I was just browsing some of the things I've written when I found this post from last year...
I answer my pager and listen to what Tal, the orthopaedic surgeon, says to me down the phone. I sit on the intensive care unit (ICU) and my heart sinks a little as he explains the story. It’s 3 a.m. on my third night on the trot and, to be honest, I’d been semi-expecting a call like this at some point. I sigh and tell the surgeon that I’ll be down to A&E soon. As I leave ICU, I scoop up some drugs and let the ward sister know where I’m heading. She rolls her eyes as I tell her what’s going on. “I know.” I respond, “I just don’t understand what some people do for kicks.”
I take a stroll down to A&E through the empty corridors of the hospital. My clogs create a faint echo with every step I take. I have a few moments to think about what I’m about to see and have to deal with and I surprise myself a little. You see, the main emotion I’m experiencing is not fear or excitement and it’s not sympathy or concern. It’s irritation. I’m annoyed by the situation that I’m being called to help sort out. I know that I took an oath to “make my patients my first concern,” but, despite myself, already I’m thinking that the man I’m about to meet in A&E is a bit of a dick.
A&E is busy, which is not surprising seeing as it’s Friday night, and as I wander through the department looking for Tal, I spy my punter. To be honest, I hear him before I see him. He’s shouting, he’s obviously in an awful lot of pain and he’s obviously very, very drunk.
Tal is in the doctors’ office scribbling some notes and he looks up at me as a walk in.
“The guy round the corner?” I ask, somewhat rhetorically.
“Yeah, sorry about this,” Tal replies. “He’s had 10mg of morphine from the paramedics, I gave him another 10 before I called you, he’s got some Entonox, but as you can hear, he’s still in agony.”
“Hmmm,” I grunt. “And his injuries are where, exactly?”
“Well, he’s lost two fingers and has a deep laceration going across his whole palm.”
“So, all three nerves then?” I enquire, referring to the three nerves that supply the hand: the median, the radial and the ulnar.
“Yeah, we haven’t dressed the wound yet, so you can look for yourself.”
“Cheers,” I say and smile at Tal. I can tell that he’s just as unimpressed with the situation as I am. I think there’s a bond that develops between hospital workers when you have to deal with situations like this in the middle of the night. “Tell me again, what happened to this guy.”
“Well, he says he got into an argument and thought it would be a good idea to light a firework and throw it at the other guy.”
“As you do…”
Tal laughs dryly, “As you do. Anyway, the firework goes off, the flames scorch his hand and then it explodes and blows his fingers off.”
I picture the scene in my head, it’s like something from a cartoon. It would be pretty comical if it hadn’t ended up with the guy in hospital “Why on earth did he think that throwing fireworks would be a good idea?”
Tal shakes his head. “I don’t know, I didn’t go into it. To be honest, he’s so pissed that it’s hard to get any sense out of him at all.”
“What’s his name again?”
“OK, I’ll go see what I can do.”
Simon is sitting on a trolley with his girlfriend and his Dad next to him. The two of them are sober and obviously really worried. Simon, on the other hand, is not. He’s totally off his face and is singing a Girls Aloud song between cries of pain. I introduce myself, but Simon’s not really paying any attention to me.
“It hurts! It hurts!” he yelps
“Of course it hurts,” I say. “I’m going to give you a couple of injections to help with the pain. They sting a bit when they go in, but it won’t be anywhere near as band as your injury.”
“It’s killing me!”
“Keep using your Entonox, I’ll be back in a minute.” I go off and find a syringe, some chlorhexidine and a small needle. I return to Simon’s trolley and tell him, “Right, I need to take a look at this.”
“I don’t want to see it!” he yelps.
“I need to see what I’m doing.” I respond, firmly. “If you don’t want to see it, close your eyes.” Simon keeps his eyes open and stares intently at what I’m doing. I shrug.
I remove the Incopad that Tal had put over Simon’s had and had a look at his injuries. Simon has lost all the skin and flesh from his middle and ring fingers leaving just the bones sticking out like something from a grotesque film. His little finger was missing altogether and a wide, deep gash ran from where his little finger should have been to the base of his thumb revealing the tendons underneath. It looked horrific. It was horrific.
“Aaargh!” yelps Simon as he catches sight of his mangled hand again. I ignore him and set about cleaning his wrist the best I can.
Simon starts to laugh. “Look at that!” he says as he lifts up his hand. He starts moving his fingers and the visible bones start to flex and bend. It’s a really surreal effect, it looks like something from a horror film. “Ha ha ha ha ha!” comes Simon’s laugh. “I bet you’ve not seen anything like this before, have you doctor?” He’s right, I haven’t. He jabs the skinless bones of his middle finger in my direction. “I bet you’ll always remember me now! Ha ha ha ha ha!”
“Simon! Pack it in! Behave yourself!” comes the sharp, reprimanding voice of his girlfriend. I look up at her and she looks really green.
“Are you OK?” I ask.
She nods. “Do you want to have a seat or maybe get a cup of coffee while I do this?”
“No, I’ll be OK, I want to stay with him.”
I turn back to Simon. He’s not really behaving like someone who, in all probability is about to lose is hand. I shrug. It’s most likely the effects of the morphine, the Entonox (a.k.a. “laughing gas”) and, most of all, the vast amounts of alcohol he’d consumed earlier in the evening.
“Put your hand down and keep still.” I tell him.
By now, Tal had come in as well because he wants to see how I do the nerve block. I talk Tal through what I’m doing, the landmarks I’m using to try and identify each of the three nerves and tell him what dose of Bupivicaine I’m using in each place.
“Right, that’s done now.” I tell Simon. “It’ll take about 20 minutes to start to work, so it the meantime, keep using the gas.”
“Will what you’ve done take the pain away?” asks Simon’s Dad.
I shake my head. “No, it’ll make the pain much less severe, but it won’t take it away completely.”
“What’s going to happen now?”
I look at Tal and he starts to explain the next steps to Simon’s Dad.
I leave them to it and go and jot down what I’ve done in Simon’s notes. My attitude towards Simon has changed since I first took the call from Tal. I still feel annoyed by him and what he’s done to himself, but now I see that how I feel about it is really not relevant to anything at all. This guy’s just lost most of his hand. When he sobers up in the morning, this realisation will hit home. There’s no point in me thinking about what a dick he’s been because every day for the rest of his life, Simon will have to live with his injuries. He’ll have to learn to write all over again, to dress himself to open jars, to do all the simple little things that we all take for granted. Every day, he’ll look down at his hand and he’ll think to himself “Why the hell did I pick up that firework that night? Why was I such a twat?”
Simon’s made his own bed to lie in and he’ll have to face up to that soon enough, my personal feelings towards him is neither here nor there. You see, I can walk away from the situation and not have to deal with it anymore, Simon doesn’t have that option.
I sincerely wish him all the best.