Weekends Are Fun. Right? (2)

And so to Saturday.

It can't be any worse, right. Not worse, maybe, but just as bad in a different way.

The Dept was as busy, if not more so. I think the second board was out on arrival. (This means there were so many patients in the department, that we'd run out of space on the regular board. It is not a good sign)

Again, the details are beginning to escape me. I'm not sure if my memory was always this shaky. I can't remember.

A heaving department, but resus call after resus call. Once again the department becomes crystallised into this small room. Outside I know we're up shit creek without a paddle, but I can't do anything about it. I can't get out of here, they won't stop coming.

Tonight's featured cases are trauma, again.

First up an RTC. High speed, head on collision. Two victims. The driver was the subject of a prolonged extrication; a BASICs doc was on scene and asked for a surgeon to be waiting. The BASICs guys, and gals, are pre-hospital docs, working in their own time. They embody the spirit of the orange jumpsuit.

Anyway - we had a fifteen minute heads up, but that didn't translate well to the duty surgeon, who was crash bleeped to resus, and slightly nonplussed on his arrival. Eventually the patient rolled in. His entrapped state had required ketamine on scene. This is a 'battlefield anaesthetic'. Can be given intramuscularly, and produces analgaesia and dissociative anasthaesia. There is an occasional view among the ED regs that the BASICs guys are a bit too liberal with it.

So, the guy is boarded and collared. His airway seems ok, but I'd better check.

--'Sir?, Sir? Can you tell me your name?'

He opened his eyes, very slowly, looked me dead in the eye, and said:

'Wow!' (I'd like you to imagine this being spread out over about five seconds. That gives you the idea)

I guess there's something in this drug being used illicitly.

Primary survey revealed a tender abdomen and pelvis, with hypotension, transiently responsive to fluids. Chest X Ray showed pulmonary contusion, with possible haemothorax, and FAST scan was negative.

As per usual, my knife wielding colleagues wanted a CT scan, but the patient's blood pressure intervened, and straight to theatre he went.

One ExLap later, and all that could be found was significant retro-peritoneal bleeding. He continued to behave in a labile fashion, and I can't help but wonder if there was some other injury, but haven't heard yet. More or less a tick in the positive box; ah, but the night was yet young...

Weekends Are Fun. Right? (1a)

And so it went on...

While keeping an eye on some poor fella who'd been stabbed in the belly - We guessed he wasn't too bad when he began devoting his time to feeling up the nurses - I was chatting to one of the local Constabulary. I think they were all in the ED at some point that evening. Anyway, their little shoulder radios are always going off; they sound a little like the teacher from Charlie Brown to me. You can never quite hear what the jazz is.

Anyway... this time, the radio goes off, the copper listens intently for a while then looks over at me. I raise an eyebrow, quizzically. (In my mind...)

More squawking chatter; another glance.

What?

Rueful smile. 'More business for you, Doc...'

What?!?

Shake of the head. 'Doesn't sound good...'

WHAT?!

'Another stabbing. In the neck. They're not sure if he'll do'

I look around the rest of the Dept. Minors and Majors are both heaving. I can't remember what the wait was by this stage, but I'm guessing it was over 6 hours to be seen. Ambos were already queueing...

Sure enough, a few minutes later the call came. Young man, multiple stab wounds, suspended. I remember the first time I took a call like that, I couldn't figure out why everyone was so excited, or why someone would be suspended.

From what? Eh? Oh.... that's what it means...

How times change.

The next few hours were very ER.

The details blur around me, faster and faster as the days go by. I remember his colour, a pale, waxy yellow. It's never good, but you don't need me to tell you that. His chest laid bare, the wounds on his chest so small, so innocuous looking. So little blood.

That didn't last.

Part of you knows there's no hope. But most of you doesn't want to believe it; and you want to try. He's so fucking young. The worst part of you feeds on the adrenaline, and wants to act because it's cool. It's exciting. It feeds the beast.

