A long day continues

1700 hours. Sitting in a café in wellington beside a bunch of french folk. Perhaps unremarkable. But i’ve been having a good day.

Good in that it’s already 32 hours long and I haven’t slept. I’m not gonna make my bed for another 14.

I’m on night shift in the unit at the mo, which is turning into one prolonged entire weekend shift. I started at 4pm yesterday. I left spuddy and phil to go to taupo for the evening (people who know NZ geography know you don’t go to taupo for a night), and plodded into a busy enough evening and night shift with a third of my work being nursing (rolling patients, giving drugs, doing the bloods) cause we’re just desperately short at the mo. Of nurses I mean.

One pretty sizeable overdose, a woman with lungs so stiff we couldn’t get air either in or out of her lungs a little old man with inoperable bowel cancer and four cups of coffee later, i’d made it to morning. I phoned spuddy (weird phoning your own flat to get hold of someone else) and got a groggy, sleepy agreement to a  morning surf. Only slightly less groggy and sleepy than my suggestion.

At ocean beach for 9am. And the surf was pretty big. Not exactly consistent or even that surfable but big. Each wave like a rugby tackle (ta for that one spud) to the chest and a huge rip tide that dragged you down the beach at an alarming rate. Lots of fun. But hard work. Didn’t matter, it was another crisp hawke’s bay morning and I was on the beach.

I’d made it five mins from home (and sweet brekkie) when the phone rang and Ross (my boss) asks was I doing anything important and could I fly a patient to wellington. 20 mins later i’m back in work and facing the usual ‘do you never leave?’ comments.

Because I was on nights at the weekend spud and phil were over, they’d planned to go off and their own and do a few things. Top of the list being NZ v France at the Westpac stadium in wellington. I was jealous, good old fashioned jealousy. The first time since i’ve got to NZ that I didn’t really want to go to work.

Cause i ‘d come back in to do a transfer when I was meant to be kipping, ross said to not bother with the night shift and just come back on sunday night. At which point a cunning plan formed.

I’m about to get in a helicopter to go to wellington, and will in fact get there before spud and phil (who left an hour before). My boss is now telling me that I don’t need to come back to work tonight. There’s  abig rugby game tonight in wellington. Indeed there are tickets left. So in fact there’s no need for me to come back in the helicopter at all. It’s just a cheap and efficient means of getting to the game, well for me anyhow.

So with the encouragement of my boss (‘give me a ring if you can’t get a ticket, I know some people’ dear knows who…) I grab a warm jacket and a camera, and oh yes the patient having the heart attack, mustn’t forget them, and jump in the chopper.

Land on the roof in wellington, hand over the patient and 10 mins later i’m in a taxi to the stadium as the heli goes back to hawke’s bay. I feel like royalty. This doesn’t happen often, let me have my moment.

Turns out wellington is a lovely city, though that’s maybe only because the sun is shining for the first time in 10 months of flying patients here. I get a ticket easy enough, just two rows from phil and spud, which is of course most unfortunate, and in no way intended…

And so I end up here sitting in a café in wellington beside a bunch of french folk. Perhaps unremarkable. But i’ve been having a good day.

So whenever spud and phil finally get here… I mean they left an hour before me… Some people… We’ll watch the game and then spud will drive me back as I try to get a few hours sleep in the back of the car. If only cause I felt bad for abandoning Ross without a registrar on a saturday night. I’ll be back in the unit by 2am, and only another 8 hrs till the day is finally over, somwhere around the 52 hour mark. Pass the espresso…

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Two stories

Two stories.

One. I’m walking into work and meet my consultant on his way in. I ask if he’d had a quiet night on call and as I said it his phone rang. Quiet up till now I suppose. So there’s a patient in the GP hospital 30 mins flight north who’s not too well and could the helicopter come and pick them up. And so that becomes my job for the morning. I grab the trolley with all the gear, enough to run an ICU in the middle of nowhere, and go to the hangar.

In Wairoa (referred to as the wild west of Hawke’s Bay) there’s a poor wee 62 year old Maori lady with not enough breath to utter a word and so sweaty and cold she feels like death. She’s now confused and wanting to stand up and sit down and then stand up again. Not a good option in a helicopter. I fill her with drugs for half an hour and if anything she’s worse. For once it’s probably not my fault.

