To all my readers, who love doing just that - reading. Dedicated especially to my friends who are sure I sit home and Youtube all day (sometimes I do.) And here's why. :)
He works in one of the busiest Emergency Departments in Victoria.
He gets to work at 1.45 pm, fifteen minutes before he's actually meant to start. He goes to the laundry trolley and reaches for a white gown which he ties around his neck.
He scrolls through the computer screen and sighs. So many patients waiting to be seen, and not enough doctors around to be assigned to every one of them.
He is given three patients to see by his consultant, and he cannot find room to see them in. He sees the first one, a gentleman who had come in with abdominal pains a few days ago who was representing with the same pain. There were bugs in this patient's urine, but after discussion with his consultant, he is asked to order a CT scan to make sure there's no stones. He goes and talks to the radiologists, often not the friendliest of people especially when busy, and after a bit of growling at, he gets his CT request granted.
He picks up his next patient, a gentleman who was washing his concrete truck with some acid when some of it had gotten into his eye. He sits the gentleman down in the procedure room and proceeds to examine him with the slit lamp. He sees a small area of debris lying in front of the pupils, and reaches forward with a small needle to clean out the debris. The man is thankful to be rid of his pain and irritation and he is all smiles as he leaves. The doctor feels fulfilled by his immense gratefulness from having done so little for him.
The next patient is a lady in her late forties, who was coming in with a two week headache. There is no room in the department to see her, so he brings her around to the clinic areas, and makes do with seeing her in a treatment room. There are other doctors just sitting outside the waiting rooms seeing patients, so precious was the bedspace in the Emergency Department.
Something worries him about this lady - she has had an intermittent headache for two weeks and some dizziness. What concerns him is that she is normally a high functioning professional, and when he's examining her, she can't seem to get the place right, and the year as well. And there was almost a childlike detachment about her, giggling in an almost fascinated way as the doctor examines her neurological status. He orders a scan of her brain.
He sees the next patient in the triage area, an area with a nurse deciding how urgently a patient needed to be seen. There were two reclining chairs and a bed in that area.
It is a gentleman with a worsening large chronic ulcer of his legs, and the doctor is a little surprised that it hasn't smelt worst than he'd half expected it to. He knows this man needs a bed in the Emergency Department, but he can't get one yet. The doctor puts in a cannula and sends some bloods off.
It is time for handover, where the morning doctors would hand over their patients to the evening doctors, and they congregate in the dark handover room. The morning doctors speak about their patients and the consultants reassign the patients in the department to the evening doctors. They then disband out into the department again, and see the patients that they have been handed over, as well as the new ones.
He has been handed over a 19 year old with a headache, which could be a migraine. And given a new 1 year old with a crush injury to her 4th and 5th fingers.
when it hits the fan His mind is now torn in five directions. The gentleman representing with the abdominal pain. The gentleman with the ulcerated leg. The lady with the headache. This new boy with the headache. And the one year old.
But the alarm suddenly goes off in the department. A lady in one of the monitored cubicles had crashed. There is no pulses that anyone could feel, and she is turning a dusky grey colour. There is a brown fluid that she is vomiting out. It looked faeculent.
A group of doctors and nurses descend upon the cubicle, suctioning her mouth, starting CPR, putting on the defibrillation paddles, giving her adrenaline. They rush her into one of the two resuscitation cubicles, CPR continuing the whole time.
"She's got a shockable rhythm," the doctor volunteers. The consultants look up and the nurses as well. Let's shock her, came the decision. Everyone stand clear. They deliver one shock, throwing her body about four inches from the bed. Her heart rhythm returns to normal.
They put a tube down her throat to help support her breathing and put in needles so that they can hook up the fluids and medications to save her life. The brown fluid is still coming, and they put another tube down into her tummy to try and drain it out so that it didn't go down her lungs.
The chaos settles down in the resuscitation cubicle as the patient is stabilised, for now. He asks if there's any other thing else he needs to do, and the consultant says, I think we'll be all right here.
now that you've saved her, for now/this is the sound of universes collapsing, againNow back to his patients. Where was he?
He checks on the report of the gentleman with the abdominal pain. It shows diverticulitis, an inflammation of the large colon's little outpouchings. Causes diarrhea, fevers and painful bowel movements. He gets a bed for the gentleman in the department and starts some antibiotics and fluids. He then speaks to the surgical registrar, who is thankfully an old friend, making the referral easier.
He remembers too that he needed to check on the lady with the headache. He approaches the radiology registrar, whose face told him that the news wasn't good. She had a frontal brain tumour, and it was squashing the brain to the point of imminent death. The doctor starts getting a little rush of adrenaline again, as there were things that needed to be done for this lady
now.
He talks to his consultant, who follows him into the radiology department to see the images himself. She needs to be transferred out into a tertiary hospital. He begins the long walk back to the patient and her husband to break them the bad news.
The doctor cannot believe it himself. This is his second brain tumour in his two and a half months of work here. How do you tell someone that they have a horrible tumour with only months to live? He does not cry this time. He cannot cry this time.
He sits her down and the husband as well, as he breaks the bad news. There are no tears coming from either of them.
She stares at him as the words roll out of his mouth in slow motion, but there is this invisible glass pane that has stopped her from understanding fully what he was saying to her. The tumour was also affecting her ability to take this all in and understand the true consequences of what she was being told.
