Blood and Leather

What is it about motorbikes that turns grown men into teenage boys with too much testosterone floating around inside them every time they get on one?

I've lost count of the number of times we've nearly been wiped out by one of these idiots coming round a blind bend on the wrong side of the road when I'm out for a country drive with Mr Mousie at the weekend. When I am finally able to prise my fingernails out of the dashboard and regain my composure, I congratulate Mr M on his lightning-fast reflexes and the advanced driving skills which enable him to take evasive action so effectively. Then I start swearing and ranting (and generalising wildly, granted) about what selfish bastards motorcyclists are.

John was not such a biker. His wife explained to me that he'd never had an accident in all the time he'd been riding. She told me he often talked about the behaviour of other motorcyclists and how they gave biking a bad name. He was conscious to always ride safely and courteously, for the sake of his two young children if nothing else.

The friend who'd been with him riding down the dual carriageway this morning told me they'd been doing the national speed limit. No more. There was no need to go faster - "Seventy feels just as exhilarating as ninety" John always said.

Which is why it's so unfair that the tractor pulled out of a side road right in front of him this morning. He didn't stand a chance. I can only imagine the horror as he realised, with his final thought, that he was going to hit it. His mate, riding behind, saw it all.

We got the red call through on the radio and called down the trauma team, but it very quickly became clear that he was dead. Traumatic cardiac arrests rarely have successful outcomes in my experience and you don't go head-on into a tractor at seventy miles per hour without doing some serious damage. It wasn't long before we switched off the machines and started removing the tubes and lines we'd just put in. As we rolled him off the spinal board, inside his leathers his smashed leg bones crunched and flopped and bowed horribly in my arms. One of the paramedics brought in his helmet, the inside flecked with blood and bone and brain. I felt sick.

John's wife arrived shortly afterwards with a police family support officer. What an awful job it must be to have to knock on someone's door and tell them they have just become a widow. As she sat in the relatives' room with her head in her hands, she could not cry, she could not look up. Once in a while she quietly spoke, saying something like what a careful rider he'd always been or how he'd always kept to the speed limit, or how he'd never even had such thing as a minor shunt before. As if, somehow, these things meant that this could not be happening to her now. That this thing could not be true.

Making Life Taste Better...

We've recently been seeing quite a lot of John. I feel I am getting to know him quite well! He tells me he's moved from the big city "to take advantage of the cleaner air" around here. He says this without a hint of irony, despite the fact that he spends the vast majority of his time drinking strong lager and smoking roll-ups in the scummy basement of a dingy flat.

John's favourite trick is to help himself to a bottle of whisky or vodka from the shelf of a local supermarket. He opens it, takes a seat on the floor and starts swigging from the bottle right there in the booze aisle! When he is approached by the store security guard, he "collapses" so that an ambulance is called. Somehow he always manages to secrete the bottle about his person and, funnily enough, the supermarket is never too bothered about getting it back once he's had his chops round it.

His other scam is to fill up his trolley with shopping, go through the checkout and then, just as he is about to pay, to collapse to the floor. Once again, an ambulance is called and, as he is being loaded into the back of the truck, invariably some kindly soul will follow on with his bags of shopping. When he "comes to" the first thing he asks is where the paramedics have left his groceries!

I hate memes!!

But Noddy tagged me and I could never say no to him!

The Rules:

1) Link to your tagger and post these rules on your blog.

2) Share 7 facts about yourself on your blog, some random, some weird.

3) Tag 7 people at the end of your post by leaving their names as well as links to their blogs.

4) Let them know they are tagged by leaving a comment on their blog.



K, here it is:

1) I once had my nose pierced and all my hair cut into a pixie crop and dyed bright red at an "out-there" hair salon in Camden market whilst I was on my lunch break. It took 2 hours. My boss wasn't very impressed. I was only meant to take half an hour for lunch. The cut was wicked though.

2) When I was in 6th form I had a cat called Kevin T. Kat (I know, I know....) who was the coolest thing on 4 legs. I forget why... He got run over by a Volvo driver while I was away on my gap year out. I've always hated Volvos since.

