Can we fix it? Yes we KishAN

Despite the fact that I'm in the middle of my week off I am, in fact, knackered because I appear to be allergic to the winter and so my respiratory system takes it upon itself to occasionally shut down in the middle of the night, awaking me from my happy dreams (though in reality hideous nightmares about my next rotation) into a world of desaturated haemoglobin and blue lips. Why am I telling you this, you ask? Well because I'm fairly sure that the hypoxic brain injury that I have now suffered will result in a less than thrilling instalment of the blog, so there, you have been warned. In the news this week: Everything in the world is terrible, we're all going to die a paupers death and, as a result, be just a little bit more like Mozart. So that's not too bad is it.


Day 1


07:30 Arriving super keen-o early I find Matt looking impressively spritely for someone who's just done 13 hours of night shift. I soon discover the reason for this
"So did BleedFace (Formerly Star Trek Villain) bleed again last night"
"Yup, but I just told them to sort it out and they left me alone"
Clearly Matt has a way with the Paediatrics department that I lack; further lending to the theory that Paediatrics may not be the optimal career path for me after all.

07:50 Matt is taking me through the list of patients, which has changed completely in the 3 days I've been off and, as a result, will make me look like quite the fool on ward round, an april fool if you will. One of the patients managed to slice his nose open all the way through the skin and cartilage by knocking into a door. A DOOR. I don't know what kind of crazy doors this guy has at his house, such that the corners are razor sharp and positioned at nose-height, but he might want to consider being more careful around them. Obviously he never heard the old childhood adage "Never run near a door", because that adage DOESN'T EXIST as DOORS ARE MORE OR LESS COMPLETELY BENIGN.

Perhaps he was actually beaten up by his wife and was forced to use the tried and tested "I walked into a door" line as default (my mum did actually get a black eye from walking into a door once, she had to make up a different story lest the neighbours get suspicious). That or, as Matt suggested, he was actually polishing the spikes on the door of his Iron Maiden and slipped.

Anyway enough about this door.

08:30 I notice that there is no Steve to crush my self confidence with his unfailing criticism nor is there Brodie to be generally irritating. This could turn out to be a good week.

10:00 One of the nurses asks me to go and review a patient we saw on ward round. When I find him he is looking generally sorry for himself and complaining of pain around the nose that we recently took a FRIKKIN CHISLE to and literally GECHASSLED UP. He is, however, blaming the pain on some soft packs that were stuck up there and he's under the impression he has to keep them for two weeks. I laugh at this concept and tell him we wouldn't do that to him.

11:00 The emergency call buzzer goes off again, I run out of the office at a speed that makes me look like I'm trying to get there first but, 'unfortunately', won't be able to. It proves extremely difficult to actually FIND the, presumably arresting, patient and the nurses and I run up and down the corridor a few times like some kind of Benny Hill sketch. During this time Kishan remains sitting in the office but, as we eventually find the patient he emerges in a cool as ice manner, pops his head round the curtain, takes one look at the patient and declares 'She's fine' before gesturing for me to leave.

It is at this point that I decide that I need to, somehow, become Kishan. Which could be difficult being that he is both Asian AND happy with the world.

13:00 "Teaching. Oh how I lement thee, thou wasteth both my time and my energee." I think as I trudge towards the Education Centre.

For people who do REAL jobs in the hospital say, for example, everyone else in the entire year, teaching is probably an oasis of calm in the hurricane of hellish tasks that is their day. There's even a 'Bleep Creche' where you can leave your infernal device and let someone else deal with its incessant demands. However, for us ENT slackers, it really just causes hassle and, as our bleeps go off around once a month theres no point in even USING the helpful creche service. I mean sure, we occasionally learn amazing things about Paracetamol, but aside from that it's just a chore.

Except for today, when we are taught about blood gasses. Blood gasses are the bane of my existence (though, as you may have realised, more or less EVERYTHING is the bane of my existence) because they require minimal knowledge to understand but require you to be able to think. Thinking is generally my strong point and, furthermore, I do actually fully understand things about blood gasses that noone had even THOUGHT of because of all my chemistry degrees and suchlike. However every single time I come across a blood gas question on an exam I get it wrong. Without fail (although as I FAIL the question I suppose it would be WITH fail).

