Another Monday after nights, another bout of insomnia.
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:
Highs
---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)
Lows
--- 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.
Showing posts with label Nurses. Show all posts
Showing posts with label Nurses. Show all posts
Monday, April 21, 2008
Saturday, April 05, 2008
Whirly Whorl
Grumpy Bastard alert.
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.
Why?
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.
But... morphine.
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.
So... fentanyl.
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.
Why?
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.
But... morphine.
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.
So... fentanyl.
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.
(Here She Comes) Kitty's Back
Do I Look So Hard
So Impersonal?
Dispassionate? Or Just Unimportant.
When You Turn Me Aside, Disregard My Time
Throw It Away So
Carelessly; Overvalue What You Have
Casually Tell Me How Little I'm Worth...
When We Stop Talking Names;
Once Conditions
Then Organs
Now Only Numbers Pass Between Us.
When We Try
And You Want More
Pushing; Pushing; Pushing.
Inflexible:
You Mock Me
When You Walk Away
Turn Your Back
I Forget
Once We Stood
Shoulder To Shoulder
We Were Family
We Were Doctors Once, And Nurses
Wednesday, October 31, 2007
NFR
More pontificating on the matter of who should or shouldn't be resuscitated, and more importantly who makes the decision.
Frankly, and I'm thinking my opinion will verge on the wrong side of 'PC', it seems like a big ol' storm in a teacup to me. But the public do worry a great deal about it. Fair enough, I guess. There seems to be an over-riding fear that one will go into hospital, and be written off as a no-hoper by a wet behind the ears junior staff member, possibly just so they don't have to get up in the middle of the night and jump up and down on you.
That could never happen, right?
Not any more. God forbid we give our junior staff any responsibility. Or assume that they have any nous at all, after six years of medical training.
And now they want to let nurses make the decision...
Fine. Good. Why shouldn't they? It has been my experience that people who shouldn't be making important clinical decisions generally don't want to.
I guess times are always changing, but one of the bigger differences between the way doctors and nurses function, in this country at least, seems to be the level of inter-professional support. While medics are only too happy to moan about each other, often to each other's faces, or behind their backs, if necessary, we usually back each others decisions to the public. Nurses, on the other hand seem to distrust each other, and rarely seem to stand together; on anything.
So I always felt, even as a junior Shroom, that when I made decisions by myself, they would be supported by the rest of the Firm, provided I had a robust justification for them. Nursing staff seem to have a morbid fear of overstepping their boundaries. This seems to be crystallised in the current climate of rigid adherence to protocol.
This is not a criticism, but suggests to me that many nurses would rather not make a resus decision, unless there were strict guidelines about how to do so. Not because they aren't capable of making a well informed reasoned decision, but because if it became controversial, their colleagues would hang them out to dry.
From day one on the floor, I was making life or death decisions for the patients in my care, especially decisions about resus status, and frequently late at night, on my own, without consulting anyone. Should I have been? I suspect most people would now say not. But that was the way things were; and I like to think I made appropriate decisions - most of the time. Where it turned out my Boss differed, in the cold light of day, his reasoning was calmly explained, and the decision reversed. And I learned a bit more about how these decisions were to be made in the future.
So... who should make these decisions? Anyone who's prepared to, I say. Stand up, and be counted. Someone's got to...
Frankly, and I'm thinking my opinion will verge on the wrong side of 'PC', it seems like a big ol' storm in a teacup to me. But the public do worry a great deal about it. Fair enough, I guess. There seems to be an over-riding fear that one will go into hospital, and be written off as a no-hoper by a wet behind the ears junior staff member, possibly just so they don't have to get up in the middle of the night and jump up and down on you.
That could never happen, right?
Not any more. God forbid we give our junior staff any responsibility. Or assume that they have any nous at all, after six years of medical training.
And now they want to let nurses make the decision...
Fine. Good. Why shouldn't they? It has been my experience that people who shouldn't be making important clinical decisions generally don't want to.
