#just sick with your bog standard. illness. i guess

[cowboyhat]

THREE negative covid tests but whatever I have I still can't smell/taste anything :( if the girlies have any remedies that might help clear me up I'd love to know!!

[dxmedstudent]

Hey, I was wondering if you would consider reviewing the latest episode of Casualty (med drama) on BBC iplayer? Obviously only if you want to, no pressure. I thought it was a really good episode with the way they handled the patient case study, but it would be fun to see how accurate it is from a Dr's perspective.

Hello, I appreciate that you watched something medical and thought of me! That’s a lovely thought.  You’ll be pleased to know that in real life there’s a lot less drama and… explosions. There wouldn’t be any of us still alive in hospital if life was that harrowing. So it’s been an interesting diversion. Not my usual kind of viewing material for when I’m not at work (because when I’m home, nobody is supposed to die, all we want is something relaxing to watch)… I do, oddly enough, like superhero stuf just fine; same over-wrought themes of saving people, balancing two halves of your identity and letting your loved ones down, and oh no! someone died and you couldn’t save them! But because it’s not medical, it doesn’t set off that annoying voice in my head that tells me I ought to go over there and fix it myself. I don’t watch casualty, but I thought “Why not?”. And decided to watch the episode you mention. I don’t know the background of any of the characters, so I’ll be skipping over a lot of the overarching plot to focus on the bits I get.Warning: discussion of severe burns,  neonatal death and unrelated rape. And spoilers, obviously.

I’ll skip through the rape storyline because it’s upsetting; I’m glad that there are storylines out there tacking the idea that just becaus esomeone has consented to sex in the past doesn’t automatically mean they consented to sex with someone in the future. I hope that media exploring rape myths can raise awareness that there are lots of situations where consent changes, and that consent has to be a costant, active and ongoing process.

There’s a sub plot about a neonatologist who lost a patient who was a baby; I don’t know the background of how or why that happens, but they seem really, really broken about it. And I’m not saying that’s not horrific (God, crash calls involving infants are the worst). By the time you get to their point in their career, you will have seen children or babies die, and so their reaction feels…worse than the usual. I can’t tell if they have an underlying background of depression or other problems, or if the case was particularly harrowing, but it seemed to affect them particularly deeply. That’s the kind of context I don’t have, and I wonder f knowing the history would make a difference. But we can accept that they’ve clearly had a harrowing case to deal with.  I think the case you were probably referring to is the burns patient? So let’s focus on that. They use a reasonable amount of realism in the medical science, albeit all a bit more fast paced and dramatic than real life. Whilst there are definitely times when we act very quickly, most emergencies don’t quite move as fast as on TV, if that makes sense. But then again, people don’t have time to watch the same programme for 6 hours or 3 days to see the same things happen. They used a reasonable amount of real science; I think they tried pretty hard to inject a bit of medical accuracy into their story. That’s not to say that it was perfect, or always particularly realistic, but I think if things were more relaistic it would often take the plot in quite different directions that perhaps viewers would find a lot less interesting. And I think that although realism is important (or at least, frank outright misinformation is unacceptable), I don’t feel that forcing all plots to be medically accurate 100% of the time would necessarily make for good viewing. Don’t get me wrong; writing is often very (even unnecessarily sloppy), but the real happy medium that allows for good storytelling probably woldn’t be always 100% accurate either. Not always. For example, I liked that they explained what was going on; though in real life we don’t pehaps explain science to each other quite like they do on TV, but I think it’s nice for it to be spelled out for viewers. They don’t write medical dramas for people like me, after all. I don’t even think medical personnel are as into medical dramas as other people are. (on a side note: You wanna know what everyone in A&E is watching? Love Island. The mind boggles; I guess we all have our ways of switching off XD)…Although burns patients are at risk of infections and do sometimes need to be intubated due to swelling in their airways as a result of burns or smoke inhalation. Some of the effects of burns are immediate, others take longer to kick in.  And burns are very painful, so, so painful. So they handled that aspect quite well.

Because you seem quite interested in the episode, I thought I’d include a graph for survival rates after burns, based on age and percentage, because in the episode they sort of danced around how bad the patient’s burns were, by baguely implying it’s a VERY BAD thing whilst not actually clearly explaining why. Because the patient and the partner are medical, it was taken as part of the plot that they all knew what was going on, but it wasn’t really explained for viewers. So, yup, having like 35% burns isn’t great news.

