The nights roll on...
I am failing in my duty to one of my SHOs. They are not working fast enough for the ED, and I am not showing them how. It is mkaing very unpopular with the Nursing staff. I will have to try harder.
Last night seemed to bring an unwelcome reminder of our limitations as doctors. Perhaps as people, too. Two patients, both ED 'bread and butter'; the first a 'blue bloater'; long term COPD, unwilling or unable to give up the cigarettes that have done this to him. Reluctant attender, as so many of them are, knowing all too well the poking and prodding that awaits. But tomight he was tired, too tired. His CO2 levels, always high, are creeping higher, slowly anaesthetising him, in front of our eyes. He has been here before, been judged in the eyes of the Intensivists, and found wanting. He is not for ITU, not for invasive ventilatory support. We all know that once attached to the vent, he will likely not get off it.
I offer him what we can, nebulisers hissing softly in the quiet of resus, steroids, i.v. because he cannot swallow, theophylline coursing through his veins, salvation in a plastic bag?
Not this time. His chest remains tight, each breath an effort, hardly lifting his chest. Non-invasive ventilation is next, an uncomfortable mask, held awkwardly on the face with a Heath Robinson-esque collection of straps, designed by the lowest bidder.
None of it does any good. His numbers stay the same, low, low oxygen, and high carbon dioxide, creeping slowly, slowly higher. He himself slips away as I watch him. The light has gone from his eyes, his defiant humour, that he held onto at the beginning is gone. All of his being is breathing now, and even that is an effort. He is exhausted.
The next, an elderly lady. Suddenly ill, suddenly very ill. Almost no warning. A little breathless, then she slipped away. By the time the Ambos get there, she is gone. But not so gone, as to be beyond us. Slickly, professional, she is resuscitated, her angry, irritated myocardium teasing them with hints of life. She is still slipping back and forth when she is delivered to us. A few more rounds, and she comes back, and sticks. Something we have done keeps her heart in synch this time. We wait a minute. Have all seen this before; false hope. A sort of 'dead-cat bounce'. But she stays with us.
How long? Long enough to call the intensivists. Long enough for us to gather and decide that although we have restarted the clockwork, the soul is long gone. We will keep watch, standing guard against the unlikliest of returns, but we all know it is futile.
Have we achieved anything?
Sunday, January 27, 2008
Saturday, January 26, 2008
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
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
Thursday, January 24, 2008
Late Night Ramblings
So, I'm on health kick (again). Not know, you understand. Now I'm listening to Miles Davis and John Coltrane, while drinking scotch and smoking cigarettes.
But, I'm trying (again) to get off the fags. Patches and gum have proved ineffective in the past, tho I suspect that has more to do with my lack of willpower. I'm currently on Zyban (buproprion) and am hoping this will compensate for my lack of will power, while not turning me yellow or making me commit suicide.
So, for the first few weeks, I have to keep smoking to give the drugs a chance to kick in. This has coincided with me having time off, so I've had no excuse not to smoke. Can I smoke? Like a fiend I can. (Apologies to Bill Hicks' estate)
What I have started doing again, is going to the gym. Frustratingly, I do feel better after a run. Maybe there is something in endorphins, after all. I find my gym vaguely amusing. Or rather, the people there, mostly because I find it difficult to take them seriously. I imagine they think the same of me, especially since I'm so vain I'm always checking myself out in the full length mirrors (well I haven't got one at home), and have discovered the fun I can have blow drying my hair. (Can you say bouffant?)
My other new trick is forgetting bits of my kit. In the last week, I have left 2 pairs of trainers behind. The club's lost property policy is to sweep it up and throw it away. The first pair of trainers wasn't too much of a loss - they were old, smelled funny, and probably had body fluids deep in their fundament. The second pair, bought to replace the first, natch, lasted two visits before I forgot 'em. Actually I'm not too upset. I was beginning to dislike the look of them. They cost me £20, which is a pain, but I actually consider it small beans in trainer terms.
I have recently started reading Mousie's blog. I commend it. She thinks the same way I do, and expresses things I wish I'd thought of far more eloquently. I think I'd like working with Mousie.
I recommend, especially :
Steep Learning Curve I and II
This is My Life
Things I Hate
The first two are serious, the last light hearted. I really loved the things I hate post. I get good vibes from Mousie.
I'm concerned I'm coming across a bit like a Mouse Stalker... sorry, but it's good to find kindred spirits out here.
Anyway, I'm on a 5 night stretch from tomorrow, so hope to have some tales to tell.
But, I'm trying (again) to get off the fags. Patches and gum have proved ineffective in the past, tho I suspect that has more to do with my lack of willpower. I'm currently on Zyban (buproprion) and am hoping this will compensate for my lack of will power, while not turning me yellow or making me commit suicide.
So, for the first few weeks, I have to keep smoking to give the drugs a chance to kick in. This has coincided with me having time off, so I've had no excuse not to smoke. Can I smoke? Like a fiend I can. (Apologies to Bill Hicks' estate)
What I have started doing again, is going to the gym. Frustratingly, I do feel better after a run. Maybe there is something in endorphins, after all. I find my gym vaguely amusing. Or rather, the people there, mostly because I find it difficult to take them seriously. I imagine they think the same of me, especially since I'm so vain I'm always checking myself out in the full length mirrors (well I haven't got one at home), and have discovered the fun I can have blow drying my hair. (Can you say bouffant?)
My other new trick is forgetting bits of my kit. In the last week, I have left 2 pairs of trainers behind. The club's lost property policy is to sweep it up and throw it away. The first pair of trainers wasn't too much of a loss - they were old, smelled funny, and probably had body fluids deep in their fundament. The second pair, bought to replace the first, natch, lasted two visits before I forgot 'em. Actually I'm not too upset. I was beginning to dislike the look of them. They cost me £20, which is a pain, but I actually consider it small beans in trainer terms.
I have recently started reading Mousie's blog. I commend it. She thinks the same way I do, and expresses things I wish I'd thought of far more eloquently. I think I'd like working with Mousie.
I recommend, especially :
Steep Learning Curve I and II
This is My Life
Things I Hate
The first two are serious, the last light hearted. I really loved the things I hate post. I get good vibes from Mousie.
I'm concerned I'm coming across a bit like a Mouse Stalker... sorry, but it's good to find kindred spirits out here.
Anyway, I'm on a 5 night stretch from tomorrow, so hope to have some tales to tell.
And Another Thing...
Brevity.
