Sunday, April 09, 2006

I am not the urology surgeon... I am a human being.

Never, and I mean never, take anyone you know and care about, to Shipman Emergency Department. Ever. Ever. At all.

And by the way, hideous image warning. Proceed at own peril.

I had decided to use all this ‘early morning wakening’ time more productively. Rather than worrying about the usual dreary round of car crashes and hideous diseases, I decided to worry about our finances. This is a fruitful ground for the dedicated panic merchant to till, and by the time the sun rose I had decided that the only sensible course was for me to go on the game, Sarah to take her French horn and busk in the mall, and my niece to sell her hair on the internet.

When Sarah got up, I gave her the results of my meticulous and even-handed micro-economic analysis.

“Jesus Christ!” I shrieked. “We earn hundreds of thousands a fucking year! How come we’re on the verge of fucking bankruptcy and are going to be thrown into the street?”

Sarah agreed that she had allowed the situation to become inexcusably dire (we have an agreement – she manages the finances and I do the cat litter. From each according to his ability, to each according to his need), and admitted that aside from the fact that we did not earn hundreds of thousands a year, were not on the verge of bankruptcy and were not about to be thrown into the street, my grasp of the situation was flawless.

“We have to learn to do more with less” I trumpeted, as my wife hunched miserably over her cornflakes. “More and more with less and less. Either that, or someone’s going to have to sacrifice a bit of their precious sitting-on-their-arse spare time and do some work around here.”

At that moment, my phone rang. I grabbed at it.

“Hello, Dr Bronze” came the small, pleading voice at the other end. “It’s Lucretia from the Shipman ED. One of our doctors has called in sick and I was wondering if you could help us out with a shift today?”

Not what you want to hear first thing in the morning, especially a morning you have dedicated to pottering around and maybe seeing a few friends. But I could see Sarah’s big brown eyes peering into mine, into my soul. She had heard every word.

I agreed to the twelve to ten shift. A few hours later I pulled into the carpark, collected my ID card and returned to Shipman.

By the way, I should point out that, although elements of this blog are fictionalized to protect the innocent, every word of the following is as I remember it – and as the night wore on I actually started taking notes to “prove” what had happened. I should also point out that Shipman is a public hospital being run by a private company, a private company celebrated for its ability to produce a profit from situations not previously thought of as money-makers, and that any day now it is apparently going to be bought back by the State and converted into an institution for caring for the sick.

At Shipman you pick up a form (the MR5) from the inbox, check on the form and the whiteboard to see where the patient is, write your initials on the whiteboard next to the patient and go to the cubicle to see them. My first MR5 and the whiteboard, suggested that I would be seeing a 53 year old woman in cubicle M with depression.

I walked down and opened the door to cubicle M. A tall, patrician man with a urinary catheter, sitting on the bed, looked up at me hopefully.

“Are you the urology surgeon?” he asked.

“No. Are you Mrs Dolor?”

“No” he admitted. I backed out, murmuring apologies, closed the door and went back to the nurse’s station.

“Where’s Mrs Dolor?” I said.

“In M” she replied.

“No, that’s an old man with an IDC.”

The nurse glanced up at the whiteboard. “It says she’s in M.”

“I went there myself” I said. “Ten seconds ago. It’s not her.”

“Are you talking about M?” asked another nurse. “I thought it was empty, so I put Mr Faucet in there.”

“Well, move him out again” snapped the head nurse, with a roll of her bright blue eyes. She stalked over to the whiteboard and scrubbed out the information for M. “Problem solved” she said.

“But where’s Mrs Dolor?” I asked.

She stared at me, then at the whiteboard, the one from which a few seconds ago she had erased all mention of Mrs Dolor’s existence. There was a pause. “Don’t know” she admitted eventually. “Is she in N?”

Eventually I traced Mrs Dolor to the waiting room, where she lay curled in the foetal position on a hospital bed. I walked back to the nurse’s station. On the way back I passed cubicle M, which had by now been filled (almost literally) by an obese boy with a twisted ankle.

I gave up on Mrs Dolor and grabbed the next MR5. It directed me to cubicle H, where it assured me I would find Mrs Blear, an 81 year old woman with confusion who had had a fall. I flung aside the curtain.

It was the same elderly man with the same catheter. His face brightened.

“Are you the urology surgeon?”

“Sorry” I murmured, and backed out. As I left the room his voice floated after mine. "I've been waiting five hours!"

Eventually I tracked down Mrs Blear in cubicle Q, behind the linen cupboard. Apparently Q can look quite a lot like H if you write it fast.

An hour later I felt in my pocket for my pen, one of those cheap black hospital issue biros. It wasn’t there. I remembered lending it to the surge reg when I told him about my fairly unlikely (but eventually justified) 59 year old man with appendicitis. I swore. It hadn’t been my pen anyway, I had picked it up from the admin desk when I came in.

I grabbed Dr Valentina, the slim and remarkably fecund emergency registrar (one pregnancy on condoms, one on the pill, one on Implanon). “Where are the pens?”

“Pens?” she said. “Pens? Ah, that can be difficult around here.”

I stared. I promise I am not making this up.

“No, really, come with me.” She went to the stationery cabinet and opened the door. It was empty, except for some old Xray forms and three large boxes of booklets about the Shipman High Fibre Diet.

“Goodness” she said. “There’s always the doctor’s emergency cabinet.”

