Monday, 30 June 2008


Saturday was very busy and not made any easier by the drug addict who informed me that he had missed his chemist and did not have his medication - what was I going to do about it! Answer, nothing pal, it is your problem. He then thought he would try the guilt card - if we did not give him medication, he would be forced to get illicit drugs. This does not work on me or our department so he was thinking about getting aggressive and abusive but thankfully changed his mind and left. If you had not thought that it was 5:00am instead of 5:00pm you might have realised that you need to get to the chemist instead of coming to us and telling us that your head was "buzzing". He managed to get a taxi to the department and blamed the taxi driver for not telling him it was the afternoon instead of the morning. How does he manage to afford a taxi? I have been unemployed in the past and struggled to afford bus fares never mind taxi fares, but then I always wasted my unemployment benefit on food and rent for my family. I'm really starting to wonder if being unproductive and lazy and sitting at home sponging from the state is the best way to go. Never mind, I will do enough sponging from the state when I retire in a few years, only problem is, I have managed to build up a pension through the NHS so it is unlikely I will qualify for benefits when I retire. Ah well, can I still work as a nurse at 70?

After having to work Saturday I decided I needed some down time, so having relatives in Dundee I went there to catch the Blues Bonanza on Sunday. Absolutely superb and I can thoroughly recommend it if you like live music in a nice friendly atmosphere. A couple of bands I saw were the Rattlesnakin' Daddies and The Jed Thomas Band, very very good. Next year I will make sure I am off for the whole weekend.

Wednesday, 25 June 2008

Being Scottish

At last, we men are getting a screening all of our own. Women have, quite rightly, had smear tests and breast screening for years and we have had at best bowel cancer screening - although this is a unisex one. Finally, there is one being offered to men only. It's for Aortic Aneurysms see the report here. Unfortunately for the rest of the UK it is only being offered in Scotland. Now I don't know if this was first thought up by the previous labour executive but it has come in under the SNP executive, and along with other things that are going on up here - prescriptions going down in price until they are free springs immediately to mind, makes you wonder if one bunch of Scots can do some things so well and so popular, what happened to the other Scot in Number 10 Downing Street? Why are they not offering this screening down South? Being Scottish has it's advantages, despite what they say in Trainspotting. Unfortunately we still have the highest death rates from Heart problems in the UK.

Sunday, 22 June 2008

A Sunday Morning Moan

The weather is horrible here, I was supposed to be going to a family barbecue which will now be held inside and my wife is working today. So a quick moan.
When patients present at triage they say some strange things, we have a few tricks to allow us to determine whether you are really sick or if you can wait, these are unfortunately mostly down to experience and take a bit of time to learn, sometimes you will see something once and then never see it again. But these are the things which give us our challenges.
If you attend and tell me you are breathless I don't believe you - if you can tell me you are breathless in a full sentence, your not!
Telling me you have been unable to stand on the ankle you hurt 2 days ago and have not taken painkillers for will not get you seen quickly, I was watching you walk towards my room.
If I ask you for your pain score - 0 to 10 and I say that 10 is the worst imaginable do not say it is a 12. It makes you look a moron and we disregard everything you say. If you really are a 10 you are unable to tell me and I will know - trust me. (Yes, yes, I know other bloggers have mentioned this. It is a common theme with ED staff).
Don't tell me you lost gallons of blood from your little laceration, the human body does not hold that much, and a little blood goes a long, long way. Oh, and by the way - only very, very rarely is that the bone you see in the bottom of your wound - honest.
Telling me that you did not want to give your child his/her Ritalin or other medications or any pain relief "in case it masked the symptoms" is just stupid, no other word for it.
I know you are his mother, I know that he lives with you and that you love him,that he is your little boy and don't want to see him hurt, but please, let him answer the questions himself. He is 25 after all.
If I ask you about pain or disability or your problems, tell me the truth. I know you are sick, don't say you are fine, downplaying it does not help you, and it makes me look incompetent when my colleagues find out just how serious your condition is.
If you are 19, unemployed and have been since you left school, you do NOT pay my wages (nor does your dad). Get a job and then tell me that - and you're still wrong.
And finally, one for staff, if a patient comes in complaining of headache first thing in the morning and it is New Years day, do not assume that she is hungover. She probably is but she may not be. And the last I saw of that particular patient was her being wheeled to theatre after having a CT scan which showed a bleed in her brain. If nothing else it cured me of my cynicism.
Have a good day everyone.

