Back to what matters
Posted on April 30, 2013
I was back at work today – after a huge period of being away. Going to work is like no other experience and I have had many. It is a roller coaster, a white knuckle ride off a giant waterfall, a stomach churning bungey jump – it is all those things and so much more. It is pure fear. And it is also pure joy. To take part means to be part of that group, that team and that kindred spirit. To stay away is the easy, maybe healthier and sane option but it is also the boring and empty way.
So today after a sleepless night of bad dreams in anticipation of my first day back in the ED I made it in for my shift. It was a wobbly start as I re-acquainted myself with the surroundings. It was sweet that my colleagues had noticed my absence – it has been about 6 weeks. I have been away filming, doing media kind of stuff and being a filmmaker.
But as I fought back my own tears of disappointment with myself I realised that taking too much time away is not the best option. I have chosen this weird hybrid life and I have to make it work. There will always have to be at least two days of the week if not more in department. That’s it.
I am home and I feel great. It was hard, I was tired and I was pushed – and I feel alive. Today counted. I cared for patients and for me they were the main focus of my day – not anything else. My patients are my teachers. As I walked into work today I was hit by reflection and thought of all the patients who have left marks on me – the one’s that didn’t make it. And I feel them with me all the time – like my ghosts, my companions and my friends. We shared the last few hours of their lives together – how do you break that bond?
And today – what a day. Busy as usual. The banter was therein all its Essex glory. A policeman with back pain, a recently widowed woman who could not hide the tears when she told me when her husband died and had an ongoing issue that needed attention from gynae, a alcoholic man saying he had a pr bleed and difficulty in breathing – but was actually fine, just drunk, a man with chest pain and finally a man looking so out of breath and sweaty he was peri-arrest. It was midnight and my shift was over – but he was on his way to crash. We had the CPAP versus BIPAP discussion with the bed manager who refused to bring the BIPAP machine to resus saying that this patient was a young man and should be intubated. Sorry – are you the doctor? When did you squeeze in med school and ten years of experience to get to consultant?
So we bought time for the near peri-arrest patient by getting his pulmonary oedema in mild control through CPAP – whilst we watched his CO2 rise and he became increasingly drowsy and also GTN. I am not able to intubate and the anaesthetist had not arrived and so BIPAP would have helped a huge amount – but it never came. Instead we did our best – after the annoying unhelpful input from the bed manager duo- but that is part of the job I hate. We sometimes work with those who do nothing but make things worse and obstruct and it is those people that sometimes make me want to leave this job.
And then I work with those who are professional even in amongst the unhelpful ones. Repeat gases got progressively worse with acidosis rising and CO2 increasing – but on the last one we turned a corner and the numbers started to improve – with the base excess falling to 2.8. We moved him to ITU and put on the BIPAP – and guess what – he smiled. He stopped sweating. The NIV worked. In your face BM. You are not conducive to being helpful and it gets annoying sometimes not to mention being life threatening.