When the night has come, and the land is dark...

Wilkommen, bienvenue, welcome zuruck, retour, back. You may (not) be wondering why this blog has come so late in the week, I can only apologise. The truth is I've been busy doing exciting things that mainly involved eating curry and, furthermore, am on holiday this week so am trying to space out a few entries to cover up the fact that a blog about my week off would be BRAIN SHATTERINGLY DULL.

Night 1:

19:20 Driving to work, it's impressively dark and wintery. In years to come English scholars (thats scholars of English and scholars who are English) will read this as pathetic fallacy, possibly they will unpick the rhythms of my sentences and realise that they follow an 8-2-5-6-4-7-2 pattern that shows I was trying to create a feeling of unease in the reader. Alas the truth of the matter is that it is now late September and the weather sucks. Maybe that was also the case in Jane Eyre, now GO GET A JOB.

19:40 More mentalist drivers are attempting to end my life. A particularly fun one drives right up my ass, despite the fact I'm already breaking the law, and flashes me repeatedly. I switch lanes and, for good measure, give him the finger. Apparently he sees this and pulls back in to my lane, slamming on the brakes. I'm in no mood to be killed (for once) so I just stay behind him but he starts getting slower and slower until I am forced to overtake him if I'm to get to work on time.

He then pulls back out into my lane and starts flashing me again so I flip open the top of my gear stick and hit the red countermeasures button. He skids on the resulting oil slick and, losing control, flies into the side of a truck.

"Manure", he says, spitting out faeces "I hate manure".

19:50 I arrive to relieve Ravi the hitherto unnamed F2 (I read in a 'How to write diverting blogs' book that introducing new characters keeps people interested). He's new in town and just moved into the old Johnson house, some say he had to leave Pittsburgh in a hurry and that there is some kind of daaark secret in his past but all we do know is that he's a dreamboat. He hasn't got much exciting news for me and there isn't even a "horrifying airway emergency" that I need to sort out.

Horrifying airway emergencies when you come on shift are the ENT equivalent of the classic 'We're having a party tonight meet us under the bucket of pigs' blood on the sprinkler dense lawn, oh and make sure to come dressed as a Nazi because there definitely isn't a Jewish war survivors meeting happening nearby' trick. Essentially someone senior spends at least 10 minutes trying to convince you there's someone downstairs in A&E whose trachea has gone into spasm and they need some kind of ENT deus ex machina to bring them back to life. Then HILARIOUSLY, just after you shit your pants, they tell you it's all a joke.

Unfortunately for Matt the one time this happened to him it really wasn't a joke and his mild amusement was quickly transformed into brown trousers time when he discovered that the patient had stabbed himself repeatedly in the throat (this seems to happen a lot lately).

20:30 I'm told by the nursing staff that Mr Complex thinks I "need some lovin'". It turns out he's becoming quite the hypersexualised old man as the weeks go by and the previous night he'd forcefully stated that he, and I'm quoting here, wanted to "fuck Brodie". Given that the guy can't even stand up without being guided step-by-step through the process I doubt he'd have the coordination for such things but even so Brodie has been keeping a clear distance ever since.

01:30 Three hours into the movie, just as King Kong has, in a thrilling climax, started climbing the Statue Of Liberty my film night is rudely interrupted by an unfamiliar bleeping noise. I eventually track the noise to a strange pager-shaped device attached to my belt and wearily go off to find out who DARES bleep my while I'm at work, on call and getting paid extra as a result.

01:32 It's A&E who, it's fair to say, usually SUCK ASS. In this case, however, I have some extremely competent sounding SHO

"Oh Hi, I've got a 84 year old guy normally fit and well, he's had a nose bleed for the past 5 hours that has now stopped. I wouldn't normally bother you with it but I can see the bleeding point right at the front of his nose and just thought you'd probably be better at cauterising it than me"
"Of course" I lie, knowing that the last time I cauterised a nose was in a PREVIOUS LIFE "Just send him upstairs"

02:00 I'm waiting on the ward for this nose guy to come waltzing in when the porters bring in someone on a hospital bed. He's got an IV in place, is in a hospital gown and looks, from all the paraphernalia around him, to be in a bad way. Probably a Max-Fax patient, I reassure myself.

