Sunday, 1 October 2017

An Emergency Happy New Year!

                                          Happy New Year!

        It was my first night on call in the Emergency Room, all by myself, away from the legions of senior supervising residents and  experienced physicians and specialists of the teaching hospital, in a smallish city in Kent.    Me, the brand new intern, alone for the first time and terrified.   

        At half past eleven I had finally seen all the patients and the waiting areas were empty.  It wasn't that it had been so busy, but there had been a constant stream of patients all evening.  New years eve and  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 Mary Hand, the nurse.

        "No thank you.  Have to leave room for a tiny drop of whisky at midnight."  I grinned.

         "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.  As she was on her way home after the late shift and passing by, 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 are bringing in a man who has just been hit by a train.  Real bad they say he is.  They’ll be arriving in five 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 were getting exposure to enough clinical material.  Consequently, junior interns were pushed aside, and although present, often didn't get the hands-on experience that is so important. 

         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 I felt to run away.  The sight that greeted my eyes justified my fears.  On the gurney lay a man of about forty-five, motionless and intact, until my eyes came up to his head.  The scalp and underlying skull were avulsed from just above 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 to me 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, smilingly, with an Oxbridge drawl.  The he laughed.  "What the hell are you doing?"  He laughed again and then went on. "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.  I knew it doesn't last long.

         "You must be the new intern from Ireland, Lord save us," he said, with a mock Irish accent.  

         "Bejaysus, that I am," I answered, in my mock Irish accent, to disguise my embarrassment because I had very little accent at all.

         "We better give the coroner a call, this will require an autopsy.  Only, of course," he chuckled with a wicked grin, "if you didn't get a pupillary reflex.  And since you have cleared the waiting room, you might just want to stop in at the residents lounge on your way home for a quick glass of Kentish cider."
           I was only too eager to oblige!

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