Yeah right you fell

A patient walks in holding his hand in pain, saying that his hand has been hurting since this morning. He claims that he just "woke up" with the pain, and on examination there is swelling of his hand along with tenderness around the 4th/5th metacarpal.

It was pretty obvious what had happened, but we asked him again, and still he insisted that he just woke up with this problem.

So we sent him off for an x-ray.

Which, to nobody's surprise but perhaps the patient's own, came back looking something like this:

Pointy arrow says "hello fracture!"

For the uninitiated, this is a distal fracture of the 5th metacarpal, also known as Boxer's fracture, due to the nature of how this injury is commonly sustained.

Despite what patients will have you believe, the only way you can fracture your metacarpal like that is by punching something (or someone, you never know).

In my short A & E stint I've become a bit of an expert at looking at these fractures, thanks to the crazy amount of people who turn up in the department claiming that they fell or don't know where this pain came from it just magically popped out of nowhere or straight out admit they've been punching walls in anger etc etc.

I'd like to see someone try falling onto their closed fist.

You have to give this guy credit for sticking to his guns, even though we told him there was no other plausible way he could've fractured his hand unless he's gone around punching walls, he still insisted he woke up with it.

Perhaps he's been punching things in his sleep? I worry for his wife.

Why anyone shouldn't be a doctor

In a phone conversation with my parents the other day, my mum asked if I had enough money to survive, after paying the extortionate amount that is my tuition fees.

I will do, if people click on the adverts *hint hint*.

Anyways, one of the FY1s showed us her paycheck the other day. Even the consultant was shocked by the amount, because it was the same amount he used to get as a house officer. Over 30 years ago. The cost of living has most definitely risen since then, but not our wages. Figures.

My friend who is on a placement year gets the same amount. In fact, most of the auxiliary staff in hospital get the same amount, if not more.

I wonder whether it's too late to reconsider another career path.

All you wannabe medics out there, heed my words, the life of a doctor is not all glamourous as it seems. You're generally overworked, unappreciated and underpaid. And hugely in debt.

Back to the phone conversation with my mum, I was half expecting her to say something along the lines of, "If you don't have enough money, you can ask me for some."

Instead she said, "If you don't have enough money, go ask your brother for some."

I suppose this is one of the reasons they are happy he's got a job.

Writings from the A & E

The strangest things walk in through the A & E department sometimes, that when you look at the triage form you think, maybe the triage nurse didn't really mean what she meant.

Some examples of presenting complaints as seen written on the triage form:

• Swollen finger after repeatedly poking someone with it yesterday.
• ? Deliberate self harm - has stuck metal can in vagina
• Fell down stairs, hit both arms and ironing board. Both arms swollen.

People should compile a book about most random A & E presentations. Or is there already one?

Illegal Transactions

My friend called me up and asked to meet at the train station so she could pass me something that needed to be returned to the hospital.

That something was this:
Adam, Rouilly: Opthalmoscopy Training Head

It looked like we beheaded someone, cracked their skull open, removed the brain and was exchanging the remains in the middle of the street in broad daylight.

I got so many weird stares from people when I walked home with it swinging in my arm. I suppose it's not really usual to see disembodied heads in the hands of some random person walking on the street.

But luckily nobody called the police and accused me of murder.

So you had a bad day

Woke up rather reluctantly this morning, went to the car, and discovered that some bird(s) had done some rather amazing diarrhoea all over it - it must've been some really ill bird(s). Never mind that the car is parked indoors.

Drove to GPLand, which is usually about 15 - 20 minutes away, but took a bit longer than expected because of traffic, but managed to reach GPLand on time, only thing that parking at the practice was full so I had to find some random residential road and park up there, all the while worrying about people breaking into the car because it was a very dodgy area.

I hate being in GPLand, so that's already bad enough. GP Tutor didn't look to happy when I said that I had to leave early because I had to go see my supervisor at 3pm. Then she sent us out on a home visit equipped with just the address of this person.

I find that all GPs that I've been attached to expect us to have extensive knowledge of the surrounding area down to every random lane, despite the fact that we do not live anywhere near there. Thank god for Google map.

Anyways fast forward to rushing off to meet my supervisor for 3pm. Luckily we managed to make it in time because he just finished surgery. He told us to wait while he took a quick break, so we waited. And waited. And after an hour decided that perhaps we shouldn't really be waiting anymore. Went off to find him only to discover that he went home. Nice.

Then it took me 50 minutes to get back home because traffic was just crazy.

I wonder if this counts as a bad day?

Anyways, digressing a bit (I tend to this a lot), on my 50 minute journey home down a straight stretch of road I saw 6 ambulances and 2 police cars.

A & E seems to be very busy this week.

Saw, drill and hack.

Orthopaedic surgeons are like carpenters.

Their theatre is like a handyman's garage with lamina air flow, and their tools probably came straight out of your standard toolbox, only difference is that it is all sterile.

Throughout the surgery the surgeon kept talking about how foundation is the most important bit when building a house and how you need to have grout and cement to hold the bricks together - all the while drilling holes and sawing and hammering nails into this poor old lady's femur.

I think orthopods would naturally be very good at DIY jobs.

Pre-hospital Trauma Trained

Trauma course weekend is over, now to await the ever elusive results... and then be a fully certified... actually what would I be after I get the cert?

I suppose "qualified" is a bit too strong a word.

Anyways, I can now assess a trauma scene for danger and maintain an airway!

And that's about it really. I can now go buy that hoodie from university that I've always wanted, the one that says MEDIC on it, because at least if someone gets knocked down by a car in front of me while I'm wearing it I would know exactly what to do - shout for help and scream like a little girl.

I'm on A & E all this week, and it's fresher's week, so I'm hoping to see some broken bones and random drunk accidents.

You can probably already tell that I'm a pretty sadistic person.