There isn't even much to them. There are essentially 3 pieces of information you need to look at, the pH, CO2 and bicarbonate levels in someone's blood. From these you need to work out whether they are in one of 4 different situations. Simple. Can't go wrong. Except that it always does.

Anyway, this particular lecturer explains a really simple system to use that means you can't possibly come up with the wrong answer. Thus removing one of many shards of glass from my soul. So thank you, anonymous Anaesthetics Consultant, I owe you one.

15:00 Kishan is teaching me the Way Of The Kishan.

"Firstly you'll need an asian name, for example Burnhillaratna"
"I see"
"Then you need to learn to smile, constantly"
"But that hurts my mouth"
"Look, do you want to follow the Path Of The Kishan or not?"
"I'm sorry. So what if a plane, piloted by my newly wed fiancee and carrying my entire family crashes into my uninsured house and I have inoperable cancer?"
"Continue to smile"
"Ooooo"

16:00 We all come to the realisation that noone really wants to take the packs out of the whingy guys nose and there's a bit of confusion as to whether we're really supposed to. It then transpires that he IS supposed to have them in for another 2 weeks which makes me a MASSIVE LIAR. He says he's not happy to go home with them in so we decide that the courageous and decisive move is to keep him in overnight for the registrar to sort out in the morning.

Day 2

08:00 "...and so we thought you might be the best person to get him to leave" I explain to the registrar.
"Whatever do you mean, I'm very sympathetic"
"Sympathetic like NORADRENALINE" I retort, and everyone laughs. Oh yea.

08:10 "MORNING SIR" shouts the registrar "I HEAR YOU WERE HAVING SOME PAIN LAST NIGHT?"
"Oh yes, it's these packs they're awfully sore"
"THAT SEEMS UNLIKELY, THEY'RE MADE OF JELLY"
"But it hurts"
"YES I'M SURE, ANYWAY YOU CAN GO HOME TODAY"
"But I really..."
"WE'LL SEE YOU IN TWO WEEKS. BYE"

She dusts her hands in a Job Well Done manner and continues on the ward round.

08:45 "Geoff, did you not think it would be a good idea to check that lady's calcium so that she didn't have to stay in another 12 hours just to have it checked?" moans the registrar as the ward round ends.
"Yes, but I wasn't on last night, someone else was"
"What about in the evening?"
"Again, someone else"
"Right well, just make sure it's done next time otherwise the £500 cost is coming out of your wages"

What part of 'I wasn't there' are you not getting? It would have been difficult, nae EXTREMELY difficult for me to remotely stick a needle in a patient I didn't even know existed and find out her calcium levels whilst playing the piano 20 miles away from the hospital. But you're right, I do suck, I'm sorry.

10:00 I'm in theatre with Alun and Mr Archer, having wandered the 50 miles to Costa to buy the coffee as usual. This is only a half day list so at least I'm not stuck in there for too long. Mr Archer is discussing computers.

"So, what your saiying bru is that oye need a nu grapheeks card?"
"Yup"
"And could you instawwl that?"
"Er.... I guess"

SHIT SHIT SHIT. There is literally NOTHING I hate more than fixing people's computer problems because as soon as you do it once it means you're immediately on-call for any computer issues day or night. This usually manifests as, like, their hard disk failing the day after you installed a new modem or something and then the loss of all their files and software is somehow your fault. This is bad enough when it's your friend's dad or something but when it's your CONSULTANT, well, it doesn't bear thinking about.

10:30 "So why is this person having a polypectomy rather than medical treatment?" asks one of the med students who is standing around looking bored.
"Well I guess it's because it's a unilateral polyp and they want histology on it"
"Oh I see"

At that moment Alun takes the polyp remover from one of the nostrils and sticks it in the other, conclusively proving that that the polpys are not unilateral at all. I can feel the medical student judging me and can imagine the "I was with this F1 in theatre who was totally shit, I knew way more than him" conversation he's going to have with his flatmates when he gets home. If only he was aware of how much I DO know more than him, he just asked me the wrong question. HE JUST ASKED ME THE WRONG QUESTION DAMN YOU ALLL.

