First night is always the hardest since my body clock is still set at daytime. I had stayed up the night before in an attempt to get into the rhythm earlier. It worked to a certain extent since I was ready to drop by 10am but I had to attend an inquest at County Court as part of the junior doctor's teaching. Unusually for an inquest, ( I was told) the court was full and there were three counsellors present - which suggests a not-so-straighforward case. Unfortunately I was so tired, I fell asleep half an hour into the session and woke up to find that things hadn't moved on very much. I excused myself, drove home, and fell, blessedly, into bed.
There was no middle-grade doctor on tonight, only little old me and a locum senior house officer, who thankfully, has more experience than I do (which isn't hard since basically everyone does). Nice bloke, very helpful. Not a particularly busy night, had the usual after 3am lull where the department was completely empty. Things started heating up again at 6am, once people start getting out of bed and falling over.
An hour before the both of us were to knock off a woman was brought in by ambulance after the police had to break her door down. She had taken an overdose of various prescribed medications, including an anti-depressant and a sedative. Never very nice, anti-depressant overdoses, especially if you're on one of the older ones. This lady had blood-stained vomit all over her front, but she was alert and responsive, and except for a mildly high heart rate, was doing fine. Her relatives later informed us she was due to attend court that morning. For whatever reason, I don't know. Not my job to ask.
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The British Isles are in the middle of a 'heatwave'. Well, heatwave by British standards. Being from a tropical country myself, I'm pretty much adapted to hot weather. Though it has been nice to work at night when it's cooler. Some of my colleagues have been having a hard time, some claiming to get confused and stupid in the heat. I got a lot of queries about how I managed to sleep during the day with the weather being so warm. Very well, thank you, the best sleep I've ever had on a night shift. Which is probably why I've been so chirpy during this past week - I've managed to get six solid hours of uninterrupted sleep each day.
It's the day England lost their World Cup match to Portugal. I managed to watch some of it while I was at home. Game goes into extra time. I thought, "If this goes into penalties, England will lose." And whaddya know, I was right.
It is generally agreed that attendances to A&E would increase when England was playing, but all the times I've been on duty when England played, I didn't notice any particular increase in heart attacks or assaults. This time round, there was a parade of people coming in after getting their heads kicked in. They were all English. Funny that - I would have expected Portuguese people to get their heads kicked in. Maybe because there weren't any in this area. People are daft though. It's only a game. Why do you feel the need to beat the crap out of somebody when a bunch of overpaid primadonnas can't get a ball into the back of the net?
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It's night number six for me but first night for the middle grade on tonight. It's gone past 3 o'clock in the morning and he looks like death warmed over. Three patients who have taken overdoses roll in within three minutes of each other. Nothing too serious, no one took enough to physically harm themselves. Except one man who claimed to take 48 tablets of ibuprofen daily for the past 5 years (maximum dose is 6 x 200mg tabs per day), which I seriously doubt since he would have been dead a long time ago. I see all three of them and start on a young man with abdo pain, then pop back to the office to finish writing up the previous patients I'd seen. I didn't mind seeing all of them, since I was wide awake and figured my senior needed a break more than I did. Besides, middle grades have put in their time, and they need to save their brains for when the real shit hits the fan. I went back to the young man, took his bloods, turned around to find the middle grade standing there with a fistful of blood bottles, cannula and an infusion bag with ketorolac (a painkiller) in it.
"Errr...."
He hadn't realised that I had seen the patient already and already given him an oral dose of diclofenac, which meant he could not give the ketorolac. He got annoyed about the waste and mumbled something about putting your name on the board when you've seen a patient and why didn't I put a cannula in when I took the bloods.
Hmm, because he was apyrexial, had a pulse of 58, a soft abdomen and I didn't feel that I needed to waste money on a cannula or that he was ill enough to be admitted.
Poor guy looked sick as a dog (the doctor, not the patient) so I let it pass.
15 minutes later, a patient collapses. She has a pulse of 18 and a near-unrecordable blood pressure. The nurses whipped her into the resus room and I stuck a massive cannula in, bunged in some fluids and atropine. Senior doctor finally walks in - still looking like death - but this time round the patient looks worse than he is. Now is when I need him because I've come to the end of my knowledge here. We get the external pacemaker out and start shocking her, called the medical registrar who comes and sticks a sheath into the woman's jugular all the way to the heart, then the consultant comes in to stick a pacing wire into the sheath. So at last the poor patient can be properly paced from within rather than flopping like a fish every time we shocked her.
Both patient and doctor now looking fine.
