When randomness is the routine

July 12, 2008

Random bit #1 : The Greek and the groin

As I was walking past one of the nurses’ workstation, I could see a mini-crowd building up in one of the rooms. I could hear a number of people talking all at once; couldn’t quite make out what they were saying. Curious, I poked my head in.

“What’s going on?”, I asked. There were 2-3 nurses all standing around this middle aged patient. All of them turned to look at the newest entry into their lil’ conversation.

The nurse closest to me threw her arms in the air. “I can’t understand what he wants. He’s been restless for the past hour.” she said, sounding exasperated.

I glanced at the patient. He just shook his head and shrugged.

“Hello mister, is everything okie?”, I started. Within 2 seconds I was greeted with some rapid-fire reply in a language that I couldn’t understand.

“He’s Greek”, said the male nurse. “Can’t quite understand nor speak English”.

The patient reached for his urine catheter. I instinctively grabbed his arm.

“You don’t want your catheter?”, I looked at him. I can understand it’s not a very comfortable thing to have a tube being stuck up your bladder, but if it’s overly painful for him then we’d have to remove it in case of an infection.

The patient just stared blankly at me.

I pointed to his bladder. “Is it painful?”.

He goes spurting his native language in a very purposeful manner. Trouble is, neither of us could understand Greek. The female nurse looked at me and said, “What does it sound like to you?”

I grinned. “Sounds like Greek to me”.

I pointed to his bladder again. “Pain?”.

To my surprise, the male nurse in the room started pointing to his own groin and emulating some pain response. He was clutching his groin and going “OW? OW?” while looking at the patient questioningly.

I knew immediately he was trying to help, but it just looked just downright funny and kinda wrong. He even did the mini squatting motion with every ‘Ow’ he made. The patient looked amused. He shrugged and shook his head.

After shooting some blanks for a while, we decided to call up his son whom would be our translator via the phone. Turns out that the patient was just amazingly persistent in wanting to know what time his family would be visiting him the next day. Ah.

Random bit #2 : My hand is numb, but then again maybe not.

I received a bundle of pages for this same complaint from the same patient. She was admitted for a fractured wrist and was on the waiting list for surgery the following day. First page in the series was from the nurse, raising concerns over the patient’s hand being numb.

Well it’s not a good thing for one’s hand to be numb, especially when you have it encased in a plaster cast. My first thought was the cast was probably put on a lil’ too tightly – impeding the blood circulation to some degree and/or pinching some nerve.

I headed downstairs to see the patient.

Patient : Oh, it was numb. Now it’s not.

Me : Eh, that was quick. Everything okie now?

Patient : Ya.

Me : Alrighty then. Just let one of us know if your hand’s feeling funny again okie?

Patient : Okie.

Seeing that everything appears to have settled, I headed back upstairs to another ward. Within 10 minutes, my pager beeped. Ah, the hand’s numb again.

Me : Hello. How’s the hand? Numb?

Patient : Ya. Um, just a little bit numb. But if I massage it, it goes away.

Me : Hmm…well it’s looking a lil’ bit swollen than previously. I have a feeling the cast is on a bit too tight.

Patient : Um, are you gonna saw it open? *looks anxious*

Me : There’s a good chance we’re gonna have to do it. The cast is keeping your fracture immobilised but if it’s gonna cut off your blood circulation then there’s more benefit of having it off than on. That could be the reason why you’re feeling a bit numb now.

Patient : Well…yes.

Me : Okie, I’ll discuss this with your treating team just to inform the senior doctor and getting approval to split the cast. If he gives the green light then we’ll do it.

Patient : …okie.

I made a quick phone call to the senior orthopaedic doctor explaining the situation. He told me to proceed so we gathered the equipments necessary for the procedure. This includes a few ‘scary’-looking instruments like the plaster saw and the retractors.

Patient : While you were talking to the doctor, the numbness went away.

Me : Hmm.

I had a strong feeling that IF the cast is to remain on her, I’m gonna be getting a lot of subsequent pages overnight about her intermittent numbness. The cast looked tight to begin with, and the increasingly swollen hand is a big NO-NO. And besides, I can’t possibly keep running up and down the place playing hide and seek with the numbness.

Me : Ma’am, your hand appears to be more swollen now. The numbness appears to be coming on and off but I’m quite concerned still as swelling is another indication that your cast is on too tightly. The cuff is trapping your circulation and it needs to come off.

The patient hesitantly agreed. She was more worried about the sawing part which I could understand. The saw has a circular blade which actually works via vibration instead of an actual rotating motion as per the usual hardware saws. The blade is actually dull; covered in blunted serrations. But then again, a saw is still a saw through the eyes of the patient. The deafening noise that it makes while turned on didn’t help to alleviate her anxiety either.

After much grunting (from us) and much yelping (from the patient), the cast came loose sometime later. Swelling’s going down, and no recurrence of any numbness. Yippee.

