perspectives

somehow we see things differently. i'm not saying we are not part of the common human experience but we are involved in this experience on such an acute level we just end up seeing things differently. i mean if someone drops the word 'urgent' into a message for me i get visions of someone bleeding to death rather than images of having to stop at the shops to buy milk on the way home. maybe what i'm trying to say is we can come across as slightly glib at times. there are so many stories to illustrate this that maybe this needs to be discussed in a number of posts, but i remember when i was confronted by my own attitudes to the realities of life.

i was in casualties resus, a place i really felt at home in. i was stabilising a gunshot abdomen patient and preparing him for theater. it seemed the bullet probably went through the liver and the patient was bleeding enough that i was quite concerned. i was determined to stay with him until i had him under my knife, just in case something went wrong. but once the lines were up and the blood was running in there was little more to do than to wait for our turn in theater. it was a time to sort of stand around and maybe share a joke or two with the rest of the team. it is also a time to see what else is going on in resus.

the patient lying next to mine was a neurosurgery patient. he had been attacked in his house during a break in. for good measure his assailants had driven his skull in with some sort of blunt object. i had nothing better to do so i took a look at the scan. it was clear my neurosurgical colleagues were also not going to get too much sleep that night either. we laughingly teased each other about whose job was the worst.

all this time i noticed there was someone standing just outside the back door of the resus room. he had an expression somewhere between awkwardness and sheer terror on his face. he was clearly totally out of place but he wasn't bothering anyone and i sort of just ignored him. but he looked very familiar, so in between making sure my patient wasn't about to die and teasing the neurosurgeons i racked my brains to try to remember where i had seen him before. suddenly i remembered. he was a pastor at a local church and many years ago, when i was still a medical student, i had seen him there. the polite thing to do would be to greet him, i thought. i moved towards him.

as soon as he saw me approaching he seemed to take a deep breath and gird up his loins and he set out directly towards me much faster than i was moving in his direction. he walked with such a determinedness i wouldn't even have been surprised if he decked me when he got to me. i readied myself to say something, but suddenly realised the usual 'hello, and how are you' somehow just didn't seem to work in this setting. i was formulating a slightly less formal 'hi there' in my mind when he beat me to it and started speaking.

"excuse me," he said with an intense expression etched into his face, "but would it be ok if i prayed with this man who has the head injury?" somehow my 'hi there' suddenly seemed so out of place. even a 'i once saw you in church many years ago' seemed a bit unimportant compared to the fact that his friend would be lucky ever to talk again without saliva running down his chin, assuming he survived. i felt stupid.

i went through it afterwards in my mind. you see when people come into contact with me it is more often than not at one of those extremely important moments in their lives. often the only question to ask is whether they are going to survive or not. things like what ply toilet paper they prefer becomes somewhat irrelevant. but on any given day i may be faced with many people at these crucial crossroads, but each of them will maybe be faced with the situation only once or twice in their entire lives. maybe in a sense sometimes we become used to things no one should ever be used to.

and therein lies the secret. we may never become blasé or glib about the sharp edge of the human condition just because we see it every day. for me it may be just run of the mill or just another gunshot, but for the patient in question it is probably the single most significant moment in his life. even if we can't empathise with each and every patient, we need to remember these facts and respect the patient's experience for what it is, deeply significant.

in the end i mentioned quickly and in passing to the man that i recognised him and then left him to support his severely injured friend in whichever way he saw fit.

nudge nudge ... ...

i recently read a post that reminded me of an incident. depending on which side of the eyelid you found yourself that day, it could have been funny...or not.

i was doing casualty sessions after hours. it was a way of making ends meet while i was specialising, but mostly i just hated it. anyway one night, between the snotty noses and neurotic parents a patient actually came in with a casualty-worthy complaint. he had a small laceration on his forehead. we decided to glue it together with dermabond because it was so small. i decided to leave it to the sister. after all the unit was full to overflowing with snotty noses and paranoid parents that i was required to work through and get rid of.

after a while the sister came to me. she had terror written all over her face. i tried to think what had gone wrong that she looked so shocked. i started imagining i had somehow missed a life threatening injury and the patient had crashed. turns out the problem was not so deadly but just as sticky.

while the sister was applying the dermabond, which is essentially superglue, a drop fell into the patient's eye. luckily he had closed his eye on time. unluckily he had developed a permanent wink.

i confess i laughed. the sister was not impressed. she took me aside and begged me to help. i stopped laughing. it seemed it wasn't funny to her and unless the patient was deliberately winking to show he was in on the joke, it wasn't funny for him either.

the problem with gluing your eyelid together is you can't dissolve the glue with acetone because acetone would do its own damage to the eye. so i took a scalpel and very slowly and meticulously got to work. as it turned out, the eyelashes where glued together along most of the eyelid and only in certain areas was skin involved. by the end the wink had been surgically removed, along with all the eyelashes.

i often wonder if there is anyone else who can say they have surgically removed a wink, and broken bottle injuries from bar brawls don't count.

i smell drunk people

it's funny how smells can be so emotive. i have spent a fair amount of time in the state hospital lately. and going through casualties the smells were so familiar. it is a smell common, it seems, to all state hospital casualty units that i've ever worked in. and somehow alcohol is the constant thread.

i'm not talking about smelling alcohol on the breath of an aggressive family member, although that is also something one does see (or smell) a lot of. but it is so much more than that. i'm talking about the residual smell of alcohol laced bodily fluids after a busy trauma night. it is a smell that is resistant to being washed out.

it's difficult to explain but the smell left me with a longing for days gone by when i was the surgical registrar on the floor. i was the guy placing the nasogastric tube when the patient brings up the night's festivities all over the bed and often my shoes, leaving a sour smell of alcohol and stomach acid. when i was the one placing a high flow line into the neck of the nth drunk uncooperative gunshot wound patient, where part of the technique is to dodge his often well placed punches. in those moments you are not aware of the smell. maybe the adrenaline drowns it out. but it is always there. the next day when you walk into casualties and the smell hits you, the nigh's activities return so vividly to your mind.

i remember when i first learned the smell of alcohol in blood. strangely enough it was during an operation on a sober gunshot patient. he was bleeding profusely. i kept on thinking there was something missing. the blood didn't smell right. and then i realised that the smell i was missing was the smell of alcohol in the blood. how weird is that to know what alcohol in blood smells like.

yes i miss those days sometimes. alcohol doesn't play that prominent a role in private but you still see it. so it was a nice trip down memory lane this weekend to smell that smell again.

p.s the patient at the state hospital this weekend survived and was even extubated the next day.