Wednesday, May 25, 2005
The Effect of Senescence
Two of the nurses I'm working with are rather attractive.
Both of them are about the same height, which is relatively tall compared to the average Singalander female, but the similarities end there.
The first is attractive by dint of her personality. She's bright, well-spoken and kinda funny in a rather awkward, endearing way.
The second is simply slinky, streetsmart, and good to look at (ran out of S words, aside from the mundane). From front and back. And side. She has nice eyes and a nice smile too. heh.
Once upon a time a younger me would, if it came to the crunch have chosen humour over looks without a second's pause.
I guess I must be getting older now.
pause.
pause.
pause.
heh heh heh.
It's a shame they're so young...
*****
So you're sitting in the middle of the floor in front of your registrar's computer wondering how you got saddled with the impossible task of exorcising it of all spyware, adware, and repairing the registry before sunrise.
It's a beast of a machine, you realise that the second you pick it up and almost fall face first onto the floor. We're talking serious firepower here - this machine belongs to a geek of the finest calibre. The casing may read Dell, but you doubt anything even vaguelyHell Dell-ish remains within the deceptively cheapo skeleton. It weighs about four times your machine, and yours is a cadillac amongst computers upgraded to near-perfection.
O-kay. First things first. How do you crack this baby open...
*****
You feel the same pit of fear in the depths of your stomach as you examine him - that same fear you used to ride on the crest of, working in casualty.
His pupils aren't symmetrical. Not by a long shot. One of them is blown - way, way blown. And as you watch you can almost imagine it dilating still further.
You flip through the casenotes in a hurry, and the story emerges - a story that is best kept off the public domain in respect of patient confidentiality.
The boss decides on an urgent CT head - there's no question about it, really.
You call for resuscitation equipment to go with the patient to scan - your training in accident and emergency medicine makes you almost paraniod about patients arresting or losing their b/p in the doughnut of death.
As you leave the unit, you notice there're no fluids - which you expressly asked for. You ask the senior nurse why, and she says we don't need it because the patient has noradrenaline running. Anger flares for a brief moment - your decision has been countermanded, and in your heart you know this is a mistake - it goes against everything you've learnt in ATLS -- and ACLS. You tell her so, but the trolley moves ever onward, and you decided that time is of the essence; perhaps there will be fluids in the scan room.
There aren't. It's not the same scan room as usual. It's not even the same department.
The scan finishes, interrupted several times by false low-saturations readings which you know better than to panic about, just put the probe back on his finger more securely, and tada, 100%
It begins as you leave the scan room. The b/p begins to fall a little. It's a short one minute dash back to the ward, and the noradrenaline stabilises the b/p enough at a relatively acceptable level to buy time.
You reach the cubicle and begin calling for stat iv fluids, NOW.
The senior staff is unhurried, moving almost in a dreamlike slowness - perhaps its the adrenaline flowing through your system. You watch the gelofusin flowing through drop by drop through the long femoral line. You watch the b/p slide down to 70/40
It's too slow. It's just too slow. It may be a big vein (flow is proportional to the fourth power of the radius) but it's also a long line (inversely proportional to the length of the cannula) and it's clearly blocked.
The senior staff nurse fiddles with the line, and you call for a large grey venflon RIGHT NOW.
She orders her junior not to give it to you, she says there's already a big line here, you don't need it.
Anger flares again. You bite it back... again.
You tell her there isn't any time for this, you're wasting time. You turn to the junior nurse (she's still attractive even in crisis... heh) and ask her for the venflon. She slaps it into your hand and you ram it home despite the senior nurses protests about hurting the patient and raising ICP. This guy's GCS is 3. He isn't going to feel this, I really don't think...
You call for another bag of gelo after realising the senior's just going to keep on fiddling with her stupid long line, and the gelo runs in stat within a few minutes as you try to reason with the senior staff : time is precious. Every moment you waste costs him brain, and life. She says she knows all this.
You tell her this patient is in shock, and needs stat fluids. She tells you that "we all" (as opposed to me, the unwelcome "rookie") know this patient, he's won't go into shock one, don't so kancheong.
You pause as you realise in shock, that this senior staff nurse old enough to be your mother has absolutely no idea what clinical shock is. Alarm bells which have been shifting about uneasily in the back of your head now sound a racous klaxon. You're tempted to tell her to leave the room, right now.
The b/p comes back up to 120/80
You decide to be nice instead of horrible, and try to explain it to her in terms she might understand. Give her a chance to learn.
You say : This patient had a systolic b/p of 70, making his mean arterial pressure about 50. His intracranial pressure - we both saw the scans - is probably about 20. This leaves him with a cerebral perfusion pressure of thirty.
She says she knows all this.
You tell her you're ATLS and ACLS trained, and you know how to resuscitate patients. She tells you that that is heart, and this is brain, and they are different.
