Thursday, June 08, 2006


I have just got back from work, and am wondering how I am meant to sleep when it looks so gorgeous out there. The department was rammed last night, and so hot, even I was nearly melting in a set of scrubs (how elegant they are).

I felt very sorry for the poor old dear who had been brought in my ambulance and her daughter had wrapped her up in a big fleecy dressing gown to "keep out the cold", the paramedics had then put a blanket over her (they always seem to put a blanket on you, do they not realise that the NHS can provide sheets) and then the nurse who had signed her ambulance sheet and put her in a bed hadn't taken either her dressing gown or her blanket off. Said nurse then decided to run through a set of observations (vital signs; things like temperature, blood pressure, pulse etc.) and hurriedly ran across to me to exclaim "I'm a bit worried about the patient in bed 3 as her temps running a bit high". I wouldn't have minded this if she had been extremely pyrexial but her temp was 38.4C, a little high but could possibly be down to the fact that she was wearing enough clothes to go on an Arctic expedition in a hospital that had a more sub-tropical theme to it. My advice? Take the blanket and dressing gown off, put her in a gown and cover her with a sheet, if that doesn't make her feel better in about 5 minutes go and get a fan. The nurse's comment "gosh, I would never have thought of that" in a very sarcastic tone. Well don't ask my advice if you know, I mean I have got other things to deal with.

The patient I was actually dealing with was a 19 year old first year university student (studying something obscure) who was convinced she had failed her first year exams, convinced her parents were going to stop funding her if she got below a first or 2:1 this year adn had swallowed a large amount of painkillers, antidepressants (her own she claimed, but then then also claimed she didn't have a history of depression) and anti-histimines. She was found in her room by her boyfriend who bought her into A&E and then proceeded to berate her at triage and dump her. Good timing. I tried to pick the pieces of all of this up with a girl who won't talk to me, and even if she would she was crying so much she was nearly hyperventilating. She's promptly throws the activated charcoal across the room at my colleague (who has been working for about 15 hours at this point due to a staff shortage) and he doesn't take kindly to having things thrown at him and goes over to "have a word with her". She then decides to run away, hide in the toilets and is found crying in the corner of a cubicle having smashed a mirror and is slicing her arms with the remnants.

We (the nurse who found her and I) got her back into a cubicle, calmed her down, got her to drink the charcoal and ran the necessary blood tests and ECG. They all came back normal/slightly abnormal. She was a bit tachycardic but then she was in an anxious state so the rapid heart wasn't so much of a problem. However, we did still want to keep her in until later today either on CDU or a general medical ward. Trouble was CDU was full and none of the general medical wards would admit her unless she had a medical problem that needed treatment/observation. Time to call in the psychs as she obviously was about to be discharged and I didn't want to send her home without an assessment. Along trot the Crisis Resolution Team (we no longer have a duty psych, we have nurse led 'teams') who carry out the necessary paperwork (i.e. tick boxes 1-18, fill in questions 19 & 20 etc.) and declare that my patient (who is acutely distressed, has run out of the department and been found actively self-harming) is at no risk to herself and is not likely to self-harm again! I couldn't believe it. Anyway, we pushed the boundaries and she's being kept until midday on CDU.

Another fun filled night and now I am off to bed. Goodnight!

Tuesday, June 06, 2006

Summer Nights

I am on a week of nights this week which I don't actually mind. I hate nights in winter when you arrived at work in the dark and leave work in the dark and because you're working in some goddamn awful NHS hospital (and I note proper 'old style' NHS hospitals, not a new fancy PFI one which looks more like a shopping centre) which has very few windows and ghastly flu-tubes meaning that you never get to see any daylight. No, working in the summer is quite pleasant as the hospital has cooled down somewhat (why do NHS managers seem to think that simply because 'it is a hospital' do we need the heating on when it's 23C outside) and you see some daylight.

Most of the work is the same... alcohol related, poisonings, collapse from unknown cause, etc etc etc. However, you do get to see some different types of patients, such as those with heat stroke or surprisingly there tends to be an increase in the number of poisonings by illicit drugs, so I was relieved to find this article from the 'New Scientist' which clarifies my thinking. Obviously, you see more alcoholism related injuries/illnesses which occur from people sitting outside in the sun for lunch, having a few drinks and then deciding that they can drive home/return to their manual job/construct a garden shed. Also, more dehydration and self-neglect as elderly people (in my observations) don't go out when it is hot, and therefore do not stock up on food etc and it is startling how many say "well my daughter-in-law was meant to go to the supermarket yesterday for me but she rang and said she didn't because it was a nice day so she was going out for a drink with her friends from work". Members of the public, sunny weather does not mean you can neglect your duties, whether this is collecting food from the supermarket for mother-in-law, leaving your kids in the car for "just 5 minutes" whilst you chat to a friend (with no window open and in direct sunlight), doing the same with your dog or neglecting to apply suntan lotion to your child who is about to spend all day outside on a school trip and will come back with very nasty burns (although I sense the teacher should have had some input there, but now I remember that teachers are not allowed to touch children anymore so the child suffers severe burns, dehydration, heat stroke and ends up in A&E... bureaucracy gone mad!).

On another note, I will soon be unemployed in August and have just been informed by my darling fiance that he is moving South with his job (surgical registrar). Currently we both work in the North, me in a city and him in the country, but we are to move. He is an army medic and therefore has to work where there are MDHUs and so we have been told where we are going. I have just had a quick look on the NHS Jobs website and there are a couple of job opportunities that look promising, both Registrar posts in Emergency Medicine. They are both under the scheme where you train 'on the job' for 5 years after being qualified for 3 years and having been considered to have had enough training in a junior role to undertake a more senior role and senior training. I guess I'll have to start applying!

Thursday, June 01, 2006

Public Health Announcement

I have a few words of advice for those of you wishing to conduct 'Do It Yourself' projects over the weekend. This comes from my observations over the Bank Holiday weekend of injuries people have caused to themselves.

1) When a set of instructions says that the project requires 2 people, it says this for a reason. This is probably because a wardrobe is a heavy item and one person cannot support it. I don't want to see more people with crush injuries and suffocation from a wardrobe falling on them.

2) Do not walk around the house holding a battery powered drill at a 45 degree angle to the ground (i.e. straight out in front of you) and still have it switched on. The likelihood is that you may bump into someone when you turn the corner and the drill bit will penetrate their lower neck (not pretty).

3) Never think it is a good idea to hold screws/nails/pins inbetween your teeth until they are needed as they can go through your tongue and cause a lot of bleeding. Plus the Max Facs doctors will not like you for it.

4) Place the ladder on a hard, stable surface and not near steps. Ladders have a habit of moving backwards slightly when weight is put on them and if you placed your ladder at the top of a set of stairs, hey presto, you just fell down the entire flight and broke numerous bones in your body.

I think that's it for now. In all fairness, just show some common sense.