Best vs Worst

No further rigors, no idea what the source was. Slightly worried I'm harbouring something nasty... but declined investigation so I guess I have to lie in my own bed.

Increasingly find myself gripped by malaise, and dark feelings of hopelessness, which is somewhat self-indulgant considering my situation versus how it could be.

Anyway, blame that for this post.

In general, I have a low opinion of humanity. Essentially, I don't think we're as far removed from the beasts as we like to think we are. Left to our own devices, I think most people will happily crap on their fellow man, if it's to their own advantage.

Altruism, generosity seem to me to be the exception.

La Belle Fille firmly believed quite the opposite; she does have a bright shining soul though. She may be right.

I suspect my job biases me.

Certainly LBF rarely encounters stuff like this: I was wary of telling this story, because it's sensitive, but I've seen it reported in the Daily Mail, which I think makes it common domain.

A young man died recently, and he probably didn't have to. Maybe it was his time, but he was awful young. He fell into a pond. The Mail reports he had an history of blackouts; I heard seizures. Semantics, really. If you were very uncharitable, you could argue someone with that history should probably stay away from unfenced bodies of water unsupervised. I assume he was alone.

I could be wrong.

Anyway, he fell in the pond, and was unable to get himself out, likely because he was unconscious. It took 25 minutes to get him out. No-one would go in after him.

The Mail is quick to chastise the EMS, whose bosses won't let them go in, in situations like this.

But someone called the ambulance. People stood about and watched. No-one, no-one even tried to get him out.

Stood and watched him die.

Music Nazi recommends Eccentric Soul: The Prix Label.

Little Wing

Where once there used to be an 0600 Cardiac Call, I now seem to attract an 0755 squeaker. This one came with a warning. The BatPhone trills us out of Monday morning's quiet reverie. It had been peaceful for a few hours. I even lay down for half an hour.

I should have known better. Superstition dictates that the Shroom who is planning a quick getaway brings ruin on himself; and the poor bugger that ends up in the ED, of course.

Control is calm; matter of fact. They always are. Car smash, sounds high velocity. Three casualties - two kids.

Enter the squeakers.

They arrive piecemeal, not in the order we were told. A 10 year old first - she looks well, and I deploy SHO Kingsmen.

We wait. Not for long. He's right behind, made smaller by the board. He looks tiny surrounded by the Techs and Paramedics; dwarfed by the monitors.

He's very quiet.

This makes me nervous; the quiet ones make me nervous. This fact is generally lost on adults, who generally believe that by shouting good and loud, they'll get dealt with quicker. It just tells me they have a patent airway, and breath enough to shout, and energy enough to waste doing it.

But the quiet ones...

A quick eyeball reassures me. He's alert, engaging his surroundings. I remember his eyes as piercing blue, but maybe that's dramatic licence. His view is limited by the sandbags stabilising his neck. The traditional ED view - nothing but ceiling tiles - and now me. He locks on as my face hoves into view. I try to think of something to say that will make this all alright for a 4 year old.

He looks less than impressed, but doesn't struggle as I clamp my hands and forearms to his head. A soft tissue vice, if you will. We run the primary survey ruler over him, and he comes up clean.

By know his sister has spilled the beans. L'il fella speaks no English. They were in a car hit at speed from behind, and rolled. Big sis crawled in to pinch him from his car-seat. My respect for both of them grows, enormously. I keep talking to him, aware now that tone is more important than words. He fixes me with his steely gaze once more; all the acknowledgement he can manage, he goes back to studying the ceiling.

Finally in a well fitting collar, we roll him; still no sign of injury, but we have to have his sister translate the indignity visited upon him. When I ask him to clench his buttocks, he does so with vigour. I half expect him to yell "Ta-Daa!" to accompany the demo of neuro-muscular integrity. (Which is the purpose of said request, in case the non-medicos were just thinking I was warped...)

He doesn't flinch as we cannulate him, draw his blood into tiny vials, virulently red against his pallor. I try to cheer him by making one of our Masonic teddy bears put on a little song and dance. He treats the display with the contempt it deserves. Everyone a critic...

By now I'm ready to hand over; pass his care like a baton; he is stable, needing some X-rays, but I feel he'll be OK. By now, his Mum has arrived. We MacGyver the trolleys next to one another, so L'il Fella can hear and touch his sis and Ma, even if he can't see 'em yet.