12:00 Merry Xmas (Theatre Is Over). I'm about to leave when Alun says "Oh, you're not in a rush to go are you? Just give me a minute and I'll come with"

13:00 I'm following Alun randomly around the hospital doing things that don't concern me. I'm enjoying the fact that he doesn't hate me so much as to demand that I leave but at the same time am feeling bad for Kat who has been doing what is essentially my work all morning despite her being senior to me in all ways (except in age, as she is many years younger than me. Oh god that's depressing). Presently we arrive in day case and I sit around at the nurses desk while Alun tells someone he has cancer, again.

"Hello Geoff" says a quasi-familiar voice from behind me. I turn around to discover Mr Talke my first ever consultant during my medical school years. The fact that he remembers my existence, let alone my name impresses me greatly. This is the kind of quality you get at my particular hospital, in stark contrast to other hospitals in the trust where students and junior doctors alike are generally regarded as filthy vermin who would be better off being gassed so that they weren't constantly in the consultants way as they attempt to do important consultanty things.

After a brief conversation about life Mr Talke goes off and Sri appears. This is a relief as noone had seen Sri for the last few days and the hospital is just a less happy place when he's not around. He doesn't explain where he's been so I can only assume it's on some kind of secret government project, potentially working with Hywel's wife.

14:00 I eventually arrive to the ward to find that, of course, Kat has done everything. I therefore set about typing in thousands of pieces of data into the audit I'm doing. This has become increasingly a pain in my ass but at least if it gets published then I might stand a chance of getting some kind of job one day. Furthermore the Speech And Language Therapist who's involved with the whole thing has promised to teach me some tricks about vocal warm ups so that I can use them in my musical theatrey groups and can cast off the irritatingly pseudo-scientific techniques taught by all the singing teachers. "Breathe with your diaphragm not with your throat" they always say, failing to realise that you can ONLY BREATHE WITH YOUR DIAPHRAGM (and a few other muscles but certainly not your throat ffs).

Day 3

10:00 I'm on-call this morning, for the first time in a long time. Nothing much is happening.

BLEEEP

It's a GP somewhere who's got a women with a massive neck abscess and wonders if I should take a look. I think that's a good idea so get him to send her in. I'm aware that I have med-students to teach at 11:00 but maybe I'll have her fixed by then.

10:05 BLEEEEP

It's A&E somewhere who've got a man with a massive neck abscess and they wonder if I should take a look. I think that's a good idea but am perturbed when they tell me that Max-Fax had a look last week and did 'something' to it. However when contacting today they said 'if it's got nothing to do with the teeth than it's not our problem'. Interesting, given that Max-Fax, though staffed by scummy dentist scum does stand for Maxillo-Facial Surgery and not 'Teeth'. Either way I accept the patient anyway because I can't just leave him to die.

10:45 Both my patients arrive. I text the students to tell them not to bother coming as I'm going to be dealing with pus for quite some time now.

10:50 Ideyalovechk Imbrozbzbweischenomavic, my first patient, doesn't speak English too well but is pleasant enough and has no qualms with me squeezing the pus out of the giant boil on his neck. However it does look pretty horrible so I ring the registrar to find out what else I should do.

The registrar does not answer.

I go to find the registar in clinic. She is not there.

I ring Kishan to help, he suggests I talk to the registrar.

Just as I'm realising what it must be like to be on the other surgical specialties where having a registrar is as commonplace as girls having an orgasm I bump into Alun who gets all irate at the bastard Max-Fax bastards and demands that they sort out their own patient.

To this end I bleep the scary max-fax SHO who, as his description would suggest, is quite scary.

