Twas the night before the weekend, and all through the pit
Not a clinician was stirring, including the two Asian looking brits;
Resus was calm and the bays were free
No files in sight and no patients to see;
Such a change from the previous shift's riot
Still no one dared speak the forbidden phrase 'it's quiet';
Yet as the silence continued, unease began to spread
With every passing minute a growing sense of dread;
Surely this blissful peace could not last
Though we were by no means displeased at the stark contrast;
We thought we could get used to this uneventful life
Then some very sick patients appeared who'd been stabbed with a knife.
That essentially sums up our Friday night this week. After our busy shifts on Monday and Tuesday we rested and recuperated in time to watch England come to the realisation that it is not in fact coming home #surprisesurprise #noitprobablywon'tcomehomenextimeeither. Riki has spent much of his free time in the previous weeks scrolling through google search results of 'Asian hair styles' and finally built up the courage to get a hair cut so on Friday during the day we set off to one of the biggest shopping centres in Africa - the not-so-subtly named 'Mall of Africa'. I went with the proviso that I was going to buy some books to read on the flights we have coming up. When I discussed this with Riki he was relatively derisive making it very clear that he believed reading was an inefficient means to consume entertainment. Well, apparently my enthusiasm was infectious because Riki is now the proud/slightly confused/distressed owner of two new books. He claims he didn't want them and is somehow inexplicably angry at me - as if I forced him in to getting them. Retail therapy complete we prepped for our penultimate weekend night shift.
As I have expressed in poetry form for the first half of the night everything was very civilised. Everything swiftly began to fall apart when stab wound after stab wound rolled in one after the other. One particularly horrible case involved a man who had stabbed himself repeatedly in an attempted suicide after murdering his wife. He'd totally botched it and it took 4 police officers to hold him down while nearly the whole trauma team worked on stabilising him.
Riki the suturing Gremlin
Some members of the clinical team were more enthusiastic than others for the 3am photoshoot
Other memorable moments from the shift:
- A patient was asked if he had any pain anywhere, he responded 'yes in my stomach'. My thought was well yes that much is obvious, because that is where you have been shot.
- Another confusion about our investigations for patients - 'We need some blood for the shot abdomen' 'Wait do you mean the shooting or the stabbing? Oh wait no I'm confused, that's the other stabbed abdomen, this guy's definitely been shot'
- Bullets. Very hard pointy things that travel very quickly presumably causing lots of damage on impact. Apparently not. We had a patient shot through the hand and another one shot through the foot and both of them had ZERO significant injuries. It was a bit like the bullet had teleported from one side of their appendage to the other. Witchcraft I tell you.
- The realisation that we now have a concept of a 'proper' stabbing. When one of the sick patients arrived with stab wounds to the stomach, someone remarked 'finally a proper stabbing'. Apparently superficial wounds no longer count in our minds. To be a 'proper stabbing' the patient must require a CT chest/abdo or a CT angio.
Interns working hard [DISCLAIMER - I think they napped for about 5 minutes in a 24 hour+ shift so props to them]
Tired and hungry we snuck off before the morning ward round - my plan of getting in to bed as quickly as I could rapidly changing to incorporate a shower after Riki commented on the dried blood in my hair.
'Why the hell is there a fluid bag with a blood-stained cannula on the floor outside?'
Saturday night was set to be our last shift and it's certainly not one we'll be forgetting in a hurry. Like most of our nights it's a bit of a blur because we only tend to get one break through the whole night but it was BUSY. At times resus was full and the registrars were struggling to make room for the new patients being wheeled in through the sliding doors. We were kept pretty busy throughout either clerking new patients, helping put up drips for resuscitations, suturing the back log of stab victims and trying to avoid the unenviable job of taking patients round to CT and dealing with the radiographers and radiologists. That is a little unfair because the radiographer on last night was actually a great laugh. Nope last night it was the turn of the radiologist to get his knickers in a twist. When Riki visited to have some request forms approved he commented 'it's bad enough that we have interns come and talk to us, let alone elective students'. Someone has a mighty high opinion of themself. It was also really nice to see the interns who've been at the job for a week smashing it now they've gotten used to the nuances of the trauma unit.
