Surreal ++++

I thought I was tough. I thought I could hack anything medicine could throw at me. I thought ITU would be fun. Thats 3/3 wrong.

Surreal was translating clinic letters from a language I don't speak to get a PMH on a guy who's about to go for his third orthopaedic procedure in a week. Every limb you can break was broken when his vehicle hit another. His wife is in the hospital too, with C-spine fractures. Watching two teenage girls see their dad for the first time and not crying is the hardest thing I've done this week, including exams.

Surreal is watching a man, handcuffed to a policewoman, cry over his unconscious alcoholic mother.

Meningitis in lectures is fine. Meningitis in a lad my age, on every organ support machine possible, is not.

I've learnt that there's a special type of COPD you can get from smoking heroin. That a litre of vodka a day will make you fall out of your wheelchair and give you a massive subdural haematoma, and surgery to fix that involves more scalp staples than I ever thought possible. That whilst ITU is not the worst place to die, it is the worst place to be a conscious patient. That no one leaves ITU without after effects - dead, disabled, or PTSD & hallucinations. That the healthiest looking patient on the unit is the one with terminal cancer, conscious and talking, with less than days to live. And the logistics of taking an intubated patient home to die are nigh on impossible.

Yesterday I held the hands of someone who was getting his central line changed, whilst heavily sedated. I had to prise his fingers off mine at the end. Today he is dead.

It is a vegetable patch. Row upon row of slanted mounds of patient. I have heard medicine reduced to such a molecular level over the past two days, it was hard to relate it to the slab of flesh in front of me. Patients talked of in terms of biochemical figures. Of vessels of infection.

A consultant admitted that most of what they do would be considered torture in any other context. Yet the nurses reassure relatives with the "No pain" line. I stuck six cannulas into two patients. Both squirmed and withdrew, despite being "comatose". Four failed cannulae, just from me. I saw 3 attempts at an NG tube, which ended when they suctioned 200ml of blood out of his throat. Blood that wasnt there when they started. Hands bandaged like mittens to prevent tubes and lines being yanked out. Consent and Gillick competency don't exist.

I can't write any more. I could, but I think 6hrs sleep over 2 days is adversely affecting me. I DONT CRY. Except after ITU.

Friday night rambles.

Everything hurts. The broken wrist (more painful than last years, therefore more broken). The heavily bruised shoulder (can't push doors open with broken wrist, other hand is mostly occupied with folders, mobile, handbag...). The revision (or lack-thereof) induced headache. Kneeeees!!! There are very few bony parts of my anatomy that are not aching in some way today.

Pity party over. Today was the last day of class before January exams (strangely, held in February), so The Fear was starting to hit people - when I left at 6pm, 4 hours after our class ended, there were 5 medics in the computer room, 12 on one floor of the library, and goodness knows how many on the other floor, or the other library. Revision pizza party has been scheduled for Tuesday night (to coincide with Domino's 555 deal! Eeee!), so some semblance of study should probably take place prior... Heh, it's Friday night and the blogs are calling.

I keep reading Mothers in Medicine and I have to admit it terrifies me! I cannot wait to have lil kiddies of my own (kids clothes are so cute! Much better than dressing up the cat), but OMG. I am terrified that my (non-medical) boyfriend will not cope well with a) not being the breadwinner, b) being left at home with the kids, c) me studying in the time that isn't spent working, d) me getting all excited over Charnley hips and the relative benefits of cemented over non-cemented NOF fixations.... I love him to bits and I can't wait to start our proper life together, both in the same place (same country would be a nice start!), with a lil flat of our own, and kidlets on the way... *daydreams*. I always thought if I was a doctor, my husband would be a doctor, you know? Not a supermarket manager/PhD student/primary school teacher/psychologist [delete as applicable when Boy finally picks a career]. That's not to say I belittle what Boy does, I just want him to be in a job he's happy with, one he gets excited about doing for the rest of his working life! Like I am with Ortho, ha. I think, no, I know he'll be awesome whatever he does - he's smart and caring, and he just gets people. I don't know how, I seriously wish I did! It was recently anonymously commented that I'm not a people person. I'm not a people person, right on. I am a patient person. My clerking today had such a crazy lifestory, I wish it were within the limits of patient confidentiality to say, but needless to say, it was full of hardship and overcoming adversity and sheer gutsiness and an immense drive to do life. I adore our wards, as I keep saying, but certain patients make you come out grinning, and today, he did.

Certain consultants also make you come out grinning, when they catch you on your own and tell you you're "a good one". EEEEEEE -SUPER-HAPPY-JOYFUL-JELLY! Out of our group of 8, there's an academic range. The 12's, who work hard but don't quite get the big concepts or the sheer volume, but are happy regardless. The 15's, who work a bit, play a bit - the popular kids. The 19's, the super-academics; the one's who, faced with a real patient, get a bit tongue tied, and mumble, and display that their only knowledge of performing an exam is from MacLeods. I am the quandary. My average is a solid 16, a 15 on weighted average. Yet on wards, I am the 20. I am the one who presents, I am the walking BNF, I am the one who answers.
Wards are my reason to feel good about this course, my motivation to keep going. Of course, time in Theatre is what makes me leap out of bed in the darkest morn before the dawn, and stay til the last patient is into Recovery, still hoping for more, but theatre days are few and far between. Wards are my weekly saving grace.

Drug-induced.

On a train. From one end of the country to the other. On Friday 13th. Grr.

Awesome recent patient I wanna blog about [Hello, Dean of Medical Undergraduate Education. I am blogging about a fictional patient that most certainly is currently not an inpatient at your teaching hospital].

I am always totally blown away by patients. The little old lady that walked out on her husband after sixty years of marriage. The guy who was made redundant by the only company that would ever employ him. And most recently, the ex heroin addict who ranted for ten whole minutes about people who drink alcohol.

I say this with a beautiful, chilled cider in hand.

While I agree that alcohol hurts people, and that it is pretty dangerous, I have absolutely zero urges to become tee-total. I'm not sure how a heroin addict (I won't say ex-addict, since I think that betrays the current Methadone addiction) is competent to judge those who drink. Firstly, alcohol is a legal drug. Heroin is clearly not. I understand that there are those who believe that, were alcohol discovered today, it would be instantly classified as a Class A drug. However, there is also the side that believe alcohol is good for you - a glass of red wine a day prevents heart disease, for example. (I'm a firm believer in this, but since the idea of what you should drink daily keeps changing, I'll stick to varying my tipple).

Even Jesus drank alcohol! Everything is good for you in moderation, except heroin. This guy even tried to justify his addiction by claiming that he never injected. Does this mean I can do coke if I just lick it? No - because the overall effect is the same. You're still putting an incredibly harmful substance into your body for no reason.