"Oh it's OtherMatt here, I'm just answering the SHO bleep"

Now OtherMatt is more of less the most lovely person in the known universe. He once waiting around 3 hours to give me a lift home even though he lives miles way from where I live just because he's that nice. This meant that I could turf my patient over to them with ease, however I did worry that OtherMatt might get grief from the scary SHO in my place. This made me sad.

11:00 Just as I leave the office after ringin Max-Fax one of the medical students appears.

"Have we got teaching with you today?" she asks
"Oh yea sorry no I texted one of you, I've got loads of patients"
"Oh... oh right" she replies indignantly
"I'm really sorry, I didn't know they'd be coming in when we organised this"
"No it's fine". When a girl says everything is fine, NOTHING is fine. and when a girl says nothing is wrong EVERYTHING is wrong and when a girl says "that's not funny" you'd better not laugh your ass off.
"Well yea sorry"
She storms off. I feel terrible, like I usually do about everything, even though it's not my fault and, frankly, medical students never turn up to SHIT.

11:15 I call through the next neck abscess patient who is sitting looking very sorry for herself in the waiting area. I assume this is because of her giant neck abscess. On entering the room she sees the examination chair and shudders.

"No, I can't do it"
"Yes you can" replies her worrysomely long fingernailed husband
"No, I really can't"
"Yes you can"

This goes on for some 39 hours before she eventually plucks the courage up to sit in the FUCKING CHAIR.

It transpires that she is a huge wuss and can't really cope generally with life. I do various painless investigations on her that cause her to cry and call our for help and be a general pain in my ass before deciding to ring the reg again.

11:30 The reg is generally unimpressed with my call because I knew exactly what to do anyway so why did I ring her. I don't even know why I rang her but I have a theory it was to GET THE HELL AWAY FROM THAT ANNOYING PATIENT.

When I return to the room, having decided it is a gland abscess with the reg, she divulges that she hasn't been to the dentist in some 20 years. This is interesting as the other thing that can cause giant neck abscesses is untreated dental infections. I rather hoped she might have mentioned this during my "any other problems?" line of questioning but apparently having only 8 teeth left of which 1 is hanging on by a thread is not a "problem" just a challenge, a challenge to resist the temptation to SHAKE HER BY THE LAPELS WHILST SCREAMING.

You may have noticed that I have a sense of disdain for this patient which I know is terrible, I mean I don't know what she's been through in the past and I'm supposed to be a super-empathetic cuddly fluffy doctor but SERIOUSLY she needs to brush her teeth once in a while and, moreover, she made me fail to endoscope her and I LOVE endoscoping people. Bah.

12:00 Being pudgy at best, this patient has no veins. Furthermore she is needlephobic (of course, despite her thousands of tattoos) so my hope of cannulating her is minimal. I use Phoebe's patented 'using a Green cannula' technique on the only thing that vaguely resembles a vein. It actually works and, as a result, lifts me from the dark pits of despair in which I was residing (though only temporarily of course).

14:00 The results of the woman's dental x-ray come back and prove that she has the biggest dental abscess ever known to man. As a result I turf HER over to max-fax as well, knowing that as it's to do with her teeth it must surely be their problem.

Day 4

08:00 It turns out that Max-Fax aren't convinced it's a dental abscess, despite the obvious dental abscess on the x-ray and the history of her having not seen a tube of toothpaste since she read the illustrated edition of Charlie And The Chocolate Factory (anyone who works out that reference can have 50 points), 30 years previously. Fortunately we have WonderSri on ward round who has a word with them and convinces them that they should really get their consultant to check the patient out before the decide such silly things.

08:45 Breakfast time. Sri is hungry for some grub but upon opening his wallet finds only moths and some Indian currency. We all lend him some change and feel bad that, though he knows more about ENT than a giant tree from Lord Of The Rings he is only a Staff Grade and so gets paid literally in moths and rupees.

09:30 "So why is it Sri" I ask "that all Indian people say 'isn't it' at random inappropriate times?"
"We do?"
"Yea all the time"
"Well I suppose it's just the way we talk, isn't it?" he says, before realising what he's done.

