The Good, the Bad, and the Odd
July 27, 2008
“You are getting all the overnight handovers”
I peered at the list. There must be about 20 odd patients still lingering in the ED.
“Half of our doctors have taken leave today. We’re really short and you’re taking everything”
Oh wow. This would mean that I’d be the one sorting out all the overnight patients. The docs on duty the night before looked really weary and worn out. It looked like they had a pretty rough night. There were a few patients in the resuscitation cubicles; one was unconscious, one with very bad shortness of breath, and one whom had lost probably a few litres of blood overnight due to an assault.
I consoled myself. At least it’s the registrar who usually takes over the resus patients. The serious stuff.
“Hmm, registrar is busy. Okie Newbie, you take the resus patients”
You must be kidding me.
I mentally pictured my jaw dropping. There I was, in the middle of the morning handover, imagining myself demonstrating all sorts of horrific newbie incompetencies. It’s not easy juggling several patients in an acute setting, let alone now that I’ve suddenly got 20 plus in my hands.
Resus patient #1 – Unconscious patient. His heart arrested and staff were all jumping on him performing CPR. Unfortunately the effort was futile – patient died. According to the paramedics the patient had the arrest in the back of the ambulance and by the time he was brought to the ED it was approximately 20-30 minutes after.
Resus patient #2 – Came in with huge difficulty breathing. Patient was propped up in bed with a huge face mask strapped unto her face. Oxygen was trained via 2 huge lateral blue plastic tubings. She was leaning forward with her arms gripping the bedrails and breathing heavily. For a split second she reminded me of a scuba diver.
Resus patient #3 – Is missing. Or at least I thought he was till I was informed the surgeons have admitted him. This guy appeared in the ED overnight post-assault with a huge knife sticking out of his bum and blood gushing out of his wounds. Previous doctor was exclaiming there was ‘blood everywhere’ and waved animatedly for emphasis during handover. We can only imagine. As inappropriate as it was, the image of a chef sticking a knife into a hot bun came into my mind.
Random patient #1 – Was hard at work coughing till she heard a ‘crack’ followed by a ‘pop’ over her ribs. Chest X-ray didn’t quite show any obvious rib fractures (but then again it’s not easily picked up to begin with) although there was a small area of lung collapse. For further review and could be discharged home if pain is manageable. It’s not uncommon to pop a rib while coughing or sneezing a lil bit too hard. I’ve heard a case where a guy cracked his rib from laughing too hard (and another whom dislocated his jaw). Must be some really funny stuff.
Random patient #2 – Huge tooth abscess. Had a tooth abscess drainage done recently but wasn’t taking the prescribed antibiotics. The infection blown over and the patient ended up with a really swollen jaw (looked as though he hid a ping-pong ball in his cheek). Oral (facio-max) surgeon on-call remained uncontactable for the rest of the day and this guy needed an urgent transfer under another surgeon outside the hospital. The infection trailed up his nasal sinuses and is now discharging from his nostril. Not good.
Random patient #3 – Another jaw abscess except this is on the side opposite of the previous guy. Very huge and angry-looking swelling right under this guy’s jaw. He was in agony whenever he speaks and was obviously frustrated as he had multiple recurrent abcesses before this one. Both of these guys needed IV antibiotics and subsequently tranfers over to another hospital. I have a strong feeling there was a mix-up with the on-call roster of the oral surgeon; he didn’t appear on our on-call list although under the main system he apparently is.
Random patient #4 – I didn’t find him, he found me. I was at the work area writing case notes for another patient when he stood right in front of me.
“You a doctor?”, he said. I nodded. “I need to talk to you”.
He leaned towards me and whispered, “See that nurse over there? The one in pink?”.
I had a look. Yup I could see the part-time nurse donning the pink scrubs.
“Don’t let her anywhere near me. She turned up at my house trying to kill me“.