Slightly harder hitting somber segment to follow: if the earlier attempted murder-suicide wasn't quite your cup of tea, maybe call it a day here.
I saw a patient last night which I can honestly say is the first case that has properly thrown me while we've been here. I was busy about to cannulate a patient when I heard a commotion behind me. When I turned around I was greeted by what I would best describe as a zombie writhing on a stretcher. Their skin was gnarled, black and peeling, their limbs were flailing and inaudible moans were escaping from their swollen cracked mouth. The paramedics had run in with him (it was a him) at full tilt and in braking nearly threw the patient on top of me and on to the man I was trying to cannulate. As they hurtled further down the resus corridor, a doctor behind me, probably in response to my silence and slightly open mouth, said 'guess you haven't seen a proper burns patient before?'. I hadn't. Not like this. Further down the room in attempting to transfer him the patient had fallen off his stretcher. I wandered over and helped scoop him on to a bed, his skin hard and leathery in my hands, leaving a scattering of black flaked skin behind him on the floor. Having spent a fair amount of time in theatre where they use diathermy a lot I thought I had a good idea of what burnt flesh smells like. This was very different. It was smokey and thick and hung on my clothes so that it was all I could smell for the rest of the night. The patient had full thickness burns over 95% of his body. He had no superficial nerve endings anymore so he continued to move his limbs around feeling no extra pain. There was no blood but already you could see the skin around his chest begin to contract - before long this pressure would have to be relieved by cutting down to the subcutaneous tissue or he would lose the ability to breathe. After finally getting venous access and the senior registrar putting in a tracheostomy he went swiftly to theatres. The survival stats after burns of that severity and extent are not good.
And on that light hearted night we concluded our bara night shifts. They are not experiences Riki and I will be forgetting in a hurry. Next week we're taking a break to visit Cape Town and hopefully go on a short safari when we're back!
Not a clinician was stirring, including the two Asian looking brits;
Resus was calm and the bays were free
No files in sight and no patients to see;
Such a change from the previous shift's riot
Still no one dared speak the forbidden phrase 'it's quiet';
Yet as the silence continued, unease began to spread
With every passing minute a growing sense of dread;
Surely this blissful peace could not last
Though we were by no means displeased at the stark contrast;
We thought we could get used to this uneventful life
Then some very sick patients appeared who'd been stabbed with a knife.
That essentially sums up our Friday night this week. After our busy shifts on Monday and Tuesday we rested and recuperated in time to watch England come to the realisation that it is not in fact coming home #surprisesurprise #noitprobablywon'tcomehomenextimeeither. Riki has spent much of his free time in the previous weeks scrolling through google search results of 'Asian hair styles' and finally built up the courage to get a hair cut so on Friday during the day we set off to one of the biggest shopping centres in Africa - the not-so-subtly named 'Mall of Africa'. I went with the proviso that I was going to buy some books to read on the flights we have coming up. When I discussed this with Riki he was relatively derisive making it very clear that he believed reading was an inefficient means to consume entertainment. Well, apparently my enthusiasm was infectious because Riki is now the proud/slightly confused/distressed owner of two new books. He claims he didn't want them and is somehow inexplicably angry at me - as if I forced him in to getting them. Retail therapy complete we prepped for our penultimate weekend night shift.
As I have expressed in poetry form for the first half of the night everything was very civilised. Everything swiftly began to fall apart when stab wound after stab wound rolled in one after the other. One particularly horrible case involved a man who had stabbed himself repeatedly in an attempted suicide after murdering his wife. He'd totally botched it and it took 4 police officers to hold him down while nearly the whole trauma team worked on stabilising him.
Riki the suturing Gremlin
Some members of the clinical team were more enthusiastic than others for the 3am photoshoot
Other memorable moments from the shift:
- A patient was asked if he had any pain anywhere, he responded 'yes in my stomach'. My thought was well yes that much is obvious, because that is where you have been shot.
