Saturday, October 23, 2004
It had to be 3 o'clock in the morning
What did I say about 3 am? Huh? What did I say? So yes the night was long and bumpy. I mean it literally.
Kevin bleeped me at 02:45 to say that a 19 year old was coming to Accident and Emergency with a nasty head injury. No questioned asked, I detached myself from reality and zombied over to A&E.
I have never really worked with Kevin. He is about 6 month more senior and about to marry an ICU nurse ( If I was told correctly that is). She shops at Monsoon. I know that much. After last night I have to say that we've positively bonded and I have to rethink about some of the things that I have said quietly to myself about him. Especially about the way he'd look at me and Deepa when we first started at Hull.We thought 'Twat!'. He's not the only one though. There was another one. But I'll leave her alone for now.
Kevin was already there when the boy arrived. Apparently his mates had kindly picked him up after what looked like a whack in the head, and put him through a plasma TV. Maybe the ad which was on didn't quite agree with the curry and lager they had and they've decided putting this poor fella through the screen would be a laugh. We were getting conflicting stories from everybody. The bobby who was there had a different story to the girlfriend who was crying hysterically. PhhooaHHHH...stinking and gobby!She's had a bit to drink I thought.
The boy had laboured breathing, not responding much to us calling, so half dead basically ( in Glascow Coma Scale language this is 4 over 15. 3 is dead 15 is you and me). He needed to go on the machine and so we had to stick a tube down his throat. So with that he will look properly comatose.
We were waiting for almost 20 minutes for the ODA (the assistant) to come over from where she was sleeping, and during that time, about 3 bleeped went out to wake her up. Stuff it we thought and Kevin agreed to play ODA. I took one look with the laryngoscope into the mouth, and it's blood everywhere. This guy could not have simply been whacked. He's been battered.
The tube went in and the machine took over. I'm pretty sure it looked all smooth and slick on the outside, but I was running a 100 metre inside! On one hand, I have done it now. It's an experience, but on the other? It could only get worse from here. Kevin was all the way in the background, not taking over the whole situation but he's watching and observing. I was very surprised that him watching over was more catalytic than an impending doom, eagle eyes scrutinizing.
After a few jabs in the wrist later, Kevin asked me to try and see if I could put the arterial line in the left wrist. He's had a few goes and not doing so well. I spent about 5 minutes trying to feel the pulse, and everybody was relying on me to get it in. Go away, go away stop looking at me. I was so flustered and I hated being watched. The pressure was so much I felt like vomitting. A quick jab and to my surprise it went in. Ace! Fair enough, not bad afterall then.
We took him to the CT scanner where it's all dingy and muggy. I can understand now, why all these radiologist seemed like they 've never had enough to eat and just waiting there ready to bite our head off every time we request a scan, any scan for that matter. Why do the job in the first place if you are going to be arssy 24/7? Well it was by then 4 am in the morning and I thought he should have just changed his name to Dr Grumpy. What was his name by the way?
The boy had a basal skull fracture. The brain was contused and the prognosis is not good. We had to blue-light him to Hull for neurosurgeon boys to have look at him. It only occured to me then that it will take a good couple of hours more to get ready, to arrange an ambulance, to arrange the crew for the escort and who is going with this boy? It was me. We knew what this means. It means that I will get back here so late that I will miss my hair appointment again, and I'll be so miserable I won't be able to come in to work. Day off! So.. Not..
We rang Hull and guess what they wanted us to do? Suture the blimming wound???? Why can't they just take the patient as it is? He's not oozing from the wound anyway. But it was the consultant neuro who wanted that done, so , just get on and do it. This is when Kevin just said he'll take the head and I'll do the stitching. I thought that's very positive and supportive of him. The head is the heaviest part and does make your hands shake like mad after 5 minutes holding it up. For him to have agreed to do that was very kind indeed.
So we turned him to the side and 3 nurses and Kevin kept him at that position while I did my speedy gonzales stitches. 5 at the top and 2 at the bottom, a quick dab with some chlorhexidine and it was done. Under normal circumstances, this would have been done meticulously and under very very sterile procedure. Nobody gave a toss and I just went with the flow. I hope he'll get that redone when they open him up, but for now, it 'll do. As long as it's not gaping open.
We were strapping him onto the scooper to feed him through the back of the ambulance, when his blood pressure dropped. This is not good I thought. Kevin looked at me and we both asked for the phenylephrine almost simultaneously. The cannula he put in earlier, was not in the right place so I stuck another one in. No second thought. No permission needed no explanation, no nothing.
It's always good when your patient is out. That was part of the reason for doing this job. Not much talking. However, nobody warned me about turning into a parrot. You have to tell exactly the same thing about half a dozen times to half a dozen different people. Not to mention the certain same people, who are thicker than my filofax. Yes I use filofax and I am not techy.I hate PDAs. They kept going missing and they are not cheap so stuff them.
