In my previous career working as a nurse on Intensive Care we would rotate downstairs to help out in Casualty (ER) if they got busy and we were quiet and vise versa, they would come upstairs if it was quiet there and we were manic. This was good practice as invariable patients went from Casualty straight into ICU, so it was good for the nurses downstairs to be aware what we would be doing and they could anticipate that and make handover much smoother and easier.
On the very first day I walked onto ICU I thought Holy Crap! This is like the bridge of the Starship Enterprise, all these machine and equipment, I thought I had made a huge mistake and would never be able to learn all how to work all the equipment. However, when I went for my first shift on Casualty I thought Holy Crap! this is like a friggin warzone; blood and guts everywhere and I’ll never be able to understand the organised chaos that is Casualty. And of course I did, it didn’t actually take that long because there are many similarities between ICU and Casualty, in ICU the priority was heart, lungs and kidneys, as long as you looked after those systems then the odds were good that the patient would survive and we had the same philosophy in ICU, look after the heart, lungs and kidneys and the rest will follow all in good time.
That was one similarity ICU had with Casualty; the other similarity was nurses reaction to the fire alarm. In theory nurses should prepare their patients and decided which ones can be evacuated from the Unit and which ones are OK to stay, and the nurse should be getting ready to move the patient into the next safe area, usually theatres. However, what invariably happened was that every single female nurse (and some of the gays ones too), would make a beeline for the changing room and put on their lippy and brush their hair for the expected firemen. Nurses and firemen… (and policemen) a potent mixture.. When the fire alarm went off sometimes I would be the only one on the Unit looking after twelve patients!
Generally, nurses in Casualty and ICU wore scrubs, this is what surgeons wear in theatre, it’s to help minimise infection control, you get a fresh set each shift and dump them in the laundry at the end of you shift, however, even Pamela Anderson with her enhanced silicon valley wouldn’t get a second look if she was wearing scrubs so the priority is to rush into the changing room and pretty oneself up. Sadly we never had any female firemen – ermm firewoman so I never got to dash off to the changing room to make myself (even) prettier.
Another similarity between Casualty nurses and ICU nurses is that nothing grosses us out – plus our sense of humour would always stray to the really sick kind, it was a protective reflex, nothing grosses out nurses or doctors. I’ve been out with a gang of medical staff and their respective husbands and will happily discuss wee, pooh, blood and guts and some intricate procedure I assisted the ICU staff with and then notice that the non-meds are turning green and off their food.. oh dear!
But there are a few differences between Casualty and ICU, in Casualty there’s a special phone and when that rings everyone stops what they’re doing and listens. It’s a direct line from Ambulance Control and it’s nearly always AC telling us of a Blue Light on the way in, the ETA and any details they have from the Paramedics.
Another difference is that the Casualty staff generally only ‘patch & dispatch’ as we say, patch patients up and dispatch them on to ICU/Surgery/Wards so the time they have with patients is limited and they don’t get to know patients in the same Intensive way we did on Intensive Care. As a digression, in the Medical School they have a department that incorporates Obstetrics, Genetics and Elderly and it’s referred to as the Hatch’em, Match’em’ Dispatch’em Department!
But by far the best difference between Casualty and ICU is that occasionally Casualty Staff get to go on the Ambulance so they have insight into what the Paramedics do. In reality it’s just an excuse for the Paramedics to chat up and impress the nurse and they were always disappointed to see a male nurse join them… I have been out in a ‘blue light’ a few times. It’s fantastic! It’s like being in a snow plough, all the traffic in front of you just parts like Moses and the Red Sea, it’s magic, I’m sure there’s a scene in Bruce Almighty like that, it’s the fastest time I’ve ever got from work to the other side of London.
Something you probably don’t know is that ambulance will put the sirens on full blast on the way to an incident but usually will not use the sirens on the way back except for obstinate traffic, you see, they need to get to the scene of an accident ASAP but on the way back to Casualty they will only used the blue lights and try not to use the siren because it will freak out the patient in the back when they hear the sirens.
During my time in Casualty I learnt a few things that I thought I might share, these are not all mine but the medics out there amongst you will be able to relate to them.
You will still be able to deal in drugs whilst in Casualty, just tell your customers to say they are a relative (even if they are a different race) and pull the cubicle curtains around and deal in your drugs. Yes, I did catch someone doing this. Also, never decide to hide your drug money wallet in the ceiling while you go to surgery. It’s hard to explain to security why you came back a week later and tried to force a patient out of bed to get it.
Don’t tell the nurse you have a bad back and then have sex with your GF on the trolley behind the curtains. Yup, coitus interruptus was interrupted by moi.
The phrases “I know what I’m doing” and “Hey, watch this!” is almost always followed by a trip to Casualty
Never get into a road rage incident and go head to head with someone who has a wrench in his hand.
Never try to get away from a police dog, they are quicker and from what I have seen, have VERY sharp teeth.
Never allow your sex partner to push a screwdriver/wine bottle/apple/cork/banana/etc up your jacksie, and then tell the nursing staff you don’t know how that got in there. Remember, your rectum is an exit point really, and bowel perfs are NOT fun.
Never walk in front of your brother when he is practising his golf swing.
Don’t jump off a bridge into the river without first checking it’s more than one foot deep.
Never…NEVER…hide your weed in a toothbrush holder and stick it up your butt and think it’s a safe hiding place from the security officers in a prison. It could get stuck! Also when you have been smoking pot and slam your finger in the car door it may be funny tonight – but you wont find it nearly as funny tomorrow
Never assume you are sterile just because you didn’t get pregnant with your last 3 lovers.
If you are having an MRI done, we REALLY need to know about those “personal” piercings, because they will get ripped out by the magnetic pull.
You should never tell your nurse that your occupation is “phone sex operator”, and then be found on the phone just as he comes in to give your evening meds.
Always wear safety goggles while playing paint ball/or checking out the paintball gun
Don’t jump off a 2 story building to escape from the police because your boyfriend to whom you have a restraining order is visiting for a booty call… man was not meant to fly and an umbrella is no substitute for a parachute.
Vases are uncomfortable in the rectum.
Spermicidal foam tastes like Downey
Cows may be domesticated, but very few have really had adequate training under saddle. Even fewer have ever expressed a desire to jump fences, and their enthusiasm tends to be further dampened by the presence of a passenger.
When your dog dies after eating some weird plants in the garden, it is not a good idea to try and eat them yourself to see what will happen.
Vaporub is not a good thing to use to prolong an erection (more like KILL the mood).
Do not assume you are “going thru the change” when you suddenly stop having a period when you are 43. Consider the fact that you might actually be pregnant!
Driving out the garage before the garage door is up is going to spoil your day.
Do not try to sandpaper off tattoos by yourself. Also do not use a sandblaster or scraper to do it with.
Spraying an alcohol-based facial toner WHILE the cigarette is in your mouth is evidently a bad thing.
Never threaten the nurse who is going to give you your painkilling injection, see how their hands shake when you do this?
Insulin needles should not be shared by family members, especially for weeks at a time.
And finally, no matter how bowel obsessed you are, do not strip down naked in your back yard and have your husband (whom you met at a psych unit) give you an enema with a garden hose. Your neighbours will call the police and you will get a bowel perf and peritonitis, and you will be sent back to the psych ward where you met your husband in the first place.