Sudden And Unexpected.

It's amazing how much better I feel having finished my exams. Conscious of the stress as I was, I'm still surprised to see how much better I feel, with them over. Of course, now I have to wait 3 weeks before learning of my fate,and possibly starting all over again.

Ah, well...

LBF has had to endure more than her fair share of deprivation, and I hope that now, we can spend more time making mischief. Although, of course, my rota may well continue to get in the way. She has been somewhat under the weather of late, but, having undergone emergent needling treatment, and something to do with balls in ears, is feeling more like her old self. Which, in case there was doubt, is witty and funny. (Almost always)

Anyway; the ED is often witness to the unexpected; as it should be, really. Almost by definition, emergencies ARE unexpected. Of courser, that's not always what brings folks to the ED, but there you go...

A young woman spent her evening getting drunk; I'm assuming that's what she did. To be fair, she might have been up to almost anything, but at the end of the day she was virtually insensible. An all too common problem reared its head - she ran out of, or could not find any, money. Her taxi driver called the Police, and they tried to intervene with her family, but they were unwelcoming. How many times must the have heard this call before? For they would not answer the call. Why?

We'll never know.

The Police had subsequently arranged for her to stop overnight in an Hostel, but by the time she reached it, she had grown cold and still. I suspect she choked on her own vomit, en route, but again, we'll never know.

Almost an hour of aggressive resuscitation did nothing to improve her countenance, nor restore her cardiac output.

To see the death of the young is always sad, and to see one that could so easily have been avoided, more so.

Maybe it's true, we pays our money, and we takes our choices, and the Devil take the hindmost.

On Pathology

Students in the department today. This usually means it's very quiet, but not today. Chief among the citizens who walked right out of a textbook was a fella who had been rather too friendly with the booze; years of one too many had rotted his liver, shrivelling it and firming it up, making it almost impassible for its rich blood supply. So now blood finds another way round, and one of those ways is through large dilated veins at the base of his oesophagus.

When these varices leak, they do so like a hose. He's been through this once before, but been lost to follow up. So he sat before us, shivering, an odd lemon yellow tint to his gaunt skin. Even as we called the Magicians and the endoscopist, telling them that he was stable, we knew it would turn out to be a lie.

But he didn't look too bad.

'Fooled you'

Innocently mumbling something about feeling a bit rough, he sat up and disgorged a river of claret. Bowl after bowl he filled, till his pressure dropped low enough that he couldn't hold his head up no more.

And still it came.

Then we moved in a blur. Organised flail - central lines, arterial lines, blood, platelets, the works. Curiously, he was most worried about having to have a catheter, and fretted about the speck of vomitus that streaked his chest, daubing him like some sort of Biblical door-frame. Odd, what seems important when one's life is literally draining away.

As all this raged, a young fella stabbed to the chest occupied my colleague on nights, and as I left, I saw the Sister of the Night pass him a CodeBlue sheet. I didn't catch the full story, but distinctly heard the words septic and unwell.

When it rains, it rains...

Finale

Wimbledon is going to the wire as I write...



So - yes, a fractured clavicle, which was spotted; but as the second recall X-Ray shows, a few busted ribs too. Try as I might, I cannot see them on the original, even with the advantage of digital viewing, denied you guys...




It's still not a brilliant image, but I think you can see the healing right sided rib injuries. Thankfully, no underlying lung damage.

Nights pass, as they do; Friday was busy for TooTall Student, so I think she got a good flavour of the ED. My main flail was trying not to call her by La Belle Fille's name... We ended on a Shroom 8 a.m. special. Just as we wound down for handover, the call came in, courtesy of BatPhone. The real deal - 40s, cardiac arrest 15 minutes away. !5 anxious minutes to try and gear up, try and get your mind running again. The nurses change at half seven, so they're fresh, but we medics all smell a little fusty. It's an odd scenario, as the bustle in resus goes on with the night guys drifting out, saying their goodbyes, making breakfast plans...


As our patient arrives, so do the day staff; we're short handed at weekends, so I stay and DayReg takes handover; he floats on the periphery, filling in the little details that my morning brain can't quite fix on.


The damage - a young fella, we think he has Wolff-Parkinson-White, an electrical short-circuiting of the heart, predisposing him to arrhythmia; we think he may have taken some drugs... we know he was found down at 7, we know he had no output at quarter past. He is unceremoniously dumped on our trolley, the Ambos herding round, bright-eyed, a sheen of sweat on a few brows; they've done their bit, and done it well. They know this, and don't need me to tell 'em, but want to know if we can finish what they started.


Chaos ensues, for a minute or two, checking the tube, forcing air into unwilling lungs, hands slipping on his greying chest. Then, we pause, come up for air, re-assess.


Got him.


Weak, yes; thready, yes. Hardly a thing to be proud of, but he's got a pulse. His rhythm is crazy on the monitor, never staying in one place long enough to get a fix. More drugs, more air. ITU and Cardio arrive.


Lost him. Four more frantic minutes until we find him again, pull him back over the edge. ECG shows a large MI, and we know why; the CathLab is being warmed up - we have indeed moved into the 20th Century - but I'm not sure we'll get him there.


Thankfully ITUMan is. He doesn't strike the epitome of cool across the room, but he is. Collected, organised, he casually takes over... and I am glad. Slowly, the patient heaves to, listing a little, for sure, but slowly doing what we want him too. ITUMan disabuses me of some ideas about the properties of fentanyl, and I feel generally clumsy next to him. I blame my 8 a.m. brain.


No matter; just under an hour later, he rolls out, with our patient, stable for now, onward to the CathLab. From what is undoubtedly at least two people's public tragedy, we are all smiling. We've done well, here today. Done what we were paid to do. We don't know if it will make any difference in the long run, but that's not our job. A little messy, disorganised? Probably; I expect I shouted a bit too much, too, but he came in dead, and went out alive... cliched?


Sure, but right now, I don't really care.


They're still on at Wimbledon...