As ever, telling the family was the worst. They look you in the eye, and plead: 'Why can't you fix him. Do something, fix him, make him better...' The despair tailing off as the brutal reality slowly sinks home; oh, so slowly.

You could stick a fork in me after that. I was done.

Does it count for anything? Does it tally somewhere that we all tried as hard as we could, flying in the face of a lost cause.

I'm not sure. The only tangible results will be a blip in the waiting time for those hours when we tried. Will a time come when I see this case and call a halt straight away, when I admit the hopelessness, and devote myself to the big picture?

I don't know.

Weekends Are Fun. Right? (1)

Friday Night.

Actually, I like working nights. More autonomy, and it feels vaguely romantic to me. It's ok, I have insight. I know this is weird, but I can't help it. There's something about hospitals at night...

The Department is busy when I come on. Not the best sign, but it's do-able. The waiting room is bristling as usual. The world's most aggressive goldfish bowl.

I have resolved to try and let the SHOs run resus tonight. It doesn't quite work out that way.

Resus is packed when I come on. In bay one is a patient waiting to go to the ward. Some have been waiting 9 hours for this privilege. I think she's got a broken femur, and assorted other fractures. In two is wheezy, short of breath. Also waiting on the ward. I forget who was in three.

This strikes me as terrible. It was less than a week go, and already I have forgotten so much. I think maybe it was a kiddie.

A few simple resus cases flow in. Then it starts to clog. At one stage we have 5 acute cases in a 3 bedded resus.

Then the first of the big three:
Young-ish. Attempted hanging. Head injury on being cut down. Agitated.

When he arrives, my worst fears are not confirmed. His airway is patent. No laryngeal fracture that I can appreciate, and although he looks congested in the upper half, I can feel no sub-q emphysema.

(This is air within the skin. It feels a little like Rice Krispies, or bubble wrap. It is indicative of air leaking into the tissue, usually from the lungs. It is high on Shroom's list of Ways I do Not Want My Skin To Feel.)

He is agitated tho'. And de-cerebrating - an abnormal extensor posturing of the limbs. This is, of course, high on Shroom's list of Postures You'd Rather You Weren't Exhibiting.

He has an ugly wound on the back of his head; evidence of where he was dropped. The final indignity, if you will. Cruelty, heaped upon cruelty.

While trying to restrain him safely, we get to play the ED sedation roundabout / roller coaster game. Up and down, round and round she goes... where she stops, nobody knows. Fortunately, I'm a veteran of this game, and we stop just where we need to. Help arrives in the form of a friendly gas-passer, and we send our guy away to a better place. This, at least affords me the opportunity to come over all ER by straddling the trolley to provide manual in-line stabilisation from the bottom end.

The long, dark walk to the scanner, while I make a few unwelcome phone calls, and break a few hearts in the relatives room. I do not feel a better person.

The scans all come back negative, which is only slightly reassuring. Anoxic brain injury can be like the wife-beater's kidney punch, ruining lives without leaving a mark. That will come later.

There briefly follows a surreal period where I and my anaesthetic colleague try to arrange admission for our guy. Ortho and Neurosurg all agree he will need their input; just not right now, so they aren't admitting him. I am disappointed to discover this doesn't really surprise me.

After a brief hair tearing, my Maiden in Shining Armour (she of the Expensive Scares) convinces the Magicians that they should take the patient.

I can't pretend to understand it, but at least we found him a nice warm vent for the night.

How To Be Dead

I am particularly melancholic right now. A hard weekend, another week going by without a 'new me'. And now I'm watching a film with Sean Connery in it, wherein he seems to have been cast 20 years too old...

I need a drink. I think I'm out of scotch...

I had a hellish weekend. I composed several posts in my head during the course of it, all of which have flown by-the-by. Maybe a Dictaphone..?

Of the people I work with...
They are, by and large, a sterling bunch. 3 of my peers I am particularly fond of, and will be sad to lose them at the great rotation in May. Or maybe it's August... I forget. One, however, is increasingly showing their true colours as a bandit practitioner. The shady instances just keep mounting, and mounting.

