Wednesday, July 30, 2008

blue light, part deux

There I was sitting at the back of the ambulance - the only time I was actually chilled, after a really busy night drawing up drugs, chasing up blood results and doctor referrals. Then there’s the most challenging bit, I think. Reassuring family at bedside. You wouldn’t send a family home when there is a possibility of ‘movement forward’ to another facility, need for involvement in a significant decision making process and quite possibly termination of therapy if deemed futile.

I felt weird (I always do, anyway) that there I was running around pushing drugs and fluids to preserve or keep organ function stable and restoring a family member’s confidence every time the machine beeps, but at the same time painting a rather bleak picture as quite often, it is better to offer little or no hope to prepare them for any negative outcome. You would have to continuously assess the family's emotional stability and intellectual capacity to understand the situation obviously.

It is during these times (early morning) when Consultants are hard to come by and decisions become really slow. The family have also decided to go home at this point which I thought was fair enough since they were practically up the whole night. We haven’t heard from the London hospital and dispiritedly, I was looking after a patient with a very unstable blood pressure and not blowing off his carbon dioxide despite of all the tweaks done on the ventilator. A high CO2 concentration on a head injured patient is basically, a ticking time bomb.

So I was quite happy that by six in the morning, we were whizzing our way to London. I didn’t mind that I had to catch a syringe flying in my direction from an ever so sprightly young doctor who can’t be bothered with her seat belts. These things happen. Once not so long ago, it was a sickie bowl.

I phoned up the patient's wife explaining to her that they might place a bolt through her husband’s skull to monitor the pressures inside and they may or may not operate on his brain depending on the degree of the damage. And that he may or may not survive the operation. I really felt sorry for her and she was really grateful for all the care and the honesty. I have omitted that part where we ask if the patient is on the organ donor register.

I apologized extravagantly when I handed over to a colleague. I know, I passed the buck.


Saturday, July 26, 2008

blue light

Still couldn’t sleep after one yet long graveyard as I clocked two hours more than my 12 hours shift last night. Good thing it’s my day off and it’s a lovely Saturday morning. Which doesn’t make any sense really as any random week day is fantastic as long as it’s my day off, to be quite honest. Well, aside from the fact that Subway’s £1.99 ‘Sub of the Day’ today is beef. I have to say it’s a greasefest already equivalent to my one week calorie requirement, but what the hey. It’s all about the jalapeños, baby. And I had zero calorie points last Saturday to make up for.

Grilled scallops with carrots and asparagus. Not so sure about the caviary pink fish roe mess though.

The reason for the two hour delay trip to the ever so lovely land of nod was the fact that by six o’ clock this early dawn, I was sitting at the back of the ambulance with all the liquids – what remained of the uninteresting shabby cuppa tea swirling in my gut space as it blue lighted (I would imagine more than 90 mph) it’s way off the motorway to London. I had admitted a patient from Accident and Emergency last night – a 60ish gent with subdural haematoma and cerebral contusions according to scans taken off his head.

A proper Level 3. Score we give to intensive care patients depending on how many organ failures they have equivalent to how often you have to run round the store cupboards like a headless chicken rummaging for wires and monitoring equipment to keep you interested.
Quite often the gizmos work, but other times they just become random number generators producing randomly generated algorithms i.e. the machine is telling you that patient is really dry and needing lots of fluids when obviously overloaded. Sorry Asimov, but sometimes Artificial Intelligence is just shite.

To be continued. I got a party to attend to this evening.


Wednesday, July 16, 2008

back to reality

I’ve just been back from my holidays and even though I’m still struggling with jet lag and physical unease from exhaustion, I went straight back to four straight twelve hour shifts last week that I feel the need for again, another two weeks holidays. Back to life and (trying hard not to make it sound like a sing-along) back to reality.

No more lobsters in England!!!
I’m quite sure there’s a cheesy pop song like this one in the early nineties. Work as usual is pretty much as dull and boring as the weather. Since coming back, I have only just looked after bog standard post-operative patients monitored overnight, woken up the next day, extubated then discharged to the wards.

Kayaking is not for the fainthearted quite literally. You can flip over and you need at least half an hour of cardio warm up before you step inside the lithesome vessel.
I wonder if patients with complicated problems which we often think are more interesting also go on holidays. Say, somebody with Addisons disease that had been going on for years undiagnosed could be admiring the works of Gaudi in the quirkiest streets of Barcelona until he/she has a crisis. That’s a pretty morbid thought and not a very good example, so I will slap my wrist and change my topic. Of course, patients that actually get better are way far more interesting and rewarding.
My holidays went really well. I enjoyed the picnics and the barbecues.

Soaking up magnificent late afternoon sunshine petting the maple leaves as barbie gently sizzles in flame.
That’s Canada. Quite simply, the most glorious place on Earth.
They get really stroppy when you disagree. Next they’ll be telling us all evil villains are British and a bald head really is a solar panel to energize the brains.