I got the job, I'm heading home.

  

Moon rising over Holy Cross.

There is little else more satisfying than the clonk that comes with relocating a dislocated jaw. Apparently the elderly lady, whose mouth I had my hands in earlier, was doing some serious mastication at the time of the incident. Recently I have been thinking that, as my time at Holy Cross is nearing an end, the amount of trauma seems to have reduced. Of recent, no nasty wounds to suture, chest drains to insert or fractures requiring reduction, pop into my head. However, maybe I just don’t notice these things as much anymore. It seems to take rather a lot to make me squirm and look aghast with a slack jaw nowadays. In addition, I’m just not on call as much as when I first started. Working one in two weekends a year and a half ago was a baptism of fire, but one that really built my confidence in managing exceptionally grim situations, some of which I have written about. I have three weeks of work left: I shall be working straight through as I’m on call both weekends, and on one of which I shall be the most senior doctor on site. Before I have always had the “phone the boss” option; next weekend I am the boss. This strikes rather a large amount of fear into me; it feels as things have been so quiet recently that maybe this is all the calm before the storm.

I say things haven’t been that busy, but as I look at the list I keep of interesting cases, perhaps I could have been mistaken. There’s a good reason for keeping lists: it’s easy to forget things. Here are a few memorable snippets from the past few weeks:

1. A thirteen year old boy on the medical ward decided to go into cardiorespiratory arrest (that’s when one’s heart and breathing stops; the same thing that happens in death) after a nurse gave him intravenous antibiotics. Fortunately, my colleague was on the ward and after thirty seconds they brought him back to life. Neither of us are quite sure if he had an anaphylactic reaction (this would be quite unusual in the way it presented) or just a serious vasovagal (fainting) episode as he was a little needle phobic. Needless to say, I was not willing to try the same antibiotic again.

 

2. I saw a four month old baby girl who was in severe respiratory distress. In fact I had seen her just days before with a mild chest infection and told the Mum to return if things didn’t settle. The baby had developed a massive collection of pus on the right side of her chest (empyema) that was severely compromising her breathing. Initially I inserted a needle to aspirate a little fluid and see what it was: when I saw pus, my first thought was: “Bollocks.” It was Friday afternoon and I was hoping to shoot off for a fun weekend away; it looked as if I’d be leaving a little later than planned. However, the main reason for my swearing is that pus doesn’t come out by itself, it needs to be drained and this would mean putting a surgical chest drain into a tiny little chest. To make things even better, when I put the needle in through her ribcage, I created a pneumothorax (air in the lung). This meant she would definitely require a drain. I have no qualms about cutting a massive gaping hole in the chest of an adult, getting my finger in, having a good poke around before I slide a big tube in. In a little baby, this is a very different business and something way out of my comfort zone. However, without the procedure she probably wouldn’t have survived the weekend. Anyway, without too much deliberation, I inserted the drain and watched the baby improve by the second. She has since been discharged and is doing very well.

The left shows a whole load of fluid (empyema) in the baby's chest. The chest x-ray on the right is following my attempt to aspirate all the pus and in turn creating a pneumothorax.



Pus.





Baby with chest drain in situ.
 She also has a femoral line in her right groin.

 

3. Whilst on call two weeks ago a young girl came in after slashing a big gash in her foot when she was cutting the grass at home. The wound was under a small bandage, but right over an area where a rather large artery runs – knowing anatomy can be key in times like this. I asked the nurse: “Is it a squirter?” She wasn’t sure as she hadn’t applied the dressing. So, having been almost caught out on several occasions before, I donned my goggles, asked the nurse to step aside and removed the bandage. Unfortunately, the side where the nurse stepped was right into a shower of arterial blood. It most definitely was a “squirter.” Fortunately, I managed to tie the bleeding off rather fast, although my nurse wasn’t too happy with the stain on her nice white uniform.

 

 

 

I love it when patients bring in the stuff that comes out of their gobs and bums. Here's a nice example of a worm that has been having a swell time feasting in a clients intestines.



4. Sunday is a day for church and football over here. Passions run high in both institutions, however, some people really do get slightly over zealous when it comes to kicking a ball about. Within thirty minutes of each other, on the day of “rest” and at 2pm, two grown men were both brought in with stab chests. One felt he was being overly criticised by his team mates for his ball handling abilities, so tried to stab them, but failed and received the knife himself. The second was a spectator who got into an argument with his friend over whose girlfriend was better looking. Well, I would defend the love of my life to the death, but I wouldn’t enter a death fight over how pretty she is. We all had a good laugh about the entire affair, but it does make me a little sad this culture of aggression. 
 

***

In other news, I got the job: three years of emergency medicine training in South London. I have very mixed feelings about leaving, but I think I’m ready to go. More importantly, I cannot wait to get home to see my dear family, friends and, of course, the girl.




A leaving party for Sr Lupondo: the head of casualty. Fortunately on this day the department was empty, which meant everyone could attend for a little dancing, cake and an whole lot of meat.

 

 

A few goodbyes: myself and Sr Ndamase. I know one shouldn't have favourites, but she is definitely the nurse I admire most. She helped me through some very challenging times at the beginning and is exceptionally dedicated. In addition, I share a birthday with her son Bebo, who is a cheeky little chappy.

When oysters cost £18 for 100 delicious nuggets of seaside, it can only mean one thing: breakfast, dinner and lunch. A well deserved weekend off after fiddling with chest drains in babies.

As well as oysters, it's crayfish season. Yum yum in my tum.