Wednesday, 17 August 2011

Tips for Junior Doctors part 5: DO wake your patients.

My patients and I survived the first night shift. I'm apparently not the type who is extremely sharp in the middle of the night. My sharpness returned with the sunrise... and my, what wonderful sunrise it is if it promises the end of a night shift.

Typically, there are two doctors on call (SHO/residents), a surgical one and a medical one. I'm the medical one. It's just me, and the entire hospital. Me, the wards, and emergencies.

And it was busy. I work in a relatively small hospital, in international standards. My phone kept ringing, a few sick patients on the wards who required attention, a random transfer in the middle of the night from another hospital ending up on the wrong ward because I didn't know the patient was expected and 'admit through emergencies' was misinterpreted, and an emergencies department which never got empty. Until 7:45AM when I sent my last patient home, and the patient arriving had blood all over him, which means it's surgical.

Surgical doc had phoned me at 11:30pm to ask if he could use one of the on-call rooms. He slept most of the night, and his ED patient arrived at a decent time. I didn't even have time to go to the medics room to eat something.

But then again I forgot that I have no appetite at night.

Because it was busy on Emergencies, I didn't have time to go and admit the misplaced patient before he fell asleep. I phoned the lung doc (patient got admitted to pulmonology) to let him know that patient is there... because really I had no idea how to go about this. Basically, the problem itself was something that required no immediate attention. Lung doc normally is a very nice man, but not when sleeping. I got burned down. Because I didn't wake a completely stable patient to take a history.

Actually the main thing that went wrong is that Ghost Doc saw said patient earlier in the evening, and sent the patient to a PCI centre who sent them back to us (because it turned out to be a suspected pulmonary embolism and not a heart attack). Ghost Doc wanted to finish off the case herself, and didn't hand it over to me. She fell asleep in one of the on call rooms, with the patient's chart. Ghost Doc's shift ended at 11PM, but she always haunts the halls of the hospital when she's not supposed to be there. I got phoned by the other hospital, who wanted the patient on a pulmonary ward, not a cardiac one. I didn't know the patient was already expected on the CCU, in the end the message was 'fine, send them in through Emergencies'. And they told the ambulance to go straight to the pulmonology ward. Had I know the patient already had a bed, we wouldn't have a problem at all, because I know that CCU nurses are capable of administering Fragmin, and are capable of detecting respiratory distress, and that the doc on the CCU is capable of organising a CT scan for the patient and transferring the patient to another ward after the friggin sheeth had been removed!

Monday, 15 August 2011

Medicine drugged my creativity

Or maybe just my inspiration.

See, I used to be a talented artsy kid. Part of this artsiness already went slumbering in my teens, I guess, maybe. But still, I've made some pretty nice things. But it wasn't all dead, I was known for my style in medical school.

I also used to be a talented writer. People liked reading what I wrote because I wrote it well, even if I only wrote about something rather uninteresting.

But nothing seems to work right any more. I don't even look as nice as I used to; in part because there's no point in looking pretty for dreary hospital work. I'm not happy about my writing, my painting for a friend failed and even the tray I'm pimping instead just doesn't have it ...

And I don't really know how to revive it. It's like I have forgotten how to create.

Something is missing from my life!

Monday, 8 August 2011

Adventure running

I went for a little explore-run yesterday. Recently moved to a new place, and the weather was good. I never went fast, and I walked bits in between, and I discovered bits of trial and lots of water and green... and I was having fun in the sun and then in bits of rain and then in the sun again (all in a matter of less than an hour!). At some point I found myself eye to eye with a couple of bovine ladies.

At some point I failed to notice a bump in the road, and the result is a very sore knee. Guess that makes for the end of running again, for now.

Saturday, 6 August 2011

Motivational Speech

I used to be a child psych intern. I switched to medicine, because, well, psychiatry is not the right career for me. That doesn't mean I wasted my time with psych. I've learned skills which I use on a day to day basis still; sometimes managing things my consultants don't (or I like to think so).

Example number one: a more-or-less elderly lady is a notorious care-avoider; leading to her losing her mobility and her vision in one eye. She probably has OCD and some cluster C personality traits, maybe even obsessive compulsive or avoidant personality disorder, says my own quick psych screening. Now she's here with a diagnosis of double cancer, and she's tending to start avoiding it again. The oncologist worries about it, and after the bad-news convo orders me to go over it again with the patient and the family. I managed to get her to acknowledge her cancer and the prognosis, and a few days later she was able to tell me she wanted to fight for what she had left of her life.

Example number two: a depressed 80-something year old lady who just returned from ICU where her life had been saved a few times BUT she still has her chronic abdominal pain (possibly psychogenic) and I have to tell her -wearing this:   that we have no answer for that, but the best for her is to enter revalidation and go home in the end. Her son wasn't impressed, they want her to go to an academic centre to find the cause of it all. The reason for my pretty yellow outfit is that she's got three super-opportunistic multi resistent bacteria on her, and if I get those on my ward the ward can be closed down. She started crying, she doesn't see the light, she sees no progress in it all and she's still in pain. So here I was, dressed as a duck, motivating an old lady and her son until they both started listing tiny progresses.