Drone drone drone drone, cannulation, drone drone drone, Brodie being an idiot, drone drone drone cannulation failure again, drone drone drone.
Think that about covers it, see you next week for more droning on about cannulation and Brodie.
Oh FINE I'll write a bit more but only after I express my extreme sadness at the loss of Steve Jobs from our lives. Sure I never actually met him and sure my own father is pretty great but he was like a FATHER to me man, without his products I'd simply not have any reason to go on living. At this very moment I'm placing an order with Dell for a Windows 7 (Slogan: "This time we've made a version that actually WORKS." PC that I can throw in a volcano as a sacrifice to Steve so that one day he might return to us and show us the path to a better tomorrow, today.
Day 1:
08:00 I arrive on the ward to find one of the nurses waiting for me ominously.
"Mr Complex is due to have his injection at 8:30 so you'll need get his cannula in"
Now Mr Complex hates having cannulas, in fact he hates more or less everything except for the prospect of "random play" with Brodie, but I've got a plan of action. As I kindly helped out one of the ST2s the previous week his is to repay me by giving me a hand and by "giving me" I mean "putting a cannula in" and by "a" I mean "Mr Complex's".
08:05 We find Mr Complex asleep in his bed, he is not a morning person.
"Mr Complex, we need to put a drip in your hand", the ST2 says loudly
No response
"MR COMPLEX, GOOD MORNING, WE NEED TO PUT A DRIP IN YOUR HAND"
Nothing
"MR COMPLEX?"
The guy does seem vaguely to be alive so the ST2 grabs his hand in the VEIN hope of finding a vessel in it. Mr Complex bats him away with his arm.
"Muuuuugh"
"I'm sorry but we really have to do this" says the ST2, grabbing the hand again.
"MUUUUGH" comes the response with further batting.
We play this game for a few more minutes before deciding that it's just not going to happen.
I explain to the Reg that he won't have the cannula, I also explain that he refuses any treatment and that, really, doing this multithousand dollar test is a waste of NHS resources. I've been trying to tell people this for weeks but they've been generally ignoring me and proceeding with it anyway despite the fact that it is likely to distress both him AND myself heavily.
"I think you're right" she says "It's ridiculous putting him through this"
"Yes I know we want a conclusive answer, but he's just not willing to acce-" I begin to say before realising that, for the first time ever, a senior is listening to what I have to say.
"I'll have a talk with Mr Archer and discuss why he wants the test doing"
AT LAST. AT LAST!!
09:30 It appears that after this morning's shinannigans we've broken Mr Complex and he's now just standing in the corridor shouting the name of his partner, Tim.
10:00 I'm the only F1 on the ward today as not only are Matt & Brodie off but so too is OtherMatt the Max-Fax F1. As all the higher up type people are off doing important things like Theatres & Clinics it means it's all very lonely (*violin music*). Fortunately, though, there isn't much going on and the extra-helpful nurses have even done some of my jobs for me so at least I'm not running around trying to do 3 people's work. Not that that could ever be the case because ENT is a cake-walk.
11:00 "Uh-hu and can you tell me the MOLECULAR WEIGHT of adenosine?" I ask my student, in an attempt to ask him something he DOESN'T know.
"TIIIIIM, TIIIIIM" echoes down the ward as I speak.
"Well if you mean adenosine including the deoxyribose sugar then the answer is, rounded of course, 129, however if you meant to ask the weight of the adenine base alone then the answer is 68"
I scribble a degree certificate on a drug chart and give it to him. There is clearly no point in him waiting until the spring.
13:00 Stupidly, despite the fact that Sam bought delicious Ham I forgot to make myself any lunch this morning, Damn. This requires buying stuff from the hospital canteen.
The canteen, like in most hospitals, is the (not-so) secret way in which most of the care is funded. For example a sandwich costs around £4, is invariably stale and the only available flavours are "Cheese", "Cheese and Ham", "Ham and Cheese" and "Urine". Despite the fact that for £4 I really expect a french baguette stuffed with venison & caviar the inflated price does come in useful because in order to pay on card you have to spend over £6. It would make much more sense, of course, to just get cash out and buy, like, a 99p salad but that would involve going to the cash point on the ground floor. Malheuresement the canteen is on the 5th and, as the song goes, too much stairs can kill you (terrible grammar I know but what can you do).
