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!
I was only too eager to oblige!
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