Q4 - JOURNAL ENTRIES

Journal entries from the fourth quarter of my second year in basic specialist emergency training:

• MVP of the year:

  • • Me: How far into your pregnancy are you?
    • Patient: I’m not sure. Two or three months.
    • Me: Is it two or three months?
    • Patient: Does it make a difference?
    • Me: A fairly big one.
    • Patient: Well, I’m sure you can figure it out. 

I proceed to take a full history.  

• • • Me: Do you smoke, or did you smoke before the pregnancy?
    • Patient: I cut down to one an hour.
    • Me: What about alcohol?
    • Patient: Do you think I’m nuts? I’m not even having energy drinks, for goodness’ sake!
    • Me: You realise that smoking is much worse than drinking energy drinks, right?
    • Patient: If I quit smoking, I’ll get depression.
    • Me: You’ll also get depression if your baby’s all messed up.
    • Patient: …
    • Me: …

• I was sitting in the doctors’ car park when a woman pulled into the space beside mine. “I don’t think I can park here,” she told her husband. “It’s for doctors.”. “Who gives a crap about doctors?” he replied. I lowered my window and took out my phone: “Hello, I’d like to report an illegally parked car.”. Within minutes, their car had been clamped. In a hospital where nothing seemed to happen quickly, parking enforcement had apparently achieved resus-level response times. 

• During my anaesthesia rotations, I was occasionally assigned to work with one particularly exacting anaesthetist who had become somewhat renowned throughout the realm. She called IV fluids “liquids” and syringes “injections”, wanted everything done precisely her way and occasionally swatted your hand aside if you reached for the wrong thing. The main difficulty was that “her way” appeared to change without warning. Even when you did exactly as instructed, it somehow remained wrong. A few excerpts:

  • • I was working alongside her and a junior anaesthetist when he suggested using a video laryngoscope because the patient had an enormous moustache. She insisted that this wasn’t how he was supposed to learn and instructed him to use a direct laryngoscope instead. The moustache then got in the way, forcing her to hold it up throughout the intubation. Medicine might have developed all kinds of advanced airway technology, but sometimes what you really needed was someone assigned to moustache duty.

    • She scolded the junior doctor for not placing the leftover medication in the fridge for the next patient on the surgical list. When he did as instructed, she scolded him because the current procedure hadn’t finished and she might still need it. He brought everything back, only for her to announce a few minutes later that the procedure was over and that he could return it to the fridge. By the end, he had followed every instruction and somehow still been wrong at every stage.

    • She scolded me for disposing of a used syringe because she liked to keep track of everything she used during a procedure. I told her she should have told me to do that beforehand and that I had been taught never to leave used sharps lying around. The syringe remained in the bin.

    • The surgeon instructed me to raise the operating table. Given that its remote control was attached to the table itself, I simply pressed the “up” button without pointing it anywhere. “You have to point it at the table,” she told me. “It doesn’t have a sensor,” I replied. “Yes, it does.” she went.  I pointed the remote at the table and pressed the button again. “You see?” I said. “It’s moving at exactly the same speed.”. “No, it isn’t.” she insisted. Surviving the rotation suddenly felt more important than winning the argument.

    • Between procedures, she volunteered an astonishingly detailed account of her sex life and explained that she was still single because nobody could handle her in bed. Nobody had asked. The operating theatre, for once, fell completely silent. 

• Things patients say that make every doctor quietly brace themselves:

  • • “I have a high pain tolerance.”
    • “I’m a member of staff.”
    • “Lemme start right from the beginning…”
    • “Ever since I had the COVID vaccine…”
    • “I Googled my symptoms.”
    • “My relative is a doctor.”
    • “I need a full-body scan.”
    • “I’ve already diagnosed myself.”
    • “I don’t believe in medication.”
    • “I’m flying tomorrow.”
    • “I’ve written everything down.”

• Reasons people give for visiting the emergency department:

  • • “I was close.”
    • “I was already here with a relative.”
    • “I needed a check-up.”
    • “It’s been bothering me for six months.”
    • “I wanted a second opinion.”
    • “I’m going abroad tomorrow.”
    • “I wanted a second opinion.”
    • “I need a medical certificate.”
    • “My friend told me to come.”