The road to hell can be paved with good intentions…

The practice of medicine gives you an unparalleled opportunity to look like a goose. Of course the opposite is also true: some days bring an impressive diagnosis or even a simple procedure that saves a patient’s life and enables you to be a hero for a brief period. But what goes up must inevitably come down. I have witnessed a multitude of Doctors sink like a lead balloon in the course of everyday hospital medicine…

I recall one of the first Medical Emergency Team (MET) calls I was involved with as a freshly-graduated intern: The call was broadcast over the hospital speaker system early one afternoon stating that the MET team was required at the cafeteria. Medical staff rushed to the scene from all directions, where a senior medical Doctor had taken control in examining an elderly man who had collapsed amongst the crowds of people queuing for lunch. He thoroughly and systematically examined the patient before announcing to the multitude of onlookers that he believed the patient had suffered a serious stroke as his right pupil was dilated and not responding to light (an ominous neurological sign). He barked instructions to several other Doctors, instructing them to urgently bring a stretcher, insert an IV drip, place the patient on oxygen and sent others to organise an immediate CT scan of the brain. Junior doctors ran in all directions while the Registrar calmly examined the contents of the patient’s pockets, extracting his wallet and mobile phone. Finding the patient’s name from his licence, he immediately used the patient’s mobile phone to call his wife:

“Mrs. Brown? It’s Dr. Anderson, I’m one of the senior Doctors from the hospital. I’m afraid I’ve got some rather bad news. Your husband has taken ill. That’s right… he has collapsed in the hospital cafeteria. We are transferring him to the emergency department for urgent treatment. Do you have any children? I think you should call them and all make your way into the hospital as quickly as you can. I need the CAT scan to confirm this but after examining your husband’s eyes, I’m almost certain he has had a serious stroke.”

Mrs Brown didn’t skip a beat and in a loud voice, clearly audible to everyone watching the scene unfold she replied: “Doctor… you’re not shining the light in his glass eye are you?”

A few months later whilst on rotation in the Emergency Department, I witnessed another senior Doctor attempting to resuscitate Margaret, an elderly lady who had been brought in by ambulance extremely unwell with end-stage chronic airways disease, or emphysema, from smoking. Despite treating this lady for several hours, she had continued to deteriorate and he watched as her breathing became increasingly laboured and slow, until finally the chest stopped moving. The Doctor threw off his gloves and gown and marched into the waiting room, inviting the numerous concerned relatives to come into a private room. Once inside he quickly introduced himself and began to explain he had some bad news when there was a frantic knocking on the door.

“Sorry for interrupting Dr. Simons”, said a nurse as she popped her head around the door. “Could I see you for a minute about an urgent issue?”

“Not now” replied the Doctor firmly. “I’m just in a family meeting. Can you let one of the other Doctors know”. The nurse paused for a second before closing the door.

“Sorry about that” continued Dr. Simons, “Now where was I? Oh yes, I’m sure you all realise your mother was not a well woman and had severe lung disease. She was extremely unwell when the ambulance brought her in and unfortunately despite our best efforts she hasn’t made it through. I want you all to know we did everything we could…”

Again his train of thought was interrupted by more furious knocking on the door before another nurse entered the room.

“Dr Simons, I’m very sorry to interrupt… is it possible to have a quick word?”

“Not now!” declared the Doctor, becoming visibly annoyed. “I’m in a family meeting at the moment. Whatever it is will have to wait”.

“Are you sure I can’t just…”

“Lisa” interrupted the Doctor, “I’ll be out in 5 minutes. If it’s something urgent one of the other doctors can help you.”

The nurse shook her head slightly and left the room.

“I’m sorry about that everyone” apologised Dr. Simons. “As I was saying…”

KNOCK, KNOCK, KNOCK.

“This is ridiculous” hissed Dr. Simons under his breath. “Excuse me everyone for just one second, I do apologise” he said to the bewildered and now crying family members as he sprang out of his chair and flew to the door before opening it angrily.

“What. On earth. Is so urgent?” he yelled to a third nurse standing outside the room. “Can’t you see I’m in an important family meeting?”

“I’m terribly sorry” replied the nurse. “It’s just about Margaret in the resuscitation bay Dr. Simons. The nurse in charge thought you might like to know that she’s not dead”.

 

Unfortunately I was not immune from this curse. Over the course of my career there have been several occasions when I have made errors and, despite my best intentions, looked like a fool. One experience in particular stands out…

Brian Winchester was a delightful 68 year old gentleman who presented to the Emergency Department of the country hospital I was working in late one Saturday evening, complaining of high fevers, shortness of breath and a cough productive of purulent green sputum. Usually fit and well and still working as a dairy farmer, he was now wheezing and gasping for breath even walking from one room to the other at home. I was called to assess Brian as the Medical Registrar on for the weekend.

I entered the cubicle to meet an elderly man who was obviously struggling to breath.

“I used a be a footballer, young sport” he informed me as I introduced myself, “A good one too. Played for the firsts in fact. Couldn’t blow a candle out at the moment though!”

As if to emphasize the point, he soon launched into a violent hacking coughing fit and as I listened to Brian’s chest with my stethoscope I heard course crepitations throughout the right lung, suggestive of air struggling to flow through an area of lung infiltrated with infection and pus. A subsequent chest X-ray confirmed my suspicions – Brian had contracted a nasty case of pneumonia

I didn’t realise it at the time, but our paths would cross quite a few times in the years to come. From that first meeting on a wintery Saturday night, however, Brian has referred to me only as “young sport” ever since.

I admitted Brian to the High Dependency Unit (HDU) of the hospital as his oxygen levels were dangerously low, and commenced him on intravenous antibiotics, steroids and nebulised ventolin. Over the next 48 hours he remained intermittently febrile and extremely unwell, his severe shortness of breath confining him to bed. Each morning I could hear his wheezing from the end of the corridor as I entered the ward to begin my rounds. Gradually though, the antibiotics worked their magic and ever so slowly he began to improve.

“They make us tough in the country young sport” he mused good heartedly, “Not like you city folk. A touch of pneumonia would probably see you over the edge… it’ll take more than that to see me off!”

Brian was a delightful patient – someone you enjoy seeing each day. So I was surprised the following morning when there was a flurry of urgent calls from the HDU nurses asking me to review Brian immediately as he was agitated and attempting to self-discharge from hospital. I rushed up to Brian’s room to find the usually meekly mannered man standing out of bed uncontrollably shouting at the nursing staff:

“Don’t you DARE try to keep me here”, he bellowed as he ripped the intravenous cannula out of his arm, blood spurting like a fountain over the floor. “I’ve told you… I have to fly to Belgium immediately! My future depends on it. I’m meant to be buying a one-billion dollar pulp mill and if I don’t arrive on time the entire deal could be in ruined”.

He tried to continue shouting as his substantial frame was racked by bouts of violent coughing; I could see the ordeal was taking it out of Brian.

“Mr. Winchester” I yelled as I walked through the door, “What seems to be the problem? Why don’t you take a seat and let the nurses place the oxygen mask back on and we can try and sort this out.”

“I don’t have time to sort out anything young sport!” he wheezed. “I’ve told these nurses 100 times… I have to get to Brussels immediately. I’m late don’t you see and my financial future depends on this deal going ahead”.

“Why didn’t you mention this trip before Brian?” I enquired. “You’ve been here three days and this is the first I’ve heard about it”.

“Don’t give me that young sport” he retorted. “This is critical… absolutely critical. I’ve put years of work into this pulp mill deal and I must be at this meeting to sign it off. Now what do I have to do to get out of here? I’ll be lucky to make my flight if I left now”.

Red faced, Brian hunched forward as a coughing fit convulsed through his body. He wasn’t fit for a haircut let alone a long haul flight to Brussels.

“Just wait there for a few minutes while I give your wife a call” I said as I left the room.

“Don’t bring her in to this young sport” Brian screamed behind me. “This is my future… my future…”

I regrouped with the nurses in the doctors’ room, who explained that Brian had transformed from the perfect patient to this aggressive monster within the space of a few minutes.

“It must be steroid-induced psychosis” I thought to myself as I dialled Brian’s wife’s number. “Ah Hello, is that Mrs. Winchester? Oh good. It’s Dr Kirkland here from the hospital. I’m just giving you a quick call about your husband… No no, there’s nothing to worry about. Brian has become quite agitated in the last few hours about a trip to Brussels he has planned in order to buy a pulp mill. Do you know anything about that?”

