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.
Thursday, February 11, 2010
Saturday, February 6, 2010
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.
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.
Thursday, February 4, 2010
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!
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!
Tuesday, February 2, 2010
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.
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.
Friday, January 29, 2010
upstairs hollywood medical school...
A middle-aged chronic ethanol-abuser (alcoholic, for you folks at home) came in after a nasty fall. He was wheeled in as he couldn't stand, and his knee, elbow and ankle were swollen beyond belief. He got x-rays of all three joints, which I took to my consultant (boss).
"Boss, I can see a definite fracture in the ankle, maybe a fracture in the elbow and the knee is intact..."
"Yes, the knee is intact, there IS a fracture in the elbow, but... I don't know about the ankle. I think what you're seeing is an old fracture."
O, but I was sure. I argued my point, demonstrating the interrupted cortical bone, the exquisite tenderness of the medial malleolus, the massive swelling of the ankle.
Finally, my boss agreed, and I put the man in a plaster from knee to toe.
He also needed a sling, which meant he couldn't use crutches, and so we had to admit him so we could keep him safe. (Alcoholics are not very well people, and definitely not good using one crutch with two broken limbs). Admitting him meant I had to I call the Orthopaedic surgeon to let him know about the broken boned patient.
Let's call him Bruce.
"G'day, Bruce here, I've had a squiz at the X-ray and there's no new fracture. It's an old fracture."
"But, we're admitting him to hospital..."
"Nah, he's fine. He can go with a walking boot."
"But...I already put him in a plaster!"
...silence....
"Are you one of the new interns?"
"Er. Yessir."
Hysterical laughter down the line.
"Look, love. Take the plaster off, find him a boot, send him home. He's not coming into hospital"
The only upside was that my patient had serious DT's by now and really wanted to go home, where he could drink in peace. I cut the plaster off, found him a boot and sent him home.
Another fine day for intern medicine.
"Boss, I can see a definite fracture in the ankle, maybe a fracture in the elbow and the knee is intact..."
"Yes, the knee is intact, there IS a fracture in the elbow, but... I don't know about the ankle. I think what you're seeing is an old fracture."
O, but I was sure. I argued my point, demonstrating the interrupted cortical bone, the exquisite tenderness of the medial malleolus, the massive swelling of the ankle.
Finally, my boss agreed, and I put the man in a plaster from knee to toe.
He also needed a sling, which meant he couldn't use crutches, and so we had to admit him so we could keep him safe. (Alcoholics are not very well people, and definitely not good using one crutch with two broken limbs). Admitting him meant I had to I call the Orthopaedic surgeon to let him know about the broken boned patient.
Let's call him Bruce.
"G'day, Bruce here, I've had a squiz at the X-ray and there's no new fracture. It's an old fracture."
"But, we're admitting him to hospital..."
"Nah, he's fine. He can go with a walking boot."
"But...I already put him in a plaster!"
...silence....
"Are you one of the new interns?"
"Er. Yessir."
Hysterical laughter down the line.
"Look, love. Take the plaster off, find him a boot, send him home. He's not coming into hospital"
The only upside was that my patient had serious DT's by now and really wanted to go home, where he could drink in peace. I cut the plaster off, found him a boot and sent him home.
Another fine day for intern medicine.
Tuesday, January 26, 2010
rite of passage
I stand over the ironing board, steam curling up into my eyes. I am thinking about yesterdays shift. Specifically, the moment when the nurse taking an ECG on my patient said, "He's in VT."
I have been trained for this scenario over and over. Vincent, our state-of-the-art mechanical patient, goes into VT all the time. I know what to do when Vincent goes into VT.
Call for help.
Oxygen on.
2 large IV access points established, fast.
Paddles on.
Read the rhythm again. Still VT? Shock.
etc etc
When Mr Smith went into VT, I froze. Luckily, no one else did. The nurses around me flew into action like the proverbial well-oiled machine. Within minutes lines were in, aspirin given, oxygen on, the paddles were tracking his heart and we watched as he flipped from runs of VT to bradycardia...
It was my first real emergency. Next time, I'm hoping to actually participate in the code. By my 25th time, I'm hoping it will feel natural.
