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Friday, October 2, 2009

Friday night Folly

The following is an account of our end of the month friday night shift a few weeks ago. It's long. It has no structure. It might all seem a little pointless...

Which is pretty much a description of the evening itself:


My arrival at work is unfortunately not signalled by the large marching band, fireworks and a rip-roaring guitar solo played by a topless Greek God that I think I deserve.

Oh no...instead I am greeted with that age-old traditional greeting, peculiar to the lesser-incisor'ed native of the Cape Flats:
"Jou ma se poes!" (your mother's cunt!).

Seems that one of the psych patients has escaped from the front room, and is currently freaking out in the parking lot outside the unit, screaming obscenities at everyone. He is wearing a hospital blanket and shoes. As I walk past him into the unit, the security guards rush past me to try and capture him...but this one is a wily little bastard who immediately dropped the blanket, exposing his naked buttocks to the world and took off running like a man escaped from prison into the darkness...They might catch him, they might not.
Judging by the pendulous belly on the security guard, my money is on the patient.


I walk into the unit giggling...but this false sense of fun is soon arrested when I realise that there are no other doctors to be seen. Alarm bells start ringing when no-one is in the front room, it's a sign that they are somewhere else. And that somewhere else is usually in the resuscitation room, where there is probably some major shit going down.

I sheepishly shrink off to the tea-room to deposit my things, before braving the carnage I'm certain is waiting for me.

I'm not disappointed.

Dr MB and Dr Mommy are busy doing CPR on a morbidly obese lady in one corner.This happens in the resus room all the time. HOwever, what is peculiar about this is that they are performing this potentially lifesaving manoeuvre on the floor! Hospital is at capacity so no more stretchers available. Silly me to expect stretchers, in a fucking hospital.

What's that Department of Health? Oh, you don't give a shit? Tell me something I don't know.

Oposite them, Dr K and the surgeon are frantically trying to gain intravenous access on a patient. This man has been shot through his chest, possibly through his heart/aorta/lungs/trachea/oesophagus....blood pressure is dropping very quickly and things are looking pretty grave over there...

I notice the medical intern at the back of the room struggling to intubate one of his patients in severe respiratory distress...Looks like that's where I'm needed most, so I make my way over to help.

However, my efforts are thwarted by the head nurse who thrusts a fat folder into my hands and tells me that there is an old man having a heart attack in the waiting room. ARGH!

Sorry little intern...you're on your own.

As expected, the old man is of the Kentucky Fried Chicken-loving kind, and I can see the nicotine-stains on his teeth. According to his clinical symptoms and ECG he most definitely is having a heart attack.

By this time the resuscitation on the lady on the floor has been called off.
We couldn't save her and she couldn't save herself. Call the family. Break the bad news and move her out of there. My heart attack guy needs a bed in resus so that we can initiate treatment and try to save what's left of his myocardium, so that he can get to work on destroying that too .

As I wheel the old man into resus the gunshot wound patient is being wheeled out of resus to the trauma theatre...
He doesn't make the few metres to the operating table, and goes into cardiorespiratory arrest in transit.
All efforts to resuscitate him fail.
I wonder why he got shot? Was he the bad guy or the good guy? I suppose it doesn't really matter..

I stabilise Heart Attack Guy ( we speak about our patients in terms of their diseases, rarely bothering to learn their names) and hand him over to the medical team.

What a start to the shift! As I walk out of resus and back into the front room I am confronted with a warzone.

The front room looks like it has been the site of a recent explosion, people shouting, people wandering around aimlessly, people crying, people everywhere.

In five years time I am gong to have post-traumatic stress disorder and then I'm going to have Vietnam-war-like flashbacks to this moment.

I am immediately cornered by the staff from the ambulance vehicles who have brought us five patients involved in an MVA. Where in God's name are we going to put these people? As I wearily start accepting the patients I hear the door creak open to reveal the paramedics wheeling some more people in on stretchers.

Doesn't it ever end?

Despite the ambulances dropping off new patients, there are still about twenty unseen patients names in the book from the previous shift. Some of them have been here for more than six hours waiting to be seen. They are scattered all over the front room. standing, sitting, lying on the floor. There are no more stretchers available and the super-intendant is taking forever to close the hospital despite being at full capacity. I secretly want to curse the previous team for leaving us with so many to see, but I know that they were just as busy as we are and that I can't really blame them.

A little while later I hear a commotion in the corner, and look up as the police escort two violent psychiatric patients into our unit for assessment. While trying to wrestle them to the ground, the policemen are sending impatient looks our way as they wait for one of the three of us on for the night to sedate the patients so they can carry on with their jobs. I ignore them.

Almost immediately some traffic officers join the party and escort in three drunken drivers for blood alcohol testing. I most definitely ignore them.

Christ almighty I'm seriously hungry. Not sure when I'll get a chance to eat.
While contemplating how many patients could have been seen in the time it takes for me to eat supper, I notice an old demented granny using the dustbin to poo in.
After I shouting at her not to do so she stops, mid-poo and trundles back to her bed...dripping the rest of the interrupted evacuation in neat little puddles on the floor behind her.

I have suddenly lost my appetite.

Straight ahead lies an epileptic patient who is confused after having a seizure. He promptly whips out his penis to pee on the floor next to the bed. Some of it splashes on the escort of the patient lying next to him and a fight ensues between the escort and the confused epileptic.

Inhale. Exhale. Inhale. Exhale.

I try to comfort myself with the fact that I'm gaining invaluable experience tonight that I probably wouldn't have learned anywhere else.