“What?” declared Mrs. Winchester, her surprise obvious over the phone. “What on earth are you talking about? Brian’s a cattle farmer from Horsham. He wouldn’t know a pulp mill if it sat up and bit him!”.

“I suspected that may be the case” I informed Mrs Winchester. “I believe Brian has developed what we call steroid-induced psychosis. We do see this from time to time. The high doses of steroids we are giving to settle the inflammation in the lungs can sometimes play with people’s minds and cause them to behave in bizarre ways. Brian is pretty determined to leave hospital, but I really don’t think it is safe for him at this stage and certainly not in this frame of mind. If need be I will have to keep him here against his will until this settles.”

“You’ve got my permission to do that” replied Mrs Winchester. Brian’s hard to live with at the best of times let alone when he’s barking mad and planning to buy a pulp mill overseas. I’ve never heard anything like it!”

I returned to Brian’s room to find him just as agitated, pacing up and down yelling that he would miss the plane.

“I’ve been chatting to your wife Brian and we both agree you are just too unwell at the moment to leave hospital. Why don’t you return to bed and we’ll can reassess the situation in a few days?”

Brian turned to me with a face twisted by contempt and roared: “That… young sport…. will simply NOT do”. With that he dashed out of the room in a last and somewhat feeble attempt to abscond from hospital, lurching about 20 metres down the corridor before grasping at the nearest door handle panting and coughing uncontrollably.

“Enough of this Brian” I said firmly as two nurses escorted the still distressed man back to his bed. “You’re not leaving and that’s the end of it”.

I went outside and prescribed a sedative and an antipsychotic medication before reluctantly filling out the necessary paperwork under the Mental Health Act to ensure that Brian no longer had the right to leave hospital. Finally I contacted the Psychiatrist on duty and asked for an urgent consult.

Brian required regular sedative medication over the next 24 hours and at once stage required restraints to keep him safe, such was his intense desire to leave hospital and travel to Brussels to purchase his pulp mill. The Consultant Psychiatrist arrived to review Brian the following morning and after an extensive assessment he sought me out in the cafeteria:

“I’m not convinced it quite meets the definition of steroid-induced psychosis Ben” he mused, “but at the very least that man certainly has delusions of grandeur! It could possibly be an unusual delirium from being so unwell. Regardless, I’m happy to keep the involuntary order going for now and keep him on regular anti-psychotic medication. With a bit of luck this will settle over the next few days as the steroid dose is reduced”.

Thus began Brian’s period of enforced convalescence. Over the next five days his pneumonia gradually improved until he no longer required intensive support in the high dependency unit and could be safely managed in the regular hospital ward. I dosed him regularly with anti-psychotic medication and sedatives if he became agitated. His initial overpowering delusions of needing to travel urgently to Brussels seemed to lose their vigour and Brian slowly accepted his need for hospitalisation with better grace. On questioning he seemed almost fatalistic about the entire experience. “It’s too late now to worry, young sport” he would occasionally mutter as he gently shook his head.

Seven days after his psychotic episode Brian had improved to a point that he was safe for discharge from hospital. Still weak and needing a period of rest and recuperation at home, he no longer required oxygen and the harsh infective noises I had heard in his right lung with my stethoscope had improved drastically. While not back to the bubbly and debonair character I had initially met in the Emergency Department, he was mentally much more stable.

Later that morning, Brian’s eldest son George, who I hadn’t previously seen at the hospital, arrived on the ward to drive him home. I introduced myself and shook hands, giving a quick summary of Brian’s progress as I led George to his father’s bed.

“Nice to meet you George. Your Dad has been extremely unwell with a very nasty case of pneumonia” I explained as we walked along the hospital corridor. “Unfortunately with his past smoking history his lungs aren’t normal to begin with. It’s taken quite a while for him to turn the corner but he’s much much better now. I expect he will feel quite weak for a week or two yet, so you and your Mum need to encourage him to gradually do a little more each day. We’ll arrange for him to have a check up with his GP in a week’s time”.

“That’s fantastic news Doctor. We’re absolutely thrilled he’s improving. Mum was really worried about him last week” George replied as we entered Brian’s room.  “Just between you and me though” he added, “it’s a damn shame he wasn’t able to travel with me to Brussels last week. We’re in the process of negotiating the sale of a huge pulp mill and the whole deal could be in jeopardy now. I’m surprised he didn’t mention it.”

Something inside of me fell on its side.

In that instant I experienced a vivid flashback… Brian’s desperation to leave hospital; holding him in hospital against his will; sedating him for his “delusional business trip”; plying him with antipsychotic medication. I felt absolutely sick to the stomach. I had just committed a perfectly sane man.

“Business trip… Brussels… But I spoke to your Mum”, I stammered, the enormity of the situation hitting me like a tonne of bricks. “She told me Brian was a country farmer… she had never heard of the pulp mill”.

“Oh God” George replied, “As if Mum would know anything about Dad’s business affairs.”

Posted in Uncategorized | Tagged , , , , , , , , , , , , , | 1 Comment

Medical liaisons Part 1 – Chopper Reid with a perm

I have never been particularly successful in attracting members of the opposite sex. There is some kind of sign on me – God knows I’ve tried to find it  – that firmly states “shoulder to cry on”, “safe friend” or “harmless comedian”. I can make women laugh but for some reason I have rarely been seen as boyfriend material. Consequently, while many of my fellow doctors – some of whom sport a face like a half-sucked aspirin – would parade around with gorgeous women hanging off them and relay stories of the latest nurse they had enticed, I remained a defiantly single junior doctor in search of the perfect woman.

Take Calvin for example – a fellow intern I worked with. Known throughout the hospital as the “Asian James Bond”, he frequently reiterated that he was not able to sign up to Facebook, lest the various women he was going out with at any one time found out about each other. Calvin had spent almost his entire intern salary buying an ostentatious car and it was now really paying dividends. I was present in the hospital cafeteria day after day when various nurses, pharmacists, physiotherapists and quite a few female doctors sidled up to Calvin and discretely handed him their phone numbers. After a hard day’s work, I would frequently leave the hospital in the evening and notice Calvin’s car still parked in the staff car park, discovering later that he had again been “studying late” with another member of the allied health staff. He was unstoppable. Unstoppable until one Friday morning when he had arrived at the hospital early to update the pathology and radiology results prior to starting a Consultant ward round. As he diligently updated his patients’ files, a very attractive speech pathologist that Calvin had fancied for some time entered the ward. Taking his opportunity, Calvin stood up and warmly greeted the “lucky girl”, swooning her with his witty repartee before finally asking: “So… are you single at the moment?”

The loud grunt and incredulous laughter than erupted behind Calvin startled him, and he turned quickly to see Professor Martin – head of Medicine for the entire hospital – who had discretely entered the doctor’s office unnoticed. As Calvin turned a bright shade of red and began stammering explanations, Professor Martin exclaimed: “My dear boy, you’re doing a fine job! Don’t let me stop you – in fact let me get out of your way so you can seal the deal!” He ran over to the corner of the small room, opened the storage cupboard door and jumped inside, still laughing and yelling “Ignore me, I’m not here” as he shut the door.

It was one of Calvin’s few failures.

I was no match for the Asian James Bond. Throughout the course of my first hospital year though, I began to notice that I did seem to strike a chord with two distinct groups of patients. The first had been known to me for quite some time and indeed I am renowned amongst staff at many hospitals for possessing the unwavering ability to charm any lady over the age of 65 – particularly if she has a body mass index to match! This is not a new phenomenon. In second year university as part of our medical training, each student was required to spend one day per week completing a community service project. I was lucky enough to be placed at a Brotherhood of St. Laurence opportunity shop where I served customers for eight hours every Tuesday. While the immediate benefits of this experience to my career as a doctor remain to be seen, I did as a fringe benefit receive a 33% discount off the exorbitant opp shop prices, and thus managed to outfit myself in pants and shirts – the compulsory hospital attire – at a fraction of the cost I had envisaged. In the process of working at this store, I also managed to unintentionally woo some of my spritely pensioner colleagues. At one stage, approximately four weeks into my term at the store, I was almost at the point of filing a sexual harassment case against a couple of the ladies, who refused to walk past me without insisting on a hug and planting a giant kiss on my cheek. My parents used to wonder what went on at that Opp shop, as every night I came home I was covered in lipstick. One lady – 77-year-old Edna – was not backward in touching my backside whenever she walked past and I was romanced with daily offerings of scones, muffins, slices and home-made jam! I was also invited to a glittering array of pokies trips, bingo nights and boot-scooting classes by a variety of these predatory widows. I was the only volunteer in that store under the age of 70 and they were making the most of it!

