Annoyance

We've had a busy few nights, and I'd struggled to sleep this time around. Rarely, some things get to me. I think my lack of sleep has contributed to it though.

A known alcoholic came into the department at around 23:00, presenting with chest pain. He comes in fairly regularly, in fact it was the second time he'd come in that day.

We went through the usual routine, anyone with chest pain gets seen first, we do an ECG, if the ECG is abnormal the patient either goes into resus or is prioritised, if it is normal then they get put back out to wait and they are called in time order. I do at least 20 ECGS in a shift, if it's manic then that number is probably closer to 60. Of the hundreds of ECGs I must have done since starting in January, two of them have been acute MIs. This is very recognisable in an ECG. I would have liked to print off two ECGs so that I could keep one, but as soon as I see the MI I go into serious mode and find myself unable to think of anything other than the patient. The frightening thing is that the two males who have presented to me with MI have appeared fairly healthy, 'I'm sorry I'm sure it's nothing, I just have a little bit of pain in my chest and I thought I should get it checked out'. One of them had driven himself there.

Anyway back to our alcoholic; his ECG was pretty worrying so he went to resus (sorry I can't recall exactly what the ECG showed). As he'd already come in once that day, it would be quite important that we obtained the ECG from earlier, so I went to try and find the notes. I went to reception, as they usually collect the discharged notes and keep them, and the receptionist said she couldn't find them. 'Could you look please? It is quite important,'

'Well what do you want me to do? Drop everything? I have ambulance notes to do AND a patient waiting'

She more or less shouted this at me.

'Well do whatever you need to do first, here's the hospital number, could you please look for me?'

I walked away thinking how ridiculous her little outburst was, I mean I could possibly understand if it was Friday night and they were queuing out the door and she was on her own, but doing two sets of notes would only have took her 5 minutes. I failed to see any sort of reason for her to be so stressed.

I went to see the nurse who'd asked me to find them when I was told;

'Well that ECG would determine whether we thrombolyse* or not'

Great. Just bloody great. No-one at reception wanted to help me, or even try. I went back and looked myself, only to be told 'Well you won't find it there'. Never did find it. The good news is that he was ok in the end and did not need thrombolysis, and we've seen him a couple of times since. I just hope this never happens when someone's life is really on the line. But then it's up to the cardiac nurse.

There was something else on this shift that annoyed me. I'll call him Mike. He'd come in seeking help because he'd had too much alcohol to drink and was feeling suicidal. He'd asked for some sandwiches and a hot drink, which I was happy to get for him. Typically, I managed to spill the drink down my hand. When I gave it to him I said 'Now be careful it's hot, I know because I've just spilt it on myself'. I put it in his hand and went back. I'd got no more than 2 metres away when he's spilt the lot down his leg and scalded himself. He then refused to let me help him get out of his wet clothes and into something dry, so I went to get his notes to document what had just happened. When I asked who he was, he thought it would be hilarious to give me some fake names, so I had to guess which notes belonged to him by process of elimination. He started to wander off, and his trousers slid down to his knees. A couple of the elderly patients found this fairly distressing, so I covered him up with a blanket and showed him back to his cubicle. I once again tried to convince him to change into a gown,

'Come on now, you can't be comfy in those wet clothes'

'Well it's your fault'

'Excuse me?'

'You just threw that drink down me'

*speechless*

I felt so offended that he'd just accused me of that.

'No, I gave the drink to you and told you to be careful because it is hot, and YOU spilt it onto YOURSELF'

He sat there laughing at me. He found the whole thing amusing, but he was wasting my time and I'd had enough of it. I left him in his wet clothes and notified the nurse looking after him. He self-discharged shortly after. Fine by me. I found it very difficult to sympathise with him. He'd come into hospital, by ambulance, asking for help and wanting someone to talk to. When he got here he treated everything like it was a joke, scalded himself (which may have been intentional), was horrid to the staff and then went home - with some free food of course.

People, mainly patients, always talk about the bad things that are involved in my job. I guess I talk about the bad stuff quite a bit as well. But still, there are plenty of good things that make up for it, so I'm still smiling.

*Thrombloysis - this is a treatment given to a patient that is having a heart attack. It carries a significant risk, so it is only done when it is absolutely necessary.