Tuesday 7 April 2009

From your lips to my ear



Its Sunday evening...its 21H28...and we stop booking patients in at 21H30 in order for us to close at 22H00...the idea being that we have a protected 30-minute window to complete paperwork,check drugs,finalise care,steal KY jelly...okay...in fairness...that's probably just me...but you get the point.

Invariably there is always at least one patient who arrives a minute before we close seeking care generally for a problem they've had for a week or two...or sometimes just all day...and they think it would be a good time to come in that late as the Unit would be empty as we are about to close.

These are the same people who think its a good idea to send money to a prince who is held hostage in Nigeria...to vote Labour...to ask for the morning-after-pill a week later...

"Mr ffoulkes-Ayke ? Mr Arthur ffoulkes-Aycke?"
A well dressed young man with an expensive fashionable haircut,wearing even more expensive and fashionable glasses stands up and walks into my room. holding a blood -stained handkerchief to his mouth.

"Hello Sir...and what can I do for you tonight then?"

Well...what it is...obviously...I was playing football this morning and got headbutted in my lip...

"Football ?"...Julian looked at me...I looked back at him and shrugged...

Indeed his very swollen and bruised lower lip is the same shade of purple as his polo shirt...Julian tells me its called 'mulberry'...who knew?

"Right...so what time did this happen?"

About 9 o'clock this morning...

"Uh huh...and why have you only come in now then ? At 9.30 at night?"

Well...I thought it would get better by itself...

"Uh huh...but...?"

Well...it hasn't stopped bleeding...and its still swelling...and anyway...I'm very busy...I had to work on a marketing project today...and I knew you would be quiet at this time of night and I really didn't want to wait...

"Oh...well...thats nice for you...So its been bleeding all day then...hasn't stopped at all?"

No...its been oozing all day...

*sigh*

The outside of the lip is macerated...and has a stellate-shaped wound...like an over ripe plum that has fallen onto the ground from a great height...
More importantly,its a communicating wound as he also has a large laceration to the inside of his lip...


In itself this is quite a straightforward injury...however...there appears to be a little globule of fat that is sticking out of the wound on the inside of his lip...and when I touch it,it feels fibrous

"Right...well...a couple of things going on there Sir...but mainly...theres a little salivary gland sticking out of the inside of your lip...so I'm going to have a quick word with the on-call maxillo- facial surgeon..."

Oh...why?

"Well...its probable that the salivary gland will need to be cut out of the lip...and there are some minor but irritating consequences to that...specifically a thing called a mucocele...so I just want to check with the MaxFax so that we treat this correctly..."

Now I must say that of all the disciplines I ever need to refer a patient too,the MaxFax team in any hospital I have ever worked,are generally the nicest,politest,most accommodating group to deal with...and the guy on call on Sunday was no exception.

Having discussed the patient with him,he told me that he was quite happy to see and treat the patient himself up at St Vulvas'

Result!!! Buff-and-Turf!!!

"Right Sir...I've spoken to the MaxFax and he's going to have a look at your lip and do a spot of repair work...so I'll print out your notes and he will see you up the road at A&E..."

What?...Do you mean to tell me that I've got to go to A&E? What ? Now...at this time of night?

"Exactly right Sir...this time of night...to get definitive care from a specialist surgeon."

But I came here because I didn't want to wait...I've got an important presentation in the morning...can't you just sew it up or give me a cream or something??

"Well...I suppose that you could try haemorrhoid cream ...that should take away the swelling...or I suppose that you could try some duct tape..."

"But you have a large hole in your lip that has been bleeding for 12 hours and you have a salivary gland sticking out waving at your left nostril...so really...you need to see the Maxfax"

Well...I don't think that's very good service!!

"Well Sir... Don't believe everything you think."

2 comments:

  1. 'dont believe everything you think!' thats hilarious, you have just made my day. I am going to use that on a patient as soon as I can (shouldnt take too long... my town sounds a lot like your town!)

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  2. I agree with the annester - that sentence is hilarious. However, I confess I was already sniggering at the KY jelly reference ...
    Another fantastic post. Thanks.

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