My intern year provided me with unparalleled exposure to women over the age of 65 and I soon realised that my reputation as “pensioner eye-candy” or “Casanova of the geriatrics” was bounding from strength to strength. I unexpectedly hit peak form one evening in July, when instead of braving the gale-force winds, freezing temperatures and torrential rain of the glorious Melbourne winter and travelling home, I volunteered to stay and assist in the Emergency Department of the small suburban hospital I was working in at the time for a few extra hours, as another doctor had called in sick.

The first patient I was asked to see was an 81 year old Polish lady by the name of Elsa, who had presented to the Emergency Department with cellulitis of her right leg. Febrile and systemically unwell, it was obvious that Elsa would require admission for intravenous antibiotics and I decided to get things moving by inserting a cannula. As I applied the tourniquet to Elsa’s arm and took a seat by the bed with the needle poised in my hand, Elsa looked across and placed her hand on my knee.

“My dear” she said in a thick European accent, “Are you married?”

“No, no, not yet” I replied.

“Ahh” she cried, “Still fishing…” as her hand slid higher up my thigh towards my groin.

“Not for a pensioner” I thought, as I waved the needle menacingly.

“Elsa, I have a needle here. Behave yourself!”

“Hmphf, such a waste” she mumbled, as I plunged the cannula into her vein.

Drip in, I escaped Elsa for the safety of the staff area, still not quite believing that I had just been violated by an octogenarian. After a cup of tea to calm my nerves, I collected the triage information sheet for my next patient. The sheet described Maureen, an 86 year old lady who had presented with some cuts and bruises and a possible fracture of the hip after falling at the nursing home where she resided. Attempting to read her file as I prepared to meet the patient, I cursed aloud as I saw the pages of completely illegible scribble sent in with the patient by the nursing home.

“Haven’t these people heard of a computer?” I muttered, “I’m sick of trying to interpret hieroglyphics!” Scanning page after page of the photocopied jargon, I thought I could interpret the word dementia, and my heart sank as I noted the dreaded word unco-operative written several times throughout the pages.

“Fan-blooming-tastic” I thought to myself, “This should be an absolute joy! A violent lady who won’t even remember punching me; why couldn’t I get someone easy? “

Silently grumbling about the unfairness of life, I opened the curtain to find a sweet little old lady lying on the bed in the standard hospital gown. I introduced myself as Dr. Kirkland and attempted to elicit the details of the fall along with a full medical history. Maureen welcomed me sweetly and relayed in depth the events leading up to the fall. She denied being in pain: “I’m perfectly alright Doctor” she assured me, “My mind wandered for a minute and I just missed the step”. I was most surprised at her memory of the recent fall – from the small amount of legible writing provided by the nursing home, Maureen was meant to have significant cognitive impairment and be reliant upon nursing staff for almost everything.

As I concluded the interview, I informed Maureen that I needed to examine her back, hips and legs to make sure there was no sites of pain, trauma or restricted movement and also to gain an X-ray of the hips and pelvis to exclude the presence of any fractures. At that point, Maureen beckoned me closer and quietly whispered for me to close the curtain fully as she wanted to show me something. Slightly bewildered, as the cubicle was very private, I complied. Turning around, I discovered that Maureen had pulled her gown up and spread her legs and was now lying, stark naked, on the bed.

“I want you to f*^# me!” she whispered, contorting herself into as seductive position as her arthritic 80 year old frame would allow, before she drew her knees up to her chest and blew me a kiss, “Go on, you can be my boyfriend!”

I’m not sure which I found most distressing: the sight before me, or the language – which I couldn’t quite imagine my Grandmother (who is no Saint but has not been heard to utter an expletive more colourful than “bugger” in the last thirty years) – ever resorting to. Avoiding the impulse to run screaming out the door and trying to look anywhere except at the pensioner voyeur making seductive gestures at me while trying to reach for my groin, I mumbled something about doctor-patient relationships and left the cubicle, desperately searching for some support.

I quickly found Maggie, an Irish nurse I had befriended in the Emergency Department and explained the unusual situation.

“Oooh, you are a tease aren’t you!” she yelled, tears rolling down her face as she cried with laughter, “There’s just no stopping you – you always get the old one’s juices flowing! Have you got her phone number? It’s not every day you get a private strip tease in ED!”

“Very funny” I retorted, “Laugh all you want – I’ve already been groped by an 80 year old tonight; now I’m in danger of being raped by one!”

The look of distress in my face sent Maggie into hysterics once again, and it was quite some time before she was in a state fit to chaperone me.

Eventually Maggie composed herself enough to follow me into Maureen’s cubicle and she redressed the patient while I quickly completed a very cursory examination. “I might rely more on the Xray than the examination” I thought, wondering if the radiographer too would be propositioned. Maureen remained silent as I looked for shortening of one leg that might indicate a broken hip and then palpated her knees and lower back for signs of pain.  Slowly she looked Maggie up and down then turned to me. The sweet old lady I had introduced myself to and the passionate vixen I had apparently unleashed gave me a look of utter disgust, and a dangerous glint appeared in her eyes.

“So you’re cheating on me with this tart are you?” my admirer hissed, and Maggie let out a hoot of laughter.

“Now now sweetheart, settle down. I know he’s a bit of a peach but you’ve got to restrain yourself,” she cooed.

With that, Maureen went absolutely ballistic, spitting at Maggie while simultaneously unleashing a violent kick aimed at her face. Maggie leapt back; narrowing missing a wrinkly foot that rocketed passed her nose.

“I’ll kill you! How dare you cheat on me? He’s mine!”

To this day, I have never seen an 86-year-old lady dish out such vicious and well-aimed kicks. I knew then and there that there was absolutely nothing wrong with her hip as no-one with a fracture could possible execute a leg raise like that. I attempted to restrain her, enabling a shaken Maggie to leave the room, as Maureen swore and ranted at me, eventually declaring:

“I’ll kill you. No one cheats on me. I’ll see you in hell!”

Making a hasty exit from the cubicle, I took some deep breaths as Maggie came to comfort me.

“You certainly have a way with people”, she laughed. “I’ve never seen a patient proposition and then threaten to kill an intern within the space of five minutes”.

“Ah well, that’s the usual course of most of my relationships”, I replied. “Now what on earth are we going to do with her?”

In consultation with the senior Doctor, who also had a good laugh at my expense, we decided to give Maureen some quiet time to mellow and maybe even forget her new fatal attraction and arranged an X-ray just to be on the safe side.

“Where’s her file?” the doctor asked. Perusing through the illegible pages of information, he suddenly gave a chuckle.

“Ahh, there’s your first mistake. That’s not just dementia written here” he exclaimed, “That’s dementia with psychotic features! You’ve scored yourself quite a handful here.”

“Fantastic” I exclaimed, “I just knew I should have just gone home with everyone else”.

Half an hour later, when Maggie popped her head through the curtain to check Maureen’s pulse and blood pressure, she bore the brunt of a similar physical attack from the grey haired kick boxer. Fifteen minutes after that I had a cup of hot tea launched at me by the jilted patient, accompanied by a barrage of obscenities and abuse. I had cheated on her, Maggie was a tramp, and Maureen wasn’t in a forgiving mood. This pattern continued for most of the night and when the senior doctor told me I should put in a drip to ensure she didn’t become dehydrated, I felt about ready to scream.

“And just how am I supposed to do that?” I pleaded, “Would it even matter if she did get a little dehydrated? It might slow her down a bit and lessen the intensity of her attacks”.

He laughed. “Oh come now Ben, it couldn’t possibly be as bad as that. You’ve been here for six months now; you are competent enough to do this. Just explain what you are doing and I’m sure it won’t be a problem.”

“Explain what I’m doing? This is an 86-year-old lady who asked me to sleep with her, and ever since I declined has threatened to kill me! Do you really think she is going to be persuaded by a rational train of thought?” I countered, the desperation welling in me.

“Look, give it your best shot. Maggie is assigned to that patient, I’m sure she will be able to help”, he enthused as he strolled off to see another patient.

“I don’t care how senior you are” I seethed under my breath when he was definitely out of ear shot, “You have absolutely no idea who we are dealing with here. This patient is Chopper Reid with a perm!”

