Classic House of God style Turf to Ortho today. Two days ago, GOMER escapes from bed, goes to ground in the toilet and NOFs out. Classic.
Almost de-buffs himself, however, by acquiring a PE. I get handed over the organising of the CTPA when I come on, early evening. He's reasonably compos mentis and I get the venflon in no problem. Then an hour later I get a bleep from the radiology reg saying patient absolutely refusing transfer onto table to go through the magic doughnut. My solution is to find patient's wife and escort her halfway across the [hospital name deleted] to talk some sense into her by now unfortunately acutely-on-chronically confused husband who's going absolutely mental in a London accent whenever anyone touches him. (He may or may not actually have been from London.) Well, in the end I persuade radiologist and attending nurses that he's really not currently competent to make a decision about the pros and cons of this particular line of investigation, so let's just wheech him onto the pat-slide and see what happens. All seems to be well as thereafter no-one needs to touch him. Unfortunately though, he pulls off a masterly version of the classic demented gerry venflon-pull manoeuvre (VPM*) halfway through contrast administration (adding risk of compartment syndrome to my accumulating list of de-buffing factors.) I'm all for banging another one in and cracking on, but by now the already perturbed radiologist is completely unglued and in a state of extreme reluctance. So back to the ward we go. Fortunately I'm able to charm the [hospital 2 name deleted] ortho reg into taking the patient anyway, leaving only the small matter of bolusing in some heparin and starting an infusion. Unfortunately this involves getting another venflon into a patient who is by now a total mentalist, maddened up to the eyeballs with NOF pain, hypoxia and gerry-rage. Neither is sedation an option as I'm not going to make friends and influence people by giving him a bit of respiratory depression. So the classic FY1 vs mad-as-a-lorry-old-man Battle of the Venflon commences. I don't know if you've ever tried cannulating a man who doesn't want anything to do with your "fucking crazy needle you fucking bastard what the fuck are you doing to me!?!?!" but it's pretty f*cking difficult, I can tell you. Took about four goes and there was blood on my hands by the end of it but I won, thank goodness, and not a moment too soon as the men in green suits showed up. Phew.
* Said manoeuvre constitutes one component of the classic triad of Keats' Syndrome: venflon-pulling (catheter-, NG-, nasal prongs-, oxygen mask-, stethoscope-, tie- and hair-pulling are closely associated behaviours), an irrepressible desire to escape from the bed/chair/room/ward/planet and an extreme reluctance to become the subject of any medical examination, investigation or treatment (particularly those involving sharp instruments, log-rolling or the unnatural insertion of fingers into bodily orifices.) The syndrome is, more often than not, accompanied by the liberal employment of profanity in the direction of medical staff and/or allied health professionals.
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Speaking of House of God, the unrivalled highlight of my weekend on call three weeks ago was going to see a rather deaf old gentleman with my consultant. It quickly becomes apparent that he can't hear a word we're saying - hearing aids MIA as usual - whereupon consultant says, "Right, let's try the Communicator!" whips off his Cardiology III, plugs the earpieces into the patient and addresses him through the bell-end. Result: therapeutic relationship restored. Marvellous!