3) When I was little I saw some older kids break an egg onto a girl's head as some kind of weird birthday ritual. I've disliked eggs ever since.

4) I've got a thing about crap signage and would happily go out after dark with an indelible marker pen correcting poor grammar, punctuation and spelling if Mr M. would let me. There's a shop on my way to work with an A-board outside which reads "STOP HEAR,AND BYE ONE!!! ICE-CREAM'S,AND COLD DRINK'S!!! 2-4-1!!!" It makes me want to commit arson whenever I drive past it.

5) I can speak 5 languages fluently, although, occasionally, if I start speaking in one, bits of all the others start creeping in and I can barely understand myself at times.

6) I have been known to abseil off very high bridges and viaducts in the wee small hours of the morning for kicks. I was also part of a gang who scaled the walls of an historic building (I can't say which one obviously!) and "borrowed" the flag from the flagpole one dark night. We went back the following night and returned the flag to its rightful place.

7) When I was at university I used to work in a pub often frequented by premiership footballers and spent many a quiet, relaxing evening drinking red wine with Ruud Gullit, Glenn Hoddle, Mark Hughes, David Platt and Dennis Wise, to name but a few. Things were so different back then...

So there you have it.
Random? Definitely.
Weird? You tell me.

I'm tagging:

• Steph
• GND
• BBP
• Faith
• Elaine
• PCSO Jo
• CPM

I look forward to reading them!

R.I.P. G.P.A.C.

GPAC is to close.

This is Not A Good Thing. For as much as I may have pretended to hate them, the people formerly known as the bastards that work there are now known as the poor bastards that won't be working there for much longer. They've all been given ninety days notice that they'll be moved to another ward or department somewhere... anywhere... to plug the staffing gaps which are rife throughout the hospital: like it, lump it or leave. I notice that the gynae ward currently has three vacancies, but who wants to do nippers and kippers? Can I still say that in 2008?

Meanwhile, back at the ranch... We are, we're told, in the middle of an "ongoing financial crisis" and shutting wards is the only way to save the hundreds of thousands of pounds needed for:

1. The Chief Exec's annual office refurb
2. New artwork in the foyer
3. Restocking the flower beds at the main entrance; and
4. Those essential board meetings coffee and sandwiches

GPAC was the "obvious choice" because patients referred by GPs can instead now be "absorbed" elsewhere.

And where exactly might they all be absorbed? I'll give you three guesses.

Polishing off the Pen-Pushers

It is nine o'clock in the morning. Barry, one of the senior "nurse" managers, walks in and rolls up one of his grey suited trouser legs in front of me. I start running through the possibilities in my mind:

1. He's gone mad.
2. He's coming on to me.
3. He's joined the Freemasons and/or Scientologists and is checking to see if I have too.

Then I notice the urticaria creeping up to his knees and breathe a sigh of relief: it's none of the above; he's simply having an allergic reaction to something. I can deal with that.

I show him to a cubicle and he tells me that, apart from the itchy rash, he feels otherwise well, his obs are ok, he's not short of breath and has no facial swelling. One of the MAU managers has had the sense to give him an antihistamine tablet so I sit him in a cubicle and cannulate one of his veins (just in case he deteriorates) while he waits to be seen by a doctor; I'm buggered if I'm going to move him up the queue.

Some time later, one of our more, er, enthusiastic SHOs goes in to see Barry. He has a listen to Barry's chest, hears a wheeze and, without pausing to ask Barry about his recent chest infection or his 40-a-day Benson's habit, reaches into the resus trolley next to him and whacks some intravenous adrenaline into Barry's cannula.

I choose this moment to walk past the cubicle and see Barry looking rather more unwell than he did when I left him five minutes previously. He is grey. Except for his hands, which are blue.

Come to think of it, even the doctor's looking a bit peaky now too.

I give Barry a bit of oxygen and attach him up to some monitors and he soon comes round a bit. Then, after exactly 3 hours and 59 minutes of observation, we send him up back to his corporate office suite and all's well that ends well.