In my previous post but one, I may have suggested that medical students in general were maligning us whinging docs. That is not the case. What I meant was that much of the 'debate' was originating with e.g medical students rather than qualified docs. I did not mean to suggest that most medical students were engaging in the 'debate'.
The Shroom is happy to clarify this, and hopes he had not caused any offence. (This means you, TLM...)
On the matter of the huge piles of cash we're all rolling in: my salary is a matter of public record. You can go to a variety of websites and see the NHS payscale. This is in stark contrast to several of my friends whose salary is so secret that they are contractually forbidden to disclose it. I notice that when we worked for hourly rates, people were only too happy to share their details.
Now, it's vulgar, apparently - although only the people I suspect earn multiples of my salary think so.
Anyway, depending on how much you think I actually earn, and how many patients I see, the cost per patient works out to be about £20. This is excellent value if you're in a diabetic coma, and I spend six hours of my life resuscitating you. Not such good value if you have a sore throat, and I spend 30 seconds telling you it's viral, drink plenty of fluids, gargle aspirin and munch paracetamol. Granted, but this is averages we're talking about...
Anyway, think on it. £20, all in.
I don't think that's too bad. But then, I wouldn't, would I?
In my previous post but one, I may have suggested that medical students in general were maligning us whinging docs. That is not the case. What I meant was that much of the 'debate' was originating with e.g medical students rather than qualified docs. I did not mean to suggest that most medical students were engaging in the 'debate'.
The Shroom is happy to clarify this, and hopes he had not caused any offence. (This means you, TLM...)
On the matter of the huge piles of cash we're all rolling in: my salary is a matter of public record. You can go to a variety of websites and see the NHS payscale. This is in stark contrast to several of my friends whose salary is so secret that they are contractually forbidden to disclose it. I notice that when we worked for hourly rates, people were only too happy to share their details.
Now, it's vulgar, apparently - although only the people I suspect earn multiples of my salary think so.
Anyway, depending on how much you think I actually earn, and how many patients I see, the cost per patient works out to be about £20. This is excellent value if you're in a diabetic coma, and I spend six hours of my life resuscitating you. Not such good value if you have a sore throat, and I spend 30 seconds telling you it's viral, drink plenty of fluids, gargle aspirin and munch paracetamol. Granted, but this is averages we're talking about...
Anyway, think on it. £20, all in.
I don't think that's too bad. But then, I wouldn't, would I?
Seven Things Meme
The Seven Things
I've been tagged by Chrysalis Angel—my Angel of The North.
7 weird/random things about me
Here are the rules: Link to the person (i.e. Angel) who tagged you.
Post the rules on your blog:
Share 7 random and/or weird facts about yourself on your blog.
Tag 7 random people at the end of your post and include links to their blogs.
Let each person know that they have been tagged by leaving a comment on their blog.
Well, I'll try...
1. I firmly believe that God (or the Devil) is in the details. Especially in music, and often have a favourite bass line / drum fill etc in a song. (For example, Billy Preston's keyboards in Get Back, the little bass run toward the end of Son of a Preacher Man, the horns in Hazey Jane II...)
2. I am more sentimental than I would like to let on, and can usually be found carrying mementos of absent friends in my pocket.
3. My 3 favourite American Football players are Lary Csonka, Fran Tarkenton and Dan Marino.
4. I am becoming increasingly obsessed with the Napoleonic Wars.
5. I weigh exactly the same today as I did when I was 18; I'm not sure if this is a good thing, or not.
6. I cannot help but develop unusual favourites -for example: hernias (spighelion), bacterium (bacillus cereus, tho cytocapnophagia canemoris runs it a close second). I genuinely can't understand the looks I get when I tell other people this. You've gotta have favourites, haven't you? It's not like their my kids or anything?
7. I've been half a Best Man 3 times.
All in all, a bit lame... sorry. And because I'm such a curmudgeon, I'm not taggin' anyone else just yet. Maybe later.
Tuesday, January 22, 2008
Work In Progress
Yes, I'm buggering around with the layout. Comments welcome.
Yes, I'm still working on the meme set me fucking ages ago, by the Angel of the North.
I'm fairly cross this eve. The blogosphere continues to reverberate with polemic diatribe. There's even more out there than I realised... I'll edit this in due course, to link as apt. But... Dr Rant has drawn my attention to this current outburst. Or maybe it's not current.
In fact I'm sure it's not current; it's eternal.
Forgive me if I oversimplify. I am a simple man.
There appears to be a backlash, directed against 'whinging doctors'. Mostly, as far as I can tell, from medical students, and other non-doctors.
So; currently doctors feel over-worked, and under-valued. There appears to be a campaign in the media to portray us as overpaid, and underworked.
When we complain, the response appears to be that we don't know how good we have it, and should put up, shut up or fuck off.
As far as I can see.
So... I do feel undervalued, and increasingly asked to work to conform to targets rather than what is necessarily best practice.
Do I feel underpaid? Well, I get good money, make no bones about it. Although, I earn less now than I did three years ago. So in real terms I have taken a pay cut in the region of 6 - 8 % over 3 years.
But; if I complain, I'm told I shouldn't because I have it better than many others, or am seen as ungrateful. This is after all a vocation, so I must be altruistic and compassionate, working only for the love of it.
I feel undervalued because I see other professions earning shitloads. My cousin earns as much, if not slightly more than I do, working for a mobile phone company. I'm not sure anyone tells him he is overpaid, or not working hard enough.
GPs and Hospital Consultants have done very well of late, but it is no more than they deserve, as far as I can tell. Their rise has come from the Govt deciding to pay them for work rendered. It's hardly their fault if it turns out they actually work quite hard...
Comparisons to other professions, are, in my opinion lacking in validity. Are we special? Maybe. I consider it an honour, and a provelage to be a Doctor. There is nothing better than treating patients. Nothing. But nothing else offers the highs and lows. We know things you don't, but then loads of people know stuff I don't. However, I think the responsibility we take on is greater. Which is why we get so very roasted when we get it wrong.
Conversely, the public sense of entitlement, with no sense of community responsibility, means when we do it right, no-one notices. Fine. It's not the same as lawyers, or any other professional, as far as I can see. Any individual working in the public sector gets beaten with it. Teachers, Nurses, Policemen (or women)... all fucked, because they provide a community service, and we're supposed to be honoured by it.
Education is as important a concept for society as anything. And we treat our teachers like shite. I can't figure it out.
How else does our profession differ? The public regularly come to my place of work, sometimes drunk, or on drugs; they make a mess, they piss on the floor, they assault me.
And they think it's fine.
