A change of scene

With one thing and another, I haven't really been home in daylight since well....October, and noticed this morning that the new 'roof extension' to the building opposite seems to be well underway with structural floors and supports in place and the outer skin being put in place. This is to be covered in glass apparently.

Continuing the cheery theme....

The new Barnado's campaign is on TV and cinema's. It is hard watching, and a telling reflectiuon on an aspect of society today... for a media obsessed at the moment ith child rape, child murder and hoodies, knives and teenage gangs, what about looking at teh root causes. Are the former linked to the latter. What is cause, and what is effect......

Should we get annoyed?

a.k.a. Why do good things happen to bad people.

Over the past few weeks, a common pattern seems to be emerging - often young, previously healthy patients with wives/husbands, young families, and who are working and contributing to society* are getting very sick, and or dying, whilst chronic alcoholic, IVDU's end up recovering from their alcoholic encephalopathy, seizures, and coronary events*.

*the above are composites of different patients.

It seems unfair that people who were doing good, and are only a little older than myself are dying, despoite all the treatment we can offer, and yet people who are on their second or third ICU visit are recovering, but not reforming and going back out to continue their downward spiral.

I am not suggesting that some lives are more important than others, but there does seem a fundermental unfairness about the fact that those who contribute to society are the ones to die, and those who sponge/take from socety are the ones who survive.

As one doctor put it today "those with a rough paper-round have just become so tough that it takes more than a bit of alcohol and an MI to kill them".

Sorry

Sorry about the lack of posts recently, but I seem to be really tired after my SSM days, which is worrying as I now have to work on the essay etc!

Skills....

This has been a week of firsts.....................

• My first pleuritic tap...maybe next time my hand won't shake so much..... and the patient will have less excess soft tissue so I can feel the top of the rib - the tap needle must go along the top of the rib not the bottom because the neuro-vascular bundle runs along the bottom of the rib.
• My first 12 lead ECG which I managed to set up, record and then have a go at analysing myself....though I did need some leading through it. ECG's are one of my bogey areas.
• My first Arterial blood gases (sterile procedures) and blood cultures.
• My first dead body in a mortuary...technically it is my second, since I saw a PM during my BSc Honours year in 2004, but this was the first where I had known /met the patient.

Many of the patients this week seem to be either very, very sick, or alternatively just bobbing along getting better slowly...more to follow later.

Snow!

This past weekend was the DIME weekend away, again in Aviemore, and it snowed!

Fireworks!

Down at seaside hospital last week, we attended the fireworks at the local sports area, in aid of the local hospice - £4 to get in... here are the best of my pictures.

Belt up!

I've waited a wee while to post this, so as to avoid anyone reading this, then the paper and thinking "ahhhhh".

At seaside hospital we were encouraged to be on the receiving surgical team, and accompany them between teaching sessions, clerking patients in, examining them, taking bloods etc. This was quite good fun, though could be very slow depending on what turned up.

One Friday night, at the end of another quite long week - pub quiz, many cases to write up and lots of tutorials, Irish Hunter, with whom I had been at DepCat Hell Hospital, and I decided we fancied some A&E action....or laughing at drunks as he termed it. So one Friday night, after some food we headed down to A&E. At first it was quite quiet, with only a few early drinkers in having fallen (it was freezing) after a few too many (it was near payday). The first patient was Irish and had a scalp wound which was bleeding like crazy, so while Irish Hunter tried to get enough blood from his cold arms to fill the tubes (and try to do so in the right order), i as set to work suturing his wound, after the middle grade had injected some nice local anaesthetic. It was quite tricky as his head was lolling all over, and the needle was hidden under the blood, and it was the first tie I had done it, except on the chicken....

Anyway, he was patched up and sent round to the observation ward for the night. We wre just commenting on how quiet it was and why weren;t more drunks alling over, when the ambulance radio squarjked into life

"XXX to Seaside Hospital, Over"

"Seaside Hospital Casulaty receiving, over"

"We are inbound with a [young adult] male, RTA, unrestrained driver, with no obvious broken bones, but a sore neck and no feeling in the legs. He is not bleeding and has minor bruising and scratches to face and arms. ETA 15 minutes"

"Received. Can you give GCS? over"

"GCS 15, Over"

With this, everyone sprung into actions, Orthopaedics were paged, and everyone went into the resus room. Over the next 15 minutes, the consultants ran through the importance of ATLS assessment with us, and indicated roles which we could assist with at various stages, depending on the various scenarios. When teh patient arrived, he was on a spinal board and had dirt and grazes on his face and arms, but no bleeding or obvious wounds. However, as we ran through the ABCDE, it became clear that D was his mahjor issue. He had altered sensation below the nipples and no sensation below the waist.

A trauma series of Xrays (neck, chest and pelvis) was ordered and when these came back, they showed a strange shape to his spine at the chest level. Since he was otherwise fairly stable, with oxygen and fluids, he was transferred round to the CT scanner where teh duty radiologist and radiographer were both present.

The CT of his neck was unremarkable except for a congeital malformation at C1, but when his chest CT came through, there was a gasp from the consultants, who were nearest the monitor, as it became clear that he had a complete dislocation of two of his vertebrae, with a movement o about 3 inches laterally, and complete transection of his spinal cord.

The neuroscience institute were consulted and so on.....but as we came to leave at 1am, the consultant said, "remember guys, wear a seatbelt....." And as we stood in the car park, waiting for the car to warm up and scraping ice off the windscreen before the drive back home, we were reflecting on how different life would be if people did things slightly differently - split second timings etc......