Hattie is not impressed: she and Barry go back a long way; over the past few years there have even been some malicious rumours that they go back a bit further than most... But, more importantly, he's her boss now and she could do without the staff trying to bump him off. It doesn't look good when she goes for the next grey suited position. She gives the SHO a lecture on the difference between a mild allergic reaction and full-blown anaphylactic shock, then goes on to outline the dangers of the indiscriminate use of potent intravenous drugs.

“And, young man... You can be grateful for one thing” she thunders “At least he didn't breach!”

Door-Mouse

Regular readers of this blog may be forgiven for thinking that I am always... ahem... sweet, kind, compassionate and non-judgmental. I am therefore sorry to have to break it to the three of you that this is not always the case. In fact sometimes I am uncaring, heartless and downright horrible to my patients. Difficult to believe, I know, but nonetheless true.

A case in point: this evening, a chav family outing at a local hostelry ended up in a brawl, leading to three of the tattooed, toothless and tracksuited cretins rolling up in my A&E department. They'd set about each other with knives but unfortunately none of them appeared to be seriously injured. Indeed, they all seemed to be best mates again so after triage I sat them all out in the waiting room together.

A little while later, a woman in a nice pink scarf came through and asked politely if I could do something about "those idiots in the waiting room". She told me that they'd been spitting, swearing and shouting and that their behaviour was alarming some of the elderly people there.

I paged Security and went out to the waiting room to have a word. I reminded them of their whereabouts and warned them to moderate their language. "No, I fucking won't" says chav number one. Chavs numbers two and three have gone very quiet and are looking at their scruffy trainers. Chav number one obviously thinks he is the boss here. He is wrong.

"There are sick people here. They do not want to be disturbed by your foul language and juvenile behaviour" I say, giving him one last chance.

He blows it. "I'm not arsed" he says.

I bring myself down to his level, both physically and metaphorically. "Well that just makes you a selfish little twat, doesn't it?" I say in a low voice. He is outraged that I have offended his person with such a defamation, incredulous that I could insult his character in such a way. His mouth flaps open and his lips are trying to form words but no sound is emitted. As he stands there like a goldfish with nicotine-stained teeth I send him on his way: "Now the three of you better fuck off out of my department and crawl back under whichever shitty rock you came out from because until you learn some manners, you will not be treated here."

"But I'm fucking injured! You have to treat me!" Chav number one turns to his mates. They are already walking towards the exit. He looks at me one more time to check whether I'm serious, then he heads after them. "Fucking slag" he says under his breath as he goes through the door.

As I get back to the nurses' station, the security guard is arriving back from the refectory. I can tell that's where he's come from because he still has ketchup in his beard. One of his shoelaces is undone and his trousers are a couple of inches too short. He's not a particularly imposing figure of authority in all honesty."They've gone" I tell him."Oh good" he says and turns to leave, pulling a half-eaten bacon sandwich out of his pocket as he goes round the corner.

The woman in the nice pink scarf comes back through the doors from the waiting room. She looks cross and asks me if she can have a word. "I heard what you said to those boys. So did most of the waiting room. The language you used, I mean".

Oh hell's bells, I'm in the shit now!

But then she smiles. "Thanks a lot" she says. "You were great. If you ever get tired of nursing, you'd make a fabulous bouncer!"

It's not the nicest compliment I've ever been given, but it felt good!

Be careful what you wish for...

Some friends of ours are over from Ireland, staying with us for the weekend. He is a professional footballer, she is an A&E nurse. I often tease her that she ought to be out spending his (not-very) hard-earned wages on handbags and designer frocks, rather than cleaning up sick and being insulted by the general public. In return she tuts disapprovingly at me and reminds me that nursing is "a vocation" while I roll my eyes and stick my fingers down my throat. It's always lovely to see them!

Last night we went out for dinner at a fabulous local japanese restaurant and had a few glasses of sake. The boys were talking football and our conversation turned to work. As I am wont to do, I was bemoaning the fact that waiting times are now the sole focus of emergency care managers in the UK when I was interrupted by my friend who informed me that waiting times in Irish emergency departments often exceed twelve, twenty-four and even forty-eight hours!

