'Cafe coronary' certification

There is an endless stream of serial and annual certification that you have to endure to work in the NHS,that ranges from the ubiquitous 'Health & Safety' absolutely-blindingly-obvious rubbish...usually a lecture from some retired Naval petty officer on the need to wash your hands before using a fire extinguisher which you should only activate if your back is in the safe position...to more prosaic subjects like "infection control",ie,wash your hands before, during and after sex...actually...maybe that's just what they tell me!

My personal bete noire is "Basic Life Support".

Now there are occasional seismic changes to the rate and rhythm of life support but the truth is that if you work in Emergency Medicine in any capacity then you probably know about it already.

So you typically have the bizarre situation where some self-proclaimed 'Resuscitation Officer' who has long ago forgotten what an actual patient looks like,teaching basic CPR to a group such as I was in last week that included two ER consultant surgeons who...like all of us...do this on a daily basis for real!

Also...I am currently ALS and ATLS and even APLS qualified...but despite that,I still have to do the basic course...because everyone has to do it!

And of course,its fair to say that if you're South African,then you probably have seen all the weird stuff anyway...certainly I have yet to face any scenario that is worse than the quietest night ever was in the Jo'burg Trauma Unit.

*sigh*

Anyway...there I was trying to look interested as we moved on to the 'choking scenario'...and a demonstration of the 'abdominal thrust' technique...what used to be called the 'Heimlich' maneuver

Has anyone here ever had too do this?

I raised my hand

Oh...you again...well...would you like to share your story with us?

Many years ago then,in the early 1990's I was for about 15 months the 'Night Superintendent' of a very prestigious and very private Johannesburg hospital.

I used to utilise a small office space behind the main reception area which was shared with a part time driver and telephonist and the full time Night Receptionist.

Her name was Jean and she was evil.
Evil.

She had the compassion on Lucrezia Borgia and had all the charm of Myra Hindley.
Evil I tell you.

One of the perks of the job was that the kitchen would frequently leave me cheese-and-fruit platters...or smoked salmon...or some such edible delicacy which would help get me through the night.

Which she would steal.
All the time.

Typically I would return to the office with our meals and then get called out to one of the wards...and when I got back the salmon or slice of cheese-cake would have miraculously been stolen from under her very nose.

This one particular hot Saturday December evening I had been left a fresh fruit platter...strawberries,grapes,melon...and...as I sat down to eat it I got paged to ICU to sort out a problem.

On my return both my dessert and the fruit platter had disappeared...and Jean denied any knowledge of its disappearance...

So I made a cup of tea and sat at my desk, opened the Star to read the obituaries...

As I read and sipped my tea,I became aware of a hoarse guttural "cough" coming from the general direction of Jean's desk.

I lowered my paper and saw that she was making the classical sign of someone who is choking...both hands at her neck...protuberant tongue...and was a fetching shade of blue.

I raised my paper and read my horoscope.

She coughed again.

I lowered my paper and saw that she was quite blue at this point.

Decisions , decisions...if I let her choke and die I would be rid of a very irritating person.
I would however then have to fill in an incident report...and book all the patients in as well.

Sighing,I folded my paper,picked up my pager,switched off the light and locked the door and walked over to where she was sitting collapsed in the chair.

Evil. Did I mention she was evil.

I picked her up...and in the approved manner gave her two almighty thrusts...and after the second a grape flew out of her mouth ...closely followed by her upper denture...and shot about 4 meters across the room...

She sat back down and composed herself.

"So Jean...still have no idea of what happened to my fruit platter then?"

Looking me straight in the eye, she replied : That was a grape I brought in from home!

I knew I should have let her choke!

Great halloween x-ray

The patient was a 30-month old child who was spending the day with grandmother...who was doing her weekly wash...somehow the child was able to break a wooden peg down into its three component pieces...and having chewed but been unable to swallow the wooden peg-legs,the child promptly swallowed the metal clip.

The child was sitting playing happily in the waiting room although the granny was a little distraught.

She brought a peg in with her and the clip measured 1cm at the base;1,5cm at the top;and was 2,2 cm long.

It passed naturally!!

Day Surgery

The patient's notes read as follow:-

PC: Patient wants a "piece of gristle removed from 'down there' "

HPC: Two year history of gristle-doesnt want to discuss same with triage nurse

PMHx/SH: Pat declines to answer any questions about his previous med
ical or surgical history,medicines or allergies.He further declines to answer any questions about his work or social circumstances.

EXAM DETAILS
Alert and hydrated.
Patient is rude and argumentative.

Reports that he has a piece of gristle that he wishes to have removed=that he saw the sign outside the building that says 'Day Surgery',and has thus self-presented as he has a day off=reports first day off in 2 years and that he doesnt want to waste it.

Patient was reluctant to show RN the problem but was advised that no opinion could be offered unless it was seen.

Finally showed part of his right scrotum which appears to have a small cyst (about 0,5cm in daimeter) on it=he has had it for >2years
Declines actual physical exam of scrotum.
Advised to leave it alone unless and until it becomes symptomatic.
When asked if he performed any routine exam of his testicles patient became abusive and declined to continue with the exam.

Yea!

Hello...is that the orthopod?

The patient was 72 years old and had slipped on some wet stairs and sustained what is called a "straight-arm"/ fall-on-out-stretched-hand (FOOSH) injury.

The accident had happened TWO days prior to presentation in our Unit....the patient is 'scared of hospitals' and had naturally not taken any analgesia.

There was absolutely no range-of-movement through the elbow but...bizarrely....and fortunately...although the forearm looked like there was a compartment-syndrome happening,in fact there was no neuro-vascular damage!