I guess times are always changing, but one of the bigger differences between the way doctors and nurses function, in this country at least, seems to be the level of inter-professional support. While medics are only too happy to moan about each other, often to each other's faces, or behind their backs, if necessary, we usually back each others decisions to the public. Nurses, on the other hand seem to distrust each other, and rarely seem to stand together; on anything.
So I always felt, even as a junior Shroom, that when I made decisions by myself, they would be supported by the rest of the Firm, provided I had a robust justification for them. Nursing staff seem to have a morbid fear of overstepping their boundaries. This seems to be crystallised in the current climate of rigid adherence to protocol.
This is not a criticism, but suggests to me that many nurses would rather not make a resus decision, unless there were strict guidelines about how to do so. Not because they aren't capable of making a well informed reasoned decision, but because if it became controversial, their colleagues would hang them out to dry.
From day one on the floor, I was making life or death decisions for the patients in my care, especially decisions about resus status, and frequently late at night, on my own, without consulting anyone. Should I have been? I suspect most people would now say not. But that was the way things were; and I like to think I made appropriate decisions - most of the time. Where it turned out my Boss differed, in the cold light of day, his reasoning was calmly explained, and the decision reversed. And I learned a bit more about how these decisions were to be made in the future.
So... who should make these decisions? Anyone who's prepared to, I say. Stand up, and be counted. Someone's got to...
Sunday, September 16, 2007
In A Bad Light
Another shift down...
I spend a lot of time commuting. This not only costs me a lot in petrol, but gives me too much time to think. I often compose long witty posts on the way home... then give up, and go to bed. Or I rant - lately my beloved bore the brunt of this nonsense, but no more. So for better, or worse, I'm ranting at you this morning.
It's always a bad idea. Especially if you're as histrionic as I am - what seems to have assumed the import of the treaty of Versailles right now, will be as nothing tomorrow. But I've got a bee in my bonnet tonight. Moaning about colleagues is bad juju. There but for the grace a dieu go I, and so on.
However...
Big hospital's protocols are REALLY pissing me off right now. I accept that protocols are valuable, so everyone gets the same, best treatment available. Part of me will never be convinced that they act to cover up poor training, but there you go. What fucks me off the most tho, is that they engender a blinkered attitude. Daring to go off protocol is heresy.
Tonight, when I dared to question the accepted drug dose protocol for one of the analgaesics we use in kids, there was a flat refusal to entertain my questions. It must be said that this is, undoubtedly, in part because of the manner of my questioning.
I'm not very diplomatic.
Even so, I was always taught to ask if I didn't understand something...
In pointing out what appeared to be a misprint, wherein one part of the protocol contradicted another, the answer was: 'we don't care what you say. This is protocol. It must be right'.
This sort of blind faith / refusal to consider alternatives seems the very anathema of good medicine to me. The answer to the question 'Why?' cannot simply be: 'Because'. Can it? Aren't we supposed to think?
I become equally, if not more, frustrated when colleagues decline to discuss there treatment plans.
Again, my method of 'discussion' surely doesn't help.
Example:
I recently answered the phone (always a mistake in the ED). On the other end was the father of a young patient, wanting to know where the details of his daughter's echocardiogram were. She had been seen 2 days earlier, and "the doctor" had told them she needed an echo. But no details had reached her GP.
I told him I'd investigate, and fax the necessary paperwork to the GP.
Having dug out the notes, I was plodding through the Department, when on of the specialist cardiac nurses stopped me, having recognised her writing on the clerking. I explained the situation, finishing with my, unkind, opinion that the patient's complaint was likely to be of a non-organic nature.
'Oh, no' my colleague assured me; 'she had a leaky heart valve when she was 5'
I ventured that I didn't think this was likely to be the cause of her chest pain.
'But she was terribly breathless' came the reply.
Somewhat over-zealously, I suggested that if the concern was that this young girl had a 'leaky valve' that so impaired her cardiac function, surely discharging her from hospital, with no treatment, wasn't in her best interest.
'Well, my Reg thought she'd had a PE' (Pulmonary Embolus - blood clot on the lung).
Again, perhaps slightly rabidly, I suggested that if this were the case, surely the best management plan would not be to send her home, untreated.