We chatted for a while about the issue, how horrendous the situation is for patients, how frustrating for the staff and how the long waits are indicative of serious, deep-rooted problems in the Irish health service. I thought we were on completely the same wavelength...

Then I buried my head in my hands as she sighed wistfully and said "If only we had something like the four-hour target in Ireland..."

Dysfunctional Families and Neanderthal Nurses

A recent post of dickiebo's reminded me of something that happened to me a few months ago:

I was working in Paeds Bay when an ambulance brought in a thirteen year old girl who taken an overdose. She'd taken a handful of paracetamol and ibuprofen, then gone to tell her father what she'd done. The father, drunk and obnoxious cretin that he was, simply laughed and said he didn't care, so the girl had sought help from her aunt, who lived a few doors down.

Horrified, I listened as the aunt told me more. The father had had a leg amputated a year or so previously and had since been drinking himself into an early grave. Her mother had "mental problems" and was in-and-out of the local psychiatric unit. The two had long ago divorced and the mother lived in the next town, so she had little input with her daughter. With no guidance or boundaries, the girl no longer attended school and spent her days drinking and experimenting with drugs in the park with her friends.

This evening, after an argument with her drunken father, she'd swallowed whatever she could find in the medicine cabinet. She had no signs or symptoms of serious illness from the tablets she'd taken, so, from a medical perspective, there was little for us to do. In small doses these drugs are pretty innocuous anyway, so we usually just wait and watch for a few hours, then see if the blood tests show the need for any antidote treatment.

After a while, the girl's mother arrived at the hospital. She was clearly inebriated and seemed more interested in telling me all about her own health problems than supporting her child. I was saddened and angry to witness the way she interacted with her daughter: there was no warmth or comfort offered; her language was profane and her tone accusatory. I was not surprised when the girl started emulating her manner.

Soon after, the mother stood to leave. She didn't have time to be here, she said, she was going out tonight. Her boyfriend was waiting outside for her, she added. The girl looked heart-broken. I was glad she was leaving.

As she headed towards the door, in walked an agency nurse I recognised from the wards. I'd always thought him to be most unprofessional. He was loud, smelly, scruffy and unshaven. His knuckles practically dragged on the ground when he walked. His uniform always looked like it could do with a boil wash and a steam iron. He was over-familiar and arrogant and I hated the way he strutted around the wards in tatty shoes, chewing gum and using inappropriate language in front of patients. I would never have hired him in a million years and I could never understand why any of the wards did.

And here he was, this walking advertisement for the nursing profession, in MY paeds bay! "Alright mate?" he says to me, flashing me a gap-toothed grin. I just stand there, stony-faced as he strides up to the girl's mother, pats her on the arse and says "Fucking hell, woman, come on! We're going to miss last orders at this rate!"

On the grass being greener...

No targets for me this week, I'm on a course at the Big Teaching Hospital up the Road. I always like being volunteered to attend this sort of thing as it gives me an opportunity to see what proper other A&E departments are up to, what new equipment and techniques they're using and how behind-the-times we are in comparison. Invariably such courses are sponsored by enormous pharmaceutical companies so you get lots of free pens and post-it notes and stuff. They tend to put on a good spread for lunch too.

Another thing that I particularly enjoy about these things is when nurses from the Big Teaching Hospital up the Road start making patronising comments about how lovely (but a bit boring) it must be to work in such a small (and therefore deserted, obviously) DGH A&E department. "Oh yes," I say "It's such a doddle, it's tedious really."

You see, what these condescending bastards colleagues of mine don't realise when they scorn our miniscule workload of around 150 - 200 patients a day is that, unlike the Big Teaching Hospital up the Road, we don't have thirty nurses on each shift. Our staffing levels should be ten RNs on each shift: 1 Charge Nurse, 1 Triage Nurse, 2 in Minors, 2 in Paeds, 2 in Majors, and 2 in Resus, plus a couple of healthcare assistants. Instead, most days we're lucky to have eight. Our paediatric nurses are often used to make up the shortfall in the neighbouring adult areas and have had to become experts in managing the strokes, aneurysms and heart attacks that simply don't befall their usual clientele.

