It's been too long... again... that's all because my social life took an unexpected turn towards existence and I've simply not had the time. Furthermore, as you'll soon learn, very little has been going on at work so I've been struggling to come up with anything to say. In the news this week: Some football guy was racist, proving that all footballers suck ass. QED.
Night 1:
20:00 I arrive at work to find a stranger in the office. He's sitting in front of the ENT computer, though, so he presumably has something to do with us and, when he sees me come in he seems to know who I am. After about 5 minutes of pretending I know who he is I realise that it's Ravi, the F2 who literally hasn't been on the ward since I last wrote about him in this blog 2 months ago. Perhaps he exists only when I write about him, like in that Stranger Than Fiction film. Or I have Alzheimer's, either way. Encouragingly Sri and Alun are in the office too, perhaps to babysit me through the scary night or, at very least, to invite me to the pub.
20:06 The immediate departure of all 3 guys indicates that neither of these scenarios is the case and I am, as ever cripplingly ALONE. Ravi pokes his head round the door to mention that the Star Trek Villain must not have anything put in his nose under pain of DEATH. There is, apparently, a plan in the notes as to what to do.
21:00 The one under 70 year old on the ward (who happens to also be an attractive 19 year old with a fear of needles) needs a cannula so that we can giver her IV antibiotics for her ear infection that's been going on for at least a week. I use local, as ever, and she seems to be able to cope with it but it does take me a confidence melting 3 attempts to get it in. I tell her that we're planning to send her home the next day, which excites her a lot building her up perfectly for when, after I actually read the notes, I break the CRUSHING NEWS that she's staying in at least 4 more days.
Sigh.
02:00 Nothing has happened as yet and I've been generally chatting with the nurses on the ward due to my superstitious belief that any attempt to go to the mess will result in immediate fast-bleepage from A&E to attend to paediatric airway emergencies. This is ridiculous, of course, (it would be CHILDREN'S A&E) but it's frankly not worth taking any chances and, more importantly, the level of gossip coming from the nurses is just extreme.
In particular, they're describing in depressing detail how much sex everyone used to have in the hospital back in the old days, including a particularly vivid tale about how the matron found a missing key taped under a desk because she was lying there on her back FOR REASONS YOU CAN ONLY GUESS AT. Such a long way from today's sausagefest environment where even TALKING to a nurse can get you struck off forever and the closest you get to seeing a pair of breasts is when we have male bariatric patients as outliers and they need an ECG.
That being said apparently one of the previous F1s had nailed pretty much everyone in the hospital so maybe they just saw us coming and ran.
02:01 "Noooo" I respond to the latest bit of news, twiddling my hair between my fingers "He didn't?"
"He DID"
"Ohmigod!"
BL-EEEEE-EEEEE-EEEEE-P
"ENT 'SHO' on-call, wassup?"
"Oh Hi, it's Toucan ward here, the Star Trek Villain Is Bleeding"
"I see, well I'm not really allowed to do anything about it"
"What do you mean?"
"Well we're not allowed to pack the nose any more"
"But... but.... but... then what do we DO?"
"There's a plan in his notes apparently"
"His what?"
"Oh for god's sake, I'll come down"
02:10 I arrive in paeds and start looking through there notes. It soon becomes clear that there is no plan at all and that Ravi is as full of LIES as he is of mitochondria. There is a helpful note that says "Do not pack unless discussed with Consultant Haematologist and Consultant ENT Surgeon"
OK... WHICH consultant ENT surgeon? The one on call who's expecting to be awoken but who knows absolutely nothing about the case or the one who isn't on call and will kill us all if woken at 3am? Just as I'm about to throw a strop the Paeds Reg turns up and, with reluctance the likes of which is usually associated with paying off a parking fine, calls the haematologist who outlines a plan. The very endpoint of this plan, which is many steps long, involves getting the ENT F1 to ring the consultant and potentially shove things in the nose of the boy.
04:00 BLEEEP
"Hello?"
"Hi, it's Toucan ward, he's still bleeding"
"Right, has he had the IVs yet?"
"Er.... no"
"Well then do you want to get them?"
"Um...."