When he hears Ma, he breaks his silence, and a stream of language pours forth; the words spill into the resus bay, silent with relief that no-one appears seriously hurt. We've all seen the pics of the car the Paramedics brought in on their phones. Whether we like it or not, these images bring a flash of what could have been - the tearing asunder of the fragile forms before us.

With Ma nearby, and his voice rediscovered, it is finally too much for him, and he breaks; just a little at first, then rapidly, as his face crumples under the weight of what has happened to him. Finally he gets a little colour in his cheeks as he struggles to stem the flow from his bright blue eyes.

As I turn to leave, I have to cuff at my own eyes, just a little. Must be dusty in here...

Burn One Down

Well, after five nights on the trot, you'd think I'd have something clever to write; or something intelligent; or thought provoking. Not really. My last few shifts have passed more or less without incident.

Instead, departmental politics are once again at the fore. I have yet to hear what the Management Consultants who were prowling about have had to say. The breach targets are once again getting maximum billing. The next few months requires an extra big push. One more push, lads, and it'll all be over by Christmas!

(Foundation! Foundation! Foundation! Arbeit Macht Frei!)

The upshot of this appears to be that we are asked to organise referrals for our patients increasingly early. Not, and this must be emphasised, in a way as to compromise patient care however. I am becoming increasingly disillusioned with this. I like treaing patients. It's what I signed up for. But there seems to be an increasing drive to postpone any but the most essential treatment until 'they get to the ward'... aside from the fact that I think we could and should be instigating treatment as soon as it is feasible, the increasing admissions rate is putting yet more stress on inpatient teams who hardly had it easy to start with. So it leaves me with little confidence that the treatment will be started 'when they get to the ward'.

I suspect that actual incidents of patient harm are few and far between, but it feels in general as if we're offering a slightly worse service. But how many times is too many?

My patient with a leaking aneurysm who nearly ended up on a medical ward because somone decided to book them a bed, so they wouldn't breach..?

My patient with low potassium, and attendent ECG changes, referred for admission as not safe to stay on the obs ward, then placed on the obs ward while waiting for an inpatient bed, so they wouldn't breach..?

Maybe I'm just too cynical.

One of my patients over the weekend was a young girl who had taken her second overdose of the past few days. Mostly fairly benign drugs, but enough to make her pathologically sleepy. She deteriorated suddenly, requiring a brief dash to Resus. Her father and sister were in constant attendence, calm and collected. I wondered how many times they'd been through this before. I offer the usual explanation - first we treat the physical, then the psychological. In her case we need to watch her while she wakes up, make sure she doesn't vomit and choke on it, stop her following Jimi Hendrix's example...

As if on cue, she begins to heave; she has enough presenceleft to slide sideways. At first I think she's trying to brain herself on the side rail, but it turns out she's just aiming over the side. She scattergun splatters the floor; her dad has reacted fastest, and has a bowl under her mouth. I'm impressed - he and I started from the same point; standing start and he beat me to it. Maybe he has done this before.

We clean her up as best we can, wiping her mouth, blowing her nose. Then she heaves again; this time her sister lunges forward. For a second, I don't see what she's reaching for. We've got it covered, haven't we? Almost; she brushes a lock of her sister's hair back; it was dangling right in harms way.

The devil, it seems, is in the details.

A Sense Of Perspective

I read a post by Kal, over at Trauma Queen. His is another 'Emergency Services' Blog I recommend. I personally find it interesting to see the shit these guys have to put up with, even before they get to the Hospital. Just don't call him / them 'AmbulanceMen'.

Anyway, since my Night Shift was relatively uneventful, aside from planning to elope with one of the Nurses to Cambodia, I was struggling to think of something to post. Kal's post struck a cord.

Now, I may have posted about this before... my memory bites, and I do have a habit of repeating myself, as any of Shroom's friends will tell you. But I just can't be arsed to plow thru' my own archives. So, if you've heard it before, I'm sorry. Perhaps someone could discretely let me know I've begun to tell the same tales over and over, before I turn into the old man in the corner, endlessly recycling war stories...

Anyway...

A little while ago, I was at home, visiting Ma and Pa Shroom. An old school friend and I were off out for a few drinks, passing through the collection of shops, restaurants and estate agents that goes to make up the senior Shrooms environs. As we approach one such restaurant (which, trivia fans, used to be a grocers), I see both Police and Ambulance outside. I am almost pathologically nosey, and sidle up to the window.

