I have seen a few tricks deployed to 'jump the queue' in the ED. Last night's took the biscotti. A patient old enough to know better presented heavily inebriated, having turned their ankle. Quick exam off the Ambulance trolley suggested a bad sprain, but probably a fracture. There was swelling, for sure, but no neurovascular embarrassment, and he beer jacket was providing adequate analgesia.
The Department was kicking, heaving, alive with criticals, and sicker people needing trolleys. She would have to wait, and we apologised for this, and left her in a chair.
She muled this over for a while, and took maters into her own hand. She levered herself out of the chair, took a step, tottered for a second, and before we could reach her, turned her ankle again.
Through 90 degrees.
What had seemed a simple injury suddenly became very complex, and her foot turned white. Our efforts to restore anatomy and circulation were hampered by the patient's state of mind.
I'm not sure where she thought she was, but was incapable of grasping the (relatively) simple concept that she was in hospital, and had a (now) badly dislocated ankle.
She fought us every step of the way, and we had to settle for a half baked job, afraid as we were of over sedating her and adding aspiration to her growing list of injuries. We managed to go from dislocated to subluxed, from white and cold to purple and warm, pulses restored if anatomy stubbornly remaining abnormal.
She at leas got seen quickly, even if she never walks quite the same way again.
Showing posts with label Drunks. Show all posts
Showing posts with label Drunks. Show all posts
Tuesday, February 09, 2010
Saturday, July 25, 2009
Dude, Where Are All My Friends?
In celebration of the Friday Night Drunk...
You, who called an ambulance because you went out drinking and were sick...
You, who wanted an ambulance to take you home again, because you'd spent "all your money" on drink...
You, who'd "hardly had anything", but were slurring your words so badly I couldn't understand you...
Who banged your head on a door, and cried when I took the plaster off...
Who lasted an hour in the bar before shitting yourself...
Who showed no shame in waking up in netty-knickers and a massive nappy...
I salute you all. Your good sense, self awareness and sense of accountability is a credit to us all.
Roll on Saturday
You, who called an ambulance because you went out drinking and were sick...
You, who wanted an ambulance to take you home again, because you'd spent "all your money" on drink...
You, who'd "hardly had anything", but were slurring your words so badly I couldn't understand you...
Who banged your head on a door, and cried when I took the plaster off...
Who lasted an hour in the bar before shitting yourself...
Who showed no shame in waking up in netty-knickers and a massive nappy...
I salute you all. Your good sense, self awareness and sense of accountability is a credit to us all.
Roll on Saturday
Saturday, May 09, 2009
Good Times, Bad Times
Reading a book about John Snow, the great 'Medical Detective', and GasPasser, I came across some good old fashioned vituperative medical journalism. It seems both more genteel and more cutting than what one sees today.
Which is mostly about how shit and overpaid we are.
It makes me cross when I read articles belabouring the point that some Docs get paid large sums, as if this were an offence to God. If we do a good job, why should we not be paid well; why should we, just because we work in the public sector be paid lower wages?
I lack the energy to debate that fully.
But how much is it worth for us to save your child's life?
Fuck that; if your kid breaks his arm, how much is it worth for us to take his pain away?
How much for us to look after your daughter when she's too drunk for you to cope with?
I get paid to work long hours, and deal with shit you don't want to.
For no good deed goes unpunished.
That having said, I generally find that a polite manner, regular explanation and other interventions of a tree hugging nature are enough to produce a smile ad word of thanks from most of my patients. Handing out Teddy Bears to scared kids, and watching their shy grins as the take the bears, without letting on that they want them, is good value.
Yet for every patient who is grateful for what you do, there is the yang to this yin. There are patients who are, frankly, penises.
Just tonight we spent a goodly time wrestling with just such a man. He dedicated his Friday night to imbibing his own bodyweight in booze. He then topped that off by passing out between a couple of parked cars, where a helpful passer-by happened upon him.
he was wheeled into the ED, full of drunken cheer, shouting to all who would listen, a drunken sailor, king of all he surveyed, and pleased and excited to be on this next part of his beer fuelled mission.