We're never really off duty. Have you ever heard the Captain of an aircraft ask if there's a lawyer on board? When the call goes out "is there a doctor in the house?", they sure as hell don't mean someone with a PhD...
And they think it's fine.
We're never really off duty. Have you ever heard the Captain of an aircraft ask if there's a lawyer on board? When the call goes out "is there a doctor in the house?", they sure as hell don't mean someone with a PhD...
Am I special? No, I'm not, but the job I do is.
Am I treated badly, by the Govt, by managers? Yes, I am, but nowhere near as badly as Nurses and teachers, as far as I can see.
Am I worth more, or less, than someone who sells mobile phones?
And will your answer be different when I'm thrombolysing your coronary thrombus, or treating your child's meningitis?
I don't want to be treated differently, but I sure as hell don't appreciate people telling me I can't vent.
Monday, January 21, 2008
Anicteric
My life outside medicine continues to throw very few exciting or memorable stories. Who'd have thought one man's quest to be a bit more domesticated would be so dull?
This weekend allowed me a bit more Lemon exposure. It's hard to define the Lemons, as they are an eclectic bunch. The common denominator, I guess, is that they are all good people, and, almost unfailingly, supremely dedicated hedonists. I arrived on the citric fringe what seems like only yesterday, but was in fact four or more years ago. I hate the way that increasingly happens, but there you go.
My association is through my best friend, an old partner in crime from my school days, who has since quit this sceptred isle for sunnier climes. On Sunday, I finally located the Boat Lemons, not a million miles away from my house. In grand tradition, the bulk of them had extended their Saturday night through until Sunday. Usually, when I have begun the race with them, my bolt is long shot by now. Their endurance, and capacity for booze, is impressive.
Sadly, they were less well equipped for coffee. Undeterred, we set about constructing a percolator / filter. By MacGyvering a bit of sling (triangular bandage), some wool gauze, part of an egg carton, and the end of a Coke bottle, we were actually able to make coffee.
Our first batch did resemble brown water, it has to be said. But, we made coffee. Only took a few hours, but as my partner in coffee reminded me - 'It's the journey, not the destination'.
Sadly, this soiree marked the departure of another pair of Lemons, again for sunnier climes. Now, I know I've only known this pair for a few years, and that it gives us an excuse to go visit, and that they'll be back, etc, etc... However, this pair are among the friendliest, most generous people it has ever been my pleasure to know. I've probably met them less than a dozen times all told, by my life was a little bit better for it, and I'm worried it'll be a little bit poorer now they ain't around.
This weekend allowed me a bit more Lemon exposure. It's hard to define the Lemons, as they are an eclectic bunch. The common denominator, I guess, is that they are all good people, and, almost unfailingly, supremely dedicated hedonists. I arrived on the citric fringe what seems like only yesterday, but was in fact four or more years ago. I hate the way that increasingly happens, but there you go.
My association is through my best friend, an old partner in crime from my school days, who has since quit this sceptred isle for sunnier climes. On Sunday, I finally located the Boat Lemons, not a million miles away from my house. In grand tradition, the bulk of them had extended their Saturday night through until Sunday. Usually, when I have begun the race with them, my bolt is long shot by now. Their endurance, and capacity for booze, is impressive.
Sadly, they were less well equipped for coffee. Undeterred, we set about constructing a percolator / filter. By MacGyvering a bit of sling (triangular bandage), some wool gauze, part of an egg carton, and the end of a Coke bottle, we were actually able to make coffee.
Our first batch did resemble brown water, it has to be said. But, we made coffee. Only took a few hours, but as my partner in coffee reminded me - 'It's the journey, not the destination'.
Sadly, this soiree marked the departure of another pair of Lemons, again for sunnier climes. Now, I know I've only known this pair for a few years, and that it gives us an excuse to go visit, and that they'll be back, etc, etc... However, this pair are among the friendliest, most generous people it has ever been my pleasure to know. I've probably met them less than a dozen times all told, by my life was a little bit better for it, and I'm worried it'll be a little bit poorer now they ain't around.
Thursday, January 17, 2008
What If You Knew Her, And Found Her Dead On The Ground...
**Tumbleweed**
Off work at the moment, which should enable me to fill this with exciting tales of my glamourous life.
No such luck. I've spent the time so far revising for a (mock) exam, which I had yesterday; it passed off without incident, which was nice.
So... no news. With ref to my previous post, and regarding the 'Name That Disease' puff piece, I was initially put out not to score full marks. I only got one wrong, and that was an ambiguous q about male STDs (humph...); however, full marks accords you 'Doogie Howser' status. (feel free to deploy Google at this point...)
Whilst I can't really be arsed to enter a long discussion about how wrong I think it is to pop Doogie at the head of the table, it plainly is. So, I'm happy being HawkEye.
In defiance of my friend and colleague, The CherryPicker, I continue to promote musical "flannel". I have recently encountered The Rolling River Band. Can't hardly recommend them enough. Elements of Dylan, Young, Springsteen, Cohen and Waits. Maybe. Anyway, they sound grand. If your feeling a bit folky, also seek out King Creosote. I dare you...
Get involved, get amongst it, it's all happening....
Off work at the moment, which should enable me to fill this with exciting tales of my glamourous life.
No such luck. I've spent the time so far revising for a (mock) exam, which I had yesterday; it passed off without incident, which was nice.
So... no news. With ref to my previous post, and regarding the 'Name That Disease' puff piece, I was initially put out not to score full marks. I only got one wrong, and that was an ambiguous q about male STDs (humph...); however, full marks accords you 'Doogie Howser' status. (feel free to deploy Google at this point...)
Whilst I can't really be arsed to enter a long discussion about how wrong I think it is to pop Doogie at the head of the table, it plainly is. So, I'm happy being HawkEye.
In defiance of my friend and colleague, The CherryPicker, I continue to promote musical "flannel". I have recently encountered The Rolling River Band. Can't hardly recommend them enough. Elements of Dylan, Young, Springsteen, Cohen and Waits. Maybe. Anyway, they sound grand. If your feeling a bit folky, also seek out King Creosote. I dare you...
Get involved, get amongst it, it's all happening....
Monday, January 14, 2008
Saturday, January 12, 2008
The Fourth, The Fifth, The Minor Fall, The Major Lift
I am positively wrecked.
There is almost nothing left of my essence, my being. I have left it all in Luton. This is what you get for partying with Lemons. A generally good night, with all too much beer drunk; the usual suspects were there, falling away at regular intervals, until the hard core remained at nine a.m. this morning. This was my time to bow out, but (?worryingly) many Lemons were just getting their second wind.
