Am not sure which is worse – that….or actual Malaena in the morning.

Nonetheless it was the latter not the former that I had to deal with on my last night before a glorious eight days off.

I wandered into the unit to note that we had two patients both of whom I was familiar with.

One patient was CTD (circling the drain….you know like a bug trapped in a sink of water as the water slowy and inexorably spins toward the plug hole before a final glug glug glug) who really should have been sent up stairs to await celestial transfer. Owing to a bed shortage upstairs she remained on the unit. Which meant she probably received far better care – I was touched to see that the nurse assigned to her spent the entire shift holding her hand and making sure she wasn’t restless or uncomfortable (vs being left alone in a room upstairs on her own).

The other patient was one who had been extubated that morning and was now on BiPAP. My hope was that he would make it through the night without tiring and consequently needing to be reintubated – meaning dragging the consultant out of bed since I wouldn’t trust myself with an airway that would have already been oedematous from several days of intubation added to the pendulous tissue around the neck and the santaclaus beard.

It was with a sense of calm alarm that I was handed over these two patients. The alarm was not because the patients were unstable or in any way a problem….but for the sheer fact there was only two patients. Two patients in a unit capable of taking another 3 ICU or another 6 HDU patients only meant one thing….. a busy night.

Within the hour of my arrival I’d already had to phone the consultant to accept two patients – one with a gastro bleed who we’d had earlier in the week and another who was a transfer from a hospital on the far side of town (allegedly every ICU between here and there was full – or pretending to be full given the type of patient).

Settling the first of those admissions and knowing the other admission could arrive at any time in the next 8 hours, I took the opportunity to lie down and catch some ZZZZ.

It was not to be. I was just about to arrive in dreamland when the piercing godawful pearls of the MET pager yanked me unceremoniously back to my poor imitation for being awake and alert. Remarkably I think I was actually already on my feet and heading out the door before I’d realised that the MET pager had gone off – kind of like a reflex arc that notifies the brain at a later stage.

The MET was somewhat of a bloodbath(room). A patient had decided to defecate copious amounts of blood all over the bathroom, the room and the bed so that the end result was something that resembled a B-grade horror movie.

I’m guessing though the actors in the B-grade horror movie though only had to deal with the smell of strawberry sauce. Malaena or perhaps in this instance haematochezia (both pertaining to blood coming out the back end), has a far different more pervasive lingering scent that even in the light of day is not easy to deal with.

Walking into the room and being closer to the nadir than the zenith of my wakefulness, meant the smell hit me like a Mack truck and I was forced to retreat and gag a few times before I could venture forth any further.

That patient went to the unit for observation. So did the smell. Although I think even if the patient hadn’t gone to the unit, the smell would have hitched a ride stuck firmly to my nasal mucosa – not to be dislodged even by Agent Orange (the name affectionately given to the citrus smelling stuff we use to try and shift malodorous odours).

The night was not to end there – the transfer from the other side of town had arrived in my absence meaning more work.

The patient awaiting celestial transfer must have seen the starlight express approaching and consequently started Guppy Breathing otherwise known as agonal breaths that were accompanied by a Death Rattle (terminal secretions if you want to be more professional about it) as the lungs slowly filled up with fluid – a common occurrence towards the end.

I can usually handle Death Rattle and not have it phase me, but I guess that’s because it’s usually only a brief encounter to check on a patient and be on my merry way. Unfortunately due to the open plan nature of the unit, the rattle rang out above the “silence” (silence being a relative word and in this instance included the hiss of the BiPAP and the cacophony of alarms signifying the various parameter derangements on the other patients) like one of those church bells that mournfully (bonnnnnng) and forlornly (bonnnnnng) signifies the end of another life (bonnnnnnng) and chilled me to the core. Fortunately the rattle was short-lived both due to the fact that I had ordered some glycopyrrolate to dry up the secretions and because the patient was also short-lived.

By the time I’d finished the life extinct entry in the chart, the sun was coming up and casting an ethereal morning glow on all of the patients – both those still clinging to life and on those who had departed this plane and now watched the scene from above.

Thankfully my shift soon drew to a close and I was able to head home to a blissful sleep and 8 days off.

Consequently when it is used in two unrelated breakfast conversations at the same cafe it’s somewhat intriguing. Oh okay not really – but cause for comment. Which I have just done….commented that is, on the events of this morning…

Last night was my first night in ICU. I survived – and so did all the patients – remarkably — and I do mean remarkably.

I walked in last night to be told by the day P-HO that I was in for a busy night. Fortunately it wasn’t busy. Just the awkward task of removing ventilatory support from a patient with umpteen tearful relatives surrounding the comatose patient. The patient was not expected to make the night.

That being done, the rest of the night was unremarkable. It’s amazing how soothing it is to sit and watch the hypnotic squiggles of various bodily parameters zip …or mosey (as the case may be) across the monitors with the background hiss of ventilators and the occasional mellow alarm (as if the monitor was trying to say “terribly sorry to bother you old chap but this patient has a mean arterial pressure – MAP – of 59, perhaps you’d like to look into it…there’s a good lad, no rush, so awfully sorry to have bothered you”).

The most taxing post-ventilator-withdrawal event of the evening was solving the last few crossword clues of the mega crossword one of the nurses was working on. Who would have guessed an Ocarina is a terracotta wind instrument.

One of the other patients was a tad loopy and it was somewhat humourous to hear him first of all offer to make room for one of the nurses to join him in his bed, and then to tell us all he was taking a bath with six gorgeous young lasses.

It’s a bit bizzare sleeping on the job but apparently it’s quite accepted – all the nurses took it in turns to snooze in the isolation rooms and so I grabbed a quick 3 hours in the education room. Unventilated CTD patient was amazingly still alive when I woke – she had sats of 67 percent – and looked somewhat cyanotic.

…and so post-handover, I find myself sitting at a coffee shop eating a good helping of the old favourite – EB. I had a call from a friend and I was relaying the events of the evening – hence the use of the word BiPAP. Not five minutes later, the conversation at the next table mentions the use of BiPAP – apparently a group of interns discussing patients from a different hospital. It seems I can’t escape the grip of healthcare not even when enjoying a cup of coffee. Still it was amusing to listen to the conversation.

The remainder of my breakfast was spent watching other cafe patrons – particularly the guy trying who was preening himself in front of the woman sitting nearby – it looked particularly blatantly obvious what he was doing….not sure if she was deliberately ignoring it, or being blissfully ignorant of his valiant attempts to gain her attention.