Joy to the World
So what happened, after the crash course in management of the almost dead patient?
Well, I went in last night and it was good. Not quiet, not slack, but good, busy, a constant stream of patients, no lunch break, always someone to be seen... good.
And I had the English with me, articulate, competent, industrious.
And we had some interesting patients, a tall German backpacker who presented agitated and aggressive in the ED after a day long drinking session who started hallucinating and then turned out to have zero blood alcohol and something else entirely going on.
And we had a woman with small vessel disease (the tiny little arteries in her heart were blocking up) and a man with renal colic and a few croupy babies and someone who tried to stop one of those Bamix mixing things with her finger, and a man with a bleed into his head and a man with arterial blood squirting out of his head... stuff like that. And we fixed the up and we sent them home, or to surgery, or to medicine, for the others to deal with, now that we'd made it safe for them to handle*.
And while I slumbered wheels had been put in motion and ICU had been hauled over the flames and apparently everyone had agreed that yes, it was probably better that intubated, deeply unwell patients were looked after by people who were trained to look after intubated, deeply unwell patients - like, say, the intensive care people. And I was told it wouldn't happen again, and I said no, it won't.
And overnight I had worked out all the same stuff that anonymous posted previously in the comments bit, and then I came home and read someone authoritative sounding telling me what I already thought, which is always gratifying.
And I reckon next time I will be able stabilise someone as much as practicable and then call anaesthetics and ICU down and say "Let me tell you about your new patient", and do that and then leave them to manage her, while I get back to doing what I am able to do and they can't.
And all the nurses were wonderful, and the juniors asked sensible questions and did intelligent , competent things and it seemed everyone was on the same wavelength, everyone in some kind of harmony, everyone a machine for getting them in, fixing them up, moving them on, getting some more in. Until about six thirty in the morning, dawn outside, there were no more of them to get in.
And we had half an hour pretty much free at the end of the night, seven o'clock in the morning, and we all sat around for a few minutes and swapped stories of the last week - and I reckon I had it bad, at least I didn't get a 17 year old, hundred and fifty kilo drunk with about half a kilo of different kinds of drugs in his stomach and turn him into a 17 year old, hundred and fifty kilo drunk with about half a kilo of different kinds of drugs in his lungs. Or spray the walls with aspirated charcoal.
And it was glorious. And the English asked me only those difficult questions which I was able to answer, and we all worked together and grinned at each other like maniacs. And difficult patients with three separate violence alerts in their notes came in and I sent them away, everyone happy. And one of the younger nurses almost flirted with me, saying she'd arrange for me to have three personal nurses to tend to my every possible whim, which might have been even more disturbing of my tenuous equilibrium had she not been gay.
Or maybe possibly less. Sigh.**
"We few, we happy few, we band of brothers."
You know, it sounds weird, but that describes it. Henry V, Act IV, Scene III: "For he today that sheds his blood with me shall be my brother."
By God I love this job. Even when I hate it, even when it exhausts me and confuses me and frightens me and leaves me a few neurons away from panicking. I love it because with the ED, who needs BPAD?
My wife reckons one day they'll invent a new, powerful anti-psychotic and I'll take it and I won't want to be an Emergency doctor any more. I don't think they can do it. This here is powerful stuff.
I came home this morning singing in the empty house. Motown and stuff. "Ain't to proud to beg" in the silent kitchen, "I heard it through the grapevine" in the shower, howling to the startled chooks about my good, if tragically inarticulate friend, Jeremiah the bullfrog. Hollering and hand-jiving across the lawn, scattering cats like ninepins, giving the chickens three days worth of birdseed, because life should be lived abundantly. Chirpe diem.
And gentlemen in England now a-bed
Shall think themselves accursed they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin's day.
Thanks for listening. And thanks for letting me do this job.
*probable serum testosterone peak
** probable point of clinical disinhibition.