I ring my boss and tell him the only way I’m getting her back is paralyzed and ventilated. I feel I ought to tell him cause I’ve never done this on my own before, and if I’m gonna kill someone then I’d prefer he knew.

And so I open the mini-icu in a bag and get my bits and pieces together. Now what I’m proposing to do is give an anaesthetic, play the role of the gas man. Now usually this is in a nice controlled environment with lots of flashy screens showing nice normal numbers. I have a portable monitor that would give me most of this. If it wasn’t for the fact that her blood pressure is so low that the only pulse I can feel is in her neck so I know her blood pressure’s not good. And that the probe for measuring oxygen content doesn’t work cause her fingers are so cold and the only number it gave us was 78% and I really hoped that wasn’t right.

The idea is to give her some sleepy stuff and then some stuff to paralyze every muscle in her body (apart from her heart – which is kind of stuffed already) so I can put a tube down her throat into her lungs and breathe for her.

So that’s straight forward enough, the nurse gives the drugs (half the big syringe, all the little syringe…) and she stops breathing. And the tube goes in easy enough and I squeeze the bag and her chest goes up and down. I feel the pulse in her neck and realize it’s not there any more. In my head I swear and curse that I’ve killed her. So I stick a big hose pipe of a needle in her neck and give her some adrenaline and the pulse comes back at a thready rapid rate, wait no, maybe that’s just mine. But no, it is there, just about…

And I talk my way through this in a strangely calm tone of voice, asking for this and that, betraying the cold sweat that’s just come out on me.

We stick her on the stretcher load her in the chopper while I sit at her head with my finger on the pulse and nothing to monitor except a read out of the electrical activity in her heart. And I search through the drug bag, cracking open amps of bicarb and calcium and adrenaline to keep that pulse there.

And we land and get her into the unit and I stick some more needles and drips and tubes in her. The boss wanders over and I give him the handover and he says I did pretty well even if the induction was a bit ‘vetinary’.

You see in many ways it’s easy to keep people alive. With enough tubes in the right places and enough drugs you can keep that little sack of muscle in their chest going for well past it’s sell by date. But most of the time, in cases like this it’s ‘futile’ (as I say to the family), cause they don’t get better and you never get rid of the drugs or get the tubes out.

My only comment to the boss is that it’s another successful resuscitation of a dead person.

Story two. Again, I’ve just arrived in work (it’s been a chaotic few mornings), and there’s a patient in the fire exit (our emergency extra bed space when the unit’s full) who’s just arrived. He’s been sent down from the ward cause he’s been unwell night and no one can get a needle into him to give him some drugs to make him a bit better. He’s got some horrible advanced cancer in his belly that he only found out about yesterday.

An hour of needles and x-rays and blood tests and fluid later it’s clear he’s dying. He’s in the process of having a heart attack, his kidneys have shut down cause his belly’s so swollen with fluid that they’re blocked. He can barely get a breath cause of the fluid in his lungs and the pressure pushing up from his belly underneath.

I only look at the name on his chart after the first hour’s over. I kneel at the bedside and look in his eyes and he knows his time is up, he just nods when I ask is he comfortable. I know he’s lying. I take his family into a room and sit them down and explain things. They already knew about the cancer but they hoped he might have had a bit time. I say he won’t and I use the ‘futile’ word again. And it echoes through my head that I said the same thing two days ago about the other one. And I curse myself (though I know not why) for having the same conversation over and over.

I take them back to the patient and everyone cries and I ask him again if he’s comfortable, and again he lies and I give him some morphine anyhow.

Two hours later his nurse calls me in cause he’s ‘going’. And he’s breathing his last, and it looks horrible. The deaths I’ve watched (I’ve forced myself to watch, to be there cause they deserve that much, looking away and standing outside would be too easy, cause maybe a few days earlier I’d said it would be OK and now it’s not gonna be) are mostly not peaceful. At least they don’t seem that way. The patient would have lost consciousness a long time before it happens, often uttering their last words days before it comes. But it’s not peaceful for the families. 24 hour vigils at the bedside, resolved to what’s happening but determined that they’ll not be alone when it comes.

And so this guy breathed his last with his wife holding his hand and sobbing that he was a good man and didn’t deserve to suffer. And I stand with my arm round her and let my eyes fill with tears and I pray – though I know not what. The pastor in the room closes his eyes and prays out loud in Maori and I pray along not understanding any of it except the amen at the end. I just say sorry. Sorry it had to happen, sorry we couldn’t do more, sorry it had to be this way. I prayed again, more of an empty ache for God’s presence than a cohesive worded sentence of petition.

