Three degrees below ignition

Hail,
Sunday night here and I have wasted and frittered the weekend - lounging down the pub with my friends, walking somebody's dog, watching an old SF movie with Sarah.

And thinking.

A few days ago I rang Florey and said I was taking a holiday. It was short notice, but not at too inconvenient a time, and it didn't involve night shifts... and it was basically either a brief break now or a longer, perhaps permanent break in about a month or so.

In the last few weeks I've been getting... not quite tired, but something like tired. I go in to see people and I'm not concentrating one hundred percent, and that's partly because I'm not, I don't know, interested. Which is a weird thing to say, but I see patients and I feel somehow disengaged, somehow removed.

I saw some guy the other day, a man beaten badly by his step-children. He was trying to be cheery about it, and everyone was being very low key, but I think normally I would have been a lot more ... I don't know, "present".

But we stabilised him and we did the CT , and we rang up the Royal and told them we had someone who had blood in places in the head where blood should not be, and "significant quantities of air in the retrobulbar space", which meant air from one of his fractured sinuses had got behind his eyeball, and I reassured the patient and his wife, and I spoke to the police, while we sent him up to the Royal before his eyeball bulged out of his skull at us... and all of this I did in some mildly disengaged manner, as if observing events beneath a sheet of glass.

And things have been getting to me which shouldn't get to me. The Aboriginal woman last night, attacked and beaten down at the Mordor Train Station... I felt some of the nurses were smirking at her. And nurses are under a lot of pressure, and she was an intoxicated aboriginal woman, one of a family "well known to the emergency department", and she had been in here many times before and had several alerts next to her name for violence and inappropriate behaviour, but still, she was a woman who had been beaten up, who needed stitches in her head.

And I'm meant to be studying for the exam, and truth be told I have barely opened a book. I try, or rather I try to try, and different things get in the way. I have stories I want to write, friends I want to see, chooks I want to sit out the back and look at.

Unusually for me, this isn't whining, it's realising something. Emergency medicine demands something and of late I have been less prepared to do it.

I don't know. The reasons I stay in the ED are several.

It's the people I work with, the band of brotehrs (and sisters).

It's the helping people.

It's the stories, like I said before, when I was worried that storeis were what I was after, what I took from people, my source of sustenance. As if I was some kind of story-eater: a fabulovore, a sagaphage.

It's the feeling of comfort that nothing can actually fall apart, the reassurance that I have a basic idea of what to do whatever the situation.

A breif seque here: some people reckon it's hard (in an intellectual sense) dealing with really sick people. But it's not. Oddly enough, the sicker people are the simpler a lot of things become.

Karenina's Law (I don't know who first called it that) is the simple observation that there are more ways for things to go wrong than for things to go right. It's the first sentence of Anna Karenina:

Happy families are all alike; every unhappy family is unhappy in its own way.

In mathematical terms it is the second law of thermodynamics, the one that explains why things break down, the law that defines entropy: things fall apart, the centre cannot hold.

dS/dT > 0*, in the punchier, low fat version.

Well, that holds for medicine too - there are far fewer "correct" ways for a heart to beat than there are incorrect ways, there are many more incorrect ways for chromosomes to occupy cellular nuclei than the conventional two copies each of twenty three, and so on. So medicine is hard - you have to know not only how things can go right, but also the very very very many ways things can go wrong.

But emergency medicine is lucky in that at its core is a wonderful simplicity.
All healthy living people are fairly similar, but in the end so are all dying people. The things you need to know about keeping people alive who will otherwise die are almost childishly simple.

Make sure there is some kind of pipe from the air to the lungs.

Make sure the lungs keep filling and squeezing, filling and squeezing.

Make sure the heart keeps beating and, if possible, that there's enough stuff for it to pump. And that stuff should be as much like blood as you can make it, but that's not really that important.

Back to wat I was originally trying to write about: there are lots of reasons to do Emergency, but none of tehm are actually causing me to enjoy it at the moment.

And this isn't depression: I have this very high index of suspicion about my own mental state, I have this horror of making a poor decision due to depression or mania or whatever, but I don't think this is that.

I think it's a little bit of burnout.

Now this may well be a temporary state. Virtually everyone in the training program goes through this, maybe most doctors, certainly a lot of people in other professions. Sarah reckons that it may well be a temporary thing, that a few weeks off from the ED will be good, that I may return full of enthusiasm. And I've got over a month of holidays saved up, and considering my last holiday was the exam, I haven't had one in a while.

Anyway, I rang up and told them I was taking two weeks off. Two weeks (half time, admittedly, but still...).

Two weeks, of which the first week end will be concentrated, unadulterated, intellectual sloth. I shall not think. I will not diagnose, I will not analyse, I will not consider appropriate investigations. I will allow myself some leeway in the matter of imagining, fantasising and speculation, but nothing at all with any purpose, or end, or goal. If someone wants a bandaid put on, they will have to ask Sarah.

I am going to stretch my mental muscles, muscles that have been cramped from sitting too long in one position, and see what I can do.

Anyway, midnight. See you all soon.

Thanks for listening,
John

*Can't type "greater than or equals".