Before I start I think it may be helpful to do a bit of scene setting to put things into context. Many years ago I worked in an emergency admissions unit in an average sized city. The hospitals in the city back then were on a split site, as were the emergency departments. The 'Casualty' department was on one site, and took the trauma half of the work along with most of the self presenting 'walk-in' patients. The EAU was on the other site, and took all medical and surgical emergencies, GP referrals and self presenting patients who knew the system and didn't want to sit in A&E waiting, get transferred by ambulance and sit in EAU waiting again.
As we took all the medical stuff we got the joy of all the OD's, drunks etc, while the other site got all the glamour. Well thats how it felt some days. We had quite a fan base of regular customers, who would present themselves with varying complaints and kept us entertained. Patients that presented at A&E with medical complaints that needed investigating or more than just very basic treatment would be transferred to the EAU via ambulance. Anyone that experienced trauma of any decription, regardless of how close to us they were would be taken to the other site. This was demonstrated one day when there was an RTC on site, an ambulance was dispatched and the casualties were taken to the other hospital for treatment.
It was an average day in EAU, a weekday afternoon in early summer. Nothing much of note had happened. the steady stream of patients that had come through the door had been the usual mix of medical and surgical complaints that we saw every day. No really really poorly ones, no heroics, and quite a few that really could have gone to their GP instead. The unit wasn't rammed, but we weren't that infamous 'Q' word either. Every cubicle contained a patient, as did every corridor, and we played chess with them, moving people around every so often as need dictated.
Another ambulance pulled up outside the doors, the crew were showing no signs of being in a particular hurry, so we weren't expecting anything much to challenge us in the back of this one. If we'd had a competition to guess what was coming there is not one person in the hospital that would have called it. A few minutes later a stretcher was wheeled through the door attached to two smiling medics and containing a fairly young, and quite healthy looking chap who apart from looking a little flushed and slightly uncomfortable, looked in rude health. Now the benefit of experience is knowing that looks can be deceiving, but the crew didn't look concerned either, so we were fairly sure on this occasion that looks weren't deceiving us at all.
In fact rather than looking concerned, on closer inspection, the crew were sporting an altogether different look, something much more akin to mirth. They were desperately trying to keep straight faces as they pulled up alongside the desk to give their brief summary of the patient and to see where we wanted him.
"Male, 28, obs stable, errrrrrr probably a surgical case, where do you want him guys?"
The staff nurse on the desk, looked a little miffed. "I think thats for us to decide don't you? Whats the presenting complaint?"
There were lots of people milling around the area and the patient was looking increasingly more uncomfortable by the second. The paramedic doing the handover was also finding it harder to keep a straight face. "Well I guess you could kind of call it a foreign body type case, ummmm can we just get him into a cubicle......"
"Put him in 7 and bring me the paperwork."
Me: "Do you guys need a hand getting him over on to the trolley?"
"No we're good, he's pretty mobile really, we'll take care of it"
Bizarre, they are normally more than happy to have us settle the patient in, ah well. A few minutes later the crew head back to the desk to present the paperwork and give the handover. A hush descended as we all listened intently.
"Male, 28, normally fit and healthy, nothing of note in his obs, attempted DIY penis extension, resulting in two lorry wheel nuts being firmly wedged on his 1%."
As the 'penis' word was uttered heads shot up like meercats, and everyone who hadn't been listening at that point pinned back their ears and tried to catch up. Silence..... open mouths, followed by several staff trying desperately to keep a straight face and remain professional. The crew left to go and have a giggle in the privacy of their ambulance.
The man in question, lets call him Steve, was settled in and the paperwork done. The surgical team examined him and he explained that he thought the weight of the wheel nuts would stretch 'little Steve'. What did happen was that as the blood flowed around the area the pressure from the nuts stopped it flowing out again and the end got more and more swollen. The result was an angry looking, red swollen bulge. at the bottom of two large metal lorry nuts. We tried cold packs to try and reduce things a little, lubrication to try and help things along, but nothing was shifting those nuts. The conclusion was reached that there was nothing in the hospital strong enough to cut through this thickness of metal, and as he was not keen on the idea of cutting little Steve off, the Water Fairies were summoned. (for the uninitiated thats the Fire Service)
Word soon spread through the unit and the hospital beyond. A steady stream of nurses popped their heads around the curtain, is there anything we can get you sir? Sorry no, you can't have a cup of tea, you're nil by mouth. Are you comfortable? Do you need to use the bathroom (giggle giggle). Everyone wanted to get a glimpse of our blushing boy and his well and truly wedged nuts. Anyone not in the know that was around the department that afternoon would have been forgiven for thinking we were the best resourced unit in the entire NHS there were that many staff around. Meanwhile we carried on applying cold packs while we waited for his knights in a red fire engine to ride in to his rescue.
By far the highlight of the day for me was the arrival of Trumpton, in fire kit, with their industrial cutting gear to do the business, and the look of sheer terror on the face of the patient when he caught a glimpse of the kit. You could sense his fear on behalf of little Steve, and his disbelief that they could cut the nuts off (the metal ones) without any damage to what they were attached to, or indeed any other nuts!
They were all packed off to theatre for the procedure to be carried out under anaesthetic, so we missed the best bit! The rest of the afternoon was very dull by comparison, but we had a great story to chat about over lunch for a while!
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