Ashtmatics Anonymous, part II

"Hold on a second, you come in here, two o'clock on a saturday morning, wheezing, coughing, smelling of booze, reeking of smoke and complaining that your asthma medicine doesn't work. And you say I'm judging you!" I only raised my voice a little. I could feel the adrenalin begin to surge in my veins, my haclkes beginning to rise, any thoughts of diplomacy evaporating. Darren began to protest, but I cut him off. "I then give you medicine, which you say doesn't work, and you say I've got an attitude." I turned my back on him, about to walk away.

"Hey, I'm sorry man" Darren called out. I turned around, looking at him expectantly. "I'm just so tired, sick of being sick" their was a note of desperation in his voiced. I softened my tone as I judged him ready to listen.

"How old are you?" I asked him. "Nineteen" he answered. "Do you live at home?" I asked. "Moved out six months ago. Living with some friends" he replied. "Were you always sick when you lived at home?" he shook his head. "How much and how long have you smoked?" I asked. He shrugged his shoulders, "Couple of years I guess, although only on weekends. That was when I was at home" he said. "And now?" I prompted. He shrugged his shoulders again, his body language trying to say, I don't care, but the incongruency between the visual and the spoken message was stark. "All the time, but it doesn' affect my asthma. The medicine just doesn't work anymore." I chose to avoid talking about the smoking for now.

"When did you last see your doctor. Maybe he could try you with some different medication?" I said. He looked at me in surprise "Two years, I think. What other medicine you talking about?" I went to the respiratory cupboard and took some of the various inhalers we had available and spread them out on the bed. "There's quite a few. Have you ever heard of a preventer?" He shook his head, "What exacatly do you mean by preventer?" I picked up the brown inhaler, "Just what it says, a medicine to help preventing you from having an asthma attack." He picked up the inhaler "It won't work on me. Nothing works" he moaned. It was time to get tough again.

"Darren, start acting like a bloody adult or move back home. Take some responsibility for yourself. Stop moaning and take some initiative. I'm not the person to tell you what you should do, and I'm not going to force you to see a doctor." Darren stared at me defiantly, "Fuck you. You can't speak to me like that?" I began to walk away again. "I just did. Get over it. Here comes the doc, don't be a stubborn idiot with him" I went over to the work bench and wrote down a number. "When you get out of here, this is the number for the asthma educator. It's up to you. Make the call. It may save your life. It's free as well" I handed him the slip of paper and left the room. I let the doctor know all that had happened.

Two weeks later, in a quiet moment in the emergency room, I made a quick phone call. "Who are you again?" Asked Sheila. "I'm calling from the emergency room. Just wondering if you've come across a guy called Darren Smith" I asked. "I'm not supposed to give out inforation" she said "Why do you want to know?" I briefly explained what had happened. "Yeah, I saw him, and I'll be seeing him again. He was a nice young man, he really seemed to appreciate all I did" there was a strange lilt in her voice, almost one of satisfaction, accomplishment, or maybe she even proud. "So you could do something for him?" I asked. "Of course. He was in a terrible way, but we've got him on the right track now." I thanked Sheila and hung up the phone.

Read more!

Asthmatics Anonymous part I

"It's always bad" Darren bent forward, hands braced on his knees, wheezed several breaths then continued, "The medicine never works." Not only was Darren's breathing wheezy and ragged, but
from the head down to his toes he looked unkempt, dirty, contagious even. His hair was greasy and uncombed, his face had at least a weeks growth. His clothes were covered with stains from at least several meals. Even his shoes had holes where his big toes were peering through.

"What medicine have you been taking?" I asked. He handed his ventolin (asthma) inhaler to me. "It's empty" he gasped "Ran out last week." I took a deep breath and sat down on his bed, a voice inside my head saying 'be patient, be patient' with the poor lad. "Ah, so your asthma has been bad for the last week?" I asked. He nodded his head. "And you haven't had any medicine in that time?" He nodded his head again. "Ah, can I ask why you didn't see someone sooner?" Darren kept his head bowed, unwilling to, or perhaps too exhausted to make eye contact "It's useless. Asthma medicine doesn't work for me." I placed a nebuliser mask over Darren's face, a mask containing the exact ingredients that he claimed didn't work.

Three nebulisers later and Darren's wheeze was much less audible and his breathing more relaxed. He was no longer sitting on the edge of the bed, hands on knees. He was able to sit back on the bed, although still in an upright position. A small victory, at least in the physical sense.