13:25 It's still summer (I say STILL summer, it's been summer for about 2 days, prior to that it was winter, and in another 2 days it will be winter again) so Kat and I bask in the warmth on the balcony. The doctor's mess balcony is about the only perk left in the world of doctorness, sure we actually HAVE a mess, unlike other staff, but so too do the med students and sure we get to say "sorry officer, I was speeding cos I'm a DOCTOR" when caught by the fuzz, but that just gets you an even BIGGER fine.
I often wonder what it was like back in the "good old days" of medicine. Sure everyone died of bizarro sounding illnesses like "whapping plague", the only available medicines were "J.R. Stanley's Energising Musk Powder" and "Johnson's Liver Tonic" and women had a generally terrible time of things but think of the upsides for the likes of me. I would instead be sitting on some kind of wooden veranda, overlooking the savannah being fanned by palm leaves after a morning of telling patients to do what I say, spanking nurses on the bum and smoking cigars. Perhaps I would be about to retire to the golf course in my Bentley because, regardless of my junior status, I would be stonking rich.
Bleak days indeed, but things have possibly gone too far the other way now. Nurses generally see you as a nuisance and mostly do what they feel like doing, regardless of what you write on a drug card, patients ignore all your advice, choosing instead to just look on the internet and I'm about as close to owning a Bentley as I am to getting voted "tallest and most masculine doctor 2011".
17:00 I'm on call this evening again. It's crazy how much has happened since my first on call evening and how much less scary it is. That being said I no longer have Sri holding my hand so if anything bad goes down I have to call the consultant in Nottingham. Presumably he/she will be asleep, despite it being before 8pm and will yell at me for some reason.
19:50 Nothing at all has happened all evening. I get a phone call from Steve-o, the guy doing nights, saying that he's going to be a little late.
20:00 (exactly the time when Steve would arrive to take over). I'm called in by a nurse because one of the patients is spurting blood. He's spurting blood so far it's hitting the opposite wall.
It just so happens that this is the very same patient who happened to develop a worrying neck lump, which later turned out to be full of blood, when I was first on nights. He, very sadly, has an inoperable cancer that, in the process of eating through his neck, occasionally invades a blood vessel causing blood to come out. Unfortunately one of these days the blood vessel will be his carotid artery resulting in a quite horrifying blood spraying everywhere, patient screaming, nurses screaming, doctors screaming type affair. I am quite fearful that this might be that day.
20:00:15 I arrive in the patient's room, heart racing, to discover that, luckily, it is NOT his carotid artery and the blood is merely on the wall because it's coming from his LUNGS and he is coughing it a fair distance. Otherwise he is fine so we just give him some oxygen and leave him be. That may sound a bit terrible but this kind of thing is an inevitable outcome of his disease and, furthermore, he is also Not For Resuscitation so there would be little we could do if it was a major problem.
20:15 Steve-o arrives and agrees to scope the patient to find out why he's bleeding after I've left so I go home.
21:00 On arriving home I find that, courtesy of The Sam, my dinner is ready on the table. Now that's what I'm talking about.
Day 2:
10:00 Not much has been going on this morning and my general chatting with Kat is interrupted by a phone call from Sri.
"Steve" he says incorrectly "Just the man, I need your help in theatre, it'll just be half an hour".
I run down to theatre and get changed, finding not only that there are no spare shoes but that the frikkin medical student has taken the last pair. Tsk. I steal some boots that I later realise are 2 sizes too big for me and have some kind of spike in the heel that pains me with each step.
10:30 When I'll learn to realise that when people say they need me in theatre "immediately" they actually mean "at some point in the near-distant future" I simply don't know but eventually Sri appears and we go into the O.R.
10:35 Knowing that it takes me at least 45 minutes to scrub up I get started early. Surprisingly it only takes me about 5 minutes. As I walk out of the scrub area Sri tells me that the patient isn't going to be ready for ages because the Anaesthetists are struggling to keep his blood pressure up. The fact that there are currently 3 anaesthetists working on this is a bad sign.
10:50 Jesus these theatre gowns are hot, and I've just become aware of the fact that I've not really been breathing properly for the last 10 minutes because when I do it steams up my glasses.