You decide not to talk to her anymore, ever again, if you can help it.
There is no helping those who will not learn - and those who are too blind to realise that their silly pride comes at someone else's expense.
Both of them are about the same height, which is relatively tall compared to the average Singalander female, but the similarities end there.
The first is attractive by dint of her personality. She's bright, well-spoken and kinda funny in a rather awkward, endearing way.
The second is simply slinky, streetsmart, and good to look at (ran out of S words, aside from the mundane). From front and back. And side. She has nice eyes and a nice smile too. heh.
Once upon a time a younger me would, if it came to the crunch have chosen humour over looks without a second's pause.
I guess I must be getting older now.
pause.
pause.
pause.
heh heh heh.
It's a shame they're so young...
*****
So you're sitting in the middle of the floor in front of your registrar's computer wondering how you got saddled with the impossible task of exorcising it of all spyware, adware, and repairing the registry before sunrise.
It's a beast of a machine, you realise that the second you pick it up and almost fall face first onto the floor. We're talking serious firepower here - this machine belongs to a geek of the finest calibre. The casing may read Dell, but you doubt anything even vaguely
O-kay. First things first. How do you crack this baby open...
*****
You feel the same pit of fear in the depths of your stomach as you examine him - that same fear you used to ride on the crest of, working in casualty.
His pupils aren't symmetrical. Not by a long shot. One of them is blown - way, way blown. And as you watch you can almost imagine it dilating still further.
You flip through the casenotes in a hurry, and the story emerges - a story that is best kept off the public domain in respect of patient confidentiality.
The boss decides on an urgent CT head - there's no question about it, really.
You call for resuscitation equipment to go with the patient to scan - your training in accident and emergency medicine makes you almost paraniod about patients arresting or losing their b/p in the doughnut of death.
As you leave the unit, you notice there're no fluids - which you expressly asked for. You ask the senior nurse why, and she says we don't need it because the patient has noradrenaline running. Anger flares for a brief moment - your decision has been countermanded, and in your heart you know this is a mistake - it goes against everything you've learnt in ATLS -- and ACLS. You tell her so, but the trolley moves ever onward, and you decided that time is of the essence; perhaps there will be fluids in the scan room.
There aren't. It's not the same scan room as usual. It's not even the same department.
The scan finishes, interrupted several times by false low-saturations readings which you know better than to panic about, just put the probe back on his finger more securely, and tada, 100%
It begins as you leave the scan room. The b/p begins to fall a little. It's a short one minute dash back to the ward, and the noradrenaline stabilises the b/p enough at a relatively acceptable level to buy time.
You reach the cubicle and begin calling for stat iv fluids, NOW.
The senior staff is unhurried, moving almost in a dreamlike slowness - perhaps its the adrenaline flowing through your system. You watch the gelofusin flowing through drop by drop through the long femoral line. You watch the b/p slide down to 70/40
It's too slow. It's just too slow. It may be a big vein (flow is proportional to the fourth power of the radius) but it's also a long line (inversely proportional to the length of the cannula) and it's clearly blocked.
The senior staff nurse fiddles with the line, and you call for a large grey venflon RIGHT NOW.
She orders her junior not to give it to you, she says there's already a big line here, you don't need it.
Anger flares again. You bite it back... again.
You tell her there isn't any time for this, you're wasting time. You turn to the junior nurse (she's still attractive even in crisis... heh) and ask her for the venflon. She slaps it into your hand and you ram it home despite the senior nurses protests about hurting the patient and raising ICP. This guy's GCS is 3. He isn't going to feel this, I really don't think...
You call for another bag of gelo after realising the senior's just going to keep on fiddling with her stupid long line, and the gelo runs in stat within a few minutes as you try to reason with the senior staff : time is precious. Every moment you waste costs him brain, and life. She says she knows all this.
You tell her this patient is in shock, and needs stat fluids. She tells you that "we all" (as opposed to me, the unwelcome "rookie") know this patient, he's won't go into shock one, don't so kancheong.
You pause as you realise in shock, that this senior staff nurse old enough to be your mother has absolutely no idea what clinical shock is. Alarm bells which have been shifting about uneasily in the back of your head now sound a racous klaxon. You're tempted to tell her to leave the room, right now.
The b/p comes back up to 120/80
You decide to be nice instead of horrible, and try to explain it to her in terms she might understand. Give her a chance to learn.
You say : This patient had a systolic b/p of 70, making his mean arterial pressure about 50. His intracranial pressure - we both saw the scans - is probably about 20. This leaves him with a cerebral perfusion pressure of thirty.
She says she knows all this.
You tell her you're ATLS and ACLS trained, and you know how to resuscitate patients. She tells you that that is heart, and this is brain, and they are different.
You decide not to talk to her anymore, ever again, if you can help it.
There is no helping those who will not learn - and those who are too blind to realise that their silly pride comes at someone else's expense.
