Friday, October 07, 2005

The Big Dick Talk


Thanks for the comments, will try to reply today if I can post from work, if not, over the weekend.

Things go well. I am working at my new (half-time) job, the replacement for the Hogarth House one. It is primarily dealing with people with drug and alcohol prolems. At the moment I am working at the alcohol disorders unit, which is less than a hundred metres away from the largest Booze Brothers store I have ever seen, almost a warehouse. Within walking distance is Behan's (a very large pub), a pawnshop and a second hand clothes store. All they need to do is throw in one of those shopping trolleys and you've got everything for the discerning alcoholic.

Yesterday at Florey I had a tutorial on "managing the airway", which is basically about intubating people, which was very reassuring. But after that we sat around and pretty rapidly we got into the big dick talk. The big dick talk is a kind of testosteronefest, where doctors sit around and talk about horribly sick people they have seen, stuffups they or others have made and so on... with the most points going to the most spectacular blood or ECG results, the most alarming pathology, the biggest disaster averted. It is a kind of competition with the rules heavily weighted towards the older, more experienced doctors, although those with any experience in the third world can often do well. My contribution was relatively minor - the man who came in with a blood alcohol of point five five, i.e.: eleven times the legal limit, a dose that would kill all but the most exceptional people - and who, when this was mentioned to him, expressed suprise and said "I didn't think it'd be that high, I haven't had a drink today."

And another man with a cholesterol in the high twenties (normal, I believe, is below five) - who had pink, foamy blood, visible globules of fat, and when you took it out of the vein and squirted it in a bottle, a thin white film rose to the top of the sample, like the cream on fresh milk.

My alcohol man was eclipsed by the woman with a BAL of point five eight, who, her treating doctor said, appeared almost perfectly sober. She was so incensed at her doctor's suggestion that she should not drive that she walked out of the department, alert and orientated, half an hour before her blood result was rang through to her unbelieving doctor.

But the haemoglobin conversation was the most remarkabe. Haemoglobin is the protein that carries blood around your body. The normal male has 130 to 180 grams of haemoglobin in every liter of his blood, the average female slightly less. Anaemia means (among other things) low concetrations of haemoglobin - you get tired easily, you feel weak, you may get short of breath. Anaemia is technically anything below the normal range - for an adult male, it's below 130 grams per litre, for a female it's below 115 g/L.

A haemoglobin of ninety may indicate someone is pretty damn unwell. Sixty is catastrophic, I ca't remember seeing any lower than that. Dr Bougie, the intensive care guy could. He remembered seeing a child, a vctim of a genetic disorder rarely seen in this country, with a haemoglobin of twenty eight.

At this stage, the blood is no longer red. It is a pale, transparent pink - you put the needle in and take it out of the vein and squirt this thin, almost clear substance into the bottle. With only this extremely dilute blood (as if your blood had been diulted one part blood to four parts water) the skin is greyish white. When you shine a beam of light into someone's eyes - you see this when you take a photo with a flash - light bounces off the back of the eye, an area packed with blood vesses, giving that red-eyed "I am a demon prince, all must worship me or die" look to those photographs of your child or household pet. This is imaginiatively called the red eye reflex.

When they shone a light into this child's eyes, it bounced back silver.

Anyway, I thought that was remarkable. She did well in the end, too.

Best get back to work...

Thanks for listening,


Anonymous Anonymous said...

just a few months ago I came across a GI bleeder with a Hb of a truly remarkable 21. A committed Jehovah's Witness, she not only declined a transfusion but any other meaningful investigations. Her God was obviously on her side as her ulcers didn't bleed any more and she was discharged home a week later with the massive haemaglobin of 40, on a diet that included beetroot juice to boost the red blood count..

12:41 AM  

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