I feel your pain...

Note: Scenes of rather extreme gore ahead - I mean it. Stop reading now if you are at all uncomfortable with this.

And for anyone who missed it last time, go now to Foilwoman's blog and read about someone doing better than anyone merely human would do under the circumstances.

Well....

When I started this blog, I had a number of poorly thought out justifications for doing so: Something to get me writing again. One of those self-analysis things. Scraps for the novel/superhero comic/TV series I was going to write. That diary I got when I was twelve that I never wrote in and felt bad about.

Anyway, tonight's going to be one of those straight from brain to page things, just the data as I remember it, and maybe later it's going to be real writing, or useful self-analysis, or something for the novel.

So what did I see tonight?

Two or three priority ones. Priority one means someone who has to be seen now - in medical terms it usually means someone who has "failed their primary survey". The primary survey consists of basic measurements like heartrate, respiratory rate, blood pressure, temperature and so on. To "fail" any one of these means to be in a state incompatible with life, to be virtually dying before the eyes of the triage nurse.

There is another, perhaps softer or more subtle subset of priority ones, people who due to what has happened to them, the history of their complaint, qualify for immediate attention.

One of this "other" group, one of the "people who should be really badly damaged even though they don't look it" mob, was Mr Ergot. Mr Ergot had been driving a trotter (as in horse, not as in pig's foot) around a racetrack and the horse had "sped up a bit". The next thing he knew he was in an ambulance, and he arrived on our doorstep a few tens of minutes later.

He was alert, breathing neither too fast nor too slow, heartrate a steady sixty to seventy, all pulses regular, his abdomen was appropriately soft, and no long bones were broken. He apologised a few times for being a bother, and only admitted to "a bit of a headache" and "a sore elbow", which, when pressed, he described as "seven out of ten".

The sore elbow was because of a largeish laceration, with dirt from the trotting track deeply embedded in it, but luckily there seemed to be no deformity, nothing suggesting a broken bone or dislocation.

Hideous bit follows.

The headache was because when we undid the bandage and pulled gently on one of his tufts of hair, the entire scalp lifted up and away like the skin of a custard, exposing the smooth, slightly sticky, rounded dome of skull beneath.

The skull, you will be interested to know, is not white. Like all bones, it is the warm pinky-red of living tissue. It is only lightly attached to the skin above it, which is why you can put your hands on your scalp and wiggle it about on your skull, and why I was able to slide one gloved hand in between skin and bone all the way back to his occiput (that bulge at the very back of your head) and almost down to his ears on either side.

Anyway, we poured in the morphine and got a CT scan organised. The scan showed no fracture, but a largeish bleed, a sub- or extra-dural haemorrhage (a pool of blood forming between skull and brain) and we got him down to the Royal pretty damn quick, where the neurosurgeons presumably fixed it.

Now, I don't normally go into this much detail. But there is (possibly) a point to this.

The other patients throughout the night were actually fairly unwell - heart attacks, blood clots in the lung ("Again?" asked the woman), a swelling and possible bleeding of the great artery that emerges from the heart... and finally, towards the end, a changing down of gears, an old woman with some sort of vague decline who had been transferred from a hostel with what might have been confusion, an exacerbation of her normal state of dementia.

She needed blood taken, and I sortof volunteered. A mistake. She had those thin, spiderwebby veins that some of the elderly have, micron-thin things that look like pictures of rivers from satellites, pale purple or blue against a white background. Difficult to put even a very thin line in, and she was on warfarin, so every time the needled punctured her pale skin, she'd wince and a blossom of blue blood would swell where the needle went in, and you'd have to put a bandage on that area or she'd bruise, and start again. Ideally you'd have a nurse to help hold her hand, but my nurse was in with Twenty Eight Year Old Male, Doesn't Realise Street Lamp Poles Have Right Of Way.

So it was me and Mrs Mewl, and every time I touched needle to flesh, Mrs Mewl would shake her head and cry out, a long, high pitched sobbing sound, something that might have been a "No", had it not been documented that she no longer spoke.

Anyway - the point, if there is one. That's the one who upset me more. That's the one I was thinking about tonight when I realised I couldn't sleep.

So, what's going on? The physical pain, the physical damage - that seems to be something I can deal with. Emotional pain, that's another step up and back. Emotional pain to babies, say, that's what I find worst of all. I used to go outside and have a breather after every time I put a needle in a shrieking child, I still don't reckon I could do three in a row without taking some time out. Crying toddlers almost make me cry.

But still, I do this job. I keep going in.

Somedays I wonder - here's the uncomfortable bit - sometimes I wonder who would do this job, what kind of person. I've been thinking this a bit because I've been really enjoying it lately, and I feel that no matter how good the other job gets, no amount of better pay and better hours could really make up for doing without Emerge.

But why is this so? Who does this... or more acutely, what do I get out of it?

I don't think of myself as some kind of adrenaline junky. I'm not. I don't ride a motorbike, I don't leap off mountains attached only by some bit of string, I don't even ride horses or take illicit drugs. My recreational life was once described as "very vanilla". And I hate any kind of emotional uproar in my family.

But maybe there is some connection between say the writing and the ED (and maybe the psychiatry beforehand). Maybe - unpalatable thing here - maybe it's all feeding the same thing.

Maybe what I am is not a 'physical' adrenaline junky, but an emotional one.

I don't know. Too tired, anyway, to write on. Sorry for all the gore. More, hopefully, later.

Thanks for listening
John