I suspect the bosses know. I'm just not sure what we / they can do about it. I guess we all just work a bit harder? I think this particular colleague is moving on; and their human rights being as they are, I'm not sure we can tell anyone what a bandit they are, without being accused of prejudice, or bias, or something.

I always figured if you were shit, you were shit, and the sooner someone told you, the better? Not any more... it's always someone else's fault you weren't quite good enough.

More Light Relief

RATty, Mole and Badger

Right.

I'm going to try and pen something sensible, instead of the usual drivel. I'm not sure it'll work.

Big Hospital is trying to achieve Foundation Status. I'm sure this is very important, but can't shake the image of committee rooms full of people stood, arms aloft, fists clenched, chanting 'Foundation! Foundation! Foundation!', in a vaguely 1930s Germany sort of way.

All that stands between them/us and it, is the ED. We need to achieve 98% in the four hour target. To the uninitiated, this means 98% of our patients need to be in and out within four hours. I think it's a facile target. It does not mater what happens to these patients, as long as it takes less than four hours. So, me, a triage room and a large syringe of potassium (or air, for that matter) would actually improve our performance ratings.

Anyway, we're falling short by 0.62%, overall. Most of the damage is done at nights and weekends, when staffing levels fall, and patient numbers do not.

So, the three line whip is out. See more people, faster. But don't let clinical care suffer. After a point, these two things become mutually exclusive. To avoid that, the solution will inevitably be to refer more people for admission. If you're not sure whether you can discharge someone, simply admit them. Why waste time trying to sort out (i.e treat) patients in the ED, when it's far quicker to refer the job to someone else. (Buck, anyone? Anyone? Anyone? Bueller?)

To aid this process, the Senior Docs are engaging in a Rapid Assessment process. (Rapid Assessment and Treatment? or Triage?... I'm not sure. I've missed it being up on PICU, but re-enter the ED today.) Patients are seen and rapidly assessed on arrival, before being palmed on to an SHO, with a provisional diagnosis and plan - i.e. do these bloods, this X-ray and refer them to these guys.

We are becoming triage monkeys.

This will undoubtedly speed flow through the ED. But is it right? I don't think so. We are being asked to work more anti-social hours to achieve this target. To agree to this is surely a mistake. Other specialities do not have two Registrars on overnight. Other speciality consultants do not routinely work on the floor until midnight. (ITU excepted)

By increasing numbers of referrals we will clog the hospital with patients awaiting a 'specialist' opinion. Why not make these bastards change their working practices? Ask the surgeons to have a team dedicated to operating, an another to seeing ED referrals. That would speed up decision making, and flow. Ask the other consultants to work until midnight, seeing patients and making decisions - and, incidentally, for less money.

I can't imagine they'd stand for it.

Why should we?

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...

Flatback Caper

I think, more or less, this blog is a year old today. Woo-Hoo.
There's probably some naval gazing to be done about this... but later.

Nights are almost done; for this run, anyway. Although I'm on again next weekend. My rota has seem me working a one in two lately. I'm not sure why, but shit happens I guess. Next weekend will be my fifth on in eight. Old school. Love it.

I think I've kinda missed Hallowe'en, although we had a few freaks in last night, including one young lady wearing the shortest skirt I have ever seen. I know I'm getting old now, because my first thought was: My belt is thicker than that, followed by: I bet she's cold. I was impressed by how adeptly one of my SHOs worked the board to ensure he ended up seeing her...

Continuing my musings on parents, I saw a fella, who I'm guessing was in his 30s, admitted after a fight. He had sustained mostly superficial wounds, and I think the damage was more psychological than anything - certainly his life was never in danger - but his dad, a man of 72, sat with him all night. Possessed of quiet dignity, this softly spoken man sought me out often to enquire after his son, and I did my best to reassure him. I was struck by the way he would quietly step aside from time to time before returning to his son's side. He used these 'asides' to surrender to his own feelings, small tears breaking through his defences for a few minutes, before he'd cuff them away, recover himself and go back to his son.

