For once I won’t dwell on the fact that I haven’t written a post since the beginning of time. Suffice to say since I got back from my (first) holiday in June- the last post you will have read- things have been a bit manic. I’ve started three different blog posts- and failed to complete any of them. And in fact, I’m actually writing this quite late into the start of clinics; after the lecture based Pathology course finished in June I had a stint in GP land (with a side order of Oncology [cancer medicine]) until now, where I find myself a week into a seven week stint on Obstetrics and Gynaecology.
You’ll hear about my exploits in catching babies and grappling with the niceties of a whole new discipline soon- not least because I start labour ward on Sunday for a string of night and day shifts and I’ll need something to do in the downtime. Before then I thought I’d be semi-serious for once (although the sarcasm is hard to keep away) and tell you about an experience I had yesterday morning on the way to work. There doesn’t seem to be much else to do at the moment (I’m on a train from Oxford) and I’ll be damned if I am using those ridiculous revolving door toilets that will one day result in my inadvertent arrest for indecent exposure when I fail to fully comprehend the locking mechanism that one needs to have a PhD to understand.
The Oxford Handbook of Clinical Medicine- known more commonly as “Cheese and Onion” owing to its colour-based resemblance to said packet of crisps- is our bible, and has lots of advice and pensive asides. One of them is called “The Last roll of the dice” and talks about when it all comes down to you; the time when there is no-one else (written there in the context of a technique to gain access to someone’s circulation when they are critically ill). Primarily I think this is there for junior doctors in their first couple of years, especially when on-call during nights, and the senior doctor is busy with another patient and you’re the one that has to make that call. As students, we don’t get put into that situation much (thankfully- I’m sure if it did come down to us with any frequency it would end up with something completely fire retardant catching fire and other such endings that result in an unhealthy amount of paperwork).
Such moments do happen, however. I was walking (running just on the late side of on-time) to the Tube to go to work yesterday morning; a few minutes from my house I crossed a road and sleepily looked up. Then followed that uplifting sound of crunching metal and screeching brakes; looking up, a motorbike came skidding across the road, followed by the rider face-up in the centre of the road, with the mangled front edge of a car in my peripheral vision. If you’ve ever seen an accident happen in front of you, the silence is deafening; people say these things happen in slow motion and I can confirm they genuinely do. To my never-ending dismay I didn’t have the reactions to do a Hollywood style “NOOOOOOOOOOOOO!!!” in the brilliant slow motion voice I’ve been working on in my shower for so long.
As medics, first aiders, ambulance crews etc, we’re often trained to go into things cold. A call comes over the radio or the tannoy, or the crash bleep goes off, and we’re told (and almost know) what to expect- before we even get there we have an action plan in our minds and we slip easily into the chaos without even a whisper of fear or doubt; eventually even the adrenaline doesn’t have much of a kick. I suppose I’m lucky that my interest in trauma and pre-hospital care means that I have a good enough working knowledge of first aid and trauma management to have dealt with it as much as I could for the 8 minutes it takes for the ambulance to arrive. It didn’t make a lot of difference though; although routine kicked in and I could stabilise the guys head and protect his neck, spine and airway, the rest of the drill melted away with the shock. I think we try and deceive ourseves that as professionals there is nothing that does shock us any more; that is part of the deal to some extent, in that the public and our patients want us to have seen it all and done it all lest they be the one thing that shocks us. I do seem to remember barking orders at everyone who was standing watching and was grateful for the help of various first aiders who appeared at my side after I had made the initial jump to approach him. No doubt I came across as slightly insane, sanctimonious (or both) but all means to an end. Probably.
What was hilarious, however, was the amount of attention this garnered. The accident stopped all the traffic in both directions on a busy main road in Fulham; even before the ambulance arrived all and sundry had turnd out to have a look. This included the Manager of Tesco Express and a man in his dressing gown, casually wandering into the middle of the road and peering over my shoulder before being gently reminded by the paramedic that perhaps this wasn’t a spectator sport. I might try wandering around in my dressing gown on the street- it does look comfortable and oddly liberating, I’ll give him that. That having been said, my housemates will testify that I have enough trouble wearing a dressing gown and/or trousers in the house without venturing on to the street.
So after half an hour of holding this mans head the second crew arrived and I could be relieved and start talking to the police. Armed with an excuse as to why I was severely late for the ward round (and creased, dirtied chinos to prove it) I went back to trudging down the road to Putney to catch my tube. The rider wasn’t too badly injured- winded and with a probable knee injury- and as he disappeared off into the distance I debated whether or not it would have been ethical to catch a ride to the hospital.
So now I find myself on the way home from an academic conference in Oxford, where my girfriend and I played the part of paramedics in a simulated A+E resuscitation room, putting some poor delegate into the thick of things without much notice to see how they coped with running a trauma scenario. Turns out they did pretty well; although I managed to take out the patient’s shoulder by ramming it into the double doors. I think we’ll put that down to experience. Somehow in all of this we managed to get invited to a three course dinner in Balliol College, where we ate with various academics and the Head of the Navy- and as I think is befitting my girlfriend’s enduring attention to detail, she completly managed to miss that she was sitting opposite an admiral all evening. So if tomorrow there is a smouldering wreck where my house used to be and a battleship making haste along the Thames, you’ll know why.
Until next time,