However, shortly afterwards he decided he wanted to go home.
Clad only in his pants, unable to remember his own last name, let alone where he lived, or where that was in relation to where he was now, also a mystery to him, he resolutely insisted he could, and would go home.
Big deal, you think. Let him go....
Fine, if he could stand.
He demonstrated his inability to perform this basic task by butting his head into every available surface, all the while shouting 'What the fuck?', like some low rent Phillip Seymour Hoffman.
Now, I don't care if you wanna drink yourself into a coma; that's fine.
Go ahead, knock yourself out.
But if you end up in the ED, at least have the decency to sleep it off, and not blame me for the fact that your legs don't work
Which is mostly about how shit and overpaid we are.
It makes me cross when I read articles belabouring the point that some Docs get paid large sums, as if this were an offence to God. If we do a good job, why should we not be paid well; why should we, just because we work in the public sector be paid lower wages?
I lack the energy to debate that fully.
But how much is it worth for us to save your child's life?
Fuck that; if your kid breaks his arm, how much is it worth for us to take his pain away?
How much for us to look after your daughter when she's too drunk for you to cope with?
I get paid to work long hours, and deal with shit you don't want to.
For no good deed goes unpunished.
That having said, I generally find that a polite manner, regular explanation and other interventions of a tree hugging nature are enough to produce a smile ad word of thanks from most of my patients. Handing out Teddy Bears to scared kids, and watching their shy grins as the take the bears, without letting on that they want them, is good value.
Yet for every patient who is grateful for what you do, there is the yang to this yin. There are patients who are, frankly, penises.
Just tonight we spent a goodly time wrestling with just such a man. He dedicated his Friday night to imbibing his own bodyweight in booze. He then topped that off by passing out between a couple of parked cars, where a helpful passer-by happened upon him.
he was wheeled into the ED, full of drunken cheer, shouting to all who would listen, a drunken sailor, king of all he surveyed, and pleased and excited to be on this next part of his beer fuelled mission.
However, shortly afterwards he decided he wanted to go home.
Clad only in his pants, unable to remember his own last name, let alone where he lived, or where that was in relation to where he was now, also a mystery to him, he resolutely insisted he could, and would go home.
Big deal, you think. Let him go....
Fine, if he could stand.
He demonstrated his inability to perform this basic task by butting his head into every available surface, all the while shouting 'What the fuck?', like some low rent Phillip Seymour Hoffman.
Now, I don't care if you wanna drink yourself into a coma; that's fine.
Go ahead, knock yourself out.
But if you end up in the ED, at least have the decency to sleep it off, and not blame me for the fact that your legs don't work
Sunday, August 10, 2008
It is three in the morning, and all is not well; I have had to recuse myself from the floor, after suffering a compassion breakdown. (I hope I’ve used the word recuse in vaguely the right way, as I’m only doing so to try and impress my legal readers; well, one in particular… ;)) Today is changeover day, so all the characters in our ED drama have changed; I wonder if the punters of our catchment area know this, but suspect coincidence.
On the good news front, La Belle File is back; in fact when I was finally able to re-establish voice comms, her first words were: ‘I’m back!’ delivered with some conviction. I’ve been on nights, so joyous re-union has been slightly muted. Work, however continues to provide cortisol raising frustration;
The complaint
Complaints piss me off. I should say that I am in favour of them – people must be able to challenge our decisions and our authority if they feel we have wronged them; and we must be transparent in our practice, and robust in our defence, even of controversial or unpopular decisions. But people who complain when they are ill informed, or who will not let something drop… it is these guys that hack me off. I am currently answering for my actions of a few months ago, largely because someone not connected to the case is trying to dodge the real issue. Clearly I cannot go into detail, but a situation arose in which we had to deal with a particularly difficult patient, and were required to make several decisions for this patient, and implement them against the patients wishes. Further assessment required specialist practitioners, who were duly called and advised the patient be removed to a place of safety; some force was required to do this, and the patients relatives were unable to see the patient for some time thereafter. They clearly felt excessive force had been used, and that the law surrounding management of this kind of patient is archaic.
