Had an absolutely cracking day yesterday. I decided I was fed up with working in internal medicine and that I'm not going back there ever again. It's dull and nothing ever happens. Instead I joined my friend Seve in the Emergency Room, which was really excellent. It was very exciting and things were happening literally all of the time. I went around introducing myself to all the doctors, who were very welcoming and basically said that I could hang out wherever I wanted and check out what was happening. I started off in surgical admissions, where I saw loads of gruesome things, including some cracking examples of Charcot's foot (everyone here is diabetic, and this is a common complication). A number of taxi drivers were also in evidence - this must rank as the most dangerous profession here by far! One of them had a particularly impressive head wound, which needed fixing. Then there was a guy who had been vomiting blood, who was subjected to what seemed to me to be a needlessly barbaric investigation. Basically they said they couldn't do an endoscopy (camera-into-stomach-have-a-look-aroundy) as that is done in the gastroenterology department and it's not possible to transfer people (!). Instead they stuck a tube up his nose and down his throat, poured a load of saline down it until he vomited it all up again into a pot, and then had a look what was in the pot. It looked really brutal, especially as the intern doing it clearly didn't quite know what she was doing! After that ordeal I headed over to the medical bit to see what was happening there.
Again, many things. There was a guy having an asthma attack, a couple of heart attacks, pancreatitis, septicaemia; all sorts. I actually got to do some real practical stuff like listening to people's chests and tapping their stomachs, and I correctly identified a case of aortic insufficiency! Wonderful - it was the first really properly good day I've had in the hospital, and reaffirmed my desire to go into emergency medicine.
The other exiting/terrifying thing that happened was in the critical care ward (although "ward" is perhaps generous; maybe rather "room" or ever "cupboard"). When Seve and I went in there was a nurse there who told us about the only patient they had at the time - a 65 year-old man with congestive heart failure. He was unconscious and on a ventilator, and was generally not in a good way at all. The nurse left after a while and we stayed to look at his notes and charts. After a few minutes we noticed his oxygen saturation start to fall - from 98%, down to 95, then 90, then 80. Alarms began to sound. The guy groaned once and they lay still. Our attention turned to the ECG monitor, where something was happening... The trace jumped up and down, with the heart rate flying upwards to peak at 250 bpm. Then it flat-lined. JESUS CHRIST. WHAT DO WE DO?! CHEST COMPRESSIONS? ADRENALINE? WHERE'S THE DEFIBRILATOR?! Seve, cool as a cucumber, says, "Don't panic - I've seen this before. I know what to do". He calmly walks over the the monitor and gives it a solid thump, whereupon everything comes back to its proper state. "Loose connection", he says.
In the evening a few of us headed out to a beach/hill combo just outside Tunis to have a quick swim and then watch the sunset, which was spectacular. I needed Steph there really, as the romance of the moment was wasted a bit on the three boys I was with. We still tried though. Here are some pictures:
Afterwards I went out for a few drinks (one tea, one coffee - CRAZY) with a couple of the doctors from the internal medicine department. I feel a bit guilty about jumping ship and joining emergency medicine but they seemed pretty relaxed about it and appreciated the fact that their chosen specialty was basically dull as dulldadulldulldull. Then it was home to bed, after watching Black Swan, which is very good.
Today I have had another equally brilliant day in the emergency room, but I will avoid boring you with any more medical details. I'm just off for a power nap before Spanish dinner ce soir, followed by a football match. Good times.
Again, many things. There was a guy having an asthma attack, a couple of heart attacks, pancreatitis, septicaemia; all sorts. I actually got to do some real practical stuff like listening to people's chests and tapping their stomachs, and I correctly identified a case of aortic insufficiency! Wonderful - it was the first really properly good day I've had in the hospital, and reaffirmed my desire to go into emergency medicine.
The other exiting/terrifying thing that happened was in the critical care ward (although "ward" is perhaps generous; maybe rather "room" or ever "cupboard"). When Seve and I went in there was a nurse there who told us about the only patient they had at the time - a 65 year-old man with congestive heart failure. He was unconscious and on a ventilator, and was generally not in a good way at all. The nurse left after a while and we stayed to look at his notes and charts. After a few minutes we noticed his oxygen saturation start to fall - from 98%, down to 95, then 90, then 80. Alarms began to sound. The guy groaned once and they lay still. Our attention turned to the ECG monitor, where something was happening... The trace jumped up and down, with the heart rate flying upwards to peak at 250 bpm. Then it flat-lined. JESUS CHRIST. WHAT DO WE DO?! CHEST COMPRESSIONS? ADRENALINE? WHERE'S THE DEFIBRILATOR?! Seve, cool as a cucumber, says, "Don't panic - I've seen this before. I know what to do". He calmly walks over the the monitor and gives it a solid thump, whereupon everything comes back to its proper state. "Loose connection", he says.
In the evening a few of us headed out to a beach/hill combo just outside Tunis to have a quick swim and then watch the sunset, which was spectacular. I needed Steph there really, as the romance of the moment was wasted a bit on the three boys I was with. We still tried though. Here are some pictures:
Afterwards I went out for a few drinks (one tea, one coffee - CRAZY) with a couple of the doctors from the internal medicine department. I feel a bit guilty about jumping ship and joining emergency medicine but they seemed pretty relaxed about it and appreciated the fact that their chosen specialty was basically dull as dulldadulldulldull. Then it was home to bed, after watching Black Swan, which is very good.
Today I have had another equally brilliant day in the emergency room, but I will avoid boring you with any more medical details. I'm just off for a power nap before Spanish dinner ce soir, followed by a football match. Good times.
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