Ten minutes later, Maggie and I slowly inched our way towards the cubicle like soldiers about to go over the trench into battle. Armed with a needle, I thought wryly that at least I had a weapon if things did get too out of hand.

“Don’t be ridiculous”, I thought to myself suddenly, “This is an old lady we are talking about. How difficult could it possibly be to restrain her?”

With that, we drew back the curtain and stepped into the cubicle, our entrance heralding a wave of kicks, punches and obscenities from my grey-haired nemesis.

“Now settle down Maureen, the senior doctor has asked me to put a little drip in your arm to help you feel better. Is that ok?”

I ducked as a leg shot out towards my face at high-speed… this was obviously going to be an absolute joy!

Fifteen minutes later, Maggie and I admitted defeat and fled once again, battered bruised and licking our wounds. “I’m NOT being paid enough to put up with this shit” Maggie yelled, mimicking my thoughts exactly, “We are not going in there again”.

From that time, Maureen remained in the emergency department without a drip, and despite copious attempts at rationalisation and numerous sedative injections she maintained right until the ambulance took her back to her nursing home that I had, and always would be, the love of her life.

By this time it was approaching midnight and I had been working for nearly 14 hours straight. I had been groped, kicked, spat on, propositioned and abused – largely within the space of two hours – and I was exhausted. As the emergency department was still bursting at the seams with patients, I decided to have a look at the triage sheets for all the patients currently awaiting medical care and cherry-pick an easy, quick case to finish the night on.

I picked Sandra, a 73year old lady with a straightforward broken wrist. Calling her in from the waiting room, I noticed Sandra and her accompanying two friends all looking decidedly worse-for-wear as they made their way into the examination room. Sandra, however, turned out to be a delightful and obviously well-to-do lady who explained that she had been having an afternoon of drinks and general frivolity with her two female neighbours, before being called back to her house to answer a phone call. Upon finishing the call, she heard raucous laughter coming from the neighbour’s yard, and had climbed on to her adjoining fence to eavesdrop in an attempt to hear what her friends were laughing about.

“After at least a bottle of wine Doctor” she laughed. “Can you believe it? I’m about as dextrous as an elephant on Mogadon at the best of times, and I stupidly tried to climb a fence while tipsy! Of course I fell off. I went arse-over-tit! And just look at my wrist – it’s buggered… absolutely buggered. I won’t be able to play bridge for weeks”.

There was much laughter and general mirth from all three clearly inebriated ladies as I carefully examined Sandra’s arm and showed my patient the obvious fracture on the Xray. “It’s called a Colles fracture” I explained to Sandra. “You’ve broken the distal part of your radius and ulna – the two bones of the lower arm – and the bones are quite displaced. I need to consult the Orthopaedic specialist, but I’m fairly certain you will need an operation to correct the alignment. I’ll place the wrist in a half-cast or backslab for now, which should help with the pain”.

I spoke to the Orthopaedic Registrar who reviewed the Xrays and confirmed my suspicion that Sandra would indeed require an operation to realign her broken bones. The Registrar booked theatre for the next day, and asked me to inform Sandra to fast from midnight in preparation for surgery.

I relayed this information to Sandra and her two friends and asked her to return to the hospital at 7am the next morning to be admitted for surgery. As I was about to offer Sandra some pain relief and end the consultation, my patient suddenly interjected:

“That’s all well and good young man” she said. “You’ve done a fine job with my arm – even though you don’t look nearly old enough to be a doctor – and I thank you for that. In fact, while you’ve been away, my friends and I have been chatting and we’re not entirely convinced you are a doctor. But whether you are or not, I can tell you one thing young man… I am not leaving this room tonight without you touching me again”.

“I beg your pard…”

“That’s right, you heard me”, Sandra interrupted. “I am categorically not leaving this hospital until you touch me again. I think it’s the least you can do after the day I’ve had”.

“You must be joking” I laughed uncertainly, unable to believe my ears.

“I’ve never been more serious about anything in my life” she replied firmly.

“For God’s sake, just take her blood pressure so we can all get home and get some sleep”, Sandra’s two friends chipped in.

Shaking my head in bewilderment, I relented and agreed to take Sandra’s blood pressure. To be honest, after the night I had been through, I was ready to do just about anything to get out of this wretched emergency department and get home as quickly as possible.

“Alright then, roll up your jumper sleeve and I’ll take your blood pressure” I relented.

“The sleeve’s too tight to roll up, I’ll just take the top off” I heard Sandra say as I turned to reach my stethoscope and the blood pressure cuff from the cubicle wall.

Turning back, I knew immediately that Sandra had taken her top off as she was now sitting, naked from the waist up, her left arm extended and waiting for the blood pressure cuff to be applied.

“This shift is quite honestly going to be the death of me” I thought, as Sandra declined a blanket or any form of cover and asked me to get on with it. I quickly applied the blood pressure cuff while Sandra friend’s giggled relentlessly and whispered furiously to each other. As I finished the blood pressure reading, assured Sandra that her readings were fine and encouraged her to get dressed, the two friends suddenly piped up.

“Doctor Ben, we’ve been talking. If Sandra’s having her blood pressure measured for no reason then so are we – we’re not giving her boasting rights for the next few months!” With that, and before I had the slightest chance to resist, both ladies took their tops off as well and held out their arms.

At that exact moment, there was a knock on the door and the Emergency Consultant opened it and stuck his head through the door.

“Sorry to interrupt Ben, I just had a quick qu…”. His voice tailed off as he took in the scene in the cubicle. Picture three elderly ladies, all sitting topless in front of me – none of them in the zenith of their physical or aesthetic peak – two of them extending their arms towards me provocatively and all now laughing uncontrollably, their saggy bosoms shaking wildly.

The Consultant gave me a look of utter bewilderment that itself spoke volumes. Feeling my face burn and turn a bright shade of red, I could only shake my head and shrug my shoulders as he shut the door, shouting “It can wait” behind him.

As one of Sandra’s friends, still obviously drunk, fell on to the floor (such was the vigour of her laughing) there was another knock on the cubicle door, before Maggie popped her head through.

“Sorry to bother you Ben, have you got Mrs. Smith’s file with you… Oh. My. God! You are unstoppable! We need to issue a warning before you see female patients”.

It was quite a night.

Addit:

The events described above occurred extremely early in my medical career.

I am pleased to report, however, that six years later, my reputation as “every Grandmother’s dream” and my ability to charm elderly female patients remains intact.

Only last week I was locuming in a small hospital in country New South Wales, when a 78year old lady was brought in by ambulance in status asthmaticus – an acute, sudden-onset exacerbation of fulminant asthma symptoms that is usually not relieved by typical asthma treatments. Unable to speak at all on presentation, I worked on the patient and did not leave the bedside for over two hours, until finally she was stable enough for transfer to a nearby intensive care department.

As the lady slowly manoeuvred herself from the emergency trolley to the MICA ambulance bed that would transport her to ICU – that small exertion triggering a fit of uncontrollable coughing and wheezing – she grasped my hand and shook it, gave me a radiant smile, and summoning all her strength, word-by-word she slowly exhaled:

Doctor…

You’re absolutely gorgeous.

I feel like I’m on All Saints!”

Posted in Uncategorized | Tagged , , , , , , , , , , , | 1 Comment

Diabetes… plane and simple – Part 2

Be sure to read Part 1 first.

Exhausted, and suffering severe heat stroke, I clambered on to the plane and after stuffing the three jumpers, two coats and majority of t-shirts into the overhead locker I collapsed into my seat, begging the hostess for water. As the plane took off, I rummaged through my bag for some sleeping tablets. Prior to leaving for the trip I had asked a doctor who was a friend of mine to prescribe me sleeping tablets for the plane trip: “Find out the dose that will kill me”, I asked him, “Then just back it off a trifle!” I was not one for sitting around for long periods.

Half an hour into the flight, as I was about to take my tablets and slip into a state of blissful sleep (induced of course and possibly verging on a coma), I noticed an airline hostess come and speak to one of the passengers sitting approximately ten rows in front of me. Initially, I though the passenger must have been vomiting, as I heard the hostess say: “It’s a long flight… you’ll have to be able to eat or drink something”. Fifteen minutes later, the hostess was still by the passenger’s side and was starting to look extremely concerned. Other hostesses had congregated around this passenger and there clearly something amiss.  On a whim, I hopped out of my seat to see what was happening and walked down the aisle to one of the hostesses. “I don’t mean to intrude”, I stammered, “But if the lady is being sick, I could give her an injection to stop it” (as I knew they carried anti-nausea injections on board international plane flights).

