Tuesday 24 June 2014

Emergency!! A true Story of the Olden Days!

(This is a story of the days when there was no doctor in the Emergency except  the poor frightened Junior Intern!! Only the names of the guilty have been changed)
  
          It was my first night on call in the Emergency Room, all by myself.  Me, the brand new intern, alone, terrified.  It was a small but busy hospital in Ashford, Kent.  I had just come over from Ireland and I knew no one yet.  At half past eleven I had finally seen all the patients and the waiting area was empty.  I was relieved that the most serious thing I had to deal with was a patient or two with pneumonia and a few sick kids, and none of those horrific injuries that I so dreaded having to deal with had turned up.    It was December 31st  1961  and it looked as though I was going to get to the midnight 'Ring in the New Year' party on West One after all. 
            "Ready for a nice cuppa yet, doctor?" asked Nurse Mary Hand.
            "No thank you.  Have to leave room for beer or two at midnight." 
            "Yes, I'll go down with you for a few minutes and we'll leave Jane to mind the shop.  Then, I'll come back and she'll go down for a while."
            Another patient trickled in with a bad backache that she had had for four years, but seemed a bit worse tonight, New Years eve.  As she was on her way home after the late shift and passing by the hospital she thought she*d drop in and have it looked at.  I had no sooner packed her off than the dedicated line to the ambulance service began to ring. Jane came running down to the Cubicle where I was still completing my notes.
                 "I just had a call from the Ambulance driver.  They’re bringing in a man who has just been hit by a train.  Real bad they say he is.  They’ll be arriving in a few minutes."
            I felt a wave of panic pass over me.  Until now, I’d always been in a large teaching hospital, with its hierarchy of students and physicians of increasing experience, capabilities and specialization.  This meant that there was fierce competition when the 'big stuff' came in.  The sharks from the specialty services were constantly cruising the water to see that their trainees and not some insignificant intern were getting exposure to enough clinical material.  Consequently, junior interns were pushed aside, and although present, often didn't get much hands-on experience. 
            The sirens screamed as the ambulance pulled up to emergency bay.  The nurses had prepared the acute trauma room and directed the ambulance men pushing their gurney into it.  I rushed in, suppressing the overwhelming desire to run away.  The sight that greeted my eyes justified my fears.  On the gurney lay a man of about forty-five, motionless and then my eyes came up to his head.  The scalp and underlying skull were avulsed from just above his eyebrows carrying with it a fair chunk of brain all hanging on a hinge formed  by a delicate flap of skin.  It was an injury that no-one could possibly have survived.  That much was immediately obvious as I attempted to suppress the gasp of horror that came to my lips.  The two nurses, who had rushed to the bedside with IV fluids and other emergency equipment, also gazed at the corpse, in horror.  I didn't know what to do.  Medical care for the patient ends at the moment of death.  But wait a minute; everyone knows that the first thing a physician has to do is certify the patient as dead.  There are three clinical signs of death, dilation of the pupils, absence of heart beat and absence of breath sounds.  As I learned so well in later years, when you don't know what to do, you do what you know how to do.  
            "I called the Senior Surgery Resident.  He'll be right down." Mary said.
            'Don't just stand there, doctor, do something.'  The prevailing philosophy might often better have been 'don't do something, doctor, just stand there'.  But it wasn't, and I felt compelled to take action.  I took my pen flashlight out of my white coat pocket, retracted the blood-encrusted eyelid of the unfortunate dead man and shone the light into the dilated pupil, knowing full-well that he was dead. 
            Just then, a tall well built, blond man, in a white coat, strolled into the room, with an easy stride.
            "I'm Rhys-Jones, the surgical resident," he introduced himself, with an Oxbridge drawl.        “May I ask what the hell you’re doing?  The man's brain is lying beside him on the bed and you're looking for pupillary reflexes.  You're not going to find any, he's dead!"
             I felt stupid, not for the first time and certainly not for the last.  Even then, I knew it doesn't last long.

            "Come on, lad, there’s nothing you can do here.  We better give the coroner a call, this will require an autopsy.    Only, of course,” he added with a grim smile, "if you didn't get a pupillary reflex. You must be the new intern from Ireland, Lord save us," he said, with a mock Irish accent.   And since you have cleared the waiting room, you might just want to stop at my flat on your way home for a quick glass of Kentish cider."

            Heffan Rhys-Jones turned out to be a helpful colleague and a good friend, apart from the fact that he never allowed me to forget the circumstances of our first meeting. He never hesitated, after a couple of drinks to regale our friends with the story  (lapsing into a mock Irish accent), 'of himself checking for reflexes in a poor old soul, who's brain was sitting on the gurney beside him'. 
            Hef, as he was nicknamed was married and had a little girl about a year older than my own daughter.  
            One of the most useful things he introduced me to was the illegal Kentish Apple-Jack that the farmers in those parts illegally distilled from fermented Cider.  This was a brandy that was at least 40 proof and I suspect a good deal more.
            “I can get us a good big crock of it for about ten shillings. One of the ambulance drivers has contacts. Why don’t you ante up five bob and we’ll buy one between us” he said.  “It’ll probably last us the whole year.”  
            The prospect of having enough to drink was enough to make two impecunious interns think they’d died and gone to heaven.
             “Okay,” I said, forking over my five shillings.
            Three days later I got an urgent call from Hef.  We both lived in flats owned by the hospital in houses that were just across the plum orchard that opened onto the hospital back door across from ours.
            “Can you drop over here, Dear Boy, on your way home and help me to move this damn Crock that that the ambulance drivers dumped in the middle of our kitchen?   A bloody great ambulance pulled up at our door and three ambulance drivers only just managed to get this huge earthen wear crock into our house and dumped it in the middle of the kitchen, took the ten bob and took off as fast as they could.”
            No wonder, I thought.  They could go to jail for illicit spirits dealing.  “I’ll be right there,” I said, “We can sample some.”
           “We can try,” he said.  I didn’t know what he meant. 
            Twenty minutes later I arrived at their door.
            “Thank goodness you’re here,” said Megan, “I can’t do a thing in the kitchen with this great big thing in the middle of the floor.”
            I walked into the kitchen and there it stood.  A large three foot high stone jar, light brown upper half and dark brown in its lower portion.  We barely managed to waltz it into a corner between us.
            “We’re never going to get a drink out of that,” I said, despondently.  “How can we tip that?”
            “There’s more than one way to skin a cat,” said Hef, in a way that I knew we would be getting a drink out of it very soon!   And we did, for an entire year!
 
            
           



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