"Because I can't do anything until you do"
"Oh um, OK, it's just that we've been holding onto his nose for 3 hours now and we're getting a bit fed up of it"
At this moment I realise we have specially designed nose pegs on our ward that could really have done the nose holding whilst the poor Paeds nurses went off to do other more important things like SAVING CHILDREN'S LIVES. I take several from our ward and travel down where I find the Paeds Reg. She suggests we wait several more hours before giving him any IVs as, ironically given his ridiculous clotting disorder, he's a got a blood clot in his arm and they don't want to make it worse.
07:00 BLEEEEP
"Hi it's Toucan Ward, we gave him his IVs 90 minutes ago and he's still bleeding"
"AHHHH FUCK" I want to reply
"Hmm OK" I actually reply "I'll try and get hold of my consultant"
I decide that, given the fact the entire ENT staff are going to be here in the next 45 minutes, the fact that the registrar should really be the one to stuff his nose lest I shred the thing in my attempts and that I'm FRIKKIN KNACKERED, we should just wait another hour.
08:00 The cavalry arrive and the registar and I immediately go downstairs to sort him out. When we arrive he's stopped bleeding (potentially because he had no blood left). The team seem to think it's a bit ridiculous that I've not packed his nose by now but given that I was EXPRESSLY FORBIDDEN FROM DOING SO BY A CONSULTANT I felt like I had a good case.
Night 2:
08:00 I arrive to find that there is now a plan for the bleeding child. This is reassuring. What is also reassuring is that Laurence the Dentist version of myself (only more attractive and younger, the iPhone 4S to my iPhone 4) is on nights so at least I'll have someone to talk to/cry on the shoulder of.
22:00 I bump into one of our previous patients whose head was, the last time I saw her, brimming with pus. Apparently that is still the case as she's back on the ward and that's sad news as she was a very nice lady the last time she was in and used to spend her time ambling about the wards and being generally pleasant. This time around, however, she is far less happy and complains that she has damn well had enough of this head/pus business. She also expresses anger that she hasn't ever seen her consultant, Mr Archer, in the many weeks she's been ill.
01:30 Nothing is happening (as usual), and we're chatting to the matron in the office.
01:34 BUZZ BUZZ BUZZ goes the Emergency Patient Buzzer
The Matron and I go running into the room, hearts racing, preparing to do super-brevado George Clooney style CPR +/- intubation, chest drains, lasix, CBC, Chem-7 and a central line. Laurence goes running in preparing to... I dunno... pull out one of the guys teeth or do a filling or something.
Either way both parties are disappointed (and also relieved) to discover that it was just the patient playing with the buzzer on the wall.
"Why did you pull that?" asks the matron
"Because I don't know where I am"
It must be terrible having dementia (and I'm soon to find out I'm sure), waking up in a room containing a hospital bed, hospital oxygen delivery equipment, a hospital IV drip and a hospital medicines locker whilst wearing a hospital gown with only the giant "THIS IS A HOSPITAL" sign to offer any vague clue as to where you might be. Who wouldn't pull the giant 'EMERGENCY CALL' buzzer (only found in hospitals) in the hope it might, in a booming voice, explain what the hell is going on. It's the equivalent of waking up under a decorated pine tree, surrounded by presents, with the smell of frankenscence, mince pies and reindeer hanging in the air and grabbing Santa by the beard whilst threatening to "pop a cap in his ass" if he doesn't tell you what season it is.
("It's the season to be jolly, bitch" he would reply, kneeing you in the balls and pulling the gun out of your hand)
07:45 I'm chatting to Matt about how upset that patient was and how Mr Archer is a fool for not having seen her yet when I feel a presence behind me. I turn around to find Mr Archer inches behind me.
"Oh ho ho hello Mr Archer" I squeak before turning round to the computer to delete the "Patient very unhappy that the consultant hasn't come to visit her (surprise surprise)" note from our jobs list.
He seems not to have noticed but I have a feeling that it's only going to come back to haunt me at ePortfolio sign off time.
08:15 Kishan arrives late, as always, to find us all desperately trying to appease Mr Archer who is just wandering the ward and randomly seeing patients in no discernable order while his juniors scrabble to get the relevant persons notes and then present themselves behind the curtain just as he finishes explaining the , apparently unrepeatable, plan.