Because we're a DGH we also have less specialist services on-site, resulting in a larger volume of inter-hospital transfers. For many of these journeys a nurse-escort will be required, depleting our staff even further. "Can you imagine" I enquire "how you would cope if your Majors nurses were depleted by fifty percent every time a patient went on a transfer?"

And yes, a bigger department gets more of the exciting stuff - the traumas, the arrests, the aneurysms, the stabbings and shootings... the dramatic stuff which really ruins the patient's day. But they also get more of the shit stuff: the rude, the aggressive and the entitled; the thieving scumbags, the drug-seekers, the malingerers and the time-wasters. It's all relative. It's a trade-off. We get less of the exciting stuff in return for less of the bullshit. After ten years in the job I know which I prefer!

We also, in the main, have to do all our own ECGs, plaster casts, venepuncture and cannulation because we don't have twenty-four hour technicians to do them for us like bigger departments do. This, along with the dressings, ongoing monitoring of cardiac rhythm and vital signs, pressure area care, running through drips, administering drugs, feeding and watering of patients and their relatives, neuro-obs, documentation in triplicate, transfers to MAU, chasing up X-rays and blood results, hand-holding, bum-wiping, warming baby bottles, neighbour strapping, measuring peak-flows, providing counter-traction when reducing dislocated limbs, ordering patient transport, social services referrals, changing nappies, catheterising, checking blood glucose levels, assisting with central or arterial lines, explaining procedures, weighing patients, ordering drugs, cleaning wounds, bandaging and strapping, cuddling crying children, acting as a chaperone during invasive interventions, teaching walking aids, Waterlow and MEWSS testing, making cups of tea, helping fetch people in from cars, applying slings, splinting limbs, stemming bleeding, packing noses, raising limbs, finding pillows, giving oxygen, testing visual acuity and trying to keep confused old Mrs Bloggs from jumping off the trolley and breaking her hip all keep us from getting too bored in this quiet old deserted, unpatronised, and desolate Marie Celeste of a department.

Yes, it's a tedious existence alright. And yet, despite sitting on my arse, doing Sudoku and twiddling my thumbs for most of the day, somehow I still often work a twelve hour shift without remembering to stop for a pee, let alone a cup of tea* or a bite to eat. Oh how I wish I worked at the Big Teaching Hospital up the Road, where at least there'd be someone to relieve me for a break!



(*We did used to have a water fountain, so we could at least get a drink on the run, but when the Big Bad Debt suddenly had to be repaid, Management suddenly decided that it had to go because it was an "infection control risk". Tell that to the millions of office workers up and down the country.)

A correction...

My sincerest apologies, Dear Reader. I might have misled you a little in my previous post. I may have given you the impression that getting a patient out of the emergency department within four hours is the primary goal of A&E managers these days. This, as I am grateful to be reminded by a couple of recent commenters, is not quite true. I feel I should set the record straight.

The truth is that avoiding patient stays of longer than four hours is only paramount for the first three hours and fifty-nine minutes. Once a patient has "breached", they become invisible again, forgotten and forsaken, whilst the focus shifts to those patients who haven't yet reached the magic number.

In Management speak they are said to be "lost"; they may even have been "sacrificed" to avoid further breaches. What it actually means for the patient is this: Now it no longer matters how long they have been in A&E, they will actually be with us for several hours more.

As the next target (which cannot be breached) is at twelve hours after arrival, it is not uncommon for patients to be with us for up to ten hours before Management start getting twitchy again. Meanwhile, those who have yet to be with us four hours take priority when a bed becomes available on MAU.

There is, it is said, "punishment" for hospital trusts if too many patients breach the four hour target, but this penalty is no worse if such patients stay for ten or eleven hours. So the trust may as well be hung for a sheep as for a lamb and, yet again, it is the patient that pays the price.

So my question is this: If it is so important for patients to be admitted or discharged within four hours of arrival in an A&E department, why, once they have been here that long, is it suddenly OK for them to be with us for six or eight or ten hours?

Once again, if anyone has the ear of the Emperor, send him my way: I've got some questions for him.