Think of me fondly

Finished my shift at 10:30pm last night.
Went to bed at 11:00pm.
Obsessed about patients until midnight.
Slept.
Woke up at 2am, 3am, 4am.
Alarm rings at 5am.
Haul self out of bed.
Gotta go for my interview now.
6 hours train journey there. 5 hours back.
Wish me luck.

Innocence lost?

It's early in the afternoon and I'm working on the paediatric side of the department.

For some reason, the other junior doctors tend to avoid this side like the plague - because they tend to get trapped in the land of unreasonable babies and crying parents for hours. I don't mind hanging out in Paeds - it's fun and I get to watch cartoons.

Whilst I'm waving goodbye to a giggling 6 year old with tonsillitis, the nurse hands me with the notes of the next patient - a 13 year old boy, accompanied by his mother.

Breezing into the side room with a bright smile and a "Hi there!", I'm greeted by a red-faced lad with an equally red-faced mother.

"So, how can I help you today?"

The mother's cheeks take on an even more brilliant shade of vermillion and she gestures towards her son. Her voice seems to have gotten stuck in her throat but she manages to gasp, "Son, tell the doctor what's happened."

The boy, ruby skinned, gives his mother a stricken look and looks at the floor, mumbling something about a pain in his leg.

So I'm asking him the usual questions about leg pains - when did it start, what does it feel like, can you still walk - when the mother (whose countenance had gone through several marvellous shades of magenta) suddenly blurts out, "It's not his leg that's paining him, it's his winky!"

I swear the word "winky" echoed down the corridor and took 3 minutes to stop reverberating round the room.

Meanwhile, Tomato boy is giving his mother the Look of Eternal Damnation. Smoke is beginning to rise from tips of his scarlet ears.

I take a few steps backward. Spontaneous combustion is about to occur in this room. There's a fire extinguisher next to me. I grab hold onto it for support.

Then I smile at Tomato boy and say, "If you want I can ask a male doctor to come and see you, if that is what you prefer."

Tomato boy shakes his head, still glaring at his mother. His voice has been blown away by the gale force wind that is his blabbermouthed mother. He'll never forgive her, never!

So I smile at him, then put on my most expression-less professional mask, and get to work.

It transpires that he was having a shower and was paying attention to his (ahem) delicate areas and then certain flaps of skin got stuck and wouldn't go back and then everything swelled up and now it really really hurts a whole lot.

I examine him (much to his mortification) and then reassured him that his nether parts were in no danger of falling off. Then, with the help of some ice and some painkillers, I managed to restore him to his original appearance (much to his great relief).

As we're waving goodbye to them, my nurse turns to me and says, "Well, that's a hand job he won't forget. And in front of his mother too."

And my face flamed.

And again

I have an interview on Friday at noon.

At a city that is 6 hours away from here by train.

And I'm working the twilight shift on Thursday so I can't go up there early.

I hope I get the job.

Gifts

I've finished completing 130 exam practice questions. My head is spinning and my lips are dry. An empty glass sits at my elbow, and I realise that I've only had one glass of water since breakfast.

Checking the clock, I realise it is close to lunch time now, so I fling some stuff in a pot and turn on the stove. I also fling some laundry into the machine.

The house feels bigger than usual - MDH is on night duty at Faraway County Hospital so he is staying there for the week. It is a good plan, because it means that we will both spend our free time studying instead of snuggling. But I am missing him. It has been three days since I've heard his voice.

My eyes hurt from reading too much small print. As I wait for my food to cook, I lay back on the sofa and shut my eyes, listening to the slosh and hum of the washing machine.

Then suddenly, MDH is here. He comes home bearing gifts - a bag of Basset's jelly babies in an assortment of sugary flavours, a dozen blueberry muffins, a box of Lindt chocolate truffles and a warm hug.

He's asleep now and I'm in the living room, getting ready to tackle another set of exam revision questions.

I may return the last gift he gave me, later.

Tuesday Grand Rounds

Grand Rounds are up at Dr Crippen's - do have a peek!

My personal favourite is Emergiblog's Hitchhikers' guide to the Emergency Department.