Tuesday, 17 June 2008

We are the champions

Why do people fight in the middle of the night? They should be sleeping or at least sitting quietly watching TV. A radio call from the ambulance alerted us. "35 year old male stabbed in the chest, no pulse. We'll be there in 5 minutes". Luckily the senior doctor has not gone home, so everyone is alerted and standing ready. He is blue lighted straight into our resus room and the dance begins. It is unfortunately all very well rehearsed, we have done this before. Clothing is cut off, IV access is obtained CPR is ongoing monitors are attached fluid is hung up and run through. everything is getting done. Blood warmer which doubles as a pressure bag is already primed and ready. O negative gets started and blood is taken for cross match. The blood transfusion people are called to get more O neg while we are waiting, "Whats the patients name?" they ask, "we don't know" we tell them. "You need a name to get more blood" true but there are systems in place for situations like this. This technician has never heard of them and is not giving his blood out without a name. Only time I have ever heard the senior doctor swear. He grabs the phone and shouts down "Get the fu***ng blood here now." Blood duly arrives. Meanwhile we are fighting a losing battle. This guy is dead unless we do something but we are not giving up yet. Stab wound through the heart, blood everywhere. Get the thoracotomy tray, we are going to open him up. My job in all this has become a combination of photographer and transfusion nurse. I am taking photographs and then putting blood up and repeat - we can put a unit of blood through in 3-4 minutes and every one has to be documented and checked so I am kept busy as is everyone else in the team. The chest is opened, the wound in the ventricle found and sutured all while one doctor is doing cardiac massage but success, we eventually get the heart going - thready and weak - but going. Surgeons appear and take this guy to theatre to close his chest and then to ITU. He has got massive problems ahead of him, was he deprived of oxygen for too long, will he get an infection? Unfortunately, we will never know unless he dies tonight, as once patients disappear into the black hole that is the hospital we never hear of them again. But, he was dead when he reached us and he was alive when he left us. Good job by us and a quick chorus of Queen's "We are the champions".
What caused this stabbing? He was arguing with his brother while they were both drunk.

Monday, 16 June 2008

Fathers Day

What did you get for Fathers day? I got the chance to work a full shift and see a lot of injured people, actually had a good day, and even managed to get home on time. Mrs. Grumpy had made my favourite meal and the kids had left cards, well one had left a card, the other card had been delivered via those fine people at moonpig. Is there any presents for me? I asked. No, eldest is giving you a combined Fathers day and birthday present which you will get next week and my youngest's present (also a combined one) is coming in the post. Do I want to know what it is? What a dilemma, of course I want to know but if it is good then I will want it NOW, if it is poor I will have the time to practice my "isn't that wonderful" look. So I decide, no I will wait. After all I am middle aged and not a little boy waiting for Christmas - although I'm sure if you ask any wife she will tell you we are all little boys. I will keep you posted.
MY dad received his card and present on Saturday in plenty of time - but that was only because Mrs. Grumpy dealt with it all.