I am too old for this sort of thing; mostly.
My ex-beloved was there; and it was good to see her. Too good really; another reason to hate my job.
On a lighter note, ER is back on the TV. I can, once again, get my fix. My quest to watch them all again goes on; Santa brought me seasons 8 and 9... but they're all too soon gone.
A good friend of mine has been having a hard time of it of late. As usual, I don't feel at liberty to divulge why. Pregnancy related complications. I hate being on the outside. As I understand it, she and bubs are doing better now, but nothing is written in stone...
More burnout. One of the tricks I use to insulate myself from the psych-trauma of seeing how shit life can be is to try to disconnect; to de-empathise where possible. I think it makes me a little deader inside, but I discovered, when working on ITU, that I'm not strong enough to do it any other way.
I was confronted with a patient going South, whose background was very similar to my friend's. It suddenly became very difficult to be objective, to do my job. Let my feelings get in the way. The patient got the right treatment; in actual fact, the correct diagnosis was achieved by one of my SHOs.
But it wouldn't normally get to me.
Burnout...
There is almost nothing left of my essence, my being. I have left it all in Luton. This is what you get for partying with Lemons. A generally good night, with all too much beer drunk; the usual suspects were there, falling away at regular intervals, until the hard core remained at nine a.m. this morning. This was my time to bow out, but (?worryingly) many Lemons were just getting their second wind.
I am too old for this sort of thing; mostly.
My ex-beloved was there; and it was good to see her. Too good really; another reason to hate my job.
On a lighter note, ER is back on the TV. I can, once again, get my fix. My quest to watch them all again goes on; Santa brought me seasons 8 and 9... but they're all too soon gone.
A good friend of mine has been having a hard time of it of late. As usual, I don't feel at liberty to divulge why. Pregnancy related complications. I hate being on the outside. As I understand it, she and bubs are doing better now, but nothing is written in stone...
More burnout. One of the tricks I use to insulate myself from the psych-trauma of seeing how shit life can be is to try to disconnect; to de-empathise where possible. I think it makes me a little deader inside, but I discovered, when working on ITU, that I'm not strong enough to do it any other way.
I was confronted with a patient going South, whose background was very similar to my friend's. It suddenly became very difficult to be objective, to do my job. Let my feelings get in the way. The patient got the right treatment; in actual fact, the correct diagnosis was achieved by one of my SHOs.
But it wouldn't normally get to me.
Burnout...
Friday, January 11, 2008
Hazey Jane
Music Nazi recommends anything by Nick Drake. Only 3 albums in his lifetime, which seems desperately cruel. So, buy them. All.
Five Leaves Left. The first, minimal arrangement. Beautiful.
Bryter Layter. Contains Hazey Jane II, my own personal favourite. Possibly over arranged, but outstanding production values.
Pink Moon. Bleak, understated, tragic. Own it.
Five Leaves Left. The first, minimal arrangement. Beautiful.
Bryter Layter. Contains Hazey Jane II, my own personal favourite. Possibly over arranged, but outstanding production values.
Pink Moon. Bleak, understated, tragic. Own it.
Thursday, January 10, 2008
Burnout
I'm due a few weeks off; I'm beginning to think it couldn't come too soon. Off the back of a few nights, I worked a single day. It was not a good shift. Busy busy busy.
This is not unusual these days, with the hospital running at 98% occupancy most days. But I did not comport myself well. Over excited, showing off?
i don't know. In the final analysis, it doesn't matter much, but I was in a stroppy mood. Thankfully, no-one takes me very seriously, and they were more understanding of my temper than I deserve.
My last patient on nights was a three week old baby. One so very, very new to the world, but already too much medical history. Today's problem: vomiting. The little fella wasn't clearing his own airway, and for a few minutes I thought he was going to plug off completely. Actually for about 5 seconds, I thought he had. But a little soft suction, and I have never been so pleased to hear a baby scream. In fact, I've never been so glad to hear any sound.
Ever.
Last shift. Busy, busy, busy. But I told you that already.
Mostly in resus. Strokes, trauma, stabbings. Fractures, dislocations, head injuries.
The first was the hardest. A young woman, who had a 'minor' TIA middle of last year. All the right things were done. The proper work up.
None of which prevented a large, disabling stroke in November. Worse today. What little function she had had... gone. She came to us fitting. Easily treated.
The old routine, tourniquet on, hunt the vein. If you can't see it, feel it. A zen thing. It doesn't matter. I never miss these days. (Arrogant, moi?) The cannula slides in, almost a reflex after all these years, and a lorazepam chaser.
The fits stop; I told you that part was easy.
But she doesn't get better, she can't get better, she won't get better.
She gets worse.
I have to preside over it; the MC of this horror show. Her husband knows; he can't bring himself to say it; he tells me over and over how she was, how alive, how vital.
He's trying to do the terminal illness split. To distance himself from what his beloved has become, while staying true to her. When he looks at her, he still sees the love of his life, but he knows it's not her.
He can't do it, and we both have to take a few minutes out.
Burnout.
If all I have is being good at my job, and I'm not doing that well anymore, what's left?
I hope the break will do me good.
This is not unusual these days, with the hospital running at 98% occupancy most days. But I did not comport myself well. Over excited, showing off?
i don't know. In the final analysis, it doesn't matter much, but I was in a stroppy mood. Thankfully, no-one takes me very seriously, and they were more understanding of my temper than I deserve.
My last patient on nights was a three week old baby. One so very, very new to the world, but already too much medical history. Today's problem: vomiting. The little fella wasn't clearing his own airway, and for a few minutes I thought he was going to plug off completely. Actually for about 5 seconds, I thought he had. But a little soft suction, and I have never been so pleased to hear a baby scream. In fact, I've never been so glad to hear any sound.
Ever.
Last shift. Busy, busy, busy. But I told you that already.
Mostly in resus. Strokes, trauma, stabbings. Fractures, dislocations, head injuries.
The first was the hardest. A young woman, who had a 'minor' TIA middle of last year. All the right things were done. The proper work up.
None of which prevented a large, disabling stroke in November. Worse today. What little function she had had... gone. She came to us fitting. Easily treated.
The old routine, tourniquet on, hunt the vein. If you can't see it, feel it. A zen thing. It doesn't matter. I never miss these days. (Arrogant, moi?) The cannula slides in, almost a reflex after all these years, and a lorazepam chaser.
The fits stop; I told you that part was easy.
But she doesn't get better, she can't get better, she won't get better.
She gets worse.
