Back at the Orifice

This is it. The time I've been simultaneously dreading and anticipating - I'm back at the emergency department, orifice of the hospital.

Second time round, the perspective is different. I have a bit less fear on board and begin to see sicker patients, and spend less time on the well patients who don't need to be there in the first place. Bosses call me by name, and I bager my seniors for advice when I am uncertain of what to do next. I enjoy the variety of problems more, and try when I can to listen and communicate with the patient.

I recall my first shift back. A woman in her forties is working herself hysterical with a pain in her belly, whilst the nurses look on with obvious distaste. I approach her and she starts unloads the story about her chronic abdominal pain with spurts of tears and cries, seen and rejected by many specialists with no solution or answer. I place my hand on her body, and just listen for what seemed like a long time, but maybe only ten minutes. For some odd reason I don't give her any pain medications and just encouraged her to breath deeply.

She eventually calms enough for me to do an examination. I wanted to test if her appendix was inflammed, and pulled her leg backwards to stretch out her psoas muscle. To both our surprise, her pain lessened, and I stayed there, holding and stretching her psoas. Then the nurse came in, and gave her an injection. I then worked with the theme and taught her how to stretch other muscles to lessen the tension in the area.

I am no physiotherapist, but I did spend a few years in body-based therapy, and in that moment, it clicked, courtesy of this woman, how it may be to integrate my diverse learning into clinical practice. Her pain, as seen by the nurse, is not a true pain, therefore not deserving of quick alleviation with pain relief. Her pain, as seen by me, had a heavy emotional element, courtesy of my O&G exposure that taught me about a lot about hysteria.

Her pain had not disappeared completely, or even halved, by the time she left the department. But her relationship to it had changed significantly. She became curious to this interpretation of her muscle spasms causing further spiralling of pain, and with stretching exercises she was once again in control rather than the other way round. Her eyes were bright when she thanked me, and I felt glad. Glad that she did not need further medications, glad that she was less likely to return to us for pain management, glad that my contributions made a difference, even for a brief moment, and glad that my journey in the therapies did not go to waste.

After that day, I feel increasingly confident about being a GP. I am happy with small successes like suturing a man's big toe back to a semblance of normal anatomy after partial amputation by a fridge, lancing and expressing pus from a child's blistered wound, and applying plaster casts on broken arms and legs.

There are also not so satisfactory days where there are unwell elderly people with a multitude of problems that I can't piece together, or yesterday, twisting my back in awkward positions inside the ambulance trying to replace IV access and doing an ECG on a patient transferred from a smaller hospital with a heart attack. Indeed, as my wise medico neighbour said, when we are treating heart attacks in the hospital car park, something is definitely not right.