"Are you admitting this guy?" asks the nurse. Damn.
"Er... I have no idea who he is..."
"Oh A&E said you accepted him, he's had a nose bleed"
"Ah, I wasn't expecting him in a bed..."

As the bed pulls up to the Treatment Facility desk the shadowy figure reaches out a quivering hand

"Doctor, Doctor" he calls, his quavering voice akin to someone dying heroically in a war film.
"We need him in here" I say, turning to point at the treatment room door and cursing the A&E person TO HELL for transferring me such a sick patient.
"I can manage", he says from behind me and just as I'm about to give him a hand the gentleman jumps off the bed and strides into the treatment room, dragging his various cables behind him. He is, in fact, totally fine.

02:30 "I'm sure you get this a lot, but you look like exactly like Harry Potter" the man says, chuckling in a way only someone who is totally well and doesn't need to be on IV fluids and transported by a hospital bed can. "I bet you wish you had his money"

"I wish I had Hermione Granger, more like" I say, wondering whether he means I wish I had Daniel Radcliffe's money or whether he's such a fanboy that he knows that Harry Potter is super wealthy. I spray his nose up with Co-phenyl-caine (so named because it sounds just like Cocaine) and obliterate the tiny spot of bleeding in his nose with a cautery stick.

02:45 "I suppose I'd better stay in overnight and let this fluid run in then", the man says glumly, "Even though I'd dearly love to get home".

Bollocks to that, I decide. Given that his blood pressure is something like 300/infinity and that any more IV fluids will probably cause his brain to, like, explode or something I send him home to bed before he can catch MRSA/compare me to any other fictional characters to whom I bear no resemblance whatsoever.

06:30 A guy who had somehow managed to stick a branch in his ear has just arrived in the treatment room. The A&E dude has fed me another pack of LIES about him having increasing pain, bloody discharge from the ear and other harrowing signs.

"So this pain, how bad is it" I question him in a manner that was, on reflection, thick with undertones of "You woke me up at 6:30 for THIS?!?!"
"Oh I wouldn't call it pain, as such, it's more of a mild ache. I was just worried about the blood"
"What blood?"
"There was blood on the pillow"
"Mmmmm Pillow"
"What was that"
"Er nothing, let's sort your ear out"

06:35 I hoover bits of tree out of his face and, on finding no blood whatsoever, give the guy some ear drops to take home. I also advise him to avoid sticking twigs in his ear in future, because an informed patient is a healthy patient.

09:30 Sleep time after being stuck in traffic FOREVER.

Night 2:

19:45 I arrive to find Ravi flustered. There are many things to be done and he, after having worked 13 hours is understandably keen to get home.

20:15 We're in Paeds A&E. There are 3 kids with ENT issues, the first of which has a foreign body stuck up her nose. Maybe. Noone has actually seen it.

20:20 My love of children and desire to do Paediatrics takes a steep dive as the kid goes totally mental while we try to extract the object. It's true that children are often very cute and that when they're crying your heart goes out to them because they're hurt and it's not their fault but SERIOUSLY we just want to stick a little hook up your nose, it doesn't even hurt and you were keen on sticking things up there BEFORE, so why get so up-tight?!? Jeeeez.

20:30 We decide that it's best that this child is seen by someone with more experience/who is fearless about making children scream so tell her to come back in the morning. The next kid has an ear infection thats lasted about 3 weeks. The GP has put him on various questionable antibiotics like Donothingacillin, Crapimycin and Unlikelytohelpiclav as well as giving dubious advice such as "Every time he has a bath make sure to give his ears a big clean out" WRONG, "It'll get better on it's own anyway" NO IT WON'T and "Just come back to me in a few weeks" YOU SUCK GP.

