"The point of no return"

Sunday evening,just after 2030 and RudeBottleBlonde,one of the new ENP's had asked for my opinion on a patient with burns.

The patient was a 19 year old male with scattered burns,- of varying size, depth and severity-,to his hands,forearms,face...and nose.

On Thursday evening he had been attempting to fry some sausages which he had dropped into a pan of very hot fat...which had splashed out and burnt him.

Although most of the burns were infected they were mostly superficial...apart from his nose...the tip of which had turned white.

(He was unfortunately quite an ugly fellow anyway,sporting a crop of ripe blackheads and pimples across his forehead and cheeks.He had lank greasy hair...a surly manner...had been dressed by the Red Cross...and was...naturally...unemployed.)

His nose was large....a real 'Roman nose'....roaming all over his face.

The tip of it was flat,as if he had spent his life with it pressed up against the window of privilege and opportunity.

The tip was rectangular in shape,about 1 cm wide by 0,75cm ...and was waxy white...as was a further area around the point of his nose with a radius of about a further 2 cm in total...as if he had dipped his nose into ice cream.

I introduced myself to the young man whilst RBB gave me the history.

"Have you tested the nose for sensation ?"

No

"Okay then...What I'm going to do Sir...is to test the sensation in your nose....check if you can feel anything....and I'm going to do this by lightly touching your nose with a small needle..."

Does it hurt?

"No...its not going to hurt me at all...stay still now..."

He had good sensation until I reached the outer white area and moved towards the tip of the nose...he had absolutely no feeling of any sort on any of the white skin.

"Okaaaay then...." I turned to RBB."Have you checked for tissue viability...does the burnt area bleed at all?"

No I haven't checked.

"Okay Sir....I'm now going to see if I can draw any blood from the tip of your nose.....so just like the last test but I'm going to see if your nose bleeds at all...this may hurt....I'm sorry...okay?"

I stuck the needle in to a depth of 2mm...then 3mm...then 4 mm...5mm...he had no sensation at all...and the nose didn't bleed.

Worse case scenario for him then.

"Okay....you need to refer him to Plastics...they will want to see him tomorrow at the Trauma Clinic at the Regional Burns Centre..."

Yer wot...?

"My colleague needs to send you to see a plastic surgeon Sir....there appears to be a little problem with your nose...."

Well I'm not going to see any surgeon....I'm scared of doctors...besides...I've got no money to get there...

"Okay....that's fine..."

So...what are you going to do for me...?

"ME ? I'm not going to do anything for you.You're an adult....and if you don't want to see the surgeons,you don't have too...."

Will it get better by itself then?

"No"

So...what are you going to do then...?

"Nothing....I will however ask Julian to give you the phone number for Andrew Lloyd Webber...."

Wot?...you taking the piss mate?

"No...I hear that he's looking for new talent for the Phantom of the Opera...."

Oh....

"Jah...ohhh..."

One of the reasons why you can buy alcohol 24 hours a day in this country.

Cats have nine lives - which makes them ideal for experimentation

The patient...a middle aged lady who didn't look particularly crazy and who smelt only slightly of urine... said that a strange cat had "broken into her house"

It sounded fishy to me!!

Supermarkets....dontcha love 'em?

I have diverticulitis...as most regular readers will know.

Generally it doesn't bother me...and when it does,its usually quickly brought under control by taking Fybogel for a few days.

And so...in the sure and certain knowledge that a combination of my colleagues and the patients will give me the sh*ts this weekend,I thought I should buy some more today.

Now I don't often shop in Sainsburys...I am an M&S man...with the occasional foray into the hinterland of Fortnum & Mason...but I needed some basic stuff and Sainsburys is the nearest supermarket to where I live.

Now I do not know if you have self service checkouts where you live...and if you do...if you like to use them.

Personally I prefer them...it saves me from the chore of making inane conversation with the checkout staff who tend to fall into one of two main groups...they are either teenagers who feel that they are doing me a huge favour serving me until they land the big recording deal...or get pregnant,whichever comes first;or they are old age pensioners who can't survive on their pension and who resent me buying caviar and Dom Perignon in such vast quantities whilst they live on dog food and "own brand" orange squash.

*sigh*

I don't have an easy life...

Anyway...there I was this morning quite happily scanning my little basket load...

