I can't (obv) get enough of these guys, so here you are...
Wednesday, April 09, 2008
However, he was the rudest man I have ever come across; and yet I would crawl over hot coals to work for him again. Some people couldn't hack it. And, I believe, he could be mean spirited, but at least he was consistent. I've worked for various bosses who had short fuses, and found that difficult. But this fella... always, always rude.
Our conversations would go like this:
Me: "Good morning, sir. How are you this morning?"
Him: "Why don't you fuck off, you brown nosing little shite?"
Me: "Thanks you, sir. I'll see you on rounds, shall I?"
Him:"Why haven't you taken up something you're more suited to, like occupational homeopathy?"
I cut my teeth operating with him behind me shouting in my ear: "Jesus Christ, boy! What are you doing? The patient's bleeding to death, and you're just buggering about! Sort it out!"
On occasion, he would approach me, and, inevitably, shout: "Shroom! I'm feeling very uncomfortable!.
Me (trying not to screw up another shave and graft) "I'm sorry, sir. Why is that?"
Him: "My fucking trousers are falling down!"
Me: "I'm not sure how I can help, sir..."
Him: "You fucking can't! I just wanted to tell someone..."
This might see me skating thin ice; it's cod philosophy anyway, not medical. Bail out now if it seems apt.
I have always been fascinated by beginnings; mostly when I come upon something halfway through. But I guess that don't make me special. We all like to know our origins, our back story. Or someone else's. How we define beginnings are more or less important. More, if you're a ball of cells in utero; less if you only want to know how things turn out. Do you turn to the last page of a book?
Where do things begin? Are there always fireworks, and choirs of cherubim and seraphim? Not usually, unless you're at a synchronised firework display, or some all-comers fat kid sing off. But the idea is as old as time itself. The big bang must surely be the greatest firework display ever; and if your bent is more religious... well, "Let there be light" is as close to lighting there blue touchpaper as you'll ever need. And who's to say God didn't turn to the massed cherubim, and pronounce "Ta-Daa!"
Where do we begin? Fireworks? We surely hope so, and we surely dread the damp squib. But can it be simpler? With someone letting you in out of the rain? With someone accepting your clumsy effort to open a beer bottle?
Two become one? No; one becoming two. Maybe it starts with your "one" fitting into someone else's "two". When you can't but think of them with out a smile; when, wherever you are, you wish you were sitting next to them.
Is a beginning ever more than just that? A beginning. Can you tell what'll happen next? I don't think you should try. However important it is, it's just a beginning. Strap on, and see what it turns into, eh?
Maybe it's just as simple as the philosopher Dylan said: "I'll let you be in my dream, if I can be in yours"
Tuesday, April 08, 2008
When we all tell the same gag. Yesterday, we had a patient who shared a name with someone famous. When I heard, I said: "Oh, not the ---? Famous for ---? Surely not? " (Cue deathly silence from staff... ever seen laughter actually curl up and die ?) Then BBP enters, clocks the name, and makes the same gag. Brilliant. Then, I come to refer the fella, tell the Magician his name, and: same gag. Awesome.
See also the miming of horse attacks; funny, unless you are a radiologist. (Laughter, death, etc.)
Monday, April 07, 2008
Then I forgot my manners; I am now a contrite Shroom, and will have to hope that is enough. Sorry.
Another selection from UOGB in lieu of posting.
Saturday, April 05, 2008
L'il Shroom's irritability levels have been tripping off the scale of late. Full Tilt Kozmic Boogie, you might say, if ye were that way inclined.
Dunno, but I am eternally glad that my colleagues at work are prepared to put up with me. I was especially annoyed this evening with a work colleague, who, it seemed to me was showing scant regard for the fact that I was already an hour late leaving; I have at least enough insight to realise that this was unlikely to be an intentional slight, and that I am attributing altogether too much import to myself, and my own self worth, but it stung nonetheless. What hurts the most is the way that we sometimes get taken forgranted; but I am loathe to foster an "Us and Them" relationship. In any close relationship, the partners are bound to rub each other up the wrong way from time to time, and what should mark me out as (mostly) different from the chimps is how one reacts.
