Emergency med staff can appear to be callous, or cold hearted, or unemotional. We appear this way because we have learnt to protect ourselves against the constant barrage of disaster which appears before us every day: the heart breaking stories we hear and the evidence of human cruelty, day in, day out. Thats not to mention the HUGE amounts of stupidity we are faced with. We have to protect ourselves emotionally, because otherwise we wouldnt be able to do our jobs properly, and none of us would have family lives. So we learn to deal with patients... and then forget (emotionally at least) the things we have seen, so we can carry on.
But I believe every casaulty staff member has a pile of stories of patients that really 'got to them': the ones that you cant forget. These are mine:
The lady who tried to set kill herself by dousing the room, her blankets, and herself in paraffin and then setting the whole lot on fire. She came in alive.... barely. She had about 95% burn wounds (no exaggeration). She died later that night, on a morphine IV line, alone. I cant smell paraffin today without thinking of her.
The little kid who came in when I was an intern, with an hemoglobin of 3,4 and severe jaundice. According to his mother, he had been sick for one day (I doubt it..) He died before we could even start transfusing him, and I never did find out what it was.
The 1 year old who was brought in with 'scabies': sure enough, she had a scabies rash on the backs of her hands, but when I turned her hands over, her palms showed something much more ominous: cigarette burn wounds. Further examination revealed bruising in the shape of fingerprints all over her back, and more burn marks on her stomach. Although I did all the right things medically and legally, it stills upsets me: how can you burn a 1 year old's palm with a lit cigarette?
The 95 year old woman who came in with a pulse rate of 25, awake and talking. Together with her and the family, we decided on no invasive interventions (ie no emergency pacing). She was so polite and grateful for everything we did. She died later that night surrounded by family.
The first family I had to 'break bad news' to: I was an intern, shocked from my first 'real' resus and had to tell the chap's family that despite our best efforts, his MI had got the better of him. They all (of course) started wailing inconsolably, which left me floundering for words and trying not to cry myself.
I cant forget them, even if I wanted to.
Sunday, May 31, 2009
Friday, May 29, 2009
Today
Get to work, full box of files waiting. Nursing staff in a bad mood because no beds in the hospital and casualty acting as an 'overflow', 25 patients on trolleys taking up space. Mad, melodramatic overdose patient arguing loudly with everyone who walks past her that we are abusing her. Walk into resus: one patient on a ventilator (subarachnoid bleed), paeds busy resussing the crap out of a sick kid on the other side.
Go to 'minors' area. See 10 ankle injuries from previous weekend's drinking. 1 fracture. See 8 inappropriate GP referrals of abdo pain (...about 6 weeks doctor...). Convince the American tourist that she does not need an MRI scan to her head after she fell and sustained a 1cm laceration. Explain the term 'neurologically intact'. Explain that what happened to Natasha Richardson was terrible but that she will be OK. Counsel 2 anxious sets of parents that their child who bumped their head on the coffee table is not going to die, and give head injury instructions left right and centre. Panic quietly about the American tourist, find her in the waiting room and administer tetanus toxoid, previously forgotten.
Get called to resus to a 14 year old girl hit by a car. Pupils fixed and dilated. Abdomen hugely distended and blue, blood pouring out of left ear. Resus for all its worth and watch her slip away. Counsel her parents and see the empty desperation in their eyes and the way their lives collapse in front of me. Say a silent prayer that they will be OK.
Pull myself together, go back into minors, see the cutest kid in the world who gives me a hug after I glue his forehead laceration back together. Get a phonecall from the medical on call doc, who tells me that the STEMI patient I thromobolysed yesterday is doing much better, and said to say a special thank you to me. Reduce two dislocated shoulders. Place an elderly woman with dodgy heart and lungs on BIPAP and watch as she improves.
Leave an hour late. Run, cup of tea, blog. Think about the American again. Think about the 14 year old again. Feel extraordinarily grateful for everything I have.
Fall asleep, knowing that this job is just right... for me.
Go to 'minors' area. See 10 ankle injuries from previous weekend's drinking. 1 fracture. See 8 inappropriate GP referrals of abdo pain (...about 6 weeks doctor...). Convince the American tourist that she does not need an MRI scan to her head after she fell and sustained a 1cm laceration. Explain the term 'neurologically intact'. Explain that what happened to Natasha Richardson was terrible but that she will be OK. Counsel 2 anxious sets of parents that their child who bumped their head on the coffee table is not going to die, and give head injury instructions left right and centre. Panic quietly about the American tourist, find her in the waiting room and administer tetanus toxoid, previously forgotten.
Get called to resus to a 14 year old girl hit by a car. Pupils fixed and dilated. Abdomen hugely distended and blue, blood pouring out of left ear. Resus for all its worth and watch her slip away. Counsel her parents and see the empty desperation in their eyes and the way their lives collapse in front of me. Say a silent prayer that they will be OK.
