Sigh...

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!