Good intentions
My car broke down on the way to work two and a half months after I bought it from those cowboy salesmen, Carcraft. Never having owned a car before, much less expect it to break down on me, I panicked. If you've read my first post ( Why I Hate Driving....), you'll know how much I hate driving and all that comes with it. I drive 50 miles each way every day to work and it's no joke to have your car break down in the middle of nowhere. To cut a long story short, I had to get the RAC out, but luckily my car was easily sorted and I could safely drive to work.
I was so grateful as to the lovely, reassuring way I was treated, both by the call operator and the mechanic who came to sort my car. I felt like a right idiot for panicking but I thought, "This must be how some patients feel when they come in all scared to A&E." I try hard to listen and empathise with all my patients but it's sometimes hard to keep your cool when you feel like that person so did not need to come to hospital. But most people who come to hospital don't have a medical degree, or grandma to tell them it's just hayfever, and they're frightened that the healthy body they have that has worked so well suddenly is doing all sorts of weird things. Much like my car.
So, there I was, 2 hours late for the evening shift, and resolved that I would put on a kind face and be more patient with patients. I walked into chaos in the department and my good intentions were sorely tested with my first patient - a suicidal man who reeked of alcohol. Now nearly every shift I work on, there's always someone who has taken an overdose - usually of paracetamol. They normally don't take enough to physically harm themselves. When asked directly whether they intended to kill themselves (which we have to ask and, yes we have to say the word 'kill'), they usually say no, all they wanted was some sort of release from whatever troubles they are currently going through. The trouble comes when a patient has been drinking heavily and come in and say, "Life is shit, I'm so depressed, I want to kill myself." What do we do? You can't assess them properly when they're sozzled - alcohol is a depressant after all. The mental health service won't see them until they're sober. And how often does a drunk moan about how their life is shit and not worth living, then promptly fall asleep then wake up a few hours later denying all knowledge of being suicidal?
A depressed person is usually withdrawn and doesn't look you in the eye. Occasionally they are agitated, which is the more dangerous one as they are at higher risk of harming themselves. And they're usually not perky, smiley, good-eye-contact like this fella that I saw. Yes, doctor, I feel like I'm going to kill myself. Professional patients - they know the drill, the right words to say to get them admitted, even if all they are looking for is a place to sleep for the night.
Having said that, not all people who come in feeling suicidal or have attempted suicide are like the bloke I saw. Some are just at the end of their rope. Fortunately, most people have family or friends who would inevitably find them fast asleep with several empty packets of medication beside them. Or they wake up the next morning and realised that they haven't died, get up and brush their teeth and go to school.
Here comes the sun
When the first warm weekend started a couple of weeks ago, there was a spate of people thronging the minors department with various sprains, strains & fractures from falling off motorbikes, trampolines, cliffs, neighbour's walls etc. That was to be expected really, since the sun and warm weather is a rarity in the British Isles, so everyone gets overexcited and break or strain rarely used body parts. What I didn't expect was the increase in people getting depressed. Within 12 hours the department had 5 people lined up to see the psychiatrist, three had taken an overdose and two claiming to be suicidal but hadn't taken anything or done anything yet.
Maybe they couldn't stand all these people running around being happy.
A pain in the back
When anyone who comes in to A&E with back pain, within a few minutes of seeing them, you should have an idea what is causing their back pain. It could be anything from
1) simple musculoskeletal back pain
2) acute spinal cord compression
3) dissecting/leaking aortic aneurysm
4) pancreatitis
5) kidney stones
6) heart attack
All pretty much really painful and four of them could potentially kill you or disable you for life. It's the simple ones usually that I sweat over because I know it will take ages to sort out satisfactorily. There is only so much oral analgesia that I can give in A&E, which just about takes the edge of the pain - if it's a muscular back pain. You know, the one where people bend over, felt "something go" and then find that they can't stand up. The examination itself is pretty painful since I need them to do all sorts of things which will exacerbate their pain. And they are rather incredulous when I say that the best treatment for it is to keep moving when all they want to do is lie still on their bed.
....and at the end of the day
Doctors tend to remember patients who have been interesting cases, a case they've never seen before, somebody whose care they've managed to cock-up, or somebody who drives them up the wall, for whatever reason. Occasionally there are some people that just puzzles you and you feel sorry for. The elderly couple who look after each other usually makes me be extra nice, because I can't help think of them as my grandparents and I would hate it if someone treated my own grandparents badly.
Rarely, I feel sorry for young patients. There was a fella who came into resus the other day who was so quiet and withdrawn that I wondered what was going on. We sorted out his medical problem, but his whole demeanor was rather......... sad, for lack of a better word. I read his old casenotes and his previous consultant had noted his background life in his clinical notes and felt much the same as I did. I can't go into details of it but it brings me back to the whole mental health thing I was talking about earlier. There are some who irritate you so much with their constant demands on your attention and there are ones who seem so lost and distant that they can just slip under your radar. Both groups need help, but naturally it is the louder ones that get your attention, while it's the quieter ones who trundle on with their lives without any.
