Wednesday, September 17, 2003
Casualty has felt very much like... ER these last two days.
First a trauma at the end of my shift; my consultant quite literally picking me up bodily by both shoulders to plant me gently to rest within Resusc, with the gentle but quite incontrovertible suggestion, "you are going to see this trauma". (complete with hypnotic eyes)
Young male motorcylclist, travelling at speed, sideswiped off road into unsympathetic tree.
He comes in and looks, well, dead. (Almost vegetative, after his head-to-tree experience) Unresponsive, GCS 3/15, b/p 90/40 but falling rapidly. Minimal respiratory effort. There's blood coming out of his nose in a trickle and his arm in nasty spurts as the anaesthetist slams home the tube without any meds. (And wryly comments, mortality, 100% in a retrospective study) I stand rooted to the spot, overawed as the ATLS checklist ABCDE is run through, log roll, etc. He's got an open book spinal fracture and reduced air entry on the right; X ray confirms the unstable pelvic fracture and shows a haemothorax. The chest drain slides in guided by the ubiquitous surgical SHO and five litres of red stuff gushes out all over the floor, or the start of it, anyway. Sister has already ducked down into the flow and attached the bottle to the tube turning her rather nice blues into rather fetching purples. I busy myself with pushing in bags of fluids (and tallying the total), but something tells me this man isn't going to make it. Common sense, I think. (Or wry cynicism?)
An hour later, (and twenty two units of blood, five litres of saline, two pools of FFP, three litres of hartmann's and an unspecified quantity of gelofusin) his knackered cardiovascular system finally gives up the ghost. I'm exhausted. (Must have been all that upper arm workout) The boss comes around to ask me very gently if I'm okay, almost as if I'm a medical student seeing death for the first time. What a shame I'm not, and instead, am a world-weary, cynical bastard of an SHO who thinks "dead on arrival" an hour before it's called. I head home. I don't remember hitting the sack, but when I Wake Up, still with my tie on, it feels like the sack's hit me back. Several times.
Next morning I wake up, not-quite-chipper and head in (5 minutes late). Someone says, very quietly, "I need a hand please" and everyone starts running, because that's really the secret code for "Oh Shit! someone's collapsed in the toilet!" or "Bugger me! Mr Blogg's just arrested!!". we run around in circles for a bit then finally head outside, as an elderly gentleman in what looks to be the early stages of rigor mortis tumbles slowly and gracefully out the open door of his neighbour's car to the tarmec below - apparently, we find out as we leap onto his chest and bag him, he approached his neighbour for help, and died on the way in to hospital. We keep CPR up, even as we lift him onto the trolley from the hospital car-park floor, and wheel him in to resusc, with myself leading, pulling at the trolley, and bagging with the other hand at the head. It's a surreal experience; all that's lacking is the theme song or else I'd swear I've just been teleported into an episode of ER. We get into resusc and I hand over the bagging to the anaesthetist for him to intubate (he says, that was good bagging, and I tell him, well that's probably all I'm good at...), and kneel down smoothly to slam home a green venflon someone's been helpfully proferring me (the ever-present resuscitation sister, hovering by my ear in a blatent show of lack of confidence in my measely cannulation abilities, heaves an almost audible sigh of relief and steps back), and then, without pause slam in the adrenaline someone else? Or perhaps the same person... hands tend to look alike from close up - is proferring me, whilst all around there's a flurry of activity, b/p cuff going around, sats probe rammed on, ecg leads peeled and pressed. It's all happening so slickly and so smoothly it's unbelievable.
It's almost an anticlimax when, twenty minutes later, we call it - they don't show you THAT on ER. There the patient invariably gets shocked and gets off the table. Ours just jerks around limply like, well, a rubber chicken. A very dead rubber chicken.
Another day in the ER.
Fade themesong.
Oh and before I forget, I walked into work early yesterday, so I didn't. Instead, I sat outside at the lake that forms the frontage of the hospital and read a little Terri Pratchett. A curious little sparrow hopped lamely (he'd messed up one foot) up to me and gave me a thoughtful look, before settling down next to me. He was so close his feathers were brushing my hand. I told him I wasn't going to feed him, so he got up, rummaged around a bit in the sand, then came back and sat down on my other side. If I'd wanted to, I bet I could have picked him up; but I didn't want to scare him. He was sweet.
A couple of his mates came over to investigate, but didn't quite dare to come as close; I suppose he owns a monopoly of all the local humans.