- Another confusion about our investigations for patients - 'We need some blood for the shot abdomen' 'Wait do you mean the shooting or the stabbing? Oh wait no I'm confused, that's the other stabbed abdomen, this guy's definitely been shot'
- Bullets. Very hard pointy things that travel very quickly presumably causing lots of damage on impact. Apparently not. We had a patient shot through the hand and another one shot through the foot and both of them had ZERO significant injuries. It was a bit like the bullet had teleported from one side of their appendage to the other. Witchcraft I tell you.
- The realisation that we now have a concept of a 'proper' stabbing. When one of the sick patients arrived with stab wounds to the stomach, someone remarked 'finally a proper stabbing'. Apparently superficial wounds no longer count in our minds. To be a 'proper stabbing' the patient must require a CT chest/abdo or a CT angio.
Interns working hard [DISCLAIMER - I think they napped for about 5 minutes in a 24 hour+ shift so props to them]
Tired and hungry we snuck off before the morning ward round - my plan of getting in to bed as quickly as I could rapidly changing to incorporate a shower after Riki commented on the dried blood in my hair.
'Why the hell is there a fluid bag with a blood-stained cannula on the floor outside?'
Saturday night was set to be our last shift and it's certainly not one we'll be forgetting in a hurry. Like most of our nights it's a bit of a blur because we only tend to get one break through the whole night but it was BUSY. At times resus was full and the registrars were struggling to make room for the new patients being wheeled in through the sliding doors. We were kept pretty busy throughout either clerking new patients, helping put up drips for resuscitations, suturing the back log of stab victims and trying to avoid the unenviable job of taking patients round to CT and dealing with the radiographers and radiologists. That is a little unfair because the radiographer on last night was actually a great laugh. Nope last night it was the turn of the radiologist to get his knickers in a twist. When Riki visited to have some request forms approved he commented 'it's bad enough that we have interns come and talk to us, let alone elective students'. Someone has a mighty high opinion of themself. It was also really nice to see the interns who've been at the job for a week smashing it now they've gotten used to the nuances of the trauma unit.
Slightly harder hitting somber segment to follow: if the earlier attempted murder-suicide wasn't quite your cup of tea, maybe call it a day here.
I saw a patient last night which I can honestly say is the first case that has properly thrown me while we've been here. I was busy about to cannulate a patient when I heard a commotion behind me. When I turned around I was greeted by what I would best describe as a zombie writhing on a stretcher. Their skin was gnarled, black and peeling, their limbs were flailing and inaudible moans were escaping from their swollen cracked mouth. The paramedics had run in with him (it was a him) at full tilt and in braking nearly threw the patient on top of me and on to the man I was trying to cannulate. As they hurtled further down the resus corridor, a doctor behind me, probably in response to my silence and slightly open mouth, said 'guess you haven't seen a proper burns patient before?'. I hadn't. Not like this. Further down the room in attempting to transfer him the patient had fallen off his stretcher. I wandered over and helped scoop him on to a bed, his skin hard and leathery in my hands, leaving a scattering of black flaked skin behind him on the floor. Having spent a fair amount of time in theatre where they use diathermy a lot I thought I had a good idea of what burnt flesh smells like. This was very different. It was smokey and thick and hung on my clothes so that it was all I could smell for the rest of the night. The patient had full thickness burns over 95% of his body. He had no superficial nerve endings anymore so he continued to move his limbs around feeling no extra pain. There was no blood but already you could see the skin around his chest begin to contract - before long this pressure would have to be relieved by cutting down to the subcutaneous tissue or he would lose the ability to breathe. After finally getting venous access and the senior registrar putting in a tracheostomy he went swiftly to theatres. The survival stats after burns of that severity and extent are not good.
And on that light hearted night we concluded our bara night shifts. They are not experiences Riki and I will be forgetting in a hurry. Next week we're taking a break to visit Cape Town and hopefully go on a short safari when we're back!
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