Chapter 15
The hour of sleep I manage to grab isn’t much, but it should be enough to sustain me for the rest of the morning until my next break. The alarm on my watch wakes me at six and I unenthusiastically get up and move from the on-call room to the break room for a quick coffee before I get back to work.
My first patient has a severe headache that came on suddenly this morning. She’s thirty, a non-smoker, and assures me she hasn’t been drinking alcohol this weekend.
“Have you ever had this kind of pain before?” I ask her, going through the usual questions. She opens her mouth to answer, then claps a hand to her mouth with an unmistakable look of dismay. I leap up to grab her an emesis bag from the supply drawers. She manages to get it in front of her face just in time.
I add vomiting to my notes and wait for her to finish before I resume our twenty questions. Unfortunately, a headache and vomiting can indicate any number of conditions, ranging from very serious to completely banal. I’ve had enough excitement for a while; I really hope this patient has something boring.
“I don’t think I’ve ever had this bad a headache,” she says. “And I’ve never puked from pain before.” She puts a hand gently to her damp forehead as though to rub away the pain.
I ask her to rate the pain out of ten and she tells me it’s at least a nine. She’s taken aspirin, ibuprofen, and finally some leftover prescription pain killers before coming to the hospital, but the headache hasn’t changed. I frown a bit at that and have to tell her we can’t administer any more pain medication for a couple of hours. She looks like she’s about to burst into tears. I scrutinise her face and am pretty sure she’s not drug-seeking. If she were, she’d hardly be the first, and I pride myself on almost always being able to pick out the addicts.
I set down the patient chart and hold out my index fingers to her. “Squeeze my fingers,” I ask her. She does so, looking confused. Then I have her lie back on the exam room bed and lift her feet against my hands.
“Oh, god, you think I’ve had a stroke!” she suddenly blurts, and then she does start crying.
“No, no,” I say quickly. “It’s just routine for us to double check these things when we see sudden headaches. I don’t think you’ve had a stroke.”
After an awkward attempt to comfort the embarrassed woman, I send her to the bathroom to wash her face and get me a urine sample. I’m careful to explain to her how to give the sample. She seems intelligent enough, but the one time you assume a patient knows something like that is always the time you get a sample jar full of toilet water. Worse, once I asked a patient for a stool sample, and he brought back an empty jar and an old ice cream tub that he’d just taken a crap in.
While the patient is in the bathroom I get the needle and tubes ready to draw a blood sample. She doesn’t have any obvious worrying symptoms, so I’m inclined to run a full count just in case and otherwise treat for migraine.
After a minute she returns, trying to sort of palm the plastic bag with her urine sample so as not to flash it around. That kind of modesty usually amuses me, but instead I’m horrified by the look of the sample as she hands it over. Instead of a normal pale yellow, her pee is a really dark amber colour, and there’s not much of it.
“How much water are you drinking?” I ask her.
“Not as much as I should,” she admits. “A couple of glasses a day.”
I sigh. “Well, this is almost certainly what’s wrong,” I say, gesturing with the sample. “I don’t need the lab to tell me you’re badly dehydrated. I’ll take some blood so we can check your electrolytes, and I want you to stay here a few hours while we get some fluids into you.”
Like most doctors, I’m fairly awful at cannulating veins, so I ask Kelly to start an IV for me. She draws me the vials of blood I need for pathology and hangs a bag of saline while I fetch an anti-emetic wafer for the patient to stop the vomiting.
It’s a fairly slow Sunday morning, so I decide to keep her in emergency for now, rather than trying to find a ward bed. Dave and I can check on her periodically while she’s being treated, and as long as she gets better, we’ll let her go in a few hours.
“Hang in there for another hour,” I tell the patient. “Then if you still need it we can give you some more pain relief.” It still hasn’t been long enough to risk giving her more meds on top of what she took at home. I get her a cup of water and ask her to sip it, not wanting to provoke any more vomiting.
Kelly joins me for another quick coffee break later in the morning. We stand outside so she can smoke. I drink an iced coffee from the cafeteria, and follow it with a bottle of spring water, having realised that my own usual habits aren’t optimal for good hydration.
“Sorry to hear about your neuro patient,” says Kelly. “Awesome catch, though.”
I nod, absently raising a hand to wave the topic away. “Did you find yourself a car?” I ask.
“Maybe,” she says. “I don’t have much savings so I’ll have to get a loan if I want to buy it. I guess I need to so I don’t spend the other half of my life commuting, when I’m not here.”
“I hear that,” I say, draining my water and tossing the bottle in the bin. “If I didn’t live so close I couldn’t stand it. The jerks on the train and then the stupid heat between here and the station… it seriously blows.”
“When are you going to get a new car anyway?” she asks.
“Well, maybe I’ll just do without the expense,” I say. “Stick with public transport. Or get a bike. Save the environment, and all that stuff.”
Kelly looks thoughtful. “I wonder how long a bike ride it would be from here to your place,” she says.
I haven’t ridden a bicycle for so long, I have no idea of even what scale of time it would take. If I were to try walking the distance, I guess it would take a couple of hours, but I don’t know how fast I would cycle it. For that matter, I’m not even sure if I can cycle any more. I mean, I assume I can, but I don’t know if I could do it, psychologically. I suppose I don’t know just how broad my craziness about being on the road is yet.
Kelly finishes her second cigarette and we head back into the hospital. The air conditioning is like heaven after standing outside, even in the shade for only a few minutes.
I’m relieved as hell to see that my emergency patient’s blood tests come back close enough to normal. She’s been dehydrated but hasn’t done herself much damage.
“How are you feeling?” I ask her as her second litre of saline is almost finished. She has pillow crease marks on her cheek, so I guess she might have slept a little.
“Better,” she says. “The pain’s about a five now.”
I check my watch. “Do you still want a pain killer?”
“Yes, please,” she replies. I get her a couple of tablets and another cup of water.
“Can I go home soon?” she asks.
I smile, genuinely happy to give someone some good news. “Yes, you can.”