Fortunately for the child he is now in the hands of trained ENT professionals who eat sleep and drink ENT all day long. We send him upstairs so I can suck out his ears later not only because it'll help but because it's one of only 3 things that we ENT professionals can actually do.

20:35 The final kid has an ear laceration and a pretty impressive one at that. Unfortunately for him I know nothing about sewing things together so I ring the kindly Max-Fax SHO to give me a hand. He's busy but says he can help out later.

21:00 Hoovering out the little boy's ear and he is an absolute star. He sits patiently while I extract piles of gunk and doesn't even flinch. Compare this to Mr Complex, a grown man, who spends the whole time crying and praying to god to make it stop.

Sorry, Mr Complex, apparently GOD DOESN'T EXIST or else I would stop, as I'd presumably be killed by a bolt of lightning from the skies.

I put the kid on the correct antibiotics, write "FUCK YOUUUU, GP" on a piece of paper for them to give to their Family Doctor, and set him up with a repeat appointment in a weeks time.

21:30 The Max-Fax SHO is showing me how to suture this kids ear. He too is being extremely patient and doesn't seem to worry about the concerning sentences being exchanged between the two Doctors.

"Nono you pull the thread OVER the needle holders"
"Oh yea I see"
"No that was under again"
"Right so like this"
"Yea good. Now on the next one do it under. No that was over. No, just, no like this, oh for god's sake NOW look what you've done"
"Don't worry about the blood, mate, it's totally normal" I say more loudly so the patient can hear, before whispering to the Max Fax SHO "Is this normal?"
"Heeeell, no" he replies "You may want to get someone growing a new ear for this kid on the back of some mouse or other"

Seriously though, his ear was fine, it just took a while.

03:00 I'm bleeped by one of the kindly F1 Hospital@Night people. These guys are actually doing REAL on-calls where they actually have to do stuff ALL night and get NO sleep so I try to be extra nice to them. This person is wondering if I might be so kind as to travel around 20 metres to the next ward along to see a guy whose nose has been bleeding for EIGHT HOURS and who has subsequently dropped their Haemoglobin to 8. That's Bad.

03:05 "Good Morning Captain" he says "Lieutenant Perciville-Smithe at your command, sah"
Oh good. Dementia, my old friend.
"Going into battle now are we, sah?'
"No no I just want to put this pack in your nose to stop you bleeding to death"
"Oh, very good, what ho. Never surrender eh lad!?"

I try sticking the pack in but this guy is a tremendous wimp and pulls his head away

"Sorry about that, old chap, dont know what came over me, let's give it another try eh?"

I try again, same result.

"Bloody ridiculous isn't it, can't very well fight the Bosch with this attitude"

I try again, same result. This is getting boring now so I head off to find something softer to stick in his nose but alas there is nothing of the sort on the ward so instead I fetch some Co-phenyl-caine to numb his ass and spray it up his nose.

"Right, now I'm going to try this again"
"Oh I see, General" Oooh, a promotion, "Second assault and that eh?"

This time it goes in and the poor old man can be left in peace without having to mop blood from his nose every two minutes.

08:00 Sadly, Mr Spikey appears to do ward round and it is generally bad manners to go home when the consultant has turned up so I have to wander around with the team. It also turns out that good old Mr Complex has ripped his line out again, he so crazee.

09:30 On returning home I find that Sam has left me various gifts on my pillow. This is extremely pleasing.

Day 3:

20:30 I've clerking a patient with every ENT F1's favourite illness: a Peritonsillar Abscess (a.k.a Quinsy, named after the 80s TV medical examiner. Or not.). The reason these are so fun (for us, and not for the patient) is that we get to do lots of STUFF. Firstly we need to take a full history and do an examination, then we pass a camera through their nose to check their epiglottis out, then we take a GIANT NEEDLE and try and drain pus out of them. After that they get a cannula and we write up fluids, pain relief and antibiotics and admit them onto the ward. All on our own. How cool is that?!