So that’s why everyone was acting really grave, and why there was a big thing about ‘don’t tell her what percentage she has”, though in real life you’d never not tell people how unwell they are.  The ‘crash’ call (VF is a crash call) wasn’t called out as one; there’s usually alarms and pagers going off, or at least a crowd of people rushing in to see if a hand is needed. I’m glad they had all the equipment there. I’d be glad if people converted back to rhythm so quickly! The CPR was weak as noodles, but that’s standard for TV. In a real call, we wouldn’t just say someone was hyperkalaemic; we’re all about the actual numbers. They didn’t really follow up on actually treating it (though they did start talking about it a little), but correcting potassium disturbances can take a little while, so I can see why they decided to focus the end of those scenes the way they did. Adding several drugs and other things to the mix would just have cluttered the situation. But in real life treatment is sometimes pretty cluttered and messy and chaotic, and even when you fix one thing there are lots of other things to sort, so you don’t really get a breather. Especially not with a patient like that. But that would have changed the mood of the end of the patient case, and I can understand why they needed to give the audience a sense of closure about the case. In real life, the one managing the airways would be anaesthetics (was that guy the anaesthetist? I don’t know the characters at all), and they’d be talking a lot more about whether the patient would go to ITU or straight to the burns unit, and there would be calls to the burn unit about what protocol to use for fluid rescuscitation and when the patient might be taken over. If they are too unwell, they might have to stay in the hospital’s ITU until they were more stable. And if they are too unstable to be moved from resus, well, they stay there until they are stable enough to move to ITU; it’s pretty nerve-racking sometimes during that phase. Again, I can see why they wouldn’t want to bog down the episode with this level of detail; they focus on a few pared down aspects of patient care to make a point, rather than overloading viewers.

Now, about the things that could have been done a little more realistically…

They really should have intubated the patient sooner. And given that the patient knew the risks, I find it odd that they chose deep, meaningful relationship conversations over securing their own airways. Or that their partner would be sitting there chatting rather than telling them “we’ll sort this out later, but your airways are literally swelling up as we speak and you will die”.  You really don’t want to get to a situation when you can’t intubate because things swelled up too much. We lost a really young family friend to just such a scenario this year, and it’s a horrific thing that no clinician wants to see. I accept that the thing the writers were going for was ‘they know they may die, and they love their partner, therefore they need to talk, now, in case it’s too late’. But as medics we have it drilled into us that you do NOT delay urgent things because that worsens outcomes. I can accept it as a plot device, but I’d find it more unbelievable when the characters involved knew that better than even I do. Whilst I’ve never had to deal with the same exact scenarios (most people with severe burns get sent to burns units, often straight away if possible; I’ve not personally handled burns that severe and there’s usually less drama), but in general, when it comes to real life, the thought of staying alive becomes more all-consuming when you are sick. And it’s actually much, much scarier. People having long wistful ‘possible last conversations’ with spuoses is TV medicine; real medicine is patients weakly grabbing your hand, saying “help me”, and “Am I going to die?”.I also find that in medical dramas patients aren’t ill in the way that real people are. When patients are really acutely unwell, they are often pretty out-of-it, because of the effect that illness is having on their body. So they ften aren’t likely to be driving their own treatment very much at that point in time, or having long chats with anyone. Of course, unconsious or confused patients in varying levels of consciousness don’t always make for interesting viewing for laypeople. Which is why in medical dramas, people are usually conscious and fully with it, and being different levels of difficult, unless there’s some Big Secret ™ to be revealed to a family member whilst they are in a coma, in which case they will conveniently lose consciousness. Real life, as I said, usually contains a lot less drama. I’m not even going to touch the metaphorical and literal car crash at the end. How do people sit through episodes with this much action? It’s like a normal medical drama crossed with a Bond film. Normally, action doesn’t bother me too much, but throw in a patient who needs looking after, and some part of my subconscious that was beaten into shape during my training won’t stop shouting “BUT WHO WILL LOOK AFTER THE PATIENT?! SAVE THE PATIENT” in the back of my mind. It’s well executed drama, which is exactly what you want from a soap. I just don’t disengage enough from medical series to enjoy that level of adrenaline. As an aside, I’d appreciate if anyone sending recs gave a heads-up about the kind of content in the episode. I was hoping for something a little more… relaing to watch, but the topics in ep 44 were quite heavy; rape, people being set on fire and associated severe burns, abuse, and ambulance crews needing ambulances themselves. It’s heavy stuff. It might not affect whether I watch something, but it’d probably affect when I do it. Hope you enjoy the upcoming episodes, I’d love to hear if any interesting cases come up :)

[theboardwalkbody]

Ok so here’s the thing about my Mental Illness™ and working:

It’s hard. It exhausts me. It wears me out mentally and emotionally, as well as physically, of course.

