"So when did you fall?"
"Last night, just outside, the building wardens helped me in, I didn't want to bother anyone"
"No bother at all, where is your pain?"
"In my side here (pointing to his lower ribs) and a bit in my hip, but the worst is in my ribs"
"Ok, was it that side you fell on?"
"Yes"
"How have you been since last night?"
"Terrible, I thought it would just go away, but I tried to go to the bathroom and it took me about an hour because of the pain and I couldn't walk properly"
"Where was the pain when you were trying to walk?"
"Started in my hip and moved up my side"
"Ok lets get you something for the pain and get you to hospital"
The patient is wearing just his underpants but I can see that trying to get any clothes on him is going to be a lengthy and painful job so I ask the warden if she could put some PJ's and slippers in a bag for us to take. The patient is given morphine by Cake Monster* and we get him on to our stretcher.
The gives me a better opportunity to assess his injuries. I run my hands done the outside of his hips and feel the right hip is 'out' in comparison to the left. I look at his feet to see a slight rotation of his right foot but no obvious shortening. His history and the presenting pain point towards a fracture of his Femur at the hip (better know as a NOF fracture, or Neck of Femur).
"Where is the pain worse?"
"My side"
"Not your hip?"
"Only when I try to stand on it"
We transport to the Big City Hospital, I start to do my handover to the A&E triage nurse
"This patient fell last night and has been complaining of right sided rib and hip pain"
"Does he have any clothes with him?"
"We have some PJ's and slippers with him"
*deep sigh and withering look*"Well if its just his ribs he'll be going home and needs clothes"
"But its not just his ribs"
"You should think of this before coming"
"I was thinking of my patients pain and injuries actually, but if I can finish my handover?"
*Nurse turns to put BP cuff on patient*"Can you walk?"
"A little but its very painful"
At this point I indicate the rotation and the slight deformity relating to the right hip.
"Well, we'll still have to get you some clothes for going home"
I try to point out it took three of us to get him out the flat and that he couldn't walk unassisted, but it was made clear my 'opinion' and clinical judgement were no longer required or even believed.
3 Hours later back at Big City Hospital triage with the same receiving nurse:"Can I ask what happened with the gentlemen we bought in early"
"Fine, I'll just check on the system.......................... He was taken up to the ward.................. NOF fracture"
"So he had broken his hip then? Ok thank you"
Probie Tech walks out of A&E feeling slightly smug
"Last night, just outside, the building wardens helped me in, I didn't want to bother anyone"
"No bother at all, where is your pain?"
"In my side here (pointing to his lower ribs) and a bit in my hip, but the worst is in my ribs"
"Ok, was it that side you fell on?"
"Yes"
"How have you been since last night?"
"Terrible, I thought it would just go away, but I tried to go to the bathroom and it took me about an hour because of the pain and I couldn't walk properly"
"Where was the pain when you were trying to walk?"
"Started in my hip and moved up my side"
"Ok lets get you something for the pain and get you to hospital"
The patient is wearing just his underpants but I can see that trying to get any clothes on him is going to be a lengthy and painful job so I ask the warden if she could put some PJ's and slippers in a bag for us to take. The patient is given morphine by Cake Monster* and we get him on to our stretcher.
The gives me a better opportunity to assess his injuries. I run my hands done the outside of his hips and feel the right hip is 'out' in comparison to the left. I look at his feet to see a slight rotation of his right foot but no obvious shortening. His history and the presenting pain point towards a fracture of his Femur at the hip (better know as a NOF fracture, or Neck of Femur).
"Where is the pain worse?"
"My side"
"Not your hip?"
"Only when I try to stand on it"
We transport to the Big City Hospital, I start to do my handover to the A&E triage nurse
"This patient fell last night and has been complaining of right sided rib and hip pain"
"Does he have any clothes with him?"
"We have some PJ's and slippers with him"
*deep sigh and withering look*"Well if its just his ribs he'll be going home and needs clothes"
"But its not just his ribs"
"You should think of this before coming"
"I was thinking of my patients pain and injuries actually, but if I can finish my handover?"
*Nurse turns to put BP cuff on patient*"Can you walk?"
"A little but its very painful"
At this point I indicate the rotation and the slight deformity relating to the right hip.
"Well, we'll still have to get you some clothes for going home"
I try to point out it took three of us to get him out the flat and that he couldn't walk unassisted, but it was made clear my 'opinion' and clinical judgement were no longer required or even believed.
3 Hours later back at Big City Hospital triage with the same receiving nurse:
"Can I ask what happened with the gentlemen we bought in early"
"Fine, I'll just check on the system.......................... He was taken up to the ward.................. NOF fracture"
"So he had broken his hip then? Ok thank you"
Probie Tech walks out of A&E feeling slightly smug