I have to preside over it; the MC of this horror show. Her husband knows; he can't bring himself to say it; he tells me over and over how she was, how alive, how vital.
He's trying to do the terminal illness split. To distance himself from what his beloved has become, while staying true to her. When he looks at her, he still sees the love of his life, but he knows it's not her.
He can't do it, and we both have to take a few minutes out.
Burnout.
If all I have is being good at my job, and I'm not doing that well anymore, what's left?
I hope the break will do me good.
Wednesday, January 09, 2008
The Scientist
I'm back to struggling to find stuff to write again. I have been tagged by my Angel of the North in a meme - a word the origin of which I still don't understand - and I promise I'll get to it; I just haven't had time to compose yet. Actually, ironically, it's one I've already answered... so I'll have to try and find different answers...
Back on days today, then off for a while. Feels like I need it. Weekend nights passed in a blur. A few oddments. A young guy pitched up with a 12 hour history of right sided weakness. 12 hours.
I mean come on... I can understand waiting a few hours to see if your cough gets better - but when half your body stops working... I would generally advocate seeking urgent medical attention.
This weekends theme seemed to be waiting for shift change to present in extremis. So several hours of inertia would be punctured at half seven by the arrival of one, or more, sickies.
Of these, the most hair raising was a three week old baby. More later, I guess...
Back on days today, then off for a while. Feels like I need it. Weekend nights passed in a blur. A few oddments. A young guy pitched up with a 12 hour history of right sided weakness. 12 hours.
I mean come on... I can understand waiting a few hours to see if your cough gets better - but when half your body stops working... I would generally advocate seeking urgent medical attention.
This weekends theme seemed to be waiting for shift change to present in extremis. So several hours of inertia would be punctured at half seven by the arrival of one, or more, sickies.
Of these, the most hair raising was a three week old baby. More later, I guess...
Tuesday, January 01, 2008
It's A New Year, It's A New Year, It's A New Year...
An odd shift.
'Remedial' duty for me and another Reg. Something to do with NYE being busy... Whouldathunkit?
Felt off my game all shift; probably because I was so very tired. It happens. The Department had a fairly steady stream of trauma. I suspect BBP will have a better write up than I.
However...
This sums up NYE in an ED for me:
Half eleven:
Quiet, ish. Not too many waitin', minors or majors. All is calm.
Midnight:
Jolly nurses and doctors patrol the Department, wishing all and sundry a Happy New Year.
Midnight plus one minute:
An hysterical woman is suddenly there, out of nowhere, as if by **whammo** special BeerMonkey magic, wailing and gnashing teeth, having consumed slightly more than her bodyweight in alcohol, hence her presentation.
Midnight plus two minutes:
The Department is now full of people whose only reason for being there appears to be that they can't handle their beer. And most (all) of the local Police.
So: to sum up...
All quiet; Shroom looks left. He looks back, and there is a screaming crying woman in an ethanolic miasma. He rubs his eyes. He opens them and suddenly cannot move for Police. And drunk shouty men.
Instant transformation. Amazing.
I don't wish to generalise, but I am never surprised by how the drunk ladies are mostly tearful, and the fellas punchy.
I think the most satisfying thing I did was help an old geezer, steaming drunk, hold himself up to take a pee. Sometimes, I guess, it's the little things.
Well, I hope you all had a good one, free from blunt head trauma.
PostScript
For those of you who strayed to BBP, I did indeed give myself a papercut; then another identical one, just to prove the first wasn't a fluke. I thought about booking in... But my manners aren't as good as he seems to be implying...
'Remedial' duty for me and another Reg. Something to do with NYE being busy... Whouldathunkit?
Felt off my game all shift; probably because I was so very tired. It happens. The Department had a fairly steady stream of trauma. I suspect BBP will have a better write up than I.
However...
This sums up NYE in an ED for me:
Half eleven:
Quiet, ish. Not too many waitin', minors or majors. All is calm.
Midnight:
Jolly nurses and doctors patrol the Department, wishing all and sundry a Happy New Year.
Midnight plus one minute:
An hysterical woman is suddenly there, out of nowhere, as if by **whammo** special BeerMonkey magic, wailing and gnashing teeth, having consumed slightly more than her bodyweight in alcohol, hence her presentation.
Midnight plus two minutes:
The Department is now full of people whose only reason for being there appears to be that they can't handle their beer. And most (all) of the local Police.
So: to sum up...
All quiet; Shroom looks left. He looks back, and there is a screaming crying woman in an ethanolic miasma. He rubs his eyes. He opens them and suddenly cannot move for Police. And drunk shouty men.
Instant transformation. Amazing.
I don't wish to generalise, but I am never surprised by how the drunk ladies are mostly tearful, and the fellas punchy.
I think the most satisfying thing I did was help an old geezer, steaming drunk, hold himself up to take a pee. Sometimes, I guess, it's the little things.
Well, I hope you all had a good one, free from blunt head trauma.
PostScript
For those of you who strayed to BBP, I did indeed give myself a papercut; then another identical one, just to prove the first wasn't a fluke. I thought about booking in... But my manners aren't as good as he seems to be implying...
Monday, December 31, 2007
Takin' Stock
As the New Year looms ever larger, I'm more prone to melancholia than usual. The usual - you've been there constant reader, don't pretend you haven't...
Missed opportunity, absent friends, previous New Years - good, and especially bad.
Without wishing to sound arrogant, which I'm afraid I surely shall, as I surely am, I have been dwelling on the only thing that keeps me going sometimes - treating patients. Sad to say I haven't got a lot else.
Anyway - success stories of the past. I hope I'm not repeating myself.
The first sticks in my mind, because it harks back to 'old school' medicine. That is to say with fuck all help from labs etc. I had just finished my pre-registration year, the first year out of med school, wherein you had to prove that yes, you'd passed exams, but would you kill patients when left alone. as long as the answer was 'no', or at least 'not many', you got fully registered.
Anyway; I had secured a 3 year surgical rotation, about which I was pretty smug, but deferred 6 months. So I was earning my keep doing a few locum jobs here and there. There was quite a ramp up in responsibility for some of these, as they were all short term, so no-one had time to hold your hand, or teach you. On this occasion I was providing cover at a rehab hospital. Small scale, elderly patients, none of whom was judged to need acute care, but none of whom could quite go home. Two rounds a day, a few jobs, and pretty much no calls at night.
Usually
So, I was roused from my sleep at ungodly o'clock in the a.m, as an ambulance had arrived. This was highly irregular. We weren't an acute facility, but the ambos decided some help better than none, and didn't think the patient would make it to big hospital, with it's bright shiny A&E dept. So, dropped into our laps was a fella, of, I think, late middle age, but he could have been older. His problem was extreme difficulty in breathing.