I guess we never really grow up while our parents are still around

A Bagful of Eddie

Death by Tray

You Got Bananas? Got Bananas?



Covered in Bees

Fiddlestix

Normal service resumed

Unknown male, early middle-ish age, non Caucasian ethnicity, found down at the ferry port. Agitated, apparent right sided deficit.

Examination reveled a well looking male, agitated, but not combatative, clammy, but warm at the edges. Normal pulse, BP sky high, heart sounds normal, chest clear, abdo unremarkable.
Leftward deviating gaze, left pupil blown - only transiently, as it turned out. No other gross neurology.

There's a list of differentials as long as your arm for this guy; but he smelled like a brain bleed to me.

It took a while to convince my gas passing colleagues, while we ticked off some of the more obvious and easily treatable ones. With no improvement, he won a long dark walk to the scanner, and we irradiated his brain.

I found out later he's 41. There's no joy in being right, either...

Sad-Eyed Shroomy of the Lowlands

It seems most of what I write these days is apologies for not writing.
Sorry.

My mood has been lower than usual of late. Work, money, work, personal life... blahblahblah.
I'm still disappointed my life isn't quite ER. Ah, well...

This month has been PICU month. I'm due a 3 month Paeds secondment, but it hasn't been possible for me to do it all at once. So, I got a month. I haven't done any ITU for a while, least of all Paeds. So it's been a valuable experience, albeit perhaps not exactly what I thought.

Intensive care is an odd place; organised, controlled chaos, if you like. When I worked on adult ITU, I think it was then that the psychological trauma began to build up. Maybe. I found it very hard to see so many die. Especially the younger ones.

Now obviously in Paeds, they're all young. But it seems to me that few of them die. Which is nice.

Instead, what I have found challenging is watching the head injuries. The ones I've seen tend to be older - in their teens - and were usually on the wrong side of a moving car. They have non-operative CT scans - no large extra-dural haematomas to be hoiked out by my neurosurgical brethren. But their brains are tight.

Recovery is slow. Slower than I'll know, as I haven't seen the neuro-rehab ward. What I find frustrating is how non-specific we have to be to the parents. They'll probably survive, but we have no way of knowing how they'll survive.

It is the worst of things, and the best of things. I have never been more amazed by the strength of human spirit than I have watching the parents of these kids. I simply cannot imagine how it feels to have to come to hospital, day after day, and look at your son or daughter, previously so full of life, so vital, and look at them, pale and waxy, tiny in an adult's bed.
And keep smiling.

And once all the tubes are out - the ETT, the bolt, the EVD, the drips and all - they aren't better. They look around, blankly, their limbs flailing. Trapped in a body that won't obey them. And still mum and dad come in, holding the patient's hand, lying in bed with them, holding them tight. No parent banks on having to watch their adolescent be nursed in an adult nappy, on having to help bed-bath them. But they do it. I don't know where they find the strength.

And then... sometimes they just stop flailing, and start looking around. They start speaking. Their movements become appropriate. A 'high-five' has never meant so much to me...

Clearly, this is not the end; but maybe the end of the beginning? Or the beginning of the end? Something like that...

There really is hope. Who'd have thought?

Idiot Wind

I meant to write this up a few days ago. I was out with a few friends, one of whom revealed he reads this from time to time. Clearly not very frequently, as he was complaining I'd not written anything for months. Anyway, I've been meaning to write for a while, but everything seemed very bleak, and I wasn't sure self pity was what's called for.



I'm on the Paediatric ICU for a month at the mo', which is frankly terrifying. More of that later. Most of the cases I've seen in the ED have been either 'mundane' or depressingly bad news. Possibly more of them later, too.



A few days ago, we got a all too familiar call. A gent in his 70s had been found collapsed by his wife in the bathroom, in the middle of the night. The Ambos reported him agitated, irritated. "Irritated" has a particular medical meaning. It, usually, does not mean that the patient is in a bad mood. The implication is that there is something irritating the patient's brain, and that there behaviour is irrational, disturbed. The irritant is usually blood.



I am sure you don't need me to tell you this is not ideal.



