On Call : Dr. Daisy Dashwood writes........

......."as you can see, the deep sub-phrenic fissure is an obvious reservoir for fluid to collect. That, coupled with a wide-bore cannula, a couple of 50 ml syringes and an infero-posterior approach should solve your problem. Next!"

We were at the weekly X-Ray meeting and Drs. Neil and White were laying into us. We've all swapped teams and I'm now covering Dr. Berkeley. It's only a Tuesday and I still don't know his patients well enough to go head to head with Dr. White over their CT chests. I was dimly conscious of the fact that I probably should be discussing a few of the potential crises patients were possibly at that very moment slipping into. We had gotten a CT on someone yesterday - I just wasn't sure who and what the CT was of. I remembered the fact that I'd gone via the WRVS shop in order to purchase some chocolate but unfortunately, the purpose of the trip remained a blank.

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"It'll never work," said Mary. "You have to remember, is it indicated." Sometimes I wish Mary wasn't quite so sensible.

"Just imagine if you went in with a request for a chest X-ray on a lady with wrist pain," said John, thoughtfully. "Dr. Neil wouldn't even let you get through the door. He'd personally throw you out and stand there screaming until you weren't visible for the dust. Let's do it!"

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"Okay," said Amos, panting slightly. Amas is married to Mrs. Maradonna. We all like to tease him about being such a fantastically foreign stud, something which he pretends he is indifferent to but really secretly enjoys. "Let's run through all of the patients."

Amos still doesn't have a Consultant as Dr. Park is still missing in action. Consequently, he has taken to either latching onto whichever team is in greatest need or hanging out at the Outpatient Department, hoping to do a sneaky clinic or two. Luckily, I was able to avail myself of Amos' availability and persuade him to come on a ward round with me.

"Heartsink, heartsink, heartsink, MI, heartsink, heartsink, stroke," said Amos, ticking off the list. "Mr. Daniels is ready to have a look at some housing tomorrow so we can hopefully get him out by the end of the week; Mr. Saunders is still being held hostage by the Occupational Terrosists; Mrs. Jones has been in here since February - I think we can get her home."

"She's on placement for a Nursing Home," I recited dutifully. Mrs. Jones was a lady I had been asked to review and had labelled as being clinically depressed until a chance meeting with a relative revealed that she was merely profoundly deaf and unable to hear my questions.

"Why can't she go?" demanded Amos. "Why did she come in here in the first place? God, it was a long time since she was admitted. Can she even remember what the outside world looks like? We'll probably have to intensively rehabilitate her for the shock when we finally boot her out"

"Subacute Bacterial Endocarditis," I said. "Strep. viridans."

"It's always the Streps," said Amos bitterly, shaking his head.

"Bastards." I agreed.

"Why's she still here?" he asked again. "SBE is not an indication for a half year sojourn in the Geris Ward."

"She's just hanging on until they get her a dental appointment," I replied. "The dentist has to come and review her teeth."

"How many does she have?" asked Amos.

"Five," I said, hoping that this was indeed the case.

"Take them all out!" he said, with a sweeping gesture of his arm.

"What?!" I gasped, hoping he didn't mean me personally. "She's not going to like that!"

"Well, it's not a question of her liking it....." began Amos.

"I know, I know," I said hurriedly. "Well...why don't you go and tell her that." He wouldn't have the heart to say that to an old lady.

"I think I might just do that," said Amos, making for the door.

"Amos, I didn't mean ir," I hissed, scurrying after him. "Amos!"

We were at the room where Mrs. Jones was residing. Swathed in a vast pink shawl, she was kyphotically in repose.

"Hello Mrs. Jones," shouted Amos. "My name is Dr. Maradonna and I've come to see you."

She didn't move. I poked her. Gently, of course. Oho, that made her sit up all right!

"Mrs. Jones!" yelled Amos.

She looked at him in a puzzled sort of fashion.

"Are you the dentist?" she asked, in an extremely plummy accent.

"No, I'm the doctor!" said Amos, affronted. He couldn't have looked mroe offended had she said 'Are you a child-killer?"

"Oh," said the lady, staring at the floor. Then, looking at me : "Are you the dentist?"

"No, I'm a doctor too," I smiled.

"Oh," she said.

"She's been waiting to see the dentist for so long now," explained one of the nurses, leaning in. "It's what keeps her going through the ward rounds."

"Mrs. Jones," shouted Amos. "You've been having probems with your heart."

"What?" she said, frowning. "Speak up sonny, I'm deaf."

"Sonny!" muttered Amos grimly. "Mrs. Jones, you've been having some heart trouble."

"I know!" she said belligerently. "That's why I'm in here. The Doctor will tell you that."

Amos ground his teeth into a smile.