I remember looking at him, sat bolt upright, drenched in sweat, his skin a pale, waxy colour, tinged blue at the edges.
If you've been paying attention, you'll know what I think about these colours.
His face was vacant, lights on, nobody home, every ounce of his being dedicated to breathing. Arms locked to the sides of the trolley. Resps almost too high to count. JVP sky high, chest sounds drowned in wheezes and crackles.
Heart failure.
Now, the fun stuff. There was, I soon discovered, no working sphygmomanometer in the hospital. So, no blood pressure. Similarly, the pulse-ox readers were kaput. No labs or x-ray on site, and sending an arterial sample to big hospital wasn't an option because of the distance.
Great.
If truth be told, I can't remember what I gave him. Bronchodilators, diuretics and nitrates probably. A catheter to measure urine output, and so to judge renal function. My only measures of success were those I could see with my own eyes. The patients colour, his resps, his mental state, his jvp.
I sat with him all night, teasing him with a little of this, tickling him with a little of that. Slowly watching as he pinked up.
Should I have transferred him? Maybe, probably, I don't know. I didn't know any better. I thought I had to make him better. Out of my league, my depth? Maybe, probably.
But I managed. He managed.
Next...
I remember this, cos it's all a bit ER. Again, regular readers won't be surprised...
I was workin' in a DGH in the South East. I think as an A&E Reg, before my number. I was carrying the crash bleep, so I might have been in Anaesthetics, but anyway. The bleep squawked into life, the tinny voice of switch declaring adult cardiac arrest, in the car park.
In the car park?
Fair enough. Never one to shy away from attempted heroics, I up and ran. I remember it as pissing with rain, but it might just have been wet on the ground. It was dark, anyway.
The car park was just round the corner from the Ambo entrance, and the patient wasn't hard to find. She'd been visiting a relative on the ITU, and had just up and collapsed. I was first on scene, weak pulse, agonal resps.
For about 10 seconds, anyway.
Someone must have called the ambos, cos they pulled up. Which was nice, cos I had fuck all kit, and the car parks are not well stocked. Their AED clearly showed VF, but refused to shock the patient. There followed a brief argument between me and the ambos, first about how wrong their machine was (I was right), then about how best to scoop the patient and get her back to resus (they were right)
Back to shiny resus. A blur, resolving into shocking the patient...
And getting her back.
And sending her to the unit, to reside next to her relative.
And seeing her 5 days later, when she dropped by to say thank you...
Get in!
Well, folks, I'm working a special kindof graveyard tonight, and will be unstinting in my attempts to bore you with how shit it was. When midnight comes and goes, raise a glass and think of me and all the other poor bastards picking up the pieces.
Joy of the season to y'all.
Missed opportunity, absent friends, previous New Years - good, and especially bad.
Without wishing to sound arrogant, which I'm afraid I surely shall, as I surely am, I have been dwelling on the only thing that keeps me going sometimes - treating patients. Sad to say I haven't got a lot else.
Anyway - success stories of the past. I hope I'm not repeating myself.
The first sticks in my mind, because it harks back to 'old school' medicine. That is to say with fuck all help from labs etc. I had just finished my pre-registration year, the first year out of med school, wherein you had to prove that yes, you'd passed exams, but would you kill patients when left alone. as long as the answer was 'no', or at least 'not many', you got fully registered.
Anyway; I had secured a 3 year surgical rotation, about which I was pretty smug, but deferred 6 months. So I was earning my keep doing a few locum jobs here and there. There was quite a ramp up in responsibility for some of these, as they were all short term, so no-one had time to hold your hand, or teach you. On this occasion I was providing cover at a rehab hospital. Small scale, elderly patients, none of whom was judged to need acute care, but none of whom could quite go home. Two rounds a day, a few jobs, and pretty much no calls at night.
Usually
So, I was roused from my sleep at ungodly o'clock in the a.m, as an ambulance had arrived. This was highly irregular. We weren't an acute facility, but the ambos decided some help better than none, and didn't think the patient would make it to big hospital, with it's bright shiny A&E dept. So, dropped into our laps was a fella, of, I think, late middle age, but he could have been older. His problem was extreme difficulty in breathing.
I remember looking at him, sat bolt upright, drenched in sweat, his skin a pale, waxy colour, tinged blue at the edges.
If you've been paying attention, you'll know what I think about these colours.
His face was vacant, lights on, nobody home, every ounce of his being dedicated to breathing. Arms locked to the sides of the trolley. Resps almost too high to count. JVP sky high, chest sounds drowned in wheezes and crackles.
Heart failure.
Now, the fun stuff. There was, I soon discovered, no working sphygmomanometer in the hospital. So, no blood pressure. Similarly, the pulse-ox readers were kaput. No labs or x-ray on site, and sending an arterial sample to big hospital wasn't an option because of the distance.
Great.
If truth be told, I can't remember what I gave him. Bronchodilators, diuretics and nitrates probably. A catheter to measure urine output, and so to judge renal function. My only measures of success were those I could see with my own eyes. The patients colour, his resps, his mental state, his jvp.
I sat with him all night, teasing him with a little of this, tickling him with a little of that. Slowly watching as he pinked up.
Should I have transferred him? Maybe, probably, I don't know. I didn't know any better. I thought I had to make him better. Out of my league, my depth? Maybe, probably.
But I managed. He managed.
Next...
I remember this, cos it's all a bit ER. Again, regular readers won't be surprised...
I was workin' in a DGH in the South East. I think as an A&E Reg, before my number. I was carrying the crash bleep, so I might have been in Anaesthetics, but anyway. The bleep squawked into life, the tinny voice of switch declaring adult cardiac arrest, in the car park.
In the car park?
Fair enough. Never one to shy away from attempted heroics, I up and ran. I remember it as pissing with rain, but it might just have been wet on the ground. It was dark, anyway.
The car park was just round the corner from the Ambo entrance, and the patient wasn't hard to find. She'd been visiting a relative on the ITU, and had just up and collapsed. I was first on scene, weak pulse, agonal resps.
For about 10 seconds, anyway.
Someone must have called the ambos, cos they pulled up. Which was nice, cos I had fuck all kit, and the car parks are not well stocked. Their AED clearly showed VF, but refused to shock the patient. There followed a brief argument between me and the ambos, first about how wrong their machine was (I was right), then about how best to scoop the patient and get her back to resus (they were right)
Back to shiny resus. A blur, resolving into shocking the patient...