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I am not fine. I'm finding it difficult to adjust back into daytime. The house is a tip. You know how in American cop dramas, the police (or CSI) walk into a suspect's house and draw all sorts of conclusions from the state the house is in? I think I would be arrested by now.
There was no middle-grade doctor on tonight, only little old me and a locum senior house officer, who thankfully, has more experience than I do (which isn't hard since basically everyone does). Nice bloke, very helpful. Not a particularly busy night, had the usual after 3am lull where the department was completely empty. Things started heating up again at 6am, once people start getting out of bed and falling over.
An hour before the both of us were to knock off a woman was brought in by ambulance after the police had to break her door down. She had taken an overdose of various prescribed medications, including an anti-depressant and a sedative. Never very nice, anti-depressant overdoses, especially if you're on one of the older ones. This lady had blood-stained vomit all over her front, but she was alert and responsive, and except for a mildly high heart rate, was doing fine. Her relatives later informed us she was due to attend court that morning. For whatever reason, I don't know. Not my job to ask.
----------------------------------------------------------------------------
The British Isles are in the middle of a 'heatwave'. Well, heatwave by British standards. Being from a tropical country myself, I'm pretty much adapted to hot weather. Though it has been nice to work at night when it's cooler. Some of my colleagues have been having a hard time, some claiming to get confused and stupid in the heat. I got a lot of queries about how I managed to sleep during the day with the weather being so warm. Very well, thank you, the best sleep I've ever had on a night shift. Which is probably why I've been so chirpy during this past week - I've managed to get six solid hours of uninterrupted sleep each day.
It's the day England lost their World Cup match to Portugal. I managed to watch some of it while I was at home. Game goes into extra time. I thought, "If this goes into penalties, England will lose." And whaddya know, I was right.
It is generally agreed that attendances to A&E would increase when England was playing, but all the times I've been on duty when England played, I didn't notice any particular increase in heart attacks or assaults. This time round, there was a parade of people coming in after getting their heads kicked in. They were all English. Funny that - I would have expected Portuguese people to get their heads kicked in. Maybe because there weren't any in this area. People are daft though. It's only a game. Why do you feel the need to beat the crap out of somebody when a bunch of overpaid primadonnas can't get a ball into the back of the net?
-------------------------------------------------------------------------------
It's night number six for me but first night for the middle grade on tonight. It's gone past 3 o'clock in the morning and he looks like death warmed over. Three patients who have taken overdoses roll in within three minutes of each other. Nothing too serious, no one took enough to physically harm themselves. Except one man who claimed to take 48 tablets of ibuprofen daily for the past 5 years (maximum dose is 6 x 200mg tabs per day), which I seriously doubt since he would have been dead a long time ago. I see all three of them and start on a young man with abdo pain, then pop back to the office to finish writing up the previous patients I'd seen. I didn't mind seeing all of them, since I was wide awake and figured my senior needed a break more than I did. Besides, middle grades have put in their time, and they need to save their brains for when the real shit hits the fan. I went back to the young man, took his bloods, turned around to find the middle grade standing there with a fistful of blood bottles, cannula and an infusion bag with ketorolac (a painkiller) in it.
"Errr...."
He hadn't realised that I had seen the patient already and already given him an oral dose of diclofenac, which meant he could not give the ketorolac. He got annoyed about the waste and mumbled something about putting your name on the board when you've seen a patient and why didn't I put a cannula in when I took the bloods.
Hmm, because he was apyrexial, had a pulse of 58, a soft abdomen and I didn't feel that I needed to waste money on a cannula or that he was ill enough to be admitted.
Poor guy looked sick as a dog (the doctor, not the patient) so I let it pass.
15 minutes later, a patient collapses. She has a pulse of 18 and a near-unrecordable blood pressure. The nurses whipped her into the resus room and I stuck a massive cannula in, bunged in some fluids and atropine. Senior doctor finally walks in - still looking like death - but this time round the patient looks worse than he is. Now is when I need him because I've come to the end of my knowledge here. We get the external pacemaker out and start shocking her, called the medical registrar who comes and sticks a sheath into the woman's jugular all the way to the heart, then the consultant comes in to stick a pacing wire into the sheath. So at last the poor patient can be properly paced from within rather than flopping like a fish every time we shocked her.
Both patient and doctor now looking fine.
-------------------------------
I am not fine. I'm finding it difficult to adjust back into daytime. The house is a tip. You know how in American cop dramas, the police (or CSI) walk into a suspect's house and draw all sorts of conclusions from the state the house is in? I think I would be arrested by now.
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