I took a good look at him. His face was flushed and he looked absolutely determined with his point; speaking with such great conviction. Chances are he’s most likely one of the psychiatric patients who had wandered out from his cubicle and forming delusions throughout his trip. One part of my overactive imagination thought, ah what if it’s real? What if it’s a conspiracy?
My workload smacked me back to reality. I could have given him a mini lecture on the basis of delusions and one’s mental state but was plainly too lazy to even start. Too much to do, too little time.
“Okie, don’t worry. If there’s any concerns you could discuss this with the head nurse”, I mentioned.
The patient was agreeable to this and ventured back to his bed. Seemed pretty satisfied with the reply for someone whom was worried about a perceived murder attempt at him 2 minutes earlier.
Random patient #5 – Young guy whom was stabbed with a pair of scissors overnight. Story was some guy out the blue walked up to him and jabbed his abdo with the scissors. I took a look at the wound; appeared pretty superficial. Patient stated that he didn’t knew he was stabbed until he saw the pair of scissors held by his assailant afterwards. Yikes.
Couldn’t quite decide which one was more astonishing; the thought of scary dudes randomly stabbing people with scissors or my patient whom was still looking all bright and chirpy after being stabbed. Hmm.
Random patient #6 – The cute lady with asthma who just can’t help but to relieve everyone of her life story despite her shortness of breath. Having the hissing nebuliser mask on would usually deter anyone from talking but nah not this one.
She belongs to the category of patients whom would answer your questions with 5-10 minutes of irrelevant details of her day followed by the important bits that you’re looking for. This lady started with “I woke up one morning…” and followed up a re-enactment of the conversation that took place between her and the local bakery shop owner. Still not too sure when the shortness of breath started but I do know that she had french loaf for tea.
Random patient #7 – The patient with a very very demanding mum. All questions are to be directed to the domineering mother whom would be throwing in a demand at the end of almost every sentence. It was an interesting sight; the patient looked distressed, the mum looked pissed, while the granny just looked at the TV screen. The mum was adamant that the patient needs urgent medical attention ASAP by the senior doctor and was starting to get kinda preachy. I think we spent more time pacifying the mum above all else.
The patient is pregnant and was vomiting more frequent than usual. Mum took up the arms and started heckling the staff, ‘commanding’ the attendance of the senior specialist. Honestly, there were many more serious patients to be seen and there came a time where we told the mum straight up that they’d have to wait – they’re not really a priority at the moment. We left the room while the mum scoffed and sulked. Granny’s still watching the TV.
Random patient #8 – Hero. I first saw him with a cervical collar and a heavily bandaged head. News was he scooped up his lil’ son to escape from a wave and ended up running head first into a slab of jagged rocks. He was preoccupied with getting out of the way and didn’t realise he was running towards a huge rocky wall. Ended up lacerating his forehead and getting a concussion.
Thankfully the head and neck scans turned out to be normal overnight and he’s discharged home. I saw his lil’ bub visiting his papa in the morning and they looked really cute together. Awww.
Random patient #9 – This young guy has a cervical collar on as well but his story was nothing similar to the previous patient. After much interrogation and quizzing from the night doctors, he sheepishly revealed the history of his injury:-
1. He was chasing his girlfriend around the room.
2. Girlfriend hopped unto the bed and promptly off to the side.
3. Guy hopped unto the bed after his sweetie but was propelled head-first into the wall.
4. All fun ended there.
I had a look at the notes written by the previous doctor and saw “Head vs. wall“. Nice summary.
Random patient #10 – Now, this isn’t one of my patients BUT I was nearby when his attending doctor was discussing the case with the consultant. My ears picked up the words:-
“…testicles got stomped on by a horse…”
It was incredibly unfortunate to have that certain anatomy at the receiving end of a horse’s hooves, but also immensely lucky that further scans showed the testicles to be intact. Huge PHEW there.
These are the few that I could recall from that particular shift. The rest of the cases are not particularly outstanding (or maybe I’m just bit too lazy to think). I do have a story concerning swollen balls but I’ll save that for another day *grins*.
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