23 May; posted in retrospect

Bizarrely enough, the reason I've not been writing lately is I've felt a little saturated by the number of other people's stories I'm carrying around in my head. When one first assesses a patient, one "take[s] a history"; obviously this information then forms the basis of the examination and any further tests, and is duly recorded in the patient's notes. What the doctor is then supposed to do with the residual information impinging (sometimes rather disturbingly) on his own thoughts by the end of a 12 hour shift is slightly less clear. It is too easy for others to say, "go home, switch off, do something to relax." 4 years into working life, and I am still struggling to find a balance between empathy and detachment. Sometimes I feel physically sickened by what I've heard and seen. And then I get home, and I can't relax because I've got a clinical exam to study for! I have to read up on the conditions I've seen, and memorise the symptoms and treatments etc because I'm going to be tested on it all in a few weeks. I do go swimming or running or something if I'm on a short day ("short"= 9am to 5pm), but long days or nights (9am/pm to 9pm/am) make even this impossible. The only thing left that is vaguely soothing is doing the ironing; something about the creases coming out, I think.

One thing I learnt on nights last weekend:
A one-year old girl had come into A&E with a short history of poor feeding, crying all the time and her body being "so stiff, it was hard to get her into the car seat". Although her temperature was only 38 degrees, her behaviour (the obvious irritability) made it likely that she could have meningitis. She was otherwise pink and well-hydrated, and her condition was stable. I explained the situation to her parents, and explained that I would need to perform a lumbar puncture. They flatly refused, but did agree that she should be admitted to hospital. I couldn't leave it, so, feeling rather pathetic, I rang the senior registrar. She spent a few minutes with them, then emerged, saying, "get the LP trolley, they're fine with it." "What did you say to them?" I asked. "I said they would never forgive themselves if it turned out to be meningitis and we missed it," she said. Nothing like a spot of emotional blackmail to save the day.