The hostess replied with what is now a very clichéd line: “Thank God you’re here!” she cried. “The lady’s unconscious… we don’t know what to do!”

I looked over the hostess to see an elderly lady slumped, unconscious, in her seat. Sweating profusely, her face ashen and with saliva dripping from her mouth, I didn’t need to be an experienced medical practitioner to realise that she was critically unwell. Her family, hysterical with worry and largely in tears, were opening her mouth and pouring in lemonade as she lay there, yelling in a foreign language as they did so. In amongst the diatribe, I heard the word “diabetes” mentioned.

“The first thing we need to do”, I said to the hostess, “is stop the family from pouring that lemonade down her throat. There’s no way she could protect her airway in this state, and if she aspirates the lemonade and we lose her airway… this is all going to end in tears!”

I immediately asked the other people in the aisle to stand up, then raised the arm rests and lay the lady down in the coma position across the centre seats. Panicking slightly, I asked an airline hostess to fetch the aeroplane medical kit, and to ask passengers on board if anyone was carrying a glucometer that I could use to measure her blood sugar level. Hostesses went running in all directions, returning quickly with medical kits, canisters of Oxygen and a glucometer.

I felt the thready, weak pulse of the elderly lady and knew that something had to be done quickly. Placing the oxygen mask over her face, I pricked her finger and waited for the glucometer to calculate her blood sugar level. I still remember my heart rate rise and the involuntary noise I made as I saw the result… a blood sugar level of 0.4mmol/L – to this day the lowest blood sugar level I have ever seen. Normal in the human body is around 3.5-7mmol/L, and with a level of 0.4mmol/L, this passenger had literally minutes to live before her body finally ran out of fuel. I turned to the hostesses, who by this time were standing on either side of the aisle holding up blankets to make a mini-cubicle in the middle of the plane.

“She’s in a hypoglycaemic coma”, I stated, “Probably caused by an accidental overdose of insulin or a lack of food. We need to get glucose into her quickly or she’s going to die”.

I wish to reiterate that at this point in my life I was not a doctor… I was a medical student… a medical student who had never treated nor seen a case of hypoglycaemic coma before. But I had read about them, and I desperately tried to visualise the textbooks I had scoured through over the preceding five years and remember the management possibilities for a hypoglycaemic coma.

My initial plan was to insert a cannula and give the patient a bolus of intravenous dextrose to quickly raise her blood sugar levels; when I opened the medical kit however, I realised in dismay that there was no dextrose solution inside. I quickly searched through vials and vials of medications that I had never administered to a human being, until I finally found a small vial of Glucagon… the antidote to insulin.

“Worth a shot” I thought to myself, as I saw the lady’s breathing slowing before my eyes.

I drew the contents of the vial into a syringe and injected the contents into the lady’s buttock… the second time in my life I had administered an intramuscular injection, and praying that I missed the sciatic nerve that I knew ran through the region.

Around this time, the patient’s husband who had been lurking behind the scenes – always with at least one can of beer in his hand – went utterly berserk. In broken English, obviously inebriated and with slightly slurred speech and overwhelmingly grandiose hand gestures, he rudely told myself and the airhostesses that there was absolutely nothing wrong with his wife (currently still lying unconscious and barely breathing on the seats in front of him) and she wouldn’t be getting this sort of treatment at home. He went on to reiterate that we were all over-reacting idiots, we should sit her up immediately so he could sit down and could he please get another beer as soon as possible as this one was nearly empty. I don’t describe myself as a confrontational person, but on this occasion I surprised even myself. I stood toe-to-toe with this man, cringing only slightly from the waves of alcohol emanating from his breath, and stated firmly:

“Sir, in case you haven’t realised, we are not at your home. We are 10,000 metres about the land and your wife is extremely ill. I’m the person in charge of looking after her at this point, and she will stay lying there until I am good and ready to sit her up. Any questions?”

With that he mumbled something incomprehensible and stormed to the toilets.

I checked the lady’s blood sugar level again, and breathed slightly easier when I saw the level had risen to 2.4mmol/L. She remained steadfastly unconscious. “That’s much better” I said to the hostesses, “but we’re not out of the woods yet”. I remember feeling sorry for the hostesses, who by this time were fending off abuse from several passengers, who despite seeing the events unfold, were vigorously complaining that their meals were late.

Ten minutes later I took the blood sugar level yet again, and this time it had risen to 5.5mmol/L. By this time, the lady was regaining consciousness, and was holding her arms up in a prayer position to say thank-you. Soon afterwards I sat the passenger up and took off the oxygen, as her condition stabilised. “I think she should be fine now”, I said to the hostesses, realising for the first time how much I was sweating. The cabin manager helped the passenger sit up, then walked over and shook my hand. “Thank you so much”, she said “We honestly thought she was going to die. I’ll see if I can get you upgraded to first class to show our appreciation”.

The hostess returned a few minutes later to report that unfortunately, all first class seats were taken, but if I needed anything during the flight I was to let her know. Feeling mildly cheated, I returned to my seat and again attempted to settle down for a sleep. Not two minutes later, in the distance I saw the cockpit door fly open and the pilot march down the aisle of the plane, eventually stopping at my seat. While every single passenger on the jumbo jet stared at me, the pilot introduced himself, shook my hand and then asked me a question I never expected to be asked in my entire life:

“Mr. Kirkland”, he said “Thanks for all your help back here. I need to know whether we should divert the plane to Moscow to off load this ill passenger. If we don’t divert to Moscow, the next place we can land is India in six-hours time… I think you should be the one to make the call”.

I translated that as essentially meaning: “If we don’t land in Moscow and something happens to this lady… it’s your fault!

Sitting stunned, trying to digest the magnitude of what had just been asked of me, I vividly remember thinking to myself: “I should not be making this decision”. I was a medical student and I thought I had done extremely well treating the patient at all, but now… now…. I had to decide whether 400 people got diverted to Moscow.

I thought for a while, wrestling with an internal monologue, which ranged from:

  • “Moscow might be positively delightful at this time of year and besides, I have always wanted to see Red Square”; to
  • “If I divert this plane to Moscow and the lady is well enough to get back on board I am going to be lynched by 400 furious passengers”; to
  • “Are medical students even allowed to divert planes? I’ll probably get struck off before I even begin practicing medicine!”

In the end, I said to the pilot:

“Sir, the passenger was in a hypoglycaemic coma, almost certainly caused by taking too much insulin. I’m not sure what type of insulin this passenger in on; often it is a mixture of short- and long-acting insulin, and if that is indeed the case, when the long-acting insulin kicks in in around an hour’s time, the lady’s blood sugar levels may drop again. If that happens, I have no more medication to raise them, as I used it all the first time.”

“However”, I went on to add, “Because the lady is now conscious, and is able to eat and drink safely, she should be able to consume enough to off-set the long-acting insulin. And if worst comes to worst, and she does lapse in to another coma, I’m sure I can put in a drip and we can make up some quasi-sugar solution with saline and sachets of sugar. So all-in-all, I think it’s safe to keep going”.

Basically… I was just too scared to divert a plane.

The pilot seemed satisfied by this response, thanked me again and began the long trek back to the cockpit.

Thankfully nothing else happened for the duration of the flight and eight-hours later I arrived, sleepless, at Hong Kong airport. I was thrilled and a little overwhelmed when all the passengers on the plane let me disembark first, and clapped loudly as I left the plane.

After a two-hour stopover in Hong Kong, I once again queued to re-board the plane for the 10-hour flight back to Melbourne. As I scanned my boarding pass, alarms sounded and red lights flashed yet again. Wondering what could possibly be wrong now, I was pleasantly surprised as an airline hostess handed me a boarding pass for first class and welcomed me on board with complimentary champagne. I spent the next 10 hours in unbridled luxury.

All-in-all… it was probably one of the best days of my life. It must be nearly every medical student’s dream to take charge of a very public medical crisis, have a good outcome and for that brief second be “the hero of the day”. Sometimes, I still struggle to believe that it happened to me.

It was also the first life I ever helped to save.

