Thursday, 27 October 2011

Sometimes, you do get credit...

Nightshift, somewhere early AM. Busy night shift, I might add.
Patient on emergencies starts grumbling about how long it's taking and about my ringing phone.

Me: I'm sorry it's taking so long; I'm the only medic in the hospital at the moment.
Patient: You mean there's no other doctor on Emergencies?
Me: Well, not for medical emergencies, no.
Patient: Oh, you poor thing!

Friday, 14 October 2011

Tips for Junior Doctors part 6: How to let someone die.

A few weeks ago, a lady came to my ward just to die. I've had that happen to me a couple of times, most of them go peacefully.

This lady was in her fourties, and died of breast cancer. Her parents were there. That was a first for me; usually young ones die too fast for the parents to watch them. She was on morphine, and not really conscious any more. The oncologist went in with me that morning during ward rounds, and talked to the family, and told me I'd be checking up on them. She did not leave me any other instructions.

I checked on them about three times that day, the last time being around 3:30PM, after which I was busy talking to patients and families and doing other doctor stuff. Pretty close to handover, I went to check up on them again. At 3:30 she seemed comfortable. At 5:15 or something, she was restless. Nurses have already upped the morphine. I phoned the oncologist, who told me to start midazolam. Nursing staff needed about two hours to get it.

She didn't actually make it. My shift ended at 6PM, but I was still rounding up at 7:15 when the nurse came to tell me she passed away. Normally I don't do any actual work after hours, but I felt I couldn't let the nurses call the on-call to pronounce her if I'd been involved in her dying all along. I went in, pronounced her and shared my condoleances.

Then, the family told me it was horrible to watch her go like that, all restless. They thought she were suffering. They were unhappy. They wanted her to go smoothly. I told them I would have liked to see things go in a different way too, but I wasn't sure how I could have acted differently. I did not know it would take 2h to get midazolam to a ward. I can only act on what I know, and I didn't know she was getting restless until it was too late. I didn't want to go in there all the time, I wanted to give them their time. I explained this to them.

These kind of situations make you really nervous as a doctor. These are the 'I am going to sue you' type of situations.

They accepted it. They said they were happy to be able to discuss it, and that maybe they should have called me. They were going to talk to the oncologist too.

I also mentioned this to the nurse who was working the morphine dose. Turns out it was her first abstination. Next time she'll fetch the doctor sooner.

But the thing is, none of this is part of medical school. Medical school teaches you to save lives, and, given that this is Holland, they teach you about euthanasia. Nobody teaches you how to act, how often to check, what to say when someone is on your ward with palliative sedation and slowly dying.

Tuesday, 4 October 2011

Grumpy Junior Doctors

Somebody searched, and found my blog using 'Grumpy Junior Doctors'. ,