My gut tightens, then loosens, just a little. On the floor, surrounded by the attendant detritus that goes with it, is a young man being resuscitated. Full CPR. I approach the Copper on the door.
'Any need for a doctor on scene?' I enquire. In my experience, the Police are happy to let yo get involved. I remember him being young, and he looks pale, anxious, unsure.

'In there'; he opens the door, points unnecessarily. I can hear the sound cloud, the aural miasma that goes with an out of hospital resus. The Paramedic's voices, calm, ordered. Other voices, close to hysteria; these will be the patient's friends; we ask people if they want to watch the resus in Hospital, assign them someone to be with them, hold them, answer their questions.

These people have no choice - it's right here, live, interactive. No red button required.

The restaurant is divided into halves, by a low arch in the wall. Where I've entered is in the first half; the action is next door. The restaurant is full, and the patrons don't know what to do. Something dreadful is clearly happening next door; they can't see it, mostly, but they can hear it; they all know what's going on.

They don't know what to do. Most of them are eating, making small talk, desperately telling themselves that 10 feet away a small terrible drama is being played out. It's incredibly bizarre.

I pitch through next door, introduce myself, hoping that I will know this crew. I worked at the local hospital for 18 months, maybe they'll know me, remember me.

They don't.

Now, while the Police are usually happy to let any Tom, Dick or Harry through, the Paramedics and Techs are not. Why should they be? They know what they're doing; they don't need help, especially not from someone who might be a nutter. If I offer to tube the patient, and stick it in his belly, they carry the can.

Somehow, I do enough to convince them I'm on the level. 3 people on the resus makes life easier. They let me do compressions, the AED tells us when to shock the patient. He is young, maybe younger than me, and something terrible has happened to frighten his heart into the violent, spikey rhythm we see on the monitor.

When the drugs are gone, the time has come. Time to run, get him to hospital now; a wider selection of drugs awaits, and maybe, maybe salvation. I see it in their eyes - do they see it in mine? He's been down 20, 30 minutes in total, and while his rhythm is still in turmoil, and he's still having electricity passed through his failing body, his chances are bleak.

Now, and this was the point of this whole thing really, outside the restaurant, the road is narrow, two lanes only, narrow lanes, one already blocked by the DayGlo rig, that we jokingly used to call The London Big White Taxi Service. To get everyone out safely, the Police block the second lane.

Now it seems obvious to me, that when someone is wheeled out of a restaurant, Paramedics clearly engaged in CPR (and surely everyone knows what that looks like? Don't they watch Casualty?), escorted by Police, a crowd of tearful, sometimes screaming people in tow, that this person is not well.

That his situation might be more serious than your dinner / the pint with your mate / whatever else you will know be 10 minutes late for.

But, no.

While the cars further back quietly waited, used to jams around here, those at the front, those with the clearest view of the end of this man's life, begin to hurl a torrent of abuse. I see no point in reprinting it here, but suffice to say some of the invective was strong enough to result in an extra delay to discuss their choice of language with the Police.

5 minutes later and the road is clear. The diners are still eating.

I catch my mate, and we go for a pint, both just a little bit happier to be alive

Nurse, The Screens!

A morally satisfying weekend educating my fellow medics, as the scramble to get MMC boxes ticked heats up.

I also managed to see Ma and Pa Shroom. I was slightly concerned to hear that Pa Shroom's memory is fading. I'm sure this is, at least in part, because he's retired. When he was working, and I was a student, I was always amazed at his superior knowledge of anatomy - even for those bits he didn't cut regularly. Now Pa Shroom bemoans the loss of this knowledge, and he was telling me his short term memory is failing him too. I hope that's all it is. I couldn't bear to see him dementing...

After my hapless flailing at the fairer sex on Friday, a cheeky note from a fellow Blogonaut brought light to my soul. Thanks again, even if you were humouring me.

As the philosopher Springsteen once wrote, "Don't call for your surgeon, even he says it's too late: it's not your lungs this time, it's your heart that holds your fate."

And to finish, a picture that I 'discovered' this weekend it took my breath away. The essence of human spirit?; or maybe just a young, scared boy running for his life...?