I hate theatre.
11:00 At last it's knife time. I get to hold retractors whilst Sri cuts into the guy's neck, for some reason the anaesthetist keeps swinging round a long blue stick that we have to avoid because it's not sterile, forcing us to perform amazing feats of acrobatics.
11:30 Something is wrong, this neck is just far too large and it's proving difficult to find his trachea. We have to enlist the help of the consultant, who promptly pushes me out of the way.
12:15 I'm back in and I get to try some stitches. I can feel Sri's faith in me dwindle as my lack of 3D vision and inability to pick up tiny pieces of thread with tweezers becomes dauntingly obvious. He lets me do 2 before giving up and doing the rest himself.
Woooo. Go Geoooff.
12:45 I race back to the ward to apologise to Kat for leaving her on her own but find that she's not there. She has, however, seen to all the ward attenders and done all the F1 jobs as well. Man is she good.
13:00 Central teaching. We learn about, some... thing... oh yea GI Haemorrhage. Apparently the take away message is: In the event of a GI Haemorrhage do not ring the On-Call GI Haemorrhage Doctor.
Makes... sense... I... Guess?
15:00 The reg is instructing me that, despite yesterday's sudden realisation that scanning Mr Complex is ridiculous, the consultant still wants it done. As such he's going to need a cannula (that he hates) and a catheter (that EVERYONE HATES).
"But why does he need a catheter?" I whine
"Because his urine is radioactive after the contrast" replies the reg
"Oh right, yes"
15:05 Wait a second... he had the contrast YESTERDAY. I mention it to the Sister in charge of the ward who makes me ring Nuclear Medicine who tell me that yes, he should have had a catheter as his urine is radioactive and emits gamma radiation. It also has a half-life of 160 years.
15:20 The head of Nuclear Medicine comes to the ward with a GEIGER COUNTER and starts testing everyone for radiation. I secretly hope they're going to have to shut the whole hospital down for decontamination in some kind of ER Series Finale type way. Perhaps my consultant will get his arm chopped off by a helicopter in the process, WHO KNOWS.
15:30 The office is literally full of staff being tested, there's also a big furore going about the fact that Mr Complex should never have had the test in the first place, given that even if catheterised he would likely rip it out and wee all over the floor anyway. I don't want to tell anyone I told them so but
I TOLD YOU SO. ALL OF YOU. LESSON FROM TODAY: GEOFF IS ALWAYS RIGHT.
18:00 Just as I come on call, a nurse asks me to have a look at a patient who's had a nose bleed. It was packed earlier in the day by a colleague but it's never really stopped so I ask her to meet me in the Treatment Complex.
18:03 I put my head through the door of Treatment Complex 1 to see if my patient is in there, first I see a man, then I see that she's sitting in the chair so I walk in.
"Excuse me" says the man "Are you one of the Doctors?"
"Yes I am"
"Well, I'd just like to say that I think you're extremely rude. You just totally blanked me then. You looked through me like I wasn't there. I am NOT a piece of furniture you know, I am this lady's husband and I deserve some recognition"
"Oh I'm terribly sorry" (I am not in the least bit sorry)
"Well it's just not really on, you Doctors think you're so important but you have to spend time TALKING to people you know. Now I'm not having a go at you..." (Yes you fucking ARE and why is it that people never finish that sentence?!)
"Well it won't happen again" (Because I'll have killed you)
18:20 I stop the lady from bleeding and, as such, prevent her from staying in hospital for 48 hours. At this point the husband says
"Hey sorry about earlier, I was just anxious. I realise that, actually, you're genuinely a very caring doctor and go out of your way to be kind to patients. I also realise that you work extremely long hours and that, sometimes, just sometimes, you're in a hurry to check who people are and don't have time to fully introduce yourself to everyone you lay eyes on."
Oh no, sorry, he DOESN'T do that at all because EVERYONE IN THE WORLD SUCKS.
19:45 A nurse barges into the office:
"EXCUSE ME" she yells "Was it YOU that left the endoscope just LYING on the counter for ANYONE to touch"
"Oh yes, I'm very sorry"
"Well you're lucky matron isn't here or she'd have your BALLS"
"Oh, sorry, what do you want me to do?"