"I know, Mrs Jones. We don't want that to happen again and we think that bacteria can get into your blood through your teeth." Here, he paused and myself and the nursing staff braced ourselves. "That's why we want to take your teeth out." He leaned back, anticipating.

"What?" she said, frowning some more. "Take my teeth out?"

"Yes!" smiled Amos, nodding. "All of them."

"Oh," she said. "Well. If you must."

"You're very brave, Mrs. Jones," I said, taking her arm. Truly, I was touched.

She looked at me blankly.

"Are you the dentist, dear?" she asked.

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"I know!" said Amos. "Let's put in a chest drain!"

"Into Darren?" I said hopefully.

"No, into Mrs. Petrie," he snapped, evidently not condoning the ethicality of the situation.

"But they let us practice venflons on each other!" I reminded him, scurrying at his heels.

"If they let you practice colectomys on each other would you want to still go ahead with it?" asked Amos, striding ahead.

Hmm, that was a difficult one.

"Seriously, you're going to let me put in a chest drain?" I asked in wonder.

"The sooner I teach you, the sooner there'll be less for me to have to put in," he reminded me.

Amos loves practical procedures really. Almost as much as he loves audits. No, really. That's not sarcasm. He really does love audits.

"I'm sure Dr. Maradonna won't be long," I said nervously, patting Mrs. Petrie on her well-iodinated back. I had been scrubbing her so well for the past 10 minutes that the chances of her ever re-colonising her left shoulderblade were pretty slim.

I'd seen one being put in before, and the patient had fainted, luckily, away from the needle. I guessed the 'see one, do one' approach really did hold true up here.

"Sorry I took so long," said Amos, bustling through the curtains in a fetching white plastic apron. "How are you doing, Mrs. Petrie?" Amos is a great believer in treating the whole patient and likes to get his rapports in place.

"Oh, fine," she said. Mrs. Petrie was a rather stoical lady and very thin as well. Which is why I suspect Amos had allowed me to perform the procedure.

I drew up the lidocaine and prepared to inject.

"Orange needle first, Daisy," hissed Amos.

"I shall now inject a bit of local anaesthetic into your back," I informed the lady, hurriedly changing my needles around.

She tensed slightly but didn't cry out. Likewise with the blue and green needles. I picked up the scalpel and regarded it nervously.

"Jab!" mouthed Amos. "Like this." He extended his arm in a short, punching motion and swiftly retracted it.

"Just a litle prick, Mrs. Petrie," I said, watching Darren saunter past, making for the Quality Street.

I jabbed the scalpel and amazingly enough, it went in. I tentatively withdrew it and the bleeding was fairly minimal.

"Your cannula," said Amos, gesturing at a rather medieval-looking piece of metal.

I picked it up gingerly.

"Jab." said Amos.

I jabbed. Nothing happened. I tried again.

"You just need more pressure," said Amos. "Screw it."

Ignoring his choice of words, I applied a little rotational pressure to the needle. With a 'pop' it went through. I resisted the temptation to say 'Eeeeugh!" and concentrated in holding the cannula in place.

"Now the guidewire," said Amos, encouragingly.

We made it through and got drain in place. 20 syringefuls later we had aspirated a litre of bloody fluid from Mrs. Petrie's chest and she was looking a little less blue. I was happy that I had gotten one in without a catastrophic haemorrhage and Amos was happy that it had not been a difficult drain to put it. Unlike the lady he would have to drain 2 litres of pus off off the following week. But he didn't know that at that point, and so was in good humour as a result.

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"Guess what?" beamed Mary, bouncing through the door, her eyes shining.

"You mixed up the haloperidol and the caffeine and now all the ward's in chaos as the manic people become more psychotic and the ventilatory-challenged people slip further into a coma?" I guessed.

"No!" snapped Mary. "Guess again."

"You had to take a stool sample to the lab yourself as there weren't enough porters?" guessed Janey.

"I had to do that last week," chimed in Laurence glumly from the corner. "Blasted Shigella."

"No," chipped in Paddy O'Reilly, our student, obviously desperate to be the one to impart this piece of knowledge to us. "Mr. Harris sang us 'Just One Cornetto'. In Italian!"

"Or 'O Sole Mio' even," said Mary sarcastically.

"Yeah, maybe," said Paddy.

"He's just great!" enthused Mary. "Apparently he goes around sheltered housing and sings to the elderly."

"Yeah, you should hear him on the ward!" said Paddy enthusiastically.

"Is that what the racket's been?" asked Edward, bustling into the room. "I say, if I hear one more blasted aria I'm going to shove his Wagner where the sun don't shine."

"Will it stretch round there?" asked Paddy interestedly.

Mary fixed him with a withering look.

"Wagner," said Edward, despairingly. "What rot, is nobody here cultured anymore?"

Paddy and Neil shuffled their shoes. Darren swigged another half can of Pepsi and let out an almightly belch.

