Crimes and misdemeanors, Part 11

The old tricks are the best, we used to do this with student nurses.

During the Vietnam War Michael Herr wrote in Dispatches “war is long periods of boredom punctuated by moments of sheer terror”. I initially thought he was talking about American Football but I know how he feels, because I’ve worked in theatres and Intensive Care.

In my previous career as a nurse I had to spend about two months working in theatres (or OR as our American cousins call it) alongside some not very bright surgeons. After a few weeks working (or more accurately standing still with my arms at the same length all day watching the clock go in reverse) I realised there were some phrases that one should listen out for, for example;

Wait a minute, if this is his liver, then what’s that?
Everybody stand back! I lost my contact lens!
What’s this doing here?
Am I in the right spot, ’cause I don’t think that should be here… (why am I thinking G-Spot suddenly?)
“Hmmm, well that’s interesting” during a C-Section
Ooops!

but the worse one we all dreaded was ‘FIRE! FIRE! Everyone get out!’ I have actually experienced that one plus a few power failures and you have no idea just how transforming that is to the assembled team, suddenly you stop daydreaming about last night’s (mis)adventures and just like a warzone, everyone moves like greased lightning under those circumstances, not to get out of theatre ASAP but to get the patient off all the support machines and keep him/her alive whilst you push the operating table out of the theatre. It’s all hands on deck literally and when I was working in the National Heart & Lung institute in central London I watched a cardiac surgeon squeeze a patient’s heart manually whilst we pushed the table into the neighbouring safe zone.

I’m not sure how it works in normal business’s but in hospitals the idea of moving patients out into the street is a no-no, usually you have to shove the patients into the next ward and then the plan is to keep moving them if that area becomes at risk. Trying to get a patient down a set of stairs on a hospital bed is not easy. However, in 10 years of ICU nursing I had seen an equally miraculous transformation in patients who normally required two nurses to help them get into a bedside chair but when the fire alarm goes off then they can do the 100m sprint in Olympic time.

What is not common knowledge is that in a fire emergency there is the potential to leave about half of your patents behind. On the face of it that seems callous but there is a logic to it, you see, in an average UK Intensive Care about 50% of your patients will be sedated and on ventilators. Therefore in the situation of an ICU filling up with smoke and fumes (from a distant fire) you triage your patients and the ones sedated and on ventilators are not going to suffocate from fumes as they are on piped O2. The ICU could be filled with thick black smoke but they would still be breathing clean air so you’d leave those ones behind and drag – sometimes literally – the patients that are awake and breathing room air.  I’ve never had to actually do that but every time a fire alarm went off then I automatically figured out if my patient should stay or go. Well.. I say ‘I’ because practically every female nurse (and some of the male ones) did what they always did when they knew Firemen (or Policemen) were coming to the Unit, they ran into the changing rooms and put on some lippy and fixed their hair, think it was something to do with the uniforms..

The normal routine on any ICU is for the ICU Medics to take primary irresponsibility for the patient but various teams (or ‘firms’ as they are called) would come around and advise on specialist treatment; Surgery, Orthopaedics, Obs & Gyna, etc but on ICU we had a running joke on how we identified various teams;

Q: How can you tell what type of physician caught the elevator door just as it was closing?

A: If they put in their hand, they are a medic…if they put in their head, they are a surgeon.

Of course we nurses liked to mess around and take the piss out of everyone but especially doctors, this story did the rounds when I was working with some very posh docs in Harley Street.

Three doctors and three nurses are travelling by train to a conference. At the station, the three doctors each buy tickets and watch as the three nurses buy only a single ticket. “How are three people going to travel on only one ticket?” asks a doctor.

“Watch and you’ll see,” answered a nurse. They all board the train. The doctors take their respective seats but all three nurses cram into a restroom and close the door behind them. Shortly after the train has departed, the conductor comes around collecting tickets. He knocks on the restroom door and says, “Ticket, please.”

The door opens just a crack and a single arm emerges with a ticket in hand. The conductor takes it and moves on. The doctors saw this and agreed it was quite a clever idea. So after the conference, the doctors decide to copy the nurses on the return trip and save some money (being clever with money, and all that). When they get to the station, they buy a single ticket for the return trip. To their astonishment, the nurses don’t buy a ticket at all. “How are you going to travel without a ticket?” says one perplexed doctor.

“Watch and you’ll see,” answered a nurse. When they board the train the three doctors cram into a restroom and the three nurses cram into another one nearby. The train departs. Shortly afterward, one of the nurses leaves his restroom and walks over to the restroom where the doctors are hiding. He knocks on the door and says, Ticket, please.”