...Milk...Bleep

...Cheese...Bleep

...Ryvita...Bleep

...Bread...Bleep

...Fybogel...BleepBleep BleepBleep BleepBleep...

...and a message came up on the screen that said:

"Item needs to be authorised by Customer Services member"

What??

Its Fybogel!!

I tried to scan it again....BleepBleep BleepBleep..."Item needs to be authorised by Customer Services member"

Now this wasn't 37 bottles of whisky....I wasn't trying to buy 2000 paracetamol tablets...I wasn't even trying to buy the new Boy George CD...Its Fybogel!!

I looked around for a Customer Services Person but they were all chatting about something on a TV soap program.

Now its fair to say that there is little....in fact...there is nothing that embarrasses me...

...and so...looking directly at the Customer services people who were doing their best to ignore me...

...and so...in a clear and stentorian voice,like Plato addressing the Athenian throng,I proudly declaimed..."Can I get some help with my Constipation Medication"

(I thought it had a nice ring to it...)

There was a sudden silence in a 50 yard radius of my till...

I held up the box of Fybogel..."Price on Constipation Medication?"

Two customer service people scuttled over....

"Look...I need to buy my Constipation Medication....constipation caused, I should point out, by buying kak food from your shop...!"

Its a health and safety thing...

"What...?!?"

Well there are some things that people buy and then overdose on...

Now look...people have mistakenly thought many things of me in the past...they think that I am kind...they think I am humble....people have even thought I am clever ...one girl even thought I was George Clooney....(no sniggering at the back there!!)...but no one...absolutely no one...has ever thought I was anorexic.

So...Sainsburys...I "tried something new today"...humilitation...just what I need from my supermarket...

...I normally rely on the women in my life for that...!

The picture of Dorian Grey...not!

Saturday afternoon was pleasant...to the extent that at one stage there were no patients to be seen and we were all sitting around the nursing station,having a cup of tea.

So is it true,-asked SimplySomerset,the new Health Care Support Worker-,that you cannot give blood to a Jehovah's Witness?

"Yes....its true..."

Oh! That's strange...

"Well...its what they believe...of course,in life threatening emergencies with children, hospitals usually get a court order to give the blood..."

Oh...do you know anybody who is a Jehovah's Witness?

"Ja...in fact my hairdresser is a 'Witness' ...do you know that they also do not celebrate birthdays...?"

No....really...??

She looked bemused.

Do you mean that they don't get older then...?

"Well...of course they get older..."

The S&M Queen snorted her tea.

UglyJulie had to walk away.

But then...how do they know how old they are...?

"Well...the same way we all do...subtract your birth year from the current year..."

"Perhaps you could go and clean something now?"

So now my colleagues are a rich source of craziness!!

That will bring a tear to your eye...

It was just after opening that the young man came in and asked to see a male doctor.

I got to see him about 20 minutes later...and he walked into the Unit with the oh-so-familiar 'gun slingers' gait and sat down very carefully on the chair.

This is what he had written on the admission form:-

I examined him and found that indeed he did appear to have a 'fractured' penis...inasmuch as it resembled a small monkeys arm,bent at the elbow...as it were...

The most bizarre part was the discussion with the on-call urological surgeon who clearly had no idea what I meant when I said that he injured himself whilst having intercourse with his girlfriend who was in the 'reverse cowgirl' position...I offered to show her...at some future date,after dinner perhaps...a few drinks even...a kind offer she rejected out of hand...as it were...

*sigh*

It was a long day.

Emergency surgery

As luck would have it,we haven't had to do any emergency surgery since we opened the Minor Injury Unit some 5 years ago...the ambulance service is very good here and we are only a few miles from St Vulvas...

But I always knew the day would come though and have always been grateful that I worked in Trauma nursing in Johannesburg for so long...the days and nights standing...sweating and aching...holding retractors in the Resus Room...with a finger in some arbitrary anatomical hole in some arbitrary person, that was being rapidly over-sewn by a desperate surgeon.

And so, last Thursday , the worst happened.

The 10 year old child,-Imogen-,was crying and unhappy.

Her parents were anxious,huddled together at the foot of the bed.

Her teacher was white faced,shredding her tissue.

I had phoned the paediatricians who didn't know what I should do.

I had phoned the A&E Consultant who was also clueless

I had phoned the Poison Information center...who as usual knew nothing.

I had phoned Hamleys who were most helpful...