Why do I tell you these stories? I tell them cause I like telling stories, cause the retelling of them has been in my head for days.

One of the guys I work with is a fairly thoughtful interested guy and asks why we do the job/ He asks is it cause I get a ‘jolly’ out of it? And yeah, I admit that’s true. I do this cause it’s a buzz. I do this cause in some ways it reminds me I’m alive, cause it seems important and something of significance in a world and society of mostly meaningless dross.

And I know I do it cause of who I can be. Cause of how it portrays me. And I know I tell these stories cause of how it makes me appear. And if I use ‘me’ any more in this paragraph I’ll scream.

And I hate myself for the motives in my heart for telling these stories. I used to make deals with myself that when I did something I knew would make me look good that I’d not tell people. That I’d keep it to myself, but it never happened, I always had to let it slip into conversation at some point. I hate myself for being the self-absorbed, self-referencing prick that I am. That no matter what I touch I corrupt. That the only thing I can contribute to my own salvation is my need of it.

In ‘the great divorce’, probably my favorite CS Lewis book (though please don’t make me choose…), it talks of how when we get to heaven there’ll be such laughter. Laughter at ourselves, at our histories, at how we got so worked up over so little. That we’ll laugh at our own petty little quests for significance in all the wrong places. All our self-righteous rants and arguments, how it was so important that we were right. We’ll laugh just cause we have a better view, a better perspective on our existence and purpose. Kind of like I can’t believe that I had my hair in curtains when I was 16. It seemed like a good idea at the time. I still think our parents made worse choices in the fashion department…

So why do I tell these stories? Maybe I just needed to stand back and have a bit of a laugh at myself…

Coincidence

1610 hours. Thinking of going home, not much happening in work, tired from on call the nght before. And then I get accosted by the transport manager on the way out the door. Accosted is a bad term, politely requested to do a transfer to Auckland is a better way to put it.

My first question is can we take the helicopter. Helis fly much slower than fixed wing air craft do, but the advantage of helis is that you can land anywhere and therefore avoid all the tedious transfers to and from airports. They have a tendency to just land on the roof which is as close between two points that you can really get.

But no, the helicopter has just gone out on a job. So at 1630 I’m in a taxi-van on the way to the airport. The van with enough equipment to set up and run a mini ICU in the sky. The idea is to bring everything and use none of it. The chances of needing to do an emergency cric at 10000 ft is spectacularly unlikely. Though you’d feel awful stupid if you needed to and you didn’t have one.

With me is C. One of the ICU nurses who also does the flight team work. In jump suit and sunnies with pockets stuffed with enough bits and bobs to keep him going for weeks. The nurse with me performed a flight check of the doors and all the seat belts before we took off. Though I’m pretty sure that that’s the pilots job, not his.

So the transfer itself then. Some 14 year old kid is jumping off a wharf with his mates. The kid jumps two meters to the left of the normal spot and goes head first into a sand bar, putting his neck in all sorts of nasty positions that you normally only see in a rugby scrum.

So he breaks his neck, fracturing one of his cervical vertebrae into three pieces, spectacularly avoiding cutting through his spinal cord. So he’s OK. As long as he doesn’t sneeze. Which isn’t exactly a long term solution so I get to fly him to the kiddies hospital in Auckland where some orthopod will stcik bits of metal in his neck to fix him.

Unfortunately the kid is in Gisborne about an hours flight north up the coast. It’s a small district hospital and we do a lot of their transfers.

When I get there I meet a guy who knows people I know from back home. I travel 15000 miles and go to a hospital out on the east coast and of all the people I meet, I meet a guy who knows a doc I know from a small town in the tail end of Ireland (Portadown really is more of the tail end, lets be honest. I still love it.)

Coincidence amazes me.

So strapped up in a collar and bean bag (a moulded plastic mattress that stops him moving) we head for Auckland. On a glorious day, over the hills (and far away) and Rotorua with Ruapehu in the background, the sun setting as we cross Tauraunga. It amazes me that they pay me for this type of thing.

Arriving in Auckland childrens hospital we’re met with ignorance and contempt for daring to bring a patient to a hospital. I was originally planning to leave him at the top of road and give the trolley a push, but i have this darn conscience and sense of duty thing.