"In FUTURE put it in a red bag and then label it"
"Ok I'll just put it in a bag now"
"No it's FINE just do your job PROPERLY next time"
I'm sorry, but I'm fairly sure that putting endoscopes into bags is not actually my job at all, certainly they never tested us on it in medical school. I'm also fairly sure that every other nurse who does the Treatment Room goes in there and tidies up as that is literally ALL THEY HAVE TO DO. Another thing I'm fairly sure about is the fact that no-one was going to mistake that endoscope lying on the counter for their lunch, or for a sterile gauze or something and stick it into the open wound of a neutropaenic HIV suffering SCID patient. What I'm exceptionally sure of, however, is that I spend LARGE PERIODS OF MY DAY DOING STUFF THAT NURSES SHOULD DO JUST BECAUSE I'M NICE AND YOU SHOULD REALLY FUCK OFF IF YOU'RE GOING TO START SHOUTING AT ME. AGHHHH.
21:00 I'm moaning to Sam about how totally unappreciated I am
"Yea, that reminds me" he responds in an attempt to cheer me up "of the fact that today, just randomly, one of the bosses at work just started telling me how awesome I am at everything and how I'm the only person in the company that's really worth having around. Did I also mention I get paid twice as much as you and work around half the hours?"
I decide to murder Sam but unfortunately his springy hair prevents the anvil/grand piano that I attempt to drop on his head from doing any damage. Plus he did buy rather a lot of delicious food at the weekend and fill my car up with petrol twice so I suppose he can live. For now.
Day 3:
08:00 Steve has been up all night dealing with a patient who came in bleeding out of a hole in his neck. The hole was created by us, but so as to provide air to his lungs and not blood to the SHO's shoes. This patient had a pretty extensive cancer that has clearly come back so it is decided with him that if he bleeds again it's probably not worth using "heroic measures" to save him.
09:00 The man's consultant, Mr Week, decides that, actually, despite the guy being literally FULL of cancer, because he was treated with higher dose radiation first time round that means that he MUST be cured and that the bleeding was probably a mirage. As such I have to go and beg the consultant radiologist for a repeat CT scan.
Of course, this is another situation where the ENT consultant and the Radiology consultant could chat for around 30 seconds and get the matter sorted out but that. would. be. too. easy.
10:00 I manage to convince the Radiologist that, seeing as he has the same name as me, he aught to scan the patient. He seems to buy this reason and organises the CT for ASAP.
14:00 Mr Complex is wheeled off to his scan. I cry a single tear at the knowledge that it will likely shut down the NHS due to it's cost but also at the fact that this means Mr Complex might actually leave the hospital and I might not have to put up with his insanity any longer. In the end we didn't have to do anything horrible to him to get him there, as he'd already peed radiation all over the building, so at least it wasn't causing him any grief.
PAUSE FOR THOUGHT: Does the ability to wee radiation mean that you have a super power?
17:00 The ENT consultant has been ringing me around every 10 minutes to find out if the patient has had his scan. There is nothing whatsoever I can do to get the scan done any quicker, especially as I've spoken to the Radiologist already, but this doesn't seem to help get him off my case.
18:00 Stop RINGING Me... Jeeeez.....
19:00 Finally the guy gets his scan, which shows he is brimming with cancer. The consultant still doesn't seem to care and demands we talk to the radiologist again tomorrow. He does, however, stop ringing me every 2 minutes.
Day 4:
10:30 The guy who's actually on call is in theatre, which is fair enough because I have nothing whatsoever to do and, given that he is about the only person who has agreed to sign anything on my ePortfolio, I owe him a favour anyway. I'm phoned by the in-house officer at DeathStar Prison who tells me she needs to send one of the inmates in with an ear infection. I accept the referral, happy in the knowledge that the actual on-call guy will be done with theatre by the time she arrives at midday.
11:59: The on-call guy is called into theatre.
"Are you sure it's OK?" He asks, pretending that I have a choice
"Sure, but if you find me dead in a pool of my own blood later then it's on your hands."
12:00: I notice with trepidation that there is a lot of commotion in the corridor. A nurse appears looking flustered.
"There's er someone here from <whispers> DeathStar </whispers>"
12:05: My voice changing variably from high to low pitch like a pubescent teenager I greet the prisoner
"Oh HI, hii. My name's Giff I mean Geoff" (Oh SHIT, now she knows me name!) "I hear you have a problem with your ear?"
