"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.