Proof of love

I have to renew my UK visa in a few months time. At present, I hold a visa for 'limited leave to remain' that is 2 years long.

I can apply for a visa for 'leave to remain' that allows me to stay in the UK for an unlimited period of time but first I must prove that I am still married and that I still live with my husband.

In my house I keep a file containing an assortment of documents to prove that my marriage is real and lasting.

It's almost insulting.

My tongue

Okay, this is an extension of my previous post. I was going to write about it earlier, but I needed some time to really think about it.

When I was looking after that lady who collapsed, I had about 30 seconds to assess her, in the presence of her relatives, before further help arrived. In fact, one of the patient's daughters was still holding her in her arms, in order to stop her from falling to the floor. Her other daughter and grandaughter stood behind me.

I saw her take only ONE breath during this time. One breath in thirty seconds is not a good sign.

I said out loud, "She is still breathing." This was a lie. One breath is not "breathing". And I could also tell that it was not an effective breath.

I was also feeling her pulse which stopped *whilst I was feeling it*. I remember thinking at the same time that the patient's daughter was still right next to me. I could feel the eyes of the other relatives on the back of my neck.

And I said out loud, "I can feel a pulse." This was also a lie.

I lied twice. Why? Why? Because I didn't want to alarm her family? Because I didn't want them to panic? Because I was 'buying time' until I had more help, more time to think? Because I didn't trust my hands? Is that a good excuse?

We had to pry the daughter's hands off the patient. She was in shock - she nearly fainted. The grandaughter became hysterical and started to scream. This happened because my registrar and two nurses ran into the bay, and the registrar immediately said, "There's no pulse, get her on the trolley."

The reason why I wrote the previous post was because I felt really bad, not because I had lost a patient, but I had lied to her family. And in doing so, had I wasted precious seconds in dealing with the patient? I could have started CPR twenty seconds earlier, and it may have made a difference.

What have I done?

I must watch my mind and guard my tongue more closely.

My hands

Today I helped an old lady to get onto a commode, but before she could get there, she collapsed.

I caught her as she fell and laid her on the floor.

She gasped once.

I called her name.

No response.

I put my hand on her neck to feel her pulse. It was fast and thready. Getting faster and faster.

And then it stopped.

Her two daughters and her granddaughter stood behind me and I told them to get more help whilst I started CPR.

She died.

Who am I?

So I was playing around with this face recognition software (via mr brown) last night whilst trying to avoid revising genitourinary medicine (who wants to read about syphilis when there are so many exciting things to do online!). It scans photos and compares them with a database of thousands of pictures...apparently it can be used to trace one's heritage - but it's much more fun to see which celebrity figure one resembles.

I uploaded a photo of mine that I use on my curriculum vitae.

It came up with the following matches:

Sammi Cheng, Zhang Ziyi, Judy Garland

and I thought to myself, well, so far so good (preens).

And then it came up with this:

Michael Keaton

And I thought, EEARRGGHH!

MDH wanders along and he looks at the photo of Batman, and looks at me and says, "Yeah...you do kinda look like Michael Keaton!"

*smack!*

So I upload a photo of MDH, run the programme and it comes up with:

Sean Bean, Matthew Perry, Colin Farrell

MDH grins at me and says, "I always knew I was the pretty one."

*smacksmack!!*

(pause)

*smack!!!*

And then we turn back to the computer screen and see:

Gandhi

Heh heh heh. A 71% match.

Beware the little old wrinkly bald man, I say.

The bluebird as she sings

It’s a Sunday afternoon.  

I'm sitting on the window seat, leaning against golden cushions and wrapped in a dark red blanket, holding a book.  The words of the book are fading to a pale blue wash in front of my eyes, reflecting the pale blue sky outside which is etched with white.  I run my fingers along the cream coloured fabric of the window seat as I contemplate the scenery.  

The rustling trees are orange and bronze.  I look down and see a black and white dog running joyfully over the grass, barking, chasing butterflies.
 
Getting up, I leave the book on the window sill and walk down the stairs, one hand trailing down the wooden banister feeling the dents and imperfections in the wood.  I stop to readjust a picture that is hanging crooked on the wall.  Whilst I'm contemplating the peacock blues of the painting, I hear a sound coming from the living room.
 
