Monday, February 14, 2005

Love gone wrong

Another night shift, another tragic tale of love gone wrong in the southern suburbs.

This time love went fairly seriously wrong, ending up with three guys breaking into some guy's home and beating him half to death with the blunt end of an axe. The police said it was the blunt end, it looked pretty bad to me. Presumably if it'd been the sharp end, they would havebeen able to drive the ambulance less fast.

He came in GCS 8. GCS (Glasgow Coma Scale) is a measure of how bad things are for your brain. If you're reading this, you're probably GCS 15 - the maximum. Your eyes are open, you are able to communicate appropriately and you move your limbs in the desired way. Any deterioration - if something happened and you were unable to open your eyes, or could only move your limbs in response to pain, or you couldn't speak - means a decrease in your GCS, and it means something serious is going on neurologically - in this case, very probably increasing pressure from bleeding inside his skull, which was slowly squashing his brain.

GCS 8 means you are essentially a good way towards a coma, and the danger with that is that you don't "protect your airway" - if your tongue falls back you can choke to death, for example, or you can vomit and then inhale it and die of pizza pneumonitis or whatever they call it. GCS 8 means someone has to intubate - shove a thin plastic hose a foot down his throat and practically into his lungs so we can breath for him.

Anyway, I volunteered to intubate, because I've only done a few before, and it went well, despite the fact I started out with the laryngoscope facing the wrong way, as if I wanted to scoop his brain out rather than save his life. We put in the tube (which is greased and clear and about the thickness of your finger) down his throat and pumped the oxygen in, and then we stuffed another one down his throat behind that one into his stomach, and then a few more tubes (in the wrist, one in the inside of each elbow and one we slid the whole way up his penis so we could drain his bladder) and the team from the Royal came and took him away. Somewhere along the line someone looked in his ears and slid a finger up his bum, so there was no orifice unprobed.

Don't get hit on the head with an axe in our area.

I don't know how he's doing, I haven't been back yet.

A great deal has happened. Moods have been down, which is rather serious and which is something I will talk about later. I don't know about this exam I'm meant to be doing - we'll see. And I may be called as a witness because one of my patients from a few months ago has been murdered, and I've started working at the prisons, and another of my patients has been charged (separate and relatively trivial offence) and so on.

In the end, the "depressive episode" (what's the opposite of evocative?*) was a surprise to nobody but me.

Presumably there is some inverse relationship here - the more things happen, the less time you have to write about them.

Anyhow, sleep. It's weird how sensual your ideas of sleep become on nights - you sit there at six AM, the three or four of you, and you fantasise. You picture your bed in your mind, you imagine the plumpness of the pillows, the soft, enveloping warmth of the blankets, the smooth tautness of the sheet. I don't know if there's a word for it - "linen-porn"? Like food porn and political porn and ... well, porn.

Anyhow, there's obviously another inverse relationship about quality of thought and amount of sleep.


*I mean it. It's a crap name. We need something more poetic, more redolent - I could have had a grimmening, a sourmouthing, a joylack. Or maybe some onomatapoeia - "In later years, Sir Nigel began to suffer from what was later diagnosed as severe uuuuuurrrrrhhhhhohtohellwithit.
Watch those levels.



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