Why, I trumpeted, if you were so concerned about all these terrible pathologies, did the patient get discharged, with no treatment, and no follow up?
My less than polite manner had it's usual effect... 'Well if you're going to be like that, I'm not going to help. It's your problem.'
Indeed; MY problem. Trying to sort out a patient I had never seen, who had been variously 'diagnosed' as having heart failure secondary to valvular pathology, or a PE, but sent away with no treatment, and the idea that an echocardiogram might be of use, ("non-urgently"), BY THE CARDIOLOGY SERVICE. (Who, in case you haven't been following, were now telling me it was my problem...)
It doesn't make sense to me, to defend your diagnosis, when you didn't take it seriously enough to arrange the necessary admission, investigation and follow up. In fact it seems indefensible.
("Oh, yes, I'm sure he had a leaking aneurysm; so I sent him home...")
Rant over. I'm not quite bilious to have lost all insight, so I hope I have conveyed the petty, small minded nature of my grumbles. When I get on my high horse, I fair see me own arse. I still think I'm right, mind, but I guess I could be a bit cleverer in trying to convince everyone else of this fact...
On the plus side, we treated a fella with multiple rib fracture tonight. Everyone got on, I wasn't rude to anyone, nor did I disagree with the way I as allowed to treat him, and he and his wife were very pleased with the way they were treated
I spend a lot of time commuting. This not only costs me a lot in petrol, but gives me too much time to think. I often compose long witty posts on the way home... then give up, and go to bed. Or I rant - lately my beloved bore the brunt of this nonsense, but no more. So for better, or worse, I'm ranting at you this morning.
It's always a bad idea. Especially if you're as histrionic as I am - what seems to have assumed the import of the treaty of Versailles right now, will be as nothing tomorrow. But I've got a bee in my bonnet tonight. Moaning about colleagues is bad juju. There but for the grace a dieu go I, and so on.
However...
Big hospital's protocols are REALLY pissing me off right now. I accept that protocols are valuable, so everyone gets the same, best treatment available. Part of me will never be convinced that they act to cover up poor training, but there you go. What fucks me off the most tho, is that they engender a blinkered attitude. Daring to go off protocol is heresy.
Tonight, when I dared to question the accepted drug dose protocol for one of the analgaesics we use in kids, there was a flat refusal to entertain my questions. It must be said that this is, undoubtedly, in part because of the manner of my questioning.
I'm not very diplomatic.
Even so, I was always taught to ask if I didn't understand something...
In pointing out what appeared to be a misprint, wherein one part of the protocol contradicted another, the answer was: 'we don't care what you say. This is protocol. It must be right'.
This sort of blind faith / refusal to consider alternatives seems the very anathema of good medicine to me. The answer to the question 'Why?' cannot simply be: 'Because'. Can it? Aren't we supposed to think?
I become equally, if not more, frustrated when colleagues decline to discuss there treatment plans.
Again, my method of 'discussion' surely doesn't help.
Example:
I recently answered the phone (always a mistake in the ED). On the other end was the father of a young patient, wanting to know where the details of his daughter's echocardiogram were. She had been seen 2 days earlier, and "the doctor" had told them she needed an echo. But no details had reached her GP.
I told him I'd investigate, and fax the necessary paperwork to the GP.
Having dug out the notes, I was plodding through the Department, when on of the specialist cardiac nurses stopped me, having recognised her writing on the clerking. I explained the situation, finishing with my, unkind, opinion that the patient's complaint was likely to be of a non-organic nature.
'Oh, no' my colleague assured me; 'she had a leaky heart valve when she was 5'
I ventured that I didn't think this was likely to be the cause of her chest pain.
'But she was terribly breathless' came the reply.
Somewhat over-zealously, I suggested that if the concern was that this young girl had a 'leaky valve' that so impaired her cardiac function, surely discharging her from hospital, with no treatment, wasn't in her best interest.
'Well, my Reg thought she'd had a PE' (Pulmonary Embolus - blood clot on the lung).
Again, perhaps slightly rabidly, I suggested that if this were the case, surely the best management plan would not be to send her home, untreated.