"'s all good, 's all good," he protested. "Better out than in."

"I'll be Bach," said Edward, with a rueful backward glance over his shoulder.

"We had a great ward round with Dr. Flett the other day," said John. "We were up seeing this decant on Ward 6 and Dr. Flett noticed that he had a Jew's Harp lying on his bedside table."

"Do you play?" asked Dr. Flett. The man picked up his harp and began to strum away. 'Doing-doing-doing-doi-doi-da-ga-doing-doing-doing'.

"We were all stood around the bed for 5 minutes," said John. "All of us. Doctors, nurses, medical students, even a random OT from the community. Then he finished and we all clapped in response."

"That was really marvellous," said Dr. Flett, warmly. "You must play for us again sometime."

"So what does the man do," said John, " he only goes and picks up that ruddy harp again and it's 'doing-da-ga-doing-da-ga-da-ga-da-ga-doing-doing-da-ga-doing' for the next ten minutes. You'd think he would get some kind of horrible oral bacterial infection."

"Viridans!" muttered Amos, in the background.

John and I have been a good team this week. I know I can rely on him to hold the arms of the psychotic patients so I can slip in some more haloperidol.

"They really ought to licience the useage of tranquiliser guns in hospitals," said Amos grimly. "One shot of the dart and pow! they're in your hands."

Amos has some fairly radical ideas. But he is the Reg and our Uncle to boot, not to mention being a part-time foreign stud and so we respect him for this.

"I see that you've been writing into the Sun again," said Nick, yet another of our medical students.

"It wasn't a gay fling!" protested Darren, sitting up from his usual relaxed feet-on-table position. "I was drunk and he just took me back home."

"No," said Nick, staring at Darren strangely. "I meant the bit about being too small to pleasure your woman."

"I knew that," said Darren hurriedly. "The ladies never complainl Once they've had a bit of the Stringfellow loving, they just keep on coming back for more."

"Oh puh-lease!" said Mary sarcastically.

"What?" said Darren. "I can't help being a stud."

"It's Amos that's the stud," I said proudly. "He used to be a Latino gigolo."

"Daisy, shut up!" hissed Amos through his teeth.

"I bet it's true!" I insisted. "Just you wait, your past will come back to haunt you."

"Well, at least I don't fancy my fellow collegues!" he shot back.

"Its......rude to to talk about Mary in that way!" I grasped for a line.

"Them?" said Mary scornfully, with a disdainful glance at our male counterparts. "I should think not. My heart is elsewhere." She gazed soulfully into the middle distance.

"How about the rest of you?" asked Angie. "Who can we pair off? I'm married, Amos is married to Mrs. Maradonna, Laurence has Mrs. Seldinger, Gordon has Beth in Raigmore, Janey has her surgeon. I know! Daisy, let's find you a boyfriend!"

"We could always not!" I said brightly.

"Or we could!" she said, even more brightly.

"Oh, it's just too much fun!" she said, rubbing her hands. "How about Darren?"

"The Stringfellow love isn't limited to one lucky lady," protested Darren, from his characteristic horizontal chair position. "But baby, there's more than enough love to go around from this boy. If you know what I mean!"

"Eeeugh!" said Mary.

"How about John?" suggested Charles. "He's a nice boy."

"I'm sure John doesn't need to have you wittering on," I muttered, feeling my face flame. I noticed a flash of light from the opposite corner. Oh no, it was just John turning a similar shade of magenta.

"Perhaps he does?" sugegsted Poppy, with a wicked gleam in her eye.

I risked a quick glance at John, at the same moment as he risked a glance at me. The electricity crackled between us and we both pulled away and concentrated intently on our knees.

"Mary and Edward!" I gasped. "That's it, Mary and Edward!"

"I say!" said Edward, looking up.

"Honestly!" said Mary, blushing like a schoolgirl.

"What's going on in here?" asked Dr. Berkely, springing into the room. "Is this a little game of House Officer matchmaking?"

"No, we were just discussing the drugs," said Charles innocently. "There was a lot of chemistry involved, isn't that right Daisy?"

"Yes, I always strive for perfection in my pharmacology!" I smiled.

"Oh." said Dr. Berkely. "You kids need to get out more."

"And I know just the person to help you do that!" began Angie.

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It's important to have a sense of community within the hospital. If you don't get on well with your nursing staff then they can make your life hell.Similarly, if you hit it off with them, they'll tell you when the patient needs fluids written up before 4.55pm and go to see the angry relatives with you. And they have a seemingly limitless supply of chocolate at their station. Everybody, from the phlebotomists to the physiotherapists, and the pharmacists to the porters, has a role to play in the day to day running of the hospital, for the greater good of the patients. That's why I like the Royal Scottish Hospital. Even if everybody does know you've sneezed before you do. Or that you fancy your fellow House Officers before they do.

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