"Man, things must be bad if Mr Archer is here" he says "God left this place a long time ago"
Ahh Kish :)
P.S. if you don't get that GO AND WATCH BLOOD DIAMOND FOR GODS SAKE, HOW CAN IT HAVE TAKEN YOU SO LONG.
08:30 We go to talk to the pus filled patient. She is in a bad way and is crying all over the place. This makes me sad because she used to be so nice and we've clearly destroyed her. Fortunately because the consultant is actually there she is able to emotionally press him into sorting her operation out sooner, and by sooner I mean the next day. This would have been totally impossible for us to arrange even if we'd told the consultant that she was upset, there really is nothing like direct person to person crying to get things done.
Night 3:
20:00 Ravi has disappeared into the ethereal realm from whence he came so Matt is working late. As a result the afternoon has been horribly busy because Matt attracts patients like Brodie attracts girls (i.e. a surprisingly large amount). Fortunately nothing is going on now and he sends me off to theatre because apparently they need me, there is a pressing job to do on the ward as well but he goes to do that despite the fact he should really be at home already.
20:05 I get to theatre
"Hi Geoff" says Mr Archer before turning back to the patient and ignoring me, Steve doesn't bother to even acknowledge my existence at all. I stand around for a couple of minutes wondering if they might talk to me but am disappointed.
"Alun, apparently you wanted me?" I ask after finding him hiding in a corner
"Oh, Geoff, oh right, you're here. We're all finished but I'll be up soon"
Maaan I had to walk up whole flights of stairs to get here and for WHAT?! Furthermore my cleanly pressed PowerShirt specially chosen to help me through the dark nights (when presumably I'll have to choose between saving the love of my life and the city prosecutor and fail to do either) has creased up like a chinese fan caught in a closing vice during a particularly hilarious comedy gig. Bah.
20:10 Back on the ward Matt is drowning under a pile of work that sprouted from the one job he was quickly going to do before going home. Matt never gets to go home at a reasonable time but then he lives 2 seconds from the hospital so he still gets more sleep than I do.
20:30 The Bleep Bleepeth, it's A&E who start describing some depressingly complicated sounding story that involved horrors such as the draining of a BRAIN ABSCESS. Just as I'm about to lose all desire to live anymore they tell me that they've already spoken to my Registrar in Barbados (or somewhere equally far away) and that I just need to book the patient in for an outpatient appointment.
Ha! I can't even DO that because it has to be done during the day. In your FACE, day team.
23:00 A&E Bleep again, they've got a guy who's been bleeding out of his throat and they think that is probably a bad thing. I agree and begin pacing backwards and forwards around the office in trepidation of whats to come.
24:00 The bleeding guy eventually arrives. He is about the most well person I have ever SEEN and, furthermore, he hasn't had any bleeding for several hours now. Apparently it didn't involve any coughing or anything worrying so chances are it was just a nose bleed. This is good because it means all I really have to do is shove an endoscope in his face.
Unfortunately, however, he is a huge HUGE wimp.
00:30 "AAGHHHHH MAKE IT STOPPP AGHHHHHHHH" he screams in a way that would horrify you unless you knew for a fact that this procedure doesn't hurt at the worst of times and furthermore HIS NOSE IS JACKED UP ON LOCAL ANAESTHETIC
00:50 "Oh just one more thing" he adds just as I am trying to get him to leave because he is totally fine "I've been having these headaches..."
"Probably brain cancer, you likely have days to live see you later, bye", I say kicking him through the doorway.
That may seem a little heartless but a) It was 1am b) I'm an ENT doctor (for now) and c) if I wanted to put up with crappy pseudo-illness then I've have become a GP. OK so I couldn't under any circumstances be a GP by now but that's hardly the point. OK so that IS the point but... just shut up.
01:00 "So do you think we should order the pizza now?" Asks Laurence
"Yea, nothing is going to happen now"
"OK" *Laurence clicks on order but-* BLEEEP BLEEEP BLEEEEP
AAH BALLS
"Yeesss what is ittt? WHAAAT?" I agitate down the phone
"Geoff it's Phoebe" replies Phoebe "could you do me a favour, I'm really busy looking after 3 dying patients and ward XYZ keep beeping me for fluids to be written up, would you mind doing it?"