Posted in Uncategorized | Tagged , , , , , , , , , , , , , , , , | 2 Comments

Diabetes… plane and simple – Part 1

As a medical student, and even into my first year as a doctor, I often pondered whether I made the correct decision in entering medical school and giving up six years of my life studying. Would it be worth it? Would I find it an interesting and fulfilling career? As I faced the inevitable and regular financial problems inherent with being a poor student, I regularly compared myself to my cousin… he was a year older than me, and his marks in Year 12 had dictated that he did not go to university. Almost on a whim, he decided to become a plumber. Six years later, while I was living at home and worrying how I would get the money to buy the next tank of petrol, he had just built his third house and was now jet setting through Europe for six months of unbridled luxury. There were occasions when I really did wonder whether I had made the right choice.

After all, my reasons for entering medical school in the first place were sketchy at best. Throughout secondary school I had my sights firmly set on physiotherapy; I had visited many physiotherapists over the years for a variety of sporting injuries and could see myself cruising the world with the Australian Swimming Team, or becoming a physio for an AFL team (having obviously eliminated Collingwood as an option!). Then, while studying Biology in Year 12, my life changed when our class began to studying the human immune system and disease. I loved reading and learning about bacteria and viruses and the wily ways in which they outsmarted the human immune system. From the Black Death to Cholera to HIV; they may be single-celled organisms, but by God they were stealthy!

Coincidently, that very same month the blockbuster movie “Outbreak” was released at the cinemas. I watched Dustin Hoffman and Renee Ruso wearing spacesuits and chasing a monkey riddled with a virus that could destroy the population ofAmericawith a sense of awe. This was how I wanted to spend my life. I could visualise myself in a spacesuit chasing the Ebola virus inAfrica; curing AIDS in a top-secret laboratory and still having enough time left over before dinner to make vaccines for biological warfare.

Consequently, a few weeks after finishing Secondary School, I found myself sitting in an interview for medical selection.

“So Ben… Why do you want to study Medicine?” the inevitable question came.

“So I can wear a spacesuit and chase viruses inAfrica”, I replied without so much as a pause.

The three interviewers’ faces went through the seven stages of grieving at this very phrase. The initial surprise and shock was followed by bewilderment, anger (Was I taking the piss?) and finally humour. The three of them looked at each other and burst into laughter. Not the ideal response to my life passion, I thought to myself at the time, but in retrospect, it was probably a nice change from the 1999 other applicants who all answered with the inspiring line: “So I can help people”. Thus, I was accepted as a medical student.

After the initial euphoria, the doubts started creeping in. Wearing a spacesuit and chasing deadly viruses – although possibly enabling me to save the world from annihilation – was not a particularly robust reason giving up six years of your life. It was not as though I had a medical background either. No-one else in my entire extended family had ever done anything remotely medical. Essentially, I wondered whether I was cut out to be a health care practitioner.

It wasn’t until the end of my final year of medical study that I realised I belonged. As part of the final year curriculum, every medical student was required to complete an elective. This could be done in any area of medicine, anywhere in the world (and indeed you were encouraged to go overseas). It was, however, the responsibility of each student to organise and finance their own trip. Some students trekked to an isolated village in a third world country hoping to make a difference to the plight of a few; others boarded cruise liners and sailed the world doing “travel medicine”; some hit the high-profile tertiary hospitals in London or America to brown-nose Professors and further their careers.  I had other ideas. I had only left Australia’s shores once in the past on an Australian sporting team… if I was going overseas, I was going somewhere decidedly first-world and preferably exotic!

Upon learning that the university did not cover the costs of the trip, my parents suggested that a close surrounding suburb was the obvious place to complete my elective, particularly from a financial point of view; a clinic that was preferably on the local train line would be ideal, my father postulated. I, however, had other ideas. I initially applied for and was accepted to practice in the Emergency Department at a major international hospital inBali. This may not have been the most sensible choice, being approximately three months after theBali bombings, and the University quickly refused my application. “The local GP it is then” I thought, admitting defeat.

Then, three weeks before I was due to complete my elective, I was given the name of the Clinical Director of the Liverpool Womens’ Hospital in theUK. I emailed him half-heartedly, knowing that my application was ridiculously late and being unable to afford a trip toEnglandeven if he was mad enough to offer me a position. That same day, Professor Farquharson replied to my email and informed me that he would love me to come toLiverpool, and if I could find my own accommodation he would be more than happy to be my supervisor.

To this day I still don’t know how I managed to gain University approval, financial backing from my parents (with promises to repay the loan quickly, be a better son in general and perhaps even help out with the dishes once in a while), apply for a passport and find accommodation in Liverpool in such a short space of time. But as I entered the Qantas plane and walked the near 2km to my seat in the very back row of the plane that clearly labelled me – in status terms – as below most people’s luggage, I was looking forward to a brilliant adventure.

Liverpool turned out to be absolutely amazing! Professor Farquharson was brilliant, emphasising to me upon my arrival that he saw the next six weeks of my life as “a vacation within a vocation”.

“Do what you want laddie!” he cried in a thick Scottish accent. “Come whenever you choose, you’ve access to the whole hospital. If anyone gives you a hard time let me know. But make sure you take plenty of days off to see the sights and get up to some mischief. Rest assured… whatever you do laddie, I’ll give you a great reference”. With that he burst into raucous laughter and slapped me on the shoulder so hard I was sure I would bruise.

I made some amazing friends during that elective that I still catch up with today. I saw, and fell in love with Liverpool and many of the surrounding areas. I never once tired of the Liverpudlians egging me on to yell “CRICKEY” in the spirit of the recently deceased crocodile hunter Steve Irwin, hundreds of times per day. I may not have been able to understand the locals, but by God they were a friendly bunch.    

Six weeks later, as I arrived at Heathrow airport for the 25-hour journey home, I just couldn’t believe how quickly my time had gone.

Now, as any of my close friends will tell you, I attract drama. Within the hospital I am renowned as being a “shit magnet”… when Ben is on, you can guarantee the hospital will go on bypass, there will be an endless stream of medical emergencies and chaos will generally reign. Unfortunately, my airport experiences often mirror this character flaw.

It was not until I arrived at Heathrow airport and attempted to check in that I actually realised how much I had purchased in England. I was 25kg over the baggage allotment – largely made up of cheap souvenirs for relatives (in retrospect, hard-cover tourist guides were not the best idea for a present – and the attendant informed me it would cost £25 per kilogram… a total of £625 or over $1500 in excess baggage fees. As the colour drained from my face, the check-in attendant obviously took pity on me.  

“Not to worry”, he said, “You’ve plenty of time to go through your luggage, throw out anything non-essential and pack your hand luggage”.

In the middle of Heathrow airport I unpacked and repacked my luggage several times, disposing of toiletries and old clothes and packing my carry-on backpack to its absolute capacity. When that didn’t work, I decided upon a different course of action and duly returned to the check in counter wearing (and I am not exaggerating)…. two coats, three woollen jumpers and five t-shirts. I looked like a blimp and in the 30-degree English summer I was sweating like a lawn sprinkler. Although I don’t think I fooled the check-in attendant for a second, the plan worked, and shaking his head – a look of sheer bewilderment on his face – he handed me my boarding pass and gave me the all clear to board.

The next challenge came as I attempted to pass through security. My backpack was filled to such an extent that the Xray machine was unable to penetrate it. Alarms sounded, red lights flashed around me and multiple security guards, armed to the teeth, exploded on to the scene and surrounded me. I was herded in to a small room and asked, amongst other things:

  1. Why I was wearing enough clothes to last an entire season in the middle of the English summer?
  2. Why my backpack weighed 30kg and was so dense an industrial Xray machine was unable to see through it?; and
  3. Which terrorist organisation was I working for?

Several apologies and a complete bag check later, Heathrow security seemed happy that I was not as major a terrorist threat as first feared and I was eventually let loose on to duty-free shopping.

Posted in Uncategorized | Tagged , , , , | Leave a comment

The devil wears a hospital gown

Doctors are renowned as being terrible patients. That may be true, but if I might voice my own opinion, I would say that doctor’s mothers are no “day at the beach” either! I first formulated this opinion when I treated Mrs. Durst in the Emergency Department late one evening only a few months after graduating.