I sat across the boy who was strapped securely at the back of the ambulance. I was so so nervous. This is the first time ever I've sat in there looking after a head injured patient, with such a labile blood pressure. Should I be doing this? I asked myself that question over and over again. What if the pressure kept dropping? What if I then couldn't keep it up? What if the double door flung open and the patient got ejected out? What if we got ourselves in a bad crash? I kept the seat belt on at all times.
Kevin must have picked up that I wasn't entirely happy but confident enough to do it. Just before the double door slammed shut, he whizzed in and got my phone number, and went through a checklist of things. I nodded a few times and answered with a couple of Yes's. I felt like a schoolgirl going on a fieldtrip.
The 60 minutes in there was an absolute killer. I was vigil enough to be able to keep squirting the phenylephrine to keep the blood pressure above 100 , but at times my conscious centre failed me and I just couldn't keep up with the conversations going on in there. The bobby sat behind me, and as I was writing in the chart, I half shouted for the time we actually set off. '6:03' the bobby said. I was glad somebody was awake.
Kevin rang on my mobile but I couldn't answer him as we were tangled up with all the wires , tubes and connection around the boy in the lift up to the Neuro ICU. I didn't have a spare hand. We got him onto the bed and...where was the receiving doctor? None to be seen.
A pale, pasty, curly-ginger haired male doctor approached me sometime later, as I was setting the ventilator. He didn't say a word. I looked at his badge. He looked at me from the corner of his eyes and shifted left and right. Oiii..stand still la orang nak tengok nama you, bukan nak check your chest ada bulu ke tak' I thought to myself. I then greeted him, trying to break the ice. He looked like he just got out of bed. Did not even smile. I asked if he knew about what's been happening to the boy we brought him. I'm sure he wasn't going to say anything. He shook his head, so I parroted the story to him..Blablablablabla.
It would have been so much easier isn't it. I could have just dumped the boy there and chiow with the rest of the crew. But no..we do things right.
After I'd finished handing over the patient, the registrar turned up and what did I have to do? Rewind and replay the story again.
After bidding farewell, we disappeared round the corner. The registrar came running and enquired about the transient drop in blood pressure just before we set off. He slagged me off! He said maybe I should have given more fluid rather than phenylephrine!!! Cheeky bugger. You have no idea what kind of night I had.
The 2 nurses went beserk in the ambulance.'We've kept him alive, we've done this and that and this cheeky bugger came to tell you off?, Why did you let him Naj?" Sharon was fuming.
"They just have to say something clever innit?" said the other nurse with too much make-up on. I just didn't have the energy to even smile. I drifted to sleep while the two of them bitching about what happened and Bob the ambulance driver was kind enough to tune into Galaxy 105 for me.ZZZzzzzzzzzzzzzzz.
Kevin bleeped me at 02:45 to say that a 19 year old was coming to Accident and Emergency with a nasty head injury. No questioned asked, I detached myself from reality and zombied over to A&E.
I have never really worked with Kevin. He is about 6 month more senior and about to marry an ICU nurse ( If I was told correctly that is). She shops at Monsoon. I know that much. After last night I have to say that we've positively bonded and I have to rethink about some of the things that I have said quietly to myself about him. Especially about the way he'd look at me and Deepa when we first started at Hull.We thought 'Twat!'. He's not the only one though. There was another one. But I'll leave her alone for now.
Kevin was already there when the boy arrived. Apparently his mates had kindly picked him up after what looked like a whack in the head, and put him through a plasma TV. Maybe the ad which was on didn't quite agree with the curry and lager they had and they've decided putting this poor fella through the screen would be a laugh. We were getting conflicting stories from everybody. The bobby who was there had a different story to the girlfriend who was crying hysterically. PhhooaHHHH...stinking and gobby!She's had a bit to drink I thought.
The boy had laboured breathing, not responding much to us calling, so half dead basically ( in Glascow Coma Scale language this is 4 over 15. 3 is dead 15 is you and me). He needed to go on the machine and so we had to stick a tube down his throat. So with that he will look properly comatose.
We were waiting for almost 20 minutes for the ODA (the assistant) to come over from where she was sleeping, and during that time, about 3 bleeped went out to wake her up. Stuff it we thought and Kevin agreed to play ODA. I took one look with the laryngoscope into the mouth, and it's blood everywhere. This guy could not have simply been whacked. He's been battered.
The tube went in and the machine took over. I'm pretty sure it looked all smooth and slick on the outside, but I was running a 100 metre inside! On one hand, I have done it now. It's an experience, but on the other? It could only get worse from here. Kevin was all the way in the background, not taking over the whole situation but he's watching and observing. I was very surprised that him watching over was more catalytic than an impending doom, eagle eyes scrutinizing.
After a few jabs in the wrist later, Kevin asked me to try and see if I could put the arterial line in the left wrist. He's had a few goes and not doing so well. I spent about 5 minutes trying to feel the pulse, and everybody was relying on me to get it in. Go away, go away stop looking at me. I was so flustered and I hated being watched. The pressure was so much I felt like vomitting. A quick jab and to my surprise it went in. Ace! Fair enough, not bad afterall then.