Normally when I phone the Orthopods,they're quite blase...you can hear them thinking....'oh...he's the nurse at the minor injuries Unit...more rubbish'.Not yesterday!

Back to front

Sunday mornings are usually a steady combination of P.F.O.*-wrist injuries;liberal dispensing of the Morning After Pill,-(the locals being too cheap to actually buy any condoms before they start their typical/weekly saturnalia celebrations and bacchanalian excesses);and the removal of a "lost" condom from any one of four possible orifices....well....four if it involves Maurice the gay warehouseman with the false eye.

My first patient this week was a young man who had written the following on his admission form :- 'leaking from my spine!'

He walked slowly and carefully and painfully into the Unit...

"Please have a seat Sir..."

I'd prefer to stand...

"Fair enough...whats going on then?"

Well what it is...obviously...my spine is leaking...and its really painful...and I can't sit down...

I'm fairly happy in my own mind that he doesn't have a cauda equina or indeed any sort of spinal injury...I am equally certain that I will be phoning the surgeons in about two minutes.

"Okay Sir...just pop off your trousers and have a lie down on the bed there...on your front....and I'll have a look..."

You want me to take my trousers off?

"Ah...jah...I've got my designer glasses on today Sir,not my x-ray glasses!"

He gingerly drops his pants,-naturally he isn't wearing any underpants-, and as he starts to climb onto the bed a huge red pilonidal abscess waves its hand at me and shouts 'hello'.

There is only one job worse than that of being a Nurse on a Sunday morning who has to face a blood-and-pus-and-faeces streaked spotty bottom...and that's being the Surgical Registrar on intake to whom I very quickly buffed-and-turfed the patient!

Hee hee he!

Lucien: 1 ; The forces of darkness : Nil

The second patient was a pulchritudinous 18-year old...delectable,but slightly slutty ...so much so that I immediately called Boadicea, -the Health Care Support Worker-,to chaperone me...even on the walk from the waiting room.

"Right...what can I do for you today?"

Well....what it is...I've had my clit pierced didn't I?

Boadicea looked at me...I looked at my indemnity insurance card.

"Yerss...?"

Well...the skin is starting to overgrow it...and it doesn't feel as good as it did...

Boadicia sniffed.

"Right....well...I think you need to go back to whoever pierced it and have them look at it...."

But I had it done on holiday in Spain...

"Ah...well...perhaps you could just remove it then and go and see someone locally?"

But its painful now with the new skin...

"Well they can numb the area for you..."

And how would they do that?

Wait for it.....

Wait for it

WAIT FOR IT....

"Well...they'll go 'num num num num NUM' "

Okay...I didn't actually say that....Boadicea and my insurers both would have hit me!

"Well Ma'am...I don't really know...but thank you for relieving the tedium of an otherwise boring
day..."

It was still only 0830!



PFO= 'Pissed,Fell Over'

A weekend away

So I spent the past weekend in an "English Country Cottage" just outside of a charming little town called Dorchester in Dorset...our cottage was about 500m from the house in which the writer Thomas Hardy was born...and in which he wrote 'Far from the Maddening crowd'.

And I say "our cottage"...because I should probably tell my faithful reader that I am wildly in love with the most beautiful girl in the world...(apart from my daughter obviously)...and who I have been dating for the past 6 weeks...which explains why there have been fewer postings than normal...and we went away for a romantic weekend to explore our burgeoning relationship..."Woo-Hoo"

*sigh*

Anyway...Dorchester is a very old and quaint town,with evidence of pre-historic settlements ,and is believed to have been fortified and settled by the Romans sometime around AD70.

Its built in a series of squares and is very easy to walk around once you have mastered the nonsensical one-way system, and we were blessed with beautiful Indian-summer days.

Now as TMBGITW and I wandered hand-in-hand through the town we couldn't but help notice that the local yokels looked like...well...yokels...and like there were lots of first-cousin relationships...indeed,driving into the town,we were surprised to find that the car stereo could only pick up station - "Hillbilly Radio"- ,...and the only song they seemed to be playing was 'Dueling Banjos' .

Walking around the town and speaking to people was a bit like a cross between "Shaun of the Dead" meets "The Stepford Wives"...because I can honestly say that without exception everybody we spoke too was polite and pleasant and helpful...

We went to M&S as we had a desire to get some lobster for dinner...
Yes...yes...I know that there is a recession but really...why take it out on the fishermen?

So we asked one of the shop assistants if they sold any dressed ready-to-eat lobster...-they didn't;and if there was anywhere we could get one in the town...-there wasn't.

But whirling around like a trolley-dolly on a low-budget,eastern-European airline, and gesticulating wildly, she kindly gave us a series of directions to three other shops all of which started "...turn left at the bread counter...straight down through lingerie...past hats...out the front door... ....until you come to a stall...that may,or may not,be open..."

Helpful though,like you just don't find anymore!

Nevertheless,as the sun started to set, we were aware that the town was silent,the locals were warily eyeing the two exotic foreigners and we kept a sharp eye open for the crowds with pitchforks.

We ate lunch here on Sunday and I have no hesitation in recommending this restaurant...we stumbled across it quite by accident...and had one of the best meals I have eaten in the UK...

TMBGITW had the roast-lamb lunch and I (being a peasant at heart) had the full English breakfast;and with desserts (orange brioche bread-and-butter pudding with custard and vanilla ice cream) and 3 soft drinks and 3 cups of coffee the bill still only came to £25-00.

The food was fresh and clearly 'home made' as it were.Neither of us were able to finish the meals...well...we did of course but it was a struggle !

Its well worth a visit and they even have gourmet tasting nights!