And getting her back.
And sending her to the unit, to reside next to her relative.
And seeing her 5 days later, when she dropped by to say thank you...
Get in!
Well, folks, I'm working a special kindof graveyard tonight, and will be unstinting in my attempts to bore you with how shit it was. When midnight comes and goes, raise a glass and think of me and all the other poor bastards picking up the pieces.
Joy of the season to y'all.
Sunday, December 30, 2007
Friday, December 28, 2007
A Day In The Life
**Warning - Medical Content May Go Down As Well As Up; Past Performance Is No Guarantee Of Future Return**
I'm up early again. All too often I seem to see the wrong side of 4 a.m. I slept well enough, for a few hours; then, my all too traditional waking in a cold sweat. A bad dream? Not one I remember anyway. I vainly try to go back to sleep. Most days I'll know whether it's going to work within a few minutes.
Half an hour later, I'm up.
Pad round the house, aimlessly tidying a few things away. I spend a few moments gazing out the window. Funnily enough, no other bugger is up yet. All is quiet. I rather enjoy the peace, my horizons limited by the pool of light cast out by my lamp. Except I know it means I'm not sleeping.
I'm able to divert myself surfing for a while. I try to catch up on a bit of reading, but I'm never sure how much I take in in the wee small hours. 0430 and it's time for coffee. I dearly love all things caffeine; a taste for coffee has grown on me, over the years, ad I'm not sure it'll ever leave me. Which is good. I really love the coffee.
I'm just about ready. The cold, dark morning awaits me...
Cold showers are over-rated, but they sure as hell wake you up. It's still proper dark as I leave; full night, with only a few foolhardy souls for company. I allow myself a brief slice of boy racer as I power down the road, tipping the scales at 7,000 rpm, and glorying in the throaty roar of my Sports Penis Extension's engine, before dullShroom regains control. The realisation that there really are very few other bastards on the road slowly dawns as I encounter next to no traffic and arrive at work embarrassingly early. Even more so when I figure out I read the rota wrong, and have come in for 8, but don't start til 9.
Arse.
The morning board round is preceded by the usual rounds of shooting the shit, most notably divulging that one of my SHOs is scheming to get a date with one of the radiographers. I think she's already dating someone, so this promises to be interesting; perhaps I can live vicariously through his exploits.
Proving once and for all that I am a sad old fart, with no life, I figure i might as well work, since I'm here. Number one punter is Polish, and we rapidly discover we have no language in common. Although interpreters are available, commercially, the trust seems reluctant to use them, preferring instead to rely on bilingual staff. Who are never around when you need 'em, and have their own jobs to do, anyway. Still, at least they're cheap. The patient smells of a three day bender, and is restless. He's 'MEWSing' at 5, which means his vitals are deranged. MEWS has replaced a sound knowledge of normal physiology, as far as I can tell. It is no longer necessary for one to look at a patient's obs, and decide if they are unwell or not. No, instead, someone distills the info into a handy MEWS score. Bah Humbug. Whatever his score, I think he looks pancreatitic; the bloods go off, and drugs and fluids go in. We wait.
Next a little old lady, with no real idea of why she is here. Dementia intercedes, making meaningful history taking defunct for the second patient in a row... My first, end of the bed guess is digitoxicity. A vain atempt to show off. I don't think it was right. Eventually we decide on a pleural effusion; the patient helps us along by having a small collection of fluid outwith her lung, and I ask the magicians for their assistance...
A young man offers us his racing heart with no good explanation. I take the easy route and blame his 10 day old son for upping his stress levels. Meanwhile, I'm trying to squeeze in a manipulation of a young girl's wrist, with one of my redoubtable SHOs. We have to do it in our MUA (manipulation under anaesthesia) room. It has recently been occupied by a patient with explosive diarrhoea. Despite a nuclear steam clean, the smell lingers. I'm amazed the patient can't smell it; this nasal insufficiency plays out in my favour a second time, as she briefly ends up with her face in my armpit; never the best of places to be, and not improved by a bout of strenuous tugging on a broken radius. Despite a good old fashioned Bier's block, she still finds uncomfortable, but backs down from her original offer to slap me afterward.
All the while an asthmatic COPD-er flirts with true respiratory embarrassment in resus. She is ably handled by another of our SHOs, but not before spectacularly vomiting. Excellent coverage; professional standard.
Polish guys's bloods lean towards the pancreas. I lean toward the surgeons, and they accept. I am briefly stunned.
We get something of a rush next. The specialist Cardiac nurse, or 'ThromboMan' as I like to call him, tries to monopolise Resus, smuggling in a fella with cardiac amyloid, among other things, and an elderly chap trying to see just how slow you can go. I deny him the chance to own resus by bringing in a young guy in status epilepticus. A tragic case, this young man's life ceased to be his own a few years ago when his blood sugar dropped low enough to provoke seizures, seizures that couldn't be stopped, and robbed his brain of oxygen long enough to leach most of its meaningful function. The patient is accompanied by a carer who assures us he does not have epilepsy, or seize 'normally'. Our efforts to stop these seizures depress his respirations long enough to force 24cm of semi-rigid plastic on him.
His trip to the Doughnut of Doom is uneventful - barely a hint of doomliness. The scan offers no new info, either. This passes to embarrassment when we look at his drug chart, and finally see the raft of anti-epileptic meds, and the letters from Neurologists in his casenotes, documenting his propensity to seizures.
At least we know why he fitted. He wakes, rejecting the tube, and another one is welcomed into the warm embrace of the magicians.
Lunch beckons, ad I leave Resus echoing to the cries of a lady who fell, catching the wheels of her zimmer on an escalator. Now, I know I'm a simple fungus, but I don't think those two particular advances in mobility technology were designed to go together. She has only slightly scalped herself, but sees everything we do as an outrage, loudly objecting to our attempts to examine her. She was still complaining 4 hours later, mostly about the fact that other patients were in the Department, using the toilet, and that she needed diazepam.
My post prandial slump encompassed writing a few sets of notes I had let slide. Resurgent after more coffee, I encountered another very young chest pain, again no evidence of cardiac pathology. My reassurances fall on partially deaf ears, but I know he's feeling better when I encounter him and his partner scarfing Burger King.
Another little old lady, another broken wrist. The redoubtable SHO and I spring into action. Our efforts are less successful this time, despite truly game counter traction from the patient herself; a second attempt is better, but produces the most shameful cast. I resolve to turn to Charnley more closely. My redoubtable colleague and I labour on, past our allotted hour.