The husband sits in silence, the news obviously will have to take time to sink in. The doctor rattles off a plan to give them structure in their time of grief. We need to give her steroids to help with the swelling. We need to give her medications to prevent her from fitting. We'll need to transfer her to another hospital. They nod in quiet acquiescence.
it's not just usThe doctor sets about arranging the transfer. He calls the tertiary hospitals. No beds at the moment, unfortunately, says one.
Click. He speaks to another neurosurgical registrar. Why don't you call our bed manager and find out if we have beds?
Click.
I'm sorry, but we're on hospital bypass at the moment. No beds.
Click. Finally he reaches one of the main tertiary hospitals, and the neurosurgical registrar accepts the patient. But they had no beds as well.
Call the Emergency Department and see if they'll take him, says his consultant. I know what they'll say. They'll say we have no beds. Then she'll have to stay here overnight. It's not ideal, you know, but. He shrugs.
He calls the admitting officer of the other Emergency Department, and, by the grace of the God who loves him, manages to secure a transfer to the other Emergency Department. He tells the patient about the transfer, and hurriedly orders an ambulance and puts together the films and the drug charts of the patient. He types a letter out to the doctors in the other Emergency Department.
only humanWhile all this is happening, patients keep turning up on trollies, being brought by Paramedics into the Emergency Department. He looks at them and sighs. Where are we going to put them? he thinks quietly. He sometimes wishes he could bring the Health minister and the whole health ministry into the Emergency Department to let out his frustrations. Look at this. We need more beds. We need more staff. We need another hospital.
He is not the only frustrated one. In the midst of his trying to resuscitate the other patient, and arranging the transfer, the parent of the one year old had gone off his head, unwilling to wait any longer. He was hurling abuse at the triage nurses, and had stormed off with his child.
The doctor refocuses, not wanting to dwell any longer on what he couldn't change. The gentleman with the leg ulcers. He spoke to the medical team, and overworked as they were, they tried to play down his problem and said that he was probably okay to go home with different antibiotics.
The doctor goes out into the waiting room to tell them the news. The daughter of the gentleman looked displeased, and wanted her father to come into hospital to sort his ulcers out. The doctor once again becomes the middle man, trapped between the desires of the families and the reluctance of the medical team to admit this gentleman into hospital. Another hour of careful negotiations had to happen before the decision was reached to admit the gentleman into hospital.
breathe. focus.The consultants know that he's having a difficult day, and allow him to choose his next patient. He picks up another patient, a staff member with dizziness, but unfortunately, there is no room at all to see her in. He does what he can, asking for them to give her something for the dizziness in the triage area.
His mind is now in five directions. The man with the diverticulitis. Admitted under the Surgeons.
His mind is now in four directions. The man with the chronic leg ulcers. Seen by the Medics.
His mind is now in three directions. The lady with the brain tumour. The staff member with the dizziness. The young boy who was the hand over to him, with the headache.
He sees the young boy and discusses him with the consultants. They come to the conclusion that he needs to have his brain scanned. And then for a lumbar puncture, which is a needle into the spine to draw out some fluid around the spine.
He arranges the CT brain and waits for the results. He goes to grab some dinner, and has not sat down for five minutes before he gets called out again. The ambulance was here for the lady with the brain tumour. But her cannula had tissued. He needed to put another needle in.
He puts the needle in, and says his goodbyes to the unfortunate lady and her husband, wishing them all the best. He whispers a quiet prayer for them.
The staff member with the dizziness is asking to be seen. She wants a needle for her headache. He knows he should examine her fully first, but he lacked the time and the space, and going by clinical judgement and her story, the needle would be all she needed. He hopes. He asks for the needle to be given, and the nurses, who are Godsends, help him with it.
The CT brain on the young boy comes back normal. It was going to be time for the night handover soon, but the consultants tell him to just do the lumbar puncture, and she will hand over his patients to the night staff. He has had an eventful day, and she was being really understanding.
this is spinal tapHe sets up for the lumbar puncture, but the 19 year old is a little spooked. You would be too, I guess, if you were having a needle put into your spine, for goodness' sake, to have fluid taken out of it.
Before the doctor has finished setting up the lumbar puncture kit, a piercing alarm had gone off in the department. An old lady who had come in with a bleeding nose had gone unresponsive in the triage area. He is the only one of two doctors around as the rest were in at handover. He rushes to the lady, and they get her onto a bed and into the resuscitation cubicle. He puts in a needle and gets blood from the lady, and she comes to in a short while. A simple faint. He heaves a sigh of relief and returns to his lumbar puncture.
The staff member with the dizziness has improved, and is asking to go home. He should really fully examine her but he can't. He scuttles about organising for her medications and telling her to return if the dizziness persists.
He gowns and gloves up and proceeds to sterilise the back of the young boy with an alcohol solution. He then puts in local anaesthetic, and then guides the spinal needle into what he hoped was the spine. He was successful, thank God, and the fluid that comes from the spine was reassuringly crystal clear.
It is almost time to go home, and he ties up his loose ends, and hands over the rest of his patients to the night doctors personally. He is tired, but has had a fulfilling day. The white gown comes off easily as he disengages the knots that held it in place - and the whole chaos, the whole drama and all the frustrations fall from his shoulders with the gown.
If only for tonight.
He works in one of the busiest Emergency Departments in Victoria.
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