Sick

I'm back, sorry but I have been busy at work and not had time to post and I have also been sick. Nothing serious just a touch of Bubonic Plague or Double (treble?) Pneumonia or terminal Flu with a touch of Ebola.
Yes you're right, I had a cold, which lasted for 3 days. No I did not stay off work, I took some paracetamol and lots and lots of handkerchiefs. It is amazing the advice you get from people about how to deal with colds but I am of the Barbara Woodhouse school of thought which says that the virus just wants to be tucked up in bed with a nice hot lemon drink so I refuse to give it what it wants.
I hate being sick, one of the good things about getting older is that you don't get so many colds as you have met all the viruses in the past and your body has developed the immunity required. So it is annoying when you do get one. Strangely my wife did not get a cold so I must have got this one from her (is she a typhoid Mary?).

While I was feeling miserable a young foreign guy attended the department with obvious flu. Normally I am quite harsh with people who present at A&E with flu as all they are doing is infecting the waiting room and the staff and we are not going to do anything for them. But I did feel a bit sorry for this youngster. He had obviously heard of the wonders of the NHS and his presenting complaint to me was "I have the flu, I need someone to look after me," you are absolutely right, you do need someone to look after you but it ain't going to be us. What a shame, poor kid, I gave him appropriate advice and sent him home to bed - it is his mum he needs, not hospital.

More Sunday thoughts

I don't care what we say in public, when all hell is breaking loose in resus, when you have 2 patients with multiple injuries, another 2 are expected, patients with chest pains and difficulty in breathing are presenting at your door that is when it is really fun. This is why we work in A&E.

Why is it, that I will still smile at you when you tell me "the wife" or "pain" or "hospitals" or "work" when I ask you if you are allergic to anything? Do you have any idea how many times I have heard that? Oh, and by the way, you either have or do not have an allergy, telling me "well not really" is not helpful.

Why am I polite to the 19 year old ned who thinks he is a hard man but isn't and I am abrupt to the real hard man who could kick me all round the department and not get breathless? Do I have a death wish? I certainly have poor judgement at times.

Sunday thoughts

A couple of times I have mentioned the arrogance of doctors in their dealings with nurses, other members of the team and the public and their thinking that sometimes the rules don't apply to them. It is therefore with a bit schadenfreude that I have discovered that they are equally arrogant with each other. Apparently a junior doctor in Highland region has been suspended for daring to write about the person who masterminded the MTAS/MMC debacle in a less than complimentary manner. What he wrote so upset the person concerned's friend that she had another senior doctor in the Highland deanery suspend this doctor. The full story (and follow ups) can be found here, here and here, at least the poor guy has been reinstated but only after the newspapers became involved. So I give you exhibit A, the arrogance of senior doctors who think that they can screw up someones career because they do not like what they have said and never mind whether it is aimed at them or whether it is factual, oh, and by the way, sod employment law. A few years ago junior doctors were controlled by the fear of getting a bad reference from a consultant but that seems to have changed, now it is fear of friends in high places getting you thrown off your training. I am going to ask a question, is their any realistic way of disciplining, controlling or getting rid of senior doctors? Answers on a P45 please.

August

The new doctors start today, all over the country newly qualified FY1's will be starting their first jobs on the way to being consultants or whatever. Every department will get new FY2's and maybe ST grades as well, this is going to be fun for the next week or two until they settle down. The jobbing doctor has posted about it here. The big problem that we as an A&E department have is trying to change the doctors priorities, what they learned on the wards is not necessarily what we want them to do and also the nursing staff in A&E have different priorities, we do things differently. Never mind, they will get the idea soon enough.
Today though, I want to mention the doctors who have just left. In a time when there seems to be a lot of them and us and Dr. Crippen repeatedly alienates nurses, I want to take this opportunity to say that the doctors who have left my little part of the NHS were without exception excellent. They were good clinicians, they were nice people and it was a pleasure to work with them. Many seemed to be going into General Practice so despite The Jobbing Doctors misgivings, GP land (at least in Scotland) is going to be well catered for. No names, but I will miss you all and I wish you all success. I hope that your replacements are as good.
The Jobbing Doctor in his post mentioned that this is not a good time to go into hospital as the junior doctors are new and can make mistakes. I have commented that I have read somewhere that in fact the junior doctors are full of enthusiasm and tend to over treat and in fact the death rate goes down in August. Unfortunately I don't know where I found that particular gem and I don't know even if it is true. So if anyone has the real figures I would appreciate the reference.

Trauma

There has been an RTA, a car has veered over the white lines and hit a minibus head, on there are multiple dead and injured. Then the injured start trickling in, the first and most serious arrives by helicopter, unloaded and the helicopter heads back to get more patients. We start to work on this lady, multiple injuries, where do we start? We know we have to work quickly, not only for her but because we know that more are coming. We know this lady needs surgery, but who goes first? Surgeons or Orthopaedics? We let them sort that out between them and get her to scan then theatre. The next one arrives and then more. It becomes a blur of injuries, tubes, wires, recordings, blood, people calling out for equipment and the various bits and bobs that go into a major trauma. As nurses we divorce ourselves from what is happening, we try to listen to everyone and as a doctor will talk over a plan with a colleague we listen so that we can get the next bit of equipment, yes it can sometimes make you feel a bit like their servant but it is what the patient needs at that time and lets be honest, that is our job. We know where everything is kept and how it works.
After a time it calms down a bit, it becomes less frenetic and we can look around and take stock. We have 4 spaces in our resus room, space 1 has an injured male who is going to go to orthopaedic theatre for various fractures, space 2 is going to general surgeons for exploration of her abdomen - she is bleeding somewhere internally plus has broken bones. Spaces 3 and 4 have dead people in them who crunch when you move them, I hate crepitus, we have not had time to take them to the viewing room. We have time before we have to deal with relatives, they are all from the other side of the country and will take time to get here so we can make the dead presentable. There is blood everywhere, the floor is a mess of discarded packages, swabs and the odd bit of equipment that fell off the trays. My colleague and I look at each other and and think "if our families could see what we do".
All this carnage and so many peoples lives ruined because someone tried to overtake on a corner.