Pull myself together, go back into minors, see the cutest kid in the world who gives me a hug after I glue his forehead laceration back together. Get a phonecall from the medical on call doc, who tells me that the STEMI patient I thromobolysed yesterday is doing much better, and said to say a special thank you to me. Reduce two dislocated shoulders. Place an elderly woman with dodgy heart and lungs on BIPAP and watch as she improves.
Leave an hour late. Run, cup of tea, blog. Think about the American again. Think about the 14 year old again. Feel extraordinarily grateful for everything I have.
Fall asleep, knowing that this job is just right... for me.
Monday, May 18, 2009
Back to school
The torture has begun. In my attempt to further my career, I will be writing an awful set of exams in August, the dreaded 'primaries'. I have decided to shock the old system and actually study a little bit more in advance than I did in my undergraduate years: and oh boy, its going tough. There is a huge amount of work.
Attention all medical students: some advice: PAY ATTENTION in physiology. No matter how hard or imcomprehensible it seems now, it will be much, much worse in 5 or 6 or 7 years time. Take it from me.
Attention all medical students: some advice: PAY ATTENTION in physiology. No matter how hard or imcomprehensible it seems now, it will be much, much worse in 5 or 6 or 7 years time. Take it from me.
The Drunkest Girl in the World
She was 15. She was a mess: eyeliner smeared down her face, hair matted against her forehead, blood pouring out of her scalp wound and pooling neatly around her right ear. Her bright yellow tank top was pulled up to underneath her breasts, revealing a young, soft, round tummy bulging over her 'skinny' jeans. She had several piercings in each ear, and ones on the right were covered in blood, and dripping delicately over everything. She had positioned herself on a chair, propped herself up in the corner, and fallen asleep. She reeked of a lovely combination of cheap 'Charlie' perfume and cheaper 'papsak' wine.
I set up my suture tray, shook her awake and removed the blood soaked bandage. There was a 5 cm scalp laceration that needed cleaning and suturing. However, this is difficult if your patient keeps falling over onto your lap. I tried again and again to wake her up, unsuccessfully. Her boyfriend was at the window, shouting abuse at the casualty staff (he may well have been the Drunkest Man in the World.)
I got one of the nursing staff to hold up while I quickly fixed her up. I didnt even consider using lignocaine, and she didnt notice. After I had stapled her scalp, we got up to get a bandage to cover up her wound, and she slowly slid off the chair. She seemed completely paralysed, with no control over her limbs. She slumped between the chair and my trolley, against the wall. Slowly a puddle began to form under her. We noticed the darkening of her jeans. She had lost control of her bladder and was now lying in a pool of her own bodily fluids, blood and fresh alcohol laced urine. She didnt move a muscle, just continued to pee; it seemed like LITRES of urine. By now all the other patients and staff were staring. Even the boyfriend had shut up.
You can fix people's wounds but you cant always give them their dignity back.
I set up my suture tray, shook her awake and removed the blood soaked bandage. There was a 5 cm scalp laceration that needed cleaning and suturing. However, this is difficult if your patient keeps falling over onto your lap. I tried again and again to wake her up, unsuccessfully. Her boyfriend was at the window, shouting abuse at the casualty staff (he may well have been the Drunkest Man in the World.)
I got one of the nursing staff to hold up while I quickly fixed her up. I didnt even consider using lignocaine, and she didnt notice. After I had stapled her scalp, we got up to get a bandage to cover up her wound, and she slowly slid off the chair. She seemed completely paralysed, with no control over her limbs. She slumped between the chair and my trolley, against the wall. Slowly a puddle began to form under her. We noticed the darkening of her jeans. She had lost control of her bladder and was now lying in a pool of her own bodily fluids, blood and fresh alcohol laced urine. She didnt move a muscle, just continued to pee; it seemed like LITRES of urine. By now all the other patients and staff were staring. Even the boyfriend had shut up.
You can fix people's wounds but you cant always give them their dignity back.
ATTENTION PLEASE
To all the admitting teams I refer to:
I would like to being the following to your attention:
1)We are here to work. YOU are here to work. You are getting paid overtime to be here late at night, and while I appreciate that it is crap, you being snotty to me on the phone at 3 am will NOT help matters. I have been there, I have also done the 36 hours without any sleep, and I know it is bad. I am not waking you up/referring another patient to be funny, I am doing so because they are sick and need admission.
2) Just because A and E officers work 8 or 12 hour shifts does not mean we are lazy. While you deal with pretty much the same, day in and out (with the occasional 'pink canary'), we have to deal with everything and anything that gets thrown our way. Because of overcrowding and a lack of beds, we have to deal with uppity, angry people ALL THE TIME, because they have been waiting 8 hours to be seen. We are at the proverbial front line of people's emotions, all the time. We soften them up for you. We explain whats going to happen, we console. We also provide life saving interventions all day, and do resus after resus after resus. Its very emotionally and mentally draining. We work just as hard as you.