My car broke down on the way to work two and a half months after I bought it from those cowboy salesmen, Carcraft. Never having owned a car before, much less expect it to break down on me, I panicked. If you've read my first post ( Why I Hate Driving....), you'll know how much I hate driving and all that comes with it. I drive 50 miles each way every day to work and it's no joke to have your car break down in the middle of nowhere. To cut a long story short, I had to get the RAC out, but luckily my car was easily sorted and I could safely drive to work.
I was so grateful as to the lovely, reassuring way I was treated, both by the call operator and the mechanic who came to sort my car. I felt like a right idiot for panicking but I thought, "This must be how some patients feel when they come in all scared to A&E." I try hard to listen and empathise with all my patients but it's sometimes hard to keep your cool when you feel like that person so did not need to come to hospital. But most people who come to hospital don't have a medical degree, or grandma to tell them it's just hayfever, and they're frightened that the healthy body they have that has worked so well suddenly is doing all sorts of weird things. Much like my car.
So, there I was, 2 hours late for the evening shift, and resolved that I would put on a kind face and be more patient with patients. I walked into chaos in the department and my good intentions were sorely tested with my first patient - a suicidal man who reeked of alcohol. Now nearly every shift I work on, there's always someone who has taken an overdose - usually of paracetamol. They normally don't take enough to physically harm themselves. When asked directly whether they intended to kill themselves (which we have to ask and, yes we have to say the word 'kill'), they usually say no, all they wanted was some sort of release from whatever troubles they are currently going through. The trouble comes when a patient has been drinking heavily and come in and say, "Life is shit, I'm so depressed, I want to kill myself." What do we do? You can't assess them properly when they're sozzled - alcohol is a depressant after all. The mental health service won't see them until they're sober. And how often does a drunk moan about how their life is shit and not worth living, then promptly fall asleep then wake up a few hours later denying all knowledge of being suicidal?
A depressed person is usually withdrawn and doesn't look you in the eye. Occasionally they are agitated, which is the more dangerous one as they are at higher risk of harming themselves. And they're usually not perky, smiley, good-eye-contact like this fella that I saw. Yes, doctor, I feel like I'm going to kill myself. Professional patients - they know the drill, the right words to say to get them admitted, even if all they are looking for is a place to sleep for the night.
Having said that, not all people who come in feeling suicidal or have attempted suicide are like the bloke I saw. Some are just at the end of their rope. Fortunately, most people have family or friends who would inevitably find them fast asleep with several empty packets of medication beside them. Or they wake up the next morning and realised that they haven't died, get up and brush their teeth and go to school.
Here comes the sun
When the first warm weekend started a couple of weeks ago, there was a spate of people thronging the minors department with various sprains, strains & fractures from falling off motorbikes, trampolines, cliffs, neighbour's walls etc. That was to be expected really, since the sun and warm weather is a rarity in the British Isles, so everyone gets overexcited and break or strain rarely used body parts. What I didn't expect was the increase in people getting depressed. Within 12 hours the department had 5 people lined up to see the psychiatrist, three had taken an overdose and two claiming to be suicidal but hadn't taken anything or done anything yet.
Maybe they couldn't stand all these people running around being happy.
A pain in the back
When anyone who comes in to A&E with back pain, within a few minutes of seeing them, you should have an idea what is causing their back pain. It could be anything from
1) simple musculoskeletal back pain
2) acute spinal cord compression
3) dissecting/leaking aortic aneurysm
4) pancreatitis
5) kidney stones
6) heart attack
All pretty much really painful and four of them could potentially kill you or disable you for life. It's the simple ones usually that I sweat over because I know it will take ages to sort out satisfactorily. There is only so much oral analgesia that I can give in A&E, which just about takes the edge of the pain - if it's a muscular back pain. You know, the one where people bend over, felt "something go" and then find that they can't stand up. The examination itself is pretty painful since I need them to do all sorts of things which will exacerbate their pain. And they are rather incredulous when I say that the best treatment for it is to keep moving when all they want to do is lie still on their bed.
....and at the end of the day
Doctors tend to remember patients who have been interesting cases, a case they've never seen before, somebody whose care they've managed to cock-up, or somebody who drives them up the wall, for whatever reason. Occasionally there are some people that just puzzles you and you feel sorry for. The elderly couple who look after each other usually makes me be extra nice, because I can't help think of them as my grandparents and I would hate it if someone treated my own grandparents badly.
Rarely, I feel sorry for young patients. There was a fella who came into resus the other day who was so quiet and withdrawn that I wondered what was going on. We sorted out his medical problem, but his whole demeanor was rather......... sad, for lack of a better word. I read his old casenotes and his previous consultant had noted his background life in his clinical notes and felt much the same as I did. I can't go into details of it but it brings me back to the whole mental health thing I was talking about earlier. There are some who irritate you so much with their constant demands on your attention and there are ones who seem so lost and distant that they can just slip under your radar. Both groups need help, but naturally it is the louder ones that get your attention, while it's the quieter ones who trundle on with their lives without any.
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