When things go wrong

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It went wrong a lot last week, really it did. It was insanely busy, perhaps even dangerously so, even with full numbers we were run off our feet. Amazingly, New Year’s night was seriously not-that-bad. Busy, yes. But not like every night following. People can’t drive in cold weather, I’ve noticed that. I’ve known for a long time people in Britain seem unaware of dangers like black ice, or just plain old ice, when one would think “Hrm, it’s cold and it’s winter, perhaps I should drive a little more carefully on this ungritted road”. I knew that people here have difficulty understanding that snow makes stopping difficult (and indeed, at times, starting), but the number of ‘hit by car skidding on ice’ ‘hit wall after skidding on ice’ ‘hit barriers after skidding on ice’ ‘RTC: Collision with another vehicle, skidding on ice”s, that we saw was quite astonishing.

I was actually sick, too, so was being fairly ruthless in my Triage, because when your Triage nurse has a temperature of 38.2C she’s not inclined to feel sorry for you having ‘a bit of a cough for a few days’.

But anyway, things that went wrong? Well, when it’s busy and you’re stressed it’s easy to miss the obvious. The head injury that the Doctor was stropping about as being drunk who, it turned out, was sober as a tea-total vicar. He did, however, have a bleed inside his scull. Thankfully, it was spotted before he shoved off home.

But the one that got me was the abdo-pain which rapidly turned into Ectopic-going-to-theatre. Every trust I’ve been to has some kind of disaster-management for ambulances queuing in the door, the trust I was at when this happened, up to a point the crews just hang around in the corridor, their patients sat on stretchers or wheelchairs. They are not our responsibility but we do book them in. This is good, because as one of the RN’s pointed out, as this woman screamed, we could actually ‘get her some pain killers’ and ‘check if she’s pregnant’.

10 minutes later, she was out of that queue and in Resus with two whacking great needles in her arm, morphine flowing round her system and blood being crossmatched as she was prep’d to go to theatre.

In my own head I’d only made it as far as ‘we really need to do something for her, she looks like she’s in a lot of pain’. Thankfully, that RN stood next to me and pointed out that she was booked in, and we actually could start the care process before she was on our trolley.

What could have happened had she sat (well, that’s a loose term for it, more writhed) in that corridor for another 20 minutes or so doesn’t bear thinking about, not just in terms of her pain (which must have been horrendous), but also in terms of the dangers of an haemorrhage with an ectopic pregnancy.

In a way it went right, it was caught and she was treated, but if that RN hadn’t been there, maybe it wouldn’t have gone quite so well.

In a much lesser way, one way in which it went wrong was that I had to start ‘training’ a new doctor. He’s arrogant, stuck up, rude, and frankly wouldn’t be out of place in a 1960’s Carry On film as a consultant. He is, however, I think, only a baby little SHO*.

He almost certainly knows lots about lots of things which I know little about, and should I need my bones fixed he’d probably be a fair candidate for organising something being done about it. But when he tries to tell me how to take blood, or more accurately how much blood is required in the bottles, he’s going to get short tempered, sick Kate giving him a verbal smack upside the head. Bear in mind that I take probably around 10-15 sets of bloods a day. That’s around 30-45 blood bottles, and I know how little I can get away with in each one, because some people are right buggers for giving you blood samples.

He told me I needed to take another one ‘because the lab won’t process that, there’s not enough in it’ (and he didn’t say it in a “I think this is the case” way, he said it in a “I know this is the case and you’re just and incompetent, untrained nurse who knows nothing” way***). I told him that in fact “you can get away with a hell of a lot less in the tube than that”, and I had to really restrain myself from commenting on his general approach, which appears to revolve around him being the God from On High sent down to leave his Commandments with us mere nurses.

When I first met him I thought he was rude, but tried to tilt it as “he’s just quiet and poor at communicating”, but over the last week had given in to “he’s a rude little shit”. Unfortunately, I’m given to be terribly friendly, and tend to assume that if I’m friendly to people eventually they’ll start being nicer, and had continued to chat in a polite way to him ignoring his somewhat problematic communication method. This has, for the most part, worked with virtually every doctor I’ve ever known. However, being sick, incredibly tired after shite-shift after shite-shift, and somewhat out of patience** I just decided I didn’t need to have any conversations with him which weren’t entirely professional. I suspect he noticed that the irritating, grating nurse who keeps chatting to him had stopped. A few hours later, when he was looking at another patient in the department he walked up to me and quietly said ‘the clotting results came back’ and walked off.

I think we may have reached an understanding.

* He may even be a locum, or he might have reached the lofty heights of Registrar. At any rate, there’s no need for him to be rude.
** This may, or may not, have been related to my urge to give him an hour long lecture on appropriate behaviour and respect for one’s colleagues.
*** As a side point, I’m probably more qualified than him. Never forget people may have done other things before they started doing their current job.


Kate is lord and mistress of all she surveys at pyoor.org...