I went to work in a dark-coloured shirt with dark blue pants. Left work looking many shades lighter with plaster cast powder all over me, accompanied with several white handprints on my bum (absent-mindedly dusted my hands on my pants). Looks funky though.

Random bit #3 : “Let’s go raid some towns!!”

Naw, it’s not a mad patient. It’s just one of the my fellow colleagues. I was in the ED and I caught sight of this tall lanky guy waving at me from across the room. I haven’t seen this fella for ages. He looked like he was about to burst with some fantastic news; hopping over with a huge grin on his face. The conversation went somewhat like this :-

Me : Hello! Whatcha doing here? *He’s normally in the ward*

Him : Oh no just accompanying the resident to see this patient. GUESS WHAT?

Me : Ah?

Him : I got my priest to level 65++!!! *enormous smirk*

Me : OH WOW! Which server are you playing at?

Him : Frostmourne. You should come and join too!

Note : The conversation was peppered with Warcraft-speak. I used to have a few characters on the World of Warcraft; once upon a time I was fairly active on my server. I froze my game account 1-2 years ago as I was having my exams and didn’t really pick it up again since.

Me : Hmm but I’m working funny hours, and I’m always catching up on sleep. Not too sure if..

Him : AW COME ON! My group is a good one and we’re doing a lot of dungeons. I mean, we have a good healer *pauses to acknowledge his priest*, we have a tank etc.

Me : Are you Horde?

Him : Alliance.

Me : MAN, I would wanna go Blood Elf!

He gave me a mock frown. If I’m taking up a Blood Elf it would mean I’d be playing against him instead as we’re from opposing factions. I told him I’d consider joining if I have enough time on my hands. Sleep has become increasingly scarce as I’m working, and I think a few more hours of sleep would edge over a few hours of Warcraft anytime (although I must admit, Warcraft won this face-off many times when I was still in med school).

We bid farewell and he left. My consultant came up to me, looking alarmed.

“WAS THAT YOUR PATIENT WHO JUST WALKED OUT??”

“Oh no no..that was a nurse.” I explained. He wasn’t wearing his uniform and he kinda looks the part of a patient about to pull a runner. “He carries an ID tag, just that..um, he turned up in full winter gear today. I know him, he’s the staff”.

The consultant looked somewhat amused. “Well, can’t tell the difference”.

Random bit #4 : What the…?!?

I was driving home one day from work. It was just after I’ve pulled a late shift and the roads were quiet. The car which was in front of my on the highway changed lanes and started slowing down considerably. He has deccelerated so much so that I’d be passing him very quickly. I stole a glance over as I overtook him.

Ah the bastard. He was making a really vulgar gesture at me. He had intentionally slowed down his car to perform his lil show. I saw him gesticulating once, and that was it.

I drove my normal speed; leaving him behind. I thought that was the end of it but I was wrong. The bored fella actually sped up right till he was parallel to me, and repeated the same idiot act again hoping I’d look over and be offended.

I continued my journey home, feigning being oblivious to him. It started to get really irritating as he got into this repetetive act of keeping up with me till we’re parallel – just to take his hands off the steering to rudely gesture across. This kept going for the next 10km approx. Geez.

In the back of my mind, I did think about what a horrendous shocker it’s gonna be for him if I’d suddenly pull out a gun and aimed it at him. It’d be almost like a scene from some movie where the street punk gets his reckoning. Oh well.

In reality, the most that I could do was to applaud his performance with the one finger salute. There were a few moments when I’d ALMOST flash the finger – except that the last thing I needed at that time of the night was to get into more trouble. So regretably, no.

Random bit #5 : Kindly ignore the runaway patient, thanks.

I was in the ED explaining to a patient’s family regarding his prognosis. Both wife and daughter were listening intently when all of the sudden there was a scream followed by a flash of white.

To my amusement, a female patient had just hopped out of her bed and begun chasing her nurse. The flash of white that I glimpsed was her half-undone hospital gown flailing after her. I shall refrain from commenting on the colour of her undies here.

I laughed sheepishly (the “ehehehe” kind). The daughter quickly resumed the discussion after a quick shrug whereas her mum spent the next few seconds looking over the yonder with that distinctive W.T.F. look on her face.

Random bit #6 : YOUR PENIS, I SAY!

An elderly gentleman came in to the ED with a really tender lower abdomen. He hasn’t really passed much urine over the past few days and we’re guessing he’s in urinary retention. I could feel his bladder was as huge and as solid as a rockmelon; he needed a bladder catheter in real quick.

Me : Okie you’re gonna need a catheter in your bladder. We need to drain the urine.

Patient looks at me wide-eyed.

Me : Oh, it’s a draining tube we’re going to insert up to your bladder. The pain’s from the retention.

Patient shook his head slightly and his voice boomed, “I CAN’T HEAR YOU I AM DEAF”.

The nurse poked her head between the curtains and gave me a sympathetic smile. “You’ll have to shout”.

Oh. I raised my voice a few times, getting louder with each subsequent attempt. He’s still shaking his head.

