Secret Diary of an Emergency Registrar

Age: Start or end of shift?
Status: Caffeinated.
Likes: Chest tubes. Wearing runners to work.
Dislikes: Describing CT brains to neurosurgical registrars over the phone.

An evening shift at St Anywheres…

14:00h: Start shift. Feeling refreshed and energetic after 3 days off. Will efficiently plough through the list, yet give each patient the personal attention they deserve. Will be pleasant and professional in referrals while remaining a firm advocate for my patients and the department. Will write succinct, clinically relevant, legally ass-covering notes at the time I see the patient. Today is a fresh start. Anything could happen. A trauma! A subarach! A low back pain!.

Asked how I spent my days off. Murmur non committal utterances giving impression of rock climbing, surfing, leisurely brunches with cool friends and live music. Omit to mention 11am sleep ins, laundering scrubs and binge watching Game of Thrones.

Check roster. My nemesis, Allan the Super Reg, is on and has already picked up 3 patients. Make myself a coffee while waiting for computer to open.

15:00h: make another coffee.

16:00h: Hit caffeine sweet spot. Churning through patients. Department is humming. That’s what I’m talking about!

17:00h: See a 55 year old man with back pain. Body habitus suggests my chance of a decent AAA view will be moderate to low, nonetheless wade in optimistically, probe in hand. Am too heavy handed on the gel and the probe slides out of my hand, bouncing off his abundant abdomen onto the floor. Fx%k! No obvious witnesses. Do brief mental calculation of cost of replacement probe divided by my hourly wage. Put machine back in cupboard and begin to spread rumour I think I saw Allan drop the probe.

18:14h: Checking wait list. Next to be seen is 57 year old lady, dizzy. Multiple other symptoms relating to at least 3 different organ systems and a list of proper co-morbidities meaning serious pathology will need exclusion. She is wearing sunglasses. Indoors. Decide to check some blood results and write a set of notes and come back in a few minutes.

18:19h: Entire doctor population circling the wait list in multi-player Mexican standoff, assiduously avoiding eye contact. Wait list building. See in-charge consultant move to check computer and panic, picking up dizzy lady.

18:21h: Multi-trauma patient arrives. Allan has his name next to him before the triage nurse finishes the notification. Bastard! Should have held my nerve. Allan calls a trauma call. I am on procedures. Blow the drip. Try to do FAST. Probe not working properly. Hmmmm.

18:40h: See my dizzy lady. She is very pleasant. I have absolutely no idea what is wrong with her, or how I can help her. She definitely can’t go home.

19:00h: Put my dinner, leftover Bolognese, in the microwave, quick toilet break. Write a set of notes while waiting for it to heat up.

20:00h: In the trauma cubicle Allan has masterfully enlocated an ankle, diagnosed a pneumothorax on ultrasound and inserted a chest tube. He is now engaged in backslapping, jocular banter with the orthopaedic registrar. Get a room guys!

20:30h: It’s actually under control and quite pleasant. Make another coffee, then 5 minutes very entertaining gossip session with the resus nurses about ‘who pashed who’ at last year’s Christmas party.

21:00h: 14 walk-ins and 3 ambulances arrive in the space of 43 minutes. Oh dear.

21:30h: Delirious 84 year old lady refers to male nurse, PSA, volunteer, radiographer and the husband of the patient next door as “doctor”. Calls me “sister” and asks for a bedpan.

21:33h: On seeing me arrive bearing a bedpan all the patients in adjacent cubicles also request a pan. Holy f*&k, is that Allan doing a surgical airway? With his non dominant hand???

22:00h: Nurse informs me that dizzy lady has developed pelvic pain.

22:12h: Just remembered my dinner coagulating in the microwave. Make serious inroads into pack of tim tams out for communal consumption. Scold self firmly. Must not eat any more tim tams or the nurses won’t like you anymore for eating more than your fair share.

22:14h: A consequence I am willing to live with.

22:22h: Allan is fetching a sweet little old lady a cup of weak, milky tea and a warm blanket. Man I hate that guy, But god damn is he a good registrar!

22:45h: Right. Have all available information on DL (dizzy lady) No more procrastinating. Time to sort out disposition. Oh wait, no urine sample yet.

23:00h: Have abandoned all pretences of contemporaneous documentation in efforts to wrestle the wait list into some semblance of control for the night staff. I’ll just do my notes at the end. No worries, I’ll knock them off in 15 minutes, tops!

23:12h: Waiting room out of control. Triage nurse looks like she wants to throw 3 packs of paracetamol through the window and hide under the desk. Patient have banded together with the good humour that emerges in crisis situations like bush fires or terror attacks or Monday evening. They cheer boisterously whenever anyone is called through the door to The Other Side. Someone has started a Facebook group, We’re Waiting To Be Seen In St As ED! There seems to be a a romance brewing near the vending machine between two patients who both really should be fasting.

23:15h: Have spoken to med, surg, gynae and neuro about dizzy lady. No acceptances, only vague promises to come and review. But none of them can possibly make any sort of assessment whatsoever until they have the full ward test. If only I hadn’t eaten all the tim tams I could have used them as a bribe.

23:30h: my dizzy lady finally wees. Score! If you squint and hold the full ward test strip up to the light at the right direction there is definitely, absolutely, without a doubt a trace of leuks. And that is SOLD to med with a UTI thank you very much ladies and gentleman, over and out.

00:47h: Sit, zombified, staring at screen desperately trying to recall details of patient I saw 6 hours ago. Only 5 sets of notes to go……Merry Christmas to all and thank you for reading this year.


Old letter

Literary Medicine

…ramblings

Emergency physician and keen follower of #FOAMed | @KristinJBoyle | LinkedIn

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  1. As an unfortunately frequent ED visitor, this made me laugh. Seems pretty accurate from where I’m sitting. Thank you!