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Silly o'clock on a Saturday morning. I've been awake since two, staring at the clock. Bugger.

A fresh day awaits me, replete with all the detritus that Big Teaching Hospital can throw at me. Weekend days are a little like nights, inasmuch as you're pretty much on your own. And busy. My nights have thrown my body clock off, hence my nocturnal roamings.

Had dinner with her again last night. Am equally sure, in equal measures, that I love her, and that she doesn't love me. Still, her friendship enriches me. I feel better for it, even if my soul aches. I wonder if, deep down, I know this is for the best. I am around so little, and our paths so divergent, that I wonder if we could ever be anything more. Perhaps, on some level I prefer it this way. Unrequited love... All the ache, none of the mess? Maybe I'm not explaining it right; I'm hopeless.

I've basically spent the last two days asleep; hence nil to blog. I'm pleased to see my friend blogging; I think he'll find it helpful. Therapeutic. Some shit like that.

I almost saw an accident recently, which was odd. I was at a petrol station, buying petrol, as one does. As I was going to get back into my car, I heard a loud crack noise. Not quite a bang, or a crash, but you get the idea. By the time I turned around, it was all over. A car had wrapped itself around the signpost for the petrol station. I had real trouble getting my brain to accept that all was still. That it had all happened. Although I could rationalise that by the time I'd heard the noise, it was all over, so by the time I'd turned round all would be quiet, it didn't seem to make any sense.

Go figure.

They guys in the car were ok; I think even the car wasn't too beat up. But the physics of it confused me. Still does, I think.

Random? For sure, but what did you expect at 5 in the a.m?

Oh, and fucking Mo'vember is over, and the Mo is gone.

River Of Dreams

In the middle of the night...

Doing an extra night tonight for a colleague. Normally this would provoke a great deal of grumblage, but as it's because he's a new daddy, we don't mind. I sure as hell am getting old tho'. I used to be able to do a week of these and not feel it, but here I am after three, tired as a wet kitten, and irritable with it. Like a bulldog with a mouthful of wasp.

Anyway...

Further evidence, as if it were needed, that people throw off all sense of personal responsibility when they step through our door. Twice tonight I have had people gesticulating wildly at me, alerting me to the fact that they are bleeding.

Not unreasonable, I hear you think. Well, no, not usually; but in these cases, the bleeding was from cannulation or venepuncture sites. Not from horrendous trauma, or awful limb-falling-off type accidents.

But because the cotton dental roll we place over these pin point hole wasn't taped on hard enough.

And they are always stunned when I stroll over and press on the wound with my thumb. Shroom's Blunt Haemostat. Amazing. Quite why these otherwise healthy(ish) and intelligent people can't summon either the nous, or strength, to think of, and then do, this themselves is beyond me. Instead they stand there, or sometimes move around a bit, to ensure even coverage. Oftimes they wave the offending limb, but always held downward, never upward. And they never, ever press on it. Ever.

Folks, I'll let you into a secret. If you can see a bleeder, and you can press on it, it will stop. I don't care how big. If your finger fits over the hole, that's the treatment, right there. But keep it to yourselves...

My favourite patient of the night (so far) was a young girl, visiting family. (i.e. not local... been to several other hospitals before...) Presenting complaint? Total body pain. Another personal favourite. Atraumatic, mind you. Total body pain is quite reasonable if you've, for example, been sat on by an elephant, or fallen out of a plane. But sudden onset, atraumatic total body pain? Well, we do see this, but it tends to be in a certain demographic of patient. For fear of generalising, or being accused of bigotry, I'll leave you to guess.

Needless to say, her first words to the triage nurse were to inform us that only morphine works for the pain, and that's what she always has. Her triage obs were all remarkably stable and normal. Despite several publicly agonising trips to and from the bathroom, pointedly in front of the doctor's bear pit, I explained that without a diagnosis, or any clues as to a possible diagnosis, I wanted to try other analgaesics first. Simply telling me that your previous treatment plan is i.v. morphine and home does not encourage me to give you some. Cruel, cruel Shroom.