3) If you go to theatre for any period of time and you are on call for casualty, you need to get someone to cover for you. Or at least answer your bleep. End of story.
4) Please trust me. Again, I am not referring patients for a 'second opinion', or because I am trying to be mean. I am doing so because I believe that they have a condition which prevents discharge. This opinion is formed from a)the history I have taken from the patient, b) the examination I have performed and c) the investigations I have done. There is always a reason.
5) If I tell you that a patient is unstable, this is not to try and place undue pressure on you or annoy you. I know you have five patients waiting to be seen. But you need to prioritise. I am only telling you the patient is unstable so we can try get them to theatre/CT scan/ICU a little bit quicker. I will do my best to stabilise and manage the patient as I can, but most will need further intervention.
6) We have protocols in place for a lot of conditions: we use them. Please do not argue with me about a referral if I have followed a protocol/guideline and you are the end point.
And while we are at it:
To the doctors I have referred patients telephonically to while sitting at a peripheral hospital, terrified and desperate:
a)Yes, I might be more junior than you, but I am not stupid. Please do not treat me as such. I know you are stressed, so am I! If there is something missing from what I am telling you, or something you want me to do tell me exactly what it is, and let me phone you back. I am phoning for your help. Please give it.
b) It is easy to forget what it is like to work in a hospital that has no CT scan, no after hours blood laboratory, no after hours Xray, insufficient or undertrained staff and no consultant support. That is where I am. Picture it for a minute and then please give appropriate advice. Thank you.
And that said:
To all the doctors in Ireland and South Africa who have been friendly, kind, helpful and supportive, THANK YOU. Know that A and E has got your back.
I would like to being the following to your attention:
1)We are here to work. YOU are here to work. You are getting paid overtime to be here late at night, and while I appreciate that it is crap, you being snotty to me on the phone at 3 am will NOT help matters. I have been there, I have also done the 36 hours without any sleep, and I know it is bad. I am not waking you up/referring another patient to be funny, I am doing so because they are sick and need admission.
2) Just because A and E officers work 8 or 12 hour shifts does not mean we are lazy. While you deal with pretty much the same, day in and out (with the occasional 'pink canary'), we have to deal with everything and anything that gets thrown our way. Because of overcrowding and a lack of beds, we have to deal with uppity, angry people ALL THE TIME, because they have been waiting 8 hours to be seen. We are at the proverbial front line of people's emotions, all the time. We soften them up for you. We explain whats going to happen, we console. We also provide life saving interventions all day, and do resus after resus after resus. Its very emotionally and mentally draining. We work just as hard as you.
3) If you go to theatre for any period of time and you are on call for casualty, you need to get someone to cover for you. Or at least answer your bleep. End of story.
4) Please trust me. Again, I am not referring patients for a 'second opinion', or because I am trying to be mean. I am doing so because I believe that they have a condition which prevents discharge. This opinion is formed from a)the history I have taken from the patient, b) the examination I have performed and c) the investigations I have done. There is always a reason.
5) If I tell you that a patient is unstable, this is not to try and place undue pressure on you or annoy you. I know you have five patients waiting to be seen. But you need to prioritise. I am only telling you the patient is unstable so we can try get them to theatre/CT scan/ICU a little bit quicker. I will do my best to stabilise and manage the patient as I can, but most will need further intervention.
6) We have protocols in place for a lot of conditions: we use them. Please do not argue with me about a referral if I have followed a protocol/guideline and you are the end point.
And while we are at it:
To the doctors I have referred patients telephonically to while sitting at a peripheral hospital, terrified and desperate:
a)Yes, I might be more junior than you, but I am not stupid. Please do not treat me as such. I know you are stressed, so am I! If there is something missing from what I am telling you, or something you want me to do tell me exactly what it is, and let me phone you back. I am phoning for your help. Please give it.
b) It is easy to forget what it is like to work in a hospital that has no CT scan, no after hours blood laboratory, no after hours Xray, insufficient or undertrained staff and no consultant support. That is where I am. Picture it for a minute and then please give appropriate advice. Thank you.
And that said:
To all the doctors in Ireland and South Africa who have been friendly, kind, helpful and supportive, THANK YOU. Know that A and E has got your back.
Back in the game
I suppose its not the best idea to start a new blog, post a couple of posts... and then disappear for three weeks. So I am sorry budding fan club, we are back! Was on a brief holiday home to South Africa. And yes, thank you for asking, it was FABULOUS. Got to see my good friends Karen and the Adman, and lots of other awesome guys and gals. I cannot wait to get back for good... yes its true folks, I am going Home, and will be starting an amazing job in the Cape in July. But never fear, this blog will continue... I have a feeling there's no cure for stupidity in South Africa either.
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