The encounter is emblazoned in my memory, as that particular afternoon was absolute pandemonium in the ED – every bed was full, there was an endless queue of patients in varying degrees of infirmary waiting impatiently to be seen by medical staff, and ambulances relentlessly dispatched a barrage of the local sick and injured into the semi-organised chaos. Every single doctor on duty was juggling several patients – all of whom seemed to harbour particularly complex problems – so when an ambulance brought in Mrs. Irene Durst, the senior consultant assigned me to the case. Strolling into the cubicle, I was presented with an absolutely tiny, yet buxom lady, who I guessed to be in her early sixties, and who bore an uncanny resemblance to a gargoyle. Perched precariously on the examination bed and sporting the biggest pair of gold earrings I had ever seen, which competed in amongst a huge crop of died blonde hair (I had seen carpet stains more natural than her hair), my patient lay on her stomach with flesh spilling over both sides of the stretcher. My first instinct was actually to laugh; despite only taking up just over half the length of the bed, Mrs. Durst had positioned herself so her head jutted forward over the edge of the stretcher as if suspended by an invisible string, her mouth wide open and her eyes focussed on the entrance to the room. If there was to be any action, she was going to be the first to know about it.

Startled by the movement as I entered the room, her eyes suddenly came to life, darting erratically from side to side before quickly focussing on me and eyeing me up and down. I was just about to introduce myself and launch into a medical history, when Mrs. Durst obviously decided to take the bull by the horns:

DARLING!” she cried, almost at screaming pitch in a thick European accent, “You must be the baby doctor the nurse was speaking about. Bruno is it? Brian? No… Ben, of course darling, that’s it. Listen darling, I know you’re not very… how shall I say… experienced, but I don’t want to be in here all night waiting for some Professor to take care of me. After all darling, it’s only a scratch. So you’ll have to do darling. Do you think you’re up for it?  Well, do you?”

“I’ll certainly do my bes..”

“Course you will won’t you darling!” cried Mrs. Durst, warming to the conversation, both the pitch and volume of her voice steadily increasing.

“I know what it’s like darling. My son’s a doctor, oh a simply splendid doctor. You’ve probably heard of him darling – Dr Durst, Dr. Robert Durst. Oh he’s a brilliant man. All his patients think the world of him, darling, love him they do. He’s always booked out. He’s a genius darling. Have you heard of him?”

“No sorry Mrs. Durst, I’m sure he is an excellent doctor but the name doesn’t ring a bel…”

 “Oh, don’t they teach you anything these days darling? He’s so well known my son is. Oh, such a fabulous doctor, and years of experience too. I always like to see a doctor with plenty of experience darling. You baby doctors these days get taught all this gobbledy fancy new research darling, but give me experience any day – just like my Robbie. And do you know darling, after all these years he hasn’t lost the common touch. He always looks after his Mother, he does. If only he wasn’t on holidays darling, he would have been over in a flash. Make sure you do that darling won’t you. Don’t forget your poor Mum when you’re a doctor. Look after her just like my Robbie has over the years.”

“Of course, Mrs. Durst, I will I will” I stammered. “Now what has brought you in here toda…”

“Irene darling, call me Irene. Mrs. Durst makes me feel old darling, and I don’t feel old at all. My Robbie says I don’t look a day over 50 darling and he should know. Oh the ladies in his practice just adore him darling. Actually, you’re not bad looking yourself darling (my failsafe ability to charm the oldies coming to the fore I thought with a wry smile), but my Robbie is such a good looking boy.”

“That’s lovely Irene, what seems to be the proble…”

“Darling, darling, you’ve got to stop this chatter. It’s time we got me sorted out. Oh, I know what it’s like darling, my Robbie has trouble like that. He’s just so nice to everyone, he gets terribly behind in his schedule. But his patients don’t mind darling they love him for it. It’s my back darling… my back. Oh I am a… how-do-you-say… butter fingers? I was painting the kitchen darling, a beautiful shade of duck-egg blue; it’s fabulous darling. My husband can’t stand it darling, but I didn’t marry him for his taste. Yes, I was painting the roof of the kitchen darling, but I tripped and fell through the kitchen window darling. I thought I was done for darling, I thought it was the end. I work too hard darling, too hard. I’m tough though darling, and it looks like a made it. I’m just so mad darling that I didn’t finish the roof before I fell. Oh, and I must tell you this daring, when that charming ambulance man – very experienced he was, just like my Robbie, Oh I do love dealing with experienced people darling – wheeled me outside, I could see Gina, my neighbour darling, staring at me. If only she was in ear shot darling I would have given her what for. You’ve no idea what she’s like darling, her husband not ten minutes dead and already flirting with the postman. She brings the tone of the whole street down darling!”

And on it went.

Irene didn’t seem to stop for breaths. Eventually I managed to get a word in and attempted to salvage the remnants of a medical history.

“That’s fine Irene. Just before I have a look at your back, do you have any other medical conditions I should know about?

“What about allergies darling? My Robert always says you should ask about allergies first. Oh and he should know darling?”

“So… do you have any allergies Irene?” I stammered, clearly now on the back foot.

“Allergies? Of course not darling – a sign of weakness if you ask me. No I’m fit as a fiddle darling, never been better.”

 Admitting defeat, and satisfied that I had at least gained some remnants of a medical history, albeit unconventionally, I decided maybe an examination of the injuries would be in order. Explaining my intentions, I undid Irene’s gown amidst a relentless barrage of conversation revolving around her son, to discover a series of nasty lacerations on her back, seeping blood and obviously requiring some serious suturing to repair. As I completed a secondary surbey looking for any other injuries, quite amazingly – considering the nature of her fall – the back proved to be the only site of damage.

There was at least two hours of stitching required here, I estimated, to rejoin the jagged edges of the lacerations on Irene’s back, and as I considered what the the next two hours held in store, I think at that point, something inside of me died!

This was going to be one for the diary…

“Can you see what I’ve been through today darling?” Irene wailed as I finished my examination, “I’m going to need stitches darling, do you think you can handle that? My Robbie is so good at stitching darling, I’ve never seen him leave a scar. That’s experience for you darling. Well let’s get it over with then I haven’t got all day darling; this injury has already consumed my life darling, I’ve missed a hair appointment this afternoon and it’s so hard to find a good hairdresser these days don’t you think”.

“Quite, Quite,” I mumbled, attempting to collect my thoughts in amongst Irene’s unrelenting tirade and the chaos of patients around me. “Just relax here while I find the equipment and then we’ll get started”.

“Whatever you say darling, whatever you say. I’d use size 4 nylon myself – Robbie always says that gives the best results and he should know darling. Oooh he’s such a good doctor, never leaves a scar….”

Nearly running from the room now, I was some distance away from the cubicle before Irene’s ranting finally fell out of earshot. Taking a few deep breaths, I made myself a quick cup of tea before hunting down the equipment I would need to sow Irene back together – suturing set, local anaesthetic, size 4 nylon (who was I to go against Robbie), surgical gloves and gown; unfortunately no ear plugs were available. A quick check with the consultant confirmed my view that the wounds were superficial enough to stitch and none warranted further attention, then taking some deep breaths I prepared to head back into that cubicle. This was going to take a while.

Irene’s voice hit me like nails on a chalk board, several metres from the entrance to the room.

“Surely she can’t be talking to herself” I thought, as I pulled open the curtain, preparing for round two. Irene wasn’t talking to herself; she was venting her spleen on a very skinny, greying man who was sitting next to the bed, holding a beautifully crafted wooden walking stick.

“I hope you don’t mind doctor. The nurse showed me in while you were away,” the man spoke very quietly in a thick English accent, his wrinkled face radiating friendship and appreciation, as he stood up to shake my hand with military bearing. “Thank ye so much for helping out me wife – I was right worried when I saw her fall through the glass.”

“Harold!” Irene erupted as if her husband had just issued an obscenity, “Don’t bother the doctor. He doesn’t have time to waste on you. I’m the one who almost died today… and missed a hair appointment. My nerves are shot to pieces. I’m booked in to have my eyebrows done tomorrow and if I can’t make it… well I just don’t know how I’ll cope”.

“Yes of course dear” said Harold, giving me a long-suffering smile and sitting back down immediately.

“Now darling” cried Irene at a deafening volume, “let’s get moving, yes? Which one shall we stitch first; I think that cut on the left will need about four stitches. Robbie always says they should be about 1cm apart for best results, and he should know darling, oh, such an experienced doctor”.

Donning my gown and gloves, before I began the process of injecting local anaesthetic, I quickly checked that Harold was comfortable to watch the procedure, and didn’t, for example, faint at the sight of blood.

