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Whatever gets us through the night

Dr Paul Dhillon was the winner of the 2011 Irish Medical Writers Aindreas McEntee Prize for his short story, St Timothy’s. Here he offers an extract outlining a night of pain and perseverance.

At least I got to sleep in my own bed. Síofra was on call last night and wasn’t looking that fresh in the morning, but somehow still looked better than me. By ‘law’, she was supposed to head home at 9 o’clock in the morning after being at work for 26 hours straight. In reality, she went home at 9 o’clock that night. Mainly because I was sick.

And not just normal-sick, but really sick. But I was going to battle through it. Epic fail.

The seniors needed help in theatre, as there were a number of operations going on and not enough hands. Síofra was exhausted and the ward work was looking quiet, so I headed down to help out. I was praying to God that the consultant wasn’t in; it would become glaringly obvious that I was the medical student that had somehow made it through medical school without ever once scrubbing into an operation.

The first thing that was good was that the consultant wasn’t there. The second good thing was that they just wanted me to hold the camera while they took out her appendix.

To balance out the two good things, there were two bad things. I learned that a) it gets bloody hot with all the equipment in surgical theatre and more so with the surgical gown on; and b) being sick, dehydrated and standing in one place without really moving around is a bad thing for blood flow.

I was doing great, essentially the Spielberg of intra-abdominal video footage. I would have won an Oscar if I didn’t pass out in the middle of the operation.

Pass out in the middle of an operation.

I didn’t have a bloody notion what was happening until I fell and swooned right into the arms of the Registrar luckily standing right behind me. If he wasn’t there, I would have cracked my head right down onto the floor and it would have been more embarrassing than it was already. I just remember looking up, having a nurse bring me some water and the other end of the camera sticking out of the girl’s tummy like a solitary tree left after a forest fire. I apologised and quickly left the theatre, keeping my head down as I walked by the Registrar that was scrubbing in to take my place.

I should have gone home at this stage. I didn’t. Why? Well, because I had to be tough and try and make up for the failure of the morning. My temperature reached a high of 39 degrees Celsius. How do I know this? I know because as I was wandering the wards, I was illicitly sneaking temperature readings and robbing paracetemol to bring the temperature and my slight delirium down.

If we have a patient that is sick with a temperature of 39 degrees, we get worried. We do a septic screen, blood tests and cultures, x-ray, urine samples and start them on antibiotics in a lot of cases. Interns with temperatures of 39.1 degrees get bleeped to put in an urgent naso-gastric tube.

Modicum of privacy
I pulled the curtains around the frail elderly woman. Curtains are supposed to provide a modicum of privacy for the patient, but when you have to speak loudly to an elderly patient, it’s not that private anymore.

I was hoping for an easy procedure.

It wasn’t.

This would be my fourth attempted NG tube. I hadn’t put down that many of them in the past and my teaching involved a Registrar showing me how to put one down in a patient that had just had a stroke. He failed.

The patient sat up in some discomfort, with her thin little abdomen bulging out. Something was blocking her intestines and the tube was needed to relieve the pressure that was building up inside her stomach. She quietly readied herself and I spread the small bit of lubricant on the thin yellow tube. There may be no snakes in Ireland but there was going to be one in her stomach shortly, hopefully.

So I began to pass it down. The first little bit is easy, then it hits the back of the patient’s throat and they begin to gag a little bit. If you can get it past this point and not into their lungs, it’s clear sailing. However, in some patients, it doesn’t work that way. They start gagging. Then you either keep going and they stop, or they don’t and you pull it out and start over again.

So I stopped halfway. She settled for a second.

Then she vomited feculent material out of her mouth.
I quickly looked around for anything to catch the material that was pulsating in bursts out of her mouth. Thankfully, there was a little kidney dish sitting on the table next to the bed. Thankful for the privacy of the curtains, the little snake now lying in a puddle of poo, I gently stroked her head while she continued to vomit because of me.
The curtains also kept the smell close and concentrated.

Then I felt sick. Sick enough to vomit. I had one hand stroking this old woman’s thin, greying hair telling her that it was okay and she would be fine, while the other hand was holding a small kidney dish full of sloshing, feculent vomit.

Dr Paul Dhillon: 'I left the patient with the nursing staff to clean up the vomit, while I cleaned myself up and washed my mouth out; then I had to return to get the tube down. Thankfully it worked'

Doctor-patient relationship
I am sure the doctor-patient relationship would be greatly improved if I was to vomit into the same bowl as a patient, but I don’t think it would be that professional. So I vomited into my own mouth.

It stopped there, and I had to swallow it back down. No need for dinner.

I left the patient with the nursing staff to clean up the vomit, while I cleaned myself up and washed my mouth out; then I had to return to get the tube down. Thankfully it worked.

Time to go home, paracetamolise and vomit some ink onto a page.

  • This is an extract from Dr Paul Dhillon’s novel Time To Retract, which was published in 2011. All proceeds from purchase of the book will be donated to charity. See

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