Either way, when confronted with the harsh realities of the analgaesic ladder, and need for assessment and diagnosis, she decided to go home instead. Her gait on the way out was markedly free of the tortured limping and groaning that had characterised it a few minutes previously...

Lastly an SVT. This particular dysrhythmia is one of my favourites (sad, sad bastard) because, in my experience, it rarely compromises people, and responds well to a quick blast of adenosine. My SHO, running the case in his inimitable style, opined loudly to us all that he didn't see the point in 6mg as a starting dose as it "never works"; this minor rant against the system, and specifically the part that was compelling him to give this homeopathic dose of adenosine, continued until about 0.8 seconds after he injected the adenosine, when the patient flipped right back into sinus.

I guess protocols sometimes do make sense. Who'd have thunk it?

Oh, and the CherryPicker has started his own blog. Check it out; his tale is well worth hearing, although I can't vouch for his writing style... he did want me to offer more biog details about him here, but I'm thinking he can tell his own tale now. One doctor's battle with booze, and a reminder perhaps, of how close we all sail. Anyway, enough plugging.

Who By Fire

I seem to have caught up to myself, and my intention to manage a post a day (on average). Sadly my mo' hasn't managed a similar spurt.

I'm pleased to see I've retained a few of the extra readers generated by mt free press from Scalpel (see the side bar: "Fix Bayonets"; this incidentally is because his blog is called 'Scalpel or Sword' and the British 95th Regiment of Foot ('The Rifles') called their bayonets swords. In case you were wondering.)

I've also been added to the blogroll of another fave of mine, M.D.O.D. Anyone stumbling here from there, or anywhere is more than welcome. Pull up a chair, help yourselves to the scotch. You might need it, if my especial brand of jaundiced rambling ain't to your taste.

Here's an example of what you can expect....

I'm feeling extra proud of meself, as it seems I've successfully cemented my rep as the ED eccentric. (This is only marginally less important to me than the nurses thinking I'm an acceptable doc. It's almost pathetic how much their approval means to me. Well, the senior ones, anyway...) I confirmed this on Friday last, when, having unfortunately split the crotch of my scrubs was forced to undertake emergent repairs, using a 2/0 Silk on a curved; with scrubs still in situ, as I was in resus at the time waiting for a gasper. While my assembled team clearly thought this was funny, none of them were surprised...

SSM - Studying "Some" Medicine?

While extending my roaming through the blogosphere, a word I dearly love, I have encountered a few MedStudent blogs. Harry talks about his choice of SSM. I am now such an old fart that I'm not sure exactly what this stands for. But I note that dissection is one of the choices.

One of the choices?

Now I really do feel old.

When did this become an option? I can't think of a better way to learn anatomy, and I can't think of a more important cornerstone to medical practice. Granted, I have a surgical bias, but I don't claim it is the most important... just that I can't think of anything that should stand above it.

So, having read the blog, I know realise it's 'Selected' Study Module. I still can't understand the rationale of allowing people not to choose dissection.

Bah Humbug.

And, I still can't grow a fucking Mo'.

Music Nazi recommends Most Likely You'll Go Your Way... by Bob Dylan - original or remix.

M'Oh!

A few things.

I haven't had time to blog about my glorious march to triumph in the ED talent show yet, but, oh yes, my brothers and sisters, it is coming.

I read with interest that November is NatBloPoMo... National Blog Posting Month. A post a day. Well, I don't know if this applies internationally, and I'll never manage it anyway, bu in the spirit, I'll try for 30 posts this month. Be prepared for some truly inane shit.

Mo' importantly, it's Mo'vemebr. A tradition I'd never heard of, which seems to have originated with my crazy Antipodean cousins. November has become the month to 'grow the Mo''. So there's a lot of unshaven ED staff wandering around right now.

For the facially follicly challenged, this seems terribly unfair - especially as that's basically me. But I've been kinda shamed into it, so have resigned myself to not only getting older this month, but looking ridiculous doing so.

Reports to follow...

(Oh, and I'm back off the fags! One week and counting...)