Especially when one is a hypersensitive, moody bugger like me.
Anyway, was grumpy, have ranted, proved to have no grasp of modern verse. Feel better now.
An unusual week for ill folks. The young lady with Boerhaave's is still going on ITU. I went to see her. I felt I owed her. At the very least, I felt I owed her husband; I found I could look him in the eye, and, perhaps more to the point, he could look me in the eye. So, now we wait mediastinitis. My prayers are all I can offer her now. We'll know soon enough.
Next: a man with more than his fair share of rib fractures.
Run over; including, if you can believe it, his head. Initially, very uncomfortable (no, really?) Morphia saw to that, and we mostly goggled at him, thinking how lucky he probably was. Then, we spotted part of his chest moving the wrong way. For the non medical, what I mean is that, for every breath he took, most of his chest moved up and out, as per guidelines. But, some of his left chest resolutely declined that option. And moved in; as if it were being sucked in.Which it mostly was. During normal respiration, the diaphragm flattens and pulls down, while the ribs are pulled up and out by the intercostal muscles (between the ribs). This increases the volume of the chest cavity, lowering pressure therein and encouraging air to move in an 'into the lungs' kinda way.
But, if you disconnect a section, by, say, fracturing several ribs in two places, that section moves with the pressure - so, decrease pressure in the chest, chest wall sucks in.
As well as painful, this is bad for the whole process of respiration. In fact, it's number one on my list of 'Unfavourable Chest Wall Injuries'.
It certainly did nothing for his mood.
Part of the treatment involves placing a large bore plastic tube between the ribs, so decompress the inevitable pneumothorax, and improve respiration. Not easy at the best of times, it's even harder when the chest is not as... connected as it should be.
When I left, he was remarkably chipper, and gave me a big thumbs up. Well worth it.
Today: forehead versus horse. No contest really, although it did give me ample opportunity to flail, flail and flail again trying to garner assistance in transfer to the Mighty Donut. The injury put into perspective all the times I've palpated a scalp, wondering if I was feeling a step off, fortelling the presence of a depressed fracture. This wasn't subtle. It screamed 'behold! Here I am! The indentation produced by a rapidly moving horses hoof'.
CT showed a fracture through frontal bone and sinus, which, relatively speaking, ain't so bad. She was definitively concussed however, continually identifying her location as such esoteric locations as 'the kitchen', 'Sainsbury's', 'the garden'... anywhere but the hospital really. But she'll be fine, although I can't help but feel it might be a while before she makes any sense.
On a lighter note, I'd like you to consider how you might mime the Horse attack. We theorised that men do it one way, and women another, if at all. Think on it, and let me know, if ye can be bothered.
Wednesday, April 02, 2008
Good things continue to brew in the background for the Shroom, but it continues as a work in progress, so... shhh...
As a Doctor, part of the deal, maybe most of the deal, maybe ALL of the deal is being the patient's advocate. With all the privilege it entails, patients expect, deserve, demand that we do our best for them; that we do our best, even when others disagree with us.
And this morning I failed my patient; I missed what would turn out to be the crucial detail in her history, although I did not fail to see how ill she was. But I was unable to convince my colleagues of this fact; allowed myself to be pushed around; I could not convince myself to step up for her and force others to help me treat her.
I find this incredibly frustrating; especially when, as this case did, a patient straddles the day / night boundary. With the dawning of the day, the Hospital stirs itself to life, and suddenly everyone is interested in your case, and mostly in criticising your management thereof.
I'm not sure the delay will affect outcome; but I was stung to the quick, having spent 2 hours trying to attract speciality assistance, to have them phone me and 'pass comment' on the delay I was causing.
Sometimes, I hate my job.
For the record, the case was, I suspect, Boerhaave's Syndrome. The patient presented with abdominal pain, following vomiting. Radiograph showed a pneumothorax, possibly pneumomediastinum, and loculated effusion in the left chest, producing a degree of mediastinal shift.
I never cease to be amazed how quickly my colleagues disavow themselves of potential responsibility; all hail Specialisation.
I promised her husband we'd get to the bottom of it, and see her right. I couldn't look him in the face on my way out.