Wednesday, 11 June 2008

Doctors and Nurses

Doctor Crippen has posted a comment on his site from a junior doctor here. This piece shows how one doctor feels that he is embarrassed to cash in his cheque that he receives for signing cremation forms. He could have written a nice bit about this but (and I suspect this is the real reason Dr. Crippen posted it) he decided to tell about how the nursing staff are judgmental and abusive towards him, how the ward secretary hides notes from him and even the mortuary attendant does his job with no spark of intelligence and with minimum grace. I of course have added my twopence worth along with other commentators and I want to make my position absolutely clear.
I like junior doctors, the hospitals would fall apart without them and they have had such a crap deal recently with MTAS and pay and they are invariably great fun on a night out. I have a huge respect for medical training, I am sometimes overwhelmed by the encyclopedic knowledge that doctors display. However, doctors are not always the nicest of people. Their very training makes them abusive, arrogant and competitive. Some of the brightest doctors are in fact some of the most ignorant people. For many years doctors were bullies towards everyone, including each other, I have already mentioned this in a post here, most hospitals now have a bullying policy. Quick anecdote, young female nurse working on ward, consultant comes in to do the ward round and she is talking with a patient while he is doing the round. His reaction? He threw a ruler at her which hit her in the neck then carried on doing the round. Why were the police not called? Because he was a consultant and she was a nurse. A nursing lecturer liked to tell a story of one consultant she worked with who would some mornings start shouting and swearing at people, their reaction was to get him a coffee and toast as his blood sugar was running low. The common denominator here? Male consultants, female nurses. Bullying still goes on but it is less, what has changed? The ratio of males and females. There are more male nurses and female doctors now. However, the female doctors are just as aggressive and competitive as their male colleagues. But one big difference is that the number of males coming in to nursing has changed things. Consultants are a bit less willing to shout at a male who is liable to ask them the question "Who do you think you are speaking to?" Do not for one minute think that I am making doctors to be the villains and nurses the angels here, nurses are just as likely to be nasty to junior doctors and some nurses can be the absolute bitch queen. When I was training, one of my male colleagues (ex army) stated that he was going to ask a particular trained nurse if she was married and that if she was could she bring her husband in to the ward. When I asked why he replied that she was such a bitch that he wanted to punch her but could not bring himself to hit a woman so if he could get her husband then maybe he would sort her out, (it didn't happen). This behaviour by both sides is wrong, we are supposed to be professionals who work together for the benefit of the patient and on the whole this is what happens. But, when one profession thinks that they can get away with being nasty to other professionals then problems can occur. I would like to make it absolutely clear, when I go into work I do not expect strife and conflict, these thing only very rarely happen as we are a team and have respect for each others skills and knowledge. Happens a bit more around the time we get new doctors and it's mostly to do with changes of procedure and trying to get doctors to realise we are not like ER or Casualty.
Back to the point of this post, the junior doctor that Dr. Crippen writes about has obviously had a hard time, he is disillusioned and demoralised. Whose fault is this? He blames the nursing staff for making his life harder than he feels it has to be, but is he correct. These things tend to work both ways, if he gives attitude, he will receive attitude. He is only in the ward for 4 to 6 months so nobody has to care about him, but if he makes an effort in his next placement, tries to be nice to people, who knows, he may even get the nursing staff to help him. "Stupid is as Stupid does." (Forrest Gump 1994)

Friday, 6 June 2008

Arrest Avoidance

Have not posted for a while as a post by mouse here has given me food for thought. I have had a lot of things to write about but it has been difficult to make them truly anonymous, so as I like my job and still have a mortgage to pay I have held back. This story however could and does happen in every city.
Female brought in by police under arrest for shoplifting. Caught in the act but decided that she did not want to go to jail or was trying to make the police's life as difficult as possible. Claimed that she had taken an overdose of Diazepam and needed to be taken to hospital. Police know that this is BS but have no choice but to bring her up. We know this is BS but have no choice but to admit her for observation. So she is admitted to the ward with 2 policemen as escort. First thing she does is demand food, now as it took a while to process her through custody then get her up to us it is now well past dinner time, next food will be breakfast in approximately 13 hours. We will stretch to some tea and toast and we might be able to find a sandwich but that is all we have to offer. Not good enough for this lady, she informs the police that they have a duty to feed her - correct, but she is not in the cells so they can't help and the hospital has different rules and is not governed by the criminal procedures act. She then starts shouting at us to feed her. We pointed out that this is a hospital, not a hotel and once the meals are finished that is that and we have no way to get her food. Next thing was a demand for food to be brought in from a fast food shop - curry, kebab, pizza, whatever. Sorry, that is against hospital policy in case of food poisoning. Surprise, surprise, she decides that there is nothing wrong with her after all and wants to discharge herself. So off she goes back to her cell instead of a nice comfy hospital bed which also releases 2 very amused police officers to go and do something just a bit more constructive.