who turned the gravity up?

am post-nights again. typing this is tiring my fingers out - literally - and my head keeps lolling back into the sofa. It's hard to describe post-nights tiredness. It's a bit like being severely jet-lagged, plus having run several miles when out of physical condition, plus gravity having been turned up to 3 or 4Gs while you weren't paying attention, and the air turning to treacle. The worst bit is you have to resist sleeping, because you need to work the next morning, so you need to sleep at night, not during the day. That's why I always seem to end up blogging post-nights - and even that feels like physical exertion. Well that, and also that Stuff tends to happen at night. Any parent of a small child will vouch that sick children seem to become feverish more often at night.

*Lucy is 10 year old girl with mild asthma who had come into hospital for the removal of a small omental cyst. At 9pm, she became suddenly short of breath. The immediate thought was that something had triggered her asthma, so we put her on nebulisers. She was sweaty and pale, barely able to prop herself up. She was breathing rapidly, her upper chest drawing in a couple of inches with every breath. This was visible under her clothes, and her torso made an odd rocking movement, as she was splinting the lower half of her chest - possibly from the post-operative pain, but also possibly from pneumonia, a diagnosis suggested by her high fever. Beneath the oxygen mask she wore an expression of pure terror. Worried she might be tiring, I did a capillary blood gas - it showed she was holding up for the moment. We took blood cultures, started antibiotics and got her transferred to the high dependency unit. A chest xray confirmed our suspicions. (She was much better 24 hours later.)

hardly a case worthy of House, I suppose. But more on that next time....