LIGHTER SIDE OF A & E

THE LIGHTER SIDE OF A & E 

The A & E is supposed to treat emergency cases and accidents. It is however common knowledge that many patients with "cold" conditions prefer to come to the A & E because it is more convenient. My impression is that at least one third of patients who sought treatment in the late hours of the night are not in need of urgent medical attention. The common underlying etiology in these patients seems to be the inability to sleep, whatever the cause! 

A teenage girl came to the A & E at 1 a.m. complaining of giddiness whenever she went to bed every night (but not during the day) since the past one week. A healthy young man came because he could not "breathe" through his blocked nose which he had for the past FIVE days. One rather "well-educated" man saw me at 3 a.m. with a complaint of left earache. Clinical examination did not reveal anything abnormal. He said he had to come as "early" as possible as he was scared of it developing into some "neurological" condition. On further questioning he admitted that he could not sleep. One patient who happened to be a nurse, coughed the whole night till 5 a.m., when she decided to come to the A & E for treatment. The most ludicrous patient I met in the middle of the night was a man who brought his child at 2 a.m. with history of fever. Then very politely, he requested for a routine checkup for himself as well, since he had come all the way to the hospital! Yet another patient came past 12 midnight with a history of sustaining an electric shock earlier in the evening. He came only much later as he did not want to miss the late night movie on television! 

Sex and Rape 
Sex had its share of humour too, when it presents at the A & E. Working in the Accident and Emergency (A & E) department has always been considered a drag. Most of the medical officers in the University Hospital who, at some time during their four years' training in their respective specialties, have to serve six months in the A & E, regard the period there as a burden to bear with reluctance. However if one maintains his wits with him, even in the most trying situation, there are lighter moments to remember. One night at about 1 a.m., a frantic voice rang me up. He was rather frightened. While he was having intimate relations with his girl, she seemed to be panting and having difficulty in breathing! Another patient, who was on her honeymoon, had a sudden onset of bleeding down below. She immediately went to see a general practitioner who referred her to the A & E past midnight (what other time can one expect?). She was found to have a tear in the perineum. One rather anxious young man in his early twenties came at 2 a.m. after spending an hour earlier with a woman of pleasure. Unfortunately at the most critical moment she threw an epileptic fit. He was more worried that he might catch some infection from her, but then refused his blood to be taken for V.D.R.L. Raped victims often arrived at the A & E during the early hours of the morning, even though the event may have occurred some hours before. One young married woman was brought by a policewoman at about 3 a.m. after being raped by a neighbour. There was no physical injury seen. However the woman explained that the neighbour was a bomoh, who had mesmerised her into submission, after he had treated her for abdominal pain. He certainly had an unusual way of giving injections! 

Needles and Poisons 
Certain aspects of human behaviour manifest at the A & E, even from patients who are otherwise normal. A well-dressed man came and insisted to the reception clerk that his degree B.A. be written after his name in the registration form. A sophisticated-looking lady brought her sick mother and demanded to see the BEST doctor in the hospital. She felt annoyed when she was told by the nurse that all the doctors here were the best. One college student was very fearful of getting leprosy when he came with complaints of itchy rash at the groin. Since he read an article on the disease in a popular magazine, he had the feeling that his hair and nails were shrinking, and requested for an X-ray to find out whether he had leprosy. When one sees needles in the abdomen on plain X-rays, one would think that the patient must be mentally abnormal. However I saw one Form Six schoolboy who came one night after supper with a history of swallowing two needles. Apparently, he accepted a bet that he could swallow an entire bun in one mouthful. Only after he had succeeded was he told that one of his friends (or enemies?) had inserted two needles inside the bun. What a way to win a bet!

One evening, a tourist who had just arrived from India was brought to the A & E with multiple superficial cuts on his body. He had accidentally walked through one of the large glass panes at the airport. He explained that the glass panes were so clean, that he thought there was nothing in front of him. Poisoning cases, though usually tragic in circumstances, could sometimes be light-hearted. One adolescent girl was brought on a trolley to the resuscitation room after swallowing some poison. She was fully conscious and to my question, she replied that she swallowed a mosquito coil. She remarked that she had a feeling of mosquitoes in her stomach and she wanted to kill them! One patient, who wanted to commit suicide, swallowed liniment methyl salicylate because he saw that the bottle was labeled "poison". Another took ten tablets of paracetamol with intention of suicide. 

Wounds and Nail Pricks
 Nail-pricks are commonly seen and many patients are very conscious of the danger of "lockjaw" (tetanus). One patient was sure that his child had lockjaw on the same evening that he had sustained a nail-prick. The child complained of sore throat and could not swallow well. He was found to have tonsillitis. A journalist insisted on two injections of the tetanus toxoid, one in each arm, as he wanted double protection. My immediate reflex when I see a patient who had come with a history of nail-prick is to look down at his feet. In one patient I was surprised when I did not see any wound on his feet. I was about to call him bluff, when he pointed to his head. How on earth (forgive the pun) did he get a nail-prick on the head? It seemed that he walked under a wooden post with a nail jutting out! 

The variety of substances that patients apply on wounds and burns seems to be unlimited. I have seen coffee powder, tobacco, toothpaste, prawn paste and to top it all, one patient applied petrol on his skin burn! Patients who have been bitten by different animals have been seen in the A & E, the most common of which are bites from dogs and rats. On one particular day, I saw three patients with very unusual bites. One was bitten by his pet chimpanzee; the next was bitten by a crab and the third by a centipede. The following day, the list was completed by a patient who sustained a human bite! 

Foreign bodies in the ENT orifices are also of bewildering varieties: rubber erasers, groundnuts, seeds, marbles and plastic pieces from children's assembly sets. A rather worried mother brought her ten-year old daughter with a complaint that her daughter did not seem to hear very well. I found that both the external auditory canals were filled with thick hard wax. After removal of the wax, the girl smiled, for it was the first time that she could hear a watch tick when I placed it near her. On further questioning, she said that she had never liked any music. No wonder!