What I'm actually learning from these patients is how to make the most of one's Friday night:

Get drunk, drive a car, crash and fracture your pelvis. Get drunk, walk through the ganglands alone at night, get stabbed multiple times. Get drunk, get high on tik, walk in the middle of the road and get hit by a car, fracturing you tibia in three places. The fact that you are too high and drunk to realise that your leg is moving in the most sickening paradoxical motion unintended by nature's design is a testament to the analegesic effects of beer. I can feel the pieces of your shattered tibia grinding against each other while applying the plaster of paris. I think I'm going to vomit.


And what about you lady? What lesson will I learn from you? I see that you are lying face down on the stretcher and you have decorated yourself with long curly braids, earrings, and a large knife handle protruding from your back. I assume that the blade is stuck somewhere in your chest cavity. Tell me, what style of knife handle is in fashion now? MUST get myself one of those for the summer.

Luckily for you, the knife gods divined that the blade should only penetrate superficially under your skin so I can proceed to cut the thing out of your back.

Cool! At last something fun to do!


And...oh...here we go right on time at 04h00 hours. It's the nightly on-call entertainment, performed by the resident nutjobs.

Settle in y'all ! Grab the popcorn! Tonight it's a gut-wrenching caterwauling ballad from psych patient number 6 of the evening. The verse is an ecclectic mix of beautiful arabic verse sporadically punctuated by "Julle vokken holnaaiers". (you fucking bumfuckers). The chorus consists of her screaming obscenities as we wrestled her to the ground to sedate her.

Furthemore her insane soliloquy is manifested by an interpretive movement piece performed by psych patient number 5.
He has been pacing around the big doctor's desk in the middle of the front room incessantly for the last half an hour.
Round and round and round on a mission to nowhere, wearing nothing but a hospital gown and a cool leather hat on his head.
It's impossible to stop him circling.
I dodge bumping into him for the nth time that evening, as I bend down to take blood from another patient (who is lying on the floor). As I do so,the flesh above the back of my jeans is unintentionally revealed. This sets the psych patient into a maniacal hypersalivatory state, resulting in him screaming at me to:

"sit jou hol weg. Maak toe jou hol! Dis MY hol, net ek kan jou holle sien!!!Die ander mans kan gaan kak!" (Put away your bum! Close up your bum! That's MY bum, only I can see your bum! The other men can go to hell!)

And that's when we rugby-tackled him, stapled a note that said "please abort" to his forehead and injected enough valium to send him straight back to his days as a fetus in the womb. Hopefully his mom would read the note and take our advice.

My sense of humour is nonexistent at this point and EVERYTHING is irritating me.

Even this poor 17 year girl who was depressed enough to try and take her own life by ingesting shampoo, hair gel, and toothpaste.

Even this 20 year old girl with multiple bruises after being beaten up by her boyfriend, and claiming that it was her fault she got hit.

Even the very frustrating fact that the nurses are only taking the temperatures of every second patient and not testing anybody's urine.

Speaking of urine - I should have gone to pee three hours ago.

But I'm NOT using the front room toilet. I don't care that I'll probably develop a urinary tract infection or an atonic bladder from keeping it in, but the last time I went in there, there was a delirious patient pissing all over the walls. And there was runny poo in the bowl.

The night is almost over anyway, I'll just keep it in until I get home and then burn a hole into the porcelain when I do eventually relieve myself.

Soon the new team arrives. I barely make it through the handover ward round, mumbling through my presentations of the numerous patients I don't remember that I've seen...I'm sure the consultant thinks I'm a retard.

Bleary-eyed and hypomanic from sleep deprivation, I stumble through my front door.
How did I get home? Did I drive? I can't remember.

While undressing I discover a huge blood stain on my sock. With no sign of injury to my foot I can only assume that the blood belonged to one of the trauma victims I saw last night.

What the FUUUUUUUCK!?!?!

What other bodily fluids have been deposited on my person that I don't know about?!?!

YUK!

I scrub myself raw with nuclear waste just to make sure I killed whatever was lurking on my skin.

I then collapse into bed like a boneless toneless fleshy lump. The most I can manage is to open my mouth while my husband feeds me breakfast...

I'm barely alive, but I survived the Friday night nastiness...

Only ten hours till I'm back for the Saturday night slaughter...

9 comments:

Spark Star said...

good god what a day!!!!

I am gonna be an intern in a month..

(Shudders...)

damn the hellish duties

(shudders again..)

Femgineer said...

I guess you can't wait for this sh1t to end. I've now read ALL your posts and can continue with my work. It's addictive.

Dr S. said...

Sparkly Star*****

YOU WILL BE BRILLIANT!

YOU WILL SURVIVE!

YOU WILL BE A SUPERSTAR DOCTOR!

just wait and see...

Femgineer: Can I just say that I love your name. Hard hats and high heels are the images I get when I read your name. THANK YOU FOR YOUR SUPPORT! mwah.

femail doc said...

Another crazy shift with the Cape Flats Knive & Gun Club, eh? Haven't visited in awhile, what comes next for you?

Stupidosaur said...

Hell!

(Movie based on you will be Angel in Hell or something)

Alia said...

This is a brilliantly written post Dr S. Both shocking and funny. Well done. love it.

Alia said...
This comment has been removed by the author.
Alia said...

and i never thought i'd say it, but i miss the lesser incisor'd natives of the Cape Flats!

Dr S. said...

Welome back Femail doc - Mad Medicine missed you.

What comes next? Well, I'm applying for a post at the same hospital next year. It's a medical officer's post in the Infectious Diseases Clinic, with the overtime being done in the front room.

I'll probably end up in internal medicine some day, but am happy to learn a bit more about infectious disease and have a relatively less hectic shift life next year while I sort out my next move!

ALIA: Thanks lady. All of it is the truth. All of it is real. Including burning a hole in the procelain.

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