By this stage it’s 10 at night and I’m a tad peckish. The ambulance taking us back to the airport is kind enough to stop at Mcdonalds on the way back. The flight nurse is on some kind of cleansing diet that I don’t enquire into. Two big macs, some fries and a coke later we’re still not at the airport and ask if we can stop at the airport Mcdonalds to fill up again. Oh well, better than nothing.

I try to read a biography of Jonathan Edwards on the plane but I fall asleep before we’re over Hamilton, and wake to the sound of rain on the windows and the lights of Napier at around half midnight.

Retrieval

The main advantage of my current job, well not the main advantage, there are many, is that I get to do inter-hospital transfers. And no this has nothing to do with the Bosman ruling.

In NI I did a few transfers, but they were all very well people and they were all by ambulance, and if something would go wrong you could simply tell the ambulance to drive faster. It only takes about 18 mins to get from craigavon to the royal in an ambulance at 95mph.

Here the big hospitals are a fair distance away. Wellington is about 6-7 hours by ambulance up and down over mountains. The equivalent of dungannon from craigavon is a place called Wairoa which is about 2 ½ hrs away by road. Wairoa is truly in the sticks. Patients come from Wairoa with a ticked check list of medical conditions. Diabetes/heart disease/lung disease/morbid obesity (frequently greater than 150kg) and a legion of country yokel relatives with them too.

And they’re not great at ever taking their medication, and they’re all double-hard and tend not to visit a doctor till their leg is ready to drop off or they can’t reach another pie to their mouth without getting angina. Frequently they’ll have a heart attack in the peace and quiet of their own home and then drive in the next day cause they had to get the sheep in first. Yesterday there was a guy who got bucked off a horse and gave himself a really nasty (and potentially life-threatening) pelvic fracture (a near 10 cm pubic symphysis separation on x-ray!) and didn’t make it to us till the next day cause he couldn’t get anyone to drive him!

So this is my target audience so to speak. On Friday Im sitting in the tea room after lunch and Ted (my boss, I love it that he’s called Ted and i get to call him Ted too) asks me if I’d mind taking a wee flight to wairoa to retrieve an 84 year old with a pulse of 30 a minute (generally not a good speed that) and has probably had a big stroke too.

So I get all excited cause I get to go in a helicopter and then all scared because a patient with a pulse of 30 and a helicopter don’t mix well. I get my jump suit, which is designed to fit the 150kg patient instead of me I think. And most important of all I grab my camera, not to miss the opportunities of nice aerial photos on a sunny day.

I tried not to giggle and smile as the helicopter took off, that I actually get paid to do this. We fly from hastings to napier and I can see Mt Ruapehu in the centre of the island. I can see the marina and the apartments where I live and get a lovely shot of Napier and the port and the hill.

Dean, the pilot wearing a shiny, well-fitting red jump suit and sunnies, tries to scare the willies out of me by veering suddenly and diving. I smile to cover the fact that I’ve had the willies scared out of me.

Wairoa hospital reminds of a hospital I was in in South Africa, though that may be stretching it. The patient is a maori lady with grey hair and pig tails. Only Maoris (and south American natives) have pig-tails at 84. She has right sided neglect. With strokes you sometimes lose the knowledge that you have one side of your body and consequently ignore it completely.

We put her in the helicopter, which is a feat in itself. She’s trussed up in a blanket and a seat belt in a stretcher. Even if I wanted to do anything medically dramatic I wouldn’t be able to get at her to do it. Apparently the done thing is to just set the helicopter down and do whatever you need to do and then take off again. I have a heart monitor and I can see her wee spiky complexes of her heart beat on the screen. We take off and her heart stops for 3 seconds and then starts again. She does this all the way home till the helicopter lands again and then she stops. I mean she stops having the pauses, as opposed to her heart stopping altogether, as that would be most inconvenient.

I get back to the unit and I tell Ted that all went well and thankfully I didn’t have to do anything. Ted gives his knowing smile. He’s 64 and has been doing this for a long time, he’s allowed to give knowing smiles. And I realise that that�s why he sent me, cause it would be an easy one, and he’s breaking me in gently. Well either that or he wouldn’t trust me with anything more complicated cause he’s a bit suspicious that I’m a bit of a medical muppet. Couldn’t blame him really