As the steam rises up and I burn my shirt, I am re-living that sick feeling of panic. I no longer have nightmares about ex-boyfriends. One week in the ED brings a whole new set of nightmares.
That said, I have a beautiful new bed in which to have said nightmares, so being a working Doc isn't all bad. More tales to follow - ask me about the chick on LSD.
I have been trained for this scenario over and over. Vincent, our state-of-the-art mechanical patient, goes into VT all the time. I know what to do when Vincent goes into VT.
Call for help.
Oxygen on.
2 large IV access points established, fast.
Paddles on.
Read the rhythm again. Still VT? Shock.
etc etc
When Mr Smith went into VT, I froze. Luckily, no one else did. The nurses around me flew into action like the proverbial well-oiled machine. Within minutes lines were in, aspirin given, oxygen on, the paddles were tracking his heart and we watched as he flipped from runs of VT to bradycardia...
It was my first real emergency. Next time, I'm hoping to actually participate in the code. By my 25th time, I'm hoping it will feel natural.
As the steam rises up and I burn my shirt, I am re-living that sick feeling of panic. I no longer have nightmares about ex-boyfriends. One week in the ED brings a whole new set of nightmares.
That said, I have a beautiful new bed in which to have said nightmares, so being a working Doc isn't all bad. More tales to follow - ask me about the chick on LSD.
Wednesday, January 20, 2010
What I did wrong (today)...
I have just completed my first week of intern medicine.
I can't really differentiate one day from another, as there was a great deal of panic (is this a heart attack or gas?) and terror (so much bleeding!) and moments of utter elation (drip in! catheter in!). But so far, I've survived.
On this, my first day off, I woke up really early. In fact, I rose from my bed in half-sleeping panic, reaching for my phone, the words pouring from my mouth; "I didn't give him any antibiotics!!!"
Yesterday I saw a nice young man who works as a stone cutter. He was using an angle-grinder to hew some marble, and some of the dust flew up into his eyes. He used one hand to wipe his eyes and the grinder got away from him.
Into his thigh. Very, very deep into his thigh. Luckily, the grinder was hot and cauterized the wound, otherwise he could have bled to death. As it was, I could see deep into his leg and admire the many layers of muscle, fat and...is that a tendon?
He needed a surgeon. I called the surgeon. He said, "I'll be there soon, give him some morphine, call the registrar, set up A, B and C. And give him some cephazolin IV."
No worries, right? But I got called to look at my other patient's ECG which was showing changes that could have been a heart attack and...
Long story short, I forgot to give the antis.
In the end, after several heart-wrenching phone calls (your fellow interns are your greatest resource) I figured out that the surgeon had picked this up when he'd done the stitching and given the ceph. But for a good hour I was convinced that I'd killed a man with my stupidity.
That's why days off are better.
I can't really differentiate one day from another, as there was a great deal of panic (is this a heart attack or gas?) and terror (so much bleeding!) and moments of utter elation (drip in! catheter in!). But so far, I've survived.
On this, my first day off, I woke up really early. In fact, I rose from my bed in half-sleeping panic, reaching for my phone, the words pouring from my mouth; "I didn't give him any antibiotics!!!"
Yesterday I saw a nice young man who works as a stone cutter. He was using an angle-grinder to hew some marble, and some of the dust flew up into his eyes. He used one hand to wipe his eyes and the grinder got away from him.
Into his thigh. Very, very deep into his thigh. Luckily, the grinder was hot and cauterized the wound, otherwise he could have bled to death. As it was, I could see deep into his leg and admire the many layers of muscle, fat and...is that a tendon?
He needed a surgeon. I called the surgeon. He said, "I'll be there soon, give him some morphine, call the registrar, set up A, B and C. And give him some cephazolin IV."
No worries, right? But I got called to look at my other patient's ECG which was showing changes that could have been a heart attack and...
Long story short, I forgot to give the antis.
In the end, after several heart-wrenching phone calls (your fellow interns are your greatest resource) I figured out that the surgeon had picked this up when he'd done the stitching and given the ceph. But for a good hour I was convinced that I'd killed a man with my stupidity.
That's why days off are better.
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