And so, my shift that started an hour early draws to a close, 90 minutes late. It's dark again, and it's started raining. But I'm happy.
How fucked up is that?
Music Nazi recommends Wish You Were Here, by Pink Floyd. Do it; you kow you should.
Monday, December 24, 2007
Hey, Hey LBJ, Ruin Christmas For Me Today
Clearly, for LBJ, read Shroom; but that don't rhyme.
Last two shifts have been hellish. Busy, busy, busy, punctuated by flail and trauma.
A patient bought beer for the ED staff, however, and I intend to finish my shift drinking one in the Ambulance Bay. Merry Shrooming Christmas.
Tonight, my last for a few days, was eerily quiet. Quite nice, actually; but a quiet department makes me nervous. It's superstition, I know, but I also know it means something shit is waiting.
Tonight was no exception.
Having begun to think that we might make it through, actually having an entire shift that was nice and quiet, the BatPhone trilled into life. While this usually means someone unwell, we do get a variety of stuff phoned through. If you're dying, you'll come through on the phone, but if you come through on the phone, you ain't necessarily dying.
First, a cardiac arrest. I'm embarrassed to say that I can't remember how old he was, even though he slipped away from us less than an hour ago. 70s, I think. The crew that brought him had been going an hour, with no encouraging signs. There's really no comeback once you've been dancing with the Angels that long, but we'll try. The team is ready, and eager; callous though it may sound, it's also a good opportunity for the juniors to try their hands at running an arrest.
Another 30 minutes with us and we were finally ready to accept what we all knew was true. So my SHO got to learn the art of breaking bad news; this time of year it seems especially cruel.
As we were getting our breath back, the unwelcome trilling rang out again. Another gent, 70s again; bellyache, low blood pressure, poorly responsive. Time only to wipe our brows and breath in.
When he arrives, I can see he's in trouble. A raven might as well have been perched on his shoulder. He had apparently gone off as soon as the Ambos arrived, slipping into unconsciousness, and abandoning all attempts at breathing. His pulse, fluttering, weak, thready; barely evidence of a tenuous hold on life.
It didn't last.
Within minutes, he was gone. We were still gathering obs, still trying to make sense of the puzzle before us when he lost his fight. CPR started immediately, and I tubed him; slick as you like - Grade 1 view, some airway soiling, but the semi rigid, impersonal endotracheal tube whipped between his cords as easy as you like. Forcing air into him desperately, I couldn't tear my eyes off his belly, which was blowing up in front of our eyes.
For a few frantic, soul searching moments my 'satisfaction' with the tube turned to self doubt.
'It's in his fucking oesophagus...'
Then the CO2 monitor lit up. CO2 only comes from the lungs, so the tube couldn't be anywhere else. I think that might be called 'cold comfort'.
Another undignified struggle. Nothing made any difference; every intervention a small victory, but in a losing campaign. As is so often the case, all the cajoling, all the pleading in the world, couldn't get his heart started.
My turn to talk to the family. The usual explanations; the apologetic, quietly spoken words. I don't know how they hear them, but they echo dully in my own head.
And finally, they take it in, for now anyway - tomorrow will be different, and the next day, until the realisation finally takes root - and they thank me.
'For all you did for him'
For ruining Christmas
Last two shifts have been hellish. Busy, busy, busy, punctuated by flail and trauma.
A patient bought beer for the ED staff, however, and I intend to finish my shift drinking one in the Ambulance Bay. Merry Shrooming Christmas.
Tonight, my last for a few days, was eerily quiet. Quite nice, actually; but a quiet department makes me nervous. It's superstition, I know, but I also know it means something shit is waiting.
Tonight was no exception.
Having begun to think that we might make it through, actually having an entire shift that was nice and quiet, the BatPhone trilled into life. While this usually means someone unwell, we do get a variety of stuff phoned through. If you're dying, you'll come through on the phone, but if you come through on the phone, you ain't necessarily dying.
First, a cardiac arrest. I'm embarrassed to say that I can't remember how old he was, even though he slipped away from us less than an hour ago. 70s, I think. The crew that brought him had been going an hour, with no encouraging signs. There's really no comeback once you've been dancing with the Angels that long, but we'll try. The team is ready, and eager; callous though it may sound, it's also a good opportunity for the juniors to try their hands at running an arrest.
Another 30 minutes with us and we were finally ready to accept what we all knew was true. So my SHO got to learn the art of breaking bad news; this time of year it seems especially cruel.
As we were getting our breath back, the unwelcome trilling rang out again. Another gent, 70s again; bellyache, low blood pressure, poorly responsive. Time only to wipe our brows and breath in.
When he arrives, I can see he's in trouble. A raven might as well have been perched on his shoulder. He had apparently gone off as soon as the Ambos arrived, slipping into unconsciousness, and abandoning all attempts at breathing. His pulse, fluttering, weak, thready; barely evidence of a tenuous hold on life.
It didn't last.
Within minutes, he was gone. We were still gathering obs, still trying to make sense of the puzzle before us when he lost his fight. CPR started immediately, and I tubed him; slick as you like - Grade 1 view, some airway soiling, but the semi rigid, impersonal endotracheal tube whipped between his cords as easy as you like. Forcing air into him desperately, I couldn't tear my eyes off his belly, which was blowing up in front of our eyes.
For a few frantic, soul searching moments my 'satisfaction' with the tube turned to self doubt.
'It's in his fucking oesophagus...'
Then the CO2 monitor lit up. CO2 only comes from the lungs, so the tube couldn't be anywhere else. I think that might be called 'cold comfort'.
Another undignified struggle. Nothing made any difference; every intervention a small victory, but in a losing campaign. As is so often the case, all the cajoling, all the pleading in the world, couldn't get his heart started.
My turn to talk to the family. The usual explanations; the apologetic, quietly spoken words. I don't know how they hear them, but they echo dully in my own head.
And finally, they take it in, for now anyway - tomorrow will be different, and the next day, until the realisation finally takes root - and they thank me.
'For all you did for him'
For ruining Christmas
Sunday, December 23, 2007
Glass Onion
It should be very telling that the highlight of my shift was putting two catheters in between 6 and 7 am...
Regarding being careful what you wish for, I simply meant that before, I couldn't get a spare pair of hands for love nor money; but when the baby went off, so they tell me, every doc in the world drifted in to see if they could help.
Regarding being careful what you wish for, I simply meant that before, I couldn't get a spare pair of hands for love nor money; but when the baby went off, so they tell me, every doc in the world drifted in to see if they could help.
Subscribe to:
Posts (Atom)