I look from the screen with no patients on, to my jobs list with no jobs on, up and down the empty corridor and then at the matron who appears to be playing online poker.
"Yea I think I could manage that"
01:30 Just as I arrive back from the fluids ward I see Laurence walking towards me with pizza in hand. Pizza that I still haven't paid him for... hmmm must remember to do that.
We sit and eat Pizza and natter with the matron, who presumably is only as nice as she is to accentuate the difference between the wunderjob that ENT is and the hideous nightmare that all other jobs are.
14:00-8:00 Nothing else happens. Further showing that ENT is da bomb.
Night 4:
19:00 I arrive early to let Steve go home as he's been unfairly dished out an extra evening on call during his hideous 2 weeks of hell period. I immediately have to go and sort out a girl with a bleeding nose.
19:05 As I call her into the room, I notice that her nose isn't bleeding at all but I explain that we'll have a look in her nose and see if we can find the bleeding point so we can cauterise it and stop it happening again. Most people would be pleased about the prospect of no more bleeding but unfortunately she is also a MASSIVE WIMP.
I spray her up with cophenylcaine (my favourite drug(s) ever) to ease the pain and have a look in her nose. She has MASSIVE (well, for a nose) veins bulging out of both sides of her septum, one of which has a bleedingy bit on so I explain that I'm going to zap it with a cautery stick.
"Will you do both sides?"
"No" I reply, suddenly remembering that cauterising both sides of someones septum causes you to burn a hole through the middle. Whether I would have remembered that without her prompting me is anyones guess.
(Though OF COURSE I would, I'm a PROFESSIONAL)
19:30 Dave Taylor appears on my ward wondering if I can help him shut up a patient who keeps complaining that something is stuck in his throat even though he's been nil by mouth for about a week. As such we go trundling off down the corridor, endoscope in hand, to the Urology ward.
19:35 "Now Sir, this doesn't usually hurt although I've had alot of people who haven't coped with it very well recently"
"Meh, I've just had my prostate chopped into tiny pieces and removed via my penis, my concept of pain is very different from most people's"
Touche.
I stick the thing in his nose and he doesn't bat an eyelid. Furthermore his vocal cords are free of any trouble, which seems to please him and immediately cure him of the foreign body sensation. I like this guy.
22:00 The ear infection girl needs another cannula. In fact she asked for me especially. I feel sorry for her because she's supposed to be at uni having fun but has been stuck in hospital seemingly forever and I'm concerned she might go totally bonkers like Mr Complex (who similarly had an ear infection and was in hospital forever, the only difference between the two being that one of them wanted sex with Brodie, the other was a girl). When I go in the room I find that she is dressed in a ridiculously low cut top and short shorts, she is also all dolled up with makeup which, for someone in hospital with pus coming out of their ear, seems like a waste of effort. It is however quite offputting.
22:15 What is even more offputting is that, 3 cannulas in she has gone from making "ow and tshhhh" noises to "mmmmm, oooooo" noises. I try one more and it explodes in my face in a symbolistic manner so I decide to escape the room before she starts playing Marvin Gaye on the iPod.
22:30 Banging my head on the desk about my cannulation incompetence I bleep Phoebe who, despite being generally disapproving of idiots who can't do their job properly, is extremely nice and turns up within seconds to help me out.
"Don't be silly, she probably has terrible veins" she lies before sticking a giant cannula in her first time.
I've learned since that her next blog entry is going to be entitled "Geoff: The boy who can't do cannulas". Apt, I feel.
23:00 To return the favour I go to write up something that she needed to do on our Ward (even though there are 2 doctors on our ward at nights, general surgery patients are under the care of the Hospital @ Night scheme and so the insanely busy H@N F1 is called to do simple jobs for them while we sit around on our asses). I'm confident this will make me feel better because I can actually DO real medicine it's just all the fiddly needly stuff that fucks me up.
"This patient needs a sliding scale of insulin", explains the nurse
"Riiight" I've never done one of these
"So if you just put it on the drug card"
"Here?" I say, pointing at a section of the card
"Nope"
"Here then?"
