Horrific

Casualty was quite busy today. There were so many crazy cases that we encountered, and they were all back to back! A man came into resus with severe seizures. He ended up needing to be tubed. An elderly woman came into the ward, and I’m not sure what was wrong with her other than psychosis. She was screaming and moaning on and on and on, until finally one of the doctors sedated her. If you recall, the patient room is a huge one with around 30 beds, so it can be heard everywhere, and if you can imagine, it’s awful to hear non-stop chaos in such a confined space. There was a woman who had overdosed on insulin, and she wasn’t even a diabetic. Apparently, when you overdose on insulin it usually puts you into a coma and usually kills you, but for some reason, this hadn’t happened to the patient. She just had severe frontal lobe damage and was reverted back to pretty much baby behaviors. She would sit in a chair with her legs up to her chin rocking back and forth, moaning and crying for her mom. Every once in a while she would get up and try to walk out of the door, and the security guard would have to walk her back to her chair as she screamed and kicked and fought. She repeated this behavior literally ALL morning, with no breaks. That type of repetitive behavior is characteristic of a young baby; not understanding that when you repeat the same behavior you most often don’t get a different outcome. The doctors and security guard eventually got tired of this as well, and found a bed for her and sedated her. It was such a nice break!

There was a particularly worrisome case that I found very disturbing. A young girl, only 19 years old, was brought in early this morning by her friend. She was apparently, as her friend told us, a “previous” drug abuser of tik (crystal meth), heroin, and dagga (Afrikaans word for marijuana). She was clearly high out of her mind when she was brought in, and had very apparent brain damage from all of her abuse. We also found out that she had a baby, which is the most horrible part. Nobody knew where it was or if it was being taken care of, whether or not this woman was abusing when she was pregnant etc. In front of this girl, the doctor told the nurse that he wanted a social worker to get contact information for this girl’s mother to find out where the baby is, and to get it taken away and put into foster care because this clearly isn’t a good place for a child to be. This patient was unresponsive to the news, and just blankly stared off into space with a small smirk on her face. It was so eerie. Right next to her was a young boy who was also a tik abuser that had tried to commit suicide by jumping off of a bridge. He must have been caught before the act because he was injury free. I believe he was also waiting for a social worker. The next patient rushed in from the emergency room, and it was quite the sight.

The woman came hurriedly into casualty with a bunch of wrapping around two of her fingers, her hand held up in the air. She said she had an accident and needed to see a doctor. One came over to where the three of us and the patient were standing, and told her to undo the bandage. She told us while unwrapping that she worked in a spinach factory, and had got her fingers in the way while working and they got cut. As she was taking the layers off of her fingers, she was wincing. The last layer was pretty much stuck to her fingers because of all of the blood, and the doctor had to get gloves and try to help her, but she kept wincing and pulling away; I can’t imagine it was a good feeling. Once the bandages were finally removed, we saw the fingers. It was just two of them, fortunately, that had been sliced. The first one was sliced at an angle, so only the top corner was taken off, but her other finger wasn’t so fortunate. Somehow the blade took out a triangular piece of her finger from the side, so there was just a tiny bit of skin on the other side keeping the top portion of the finger attached to the bottom portion. It was horrendous. The doctor guessed that she would have to get them amputated because of the condition of the second finger; if she was to ever bump it on anything, the top piece would probably end up ripping off because of the tiny bit of skin barely keeping it attached. We later found out that she was luckily able to keep her fingers (hopefully!). They stitched them together as best as they could, and told her to come back in a couple days. If they were healing okay, then she could carry on, but if they weren’t, then they could need to be amputated. What a horrible day for her.

The last significant patient was also quite a gross case. She could barely walk, and once on the examination table, spread her legs apart to reveal a humongous ulcer in the crotch. She said that it hurt to pee, to walk, and to touch it. I guessed all of that just from the looks of it; it looked so raw and sore. Eeuuh, yucky. That was the last thing I saw before it was time to leave for the day. How lovely.