Diary of an FY1 – The Curious Incident of my Exploded Appendix

[box] This week, Oscar breaks the fourth wall to become a patient himself [/box]

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There is a time when every dog has its day and on Wednesday, my appendix decided to have it. That oft ignored piece of the body that scientists far and wide are still trying to justify existing made the full force of its existence known to me. To be fair, it had been complaining every few weeks for the past few months but I had assumed that it was in fact my oesophagus playing the role of a weeping heart in flames after the triage nurse at a London hospital said so. I guess the route to my heart isn’t via my stomach. And thus I fumbled along in agonising pain every few weeks across London, Tanzania, and finally Scotland before my appendix finally gave up the ghost.

There was nothing remarkable about the hour. I had gone into work thinking that the mild epigastric pains that had started the night before and continued well in to the morning would go away with the tried and tested applications of two paracetamol and a ranitidine for good measure. But as the morning creeped along with referrals forwarded, backwarded, lost, refound, started again, I decided to be order some scans. The clerkess noted that I was pale and should probably sit down. I admit I was in pain, breathing heavily and sweating myself into hypothermia but I could surely still type in a few bits on the computer right, surely?

I was sent to the visitors lounge to recuperate. Gaviscon, milk, omeprazole, which had never worked in the past continued to not work today. My registrar notified me that if I were her patient, she’d be slightly worried right now. I was accompanied to A&E whilst I slowly thought about how I had failed in my duty to send some scans off for the patient. The other reg said they’d be able to cope. I guess it dawned upon me that I was kind of ill after all.

Having given my registrar the history, she handed me over to A&E where apart from being in heinous amounts of pain, I was hoping I wasn’t abusing the fair and equal system of waiting your turn in line. My inner scientist was pleased to finally discover whether or not I was easy to cannulate. Although it was done in one sharp scratch, I was disappointed my numerous veins weren’t up to their usual high standards. In future I will need to factor in low blood pressure and ensure it is a controlled variable.

Failing to live up to my usual standards of humour, as my delivery may have been slightly off due to my need to breathe rather heavily, my joke about being a doctor addicted to morphine sounded like a question and was dutifully answered. My heart sank as it was clear that my life experience was no longer sufficient to produce humour in A&E in the role of a patient. The travesty was not that my ego was dented as a comedian, which it was, but the fact it meant I had little understanding of my newfound position as a patient.

Having spent the last three years attempting to downplay sharp scratches, strange sensations of flowing fluid, side effects, potential outcomes, adverse effects and death, it was only then that I actually began to contemplate what all of it meant. In spite of my new found patient status, I was still trained medically and yet.., still so uncertain of things. The monopoly of medical knowledge had broken the barrier and crossed the mirror’s edge. The cold silver of glass that marked the line between the reality of what I knew and the illusion of being had cracked into pieces as reality flowed both ways. But many times it doesn’t. Usually it is the patient looking in the mirror to see the all-knowing doctor, king of panaceas and bearer of the fruit of knowledge. Faith in the hours spent in the hallowed monasteries praying for the guidance of those before us, to offer salvation to the damned. I prayed in this house of god.

There is something strange about the act of being dressed in a hospital gown. For it represents the moment where one crosses the line between the well and the sickly, where one loses the liberty to abuse their vigours in the hedonism of youth, and instead becomes a captive of the miasma manifest in one’s corps. The limitless choices that we so carefully make in our appearances become snatched away under the bespeckled hues of dress fit for purpose, ready for our next presentation under the doctor’s gaze. The patient wristband becomes a lifeline between what once was and what is now. A barcode and a set of digits the sole identifiers of who we profess to be, upon a limitless database of names with personal purpose and yet collective meaninglessness. I was now a part of the hospital goods, waiting to be shipped to my bed and ready for the industrialised medical machinery that would make me well and free me. I was a patient.

Urgency faded away into the quiet acceptance of the passage of time. Salvation would come at the end of the emergency list and no sooner. The magical white pills that acted as mystic cure-alls did their part for the time being. The novelty of wearing a gown soon changed to a gradual haze as it faded into feelings of doubt and apprehension. The pull of gravity on drops of water formed a steady rain as each pitter patter marked the steady tick tock of time, flowing through the labyrinth of a plastic canal and weaving itself into the very essence of my soul. The pendulum of my mind swung back and forth between quiet acquiescence to fate and a desperate desire for judgement to pass.

I counted the twelve stations of the cross as each step I took led me closer to destiny. I took my role as the prophesised acts marked out the road I’d seen so many others tread before me. The rituals took upon a farce as I danced my head back and forth for the anaesthetist and accepted the die that would be rolled by the surgeon. So many times I had seen this, and felt that it was just a day to day routine of tasks toiled away in an endless plateau of paperwork waiting to drown the world away.

And yet, the tides that had formed higher and higher upon themselves beyond the peaks of mountains dropped with impotence at my feet. Everything stopped mattering. Damn the secretary of health as he strips away the NHS, damn the managers as they take away our time and damn the world as it falls apart to pieces. The words block-printed on the sheet smashed into me a monsoon and my body crashed as heavy stone as the dawning of my consent struck me. The words I had so eagerly expected of others now became the oath and testament to my grave and salvation.

The gravitas of the black ink I had left in the box sunk past the carbon copy, through the immaterial layer of wood and seeped, suffocating me. A curse binding me to the acts that awaited me on the stage of the theatre, as a band of tools and a symphony of sounds would form the masterpiece of an operation. The piece would be one that I had seen before with the subtle steps marked out elegantly in my mind, but this performance would not be one that I myself could see, but simply allow in my name. And this was my intoxicating fear; in a world where individualism is the champion, faith in others is a dauntingly scarce resource.

One can timelessly wander through the mirage of medical school demanding medicine as the sights, sounds, smells and more become engraved in us and guide us to be who we are. But as these things take us further and further towards the hallowed halls of practice, we forget more and more of the things we leave behind. The act of consent becomes academic, as law and ethics become to many a meaningless tirade of words spoken by dead men. And finally those words would have meaning as I was called at hand to witness their virtues.

And thus, it marked the day my appendix crossed a line. It was the day I would suddenly understand the enormity of what we ask patients to go through so that we can help them. It was the day I would go to sleep as the burning of propofol would signal the trial of fire that I would have no memory of. My mind faded away.

And I awoke.

Oscar

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