There was no time to waste....Imogen was crying and vomiting.

"Alright....",I looked at her and her parents...."I'm going to have to do an exploratory laparotomy...maybe even a thoracotomy...are you ready for this?"

Shouldn't we call someone else?

"There is no one else to call I'm afraid...its me...or...well...no one...."

Ok said the dad,do what you need to do.

I looked at the teacher..."You understand I need to do this...I have to know what is happening here?"

The teacher just nodded.

"Okay then....Julian....just position the lights then...."

He did...and mopped my brow

"Shears!"

He slapped the shears in my hand...Imogen gasped.

I grasped the patient firmly with my left hand and basically just cut him in half...

...the stinky slippery little smirking green plastic frog who had been the cause of all the trouble.

Water seeped out of him....just water...thank the Lord.

Imogen had been playing at school that afternoon and for reasons known only to herself,had decided to bite into a toy called a Splat Frog...she was adamant that some noxious green gel had come out if its belly which she had then swallowed...and of course she then felt unwell.

Looking the toy up on the Internet suggested that it was filled only with water...and so I guessed that she had 'simply' swallowed some warm dirty old rubbery water ...that contained who knew what...?

I sent her and the grateful parents home...the teacher whinged and bitched about the

unnecessary surgery...

*sigh*

I looked at Julian.

He looked back at me...Formaldehyde?

"No...Alcohol"

He nodded in agreement.

Do you want that to go?

In addition to the hundreds of patients who actually turn up to the Unit, there are as well usually dozens of phone calls to answer on any given shift.

Technically the admin staff are not supposed to put calls through to the nursing station when people want advice...they are supposed to be re-directed to NHS Direct...whose algorithms all end up saying: 'Go to hospital' anyway.

But of course the admin staff,with a few exceptions, can't be bothered to deal with the abuse from the callers so put the calls through.

So Sunday afternoon,the Unit is packed with a 3 hour waiting time....and the phone just rings and rings....and rings and rings....and rings some more.

I apologise to the parents of the child I have just examined and answer the phone.

"Minor Injuries Unit...Lucien speaking...how can I help you?"

Do you treat dental abscesses?

"Ja....well...if I think you have an abscess then I'll give you the antibiotics you'll need..."

Oh...don't you pull teeth out there then?

"No...Oddly enough,there are quite strict laws about randomly extracting teeth..."

Oh....but I can get antibiotics from you?

"Jah."

Okay...I'll get my husband to stop in on his way from the supermarket and pick up the medicine then...

"Humm...actually...if you want to be treated ,you have to attend the Unit...its a sort of legal thing..."

Well....I really don't see why I should have to come in....I know I've got an abscess...and I'm cooking the tea ^^

"Well its really very simple..Ma'am....if you want to be treated,you need to come to hospital to be examined...its frankly not negotiable."

Huh...I'll bet you're that fat South African aren't you...I hate you!

"Thank you Ma'am...its all part of the service...happy new year to you too!"

^^

(Note to foreign readers: People in the UK often call their evening meal 'Tea' which may/not include an actual cup of tea)

(Note to UK readers: "Tea"...how quaint...how Victorian)

The 7 Dwarf syndrome

First day of the new year…

…and I was feeling a little Sleepy as my neighbours had been making a racket last night celebrating the new year…

…so I was Happy to see that the first patient of the day appeared to be a straightforward case...a young woman with a cold and cough…

…who unfortunately was a little Dopey owing to a combination of her pre-existing poor genetic material which had been soaked in excessive amounts of alcohol…

…I felt a bit Bashful when I told her I needed to listen to her chest…

…and then felt Sneezy when I got closer for the examination due to her body odour as she hadn’t apparently washed for a week or two…

….”Gee Doc” she whinged when I told her she had a viral upper respiratory tract infection,-a cold-, and that I would not be giving her any antibiotics…"what a waste of my time…I could have stayed at the party”

…and so she left feeling Grumpy that I wouldn’t give her a sick note either…since her temperature was lower then mine.

As I stared out at the Snow White parking lot,thinking of the busy day ahead, I wondered why the only women I ever meet socially are the Wicked Stepmother...or the Evil Witch...or the Ugly Sister?

Or just plain mad like....well...you know who you are!!

Sighing,I bit into my apple and went back to work feeling a bit like the Grinch.