I walk into the living room to investigate.  It is fragrant with the freshly baked smell of chocolate cake, and I can see one cooling in the kitchen from where I stand.  A vase of red tulips stands on a table covered in a white tablecloth that is edged with leaves.  The carpet is soft beneath my feet, with a faint green geometric pattern on it. 
 
Kneeling in the middle of the carpet is a child about a year old, holding some building bricks in her hands.  She has dark brown hair adorned with a yellow ribboned hairclip and is wearing a caramel jumper underneath denim dungarees.  She is singing a song about rainbows and her clear voice fills the air.  MDH is sitting on the sofa watching her, and he turns to smile at me.
 
My eyes fill with tears as I realise that the little girl, the house, even the dog outside are mine.  Ours.
 
I blink and it is all gone.  In front of me is my revision textbook, and I am lying on the sofa in my living room.  My cheeks are still wet with tears.  Maybe this day will come, maybe not.
 
I am a daydream believer.  Are you?

Stupid people

A 38 year old gentleman has been diagnosed with an aggressive cancer of the bowel which has spread to the liver. A week ago, he was playing tennis with his children and swimming laps in the local pool. The surgeons have told him that the cancer is not operable - and since he is otherwise feeling well, he has been sent home.

He comes into hospital because his liver is beginning to give him problems and he is now swollen with fluid and looking very unwell. The anaesthetist comes to assess him, and he responds well to aggressive treatment...but the anaesthetist decides that he is unsuitable for the high dependancy unit.

I don't care what anyone says. A diagnosis of cancer is not an instant death sentence. Just because somebody has been diagnosed with cancer is not a good reason for me to dust my hands off and say "well, he's going to die anyway so what's the point?".

Studying

I think the post title speaks for itself.

I hate exams.

Grand Rounds again

This week's Grand Round is being hosted by GeekNurse with the theme "Glass half empty, glass half full". My submission has made it to the 'Best of the Week'! Yay!

What the...?

WHY?????

*weeps in despair*

(discovered this website via webpagesthatsuck.com)

Updates from the bowl

So the Betta splendens that we bought for our fishtank turned out to be a real killer that seemed gentle by day but spent its nights stalking and terrorising the Neon tetras. We did toy with the idea of keeping him in a separate tank on his own, but decided against it. After all, he had already earned the nickname 'Rasputin' from his evil deeds.

MDH and I figured that the betta would be better off if he had an owner who would love him and care for him and give him a friendlier name - so away he went, back to the fish store from whence he came.

In exchange, we now have four very lively, very zippy Zebra danios - golden with purple-black stripes running lengthwise. Three of them are frolicking in the bubbles, playing tag with each other at the top of the tank. The fourth is slower and spends most of its time rooting around for tidbits at the bottom of the tank (it's been doing this since we bought it...I'm beginning to wonder if it is sickly). They seem to get along fine and dandy with the Neon tetras.

We have also introduced a male guppy into the tank. He is a striking combination of metallic blue and orange, with a fiery tail fringed in black. He patrols the tank like a little helicopter and has established himself as the king of the fishbowl. The Zebra danios attempted to harrass him in the beginning, but he scared them off by displaying his fins and then beating them away with his tail. Fiesty. I have named him 'Rocky' (MDH thinks that it's for the Sly Stallone movie, but really, I've named him for 'Rocky Horror Picture Show' because guppies, you know, they are such showoffs.).

We'll see how this pans out.

My little runaway

Never lie to the doctor.

She was beautiful. Tall, svelte, with brassy gold-streaked hair. Milky skin with a blush of rose and the odd tiny brown freckle. Turquoise-centred eyes that melted into chocolate at the edges, shot through with flecks of sunlight. She spoke english with a french accent. She was only 15 years old.

She had swallowed a small peanut in a piece of candy and was known to have terrible allergic reactions to peanuts in the past. Her adrenaline pen was left at home in France. She had vomited up the offensive peanut and although she felt perfectly well, she had insisted on coming to hospital. A wise decision.