“Don’t you worry Doctor” he assured me, “I fought in the Great War and I’ve seen worse than this in my time”

“He’ll be fine darling. It’s me you should be worried about” cried Irene.

“Just one question doctor” interjected Harold softly, as I filled my syringe with the local anaesthetic lignocaine containing adrenaline (added to help prevent bleeding), “Will it be very painful?”

“Oh Harold don’t be so ridiculous” shouted Irene, “I’m not worried about a little sting. Although my Robbie never hurts anyone darling; his patients don’t feel a thing.”

“Actually Harold”, I said “The actual stitching process shouldn’t hurt at all, but to be honest, injecting local anaesthetic can be a bit unpleasant. It’s likely to sting for a couple of seconds before it starts to go numb”.

That took the smile off Irene’s face, and quietened her down for a few minutes, and as I held up the syringe and squeezed a few drops out the end, I was sure I could detect the faintest twitches of a smile appearing at the corner of Harold’s mouth. He was no fool I though to myself, and as he leaned back in his chair and folded his arms, his face said it all: after years of living with Irene now was his chance, even if only for a few minutes, to gain the upper hand.

And so it began. Amidst Irene’s assertions that I was injecting at a different angle to Robbie, which explained the unnecessary stinging sensation (that every patient receiving local anaesthetic inevitably experiences), I infiltrated the first laceration with local and waited a few minutes for it to take effect.

Unlike the vast majority of the new doctors I studied with, I am actually very confident at stitching. So many of the skills that medical students were expected to gain experience at (plastering, taking blood, putting in drips etc) required so much effort for me to master – or at least gain some semblance of competence at. However for some strange reason, stitching seemed to be second nature to me. I have thought at times that I missed my true calling as a seamstress or dress maker, as I could be presented with a jagged, dog-eared cut, and by the time I finished it was a barely discernible line. I first discovered this in the Emergency department as a third-year student when a consultant asked me to stitch up a builder who had lacerated his arm. When I explained that up to that point I had done only two stitches – both of them on fake skin – and had never injected local anaesthetic, she simply gave a laugh, said “you’ll be right”, and locked me in a room with the builder. I was absolutely sure this would end in, at the very least a medicolegal disaster, possibly the permanent loss of function in this poor builder’s arm, and the outside chance of amputation. Fifty minutes later however when I emerged – sweating profusely and with an incredibly sore back from leaning over the patient –  the consultant couldn’t believe I had transformed that gaping, bleeding mess into a perfectly even, neat line. News spread fast, and from that time on, whenever there was a stitching opportunity and I was on duty, it was automatically left to me.    

Consequently, I began stitching up the large wounds in Irene’s back with vigour, constantly assessing where to place the next stitch so as to avoid puckering at one end of the wound, which significantly decreases the cosmetic result. Irene, however, was not going to let this prime opportunity to educate the next generation of doctor pass, and now out of pain, she really opened the throttle with a stream of educational comments:

“Darling, darling, Robbie puts the needle in much further from the edge of the cut than that. You don’t want the stitch to pull through darling”;

“My Robbie never does two loops when he ties his knot darling, and I’m sure that’s why he never leaves a scar”;

“Darling, that cut could obviously use another stitch, no?”

Through this unrelenting barrage from Irene, I plodded along, anaesthetising each laceration and carefully stitching it together. I was actually amazed at Irene’s flexibility and endurance; she was able to lie on her stomach with her neck craned almost at 180 degrees to view the progress and pass  judgement. No amount of subtle encouragement would convince her to lie down and relax for a while. After the first hour, I found myself wishing that the infamous Robbie might actually show up and relieve me, but unfortunately it was not to be. Harold too, must have thought that Irene was becoming a little overzealous with her commentary, as he decided to try and stick up for me:

“Irene dear, don’t bother the nice doctor. Let him get on with his work. I think he’s heard enough about Rob”.

“Don’t be ridiculous darling” came the instantaneous reply. “I’m helping him darling. We wouldn’t have got nearly this far if I wasn’t here. He’s not a real doctor you know”.     

Two hours and 118 stitches later, I tied my final loop and stood up, exhausted, to survey my handiwork. Stretching my aching back, I looked with satisfaction at the lines of neat stitches the transversed Irene’s entire back. Irene looked like a patchwork quilt, but at least she was in one piece. As I covered the wounds with waterproof dressings, and confirmed that Irene was up-to-date with her tetanus vaccination, I explained to Irene and Harold the logistics of having stitches:

“Now Irene, the stitches will need to be left in for at least 7 days, and you can get your son or your local doctor to remove them. In the meantime, you have to keep the area dry. Also, if you notice any bleeding, you need to apply firm pressure and ice for at least 20 minutes. Should the bleeding continue despite this, which is extremely rare, you will need to return immediately to the Emergency Department. Also, if you notice any signs of infection – redness, swelling, discharge, pain – you will need to see your local doctor or come back here to get some antibiotics.”

I wrestled in my mind whether to ask the question that ended most clinical encounters, particularly in view of what I had endured through the last two hours, but in the end my morals won out…

“Do you have any questions?”

This was like waving a red rag to a bull, and I could see Irene about to leap into action, when Harold stepped in, obviously deciding that enough was enough. Summoning the courage that enabled him to leap from the trenches inFrancesome 60 years go he said quickly:

“No that’s fine doctor, I’m sure my wife understands that information. Thank you very much for all your time. We both really appreciate it and I’m sure you’re going to make a wonderful doctor. Irene… we’re leaving.”

“But Harold…” cried Irene, in more distress now than at any other occasion throughout the encounter.

“No, leave the poor doctor in peace. I’m surprised he hasn’t stitched your mouth closed!”

I could have hugged him right then and there. Instead, in a rare moment of self-control, I simply shook his hand, wished Irene all the best and left the cubicle.

 As I walked briskly towards the staff room, satisfied that I had done the job to the best of my ability, I should have known it was too good to be true. With a force that would have measured on the Richter scale, I was almost deafened by a high-pitched voice that thundered through the entire Emergency Department:

“Robbie takes his stitches out after five days darling. And he always says real doctors should wear a tie to work. You should think about that… after all, he’s very experienced!”

Posted in Uncategorized | Tagged , , , | Leave a comment

The beginning…

“They just don’t teach you how to deal with this kind of thing in Medical School” I mused, as my sweet 86 year old patient lying in the Emergency Department opened her legs and asked me to sleep with her. Avoiding the impulse to run, vomit, or yell “I think that fruit is out of season!” and as my eyes frantically focussed on anything other than the pensioner voyeur making seductive gestures in front of me, I realised, in fact, that most of the expectations I had fostered for my first year as a full-time Doctor in hospitals had been very wide of the mark.

My university years hadn’t exposed me to aggressive alcoholics, prepared me for patients who thought they were a kettle or believed they could talk to dolphins, or even accustomed me to dealing with death or people in horrific pain. University lecturers didn’t berate me for being stupid, lazy, hedonistic, immature and immoral, or at least not with nearly as much vigour as hospital professors! The simulated patients we practiced on during clinical skills sessions were all perfectly healthy, terribly co-operative and encouraging, and, with the possible exception of some of the volunteering Arts students, weren’t high on illicit drugs. Medical textbooks were literally bursting to the seams with glossy colour photos of very serene and sterile doctors calming examining angelic patients, who looked reverently at their saviours with trust in their eyes, absorbing their every word. Everyone was smiling and obviously enjoying the experience.

University open days conveniently forgot to mention the obscenely long hours, the early mornings, or the fact that in the hospital food chain medical students and interns were positioned lower than the cleaners. No… I had read – or at least browsed – the textbooks, and attended most of the lectures and there was absolutely no reference to being vomited on, sprayed with blood from hysterical patients with lacerations, being propositioned by pensioners with dementia, or having to drive to a patient’s house to feed their cat in a vain attempt to stop them from discharging from hospital.

In this instance, as I made a hasty exit from my geriatric femme fatale, I don’t know whether it was shock, repulsion or simply a defence mechanism of the body designed to help cope with extremely distressing images, but at that instant I felt that it was a perfectly acceptable option to drop out and become a postman. Funky uniform, working outdoors, a nifty bike… what more could one want out of life?

And as I relayed my horrific experience to my fellow intern colleagues at lunch the following day, hoping for some sympathy or maybe even some condolence, I was surprised to find their responses almost unanimous… “So Ben… when’s your next date?”

Posted in Uncategorized | Tagged , , , , , , , , , , , , , | Leave a comment