"Nope"
"Here?"
"OK I suppose that'll do"
I write up the insulin on there as per the protocol I'd conveniently read the previous evening.
"Oh thanks" the nurse says when I come back with the card "only it's not dex saline, is saline and it's not over an hour it's over 30 minutes and it's not insulin it's novorapid"
"Oh bollocks to this for a game of soldiers" I say, setting light to the drug card and using it to BURN THE HOSPITAL TO THE GROUND.
02:00 I'm bleeped by A&E resus. Bleeps from A&E resus essentially mean that someone has lost their ability to breathe and they're calling you, the 'expert', to help the CONSULTANT ANAESTHETIST put in a percutaneous tracheostomy. It is literally shit your pants scary.
"Ummm hello?" I tremble
"Hi is that Max-Fax?"
"No it isn't" I reply, grinning
"Oh sorry, I'll call them"
"In your FACE, Laurence" I say with a little too much glee as he doesn't really need a hard evening "that was Resus, you in da shit maaan!"
It turns out to be someone who's fallen off their motorbike whilst riding drunk without a helmet. All Max-Fax patients are alcoholics, or drug addicts, or something dubious so this kind of presentation comes as no surprise.
02:15 We go down to A&E together and spend some time dealing with the guy who is not only still very drunk but has torn off MOST OF HIS FACE. Disconcertingly he keeps rubbing his face with his palms, like you would when you've been reading for too long and need to rub your eyes, causing further grease and mud from his hands to get ground into the wounds.
Laurence begins the process of lidocaining up his face during which time he cries alot and keeps talking about "claret" which we assume to mean blood but, not having a degree in "the street" are unable to fully understand. In the end he proves a) far too annoying and b) far too complicated to be fixed there and then so it is decided he should be treated under anaesthetic in theatre the next day.
03:00 A&E call to say he got bored and walked home. He is going to feel ROUGH tomorrow.
04:00 I'm in the SALT office typing up Laryngectomy notes for Alun's study when the bleep goes off. I can tell just from the number that it's Paeds, this is particularly upsetting as this is my last ever night on-call for ENT
"Yes?"
"He's bleeding again"
"I assume you've done the plan in the notes"
"Yup it's still bleeding"
"Right I'll be down in a bit"
So that you know the plan in the notes is "Apply pressure for 60 minutes then ring Haematology"
04:05 "So how long has he been bleeding for?" I ask as I arrive
"Oh about 10 minutes"
TEN MINUTES???? SINCE WHEN IS THAT AN HOUR??! YOU SUCK ASS!
"Right well hold it for an hour and then ring haematology like the plan"
05:00 BLEEP "He's still bleeding"
"Did you ring haematology?"
"Um.... no"
"CAN you ring them?"
"Um.... no"
I'm starting to get pretty pissed off now because this isn't, by any description, my job to deal with but they're clearly so used to bleeping ENT when this kid bleeds that they are incapable of doing anything else. I storm down there ready to tell them they're all idiots but when I arrive they all look pretty harassed and fed up with life so I think better of it.
I ring switchboard and ask for the haematology consultant (as per the plan) but apparently no such consultant exists so they put me through to the registrar.
Answerphone.
I lose it a little bit and leave a shitty message on the answerphone.
"Hello, this is Dr Burnhill here, ENT F1, I've been told this is the Haem Reg On-Call. If you even ARE on-call then please ring me back urgently as we are trying to stop Star Trek Villain, a patient well known to you, from bleeding to death"
04:15 The reg rings back and is, heart sinkingly, the nicest person in the world. I try desperately to be extra extra nice to him back to make up for my horrible message but I still feel terrible. But then I feel terrible about pretty much everything I do, ever, so there's no real change there.
05:15 Having waited around for pharmacy to ring me back about the IV drugs I've prescribed BleedFace (formerly Star Trek Villain) I give up and go to get some sleep.
07:30 I handover to the day team, having heard nothing more from Paeds (woop) and, it being Sri, I'm sent home for lots of delicious Ambrosia Devon Sleep.
Tune In Next Week For More "Trust Me, I'm Not As Bad At Cannulas As I Make Out"
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