Sitting with her was a young man in his mid-twenties. He had a dusty moleskin coat on and a disarming smile. His dark hair was unruly, and curled over his forehead. He had a dimple in his chin and laughter creases at the corners of his grey eyes. In his hands, he held Miss Peanut's passport. He was a trucker. He drove a container truck and Miss Peanut had accompanied him from France. They were due back in France later that day.

He said he was her father. Not a wise decision.

Never lie to the doctor.

Whilst the nurses were busy administering the treatment I had prescribed, I went round to speak with one of my seniors who immediately alerted child protection services.

Were we dealing with human trafficking? Was Miss Peanut a victim of kidnapping or sexual trade or a runaway? Who was this trucker-father and was sort of goods does he deliver? If they absconded from the department, would we have to alert the police?

The wheels were set in motion. My seniors and the nurses were patting me on the back for making such shrewd observations and red-flagging this suspicious situation. I felt like a hero. I was going to save Miss Peanut from a horrendous predicament! It was the best of days! This is why I became a doctor - so that I could help people!

Two hours later, Mr Trucker was beginning to get nervous. They would miss their ferry in Dover if they were delayed any further. I explained to them that they could not leave because we needed to keep them in 'for observation'. I asked again about their relationship. He admitted that he wasn't her father.

He was her elder sister's boyfriend. He had thought that by lying about their relationship, it would make things easier for the both of them.

I asked Miss Peanut to call her parents in France, who confirmed that they knew she was with Mr Trucker and had given her permission to travel alone with him.

I discharged Miss Peanut there and then, feeling like a total idiot.

Champion to chump in under 10 seconds. A free-falling record. It was the worst of days. I did not become a doctor so that I could be a bumbling fool.

Never lie to the doctor.

Doctors are in a position where we can do alot of good, but we can also screw things up royally if acting on the wrong information. So be careful what you tell us. We just might do something about it.

Ah-choo

I spent three days working in the paediatric section of the emergency department, letting kids drool on my hands and sneeze in my face and wipe their snotty noses on my scrubs, and this is the thanks I get???

*dramatic snozzle blowing*

Now, if you'll excuse me, I'm just going to crawl into a dark place and whimper softly to myself.

Grand Rounds in the Emergency Department

I've made it on the Medical Bloggers' Grand Round again! Yay!

This week's Grand Round is being held at Emergiblog. Lots of great stories, lots of great writings - and you get a tour through the Emergency Department from triage to admission. Do hop on over and check it out!

LingGlass

Looking at these beautiful stained glass pendants made me feel so much better. LingGlass has been designing and making her own jewelery whilst being a full-time mom! Way to go, girl!

I really love the swirly soldered designs and the vivid colours of the glass.

Grrr

I hate cars.

Grrr.

I'm going to release my frustrations by playing 'Tomb Raider'. Maybe I can get Lara to swan dive into some lava or something.

Bad weekends

Things that have gone wrong this weekend:

1. The car broke down. At 11:30pm at night. In the middle of a dark forest with no lights. And it was snowing. Aargh.

2. It took 2 hours to get a towtruck to come. Meanwhile, it was snowing. At 1:30am. Aargh.

3. Towtruck towed the car back to the nearest garage. Which is an hour's drive away from home. And it was snowing. At 2:30am. Aargh.

4. Slept in the doctor's mess at the hospital (towtruck driver kind enough to give a lift to the hospital). Had 4 hours sleep, in cramped armchair. Aargh.

5. Talked to mechanic. Engine will probably have to be replaced. Something about holes in the oil sump and no oil in the engine and driving a car with no oil. Aargh.

6. Took the train home. The train broke down too. Replacement bus service took two hours. Aargh.

7. Took the bus home from the train station. The bus also broke down. Walked 80 minutes to get home. Blisters on feet. Aargh.

8. Had to rent a car in order to get to work on Monday. All the nearby car rental shops closed over the weekend. Aargh.

7. Found a rental car place in the next town. £150 a week. Aargh.

8. Parked rental car in my resident's parking lot. Realised that left resident's permit discs in car at garage. Aargh. Left a note.

9. Rental car clamped. £150 to release. Aargh.

10. Still had to go for work this evening. Aargh. AARGH.

Outer calm - Inner Stress

Prancing into the A&E department, I arrive at the same time as one of the other junior doctors. We are both starting the shift together.

