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.

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.

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.

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)

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.

Bank Holiday Monday

It's taken me this long to get my thoughts together and get over it. Monday started off well, traffic reduced and plenty of space in the car parks. It's not a holiday here but the schools are off for in service training so it all seems quieter, and of course there is always better stuff on TV. Nice quiet start to the day but I came back from breakfast to find a patient vomiting, not just vomiting but VOMITING!!!! I have never seen so much from one person - and of course he too had had a good breakfast. I no longer do vomit well, nowadays I am very likely to join in with the patient out of sympathy. Any way patient cleaned, sorted and admitted. The rest of the morning was uneventful until a young man appeared who had been dropped off by workmate. Writhing about in agony from his abdomen. Started asking the questions, "where are you sore?" "In my side going into my groin." "Does the pain come in waves or is it constant?" I asked. "I've not been sick" was the reply. "???" I thought I had strayed into a Two Ronnies sketch where you receive the answer to the question you were going to ask. Finally got an answer to my question. "OK, I need a specimen of urine then we will get a doctor to see you." Off he goes to the toilet with his little foil bowl. After 15 minutes I finally get 2 drops from him. I go off to test it telling him to make his way back to his trolley - which he can see as it is right in front of him and at most 50 feet away. I come back and no sign of him so I bang on the toilet door - yeah he'll be out in a minute. I get on with other stuff. 15 minutes later still no sign of him so I open the toilet door, he's lying on the dirty toilet floor - not passed out or anything sinister, just lying on the floor. I get him to walk to his trolley and a doctor goes to see him. Sounds like this guy has Renal Colic, best treatment is intra muscular Diclofenac which is a none steroidal anti inflammatory drug so I go to get it ready. I hear the doctor asking the correct questions - does he have asthma? Yes he does, OK, it is a bad idea to give diclofenac to asthmatics but he says he has had none steroidals before. Doctor decides to give Diclofenac. Just as I am about to prepare it he decides to inform us that while he has had none steroidals before he reacted badly. This is bad so to try to avoid killing this person we give him Morphine. This eases his pain so much that he now wants to wander round the department and go for a smoke. I got him out of the department as quickly as I could as I really wanted to strangle him.
After lunch there was a steady stream of elderly ladies with fractured neck of femurs some patients who thought just because their GP was on holiday ALL GP's were on holiday so came to us with primary care problems, and the usual holiday overdoses, self harmers, abdominal pains and generally unwell people. This kept me and the department very busy until home time - late off again. Next Bank holiday I'm going to have a day off and enjoy the TV or the sunshine like everyone else, whether it's a holiday here or not.

At the gym

Been a bit busy this week and not had time to post. Just been to the gym, need to keep the old bones nice and solid and stop any osteoporosis and try to keep the joints supple and the heart ticking over. Had a good session but why do people insist on walking right by me when I'm doing quad extensions? By the very nature of the exercise my feet are going to come up and hit you. So please move over 6 inches and don't give me a dirty look.
While I'm on the subject, this is to the guy who is an obvious candidate for steroid abuse. It's bad enough that you grunted and groaned like a mad thing when you did your exercises. It's also bad form that you slammed the weights into the stack every time you lifted instead of controlling the machine. But did you really have to move the pin to the very bottom of the stack when you were finished so that anyone coming up behind you would think you were lifting twice the weight you really were? I saw you doing it and I thought "dickhead" then I laughed.

Big white taxi

Something that Paramedics diary wrote here reminded me of a story from one night a few years ago. A young man from one of the outlying towns had been on a night out in another town about 10 miles from home. Had a good night and had spent all his money. Did not fancy a walk home at 2:00 am. So, as his home town had a small hospital with an Accident & Emergency department the bold boy thought it would be a good idea to dial 999 and tell the emergency operator he had taken an overdose. This way he would be taken to his local hospital and could then discharge himself against medical advice - apparently he had heard of it being done and was supposed to be good way of getting home. Unfortunately, what he did not know was that his local A&E department had been downgraded to a minor injury unit and he was brought to us, 16 miles from home. Give the lad his due, he was really giving an Oscar winning performance as what he thought an overdose should look like for the ambulance crew (who were not fooled in the slightest). Kind of spoiled it a bit when he leaped off the trolley when he arrived with us and said he was going home and had only called the ambulance so he could get a lift home. We asked him to sign the DAMA form, which he did, and off he went. Back in 2 minutes asking where he was, when informed that he was in our fair city he demanded that he be taken to his local hospital. It was pointed out that his local hospital could not deal with his presenting problem so he had to be brought to us. Next question was how was he to get home? I'm afraid we laughed a bit and said it was his problem and he now had further to go than when he made the call. He was given the phone and had to call someone to come and get him. I think one of his parents came but he did not let them come and talk to us and I think he told them he had fallen and hurt himself rather than that he was a selfish twat who abused the 999 service.

Nurses Day

A quick post tonight, just realised that it was nurses day yesterday (Monday 12th May), if I had not been reading the blogs I would never have noticed. Far too busy at work to worry about it and did not get a chance to read my e-mail from the RCN until it was all over. I was not the only one, none of my colleagues knew about it. I wondered why the American nurses were making a big thing about getting freebies from their employers - mostly cakes and pens - but hey it's better than nothing and more than I got and they even had a whole week for nurses. All I got was a very busy Monday and the chance to stay on after work for an extra hour as I could not get away on time. Ah well, maybe next year (hollow laugh).

Colleagues and other animals.

Had a young man in the other night with a minor laceration to his hand. Wound was closed and dressed but while he was alone in the cubicle I heard the cupboard door opening. Went in and had a look and there is the lad with a pocketful of tape and alcowipes. We asked him what he thought he was doing and got the usual answer - "nothing". We took the tape and alcowipes from him, he did not even know what the alcowipes were, never mind what they were for. Asked why he had taken them he did not know, they were there so they were his. Now I hate thieves, I really, really hate thieves. I sometimes think that there is a place for cutting off hands, but let's not get into that just now. I had a look in the cupboard and noticed that the needle stock seemed a bit low so I asked him to put the needles back. He of course denied he had taken needles. gave him one more chance - "put the needles back or I call the police". No, he did not take the needles. OK, police were called. To give the chap his due, he did not run off as I expected but hung around the department demanding that I search him - no way was I going near him.
Police arrived and had a word with him and his girlfriend, did a quick search and of course nothing was found. I was called to reception to have a word with the policeman where he informed me of the outcome but then said that the toe-rag was accusing me of assaulting him and his girlfriend was backing up his story. I was horrified, and tried to explain that the last time I hit anyone was 1969 when I was 14 and at school, where just occasionally you do have to hit people. Policeman was all apologetic but said I would have to make a statement and come down to the police station. I can't go anywhere, I'm in charge of this department we are short staffed as it is. then I remembered, we have cameras, surely that would show that I was no where near him. At this point the policeman, my colleague and the reception staff who were listening to this all burst into laughter. B*st**ds!! They were winding me up, the policeman blamed my colleague and said that he had been asked to do it by him and had quite happily gone along with the gag. Must have been a slow night. Not much I can do to the policeman but at least it proves that they do have sense of humour, but my colleague however will suffer, as soon as I can find a suitably dirty job for him to do.