Why, I trumpeted, if you were so concerned about all these terrible pathologies, did the patient get discharged, with no treatment, and no follow up?
My less than polite manner had it's usual effect... 'Well if you're going to be like that, I'm not going to help. It's your problem.'
Indeed; MY problem. Trying to sort out a patient I had never seen, who had been variously 'diagnosed' as having heart failure secondary to valvular pathology, or a PE, but sent away with no treatment, and the idea that an echocardiogram might be of use, ("non-urgently"), BY THE CARDIOLOGY SERVICE. (Who, in case you haven't been following, were now telling me it was my problem...)
It doesn't make sense to me, to defend your diagnosis, when you didn't take it seriously enough to arrange the necessary admission, investigation and follow up. In fact it seems indefensible.
("Oh, yes, I'm sure he had a leaking aneurysm; so I sent him home...")
Rant over. I'm not quite bilious to have lost all insight, so I hope I have conveyed the petty, small minded nature of my grumbles. When I get on my high horse, I fair see me own arse. I still think I'm right, mind, but I guess I could be a bit cleverer in trying to convince everyone else of this fact...
On the plus side, we treated a fella with multiple rib fracture tonight. Everyone got on, I wasn't rude to anyone, nor did I disagree with the way I as allowed to treat him, and he and his wife were very pleased with the way they were treated
Saturday, June 16, 2007
I Wish That For Just One Time, You Could Stand Inside My Shoes, The You'd Know What A Drag It Is To See You...
Again, long time no jib...
Sorry. If any of my dwindling readership are still trying, I'm sorry.
I've been a little distracted of late. Shroom's fallow period has ended.
I have a new object of my affection. And it is mutual! I'm not a stalker. My current squeeze, my babyluv may feature here more later, but not for now. I don't want to jinx it, and I'm not sure I have the right to publish her the way I do myself; yet...
Anyway; I have a few local interest 'pieces' to blog about, but they will follow. They're mostly me grumping about what's happening at work. What follows, since we were talking of stalkers (sort of) is the tale of Shroom's only stalker - to date.
I know I've alluded to this recently, but don't think I've covered the details.
The whole sordid affair took place years ago, when I was a Plastics junior in a London hospital. At the time, I had rotated on to the Burns Unit, which meant I spent my days there, but shared the on call rota with the other SHOs covering Plastics and Burns. One Wednesday night, I took handover, and did my rounds, as usual. On the ward was a patient who had been waiting for surgery for a few days. I'm not sure why he'd been waiting but it was a bone of some contention to him, and he already had a reputation as a 'troublemaker' among the nursing staff.
The duty Reg and I stopped by to examine him, and see if we could get the op done overnight.
As I recall, the history was that this chap had been in a house that had been firebombed, and in trying to escape the inferno, he had gone out of a window, sustaining glass laceration to the dorsum (back) of one hand. On exam, it was obvious that his injury was substantial. There was significant skin loss, tendon and nerve damage. The op would require complex reconstruction and full thickness grafting - well beyond the capabilities of the Duty Reg and I, and as no consultant had expressed an interest in staying on to do it, we had no choice but to tell him he would have to wait another day.
He was not pleased; as we continued on our rounds, I was summoned urgently back to the ward. The fella was screaming and shouting at the nurses. When I went to find out why, he turned his attention to me. His primary complaint was that too much time had elapsed before the replacement of his dressing. He claimed that his hand had been left undressed for half an hour, and he was furious at the thought of it becoming infected.
When I pointed out that we had only left him five minutes before, he changed tack; the most vitriolic stream of abuse followed, the gist of which was that nurse were "bitches in skirts" who should be at his beck and call. He expected them to fetch and carry for him, and, I kid you not, "peel me grapes".
As this, almost laughable, rant continued, Sister attempted to re4place his dressing - made more difficult by the fact that he was gesticulating wildly. It must have been uncomfortable, because he flinched, mid-diatribe, and i saw his (good) fist curl up, and he went to swing at Sister. I did the only thing I could think of, which was to step in the way, and place my hand over his fist.
