A little give and take

BMJ 2005; 330 doi: (Published 19 May 2005) Cite this as: BMJ 2005;330:1193
  1. Luke Wheeler (ldwheeler2000{at}, senior house officer
  1. Medicine, University Hospital of Wales, Cardiff

    Mount Isa, a dusty mining town in the Australian outback, was not known for its pioneering medical practices, or so I thought. I worked there for six months in the hospital accident and emergency department with a team almost exclusively made up of ex-pat British doctors. The pace was gentle, and, although this was a working holiday for me, the emphasis was on the latter. The permanent staff were grudgingly resigned to the situation.

    Members of the mining workforce would occasionally attend for the treatment of chemical burns to the eye. The patient would first have local anaesthetic applied to the cornea, then a device resembling a contact lens attached to a fine tube would be gently inserted under the eyelids and continuous irrigation applied with saline from a litre bag. A patient with kit in situ was a slightly disturbing sight, but the device's simplicity and effectiveness were impressive.

    On moving to an accident and emergency department in the sprawling city of Brisbane, I was quick to call for the “contact lens irrigator” when faced with my first chemical burn to the eye. The nurse in charge simply gave me a bewildered look. She explained that eye irrigation was done by setting up a drip attached to a saline bag and standing over the supine patient while dripping the fluid into the eye. This was time consuming, ineffective, and not well tolerated, but was all that the staff knew.

    A few telephone calls and several days later, an irrigator device arrived from Mount Isa. It was an instant hit, freeing up valuable time and stopping the nurses' shoes getting soaked. As far as I know, it is still in use to this day.

    I sometimes feel that a junior doctor's existence is rather parasitic in nature—frequent moves from place to place (sometimes country to country) assimilating as much valuable experience as possible but giving little back to the local staff. On this occasion, however, I felt that I had passed on a little of what I had learnt on my travels as part payment for what I had received.


    We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

    View Abstract

    Log in

    Log in through your institution


    * For online subscription