Sunday, May 08, 2005


Tonight I think I will break the first rule, and talk about fight club. And this won't be brilliant prose, this is bare-bones and exhaustion.

Saturday evening shift in Florey, and it was on. We are in a new department, the new, improved, safer emergency department, but still teh same old, unimproved, dangerous patients. I walked in at three and one of the RNs (Bianca, tiny, blonde, worried looking) came over and said "Look, can you look at this guy, he came in with abdo pain and now he's unresponsive". I went in and there's this mountainous man on a bed looking grey, lying on his back, staring straight up at the ceiling. I go up and ten percent of my brain is listening to the story (came in with abdominal pain, has had some morphine, suddenly ...) and the remaining eighty percent is working out that he's not seeing me when I shake him, he doesn't have a pulse on his wrist or a femoral pulse* or a carotid pulse and I'm not hearing a lot in his chest, and everyone's looking at me and I say "Well, let's call the arrest", and suddenly there's a nurse pushing on his chest.

Embarrasingly the other ten percent is thinking "I haven't had my coffee yet." Sad but true.

Then everything went really slow for a moment. I don't mean one of those "out of body, look, I'm on drugs" slows, but over what seemed the next half an hour three or four extra doctors ambled into the cubicle and checked things out, and the nurses in a leisurely fashion fossicked about for laryngoscope, tourniquet, blood gas. In reality this all happened in less than two minutes.

And we kept resuscitating him, and he got halfway back, mumbling and grasping at things with his good hand, and I handed over and went out to talk to his wife, and then when I got back he was still being resuscitated, and then he went on a transfer to the Royal and five minutes from the door the big artery in his belly finally burst and no power on earth could have saved him.

His wife, huddled in the relatives room, muddling about with cups of tea and long distance phone calls, seemed quite baffled by the whole thing. I went in there early in the resus and told her we didn't know what it was but we had three specialists in there and we were going to send him to the best hospital for this sort of thing, all possible care was being taken, and went out to where they were pummelling his heart and sticking huge needles into his unresponsive frame.

One day I am going to look around the hurly burly of the resuscitation room and see a figure of death, an avatar, an actual incarnation. It'll will take the shape of a doctor or nurse or some orderly that later no-one will recall knowing, someone slight and unassuming, just watching, and when one of us glances up from slithering a greased platic tube into the windpipe of a child or squashing a dead woman's chest and sees that figure we'll know what is going on.

Then I went out to my side of the ward (we are divided into outpatient and inpatient teams, I was outpatient) and discovered practically everyone else was in one of the other two simultaneous resuscitations that were going on (heroin in someone who had been drug free for eight years, found in a hotel car-park) and something else I never actually found out about. The only person left on was the intern who is a well-meaning girl but I think has a bit of tunnel vision - she seems to ration patients to "one patient, one diagnosis, one treatment", so the man who came in with gout who also had a blood clot in his calf and pneumonia and maybe heart failure was getting great treatment for his gout.

Once I fixed that up I got to see the actual patients. Saturdays in the winter seem to go "football and stuff" to "violence and stuff". The football side of it was a sprained wrist, a wrenched knee, three broken ankles and a concussion. Violence was a woman smashed on the head with a tyre iron, a man strangled and kicked, a thin Vietnamese man whos girlfriend had broken his nose with the base of an electric kettle, a man stabbed in the head by "his mates" who had arterial bleeding (that bright red, squirting, fountain kind of bleeding) from his temple and was talking to us while blood "squikked" out the side of his head, and an otherwise sensible man whose experiment involving cooking, alcohol and an samurai sword had gone surprisingly awry. He, too, had arterial bleeding, and when I took the bandage off and poked at the wound a jet of blood shot past my nipple and onto the wall. We ended the night with a Croatian man who had walked to his sisters' house after a high speed car collision, and was wheeled in to see us with a compound fracture of the jaw and at least three other fractures.

Anyway, the buzz is wearing off and I am going to bed. The infidelity of the title is this idea I am working on at the moment, some idea about the serial thrill-seeking beast that is on the backs of most emergency doctors, and the consequences this has in their lives. Read the book ("Intimacy") by Hanif Kureishi. He hasn't got it all right, and it's difficult to like his abyssmally self-centred hero, but it's masterfully written.


* the big pulse in your groin. No, your groin.


Blogger Chade said...

Your anonymity fades...

8:35 AM  
Blogger Bronze John said...

Thanks for that. Fixed.

11:27 AM  

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