Requests

Didn't realise I had been away for so long, no real excuse just could not think of anything to write. I have been popping up on other blogs to add my twopence worth to the comments and as always managing to upset a few people.


In A&E (ED or ER whichever is your preference) I get asked for a fair number of emergency equipment at times; an airway, an ET tube, various drugs - all no problem I can cope with this but sometimes the requests are for things I am unable to provide.


I have been asked for a condom by a person who was passing our hospital at 2:00 in the morning and thought that we should provide these - became quite irate when told that we did not provide these things and he should have thought of this sooner, possibly while he was in the pub/club which has machines. Actually asked me what he should do without one - er, abstain?

I have had drug addicts asking for needles and syringes (at least they asked and did not just steal them) and also asking for drugs as they have had their prescription stolen. In both cases the answer was no, sorry, we do not do that.

But recently I had a patient come to me stating "it is an emergency, do you have a phone battery charger!" No, of course we don't, but he seemed to think that this was a reasonable request, perhaps I should think about this when restocking our emergency trolleys, but at least he didn't ask for one stat!



I get pissed off when some young doctor goes all ER or Casualty on me and uses the word 'stat', it is meaningless and just annoys everyone. We will get the job done as fast as we can, you shouting out orders like an actor in a drama will get you nowhere. I have even been known to ensure that this word does not get uttered by saying to young and eager doctors "The first one to say 'stat' or 'right people lets move' gets slapped". It usually lightens tension and gives people a laugh.

My Future

I read this post by Grumpy Old Ken and it got me thinking, is this my future? Are all us old gits going to roam around forever befuddled? I was in England recently and came out of M&S to hear a woman in her 70's tell two men, one of whom I presume was her husband, to "stay together and she would see them in 10 minutes." Now this is the sort of thing that I used to say to my kids when they were quite young and wanted a bit of independence and would go somewhere without us. Have I discovered the great untold truth about being male? You live with your mother who looks after you until she hands you over to a wife who looks after you and then quite slowly and subtly your wife turns into your mother. Perhaps we should change the marriage ceremony, it should perhaps be "Who gives this MAN." and your mother hands you over to your future wife/mother. Ah well, as long as I get my pocket money and am allowed to get to the pub occasionally I suppose I should be happy.

Dear Doctor,

Dear GP and GP's receptionist,

When you (correctly) dial 999 for an ambulance to your surgery and the crew arrives please do not refer to the female member of the crew as an ambulanceMAN she gets a bit upset by these things and also wonders at the observation powers of receptionists. It would also be a good idea if when asking the patient to go with the crew not to say "Right then, lets get you on the bus." It is demeaning to professional people and when they tell us about it it makes you look a real dick!

GrumpRN

Dear America

OK America, what are you doing? In the past 3 days I have become aware of some really serious nonsense and downright lies that are being said about the NHS. First Dr. Crippen pointed out an idiot Conservative MEP -that no-one here has ever heard of - who uses lies and out of date and distorted figures to tell you rubbish and now there is this from FOX news which I picked from Ben Goldacre's site which is a blog which only ever uses researched and verifiable information and is dedicated to pointing out the truth.
Please be aware, the NHS that is being promoted in these 'news' segments bears absolutely no resemblance to the NHS that I work in and that I access as a patient. Can I point you to this, this is more like the NHS that I love and use.

Always always remember, if someone is telling you something is rubbish, always check their motives -who is paying them and who stands to benefit from the status quo.

Parents!!!

This post is not work related in any way.

Can someone please tell me when parents stop being embarrassing? I ask as I was out with my dad the other night in our club, and he decided to compare nails with a group of twenty year old girls. These girls were not regulars, he had never seen them before and they had only come through to the room we were in to escape the bingo as they wanted to talk and talking during bingo is a big no-no. So these poor girls were exposed to my dad who is in his 70's. He is very touchy-feely as it was OK when he was younger - doesn't care that you are not allowed to touch women these days without their permission. So these girls were comparing their nails and he shoves in showing off his nails and criticising the girl beside him for biting her nails. What is worse is that his nails were better than any of the girls there. One of these days he is going to get us barred but at least they took it as good fun. But as he leaned over the girl I suddenly had a thought; now she knows what is meant when they say old age is creeping up on you!

la fenetre

Today's word is "Fenestrate" from the French 'fenetre' for window.



