Last Night on Call

I like your necklace

Highlights package from the other night:

- A man presented to the EC with a painful knee. He had an operation on the leg ten years ago, and the clinical suspicion was already that he was suffering from degenerative changes in the joint after that operation. When I approached him, I saw: a puffy red face, full on the sides, red eyes, and a man trembling in his seat. He appeared to be distressed, and the tremor was clearly bothering him. Upon further enquiry, he mentioned very quietly that he had a problem with alcohol. What did he mean by 'a problem'? Well, he drank 3 liters of white wine a day (which is more water than I manage to drink every day). However, he only admitted that he drank 1 per day to me. When I asked him how long this problem had been going on for, he told me three months. I almost laughed out loud. People lie, oh do people lie. I saw later he had been admitted four years earlier for an alcohol withdrawal, which was I thought he was experiencing during this visit too.

Those experiencing a rapid withdrawal from drinking alcohol can deteriorate into a clinical state called delerium tremens, which is life threatening. I'd never seen one before.  I watched his shaking settle into stillness before my eyes as we gave him some benzodiazepines. Our plan was to give him thiamine and benzodiapepines in a controlled way to help him overcome the withdrawal. 

The notes mentioned that he knew he had a problem and had been counselled about it, and that he was willing to seek help. Perhaps it's the cynic in me, but I just knew when he went home he would run straight back to his box wine, and we would see him again sooner or later. 

- Belle's name flashed across my screen. That was weird, it was 11pm and she was not on call. I answered, she asked me how the call was going, so of coarse I had to ask her how sitting at home and relaxing was going, and why on earth she was awake and calling me. She told me that the lab had called her about one of her patients. He was a man from the psychiatric ward who had a reaction to his medication and was being treated by medicine. His latest marker had come out as alarmingly high, and he required fluids very urgently. I went up to the ward, and of coarse, he had no drip inserted. 

I shook him awake, and he looked up and me blurrily, a sleepy grin smothering his face. I told him I needed to insert a new drip and he nodded. I sat alongside the bed and searched his swollen arm for a vein. When I glanced up I noticed the goofy grin on his face, he smiled at me... like an over-familiar psych patient. I managed to cannulate the only good vein I could find, and I told him that if the drip came out he should call the sisters so we could put a new one in, this was urgent.

That was my first error, because twenty minutes later, the drip was 'out'. 

I returned to the ward to find him on the edge of the bed. He smiled goofily when he saw me. I asked what happened, and the answer was of coarse, that he wasn't quite sure. He then went on to explain that it was actually working, he had just needed me to check it. No need for more needles and more pricking, just for me to come to the room and check.

Of course, the sister was right and the needle had tissued - it wasn't in the vein anymore but was in the tissue around it. When I tried to flush it, his arm swelled. He didn't really seem to understand until I showed him, and a part of me was quite sure that he did not know the drip was out at all, and in fact did not wish to be poked and prodded yet again.

I applied the tourniquet to look for another vein, but his arms were both so swollen that nothing was really showing itself. I ran my fingers along the common spots, waiting to feel the characteristic sponginess of a vein, hoping I could go on feeling instead of going on what I could see. He then pointed to the middle of his forearm, and told me to insert a drip there. I told him that there was no vein there. He almost laughed and said, "yes there is, its the vernicular vein." This vein does not in fact exist.

He became so insistent at one point that I was tempted to poke around there just to prove my point. That was just the sleep deprivation speaking, of course. 

I saw a vein, and decided to go for it, hoping it didn't kink or reveal itself to be too small for the cannula. I was lining up the needle when he lifted his hand slowly and brought it to my cheek in the motion of a tender caress. I leaned backwards to avoid his touch. I decided to completely ignore the gesture, do my work, and get out of there.

"I like your necklace," he murmured, bringing his hand towards my neck. I leaned back again and luckily the drip slipped right into the vein and I darted out of there. When I got back to EC I told Carl that if there was another call I would need him to go otherwise I'd be up and down the whole night. 

The next morning, we only had one patient to see in the ward. I walked in with the round -  a consultant, three medical officers, me and two students. And wouldn't you know it, the room with Mr affection. He approached me in front of a whole team of doctors, roses in his eyes, and said loudly. "Hi doctor, I was so hoping you would come and see me today."

I felt my cheeks burning. 

On my way out, who should be in the doctors room but Belle. I strolled in to tell her my story of woe and she laughed, telling me "I told you he was strange. Weird though, he's gay."

"Is he??" I laughed.

Cameron leaned over. He was the intern looking after the patient during the day. "He was much worse before," he told me. "The other way I was worried about meningitis so I decided to do the test where we take the head and bend it forward to check for neck stiffness. So I told him I'm going to touch your head now, is that okay? And he said, I'll touch your head, and reached for my groin." Cameron didn't find that as funny as I did.