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'