The Man from Snowy Liver

Hail.

Late night, and my belly is bulging with post-first week rum-and-raisin ice cream. I have just opened my bottle of merlot and started to write. In the next room I hear occasional exclamations of joy from Sarah - she has been searching ebay for rural clothing, and so far has seen a pair of Outback Dessert Boots, and a Genuine Australian Stockman's Hat, "As worn by the Man from Snowy Liver."

Anyway. I have survived the first two days of ICU, my first shifts of hospital medicine in a very long time, and I have learned several remarkable things.

I have learned that there is some part of my, some strange, self-punishing part, that thrills to this. The first shift I woke at six, after staying awake running through stuff in my head almost all the preceding night - blood gases, scans of the brain and the heart. I got up before dawn and looked outside. The moon was full, the sky was still dark, with a few streaks of cloud in the sky. The air was cold, it seems we haven't had much of a summer here, it came late, was weak and is leaving early.

The previous night there had been a lunar eclipse, the moon had been the colour of blood, a portent. Now it was full and pale.

I stood outside on the cold lawn, filled the water-troughs for the chooks and scooped them a few bowls full of grain, and felt a thrill, and electric exultation, a feeling of being alive. Like there was some blanket of fat being removed.

I can't say what it is, exactly, but I have missed this.

Anyhow. I arrived early. One of the best things about ICU is the shifts go eight to eight thirty. This means I am in the car park at seven thirty, which means I always get a parking space. Most people aren't here at this hour, you pick your way past cars belonging to JMOs and cleaners and the pathologically keen.

The ICU is up two flights of stairs. It's a relatively small department - fifteen beds at full funding, but running at a little under that at the moment. It's almost the opposite of ED - it's small numbers of very sick people, rather than the reverse. In bed one is a woman who had a heart attack after her gall bladder surgery and has now gone into type two respiratory failure and is on her way to pneumonia - that sort of thing.

We have several overdoses - which does give me some transient feeling of disquiet - and several people in what is called "acute on chronic" organ failure. These are people who have had, say, very poor kidney function for a number of months, just hovering on the edge of dialysis, and to whom something happened - a bit of diarrhoea, maybe, or a touch of a chest infection - which pushed them over the edge. Now a machine cleans their blood.

If they are lucky, this will be a temporary thing.

It is also a place where remarkable stories are told. The boss, Dr White, a green-eyed and red-headed Irishman in his early fifties, is a vastly learned man. He spent the first fifteen minutes telling me that he must be consulted at any hour of the day or night if I had any concerns about patient health or welfare, and I spent the same amount of time telling him that I would not hesitate to consult him at any hour of the day or night if I had any concerns about patient health or welfare, and after that we seemed to get on fine. He has an inexhaustible supply of stories that he tells with evident glee - stories of surgery gone awry, for example, untimely and tragic deaths, family outings consumed by tragedy, that sort of thing.

"Talking of amphetamine withdrawal" he would say (and we had been) - "a year or so ago we had a big guy in. Not so much tall, but broad, arm'sbreadth across the shoulders, big guy. he'd been brought in by the police after causing an affray with a pickaxe handle or something, and he'd got this cut on his head, and the urine looked like rhabdomyolysis, so we got him. Anyway, the police sat on him for two days, and this guy lay quiet as a mouse. Didn't move or anything.

So they finally hand over to the security guard and head off. Security, of course, is a three foot tall geriatric with a walking frame, looking like Pinocchio's uncle in the cartoon. The cops have been gone two minutes when our guy wakes up, needs a toilet break.

So security takes the guy in to the toilet.

"I can't do it with you watching me" says the prisoner, who is handcuffed to said security guard.

"Sounds reasonable" says security, handcuffs him to the towel rail instead and steps outside.

Ten seconds later the guy erupts from the toilet stall, bradishing the steel towel rail, knocks old Geppeto to the ground and starts running for the doors. Everyone gets out of the way and he disappears down the stairs. By the time the police arrive, he's gone.

So they ask us for a description. They already have a pretty good description of what he looks like, but we tell them - squat, bald, bearded, covered with home-made tattoos.

"What's he wearing?" asked the police officer.

"A hospital gown" said the nurse. "Neck to knee, open at the back. And it didn't really fit him, because of his size, gaped a bit. Nothing underneath. And a handcuff, and a towel rail."

"Can you describe the towel rail?" asked the officer.

"Metal. Long. Like a cylinder" said the nurse. "You know, you hang towels on it."

"Right, right" said the officer. "And he's handcuffed to it." Then he looked up at the nurse. "Which wrist was handcuffed?"

We all had this mental image of the police pulling up a bare-arsed, screaming tattoed man in a hospital gown, charging down the highwayhandcuffed to a towel rail and saying "Wait a minute - this guy's got a towel rail handcuffed to his right hand. Can't be our guy. Sorry sir, our mistake."

Anyway, more tales of this kind of stuff to come. For now* I have admit my man in a wheelchair who claims to be drinking - wait for it - nine litres of wine a day. Ninety standard drinks.

The Man from Snowy Liver, indeed.

Thanks for listening,
John

*Started this entry last night, finished this morning. I am not actualy disorientated to time, person or place.

John