They have a point.
They wrote to their local representative asking what might be done to bring about reform of the laws governing this sort of situation. Their letter barely mentions the hospital, and is not critical of our treatment. Yet this representative, who I suspect spends more time polishing green leather sofas with her ass than knowing her job, has written to enquire why the patient were not more closely supervised, and why transfer to another facility not enacted earlier. The patient in question was given one-one care at all times; they could not have been more closely supervised; and the transfer did not take place because the other facility did not want the patient, not in the state in which they ran amok in my department. And yet a casual question implies poor practice on our part; and does nothing to address the original question, of what could be done to make the law more palatable.
In truth, part of the problem lies in that there is no gentle way of subduing large, violent aggressive patients, and their restraint will invariably leave them shaken; laws will not change this. Some people cannot be talked down, but relatives will always feel for their own; there is, of course no mention in any complaint of the physical violence visited on us by the patient…
The poor wee fella found at the bottom of the stairs by BBP has had insult heaped onto injury. Any death with 24 hours of admission must be referred to the coroner, and the circumstances of this case mandate an inquiry. Because the patient still lived when I went off shift, I could not contact the coroner, and neither the doc who certified, nor the admitting physician, nor the neurosurgeon who would offer no hope nor the intensivist who passed and pulled the tube would spend 10 minutes on the phone to the coroner to tell him this. An huge round of shoulder shrugging, not my problem, don’t wanna get involved. All that was required was to phone the coroner’s office, and tell them the sad circumstances. I did it; it can’t be that hard, but their indifference has left a family in limbo for a further six days, until I came back on shift.
As for tonight, and my recusal…
I generally try to be empathic, and compassionate to everyone; but as I started this piece, the only patients inn the department were as follows:
Hypoglycaemia – known diabetic, brought on by not eating, and drinking 12 cans lager
Drunk, slightly hysterical following argument with friends (not present in dept)
Drunk, decided to go swimming. Got cold, may have fainted
Drunk, mixed (non-lethal) OD
Not one among ‘em with a proper problem not self inflicted. One ended up punching a staff member, and left with HM constabulary. The rest enjoyed a restful, warm night at the taxpayer’s expense.
The last two nights have been a bit psych, in that we’ve mostly ended up chasing semi naked girls about the dept as they scream at us. One, declared fit for d/c, escaped and was found in a bush, shivering against the thin covering afforded by arseless hospital gowns, with her thong tied around her neck.
Our psych cover seems woefully inadequate. The liason service soldier on, but their primary mission was never intended to be the MH assessment of all and sundry in the ED; and yet we have nowhere else to turn. Why the psych SHO cannot do an on call like every other bugger is beyond me. And woe betide you if you’re over 65. They do have an on call doc, but they don’t get out of bed; at least not to come to the ED
If you have severe aortic valve disease, and undergo surgery to have it replaced, basal atelectesis post op is not unusual; nor is it unheard of for LRTI to develop; but when you return, 12 days later, with that LRTI inadequately treated, and worsening chest pain, breathlessness etc, it seems that your problems no longer concern your surgeon. Post op complications would appear to be either a thing of the past, or something the surgeons are only to keen to farm out to others. If our knifemen are only going to be just that - knifemen, technicians, hernia specialists - then why the fuck should we pay to send them through medical school..?