"I thought you said the medicine didn't work?" I kept my voice emotionless, as non-judgmental as possible. "The inhalers, they never work, I want what's in the nebuliser" he was able to look me when he spoke. "It's the same medicine" I replied "But you don't look like you've been looking after yourself. How much do you smoke a day?" His clothes reeked of smoke. "I didn't come here to be lectured. You don't know me, so don't judge me." Oh dear, to think I'm trying to be sympathetic, to think that this is his reaction to my nice side, how will he react when he sees my bad side?

Read more!

I think I'm an Elitist

Yeah, I'm quite comfortable saying that I tend to think less of people from wealthy backgrounds. It's this school that does it too me. More specifically, dealing with the parents of the kids whose health I'm trying to look after.

"I want a real doctor" a parent said to me today, "And then I'm going to sue the school." The woman was from Russia. She had begun the conversation by yelling and screaming, but after hanging up the phone on her several times she seemed to get the picture. "And why would you want to do that?" I asked innocently. It turns out that several Russian girls, along with forty other students, went on a school trip to France. The three Russian girls had shared a hotel room and it wasn't until the end of their three day stay that they noticed some itchy spots on random parts of their body. When they came back to school myself and the rest of the nursing staff concluded that they were bites, bed bug bites that is.

"How dare you send my daughter to a cheap hotel.." I interrupted her "Ah, I'm just the nurse, you need to talk to the headmaster" I explained. "Well, the medicine your school doctor prescribed didn't help at all. I want a real doctor. I'm going to take my daughter out of school to see a specialist." I can't imagine what good a specialist would do, except tell them to wash their clothes and bed linen, but I didn't argue. Wealthy parents, especially wealthy eastern European parents tend to like to throw their money around.

The above scenario is not unique. In fact many parents of the above mentioned ethnic group always begin a conversation by yelling, accusing and then threatening, although it does explain why the Russian Mafia do so well, if this is how the average Russian behaves.

But in reality these children and their parents aren't the average Russian. The average Russian/Eastern European I've met tends to be down to earth, honest and hard working, as well as rather poor. What I do know is that these wealthy parents made a lot of money very quickly over the last 10-20years. It's just a shame they've lost their values, although I suspect many of them had none to begin with. It's also a shame that money can't buy common class.

Read more!

Young men and other idiots

It is not too often that you come across young men or teenagers in a general medical or general surgical ward, but it does happen, and it usually happens for quite different reasons than those of a more mature age.

If you are between the age of sixteen and twenty eight, male and in hospital, then there is a good chance that you're an idiot. If you are between the age of sixteen and twenty eight, male and in hospital on a Saturday night, then you are definitely an idiot. It wouldn't surprise me that one day scientists discovered a gene for male stupidity in the hospital environment. Most times this seeming inborn idiocy is a great source of humour for hospital staff, but unfortunately these outbursts of idocitic behaviour are not always humorous because sometimes they cause harm.

As a general rule most people don’t really know exactly what to expect when they end up in hospital, and teenagers, and slightly older but still young males, are no exception. The lads don't really have a clue what to think as they sit in their bed surrounded by veterans from world war two. They even look slightly out of place. But it is sometimes nice to have a young patient in your care, as they do tend to be much more independent and mobile, and do not have the often heavy needs of an elderly patient. But they still need to be watched carefully, as they pose their own unique hazards.

Shaun was eighteen years old and had presented to the emergency room with generalised abdominal pain. He had a fever and as time went by the pain gradually became more severe and it also done something rather strange; it moved to the lower right side of his abdomen. At this stage a diagnosis was pretty easy to make and anyone with even a little medical knowledge should know what was wrong. At ten-o'clock that same night Shaun was taken to surgery where the surgeon opened him up and snipped out snipped out some innards. The surgeon said he was a very lucky young man as his appendix was very close to rupturing.

I first met Shaun at seven o'clock the morning after his surgery. It was a Saturday and the ward was quiet, it looked like it was going to be a nice shift. When I saw Shaun he looked to be in pretty good shape as he was nibbling at something light for breakfast and keen to get moving. He seemed to have had no lasting side affects from his anaesthetic, in particular any nausea, and his pain seemed under control. This was a good sign, it's always good to get patients moving early, but I did warn Shaun to take it easy.

