I posted a Facebook status like this a while back and I thought why not elaborate a bit in the form of a blog post? So here it is: tips on how to annoy the doctor on night shift in casualty.
1. The best way to set the tone is to not know the answer to the very first question the doctor asks you. Anyone whose been to the doctor enough knows they always start with, “How old are you?” We aren’t just asking this for funsies. We really need to know. Different illnesses affect different age groups. Your chest pain is unlikely to be a heart attack when you are 24, but chest pain in a 65 year old sets off a lot of alarm bells. (But mainly it’s because when I present your case to my consultant in the morning she expects to hear “twenty year old female…” before I say anything else). I am amazed at how many people don’t know how old they are. So it’s 4 o clock in the morning, I may or may not have been able to squeeze in a half hour nap in the past 20 hours and the answer I get to this question is “Ek was in 1969 gebore Dokter”. At this point I resist the urge to roll my eyes, scream internally and open the calculator on my cellphone. Because, seriously, it’s 4 o clock in the morning. Ain’t nobody got time for that.
2. Next most annoying answer: “Ek het pyn”. Pain where? Can you be any more vague? Once you’ve established where the pain is things tend to get a bit easier. However, I once had a lady tell me about every single pain she’s ever had in her life. First rule about the EC is that you get one complaint. Only one. So you should consider carefully which pain is most important to you. Pain is a funny thing though. What I call pain, might be what you call a discomfort. It is one of the most difficult symptoms to evaluate. It’s not like shortness of breath which shows in your oxygen saturations, or a cough which is easily heard. It’s subjective, and has no measure. A few weeks ago on a Friday night I had two patients who both needed stitches. The first was an eight year old girl who had slipped and cut open her foot. The second a 26 year old who had annoyed his girlfriend and ended up with a mirror slammed into his forehead. I was surprised with the way they each handled the pain. Obviously I gave them local anaesthetic before suturing their wounds, but that’s the painful part. It burns before it goes numb. And the eight year old girl sat still, albeit with quiet tears running down her face, while the 26 year old man screamed and cursed and pulled away multiple times, generally making my job very difficult. But I politely told him about the little girl who had just handled things much better than he did, and he promptly manned up.
3. Next step, tell the doctor that this pain you’ve been having has been going on for the past three years. Almost every night that I’ve been on call someone has come in complaining of chronic back pain. I’m really not going to spend much time on this one, except to say that a three year history of back pain does not call for a 2 o clock EC visit. You’ll live to see the sun rise, I promise.
4. A great way to annoy the EC doctor before you’ve even seen them is to not respond to your name being called four times and then suddenly appear at their door when they’ve already called in another patient. You see, when you don’t respond to your name being called you add a little fuel to their fire; known as the fire of hope. An absconder means one less patient to get through, maybe with a few more absconders in the pile they might be able to catch an hour of rest before the morning ward round, but then you appear and pour a bucket of water over their already struggling flame.
5. Next favorite answer: “a hele tydie”. It’s difficult to translate this one, but basically it’s like saying “quite a while”. How long have you been coughing? A hele tydjie. How long has your baby had diarrhoea? A hele tydjie. How long have you not used your anti hypertensives for? A hele tydjie. What. Does. That. Mean?! A day, two days, a week, sixteen years?! It’s probably my fault though, I should just ask when the symptom started and I might get a more precise answer. Or I might just get a “n tydjie terug”. (A while back).
6. Bring your son into the emergency center because “he feels weird, his mouth is dry, he seems really hungry and is eyes look quite red” (I know a lot of you have experienced these symptoms before), “oh and I caught him smoking weed with his friends, doctor, but I’m not sure if that’s related.” And then after the doctor reassures you that it’s very much related, ask if there isn’t anything you can do for him. No my dear, he’s high, just buy him a bag of Doritos (the party pack size) and let him sleep it off.
7. Similar to the three year chronic back pain story, presenting at an ungodly hour with period pains is a definite winner. I understand that many women do suffer terribly but surely you know by now that you probably won’t die, and you realize there is very little a doctor can do for you except prescribe you brufen or refer you for a hysterectomy, which is probably not what you want. Worse than that, I’ve had too many women presenting with vaginal bleeding as their main complaint (not even pain) and when asked when their last period was they say “One month ago” without even blinking an eye. Monthly vaginal bleeding + reproductive age + not pregnant = menstruation 99.9% of the time. It’s really not a mystery.
8. Now my ultimate favourite: the last minute sick note request. It happens often that I will spend a good 15 minutes trying to figure out a patient’s story, trying to match up symptoms that don’t really make sense, only to give up, realize this man is not going to die from this strange illness he has, and just write up some Panado for his “Ek hey pyn Dokter”. And then, once the script is complete and he is about to walk out my door he reveals his own diagnosis: “Please can I get a letter for the work”. Sure buddy, but you could have saved us both a lot of time if you’d just lead with that.
Honestly, I could continue but then you’d all think that I hate my job, and I really don’t. I love it. After being awake for longer than is good for one, these things are pretty damn annoying, but once I’ve had a shower, a cup of tea and a good rest they’re actually more amusing than anything else. One of my New Years resolutions was to find something to laugh about everyday, so that’s what I try to do. And at the end of the day (or beginning of the next one), the old man who doesn’t know how old he is because he isn’t as self absorbed as I am; or how long he’s been coughing for because he has bigger problems to worry about; or the mother who is worried about her teenage son, aren’t really there to annoy me. They’re there for my help or even just my reassurance, and hopefully I can have enough of a sense of humor to give them just that.