**Rant ends
On the good news front, La Belle File is back; in fact when I was finally able to re-establish voice comms, her first words were: ‘I’m back!’ delivered with some conviction. I’ve been on nights, so joyous re-union has been slightly muted. Work, however continues to provide cortisol raising frustration;
The complaint
Complaints piss me off. I should say that I am in favour of them – people must be able to challenge our decisions and our authority if they feel we have wronged them; and we must be transparent in our practice, and robust in our defence, even of controversial or unpopular decisions. But people who complain when they are ill informed, or who will not let something drop… it is these guys that hack me off. I am currently answering for my actions of a few months ago, largely because someone not connected to the case is trying to dodge the real issue. Clearly I cannot go into detail, but a situation arose in which we had to deal with a particularly difficult patient, and were required to make several decisions for this patient, and implement them against the patients wishes. Further assessment required specialist practitioners, who were duly called and advised the patient be removed to a place of safety; some force was required to do this, and the patients relatives were unable to see the patient for some time thereafter. They clearly felt excessive force had been used, and that the law surrounding management of this kind of patient is archaic.
They have a point.
They wrote to their local representative asking what might be done to bring about reform of the laws governing this sort of situation. Their letter barely mentions the hospital, and is not critical of our treatment. Yet this representative, who I suspect spends more time polishing green leather sofas with her ass than knowing her job, has written to enquire why the patient were not more closely supervised, and why transfer to another facility not enacted earlier. The patient in question was given one-one care at all times; they could not have been more closely supervised; and the transfer did not take place because the other facility did not want the patient, not in the state in which they ran amok in my department. And yet a casual question implies poor practice on our part; and does nothing to address the original question, of what could be done to make the law more palatable.
In truth, part of the problem lies in that there is no gentle way of subduing large, violent aggressive patients, and their restraint will invariably leave them shaken; laws will not change this. Some people cannot be talked down, but relatives will always feel for their own; there is, of course no mention in any complaint of the physical violence visited on us by the patient…
The poor wee fella found at the bottom of the stairs by BBP has had insult heaped onto injury. Any death with 24 hours of admission must be referred to the coroner, and the circumstances of this case mandate an inquiry. Because the patient still lived when I went off shift, I could not contact the coroner, and neither the doc who certified, nor the admitting physician, nor the neurosurgeon who would offer no hope nor the intensivist who passed and pulled the tube would spend 10 minutes on the phone to the coroner to tell him this. An huge round of shoulder shrugging, not my problem, don’t wanna get involved. All that was required was to phone the coroner’s office, and tell them the sad circumstances. I did it; it can’t be that hard, but their indifference has left a family in limbo for a further six days, until I came back on shift.
As for tonight, and my recusal…
I generally try to be empathic, and compassionate to everyone; but as I started this piece, the only patients inn the department were as follows:
Hypoglycaemia – known diabetic, brought on by not eating, and drinking 12 cans lager
Drunk, slightly hysterical following argument with friends (not present in dept)
Drunk, decided to go swimming. Got cold, may have fainted
Drunk, mixed (non-lethal) OD
Not one among ‘em with a proper problem not self inflicted. One ended up punching a staff member, and left with HM constabulary. The rest enjoyed a restful, warm night at the taxpayer’s expense.
The last two nights have been a bit psych, in that we’ve mostly ended up chasing semi naked girls about the dept as they scream at us. One, declared fit for d/c, escaped and was found in a bush, shivering against the thin covering afforded by arseless hospital gowns, with her thong tied around her neck.
Our psych cover seems woefully inadequate. The liason service soldier on, but their primary mission was never intended to be the MH assessment of all and sundry in the ED; and yet we have nowhere else to turn. Why the psych SHO cannot do an on call like every other bugger is beyond me. And woe betide you if you’re over 65. They do have an on call doc, but they don’t get out of bed; at least not to come to the ED
If you have severe aortic valve disease, and undergo surgery to have it replaced, basal atelectesis post op is not unusual; nor is it unheard of for LRTI to develop; but when you return, 12 days later, with that LRTI inadequately treated, and worsening chest pain, breathlessness etc, it seems that your problems no longer concern your surgeon. Post op complications would appear to be either a thing of the past, or something the surgeons are only to keen to farm out to others. If our knifemen are only going to be just that - knifemen, technicians, hernia specialists - then why the fuck should we pay to send them through medical school..?
**Rant ends
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