This fella fitted the pattern. Lights on, no-one home. Large bruise over his right eye. Not much else to see, but high blood pressure. Forcing blood into his tight swollen brain. The whole thing smelled grim.

The usual pattern - a modified rapid sequence induction, with intubation; waking a groggy radiologist to fix the scan; the long dark walk to the scanner.

In the meantime, there's always the family. I still hate this bit. I guess it's alright. Once I start enjoying it, someone needs to take me out back and shoot me.

Most-times, the family know. They may not be ready to accept it yet... but they know. We talk through the possibilities, the 'maybe's, the 'might-have's, and the 'what-will-be's. It's difficult, because in my heart, I know this guy's gonna have an huge bleed. I know I'm going to be back in here in half an hour, with the scan results, telling them there's no hope for a positive outcome...

And they know I know. We can see it in each other's eyes. I think I'm getting worse at lying with age.

So... scan is normal. Yup, normal. No bleed. Which doesn't mean he hasn't had a big fuck-off stroke. (And, yes, that's the technical term) It might just mean it's thrombo-embolic, and that we can't see it yet.

Will he wake up? Time to find out. My friendly gas man turns of his milk of amnaesia, and up he comes. We pull the tube...

There is the usual coughing and spluttering, and then his eyes... focus. He looks around, confused, and his words are husky, but he knows his name, he knows his date of birth. His neuro is exam is normal.

This case, which I knew was going to be a bleed, to be a disaster; which I knew was going to end in me ruining another family, was probably micturition syncope and a minor head injury. Well, minor-ish...

I go to see his family, and I have never been so happy to be wrong.

(There y'are J...)

Something For the Kids

Old bastard that I am, I couldn't manage to embed the Real Leary doing this, but I think the lyrics are the main thing...

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

On My Own... (Again)

I've taken the Queen's Shilling - again. And at what cost? A return to solitude.

My beloved and I have gone our separate ways; can I philosophise about it here? I'm not sure; she might read it, and I don't know how fair that is. Suffice to say, I failed in my duty as 'significant other'. Much as I wanted to, I couldn't give enough of myself to do her justice. I am become a self-fulfilling prophecy, afraid to commit, because I fear the end, but bringing about the very thing I dread most.

For right or wrong, I have allowed my work to dominate who I am. It's difficult to feel good about that a lot of the time, especially when you wake up lonely and alone at two in the morning...

I'm not sure about this one. Clearly there are some things that no-one else needs to know about; maybe I need to write it. You don't need to read it tho'...

Action in the resus room, usually fills me with an unhealthy glee. Achance for action! for derring-do! heroics! (or flailing, of which more after this god-awful set of nights...)

But it paints the most dreadful pictures too.

When the call came for a patient found down, and not seen for 10 days, all the 'joy' went out of the room; at first we thought it might be a prank. I know that doesn't sound funny, but the ED breeds its own variety of humour. Think about it - everything's funny for a certain value of the word 'funny'.



It wasn't a prank.



I've always believed a person would be hard pushed to stay alive much longer than 4 days without water. In the end, this one made it 9, we think. I don't know how they ended up on the floor, but the pressure sores made it clear they hadn't moved much. Deep, leathery, abutting bone; teeth eroding through the top lip. A smell all at once reminiscent of public urinals at the end of a big night, the morgue on a hot day, and something deeper and darker - earthy and ripe. One eye swollen shut, but the other staring helplessly out.

Dear God, let him be unconscious; I'd like to tell myself he was unaware, that all was dark to him.

But I'm afraid that wasn't true. I'll never know, for sure, but in my heart, I'm terrified that he knew. That he felt. What had become of him.

I'm sure there are worse things to behold - in war, in starvation, in poverty... I just haven't seen any of them. I've no idea what this person was like in life; they sure as hell fought hard enough to stay alive... I just don't know if that's enough.

Sometimes we can't even give you your dignity, no matter how hard we want to, how hard we try.

When that happens, is it enough that we tried?

What good are we? I'm not sure...