We took him to the CT scanner where it's all dingy and muggy. I can understand now, why all these radiologist seemed like they 've never had enough to eat and just waiting there ready to bite our head off every time we request a scan, any scan for that matter. Why do the job in the first place if you are going to be arssy 24/7? Well it was by then 4 am in the morning and I thought he should have just changed his name to Dr Grumpy. What was his name by the way?
The boy had a basal skull fracture. The brain was contused and the prognosis is not good. We had to blue-light him to Hull for neurosurgeon boys to have look at him. It only occured to me then that it will take a good couple of hours more to get ready, to arrange an ambulance, to arrange the crew for the escort and who is going with this boy? It was me. We knew what this means. It means that I will get back here so late that I will miss my hair appointment again, and I'll be so miserable I won't be able to come in to work. Day off! So.. Not..
We rang Hull and guess what they wanted us to do? Suture the blimming wound???? Why can't they just take the patient as it is? He's not oozing from the wound anyway. But it was the consultant neuro who wanted that done, so , just get on and do it. This is when Kevin just said he'll take the head and I'll do the stitching. I thought that's very positive and supportive of him. The head is the heaviest part and does make your hands shake like mad after 5 minutes holding it up. For him to have agreed to do that was very kind indeed.
So we turned him to the side and 3 nurses and Kevin kept him at that position while I did my speedy gonzales stitches. 5 at the top and 2 at the bottom, a quick dab with some chlorhexidine and it was done. Under normal circumstances, this would have been done meticulously and under very very sterile procedure. Nobody gave a toss and I just went with the flow. I hope he'll get that redone when they open him up, but for now, it 'll do. As long as it's not gaping open.
We were strapping him onto the scooper to feed him through the back of the ambulance, when his blood pressure dropped. This is not good I thought. Kevin looked at me and we both asked for the phenylephrine almost simultaneously. The cannula he put in earlier, was not in the right place so I stuck another one in. No second thought. No permission needed no explanation, no nothing.
It's always good when your patient is out. That was part of the reason for doing this job. Not much talking. However, nobody warned me about turning into a parrot. You have to tell exactly the same thing about half a dozen times to half a dozen different people. Not to mention the certain same people, who are thicker than my filofax. Yes I use filofax and I am not techy.I hate PDAs. They kept going missing and they are not cheap so stuff them.
I sat across the boy who was strapped securely at the back of the ambulance. I was so so nervous. This is the first time ever I've sat in there looking after a head injured patient, with such a labile blood pressure. Should I be doing this? I asked myself that question over and over again. What if the pressure kept dropping? What if I then couldn't keep it up? What if the double door flung open and the patient got ejected out? What if we got ourselves in a bad crash? I kept the seat belt on at all times.
Kevin must have picked up that I wasn't entirely happy but confident enough to do it. Just before the double door slammed shut, he whizzed in and got my phone number, and went through a checklist of things. I nodded a few times and answered with a couple of Yes's. I felt like a schoolgirl going on a fieldtrip.
The 60 minutes in there was an absolute killer. I was vigil enough to be able to keep squirting the phenylephrine to keep the blood pressure above 100 , but at times my conscious centre failed me and I just couldn't keep up with the conversations going on in there. The bobby sat behind me, and as I was writing in the chart, I half shouted for the time we actually set off. '6:03' the bobby said. I was glad somebody was awake.
Kevin rang on my mobile but I couldn't answer him as we were tangled up with all the wires , tubes and connection around the boy in the lift up to the Neuro ICU. I didn't have a spare hand. We got him onto the bed and...where was the receiving doctor? None to be seen.
A pale, pasty, curly-ginger haired male doctor approached me sometime later, as I was setting the ventilator. He didn't say a word. I looked at his badge. He looked at me from the corner of his eyes and shifted left and right. Oiii..stand still la orang nak tengok nama you, bukan nak check your chest ada bulu ke tak' I thought to myself. I then greeted him, trying to break the ice. He looked like he just got out of bed. Did not even smile. I asked if he knew about what's been happening to the boy we brought him. I'm sure he wasn't going to say anything. He shook his head, so I parroted the story to him..Blablablablabla.
It would have been so much easier isn't it. I could have just dumped the boy there and chiow with the rest of the crew. But no..we do things right.
After I'd finished handing over the patient, the registrar turned up and what did I have to do? Rewind and replay the story again.
After bidding farewell, we disappeared round the corner. The registrar came running and enquired about the transient drop in blood pressure just before we set off. He slagged me off! He said maybe I should have given more fluid rather than phenylephrine!!! Cheeky bugger. You have no idea what kind of night I had.
The 2 nurses went beserk in the ambulance.'We've kept him alive, we've done this and that and this cheeky bugger came to tell you off?, Why did you let him Naj?" Sharon was fuming.
"They just have to say something clever innit?" said the other nurse with too much make-up on. I just didn't have the energy to even smile. I drifted to sleep while the two of them bitching about what happened and Bob the ambulance driver was kind enough to tune into Galaxy 105 for me.ZZZzzzzzzzzzzzzzz.