“Take it easy? The sooner I get out of here the better.” Shaun was determined to get out this damn place because it was “full of depressing old people.” I couldn’t do much about the fact that he was sharing a room with three older men, but it wasn’t so bad. Sure one of them had a touch of night time dementia and kept getting up during the night calling out for his long dead wife, but at least he wasn’t in the women’s room. Any time anyone walked into the women’s room Mrs Stewart, the 85 year old nun on prescribed bed-rest because of leg ulcers, kept on calling for us to stop touching her in naughty places.

The first thing that Shaun wanted to do that morning was to have a shower. “No problem Shaun” I told him, “but are you sure you are up to it? Why don’t you wait until a bit later in the day, you’ve only just come out of theatre?” Shaun was not going to wait. I then suggested that he use the large shower room that has a chair in it that he can use, but he would have to wait half an hour as other patients were booked in first. Of course Shaun was not willing to wait; he was determined to use the normal size shower with no seat inside. I suggested to Shaun that this was perhaps not the best idea as the shower is hot, steamy, cramped and with no ventilation, he would probably pass out. Shaun seemed to think that he knew what was best for his body and ignored my advice, he was oblivious to reason.

From past experience I knew to wait outside Shaun's shower cubicle. Five minutes later I heard a ‘thump’ followed by a squealing sound that comes when skin rubs against wet plastic. These were the sounds of Shaun first hitting the wall and then sliding down the wall to lie in a tangled heap on the shower floor. As I helped bring him round I conveniently happened to have a bowl in my hand which Shaun promptly threw up into. I popped him in a shower chair and wheeled him back to bed. He was so pale that he would have made a ghost look tanned and he had broken out into a cold sweat.

As terrible as Shaun looked it was nothing serious although I made sure he hadn’t done any damage to his wound. Thankfully he hadn’t but he was in quite a bit of pain, what a surprise. I didn’t even pretend to feel sympathy for him but did give him some paracetamol.

Read more!

Wandering Hands

It's the only fun Mr Smith ever has. He spends all his time on bed because he was ordered to by the doctor. He was leg ulcers that he has just had grafted, so he'll be in bed for quite a while. The last time he was admitted, he didn't get off his bed for one whole month.

When we need to roll Mr Smith, for a bedpan or to wash his back, Sheryl usually makes me take the top half. Mr Smith says I'm not as good at Sheryl when rolling him, but that's because I'm a man and my buttocks isn't as soft as Sheryl's. I guess that's why his hands only ever wander to Sheryl's butt, and not mine.

Sheryl handles him well. "Stop being a dirty old man" she says only half playfully as she shifts his hands a little higher. "I've got parkinson's you know" Mr Smith says this every time in response to Sheryl. The tremor in his hands always suddenly gets worse when he says this. Sheryl isn't bothered by his actions, she is amused. I haven't had any patients try to grope me, and I hope it stays that way.

Read more!

Like Mother like Daughter

I am occasionally guilty of making the situation worse. But sometimes it's worth it. My good friend and colleague Michelle had put up with some horrific language from a sixteen year old girl. This wasn't unusual in itself, but the girls mother was sitting by the bedside the whole time while her daughter told Michelle to "F!@king hurry up," "F@!k off" or "Get the f@!k away from me." Michelle eventually decided that she had had enough. "Can you take her blood test" Michelle practically begged me, "I can't handle her that snarly piece of trash anymore." I was in the mood for mischief "Gladly" I replied.

What a surprise, the girl is refusing the blood test, so I tried to reason with her. "Sometimes you have to put up with a little bit of pain, for the greater good" I said. The girl never had a chance to reply because mum interrupted. "What did you just say?" she asked me. My mind briefly went blank, trying to think how exactly I had offended her. "Sometimes a little bit of pain is necessary, for the greater good" I repeated.

Mum face twisted into one of anger "I don't that's very appropriate" she told me. What the hell is she talking about. I was at a complete loss trying to figure out what I had said. "You know what I mean. About having to put up with pain." I really was at a loss trying to figure out her line of reasoning, "But blood tests do hurt" I protested, "And sometimes the tests are necessary." The woman looked furious. I could see that she was beyond reasoning, or perhaps I just wasn't communicating on her level. Maybe if I used a few more F... words she would understand, as that is the language her daughter uses.

"Who's in charge?' She asked, getting up from her bedside seat. I decided to diffuse the situation by being helping. "If you're going to lay a complaint, my name is ...." I said my name slowly, "Could you please get the spelling right as everyone gets it wrong." I then proceeded to spell out my name.

