Sunday, July 26, 2009

Be Careful What You Wish For

On minor irritations, and major catastrophe

I know I need a break when I become more irritable than usual; this doesn't take much, to be fair. One of my colleagues, through no fault of their own, has begun to irritate me hugely, and, more or less, whatever they do.

I need a break.

Then everyone started to irritate me.

I need a break.

Last night dragged, dragged on and on. I found myself wishing for something interesting, something... acute. Something to set the adrenaline on edge. Something to set against the seemingly never-ending tide of people who should know better.

People who think they can stroll into my place of work, roundly abuse me for 10 minutes straight, than apologise, and it will all be o.k.
People who really think drinking until they piss themselves and vomit on me doesn't need an apology.
People who don't know how to cope; or worse, don't want to know.

That's what I'm here for, eh?

Sometimes, we get what we wish for, and then you can't take it back.

The call came, almost inevitably, as swine 'flu. And then seizures.

Fitting isn't too bad. We can treat it. So much of what we see, we can't treat, or if we do, it's by accident, or in fact it's you, treating yourself, while we ease your symptoms. One of the things that appealed to me about surgery was that it, occasionally offers real cure. Not pill pushing. This is of course debatable; but I digress.

The point is, acutely, most seizures respond, quickly, to simple drugs. But in the context of an infection, even 'flu, a host of more worrisome prospects rear their heads.

Then it got worse; the call came through, updating us, informing us that the patient had gone into cardiac arrest. Which is awful at the best of times - of which, really there are none - but in a young patient, as this was, it fills me with all the adrenaline I could want.

It doesn't matter how much you prepare, you still have to confront the same thing. The one, unavoidable fact. Soon, a patient will be delivered to you; dumped, unceremoniously on whatever brand of trolley you have. Cold, or cooling; skin waxy and clammy; often there is a blue purple tinge. There is often a leakage of secretions, pumped forth from the mouth and nose, egged on by the chest compressions that strive to keep them alive.

What was once living, breathing, laughing, crying... now is so much mater. And resuscitation almost never works.

Well, we all have to go some time.

Not this young.

He had been fitting for over an hour, unresponsive to meds; a difficult airway, he couldn't be tubed in the field.

And worse, as the Ambos rushed him from the warmth of his home, knowing that his only chance lay at the Hospital, weighed down by the fact that they had done all they could, and it hadn't fucking worked, they slid and slipped into the rain. Chest compressions are hard to do in the dark, and in the rain.

The unthinkable happened. The stretcher, slick with the morning rain, shifted, wheeled, away. How much? I don't know. Not much, but enough. In among all of this, among all the fear, and fitting, the patient slipped off the trolley, and onto the ground.

And after that, he arrested.

We got him back.

Not often, but occasionally. It happens.

And for what? CT showed massive anoxic brain injury, a non-specific swelling of the brain, a blurring of the borders between grey and white matter. Another thing we can't treat

The Ambos were in bits. For a group of folks who have seen it all, and I mean all, this was there worst nightmare.

As it turns out, the bump on his head was the last of his worries.

I cannot conceive what went through these guys' and gals' minds when it happened. For all the jokes, all the frustrations we vent about the patients that annoy us, that tax our patience, they are our charges. We do what we think is right for them; it is not supposed to end like that.

Cold comfort to find out the injury was clinically insignificant. That it was a dreadful accident; that fate was to blame, nothing more or less.
That it was the seizures that did for him, starved him of oxygen, drove him down the dark path...

Be careful what you wish for.

Someone always suffers.

1 comment:

Capt. Schmoe said...

Excellent post. Nothing else to say, which is most unusual for me.

Thanks for the post.