Tie me up, tie me down

As medical students, we had infinite discussions about dignity, the right to autonomy, respect and minimal interventions for our patients.

Nurse Bear (cousin extraordinaire) often mocked my naive perspective; "When you've got a patient trying to punch you, see how you feel about chemical restraints..."

Night shift has brought this all to a head. Obviously, nights are when patients "arc up" - delerium kicks in, less staff is available, doctors are hiding in the residents room watching "Dr 90210" (ahem).

We were taught that agitated and aggressive patients should be managed with minimal intervention.

Then came Thursday night. The patient kept getting out of bed, taking off his clothes and pulling out his lines. I suggested small interventions - leave the light on, lower the bed so he doesn't fall, give him a gown, wrap up his drip points. He began wandering the wards, trying to get into other patient's rooms. Close his door, keep an eye on him. He began shitting and pissing on the floor, fingerpainting with his own faeces.

Haloperidol. Stat.

He tried to pull the lines out of a patient in the next bed. More haloperidol.
He got up, shat, slipped in his faeces and had a fall.

I had him shackled. Top and bottom.

The next night I had a patient who is delusional. He believes that he's in a prison camp back in Italy, posssibly under the fascists. Mindful of this, I was sticking to chemical restraint, as I didn't want to traumatize him further.

He kicked me in the head. A crafty gentleman, he would wait until I tried to examine him, then lash out with a very bony knee. (He was also kicking at the "people" at the end of the bed. I was the only one there.)

Shackled.

Lord, I don't even blink any more. Goodbye theoretical medicine. Hello night shift.

I want your disease...

Things that happened on my birthday (or within 2 hours of it):
- cupcakes at midnight
- first on scene at code blue that required intubation and CPR
- projectile vomiting
- pericardial effusion that was causing minor tamponade
*(on TV, this is solved with giant needle to heart)
- housemate party: jelly-slice cake, homemade butter chicken, eating in pj's
- finding out the UBC has changed their requirements for application again and I NO LONGER QUALIFY
- hearing "Bad Romance" as the sun came up and I struggled to get a drip in
*(hello theme song for 29!)

Last year, the birthday didn't happen due to interplanetary time differences. This year, cos of the night shifts, it lasted for about 48 hours. My work life is so strange; I have never had more texts/messages/emails of love on a birthday, but I spent the majority of the day with very sick strangers. Medicine is weird.

Today is pseudo birthday; I've had fancy breakfast at a local cafe, napped for 4 hours and am about to punish my hair with another round of "colour me random". Followed by dinner with my beloved(s) and perhaps a glass of champagne.

Behold; my birthday tune (no embedding, damn you YouTube)

Taking off the cowboy hat...

Alas, last night was my final night in Warrnambool. We decided to stay in town on Friday night in order to experience a "proper" country night out. It was the first time we didn't have to get up early to work so we thought, "Hey! We'll let our hair down, country-style".

After a semi-wholesome afternoon off (whale-watching, surfer-changing-in-the-parking-lot-watching, slutty-shirt-shopping, milkshake drinking) we met at my house to drink any leftover alcohol we could find in our fridges. Champagne, Canadian Club and low-carb beer, all served with a side of stale Doritos? The beginning of a very classy night.

Dinner and drinks, then we hit "The Pub".

I was dancing up a storm when I noticed a familiar face over Dan-the-physio's shoulder; a patient who had come to ED a few weeks ago. I started to smile at him in recognition when I remembered what he had come in for; he was a drug-seeker, and I had denied him drugs. He had been quite angry, needless to say.

I ducked and covered (thank you tall Dan), but I don't think he recognized me, cos he later tried to hit on me after grabbing my ass. Or maybe that was a sign he DID recognize me?

God bless the small country town. And thank GOD I'm back in the big city.

the rise and fall of Dr G, in one short hour

I am drunk with power! (And not, alas, just drunk)
Why? I have no bosses today!

For those unfamiliar with Australian country hospital daily operations; Every morning all the doctors meet in the ICU for a ward round. Then we split into our medical teams; A senior boss (consultant), a junior boss (registrar) and me (pig-spit). The bosses review the patients, create their care plans and alter their medications. I follow them around, frantically writing down whatever they say and trying to deflect nursing questions until the round is done.

This is often unsuccessful, and I have actually written down "Can patient have tea?" into the middle of a care plan.

Today, my registrar has a day off. My boss is away at another hospital. I did the ward round all by myself. I was excited - I could take as much time as I wanted, make sure all my questions were addressed, look up drug doses instead of guessing randomly...

But, since I have no power, knowledge or expertise, it went like this:

Sam: Hello patient! How are you feeling today?
Pt: Stone the crows! Crook-as, love.
Sam:...uh, right...
Pt: Crikey! I spewed this morning, but I'm feeling a bit better now.
Sam: Oh, good?
Pt: So, what's the plan?
Sam: (backing from room slowly)

Sadly, I have no idea what the plan is. Or indeed, whether this patient can go home, should stay, needs stronger medication for his heart rate. So I smile, duck out of the room and hide in the library. Where I write my blog.

The pinnacle of my career, yes? Maybe not.

Go!

Do you know why I hate the medical wards?

Because there is too much downtime. I've been back on the wards for 6 hours now, and I've already worked myself into a state of such grotesque self-loathing and anxiety that I could eat a cafeteria meal. This, it should be pointed out, is akin to an act of self-harm.

Do you know why I love Emergency?

The last three weeks, I have been working in the Emergency Department. In Warrnambool, this means babies, truckies, man vs farm animal, drunk guy vs plate-glass window, drunk girls, kids on motorcycles and STDs.

It also means that from the time you arrive at work until the time you leave (usually two hours late) you are ON. Running. Panicking. Chasing a pantless toddler who is determined to poop on the floor. Trying to stop your drug addicted patient from stealing your stethoscope. Trying to explain to an 18 year old girl that, "No matter how much you like him, you have to use a condom when you can see blisters".

In short, bliss! No time for self-reflection! No time for soul searching! No time to pee!

Workaholism is still better than alcoholism. Similar amounts of vomit, but at least it's not mine.