Patient : YOU WILL HAVE TO SPEAK UP DOC.

Me : I..uh…okie. YOU NEED A CATHETER. CAN HEAR ME?

He nodded. Good.

Me : WE NEED TO DRAIN THE URINE. TUBE UP YOUR BLADDER.

He nodded.

Me : I’LL GO GET THE EQUIPMENTS. BE RIGHT BACK.

He smiled and settled back in bed. When I got back, he’s still dressed in the sweater and jeans that he came in with. It’s be easier if we get him in a hospital gown (easy access, ahem!).

Me : YOU’LL NEED TO CHANGE INTO A GOWN.

Patient understood and removed his sweater. Next thing I know, he had the gown on with his jeans still underneath.

*The following conversation took place behind closed curtains but within a public observation ward. I’m pretty sure everyone within 10 feet could hear us as we were both shouting above the usual background chaos of the ED.*

Me : YOU NEED TO TAKE YOUR PANTS OFF.

Patient : YOU WANT ME TO TAKE MY PANTS OFF?

Me : YA THE CATHETER NEEDS TO BE TRAINED THROUGH YOUR…*points to his groin*

Patient : TUBE NEEDS TO GO UP WHERE?

Me : THROUGH YOUR PENIS, AND INTO THE BLADDER.

Patient : PEE-WHAT?

Me : …THE PENIS. URINARY TRACT.

Patient : OH I GET YOU. SO I TAKE MY PANTS OFF?

Me : YES PLEASE.

I was trying horrendously hard not to laugh. I could hear the few patients next door giggling, and a senior colleague of mine going E-HEE-HEE-HEE around the corner.

Random bit #6.5 : YOUR PENIS, I SAY (II)

I begun the procedure by prepping the the gentleman’s groin area with some antiseptic. Once done, I had to carefully retract the foreskin to visualise the uerthra.

Honestly, it’s not easy to retract the foreskin once it has been swabbed with some alcohol solution. Pardon me, but it keeps ‘wiggling’ (for lack of a better word) back up and obscuring the urethral opening. In practice, we can only use one hand to manipulate the foreskin as the other hand is ‘sterile’ and all contact is restricted to catheter handling.

I had a few slippery attempts; the scene equally as awkward as it was amusing. Out of goodwill, the patient grabbed his previously-cleaned penis and retracted the foreskin.

*All verbal exchanges were done at a VERY HIGH volume as the patient is, well, deaf*

Patient : HERE LET ME HELP YOU.

The nurse groaned. I groaned. The patient had just contaminated the procedural area and we’d have to swab him again.

Me : OH NO LET GO. YOU CAN’T TOUCH IT.

Patient : HUH?

Me : LET GO OF YOUR PENIS SIR.

Patient : I LET GO? BUT THIS IS EASIER!

Nurse : NO NO WE HAVE TO CLEAN IT AGAIN.

Me : YOU JUST CONTAMINATED IT.

Patient : OH SORRY. I WANTED TO HELP.

Me : IT’S OKIE, JUST UM, SIT BACK.

I just had to laugh after that. It must have looked really peculiar and hilarious; to have the few of us shielded behind the curtains for the patient’s modesty/privacy but yet resorted to yelling out every single explicit detail. The irony.

Random bit #7 : To war with the finger

Yes, it’s the rectal exam. I happened to be performing one in every 2-3 patients lately. There was a shift where I believed to have probed the behind of every single patient I’ve seen – mainly elderly patients with bleeding from their behinds.

It isn’t a very tedious nor a difficult task to do, except that you’ve gotta be careful for yourself. You wouldn’t want to finish off a rectal exam getting excrement streaked on your sleeves. Given that rectal exams are unpleasant, patients tend to be anxious and they may tense up their abdo without realising it. When this happens, half the time this would induce a ‘mini propulsion of bowel gas’ (yup, the fart) causing any semi-liquid stools to be forced through between the anal spinchter and your finger.

What’s on the other end of your finger? You.

I have seen a senior doctor getting sprayed over his shirt and tie by the glorious brown stuff. It’s funny when you’re not on the receiving end, I must say.

What I’d usually do nowadays is to get a thick waterproof napkin; partly to shield the bed as well as to shield myself. I’d toss all the paraphernalia that’s hanging around my neck (ID tags, steth, pen, etc) and roll my sleeves way above the elbows. Double gloving is the order of the day when it comes to the hand that would be doing the honours. I’d often take a step back to estimate the ‘predicted faecal projection distance’ so I’d know how much I’d have to lean away.

One thing I didn’t mention, is that every rectal examination begins with the inspection of the anus.

Given that it’s usually not a very visible area (hence the term ‘stick it where the shine don’t shine’), we’d have to peek at it really closely. It is during this time that I would be mentally chanting “Please don’t fart, please don’t fart, please don’t fart…” over and over again.

It may come across as funny here but I’m pretty sure anyone would’ve wished for the same thing if they’re in my shoes. The only thing worse than getting your shirt sprayed with stools… is to catch it with your face.

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