e

she was the first ward patient i'd looked after in a long time. a young thing, barely out of her teens, she was preoccupied with life, frustrated by an illness that seemed to thwart all her attempts at normality. for a while, as her lung function fluctuated, we wondered if she was really compliant with her treatment. our doubts made her angry: didn't we believe (in) her?

it was as if her entire existence hinged upon others believing in her. adolescence is tough enough to negotiate without having to deal with what is essentially a terminal illness. for her, walking that fine line between striving for independence and relying on others was particularly difficult. for someone who was yet to develop a strong sense of self-identity, who still needed other people to validate her choices, the loss of autonomy that came hand-in-hand with each hospital admission threatened to overwhelm her hesitant steps towards adulthood.

the final blow came months later, when i'd left the service. a colleague informed me that she was in icu with full blown respiratory sepsis. the bosses had decided to go down an unusual and bold path. she was on ecmo, and awake. the thought of it terrified me. i couldn't bring myself to go in and visit her. on each day that i went into work, doing another job at another hospital, one of the first things i'd do was to check on her latest bloods and chest x-ray. the little patch of aerated lung grew smaller and smaller; the oxygen level in her blood became lower and lower. sepsis gave way to ards. transplant wasn't an option. and then, finally...

icu is a frightening place to die. it's so completely alien. there is no day or night. there is no privacy. nurses and doctors, orderlies and clerks, family and friends, all come and go in shifts. the only constant is the throbbing fluorescent light reflecting off the shiny surfaces of medical hardware and the sterile white linen. endless miles of tubing sprout from banks of beeping machines and invade the helpless bodies on trolleys. the only view outside looks onto the enormous grey helipad, where broken bodies from traumas are brought in from all across the state. all we can offer are words, and when that fails, sedation.

she had dreams. simple, worthwhile ones. to finish uni. to move out of home. to travel. others waste their entire lives looking for reasons to live. she only wanted to live.

dream on, e. you're free at last.

nights

freezing to death in the tiny on-call room, struggling to stay awake despite twenty-seven cups of coffee. the words on the computer screen swimming around, and after trying to put them together for the third time, i still have no idea what they mean. im supposed to be studying but its not working. only four hours to go before i can go home and have a beer at nine oclock in the morning.

the loudspeakers outside my door seems to be mumbling something. then my pager goes off. code blue in rehab c. great. out of all the wards in the hospital, of course it had to be the one furtherest away from me. i put on my shoes and run. but ive forgotten my stethoscope. turn back. whats the stupid door code again? run run huff puff chest pain. going through the als algorithm in my head, getting the hs but always forgetting the ts. oh its the same guy i reviewed yesterday: why is he still here? didnt the day team do anything? the subacute nurses fluff around. ivc, ecg, do my own obs, make some whimsical comment to lighten the atmosphere, a set of bloods, call a taxi to take them to the alfred, write some notes, inform the ao. only three hours to go before beer oclock.

sigh. at least im awake now.

tagged

currently feeling -
lethargic, waiting for my first night shift to begin

currently addicted to -
procrastination

recent most funny moment -
my mate dan’s two minute phone interview with the head of orthopaedics from a queensland hospital included: “can you operate?” delivered in a growling, entirely serious tone

favourite airport-travel routine -
haven’t been to airports for a while, but id probably try to fit in a pint at the irish pub

most prized possession -
im not big on material possessions. so im going to go with the feeing in my gut

current mantra to get me through the bad times in life -
it can always get worse

currently inspired by -
fear

most entertaining online read when u have nothing else better to do and need a laugh -
xkcd

favourite blog -
minnie min

most excited about -
beer and sleep

just digested -
plain boiled rice, tinned tuna and spicy bamboo shoots from a jar

f*crap

so it begins -

- with a series of weekend lectures that threatens to overwhelm me,
- tense trainees, eyes rimmed with lack of sleep, debating minutiae,
- frantically trying to form study groups and organise study sessions,
- downloading lectures, signing up to journals i know i'll never read,
- not knowing, worried about not knowning, worried about worrying,
- feeling guilty guilty guilty about everything and anything but still
- spending endless hours procrastinating on facebook and wikipedia,
- laughing at horror stories about med reging in the country but
- knowing that it'll be me soon +gasp gasp gasp+

time for more coffee.


another customer arrives at the hotel alfred

there is no why

why do kids refuse to do anything for their parents? why do they feel that it's other people's responsibility to look after the frail elderly women and men that once did everything for them, gave them life, fed them, clothed them and brought them up?

a woman with mild cognitive impairment wants to go home. she is happy to adopt the team's recommendations regarding gaid-aids, home modifications and community services. all she needed was her children to meet her when she got home, make sure there was some food in the fridge until someone from the council could help her do her shopping in a few days' time, and ring her occasionally to make sure she was okay. but even that seemed too much to ask. they wanted us to send her to a nursing home. but why? when we finally got her home, she managed to lock herself out one night, went over to her neighbours for help, who called her son. he rang the ward and wanted us to readmit her. for what? call in a locksmith. call the cops. if all else fails go over yourself and let her in with the spare key. is that so fucking hard?

*

why do frail elderly people refuse to do anything for themselves? why do they give up their last shred of independence and dignity so willingly and throw themselves into a cycle of dependence that leads inevitably towards nursing homes?

a previously self-sufficient woman, living alone in her rented flat, walking without gait-aid and independent with her personal activities of daily living, is admitted with osteomyelitis. over the six weeks of inpatient stay for intravenous antibiotics and physical rehabilitation, she becomes fully dependent on nursing staff for personal care and mobility, declines physiotherapy and lies in bed all day, refuses clinical psychology and antidepressants for her anxiety and adjustment disorder despite their overwhelming impact on her level of function, and wants maximal nursing and community assistance for when she goes home. yet when push comes to shove (threatened with delayed discharge or placement into a nursing home), she demonstrates that she can perform at her premorbid level. so why does she insist on playing the sick role?

*

why do the frail elderly refuse to accept their declining physical health and diminishing capacity to look after themselves? why do they reject help and insist they return to the same conditions that brough them into hospital in the first place?

a man with urinary retention, faecal incontinence and poor mobility wants to go home. he doesn't understand why these things need to sorted out before he can go home, refuses to participate in therapy and dismisses all of our recommendations as "meddling". he says "i've looked after myself for eighty years and i can still look after myself just fine. i'll know when there is a problem, and until then, i don't see why i have to do anything about it". lack of insight? yes. but then at times he demonstrates an uncanny appreciation of his circumstances: "you have all the tools to rule over my life and i have no control over it. all i can do is be grumpy, and that's exactly what i am". and so there it is: absolute, glorious, undeniable clarity. so how come he still doesn't get it?