Tag Archives: fallot’s tetralogy

Fallot’s tetralogy . . . (episode 99)

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November 19 2000

1A The Hole
Hope End Street
CARPOOL C87 4AZ

Hello Auntie

I have been engaged in one of those situations (at work) which give one pause for thought. It is now my second year of study at Carpool University Hospital and I have been allocated to a 6-week-long sojourn in the Coronary Care Unit (CCU). It can be pretty scary, as I expect you can imagine, to be surrounded by potentially blue-looking people and their bleeping paraphernalia. But one man, in particular, engaged my attention. He was in his twenties and had, apparently, had a late diagnosis of a heart condition called “Fallot’s Tetralogy.” I had to go home and look this up! It means that there is a hole between the two bottom chambers (ventricles) of his heart and that the wall of the right ventricle has become thickened under the strain of trying to push blood into narrowed pulmonary veins.

But the issue more to hand, at least to me, was that he looked like he might have an intestinal obstruction. I can say this with some degree of confidence Auntie, because he was only able to manage the occasional lick of ice cream, had a hugely distended abdomen and kept vomiting up (green) bile. So as a – still lowly – student nurse, I toddled off to the nurses’ station to informing the staff nurses of Mr X’s predicament.

But, do you know, they barely gave me an uninterested flicker of the eyelids – and a bored sigh – before returning to whatever notes they were penning in patients’ documentation. I have noticed this type of attitude in the so-called “professional” nurse before; they think they are too high and mighty to engage in some actual thinking – and can’t wait to condescend to someone they perceive to be of lower status. In the absence of any interest in the information I was trying to give, I slithered off to the sluice and occupied myself in some minion-style cleaning of metal bed pans.

However, on my cycle ride home (in the pouring rain and clad in my usual black – rubberized – outfit) I had time to think the matter over. And it did seem to me Auntie that, given the opportunity, I ought to try to do something to help this patient. But what? After all, I am a man who does not even have the funds to drive a basic automobile and who, likewise, has to listen to his music from a “Walkman” strapped to his belt!

The following day, I was on a “late” shift and so arrived on the ward at around 1300 hours. During the course of listening to the staff handover, it transpired that Mr Corcoran – the cardiac consultant – was due to come and do “a round” of the patients some time during the afternoon. A “flashlight” went off in my head at that moment Auntie, and I resolved to try to hang about on the fringes of this event.

It was at around 1500 that Mr Corcoran, plus entourage, swept into the CCU. He started to attend to every patient, in their turn, while a junior doctor expatiated on what they thought was going on. Thule was among them! Eventually, some twenty minutes later, they reached the bed of the patient with Fallot’s Tetralogy and it was obvious, from what I could pick up from the sidelines, that nobody had noticed that he might be obstructed.

I felt so enraged by what appeared to be serious neglect on the part of the qualified nurses, that I found myself speaking up. ‘I have noticed,’ I said, ‘that Mr X is virtually unable to eat and he has been vomiting bile for the past three days. The vomiting is projectile in nature.’

There was somewhat of a pause at this point as Mr Corcoran looked at the qualified nurse who, in turn, glared at me. ‘Has he?’ he said. He then went over to examine the taut, drum-like, abdomen of the patient, listening to it (for interior sounds) through his stethoscope.

‘This young man’ is quite right he said. ‘This patient needs to go off to theatre immediately.’

It was gratifying Auntie to see Thule smile at me from among the group of medical students and doctors gathered around the bed. But it was even more gratifying to feel that I had had the nerve to try to do the right thing, at the right time, and that my actions might result in the saving of someone’s life.

Of course, for the rest of the week, the backs of the qualified nurses were ostentatiously turned towards me whenever I was on duty. But not only were they wrong in the first instance, they have further shown their mettle in this additional display of unkindness. They have not learned. And I wonder what further sins of omission they could commit during the course of their qualified – and “professional” – careers?

Bye now Auntie

Ralph

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