Some worth mentioning...

I only started three weeks ago, but I have seen so much. I have met so many different people, and it's been everything I've wanted. Some patients have stuck in my mind, but only some for the right reasons. These are some that I never really saw an outcome for, but still managed to stick in my mind.

A lady, early 40s, presented to us with PV bleed, which is commonly seen by us. She came in with her mum, was well dressed and looked like a typical mother herself. She had been to see her GP that morning because of the bleeding, where she was told that 'because her breasts weren't tender anymore, she must have lost the baby'. She was desperate for this child, and she was hysterical. There was nothing anyone could say to stop her from crying, as I'm sure anyone can imagine. A PV bleed does not mean that the baby has died, in fact I am told that a lot of women that are seen by us with PV bleed go on to have viable pregnancies. Not only did this GP tell her that she had probably lost the baby, but he also said that she could come into the emergency department and have an ultrasound scan the same day! I don't know how other A&E departments work, but here this is (almost) not possible. Ultrasound scans take weeks to book appointments for. We got her a chair and she was sat in a bay, still crying. She went to the toilet and said there was more blood, and was bright red. I walked with her back to her bay silently. I felt like I should have said something, but what? There was no way we could send her home and tell her to wait for an appointment through the post, so we fast-tracked her to the maternity unit, where hopefully they could prove her GP wrong. I don't suppose I'll ever find out what happened, but I'd rather it be that way then to find out she had lost her child.

I have only spent one afternoon in paediatric emergency so far, but it was definitely one of my favourites. I find a lot of people say they can't work in children's, too heart-wrenching, which is very true. Nevertheless I still loved working with the kids. A 15 year old was brought in by an ambulance accompanied by his dad, having taken an overdose of various medical drugs, including 8 ibuprofen, 13 amoxicillin and 16 dihydracodeine. His pupils were pinpoint. He didn't look 15, he was very small and weighed around 45kgs. You could see his depression just by looking at him, he layed on one of our beds, apathetic and lifeless. We took his obs, all seemingly normal, except his ECG which showed ST elevation according to the doctor. His dad entered the room, and could barely speak. His son couldn't look at him. His mum turned up, and started shouting 'Something has to be done about this now, it's getting out of hand!'. It didn't help. This is something I experienced at the same age, all I wanted to do was tell him how I understood and how people get through it, but I didn't. We left him with the help of a doctor and psychiatrist. Some people come into hospital having taken some pills, normally not enough to do any real damage. They will often call an ambulance, state they have overdosed, get into hospital and get the attention they so desperately craved. At the risk of sounding heartless, they waste our time. This lad however didn't want to be found out. He took as many tablets as he could find, lay on his bed, and waited for something bad to happen. It was only when his dad found the empty pill packets in the cupboard and went up to his son's room to find him laying there in a daze that an ambulance was called. He really did need help, more help than we could give. In my experience with self abuse, you don't learn from your first visit to A&E, or the second, or the third; it's something you have to figure out for yourself. Of course some people never achieve this.

One of my favourites was a lady aged 89, she was full of life and more able-bodied than most people 10 years younger. She'd had a fall, hurt her leg, and couldn't walk very well. She laughed at herself, and assured me that she would be back on her feet in no time. I told her I couldn't believe she was 89, when she said;

'Oh I know, but it's ok, I won't live to be 90'

I was a little suprised;

'Only got a couple more months to go now'

'Oh?'

'Yes, last Autumn I was gardening, and I have to keep myself busy, so I made a rockery at the end of my back garden. I want to see what lovely flowers will grow in spring time. So I only want to live to see spring, then I can die'

She was a charming old lady, and while it seems sad that she doesn't want to live much longer, it's nice that she can accept death like that. And it will be far nicer for her to die in her own bed, proud of the pretty flowers in her garden.