"Yes I do, it's very painful" she says smiling politely
"OK well we'll just have to have a look at it if that's OK"
"Oh of course, whatever you need Doctor, I'm in your hands"
...if only ALL patients were like this. I can see why people sign up for prison work.
12:30 I'm sucking amazing amounts of goo out of her ear when the microscope shuts down. It's been doing this a lot recently and I assume it's because somewhere David Cameron is saving money by shutting off the power.
"Soooo, what you in for then" I say, attempting to make small talk in what, under ordinary circumstances, would be an awkward situation enough but, given the fact there are two prison guards in the room (one of whom is handcuffed to the patient) is positively painful.
"Oh I killed a guy because he stuck something in my ear and it hurt"
Oh fuck.
"We-hell I'm sure we won't do anything like that today" I lie, praying to Steve that those handcuffs will hold.
12:45 The microscope is back in operation and in one of the most satisfying moments of my life I remove a 1cm x 4cm slug of ear wax from the crim's ear. One of the prison guards goes distinctly green and looks like she's going to throw up.
"I think it's time we left" she says
"OK well thank you ever so much, Doctor, you've been lovely" adds the prisoner.
The only patient that's been thankful all week and she murdered some guy. What a world.
13:00 For some reason the F2 that was writing up the paper work for the prison case has ticked the "Admit to Ward" box on the form. Fearing for everyone's life (and also because it was simply wrong) I hurriedly cross it off and tick the "Send back to Prison, preferably never to return" box instead.
16:00 Skinface, the episode of House/ER from last week, has improved quite dramatically and, after having had every test in the entire world come back negative we decide it's probably nothing organic causing the problem. As such he is fit to be discharged. The psychiatrist tells me that this will either totally cure him or trigger a psychiatric breakdown the likes of which we've never before seen. Reassuring.
Whilst she's explaining this, the F2 who is keen on becoming a psychiatrist spends a lot of time dicking around loudly before realising who she is. He subsequently tries redeeming himself by asking her how he can go about getting a job in Child & Adolescent Mental Health.
"Well you don't really need to try", she explains "There is only 1 applicant for every 10 places, you're guaranteed to succeed"
Now please open up your handy copy of Trust Me, I'm A Douche and find the bit about him acing his Psychiatry interview. Nuff said.
18:00 Mr Complex returns from his scan. I load it up on the computer expecting no improvement and find that, surprise surprise, I can't read it in the slightest. There is however one photo that makes him look like the terminator that I would dearly LOVE to post on here but obviously cannot. Damned laws.
18:05 Lovingly I write up the discharge summaries for both Mr Complex & Skinface. They feel almost like family now. A terrible terrible, mentally ill family. Of course, it remains to be seen whether they will actually leave but for the sake of both me and them I really hope they do.
19:00 I'm called to A&E to review a patient with tonsillitis. Unfortunately he is mentally handicapped or has learning difficulties or whatever I'm allowed to say these days so is very difficult to examine. I decide that as he's not been eating for 2 days and one of his tonsils looks pretty rough that he should probably be admitted to hospital. I am mildly uneasy about this though as his other tonsil looks fine and he is able to take liquids.
20:00 The blood results come back on the tonsillitis guy showing that he has absolutely no acute infective response whatsoever. This likely means his tonsillitis is not bad at all but he's already been allocated a room and may as well have some decent IV antibiotics to knock any infection on the head.
The likelihood is that I will be ruthlessly mocked behind my back at ward round tomorrow when they look in the guy's mouth and realise he has, like, a cold. Fortunately I'm not there and I'm pretty sure I'm ruthlessly mocked anyway so no big deal.
20:30 I've literally, and by literally I mean metaphorically, lost the will to live. Fortunately for me it's also the end of my week so I can go home. Woooo.
20:45 The (cursed) icing on the (frogurt) cake is that, given the rain and darkness, everyone has forgotten how to drive and there are THREE accidents on the dual carriageway on the way home. As such it takes me a full 5ish minutes extra to get back. HONESTLY.
The End.
Those of you that are still left, Tune In Next Week For More "Trust Me, My Boiler Is Now Fixed. Yey"
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