Technique

Many of the patients seen by the Infectious Diseases team are IV drug users. As it turns out, injecting random substances into your veins is actually dangerous. Any bugs that you inject go via the venous system to the right side of the heart, where they can lodge and form vegetations on the heart valves. Once the vegetations become larger, they can affect blood flow, and also flick off to the lungs. From the lungs, apart from causing infections, they can wash to the left side of the heart, and from there … the rest of the body, even the brain.

We have patients with infective endocarditis (infections around the heart), infections in the brain, infections in the blood.

You’d think that Infectious Diseases doctors would be strongly against IV drug use, when patient after patient appears with serious infection, in need of IV antibiotics, with no veins available because they are all scarred and collapsed. What bothers the consultants the most?

“There’s no attempt at sterility at all”

Yes, the consultant is most annoyed about technique.

Last week we were called to see a lady with pus pouring out of her eye due to a bug commonly found in dirt. At first it looked like she’d injected with a dirty needle and the bacteria had entered the bloodstream. Later it emerged that, having ruined all of the veins she could find, including her jugular veins, this lady had injected into her eyeball. Straight in. Turns out the bacteria was just a contaminant on the swab, and most of the damage was done from the chemicals in the drug. I think the eye is being removed this week.

How’s that for technique?

Tests

"With a hammer in your hand, everything's a nail isn't it?" - Infectious Diseases consultant after the Endocrine registrar ordered a variety of (endocrine) tests on a patient with septic shock.

The Library Museum

Perhaps indicative of a shift towards electronic references, the bookshelves in the Infectious Diseases office are stacked full of dusty, outdated textbooks. Titles such as "The Quinolones" from 1986, "The New Generation of Quinolones" from 1990, a cassette tape about Hepatitis B, and "Current Chemotherapy" from 1977 line the shelves. Until a 2010 White Pages appeared, the 1996 street directory was the newest book in the room. It's like a tiny little museum.

Like Pulling Teeth

People cringe and shudder when I tell them I had all four of my wisdom teeth out on Friday. In the chair, as opposed to under general anaesthetic in the operating theatre. I was a bit trepidatious at first too, having sat with my sister while she had hers removed a few years ago. I still remember the crunching sounds.

Now that I am officially in the aftermath of the whole operation, I believe I can safely say that the most painful part was getting the dexamethasone injection to the arm. Of course I'm very glad I got it - it stopped me from getting a giant swollen "chipmunk face" after the operation. And it only hurt as it was being injected ... and for a few minutes afterwards - but as my Dad always says, "it'll stop hurting once the pain goes". Surprisingly, it was even more painful than the local anaesthetic which had to be pushed in through the bone of the lower jaw.

If you're already a little squeamish, I suggest you stop reading now. The following passage contains graphic details of an operation that I technically didn't see or feel.

- insert transition music here -

Like any surgeon, the dentist wants to get the operation over and done with as soon as possible. He lets the anaesthetic work its magic, and then says, "Ok I'm just going to push" as he slices the gum with his scalpel. Grabbing the tooth with his pliers, he gives it a knock, and with a quick crunch the tooth is separated from the jaw.

My tongue is almost completely numb with anaesthetic, but I have mild shooting pins and needles and I am convinced I can feel arterial blood spurting onto my tongue. The assistant passes some gauze and it is packed against my bleeding gum. "That came out easily" she says, and indeed it did.

The dentist pulls out the top two first and then moves on to the bottom teeth, which he says are usually more difficult. He has approximately ten million years of experience (he's been my dentist my whole life), and as it turns out, he is right. 

The first of the lower teeth comes out easily enough, but the final tooth clings to the lower jaw and does not want to leave. Blood begins to pool in the back of my mouth - so much that the assistant has to switch the suction device to a larger one - as he cuts, pulls, wiggles, drills and taps at the tooth and gum. I request to spit, but he tells me that I can't spit straight and that I should just breathe through my nose and let the assistant suction out the blood. I tell him that I can feel him moving the tooth around, and start freaking out that I'll feel the excruciating pain of the nerve being torn when the tooth finally lets go. He tells me to "hang in there" because it's nearly over.

And finally, it is over. I'm allowed to sit up, and start drooling blood into an emesis bag that my boyfriend thoughtfully brought along. The dentist was right - with my tongue and lower lip completely numb, spitting is a challenge that for the moment is beyond me.

I am convinced that I am going to bite my giant, swollen lower lip. I am convinced that my face is distorted beyond recognition. I try to convey these thoughts to the dentist and my boyfriend, but they just laugh. They are mostly laughing at my speech - with my tongue and lip anaesthetised I am not particularly articulate. The dentist shows me a mirror so that I can see my completely normal-looking face.

Well ... normal apart from the blood around my mouth. And the blood in my teeth. And the blood that is coating my tongue. I mop it all up as best I can with tissues, and am sent on my way with scripts and recovery instructions.

My sister leaves work early to pick us up. She wants me to talk so that she can laugh at my numb blabbering, but at the same time keeps freaking out at the blood that keeps appearing on my teeth. In the end she overcomes her squeamishness, and her and my boyfriend make fun of me for several hours until the anaesthetic wears off and I can speak normally again.

Recovery has been surprisingly uneventful. I can eat normal food, I can talk normally and I'm not in any significant pain. Much, much better than I'd expected.