Magnesium, troponin and Power Girl

Hail,
A brief halt to my whingeing to actually talk about work. But be warned - this post touches briefly on the misery of others, but ends up being all about me.

Last Saturday the tide turned.

I remember where I was at the time. I had got there a few minutes early and was printing up the blood results (quick and easy guide to Intensive Care medicine - if anyone looks unwell, give them magnesium. Helps the heart, helps the lungs, helps the brain. In fact, everyone reading this should be doing so chomping on some green leafy vegetables) when we got the first MET call of the day.

"Emergency" said Dr Hu (I am not making this up). Bed-block has become so bad lately that admitted medical, surgical and psychiatric patients are waiting hours and hours in the ED. While the patients are physically in the Emergency Department, they are "legally" being looked after by the medical or surgical teams, and if something goes wrong, it's us who get called.

(Of course, psychiatric patients aren't stuck for hours in the Emergency Department, awaiting beds. That would be wrong. They wait days).

So, Dr Hu and I went downstairs to the ED, to see Mrs Ami, an eighty three year old woman having what looked very much like a heart attack. We ordered the GTN so her heart didn't need as much oxygen, we ordered the fluids to bring the blood pressure back up because the damaged heart and the GTN was dropping it, we ordered morphine, we even ordered some magnesium -

And half way through I started to feel I knew what I was doing. I made suggestions, I gave instructions, I disagreed with my colleagues and a lot of the time we did what I thought should happen (well, at least until cardiology turned up, who actually "owned" the patient). And everything went right - well, for us it went right. For Mrs Ami, who was eventually transferred to the Royal in the back of an ambulance, it wasn't looking that good. But for the first time in a long time I felt relaxed doing medicine.

See, it's been months since I've had that feeling, that faint background calm. Not since starting ICU, not since Clearwater in fact. And on the surface that isn't so surprising - I was pretty sick. I took a fair amount of time off. Prior to that I'd been working in an unrelated field, so that was over a year away from any kind of acute medicine. And I'd forgotten a lot and my professional self-confidence - never the best - had become like some kind of vestigial organ.

Anyway. That self-confidence is still there today. I'm studying too, and it's getting in, and coming back when I need it. Not that I reckon I know it all, but I feel better, less like that drowning mouse in the antidepressant test, more like someone who can actually do some remarkable stuff but who looks like maybe I shouldn't be taken seriously.

That's a real illustration, by the way. And the woman can apparently fly. Look, up in the sky...

Anyhow. I've been spending the whole post going on about myself. I don't know what happened to Mrs Ami. Not good, I suspect. She was eighty three, and had had the pain all night before coming in - she belongs to that vanishing generation, amongst whom are some of my favourite people, who die early after a lifetime of hard work because they "don't want to bother the doctor". The front part of her heart was damaged, I don't know that she would have done so well.

But we shall see. Tonight I do a bit of study and watch old episodes of House with Sarah. Tomorrow or tonight, comments.

Thanks,
John