I first came across the idea of someone being fenestrated over 30 years ago when I read a collection of short stories by Arthur C Clarke called "Tales from the White Hart", one of the stories was about a character being thrown out of a window.

Why is fenestrate the word of today? Well, I have just seen 3 patients who had window related accidents. One bumped his head on a window, one put his hand through a window and one fell out of a window. All were fine although the one who fell out of the window did require admission for observation. Isn't it lucky that kids bounce when they fall from heights, this one certainly was.

Swine Flu (again)

What the hell is going on with this country? More people die in 1 week from road accidents than have died so far this year from swine flu, 56 people per week in 2007, http://www.statistics.gov.uk/cci/nugget.asp?id=1208 and the people who have died have in the huge majority had an underlying illness -see my last post. So why are we giving away prescription drugs to anyone who wants them? For years the medical profession have been trying to cut down on giving people antibiotics for the cold and now the government is giving away Tamiflu without it being necessary to even see a doctor or other prescriber. I have a question, if we are giving Tamiflu now when the Swine Flu is fairly mild, what are we going to do if it returns in the winter all new and improved and really nasty? And another thing, when I think of the hoops I had to jump through and the work I had to do, essays I wrote, exams I passed and the research I did just to be allowed to prescribe a couple of Paracetamol and Ibuprofen, why are people with a couple of hours training being allowed to prescribe?

Swine Flu

Apparently the obese are most risk of dying during the ongoing flu epidemic/pandemic whatever we are calling it now and there has been an increase in the number of coffins being built. Are we building big coffins for obese victims of swine flu? See today's Sunday Post. So far we have not had another update of Swine Flu guidelines for over a week, at one stage we were getting new ones every day. In my department we have pretty good procedures in place to segregate suspected swine flu victims from everyone else, except for one (in my opinion) major flaw. When we have a suspected case whichever nurse is available deals with the patient using the proper protective gear and stays with the patient throughout, all very sensible except for one thing - I could be that nurse, no complaints but when did my history of heart disease stop being a "serious underlying illness"? Every patient who has died so far has had a history of "serious underlying illness".

This is so typical of nursing, we had a large patient last week who needed mobilised, who did it? The pregnant nurse and the nurse with the heart disease - so I will just have to get on with looking after what ever comes my way regardless.

Been missing for a while as I have been keeping my head down a bit, really, really don't want to be sacked for breaching patient confidentiality.

I have discovered how to reduce the crime figures to zero at a stroke, it's really simple, let me explain.

A patient came to our department, police had been in attendance as he was a bit aggressive with the ambulance crew but settled with us and the police left. Patient decided that he did not want to be with us so walked out - no problem, we were glad to see the back of him and he was not in any danger. 5 minutes later he was back, someone had stolen his bank card and it had to have been us so could he have it back. Advised we did not have his card and that probably it had gone missing when he was lying on the ground where he was found. No, he had this card when he came to us. OK, you are obviously calling us thieves so you better get the police to us. How was he to do that he asked. Told to go and phone the police he then said that he had no money so would we phone the police for him? Got all upset when I burst out laughing. Could not get it into his head that if we are thieves why would WE phone the police to report ourselves. No, he wanted us to call the police. This got me thinking, if we could only get all criminals to call the police and report themselves after they have committed a crime the figures would plummet.
Eventually he was told that if we did call the police it would be to have him removed and the chances were that they would believe us rather than him. Last seen he was heading down the hill into town.

Mobility

If you want to have your patient mobilised just ask, it is one of the things I do, I'm good at it. I can assess a patients mobility as well as a physio and tell you if they are safe to go home or not, or if they need a formal physio referral. But, I have to be able to trust you and know that you have assessed the patient properly. If the patient came in with a possibility of a hip injury I need to know that you have excluded a fracture so that I can mobilise her safely. So when you tell me she has had her analgesia a while ago and we should try her on her feet I expect her to be able to make a bit of an effort. When she struggled and was unable to move even with 2 of us I let you know that her mobility is poor and she is a danger to herself and anyone trying to help. The last thing I expect to hear from you is "OK, lets get her hip X-Rayed!" WHAT? That should have been done before I went near her. She has been in the department long enough to have been X-Rayed and it makes me look incompetent and negligent to attempt to mobilise a patient who may have a fractured hip, as well as the fact that when she was being 'mobilised' she hurt me with her pulling and gripping. So now I have had to take analgesia and avoid patients for a bit because you did not do your job.