Memories

Memory is a curious thing. It is almost infinitely plastic, and malleable. We can play with our memories, and over time convince ourselves our version of the truth is more real than someone else's. Even with insight we spin and play events, trying them out for size.

History is written by the victor, and memory is constantly re-written by our subconscious, seeking the most palatable version.

Earlier this week, a patient was brought to us from a hostel; he had been staying there for some sort of reunion. He had collapsed, perhaps losing consciousness briefly. All he could say was that he felt unwell.

He looked bloody awful. Pale, clammy, breathing fast and shallow, pulse strong, but fast. The sternotomy scar announcing his membership of the cardiac club. His sats were low, but not catastrophically so, and his pressure good. His lungs sounded clear, and his ECG looked clean.

Interestingly, the 12 lead done by the Ambos showed a Right bundle, conspicuously absent now.

While rummaging around his radial artery, trying for an ABG, his pulse volume seemed to waver and fade. I glance up at him, trying to use my patented diagnostic eyes; he still looked pale and ill, but no more so. Maybe...

"Just check his pressure again for me, please..?"

A minute later, he declared himself. I just decided I wasn't going to get an ABG on this side, when he announced his intention to be sick. This always makes me anxious, because it's often a side effect of a piss poor BP. A quick glance at the monitor showed long pauses punctuated by ugly, broad ventricular escape complexes. Instead of vomiting, the patient slumped back on the trolley, his head lolling, his tongue protruding from his pallid lips.

A few quick shakes of the shoulder and calls to attention, produced no response. The monitor still showed a rate in the 20s.

I punched him in the chest.

The correct term is probably pre-cordial thump.

The effect, dramatic. It was accompanied by a beat on the monitor, and the patient opened his eyes, wide, surprised. I suspect his look was mirrored, not only on my face, but on those of the nurses working with me. The pause was long enough, and his heart beat no more, and I lost my nerve.

A minute of frantic CPR, and he was reaching up to pull out his OPA, the monitor bright and alive with joyful activity.

What had I hoped to,achieve? A precordial thump is intended for use in a witnessed, monitored, shockable cardiac arrest. I think it had been in my mind to percussion pace him. I'd been talking about that earlier in the day. If that was the case, I didn't do it right, I lost my nerve after the initial thump.

Maybe I just panicked?

My memory rejects that version; I'll let it, for now. The patient is alive, and, at the end of the day, that's what counts.

On Swine Flu

I'm sure most of you will follow the flaming, chaotic bandwagon that is Pandemic Influenza with at least some degree of interest. It seems unfortunate that we are incapable of delaing with such medical stories with any degree of perspective.

It's flu.

I think one of the problems is that most people have never seen, or indeed had, flu. Most people think the common cold id the flu, and so when they get flu, think they're dying.

Yes, there's more of it about, so there are more cases of the complications associated with flu.

It's still flu. A relatively mild, probably quite infectious, viral illness.

And now every bugger with a fever and a cough is being told they have the flu.

I share the slightly anxious feeling some of my medical colleagues have toward the shotgun prescription of tamiflu. And the shotgun diagnosis.

9 million hits per hour on a swine flu advice line. I don't realy understand this. The advice is simple, and well publicised. Go home, stay there, drink plenty of fluids and sweat it out.

Some people aren't happy with this advice apparently. I'm not quite sure what they want. An immediate cure perhaps?

Tough.

And why are we getting our knickers in a twist abou tamiflu, a drug that, at best, seems to reduce symptom duration by 24 hours, out of a 2 week run.

Why bother?

It's flu. Yes, some people die, but rarely healthy people, and there's not an enormous amount we can do.

A few thousand people die from flu, and everyone wants a mask; AIDS is rampant, but no-one wants to wear a condom.