I have chosen to pull my hair back in a tight ponytail - instant facelift and frozen grin. I feel ghastly though, having had a very long and eventful shift on the previous day which led to my having a very long and sleepless night. The other junior doctor has chosen to accessorise herself this morning with a ghostly grimace. She looks exactly how I feel - Totally Washed Out.

The middle grade doctor peeks round the door of the staff room, where the two of us are bracing ourselves for the Friday Morning Rush with cups of tea fortified with extra sugar. He flashes me a smile and tells me to start my shift in the resuscitation room. He turns to the other doctor, pats her on the back and says, "Well, I heard that the night shift was pretty tough - you should be getting on home soon..."

I quickly duck out of sight, so as to avoid the flying daggers.

Man, if I tried to look exactly how I felt sometimes...my patients would die from the horror of it all.

Note to self

Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died
(Was there anything more I could have done?) Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died Do not obsess over patients who have died

Lost and found

It was a relatively quiet night, and the lights in the bays of the Observation Ward were switched off. The patients were resting in their beds - some fast asleep, some snoring, some shuffling discontentedly under the covers (those hospital beds can be so uncomfortable).

I was sitting at the nursing station looking up test results on the computer during my break. The nurses, I noticed, were looking tense this evening and were growling to themselves, pacing the floor like bears in a cage. One of the nurses was repeatedly opening and closing the toilet door. Another one was walking round in circles within one of the bays.

Just as I was putting my hands above my head and backing away slowly towards the door, Chief Staff Nurse walked in behind me, muttering to himself something about leaving for one minute and everything falling apart.

"What's up, Chief Staff Nurse?", I said, trying to look nonchalant.

"We've lost a patient."

"Oh," I put on my most sympathetic doctor-face, "That's very sad. Are you alright?"

He glared at me. "No, you patronising twit. We've lost a patient. She's run off. Can't find her anywhere. Got the police looking for her now."

"What?!"

Chief Staff Nurse rubbed his furrowed brow with meaty fists. "Ugh, it's cold outside, she's quite elderly and quite confused, she hasn't taken her clothes with her, just hospital pyjamas."

I clasped at my head in horror as visions of streaking grannies flood my mind, all cackling merrily whilst mooning passing cars on the motorway.

Chief Staff Nurse glared at me again. "No, you idiot. She might get hypothermia and die!"

I looked at him in shock. Did I say anything out loud?

So...I agreed to help out. We turned on the lights in the Observation Ward in a last, desperate bid to find elderly Mrs Moon.

The patients yawned at me loudly and angrily, whilst I looked round bay 3. Mrs Moon's empty bed was in front of me, lovingly decorated with plastic flowers and pictures of grandchildren. In the corner of my eye, I saw a flash of something fluffy and polka-dotted. There it was, just peeking out at me from under the next bed - Mrs Moon's fluffy polka-dotted bedroom slippers, with Mrs Moon still attached.

"Hello Mrs Moon," said I, crouching down to look under the bed, "Whatever are you doing under there?"

I am met by a pair of tear-filled hazel eyes. A tremulous voice replied, "I'm hiding. The nurses, the nurses are trying to kill me. I tried to run away, but I'm can't walk very far..."

As it turns out, poor Mrs Moon was in the same bay as Mrs Chronically-Painful-Hip and Mrs Mildly-Dehydrated. Mrs Chronically-Painful-Hip had woken up and forgotten all about her painful hip and tried to get to the toilet and collapsed, screaming. At the same time, Mrs Mildly-Dehydrated woke up from a terrible nightmare, screaming.

The nurses had rushed round to help them out, whilst Mrs Moon, awoken by the commotion, observed the nurses surrounding the others who were obviously screaming in anguish. Horrified, Mrs Moon tried to make a quick (or rather, not so quick) getaway.

Chief Staff Nurse arrived and patted me on the back. And I watched as the nurses crowded round the bed, trying to coax Mrs Moon out with sweets and toys. The whites of her eyes showed, and she shook and shook her head, trembling all over in fear.

I walked back to the main department, not sure whether to laugh or cry.