will to live

We have a frequent flier at St V's; someone who comes in again and again with the same problem. This girl calls the ambulance every few weeks.

When they arrive, she shows them the massive cuts on her arms. She then takes them to the fridge, where she has stored all her blood in jars. In this way, she can tell the paramedics exactly how much blood she has lost.

For a while, everytime she came to ED, they would fill her up with donor blood and send her for psychiatric counselling. Unfortunately, when she has enough blood in her, she feels "too full" and wants to bleed herself again. The hospital was going through all it's O-negative blood on a single patient. There is now a hospital order that we just give her fluids and stitch her up as best we can.

Did I ever say I wanted to do psychiatry? I retract that statement, officially, here.

Emergency is still good. I still enjoy my work, even during crappy, frustrating, sad days like today. This is a good sign.

bitch tits

My patient weighs almost 150 kilograms. KILOGRAMS. (2.2 pounds per kilo, people). Because of his extreme BMI, he has developed lymphedema; essentially, a backlog of the fluid that bathes our cells. Trapped fluid gets infected. Infections mean he has to come to hospital, where we try to calculate the dose of an antibiotic for a person who is 1.875 standard people.

Anyways, his wife came in with their darling baby daughter and I had an utter WTF moment. Who marries this man? How did they get pregnant? How does their daughter look at him? Does she see him as a mountain of flesh or just her Dad? He's had 2 previous lap band surgeries and still weighs more than twice me.

If I'm honest, this is not about my patient. There was an article in the paper for Valentines Day that said women who are still single past 25 are probably too picky and are doomed to a life alone. I look at people like my patient and I wonder if I'm too superficial.

Maybe there's a wonderful 100kg man out there who will be the father of my children, my best friend and apple of my eye.

Or maybe I'd rather be alone than share a bed with someone who suffocates in his sleep under the weight of his neck rolls.

Bah. Forgive me. Canada's hockey loss has put me in a foul mood. Well, that and the fatty.

eeew...

The world gets smaller while I'm at work; the patient, the blood test, the xray, the fever, the pain...The ED is super busy, but if i'm not speaking to someone about a case, "Hey" is the most conversation we'll exchange.

Sometimes there's a lull, and you get a chance to go "phew" and tell your colleagues about the interesting pubic grooming your young Crohn's patient had (who knew teenage guys were into sculpting?)...

Anyways, I go back into the world, watch the Olympics, read the web. Then I find this article about genital lipstick, and feel glad that I get to back to work in an hour.

Back into the bubble.

Valentines Edition

I only know one man who wears Old Spice, but it smelled good when we were 16 and it smells good now.

I am so ridiculously homesick after watching the Olympic opener that I plan to go back to bed and listen to Leonard Cohen and Sarah McLachlan while reading Michael Ondaatje and drinking maple syrup. Peace out.

a stern talking-to

Last night was the first ACDC concert of the Black Ice Tour. 80,000 people attended. At least 10 of those people ended up in St V's ED; fighting, drinking, falling down and biting each other(!).

Another concert attendee lost her toenail when she smashed into the stage. However, she was not seeing ACDC. She saw Taylor Swift.

I have finished my first round of nightshifts! It is 9:46 am, I have been at work for the last 10 hours and awake for...well. Too long.

I was incredibly lucky in that my Reg (senior doc) was a straight-talking, uninhibited, blue-haired Goddess of Emergency Medicine. I think she should write a book of her teaching catch-phrases. My favourite:

"Don't negotiate with terrorists..."

- patients who are refusing to comply with treatment, taking off their C-spine collars, spitting at the nurses, not taking their meds...

These patients get the patented Reg talking-to. "You are a grown-up. You don't have to be here in the hospital. You are free to leave. If you want medical attention, however, you have to let us do our jobs to the best of our abilities, which means YOU DO AS YOU ARE TOLD."

I had a patient who got drunk and hit her head. She kept taking off her C-spine collar and when I explained the risks to her (spinal cord damage, paralysis, death) she looked me dead in the eye and said, "I'm an alcoholic, I don't care if I die, you're not giving me the (pain medication) treatment I want, so I'm leaving".

I need to work on my stern voice.

so far...

I left the hospital at 8am this morning and walked into the harsh sunlight. So far, the best thing about night shift is being first to the bakery; my walk home included a still-warm pain chocolat and Ryan Adams on the iPod, which made everything better.

Last night included stitches for every young man in Melbourne (they bite each other, stab each other, knock each other over, hit each other with bottles), drunk kids, kids on too much ecstasy, kids on too much tylenol aaaaand...a post-coital penis bleed.

I am going to invest in some safety goggles.

living the dream...

I spent a large portion of Wednesday night praying for the sweet release of death. It was 35 degrees in my bedroom and the fan only served to push waves of hot air over my dry, swollen skin. I knew I had to sleep, knew I couldn't and kept having flashbacks about the gory scenes from True Blood. Death seemed like a merciful option.

Of course, today I am glad that Jebus doesn't hear my prayers.

An epic day. ALS training (Vincent the mannequin vs Sam the mannequin-killer) followed by a long shift in the ED. I was supposed to leave at 11pm. I got home at 1:00. It was totally worth it; I got to learn lumbar punctures with K, the blue-eyed Irish resident. If it weren't for the trembling, terrified patient, it would have been just like a Harlequin.

His hands shook slightly as he guided my fingers to the spinous processes. With a thrilling combination of strength and tenderness, he found the intervertebral space and reached for the chlorhexidine swab.

"Sam..." he breathed. "Can you pass me the local?"

As I handed him the needle, primed with anaesthetic, our eyes met. His blue gaze seared into mine and I felt my heart flutter. I knew I would never jam a needle into someone's spine again without trembling.

....sigh...

A girl can dream. On to nights! Expect loopiness!

heatwave

Night shift starts tomorrow. I've had five days off to "prepare" (read: go to the beach, book holidays, sleep in the sun) and I'm still not ready. I am still having nightmares about my last days at work.

It's about 34 degrees outside, which means 31 in my bedroom. This weekend is the anniversary of the Black Saturday fires and the weather has given us a heatwave.

I've been reading first-person accounts of what it was like last year. I didn't know much about bush-fire preparedness before this, but now there's a special in the paper every weekend. Heavy clothing, wet blankets, don't try to flee at the last minute. It has encouraged me to read up on my burn treatments. I've seen a couple of bad burns (paediatric ED was particularly grim) but nothing like what these people have survived.

The heatwaves also mean old people and babies overheating in their homes, which means a busy ED.

I'm hoping for 6 nights of small cuts, non-cardiac chest pain and alcohol intoxication. Wish me luck.