Unfortunately, as is sometimes the case even when you're a super-pro-ENT-master like I am not, you don't always get pus out with the needle, as was the case with this girl. However she did then spit a huge load of it into a bowl afterwards.

Stil hungry? Good.

21:00 I notice from some swab results that someone on the ward is on the wrong oral antibiotics for her ear infection and that she needs IV ones instead. Knowing also that she hates cannulas and, as you may have learned, that I SUCK at cannulas of late I am a little hesitant to stab her. Furthermore she's black which, before you report me as a massive racist to the GMC, means that her veins are impossible to see.

21:10 Knowing that she, more than most people, hates having needles stuck in her I decide to offer her the option of having some local anaesthetic for her cannula. We were taught be anaesthetists in medical school that you should always use local because it stops the procedure from hurting, which is pretty compelling if you ask me, however local isn't easily available on the wards, people aren't very used to using it with cannulas and the subject is a little taboo so the advice is usually ignored. However, because I'm super-awesome and because I don't like my patients to be sad I decide to give it a go.

I also decide, possibly because I've not eaten enough that day, but mainly because it will stay in longer that I should use a green cannula (cannulas come in different sizes and are colour coded, blue is the smallest, orange is the biggest and green is up there with the larger). What you are expecting now is a hilarious anecdote about how wrong it all went.

Sadly for you, but happily for me & the patient, it went straight in and she said it didn't hurt at all thanks to Mr Local Anaesthetic. Boom, another life saved.

01:00 It's A&E again. "Can you review this patient, he got hit in the face with a softball, had a large nose bleed and felt like he was going to pass out. I'm looking at the nose now and it looks very bruised and I think... I think it might be.... BROKEN"
"Yes, and?"
"Well I've taken X-rays of his face from about 20 different angles but they all came back inconclusive"
"OK well have you ruled out septal hameatoma?" (The ONLY bad thing that can happen with a broken nose
"Oh I don't know what that is"

Deciding that this guy got his Medical Degree from the University Of LAME I agree to go and see the patient before he's given any more ionising radiation.

The guy is totally fine, he just has a broken nose that should be followed up according to standard hospital protocol that noone in A&E seems to be aware of despite the fact that they must get about 50 broken noses a day. I also note that he was hit by a CRICKET ball had a SMALL nose bleed and felt LIKE HE'D BEEN HIT IN THE HEAD WITH A CRICKET ball. GAH!!!

06:00 I'm called by the nurses to talk to one of our patients, a very nice guy who's had most of his throat removed due to cancer and who is known for being quite anxious. I find him pacing around the room, clearly worried to death.

"I can't breathe" he writes on a piece of paper.
"OK, well I've listened to your chest and it's clear and your oxygen saturations are great"
"Still can't breathe" he writes before jumping off of the bed and pacing around the room
"Now I know you're clearly really upset" I soothe "But I think at least some of your trouble is your nerves".
"I know I know" he writes
I spend half an hour calming him down, during which time I discover he's had a horrible trauma in his past where he couldn't breathe underwater for some period of time. I endoscope his trachaeostome and see that his lungs are clear, he is visibly reassured by this and I manage to calm him yet further by talking to him.

Just to be extra wonderful I also write him up for some medicine to help him rest but before the nurses have a chance to give it, he's already sound asleep.

08:00 Ward round. Everyone questions my decision to put the ear girl on IV antibiotics because she's on ear drops that cover those bacteria, this is all very well but I thought we may as well put her on systemic antibiotics that ACTUALLY KILL THE BACTERIA rather than the current ones to which they are resistant. But whatever.

I'm then grilled on my choice of pain killers for my Quinsy girl.