Bringin it All Back Home

I think it's smells, for me.



Everyone has a thing that makes them squirm. Maybe more than one. At work, it's smells. Hospitals have a smell all of their own, and each department smells slightly different. I think I found the Burns Unit the most unsettling - because it has ripe smells, but is warm and humid. The whole effect was... unusual.



A patient came to us the other day, alive, wishing they weren't. In too many pieces.



Three, since you were wondering.



It wasn't what they wanted, I guess. I think they wanted to die. Not this. We had to hide them.



The legs, in bags. The stumps, under a sheet. Enforced denial. Information control.



But it smelled like being in the local butchers, when I was a kid. I couldn't stop the images of a bloody floor, caked in sawdust. Raw meat smells like raw meat, whoever it belonged to... I'm not sure anyone else noticed in all the bustle. And, it's hard to explain to other people.



The patient? To my shame, I don't know...



Still hard to pay the Butcher's Bill.

Feathers Stevens, Big Beak O'Reilly, and Jimmy the Penguin

Still finding it hard to write.

This morning I can smell blood, sweat and tears; remnants of quiet horror seem to have invaded my nasal passages.

How's that for melodrama? or histrionics? I'm pretty sure there's a word for it...

I've been at Big Hospital for 4 months now. I'm kinda settled in. Always takes me a while, whenever I move. This feels longer than usual. Give it another two? I dunno... I've no choice either way.

Big Hospital is a grand hospital, but I have felt less part of a team, of a family than in previous departments. Sometimes I feel less valued, and less worthwhile. Unfortunately, we both think we're cleverer than we are. I guess I've reached a stage in my training where I feel I can, and should be allowed to do things my way. It's not like that anymore, and I'm sure that's for the best, even if I can't see it sometimes.

I guess the next stage of my development is to learn how to be a team player again. especially as I seem to think I don't have to.

Jimmy? Oh, you're a penguin... so, fuck it.

Tuesday's Gone

A little light relief?

I thought this was funny, but realise it's non-PC, and I'm kinda the wrong gender to comment. Make of it what you will.

First case of the day, an elderly fella, collapsed at the swimming pool. Arrest twice, RoSC twice. Arrived flat, with a suspicious ECG. Great flurries of activity. In the midst of this, one of the Cardiology magicians came down to echo the fella for us, and pronounce on whether a trip to the cath lab would be good for him.

My boss was directing affairs, and didn't know this (female) doctor. To remedy this situation he asked her:
"Sorry, what's your name, sweetie?"

Time froze, and the temperature dropped to absolute zero. Just for a second.
Then:
"It's Susan, NOT 'sweetie'"

'Wang': Normal activity resumed. My boss, for what it's worth calls us all 'sweetie'. I've got a lot of time for him.

The echo shows a poor LV function, but, probably, nothing new. No cath lab.

Before he leaves, my boss does a final, verbal, recap; to make sure all the jobs are being covered:
"So, Shroom, you'll do the NG; Bob's doing the foley; and Susan, formerly known as 'sweetie'..."

Exit, stage left, very pleased with himself.

Yes, I know it could be dreadfully patronising, and I've never had to put up with it, etc... so maybe from the other side of the fence it ain't so funny. Brightened up my day though...

Mr Bojangles

Is everybody in..? Is everybody... in?

Let's have at it then. Yes, I'm back; for what it's worth. I've been suffering an extended period of writer's block, and haven't been able to summon the energy to blog for a while. I think I started this whole thing when I was unhappy, as a way to vent. Maybe I haven't needed to do that as much recently.

Anyways, sitemeter assures me a few of you still check in daily, tho the number is fallin'. I've no idea whether it's the same old crowd, or a bunch of randoms, but I guess I'll keep at it for a bit.

I'm increasingly convinced life moves in (?ever decreasing) circles. Just this week I've seen a fella top my list of 'colours I'm glad I'm not', and held a man's hand so he wouldn't die alone, when I couldn't do anything else...

And now, to work. More in a day or two, if you're interested.

Slainte