Sunday, January 23, 2011
The Black Dog Returns
I once again find myself wrestling with the Black Dog; posting may be affected
Saturday, January 15, 2011
I Believe I Have Transcended...
Irony:
The best thing about living alone, is living alone.
The worst thing about living alone, is living alone.
Funny, eh?
Hard Times...
Sometimes shit just happens.
I know this to be true, and mostly use it as a defence, to protect my fragile mind, but sometimes, sometimes, things leak through. No man is an island, and this man certainly isn't a rock.
The Christmas period was as horrendously busy as I've ever seen it, and I've worked a few Christmases. The rest of the hospital seems to operate a fingers-in-ears policy; interestingly, a few weeks after Christmas, when all the patients we'd seen had been admitted, and the burden of care was shifted up a level, 'they' sat up and took notice.
Suddenly we were flooded with extra staff, and, as is so often the way, they came on a day when we had precious little to do, having admitted all the sick patients in the area.
Until, of course, after 6 p.m., when everyone goes home.
Except, me.
We've seen a lot of very sick folks in their 20s and 30s, with awful, awful pneumonias. At first I though it was all 'flu related; the histories seemed to fit, and indeed some of them tested positive, but more of them are testing positive for strep. pneumoniae, which I haven't seen before.
I know this to be true, and mostly use it as a defence, to protect my fragile mind, but sometimes, sometimes, things leak through. No man is an island, and this man certainly isn't a rock.
The Christmas period was as horrendously busy as I've ever seen it, and I've worked a few Christmases. The rest of the hospital seems to operate a fingers-in-ears policy; interestingly, a few weeks after Christmas, when all the patients we'd seen had been admitted, and the burden of care was shifted up a level, 'they' sat up and took notice.
Suddenly we were flooded with extra staff, and, as is so often the way, they came on a day when we had precious little to do, having admitted all the sick patients in the area.
Until, of course, after 6 p.m., when everyone goes home.
Except, me.
We've seen a lot of very sick folks in their 20s and 30s, with awful, awful pneumonias. At first I though it was all 'flu related; the histories seemed to fit, and indeed some of them tested positive, but more of them are testing positive for strep. pneumoniae, which I haven't seen before.
Anyway, this shift, the BatPhone went off, twice in quick succession, forewarning of 2 such patients; one slightly older, one younger. The older of the two arrived first, and looked o.k-ish, just confused, in a lights-on-no-one-home sort of way.
The second, a young 'un, looked really sick. All numbers awful, half-dead in the bed already. I had to take no. one to CT, so left her in the more than capable hands of my Registrar and the ITU team.
No. one's CT checked out ok; I'm still not sure what was going on there, but when I came back, no. two had active CPR ongoing. The guys had been trying to site a central line, when her BP dropped from bugger all, to fuck all. A subtle, but important distinction.
Well, we worked as hard as we could, for as long as we could, but nothing worked, not even a flicker.
I hate losing the young ones, especially when I'm not sure why.
The conversation with her dad, was as hard a conversation as I've ever had.
Cases like this leave no-one untouched. They spread ripples of shit everywhere; they can destroy families, and ruin perfectly good clinical staff, like the Reg I left in charge of the case, who is more than capable, but will be asking himself what more, what else he could have done for weeks.
Maybe it's selfish to think of ourselves, but we can't help it.
We're not supposed to lose these ones, and it hurts.
It hurts, but I suppose it's not so much the falling down, as the getting up again afterwards.
Tuesday, January 11, 2011
Do you ever regret choosing Emergency Medicine? Does the quiet life of a GP ever seem more appealing?
Never; I wanted to be a General Surgeon (or a trauma surgeon) but since the K doesn't really have dedicated trauma surgeons, and general surgery is effectively an historical speciality, EM was the obvious next choice for me.
I'm not clever enough to be a GP
In your capacity as a doctor, what's the most unusual condition you have seen?
Toxic epidermal necrolysis, probably. Though I have, of course, seen the usual complement of objects lodged in body cavities
Tuesday, January 04, 2011
Laws of Large Numbers
Every now and again, something unusual happens.
Of course, this, at least in part, depends on your definition of unusual.
One-in-a-million?
Sounds pretty unusual, but in the UK, that might be as many as 60 times a day...
So maybe it just seems unusual; or maybe, as a great philosopher once wrote, "It's not unusual"
Nonetheless, it is a truth universally acknowledged that patients collapsing in Radiology have,usually, just fainted, sometimes as badly as Gillian McKeith. (Or, "Gillian McKeith" to give her her full medical title.)
So, today, when the Resus doors banged open and he was wheeled in I was not unduly concerned.
Shows what I know.
To be fair, he did look worse than the usual fainter, and his thready pulse and agonal respiration pattern did little to reassure us. Even that meagre effort didn't last long, and his light went out. There was surprisingly little fanfare.
His history, gleaned in shouted snatches between the requests for adrenaline and flushes, demands for pads and tubes, added little. But we did get him back, and after a prodigious bout of vomiting, he declared himself better.
Well, he didn't know he just survived a VF cardiac arrest brought in by a substantial STEMI.
In fact, one almost wonders how he'd have fared if he HADN'T gone to the pub and fallen over.
But he came back. I still don't know how long he'll stay this time, but he came.
Unusual, eh?
Of course, this, at least in part, depends on your definition of unusual.
One-in-a-million?
Sounds pretty unusual, but in the UK, that might be as many as 60 times a day...
So maybe it just seems unusual; or maybe, as a great philosopher once wrote, "It's not unusual"
Nonetheless, it is a truth universally acknowledged that patients collapsing in Radiology have,usually, just fainted, sometimes as badly as Gillian McKeith. (Or, "Gillian McKeith" to give her her full medical title.)
So, today, when the Resus doors banged open and he was wheeled in I was not unduly concerned.
Shows what I know.
To be fair, he did look worse than the usual fainter, and his thready pulse and agonal respiration pattern did little to reassure us. Even that meagre effort didn't last long, and his light went out. There was surprisingly little fanfare.
His history, gleaned in shouted snatches between the requests for adrenaline and flushes, demands for pads and tubes, added little. But we did get him back, and after a prodigious bout of vomiting, he declared himself better.
Well, he didn't know he just survived a VF cardiac arrest brought in by a substantial STEMI.
In fact, one almost wonders how he'd have fared if he HADN'T gone to the pub and fallen over.
But he came back. I still don't know how long he'll stay this time, but he came.
Unusual, eh?
Monday, January 03, 2011
Something...
I want to say that sooner or later, everybody reaches a crossroads in their life. But actually, I guess life is all about the crossing points.
When it gets difficult, where it gets runny is when you realise not everyone is pulling in the same direction. In this respect, I seem to suffer from intermittent empathy failure. Work has been really tough of late; really tough. And it continuously feels like we're being left to get on with it as a Department, to do whatever we can, and take all the blame when shit hits the fan (which it increasingly does), and should there be any goodwill to dole out... well, let's just say it doesn't come our way.
Abandoned Luncheonette; Track 4
I believe I may begin again.
Reasons may, or may not be obvious.
More later
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