Wednesday, April 17, 2013

Way To Blue

Yes, I'm back. Again.


A little housekeeping.

Those of you still here, and keeping up, will have noticed all pretence of anonymity has gone. Well, more or less. I cannot be bothered to go back through all of these posts and remove the fungal refs, but all of these posts now bear my actual name. Those of you who really want to can Google me. Or Bing me. Why not Bing that shit? Either way, I am there. For better or worse. The GMC, they who must be obeyed for the registered medical practitioner, have taken a decidedly dim view of the anonymous online physician. You can make of that what you will.  There's an interesting take on it on The Pod Delusion, if you feel it's worth more than a cursory shrug of the shoulders. Anyway; I'm out. It's probably not that important really; I'll take the opportunity to remind you all that any clinical situation I discuss herein is at least non-contemporaneous, and possibly fictitious. Names have been changed to protect the guilty, and me. If you think you recognise yourself, or someone close to you, you're wrong.

Some things, however, never change. I'm still, mostly, gazing at my own naval, overusing the word maudlin.

Debriefing. I don't know where debriefing first took hold. I want to think its the Military, but I couldn't swear to it. It sounds like it should be the Military, though. The After Action Report.

In any line of work, when things get runny, they usually do so somewhat chaotically, running with an energy all of their own. Even when it feels like you have a handle on things, that control is usually fleeting, or illusory. Without accounting for everyone else swept up in this particular tempest. As a contemporary of mine is fond of quoting,
"Good judgement comes from experience, but experience comes from bad judgement."
So we crave exposure to whatever it is we try to do on a daily basis, crave our own experience, and crave that of others. Hoover it up, in the hope that whatever was done well can be assimilated, copied and pasted into our own experience, ready for deployment next time out; and that whatever was done badly can be picked clean to try and remove it from the deck next time. More than that, it offers a chance to meet with your colleagues when everything hasn't just slipped agonisingly through your fingers. A chance just to sit down, and acknowledge what it was you just did. Sometimes, I think, its enough to look each other in the eye, and have a little cry. I don't think I did enough of this when I worked in ITU; I'm pretty sure we don't do enough of it now. Sometimes, we can't meet each others gaze. We (I) aren't so good at the more empathic sphere of what we do.

Recently, we had a tough shift. I can't go into the details, obviously. But most of us, if not all of us, have a 'worst-case' scenario. The patient we fear most; the one that we dread. Even the non Medics among you will have no trouble trying to imagine the clinical situation you would least like to be faced with. This was mine.

Actually, the case was run well; but the outcome was bad. Awful. I don't want to be any more melodramatic, but you get the idea. And debriefing something like this, talking it out, is hard when you're talking it out with people who weren't there, people not in the business. Not because we're special, but sometimes these cases are deeply upsetting, and there may be a reason why the person you're talking to didn't love ER. Or maybe it's a defect of my character, that I don't trust my friends to be able to process the chat in a way that I can; or have to; or think I can. I think there's a danger of casting oneself as the martyr, then. The only one capable of managing the psychic trauma.

Which is bullshit; I'm not that special.

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