Drug of Choice

And it's ears and drugs night here at Florey.

A rare stretch of quiet, or what would be quiet if it were not for the constant bleeping of alarms. Our department has a new set of monitors, the things that keep an electronic eye on your pulse, blood pressure and oxygen saturation, and all the machines seem to have florid anxiety disorders. Every few hours the monitor in cubicle twelve tells me that the heart of my happily chatting woman in cubicle thirteen has ceased to beat, or that my snoring septuagenarian in cube eight has not taken a breath for the last half hour. If a patient really was at death's door each time an alarm went off, we'd have this place empty in hours.

But for some reason it's ears and drugs tonight.

Several years ago I first formed my theory that people with similar interests all know each other. Maybe they meet in hospital wards, or something. Anyway, these people all arrange to meet at the local hospital - it happens at Florey, it happened at Shipton - and so they ring up. "Hey" they say, "let's go out for a drink or something, for old time's sake. Tell you what - meet you at Florey at half past".

So you turn up for work and the first eight patients you see have foreign objects stuck up their nose, or inflammation of a part of the body that is not normally inflamed, or dizzyness. ANd for the first half of tonight, it's ears.

The first wave of attacks started around ten, and the eared people had complete control of the wating room by twelve, and had started advancing to radiology. Child with otitis media. Child with unpopped popcorn kernel in ear. Girl with ear-piercing gone wrong. Middle aged man with moth in ear (we could see it inside the ear canal, stamping its foot and scowling). Young woman with earache for a day. Young man with ear-ache for three weeks, hasn't bothered to see a doctor, hasn't taken anything for it, comes to busy emergency department in the middle of the night.

And chillingly, that last one was the one I will remember. You know those pivotal points, those moments where the direction of your life, that thing you casually imagine will go on and on in a certain direction forever, angles back. Well, I looked into this man's ear (and he was the kind of nervous man who thinks that every freckle is a melanoma, every stomache grumble cancer) and saw something odd behind his tympanic membrane.

The term "tympanic membrane" is one of those medical terms we use to conceal what we mean, another example of language designed to obfuscate rather than communicate. It means what normal people call the ear-drum, the thin skin separating the outer and middle ear. Just behind this man's ear drum was something white and mis-shapen, shaped oddly like a crouching animal, and behind the eardrum was dark with blood.

I had to call my senior in, because none of us had ever seen it before, it was just something that we had read about in books, but what it looked like was a cholesteatoma. Thi sis exceedingly bad news. It is a kind of growth that occurs behind the eardrum, and grows by dissolving away the bones of the inner ear and skull. If untreated it can grow into your brain and kill you. This is extremely rare, I don't know that dying from this happens much anymore, but this was a man who insisted on knowing the worst, who asked and asked until I told him the worst, and in this case the worst is pretty bad.

A friend came and took him away, he would be presenting to the Royal in the morning. Very sobering.

And after the ear people were repelled, there came the waves of drug people. Gazing from left to right as the clock ticks past four in the morning I can see

Fourteen year old girl who had smoked marijuana for the first time today, presenting complaint "I'm going to die".

Three drunks, including a man undergoing alcohol withdrawal. His face is a mosaic of scars and scabs. He is wearing a Jack Daniels tee shirt. He looks somehow older and less attractive than the people I see on the advertisement saying Jack Lives Here.

A thin man who took heroic amounts of intravenous speed and whose heart began to kick in his chest like a caged animal, and who fell to the ground and had a seizure. I asked his friend if the man drunk alcohol, said "Christ no, not him. He's a real health freak."

A girl on ecstasy, a drug that seems to cause people to believe that you think all their jokes are incredibly funny.

And in resus a man who took large amounts of I-don't-know-what-and-we-probably-never-will. The resus team is doing all they can, but his heart is refusing to co-operate. He is the one I feel probably got most out of what he took, whose trip, if anyone uses such an archaic hippy word nowadays, was to somewhere he wanted to go. He was a man in chronic pain, well known to the hospital staff. Like some kind of acid, the pain had eaten away at his job, then his finances, his marriage, his relationship with his children. I don't know if in the end the pain took him, or if what he did was an escape from it. But I stuck my head around the corner a few minutes ago, when the cardiac compressions were starting to get that little bit half hearted. Most people undergoing resuscitation look ugly, their faces pulled and distorted, their skin grey. But, and here's another archaic phrase, he looked at peace.

John