I've never seen someone so close to exploding. She had pen and paper and was writing the names of the nurses on the duty board down furiously. Stabbing her i's and slashing her t's.
Withing five minutes she was dragging her daughter out of the hospital and into a waiting taxi.
Michelle congratulated me on a job well done. My charge nurse told me that I could have been a bit more diplomatic, but gave me a thumbs up.

Read more!

Wealth and buying Health

The kid had a tiny laceration to his forearm. Three stitches should do the job. The problem was that dad was not happy. "I want a second opinion" he said to myself as well as the junior doctor working with me. The doctor's name was Russell.

"What do you think Russ? Where we gonna get a second opinion on a Sunday night?" I managed to stop myself from smiling as I said this.

Russ looked ready to let loose on the man making such ridiculous demands. Russ was a big Scotsman known to have a fiery side. "There is no need for a second opinion" Russ was losing control of his temper and the volume of his voice rose an octave or two. "It's a plain, simple laceration which any doctor could treat. I'm not going to call my consultant out of bed at ten o'clock on a Sunday night."

I might as well go and get the patient complaint form for dad to fill out, because Russ wasn't going to back down. But instead of getting angry in the usual way, like threatening to lay a complaint, yelling, or even getting physical, Mr Trite did something quite unique. "I'm willing to pay for a private consult. I don't care how much. I don't want my son to have any scarring. Get me a plastic surgeon."

Russ and I were speechless for a moment. "Alright" Russ finally said. The fight seemed to have gone out of him.

An hour later the hospital's head of plastics waltzed into the department. He was in fine form, chatting with Dad about almost everything but the kids arm. Subjects touched upon included golf, yachting and which was their favorite place to ski in Switzerland. It took less than five minutes to suture the laceration and another twenty minutes for Dad and the consultant to finish their conversation.

"I need a pen" Mr Trite said as he fished out his cheque book, making sure everyone knew he was about to hand over a bunch of money. Russ handed the man a pen. "How much was it again?" he asked the surgeon, to which he replied "three thousand."

Three thousand pounds for five minutes work.

Read more!

Punch up in the ER

As I jumped onto the back of one of the biggest guys I've ever seen, I wondered if I was going to make it out alive. But the guy had my friend and colleague, Damien in a headlock and was going to ram him into the wall.

Forgotten was the fact that this was a hospital, that this was the emergency room where we are supposed to help people, save lives and all that other wonderful stuff. This was a damn brawl like you'd see in your average pub on a friday or saturday night.

The good news is that the giant released my friend, the bad news is that he went for me.

I'm not afraid to run, and so I did, straight behind the ranks of security guards. "Why the hell didn't you help me?" I shouted at them. "We're not supposed to use force" was the reply. Meanwhile, the giant could see that he was outnumbered and bolted for the door.

His timing couldn't have been better because he ran straight into half a dozen friendly police officers. Thank goodness the receptionist had phoned the police at the first sign of trouble.

And how did it begin, well it was the usual story. Alcohol. The giant that the police were escorting away had got in a fight, received some nasty laceration which would need some sutures, and called an ambulance. He was angry at the paramedics for taking so long, (they were there in seven minutes) and when he came into the emergency room he didn't like being told that he should stop using the F... word, even when I explained that we had young children here who could hear him.

Hopefully he'll spend some time in jail, and maybe even have to pay us some money.

Read more!

Tips for young, male adults in hospital

If you are a young male adult in an emergency room, then there is a good chance you're an idiot.

If you are a young male adult in an emergency room on a friday or saturday night, then you're most definitely likely to be an idiot.

But there are a few rules that young males can follow to make their stay easier:

1. Don't chat up the nurses, you are most likely drunk, or sick, and definitely not looking your best
2. Never grope, grab, fondle or otherwise get too close to a nurse as we can and will add an extra medication that totally kills your sex drive.
3. Do not invite your girlfriend to join you in bed for a quick romp, as this is gross and it is offensive to the other patients in the room.
4. Don't bother saying you are afraid of needles. Your body is covered in tattoos in some of the most sensitive areas, and besides, no one likes injections, so get over it.
5. Never threaten, or use bad language We will take you to court.
6. Act like a normal human being for once in your life and be nice. Being nice makes it easier for everyone, especially you.

Read more!