Another Day at the Orifice

It is almost 2am. The building is quiet and I can hear the soothing sound of soft persistent rain outside, and the occasional call of a gecko. I've lost track of how much sleep I've had in the last 48 hours, having finally finished the last night shift at the Emergency Department. I will finally be in a place to reset my biological clock, that is, if I can. All I know is, I am tired.

My mind still drifts back to the last patient I saw before emerging again into a world of bright glaring sunlight and steamy heat, from a world of variably fluoroscene-lit and variably air-conditioned environment permeated with various smells (human or otherwise) that you don't really want to know where it originates.

Somehow, everyone I see is in varying degrees of anxiety, and mostly out of proportion to their physical ailment. This particular gentleman is in his 60s, well-spoken and uses medical terminology to relay his symptoms. He is anxious, and keeps glancing at my name tag, scaring himself that I were a day 1 intern. He had woken up in the middle of the night with tingling in the left side of his body, which hadn't gone away after four hours. Obviously he is worried about having a stroke. And as it happens, he is a medical professional, which just makes the worrying so much worse. I sympathise, and at the same time trying to not let the intimidation get to me, and proceed with a mish-mash of physical examination at the end of the 10-hour shift with my already cotton-wooled brain.

He is a little reassured that there is nothing solid on my findings to indicate he's had a stroke, and that his plantar reflexes were downward pointing. He did not even have objective temperature sensation changes. But alas he is still anxious. I hand him over to the fresh day team doctor and organises his CAT scan to happen immediately (a rare feat in the public system) . And his parting words were: "Go home, Kiddo."

For the first time in a long time, I feel acutely powerless in being young, female, Asian.

I know I am still gathering experience and that my knowledge base of Neurology is limited. But I also know that the CAT scan will show very little, and he is unlikely to have bled into his head during the middle of the night. However, he will mostly likely end up being admitted to hospital and proceed to an expensive MRI scan, which is likely to be inconclusive anyway.

I think about the fear that is driving his anxiousness. The loss of control not knowing what is happening inside his brain - should he take more blood thinners, should he lower his blood pressure; could his longterm smoking have contributed to his stroke; would he lose his livelihood forcing an earlier retirement than he'd liked, due to his procedure-based medical practice. And to make things worse, he is being assessed by a glorified medical student in the relatively unsupervised early morning within a limited public hospital away from any Neurology or Neurosurgery service. He tried to protect me from the outlash of this, by being nice, by proactively giving me his history, by smiling reassuringly that I'm doing the right physical examinations, by apologising to me when he saw me being lectured by a nurse about letting him use the staff toilet, by attempting the friendliness in his farewell when I could almost see the snarl in his lips as the words came and his unlistening ears to my wellwishes.

I had felt a strange mixture of emotions since parting his bedside. The elation of having finished a long stretch of shift work and performed satisfactorily in my assessments. And the feeling of being a passive observer in another being's struggles with morbidity and mortality, unable to influence or alter the outcome. I hope he does not end up having had a bleed, or a stroke. I hope at some time in the future, he emerges from being confronted so directly with the bare essentials of life and death, and the interim hell of disability that would be for him, and rises to a new level of meaning and awareness to what life is, and what life could be.

As one of my bosses had said recently following a particularly harrowing shift during the Xmas and New Years period: "... another day at the orifice."