First a trauma at the end of my shift; my consultant quite literally picking me up bodily by both shoulders to plant me gently to rest within Resusc, with the gentle but quite incontrovertible suggestion, "you are going to see this trauma". (complete with hypnotic eyes)
Young male motorcylclist, travelling at speed, sideswiped off road into unsympathetic tree.
He comes in and looks, well, dead. (Almost vegetative, after his head-to-tree experience) Unresponsive, GCS 3/15, b/p 90/40 but falling rapidly. Minimal respiratory effort. There's blood coming out of his nose in a trickle and his arm in nasty spurts as the anaesthetist slams home the tube without any meds. (And wryly comments, mortality, 100% in a retrospective study) I stand rooted to the spot, overawed as the ATLS checklist ABCDE is run through, log roll, etc. He's got an open book spinal fracture and reduced air entry on the right; X ray confirms the unstable pelvic fracture and shows a haemothorax. The chest drain slides in guided by the ubiquitous surgical SHO and five litres of red stuff gushes out all over the floor, or the start of it, anyway. Sister has already ducked down into the flow and attached the bottle to the tube turning her rather nice blues into rather fetching purples. I busy myself with pushing in bags of fluids (and tallying the total), but something tells me this man isn't going to make it. Common sense, I think. (Or wry cynicism?)
An hour later, (and twenty two units of blood, five litres of saline, two pools of FFP, three litres of hartmann's and an unspecified quantity of gelofusin) his knackered cardiovascular system finally gives up the ghost. I'm exhausted. (Must have been all that upper arm workout) The boss comes around to ask me very gently if I'm okay, almost as if I'm a medical student seeing death for the first time. What a shame I'm not, and instead, am a world-weary, cynical bastard of an SHO who thinks "dead on arrival" an hour before it's called. I head home. I don't remember hitting the sack, but when I Wake Up, still with my tie on, it feels like the sack's hit me back. Several times.
Next morning I wake up, not-quite-chipper and head in (5 minutes late). Someone says, very quietly, "I need a hand please" and everyone starts running, because that's really the secret code for "Oh Shit! someone's collapsed in the toilet!" or "Bugger me! Mr Blogg's just arrested!!". we run around in circles for a bit then finally head outside, as an elderly gentleman in what looks to be the early stages of rigor mortis tumbles slowly and gracefully out the open door of his neighbour's car to the tarmec below - apparently, we find out as we leap onto his chest and bag him, he approached his neighbour for help, and died on the way in to hospital. We keep CPR up, even as we lift him onto the trolley from the hospital car-park floor, and wheel him in to resusc, with myself leading, pulling at the trolley, and bagging with the other hand at the head. It's a surreal experience; all that's lacking is the theme song or else I'd swear I've just been teleported into an episode of ER. We get into resusc and I hand over the bagging to the anaesthetist for him to intubate (he says, that was good bagging, and I tell him, well that's probably all I'm good at...), and kneel down smoothly to slam home a green venflon someone's been helpfully proferring me (the ever-present resuscitation sister, hovering by my ear in a blatent show of lack of confidence in my measely cannulation abilities, heaves an almost audible sigh of relief and steps back), and then, without pause slam in the adrenaline someone else? Or perhaps the same person... hands tend to look alike from close up - is proferring me, whilst all around there's a flurry of activity, b/p cuff going around, sats probe rammed on, ecg leads peeled and pressed. It's all happening so slickly and so smoothly it's unbelievable.
It's almost an anticlimax when, twenty minutes later, we call it - they don't show you THAT on ER. There the patient invariably gets shocked and gets off the table. Ours just jerks around limply like, well, a rubber chicken. A very dead rubber chicken.
Another day in the ER.
Fade themesong.
Oh and before I forget, I walked into work early yesterday, so I didn't. Instead, I sat outside at the lake that forms the frontage of the hospital and read a little Terri Pratchett. A curious little sparrow hopped lamely (he'd messed up one foot) up to me and gave me a thoughtful look, before settling down next to me. He was so close his feathers were brushing my hand. I told him I wasn't going to feed him, so he got up, rummaged around a bit in the sand, then came back and sat down on my other side. If I'd wanted to, I bet I could have picked him up; but I didn't want to scare him. He was sweet.
A couple of his mates came over to investigate, but didn't quite dare to come as close; I suppose he owns a monopoly of all the local humans.