"Geoff mate, you really need to give better pain relief than this. You need her to have Paracetamol (which she was on), Codeine (which she can't have because she can't swallow), and Ibuprofen (which she can't have, BECAUSE SHE CAN'T SWALLOW). Also I don't know why you've put her on liquid morphine (which she COULD swallow), it's far too strong for her pain relief." moans the Reg
"I'd have put her on morphine, as she can't swallow" backs up the ST2, thus being spared from death when I eventually take over the world
"Just try and remember next time, eh?'

Look, bub. I don't know if you know this but Morphine and Codeine are THE SAME DRUG. Codeine is converted to morphine in 50% of people and does NOTHING in the other 50% of people. This means that giving Codeine is just THE SAME as giving morphine only it's LESS LIKELY TO ACTUALLY DO ANYTHING.

AND SHE CAN'T SWALLOW THE F*CKING CODEINE!!!!!

Not that I was bothered or anything...

Night 4:

20:30 Clerking in a patient with a vague neck lump. Nothing is interesting about this except that I nail her cannula first time.

In your FACE er... someone...

21:00 I decide to tackle the fact that Mr Complex hasn't had a cannula to replace the line he tore out yet head on. He doesn't actually need the cannula for a few days but given that he's a huge pain in the (particularly Brodie's, if you get what I mean) arse I decide to try and talk sense with him. This guy has repeatedly said that I am wonderful and he liked it when I got some Tchaikovsky for him to listen to so I figure I have a chance of appeasing him.

Kneeling down by him I put on my most reassuring and compassionate sounding voice.

"Good afternoon, Mr Complex, how are you this evening?"
"Oh hello, your hair is looking nice" he responds. If only my mother would agree.
"Now, you know we've had this problem with the line in your hand (which the nurses, extremely unhelpfully refer to as a NEEDLE). Well we really need to get another one in so that we can get you fixed and you can go home. You'd like to go home."
"Mluergh"
"I know you hate them, so what I can do is give you a bit of local anaesthetic so you won't even feel it. We'll only do it once as well."
"Fuck off"
"I'm sorry?"
"You can fuck off, I don't want ANYTHING. You PEOPLE you just keep trying to HURT me well I don't WANT a FUCKING thing in my arm and I'm not going back to that ROOM anymore and I don't want ANYTHING."
"Well we're just trying to help you."
"Just FUCK off".

Wow, the job satisfaction we get is just amazing.

23:00 We're in the mess watching Arnie rip someone's arm off and exchanging stories about horrifying things that have happened to patients/staff with the Med Reg and the Surgery Reg. The evening is going generally well.

01:00 We order our pizza from Dominos, a treat that the Max-Fax SHO and I have been looking forward to all week. Just as the order completes I get bleeped.

"Hi it's the Hospital @ Night Co-ordinator. We're really swamped here and, if you've got any spare time at all, was wondering if you could help out down in A&E".

Given that it would be impossible for me to suggest that I was even remotely busy I go down there.

I'm offered a narcotic seeking drug addict or an ear laceration. Now that I know what I'm doing with a needle and string I decide to opt for the latter. The guy is extremely nice and makes me happy by suggesting that the fact I went to Warwick means I'm basically a Cambridge graduate.

02:00 The ear guy is all sewn up so I hurry upstairs to find my pizza waiting for me, which I am extremely happy about.

04:00 Star Trek Villain is back, he's had various things up his nose since he came in and none of them are working. I create some kind of amazing hybrid pack to put up there and it does the trick though I'm beginning to feel increasingly bad for this kid who has spent much of the last 8 weeks in hospital especially as he's really nice to me every time I see him.

08:00 Ward Round. Sri is in charge and sends me home straight away. I assume this is because he's nice but maybe it's because he hates me after I got him the wrong pizza.

10:00 There is much Deus Ex to be played so minimal sleep can be had.

Tune in next... time... for more Trust Me, My Boiler Doesn't Work And It's Really Getting My Heckles Up