I followed her to the cabinet, through a door where you swiped your card to a cabinet with a four digit pin number. It proved to contain several packets of textas, some soft black pencils, and about thirty highlighters. No pens.

“This is fucking ridiculous” I said. “Is this some kind of unusual demand around here? A fucking pen?”

There was a pause. “You can share mine” said Dr Valentina, who was not used to such language. “It doesn’t write very well. But you have to promise to give it back.”

I swear, no word of a lie.

A few minutes later (I had acquired a pen when the gynae intern put hers down for a moment) a chest pain came into cubicle D. At Shipman cubicles A to F are high acuity cubicles for urgent conditions – priority twos and so on. I went in to see Mr Wirrapanda, a thirty year old Aboriginal man with ongoing chest pressure and left arm heaviness. I took a brief history while I grabbed the stuff to put a line in his arm. I opened the drawer. There was no tourniquet.

“Tourniquet” I said to the nurse.


“I need a tourniquet. To put a line in his arm – he needs anginine and his blood pressures only one oh five – where are they?”. When you put a tourniquet around someone’s arm, the vein stands up. It makes it easier to get IV access, to “put a line in”. For an anxious doctor like me there are only two kinds of sick patients – those who have a line in and those who need a line in. The nurse – the one frazzled woman looking after all six high acuity beds, a job that at Florey occupies three – said there might be one in the blood room. I ran out to the blood room. Nope. The nurse had followed me.

“Try resus” she said.


“There’s always one in resus”.

I had a sudden nightmare image of someone trying to resuscitate a sick child, reaching for a tourniquet to get a line in to save a life – and finding nothing. At Florey the resus room is sacrosanct, checked twice a shift to ensure that everything is present and accounted for.

In the end I found a tourniquet in cubicle H – thankfully by this time Mr Faucet was asleep, catheter still in situ, still unseen by the urology surgeon. I found the tourniquet and got the line in and actually treated the sick person.

Anyway. The shift went on. I saw a little girl who had fallen off a slide and broken both her wrists, and a wman with a rash, and a girl who had broken up with her girlfriend and taken a large dose of essentially harmless medications. And a woman who was gardening and had got a spike of some plant or something through her thumb – I asked if I could take a photo of her injury, it’s a pity I can’t post these – hold on, I’ll try.

If you're not seeing an image of a thumb with a bit of stick stuck through here, it didn't work.

Hold on:

And some other stuff. And eventually, an hour over time, I crawled home, shaking my head. Because of the nail, the kingdom was lost, all that kind of thing.

And the next day I worked a shift at Florey – another doctor called in sick – and had a glorious, camaraderie building, positive self-belief affirming time. Treated a woman wiht bipolar disorder, hepatic encephalopathy, sepsis... you name it, this woman had it. And it went well, and I even got to teach a medical student something, and I came home tired and everything but happy.

All of which will be taken into account when Sarah and I do actually sit down and work out our finances and what we want to do, whether we could see ourselves doing what we are doing now in five years time.

The primary exam, should I ever decide to submit myself and those who love me to that kind of stuff again, is six short months away. The textbooks, cobwebbed, steeped in dust and in the smell of fear, are only a short walk from here, in a rooom I haven't entered in six months.

We shall see.

Thanks for listening,



Blogger Benedict 16th said...

This comment has been removed by a blog administrator.

9:36 PM  
Blogger Benedict 16th said...

Actually, apparently it is $205/hr

9:37 PM  
Blogger Benedict 16th said...

What about this from the "Shadow Minister for Health"
You could do the $200/hr $2400/shift job couldn't you?

"Up to 10 overseas-trained intern doctors at The Harold Shipman Memorial Hospital allegedly have such poor English skills that the State Government has been forced to employ a locum to help them communicate with patients.

Liberal health spokesman Robert Silverspoon said Health Minister Joe Hill had agreed to fund locums to work at the hospital from 8pm to 8am – costing taxpayers an extra $220,000 for three months.

And senior sources within the The Harold Shipman Memorial Hospital claim that some of the overseas recruits have not even practiced medicine for the past five to nine years.

“These are extremely serious allegations about the quality of care being provided in one of the State’s major hospitals,” Mr Silverspoon said.

“It is absolutely vital that all doctors and nurses can communicate clearly and effectively with their patients.

“Anything less, and patient safety could be seriously jeopardised.”

Among the latest allegations:
• A senior Harold Shipman Memorial Hospital doctor wrote to Health Minister Joe Hill complaining about the poor English skills of the overseas trained doctors. Minister Hill’s response was to employ locums for three months to help the doctors communicate – at a cost of $200/hour.
• Some nights there are no supervising GPs present.
• Some of the overseas-trained doctors haven’t practised for the past five to nine years.
• Staff have expressed extreme concern to the Health Department about patient safety."

etc etc...

9:36 PM

9:43 PM  
Blogger Foilwoman said...

We have a lot of that here as well. I wonder about it most acutely in psychiatry, where interpretation of words and meaning is relatively important (but it's also important for the doctor to understand when you say: "I feel pressure in my chest. It feels like an elephant is sitting on me when I breath" and it's important for you to understand when the doctor says "Do not drink wine or eat cheese [MAOI anyone? A medicine to avoid, for damn sure] with this medicine. Something bad will happen." Why is that not understood?). Lot's of HMOs and PPOs only have recent immigrant doctors in network. Probably great doctors, but even when talking about people from India or other countries where English is spoken, the accent is so different that comprehension can be very difficult. Eish.

8:30 AM  

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