Another shift in a Melbourne ED
The clock on the dash shows 20 minutes until my shift starts so I brake as the traffic light changes to amber, instead of racing through. It gives me time to watch the enormous Australian flag at the roundabout unfurl and undulate in the breeze. A siren sounds in the distance on Royal Parade.
At the ED I look left as I walk towards the admin area. The curtains hang open on Trauma 2, like an abandoned stage. Debris and blood, bits of cut-off clothing and a motor bike helmet tell the story of the trauma that has just been. The cleaner slowly drags the mop and bucket into the centre of the bay. Maybe the resuscitation hadn’t gone so well. I quicken my pace as I pass the worried family waiting at their relatives’ room.
I take the handovers. The young registrar is ebullient. He delivered the motorcyclist alive to theatre, despite 20 units of blood and products, bilateral chest tubes and a near arrest in emergency.
The department seems to exhale after holding its breath for too long. The nurses bustle and laugh, another shift has begun with a bang, four ambulances arrive at once and two of them will need a resus bay. It’s still early and nerves haven’t yet started to fray.
A teenager girl, suicidal, considering jumping from a building. She’s been here before. I book her for the Behavioural Assessment Unit (BAU) before I even see her.
“The room stills around us as I close the door. Defiant and aggressive, she sits on the bed, arms folded, jaw thrust forward, challenging me to alleviate her pain. ”
She’s small and pale with a pixie haircut, a nose ring and torn black jeans. The room stills around us as I close the door. Defiant and aggressive, she sits on the bed, arms folded, jaw thrust forward, challenging me to alleviate her pain.
The enormity of her isolation makes me want to cry. That wouldn’t help either of us. I parry her hopelessness with words my mum would say when I was sad.
I thoughtlessly say a quote I heard once, “If it is not a happy ending, it is not yet the end.”
As soon as the words leave my mouth, I regret it.
She snorts and looks away. I turn to the computer and order a Valium. I wish I could be anywhere else. An orderly comes to escort the patient to the BAU. I’m released.
The charge nurse asks me to come to Trauma 1, they’re having issues with a patient. It must be the prisoner who had slashed his throat with a box cutter. His doctors have been called away to another trauma. The prisoner is stable. I can see his intact larynx move up and down as he yells at the surgeon to leave him alone. His neck is strangely bloodless, as if the wound edges had been cauterized. The trauma surgeon walks towards me shaking his head in frustration. The patient is competent, he only cut his throat to be taken out of prison. The junior trauma doctors throw up their hands.
The charge nurse calls again to say that we’re getting an intubated overdose and an acute pulmonary oedema. Clearing Trauma 1 becomes even more vital.
The patient is cheerful enough when I introduce myself. I smile a lot and I think I have good rapport. The answer is still no. No surgery today, no to moving, no to assistance. I almost turn away. Is there anymore I can do right now?
But I give it one more shot. “Look mate,” I say, in my most ‘ocker’ Aussie accent. (Do I think he'll believe me more if I sound like I was born here?). “I’ll film your neck on my phone as you talk, and you can watch your own voice box moving up and down. How about that?”
He agrees and watches the video. “Holy shit!” he says.
The trauma surgeon slides the consent form across the bed. We get the patient to theatre in ten minutes.
“There are 20 patients waiting to be seen. It’s that time in the shift when we’re hungry and tired and there’s still two hours until the evening doctors arrive. ”
The room is cleaned, the bed is made, the IV set up and the drugs drawn. Another consultant comes in with his registrar just as we hear the sirens closing in outside. We exchange looks.
I leave resus and go back to the computer to calculate the damage in my absence. There are 20 patients waiting to be seen. It’s that time in the shift when we’re hungry and tired and there’s still two hours until the evening doctors arrive.
The shift ends with a whimper. I’m exhausted. As I take off my stethoscope from around my neck, I realise I haven’t used it once today.
I walk past the BAU on my way to the car park. Something compels me to look in on the teenage patient I saw earlier. I say, “Are you ok? Have you seen the psychiatrists?”
“Yes,” she says, “they were here. Thank you.”
She doesn’t seem to know who I am, so I turn to leave. I wonder how I could have felt such a connection when there obviously was none. But then she says, almost in passing, almost to herself, “Hey, what was that quote you said before? I liked it.”
