We Got Rhythm!

I know this isn't pre-hospital, but I just feel I must share something with you:

We had an elderly lady into the hospital, in cardiac arrest. So, she has no pulse and isn't breathing. Unfortunately, there is a tendency for Nursing Homes to call 999 when one of their residents dies, and this leads to a sequence of events, culminating in them arriving at the hospital, only to be certified a few minutes later.

Anyway, we start off as usual, continuing the cardiac massage. We need to compress the chest at a rate of 100 beats per minute, 30 beats followed by 2 breaths. It just so happens that the nursery rhyme "Nellie The Elephant" has just the right rate, and 2 verses makes exactly 30 beats. So, it is not uncommon to see the person providing the cardiac massage mouthing the words to "Nellie" while doing the compressions.

Today, one of my junior doctors demonstrated another song that fits the bill, of 100 beats per minute, 30 beats to a verse. However, while some of you may not think it is entirely appropriate to be mouthing "Nellie the Elephant" while attempting resuscitation, even I balked at the sound of my junior singing, fairly loudly, "Another One Bites The Dust", as she vainly tried to keep this lady alive.

Blood!!

As I lie there, awake, listening to the gentle breathing of MrsRRD sleeping next to me, I marvel at how precious is the time between first and second alarms. I have a whole 10 minutes, just to savour the quiet in the house.

Phil Collins shouldn't be here!! "In The Air Tonight" resounding around the room pulls me from my stupor, as I answer my phone from Control.

I am called to an RTC on the motorway, possibly fatal. I throw on my work clothes (thank goodness I am a slob, and I don't have to go into my cupboard for anything), kiss MrsRRD goodbye ("Did your phone ring?". "Go back to sleep.") and run down the stairs, thinking, Oh well, there goes my morning shower and ablutions.

The journey is easy today - kids off school, roads quiet, but I am stood down just as I approach. I decide that there is no time to return home, and I continue on to the hospital.

I stumble in to the Department, to various comments about the local bum turning up for work. This prompts me to a caffeine fix (well, NHS tea) and a decision to use the "value" razor I have in the office for just such an occasion.

There is no mirror in the loo, and I run the blade over my lathered face by feel, rather than sight. Ouch!! That's a small nick under the left nostril. Must remember to utilise the well-known haemostatic agent close at hand to that area when I'm done - wouldn't want to get any blood on my shirt before work!

I leave the makeshift bathroom, and go to my office for a 5-minute break. I have a mirror on the outside of my door (don't ask - it was there before I joined) and I look in horror at my ravaged face and my blood-spattered shirt. The blade has done a very nice job of removing all the stubble from my neck, along with most of the surface skin!! I look like a victim of the Barber of Seville!!!

Ok, regroup!! The blood on my shirt is only a few minutes old, and I know that washing in cold water will remove it. So, it's back to the loo, and, shirt off, I start the painstaking job of soaking and scrubbing the collar.

5 minutes later, and the shirt is clean, the flow of blood is (virtually) stemmed, and I am ready for work.

One problem - soaking wet shirt.

Another problem - meeting in 5 minutes.

Solution - wear shirt, put electric heater on, and make self-depreciatory comment about surgeons and blades!!!

Mornings

I've decided. I'm not a morning person. Especially 3am. That's not really morning, is it? That's still night time, isn't it? Ok, then, I'm definitely not a night-time person.

This is an unusual comment to hear from a chap who regularly jumps out of bed at 3am, drives at ridiculous speeds, and makes life-altering (hopefully -saving) decisions. I do all of those things, and, I hope, do them rather well.

What I find difficult is biting my tongue. When well-meaning, worried family members ask me questions in the middle of the day, I try hard to alleviate their fears, empathise with their need to know, and help them deal with the difficult decisions that are being made around them.

At 3am, when I am asked if a drug I am considering using to sedate a man to help get him down a steep set of stairs has any side effects, I answer "Yes, but they're better than just leaving him here all night." Not the most empathetic comment I have made in my life.

But it could have been worse. When same family member asks me if the neurosurgical centre I have chosen for their beloved is the best choice, I don't say, "no, I just chose it because it is near to where I live, and I'll be able to get back to bed quicker." I simply say, "yes."

Maybe I can cope with 3am's after all!

Nothing to do all day!

I've had nothing to do all day today. My nothing started at 5am, with a call to an agitated man, collapsed as he got out of his bed. The team were unable to get him down the stairs, because he was thrashing about too much. By the time I arrived, he was quiet, and easily transported down the stairs. I didn't help the crew this time... I decided to follow behind the ambulance to Local Neuro Hospital, just in case. Nothing happened

About 6 this evening I was just getting ready to go home, when I am called to a stabbing near by. He had been stabbed in the chest, and was in the back of the ambulance before I arrived. The crew were happy to wait, and I travelled in the back with them on the way to Major Trauma Centre, just in case. Nothing happened

I got home about 8.30. My new cat was waiting for me (more about him in another post), and so was my family and my dinner. About 8.35 I get a pager for an RTA not all that far away. I couldn't not go. After all, that's what I do. He had been thrown from the car at high speed, but seemed reasonably ok. I decided that, since we were only 5 minutes away from Local Hospital, I would travel in the back, just in case. Nothing happened.

I'm home now. Please let me have my supper!

I Hate You

You make me sick!! You think it's ok to go to the pub, have "a few" drinks, and then get into your car. You think it's ok to then drive like a lunatic, so hard into a parked car that you shunt it 20 feet.

THAT COULD HAVE BEEN A CHILD!!!! That could have been MY child!!!

And then you stand there, saying that you got unlucky, because you got caught.

Unlucky would be running someone over, or hitting a car with people in it. Unlucky would be driving into a bus shelter, with a queue of waiting people.

So you are going to lose your licence. Big deal! You should lose more than that, and, if I had my way, I'd be at you with a scalpel blade to your rather needed parts.

But instead I have to be polite, treat you like a human being, rather than the animal you are. At least I get to hand you over to the waiting police.

Phew!! That feels better - back to work.

Confidentiality Revisited

It's tough, you know. However hard I try, whatever I do to maintain confidentiality, events continue to conspire against me. People know people. My community is small, and my patients have family. Family have friends. And the friends read my blog. No matter what I do to try and change the facts, the facts are still there, in some form or other. And that means I am taking a risk, every time I write. For every one of you who lives so far away that the stories are just stories, there is another of you for whom these stories are ever so real.

And what does it matter? Well, I try so hard to include only enough reality to make the stories real to you, Constant Reader. I ensure that any medical information is couched in such terms as to negate the breach of confidentiality that these tales perform.

But, what if it were your kith or kin that were written about? What if you knew that what was written was at best inaccurate, and at worst a fabrication, would that matter to you? I am, on occasions, a little irreverent. How might it feel to you, reading that, at least I had gained a pair of scissors while attending to your loved one, injured so badly in a car accident that he lies between life and death on a hospital bed?

I don't know the answers to these questions. Maybe soon I will. Maybe the family of the lady I wrote about in "Scissors" will tell me. And, maybe, their words will bring this blog to an end.

You see, I write how I feel. And I cannot change the way I feel. Without the humour, the irreverence, I would not be able to cope with the endless sea of nameless faces.

To all of you out there, to all the families of those I have saved and those I haven't; please forgive my breaches, my fabrications and my irreverence. The patient is always first and uppermost in my mind, both at the roadside and at the keyboard. If you cannot forgive, then please try to understand.

Odd

I've just come back from a job on the M25, and seen I'm wearing odd boots. One's a Caterpillar, and the other's a Magnum. Funny thing is, I've got another pair, just the same, in my car!!

Goodnight!!!