Another Outback Night

‘You bloody nurses. Don’t they teach you anything?’

The nurse kept pressure on the wound and the patient just lay there. His eyes rolled drunkenly and his hand slapped pathetically at the nurse trying to bat her away like an annoying fly. She arched her body away from him and kept up the pressure, her nose wrinkling slightly at the sickly metallic scent that leaked under her fingers and filled the disinfected clinical air around them. She caught his flapping hand and firmly placed it by his side, wished restraints were legal. She ignored the doctor’s comment. He was just venting at her because he thought “on call” only really meant “if they’re dying”. His problem.

The doctor turned his attention from the nurse and cast a look of disgust over the patient. ‘They shouldn’t employ you if you can’t suture. Get me a sterile pack and sutures.’

‘Right behind you, open and ready on the trolley, 5.0 and 6.0 nylon, your choice. Gloves are underneath,’ she avoided eye contact, kept her focus on the patient.

‘I asked you to get me the pack, now.’

She looked directly at him and removed her hand from the head wound. A spurt of blood hit the doctor’s shirt. She raised her eyebrows and slid past him to pull the trolley around another couple of inches so it sat beside him. Clearly the doctor was unable to reach behind him, a tricky manoeuvre for one so highly trained. The gash continued to leak blood and the doctor tried to staunch the flow whilst maintaining his calm superiority:

‘You should have been keeping pressure on the wound.’

The nurse donned a fresh pair of gloves, opened extra packs of sterile gauze and pressed a wad over the doctor’s gloved fingers, reapplying pressure as he removed his hand. She kept up the pressure whilst he put on gloves and let his tie dangle into the sterile field laying waste to all advantage of her perfect aseptic technique. He fumbled with a new pair of gloves and picked up the syringe from the kidney bowl.

‘Ten mls of two percent. Ampoule’s under the trolley, you can check dates and dosage. Wound irrigated with normal saline. Six centimetre lac, no damage to deeper structures evident. Assessment complicated by ETOH but appears to have normal sensation around and distal to the wound, no foreign bodies, clean cut with glass,’ the nurse rattled the information off as the doctor started to infiltrate the laceration with the local anaesthetic, not bothering to check the ampoule, clearly having faith in her competence despite his outburst.

‘It’s a mess. Hold his arm down. These people never learn.’

He didn’t look up so missed the look she shot him but caught the sigh. The nurse kept mopping up the blood as the doctor sutured the patient’s face and the patient kept waving his arms around flapping feebly at them both, begging to be left alone, allowed to sleep. The nurse spoke in low soothing tones, oriented the patient; explained what was going on. The doctor worked slowly and methodically from the centre out – an immaculate line that would leave a thin neat sliver of a scar. He never addressed the man he sutured, only swore intermittently under his breath slowly calming down as he focussed intently on what he was doing. As the skin came together he spoke, milder now:

‘How did he do this? It’s a mess. Nurses shouldn’t be suturing wounds like this. You were right to call me.’

Ignoring his turnabout the nurse explained: ‘Big night, lot of grog— ’

‘Aww only a couple of casks nurse. That’s not so bad missus.’

‘Hey, you’re still with us Patrick. How you feeling? Any pain?’

‘Where’s me bro? Hey! What you doin’?’ Patrick started trying to push the doctor away as he closed up so once again the nurse took his hand and gently but firmly placed it and held it by his side. As Patrick surrendered himself to their care the nurse once again explained, ‘Doctor’s stitching you up Patrick. Bit of a run in with a beer bottle. You’re brother’s fine, he’s sleeping next door.’ She then continued to the doctor:

‘Disagreement with his brother – he’s the one snoring next door – minor abrasions but a hard head. Lot of glass through his hair but only minor lacerations and a fat lip. Hence, Patrick here also has a tooth knuckle injury, right hand. Cleaned as per facial laceration, no tendon damage evident. Twenty gauge cannula in place if you could write up cefuroxime while you’re here then I can give a loading dose.’

‘Of course. Make sure you start it straight away.’ The doctor gave a cursory glance at the cannula and the dressed hand. Patrick had fallen asleep, and the nurse was pulling up the cot sides and straightening the sheets. The doctor walked out of the room leaving the trolley in disarray and sat at the nurses’ station to write up the notes and the drug chart that lay waiting on the desk. The nurse finished settling the patient – the client these days – and looked over at the trolley. The lignocaine syringe lay bloody in the middle of the sterile field, blood soaked gauze partly obscuring its needle. The yellow sharps box hung unused on the side of the trolley, likewise the clinical waste bag. The suture needle had been dropped in the middle of the mess. The doctor of course felt no compulsion to tidy this up or dispose of his own sharps, on the contrary – nurses’ work. She rolled the trolley out of the room back into the orange glow and subterranean hum of the hospital at night.

Outside the dressing room she picked through the mess separating sharps and clinical waste, washing the trolley and returning it to its allocated space. She washed her hands, a squirt of hibiscrub for good measure. She pulled the outsized bunch of keys from the pocket of her tunic, rifled through them for the drug cabinet key and drew up 750mg of cefuroxime for Patrick; set up a blue plastic kidney dish with another phial, sterile water and saline for the next dose in eight hours then padded back to the nurses’ station. The doctor was gone. An indecipherable scrawl on a continuation sheet lay on the desk. He hadn’t done the drug chart, hadn’t prescribed the antibiotics. She named and dated the sheet and filed it in Patrick’s notes then went back into the observation room and gave him the IVs. It was a quiet night; she’d keep a close eye on him. Hope to God he didn’t have a reaction. His highness would absolutely flip if she called him out again.

© Ammie-oy 2010

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