We spend the next 30 minutes chatting and being generally amused by Sri cursing every time he says 'isn't it'. It's a little bit like when I taught my housemate how to pronounce Three correctly instead of pronouncing it as 'free' and now he can't ever use the word free without pronouncing it as 'three'. Muahahahaha.

11:00 We're still at war with Max-Fax over this damned patient and they want an Ultrasound scan to prove what it is. Radiology have told them they can't HAVE an ultrasound so they've ordered an MRI scan on the computer.

Unfortunately ordering things on the computer and radiology actually agreeing to do them are two very separate things that Max Fax, being dentists, are unaware of. Subsequently (as Alun would say) we decide to ring Radiology to see what the deal is. They tell us that there are no Ultrasonographers in the whole hospital today (bad news for anyone with an ectopic pregnancy I guess) so it can't be done.

We decide that the MRI is just never going to happen so we are about to order a CT scan on the system before realising that that would result in us having a pending order for an MRI, a CT and an ultrasound scan all for the same patient; none of which would have been vetted by the radiology consultant yet. Presumably when he saw this cavalcade of imaging requests he'd decide we're all idiots, cancel the whole lot and then shout at us.

Ravi, having more balls than me, rings up the radiology consultant preemptively but can't get hold of him or anyone else. He then, having no balls at all, runs away to teaching or some other lies.

12:00 I notice that the MRI scan on the system has changed from "Fuck youuuu, Geoff" to "Appointment Booked" this is promising so I ring MRI.

"Well we don't really do appointments you see" explains the guy on the phone "We just have a list of everything that needs doing and we randomly do them on our own whim"
"I... seee. So any idea when ours will get done"
"Hmmm not really, I mean if you want it done today you'll have to talk to one of the unreachable radiologists."
"Hmmm"
"But I can have a look for you on the system and see if it says anything"
"Thanks"
*long pause*
"Oh it says on here that the MRI is cancelled but they're now doing a CT scan"
"Oh, oh good, so do you know when that'll be?"
"No you'd need to talk to CT for that, but they're all out on lunch at the moment"
"Right, thanks"

OH for fucks sake!

At this point I decide that the woman probably will get a scan at some point so I just leave them to it.

15:00 Sri is called up to the Respiratory ward to see a few patients so I, having nothing better to do, come along for the ride. One of them apparently has a blocked tracheostomy and the other apparently has mastoiditis (infection of the mastoid process, which is really a bit like a Wispa bar and loves having those bacteria).

We see both the patients, neither of whom have anything wrong with them and gloat at the FOOLISH respiratory FOOLS for being FOOLISH. As Sri writes up the notes I look at the patient list on the wall. It. Is. Huge. There are about 40 patients on that list and, according to the F1, there is another entire Respiratory ward + outliers. Between 3 doctors. There are 8 doctors on ENT and about 2 patients, across half of one ward.

I take great satisfaction in the knowledge that Brodie will soon be on this ward(s) and, during the winter months, they take on a THIRD ward for extra extra patients. He is, quite literally, going to die.

16:30 In theatre draining the pus from the annoying woman after we decide that Max-Fax are just never going to sort it out (though they do agree to take out her teeth). Sri is initially worried that there isn't going to be any pus but as would luck would have it it begins oozing out the very moment the knife goes in. I get a little bit too excited about this

17:00 Sri lets me do stitches. I suck. I really, REALLY, suck. Like I can't explain to you how much I suck. Also, as my suckiness becomes apparent, my hands begin shaking under the pressure. To make matters worse, Mr Archer suddenly appears behind me MID SUCKING. I am close to just killing myself with the needleholders but then I realise I suck so much I'd probably miss anything major and just end up looking like an idiot.

18:00 I go home, feeling thoroughly shit and hoping that, with any luck, there'll be some massive pile-up on the way home and the A&E guy who tries to stitch up my carotid artery will suck just as badly as me and I can be swallowed up by the sweet embrace of death.

On the plus side I did social fun stuff at the weekend that made me feel like I have friends (though obviously I don't really).

Tune In Next Week For More "Trust Me, Ooooh Shit, my new job is looming horribly and I'm going to die"