When I had jobs where I would work 28+ hours I would call out on a weekly basis. Because working 4+ days a week was just too much. I would spend those days called out at home sleeping or buying things and feeling guilty about spending money when I wasn’t earning enough to support such spending (because of the calling out). I’d call them Mental Health Rest Days. But they’re not. They only contributed more to my anxiety because income is a huge source of stress. I’d feel guilty and lazy and angry at myself, but I did it anyway because I was just too TIRED to go to work. There would be times when in the midst of a 5 day work week I would call out two consecutive days in a row (sorry - really sick, still not feeling better).

Now I have a job where 12hrs is my bog standard shift. So that means, as a part time employee, I am only working 2 days a week. Sometimes those two days are bunched up (ie - work week is sunday to sat and I’ll be working thursday and saturday of week one but sunday and monday of week two making me work three days in a row with one day off after yet another shift) but guess what - hello 5-6 days off afterward.

and i have to advertise my schedule at home. because i share a car with my grandma i have to block off days i work so she doesn’t schedule doctor appointments or trips to the damn grocery store. and then, when i am off - she knows i’m off. because we live together.

but what does this mean?

it means guess who harps on me to get a second job.

the rate in which she casually drops the names of stores that are hiring is disgusting. ‘why dont you get a job at the home depot?’ ‘why dont you pick up some little job at the shoprite?’ or ‘come the summer time will your job give you more hours?’

no, no, and no.

retail demands 5+ days a week from employees. i don’t have 5+ days a week to work. Yeah, I only work 2 at my other job but I would like one fucking day off. (which is a lie and we’ll get to it in a second).

and no, my job wont “offer me more hours” because thats not how this job works. my hours are my hours. I CAN, HOWEVER, CHOOSE MORE HOURS. but thats the thing - it’s my CHOICE. they wont start scheduling me for extra shifts, they will OFFER and I can accept or decline.

but heres the thing - despite talking a lot of game before starting this job, and despite the fact that im impulsive with my money and spend more than i should and then get stressed that im broke.... i will always choose not to.

why?

because im tried.

because the idea of going to work drains me. even if i, for the most part, enjoy it when i am there. even if i get phone calls at noon asking for help for a 3-11 shift, it’s tempting to say yes because its a short shift and extra cash, but at that point im in full-swing ‘leave me alone’ mode. if i knew in advance (by like 12hrs and not 3) maybe it would be different, but most likely not.

the point is - im stressed out working only two days a week. daily i look at the calendar, even on my days off, and think ‘ok you have work on this day but then you have two days off and then you work this and this day but then have four days off’ and i have to give myself fucking pep talks. other days its ‘you only have one more day off and then you have work’ and it’s draining which launches me into the ‘but you have so many days off AFTER that shift you can do this’ and have to like talk myself down from panic attacks.

and i wish i could just tell people to leave me alone about work. and by people i mean my grandma because shes the only one who does it.

‘if you work extra hours you can save up for a car’ - listen granny, in this economy i could work 60hrs a week at my job and still not be able to afford that.

but like i wish i could just say ‘listen - i can’t work any more than what im doing because my depression and anxiety rule my life and it’s just too much’.

because what is depression and anxiety to a woman born in the damn 30s?

because what is ‘its too much’ to a woman who worked 16hrs a day 6-7 days a week to support her three children when her husband died of a heart attack in his 40s?

because what is ‘its too hard’ to an entire family full of people who have worked every single day of their lives just to make ends meet since the time they were 16yrs old?

so all i can do is blame it on work - “oh i cant get more hours it doesnt work that way,” and deal with the “you should work here” suggestions and WE’RE HIRING flyers left on my fucking desk for me to come home to after a 7am-730p shift that just get tossed in the garbage and then need a follow up explanation (for the billionth time) on “i cant work retail - they want you to work 5+ days a week and I can’t do that and work this other job at the same time”. 

yeah i know im broken. yeah i know im screwed for the future because its a fact of life that people need to work more than two days a week to support themselves and if i can barely cope with two... well im fucked, right? yeah, i know i should suck it up and stop being a baby and work while im young, i mean - everyone else in the world works 4+ days a week, so wtf is my problem?

my problem is i wish i could afford psychiatric help. my problem is i wish i could find and afford a medication that would kick my mental illnesses in the fucking ballsack and maybe then i would be able to work more hours. maybe then id be able to accept those offers of extra shifts because really, it would only make me be able to afford more of the things i need to afford.

but until that happens im stuck in a circle of ‘i need more money, so i need more hours, but i cant work more hours because im so tired and im stressed out from what i’ve got, but im stressed out from not having enough money too, so i need more money, so i need more hours....”

and it just feels like when your truck gets stuck in the mud and you can’t get traction and so your wheels are just kicking up mud all over the place. they know what they have to do. you know what you have to do, and it’s an easier path on the other side, but you just can’t get there.