Saturday, November 26, 2005

The Great High Holy Day

Five AM in the ED. The title refers to my two weeks (half-weeks, actually) of leave I have decided to take while I decide if I will quit the ED altogether. I have rarely looked forward to holidays as much.

You know, looking back on my recent posts, I am tempted to believe in some kind of literary half-life, where you write something that seems interesting, well-written and insightful and then look at it the next morning and it's turned into some farrago of half-baked thoughts and inarticulate phrases.

Since I am writing my blog rather than looking after my patients, I should explain what they actually have and why I am sitting here rather than doing something about them and their problems.

Cubicle 18 is Ms Marzano, a young woman with acute mania who has been detained under the mental health act. She is sleeping the sleep of the just (in this case the "just been given a lot of medications") and is being transferred to a psychiatric ward. I have barely laid eyes on her - all this was done before I saw her.

Cubicle 15 is Mrs Dubjek, a woman who has Some Weird Shit Going On. Her blood tests are grossly awry, her pain is considerable, her mental state fluctuates, her CT is alarming. Whatever is wrong, it's bad. I don't know what it is. Her GP does not know what it is. The medical registrar does not know what it is. The only guy who has known what it is has been Dr Rookswen, the "weapons grade stupid" medical intern who was previously in the ED. He sent her home a few days ago having diagnosed her with a rib fracture. She is sleeping peacefully.

The next two cubicles are people who have come to hospital saying they want to kill themselves. In the old days this was a passport to admission - it was like saying you had chest pain. But they will be reviewed by the psych team and sent home in the morning. There is a chance that they will kill themselves - people with personality disorders are at heightened risk of either killing themselves or "death by misadventure" - but that risk can actually be increased by hospital admissions. So they will be discharged before breakfast.

Cubicle 33 is a man with constipation, in a bed five paces from the toilet.

Cube 3 is my Aboriginal woman, domestic violence, apparently a distant cousin of one of Australia's top footballers. More on this later.

Cube 8 is an infant with croup, cube 9 has a woman who tripped over a garden gnome and fell into a rose bush, and cube 10 my pale man with the chest pain.

Cube 1 has Mrs Igvatz, who has come in here with her second heart attack. She is only forty one. Eighteen months ago (there are bad genes at work here - her mother dropped dead when Mrs Ivatz was only sixteen, and she is the last survivor of four sisters) she had her first heart attack, a heavy ache in her right shoulder and a catching in the breath. It frightened her deeply, and she has not been the same woman since. She now meets the criteria for a form of agoraphobia, and since the heart attack she leaves her house rarely. Instead, she sits at home - in the last eighteen months she has gained fifteen kilos, and now smokes forty cigarettes a day instead of twenty.

ANd the box has just gone off, and we have fifteen minutes until the zarrival of sixteen yeear old male, found unconscious post assault smells, strongly of alcohol. Which Dr Maad will probably be looking after, but better go anyway.

Thanks for listening


Blogger Benedict 16th said...

Hey BJ whaddaya reckon?
UK: 'Hangover hospitals' could go nationwide

12:24 AM  
Blogger Bronze John said...

They'd work better than the current options, i.e., EDs or prisons.


2:17 PM  

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