I suspect, in my mind, I was Clint Eastwood - as the Man with No Name.
This is part the first... I'm mid edit - apologies
Sorry. If any of my dwindling readership are still trying, I'm sorry.
I've been a little distracted of late. Shroom's fallow period has ended.
I have a new object of my affection. And it is mutual! I'm not a stalker. My current squeeze, my babyluv may feature here more later, but not for now. I don't want to jinx it, and I'm not sure I have the right to publish her the way I do myself; yet...
Anyway; I have a few local interest 'pieces' to blog about, but they will follow. They're mostly me grumping about what's happening at work. What follows, since we were talking of stalkers (sort of) is the tale of Shroom's only stalker - to date.
I know I've alluded to this recently, but don't think I've covered the details.
The whole sordid affair took place years ago, when I was a Plastics junior in a London hospital. At the time, I had rotated on to the Burns Unit, which meant I spent my days there, but shared the on call rota with the other SHOs covering Plastics and Burns. One Wednesday night, I took handover, and did my rounds, as usual. On the ward was a patient who had been waiting for surgery for a few days. I'm not sure why he'd been waiting but it was a bone of some contention to him, and he already had a reputation as a 'troublemaker' among the nursing staff.
The duty Reg and I stopped by to examine him, and see if we could get the op done overnight.
As I recall, the history was that this chap had been in a house that had been firebombed, and in trying to escape the inferno, he had gone out of a window, sustaining glass laceration to the dorsum (back) of one hand. On exam, it was obvious that his injury was substantial. There was significant skin loss, tendon and nerve damage. The op would require complex reconstruction and full thickness grafting - well beyond the capabilities of the Duty Reg and I, and as no consultant had expressed an interest in staying on to do it, we had no choice but to tell him he would have to wait another day.
He was not pleased; as we continued on our rounds, I was summoned urgently back to the ward. The fella was screaming and shouting at the nurses. When I went to find out why, he turned his attention to me. His primary complaint was that too much time had elapsed before the replacement of his dressing. He claimed that his hand had been left undressed for half an hour, and he was furious at the thought of it becoming infected.
When I pointed out that we had only left him five minutes before, he changed tack; the most vitriolic stream of abuse followed, the gist of which was that nurse were "bitches in skirts" who should be at his beck and call. He expected them to fetch and carry for him, and, I kid you not, "peel me grapes".
As this, almost laughable, rant continued, Sister attempted to re4place his dressing - made more difficult by the fact that he was gesticulating wildly. It must have been uncomfortable, because he flinched, mid-diatribe, and i saw his (good) fist curl up, and he went to swing at Sister. I did the only thing I could think of, which was to step in the way, and place my hand over his fist.
I suspect, in my mind, I was Clint Eastwood - as the Man with No Name.
This is part the first... I'm mid edit - apologies
Friday, May 04, 2007
In Praise of Nurses
This post could be almost anything; I might, at a later date muse about the Doctor-Nurse dynamic, specifically as applied to Shroom.
I could simply write how great nurses are... that would surely be too simple, and runs the risk of being condescending.
However, and this is in no way related to a realisation brought on by a comment made to me by a valued colleague while we studied an archaic looking piece of equipment at South Coast General, I would like to say how much I've enjoyed working in my last post, specifically because of the Nursing Staff there and my relationship with them. They have stood by me, even when I didn't have a clue, and when the toys were firmly ejected from the pram, and they drank beer with me, then picked me up afterwards.
Mind you they never let me forget it.
Anyway, thanks.
I could simply write how great nurses are... that would surely be too simple, and runs the risk of being condescending.
However, and this is in no way related to a realisation brought on by a comment made to me by a valued colleague while we studied an archaic looking piece of equipment at South Coast General, I would like to say how much I've enjoyed working in my last post, specifically because of the Nursing Staff there and my relationship with them. They have stood by me, even when I didn't have a clue, and when the toys were firmly ejected from the pram, and they drank beer with me, then picked me up afterwards.
Mind you they never let me forget it.
Anyway, thanks.
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