Saturday, February 03, 2007

Friday evening

It was a weird and wonderful shift last night and quite harrowing at times. I arrived just before I started to a waiting room full of patients, which is never a good sign as it invariably means there are a lot of frustrated people as they have been waiting a fair while and last night was no exception.

The first patient I saw was a 12 year old girl with a suspected fractured wrist which she had sustained from falling off a kerb whilst wearing those wheelie shoes. Her father who was accompanying her was rude and aggressive and kept telling me that they had been waiting for nearly 3 hours before they were seen whilst people who had arrived after them had been seen first. I tried to explain that the department was very busy and that his daughter would have been assigned to a triage category reflecting her injury and that patients are seen not in order of time of arrival but in order of clinical need and seriousness of illness and/or injury. The father then blew up in my face and accused me of not caring about his daughter’s wellbeing and suggesting that her injury was trivial. I bit my tongue and said that the girl needed to have an x-ray to see whether her wrist was fractured or not and gave him the x-ray form and told him to make his way there. It turns out that she probably has a scaphoid fracture, but these being notorious to not show up in initial x-rays and not wanting to send her home merely with a tubigrip, when she was exhibiting all the signs of a bone injury not a muscular injury, I have referred her to be reassessed by the fracture clinic next week where they will re-examine her wrist and take another x-ray, by which time if it is a scaphoid fracture the break will show up and I gt her wrist put in a cast as a precaution. I also gave the father and daughter some social advice on the use of ‘Heelys’, in relation to this incident.

The next patient was a more harrowing case. A 24 year old male who arrived on foot with his girlfriend after having a severe headache at the back of his head for a few hours which came on suddenly and was worse than any other headache he had ever suffered before. Now that sentence rings alarm bells at any doctor for a diagnosis of subarachnoid haemorrhage and sure enough he was exhibiting other symptoms; he was nauseated, had vomited, had photophobia (dislike of bright lights), neck stiffness and was becoming sleepy. I sent him off to have a CT scan to confirm the diagnosis, which it did – subarachnoid haemorrhage as a result of a burst berry aneurysum, and on his return put him in resus just in case he lapsed into unconsciousness and made a referral to the neurosurgeon (at a different hospital). The ambulance arrived to transfer him to the neurosurgery department and I discovered a few hours later when I rang to see how he was getting on that he died on transfer to the hospital, probably from the aneurysum rebleeding. Now I know that I couldn’t have predicted this and I did my best but I hate it when things like that happen. Subarachnoid haemorrhages are one of the things about emergency medicine I hate. They are very rare, thank goodness, but tend to affect young normally fit and healthy people and unfortunately there isn’t really any way of knowing who will survive and who won’t.

After that there were the usual Friday evening cases of alcohol related injuries, people having got into fights, the odd depressed patient attending A&E because they felt they couldn’t cope over the weekend and their CPN had gone off duty at 5pm so could they access the duty psychiatrist/crisis team and a few domestic violence cases, one serious and three non-life threatening, all with police attendance.

Then my last patient of the evening was totally bizarre. I would like to say that I thought I had seen most things in emergency medicine and the nurse who assessed this patient had told her “not to worry because we’ve all seen everything before”. Thing is, I had heard of patients like this, I have had colleagues deal with them but I had never treated one. She was referred to me by a male colleague as she was insistent on a female medic, and after discovering her problem I could understand why. She told me that she had been feeling upset and lonely and so had decided to have ‘a play’. Unfortunately she decided that as she was lacking in a vibrator or dildo that she would use a carrot. Trouble was she had got a little bit too excited and the carrot had snapped and whilst she had been able to retrieve half or it the other half was left inside. Normally I would have had a little snigger to myself over this (and don’t berate me for it because I’d like to know anyone who wouldn’t) but she sounded so embarrassed and upset and thought that I’d judge her (she was 58 and clearly thought that I would think that 58 year old women shouldn’t have sexual urges) that I couldn’t even find it that funny at the time, however typing it now I am smiling. Anyway, once I’d treated her and when she asked me my advice (which was to possibly expend some money in Ann Summers) and I’d given her a script for some generic antibiotics (carrots are not the cleanest items) she left, thanking me profusely. In fact as I left my shift she was still sitting outside the department waiting for me to thank me again and she tried to give me £10 as a way of a thank you present but I obviously had to refuse. She also praised the way I’d handled the situation and said the department was brilliant because no one had laughed at her or been cruel about her. I just smiled and walked off, feeling awful because I know the gossip that was going round the staff room in relation to her (that I didn’t partake in) and felt quite appalled that I could laugh about it with colleagues when the patient thought I had acted so professionally.

Another night shift tonight, except it’s a full 12 hour one, let’s hope Saturday night isn’t quite as eventful as Friday evening.


Calavera said...

What an interesting entry! Wow, you really do see some weird stuff!

I kinda feel sorry for the woman, though... What an awful scrape to get into.

But those Heelys... honestly.

DundeeMedStudent said...

just found your blog.

I hope MTAS and MMC go well and you and your man end up in the same country!

Doctor Jest said...

Sounds like a "normal" Friday night in Cas'. Well told though. It's the urethral insertions that always weirded me out, but you seem to be being a little harsh on yourself. So far, despite Tone's best efforts, they can't touch yu for what you're thinking, and a little wry smile now and again only marks you as human. Fact was you did a professional job in a caring manner at the time, and that matters way more than what you think during or after the fact. A job well done say I.

(So glad my A&E days are behind me, although I do kind of miss it sometimes. Then I think back to the Saturday two rival Sikh families took to one another with machettes and the urge seems to vanish as if by magic....)

Scrub said...

Just thought I'd let you know that I've sat and read through your blog (its a hell of a lot better than chemistry revision) & I have found it rather interesting! Keep up the posting as its something else for to use as a procrastination tool!
O, and 'Heelies' may be slightly dangerous but they are pretty cool and Im gutted they don't go past a size 6!

Dr. Deborah Serani said...

Came by for a visit form Angy Medic. Hope your full 12 hour shift *isn't* as eventful!

The Locum said...

I always seem to get the kids with stuff stuck up their noses - faster and less embarrassing, but doesn't get you any respect in the pub.

MJ said...

Scrub - I agree with you on Heelies being cool but I have nearly been mown over so many times by kids wearing them. I am now sick an tired of them.

Dr Jest - machetes??? I'd have found somewhere else to be, asap. The urethral insertions weird me out too, luckily there don't tend to ever be that many.

Cal - I did feel sorry for her too and the worst thing was that she was one of those people who "don't like to trouble doctors" so had hadn't been to A&E since she was about 30 and never saw her GP.

Locum - I quite like kids with things stuck up their noses although it always amazes me as to why kids stick things up their noses. Granted about the pub respect though!

The MSILF said...

Carrots are not the cleanest items? Well, not sure penises are much better...