Monday, 30 January 2012

I'm Switzerland!

 The ward I was based on was like a war zone. This was not because of how busy it was or due to the volume of workload, and let me tell you it certainly was busy, no it was because of the constant battle going on between the consultant and pretty much everyone else. I worked on a medical ward with twenty five beds and five side rooms as well as a massive MDT room where we could find refuge for five minutes from the chaos that seemed to be going on all around us. The ward was in the old part of the hospital and was in dire need of renovation. The decor was straight out of the 1970s but the architecture itself would have been more at home in a gothic cathedral. The large, stained glass windows cast an eerie glow throughout the ward which was divided up by large stone archways. Someone had decided to try and split the ward up a few years before, as the old Nightingale Wards fell out of fashion, and had done this by sticking some cheap plywood boards to these stone archways to try and create a thin wall to separate the male and female ends of the ward. This had not been a good idea. The wood was as thin as paper and so by now was covered in holes, the paint had peeled away in several areas leaving the woodchip exposed and able to give you a nasty splinter if you weren't careful and it had been known for a porter to send the whole 'wall' crashing to the floor if his aim was a bit off when trying to get a trolley through the door. As well as this attempt at a redesign, someone had also decided to fit 'modern' lights in place of whatever had been there previously. The main issue here was the fact that the ceiling was so high and the cable the light was attached to was so short. They clearly were not meant to be hung from such a height. If a light went, changing the bulb was no easy task. Scaffolding was required! This meant the ward had to be cast in near darkness before anyone would come and do anything about it. Julie, one of the nurses, told me that on several occasions she had be tasked with holding a torch over the junior doctor's shoulder as he put in a cannula.

As for the war going on around me, I tried to remain Switzerland in the middle of it all. Now might be a good time for me to you to the family.

Dr O’Henessey was the consultant. She was widely known throughout the hospital as the Ice Queen and not for her love of frozen margaritas. Not only did she have no emotion whatsoever apart from anger, she also looked as hard as ice. Her skin was as white as a sheet which was contrasted by the jet black hair she had flowing down over her shoulders to the waist. She was thin as a stick and her eyes could turn you to stone with one glance. She never raised her voice, instead when angry she would whisper so quietly that if there wasn’t absolute silence, you hadn’t a hope in hell of hearing her. The one blessing was the fact that she was rarely on the ward. In fact, the only time we did see her was for her ward rounds that happened twice a week and from my point of view, that was quite enough. Even on those days she would turn up hours late but still expect us all to be sitting in the MDT room waiting for her with fresh coffee brewed, medical notes at the ready and X rays on display. The notes had to be laid out in a very particular order otherwise she would refuse to start the meeting. We started with the most recent admission and would work our way through the others in reverse chronological order, unless one of her 'regular' patients came in, these were people she had seen for years in the Outpatient Department and for some reason, she had decided they required special treatment and so they were always placed at the top of the pile. It was months later that I found out that these patients had been seen by her privately as an outpatient, not as an NHS patient, and only came to us when admission was required. This explained why they would frequently ask me if they could book an X Ray at a more convenient time, or if they could make a special request of chef. When going through the notes during the meeting, if she found one set out of place, she would stop talking in mid sentence and stare at them until someone quickly removed them from her sight and filed the offending article in a more appropriate place.

The only way we knew she was on her way was thanks to her much abused secretary. Kate’s office was at the end of the corridor and the Ice Queen had to pass the office door on her way to the ward. Kate would then phone Carol, the ward clerk, with a warning giving us under a minute to stop whatever we were doing and get into place. It was like a military inspection. We got it right most of the time, when we didn’t the atmosphere would drop to minus twenty and the rest of the ward round would be like slamming our heads against a brick wall but slightly less pleasurable.

Once we had presented the patients to her, discussed any issues and come up with a plan of action, she would wiz around the ward at break neck speed showing her face to the patients under her care. It was my job to push the notes trolley and write, ‘word for word’ in the medical notes what was said on those rounds. This was an impossible task. On average she spent sixty seconds with a patient and then took under ten seconds to move on to the next. It was this amount of time I had to find the notes of the relevant patient, get to the correct place in said notes, write what I could remember of what was being said, put the notes back in the correct place and move on to the next. As this was all going on, I also had to try to remember the long list of jobs that were being barked out by the Ice Queen for each individual patient as I did not have enough time to write them down as well as write in the notes. Once the round was done, the team would gather and try to make sure I remembered everything that had been asked of me and I would compile a long 'To Do' list which would then by attached to my brand new clip board which never left my side. I would spend the rest of the day going through this list ticking things off with great satisfaction.

In a moment of kindness one day she told me to tell her if I was struggling to keep up and she would slow down. I took this opportunity to ask her if she would mind just giving me a moment to get myself sorted between patients. She smiled at me and said ‘of course’. I was shocked, had she actually realised the impossibility of my task? On the ward round that day she gave me fifteen seconds between patients, not ten.

Dr Neal was the SpR, the next in line in terms of seniority in the medical hierarchy. He was the complete opposite to the Ice Queen. He was kind, caring and always knew how to make you smile on a really bad day. He would offer support whenever needed and was keen to teach me skills that I had never had the opportunity to learn as a student. He seemed to take a real interest in people and would make the effort to get to know each member of the team and spend time with each new admission on the ward. Due to our absent leader, it was him making the hard decisions on the ward and it was him making sure that the day to day jobs got done by Simon, the SHO, and me. As a new doctor, there were many things I struggled with at the start but I never felt stupid going to him for advice. One month into the job he didn’t turn up to the ward round as expected. The ward sister came in to inform us that he had been signed off work due to sickness. Rumour spread that he was depressed and this spread across the department faster than any vomiting virus. I didn’t see him again for the rest of that year.

This left Simon, the SHO in the position as my main senior contact on the ward. Luckily he seemed to slip into the role without argument and soon tried to give me a good balance between responsibility and guidance. Between him and Katie, the ward sister, I soon found my feet and started to get into my daily routine without too many things going wrong. Katie was like the ward mother and was the only person strong enough to stand up to the Ice Queen when the demands she made got past a reasonable level.

It soon became crystal clear just how low down in the overall scheme of things a first year qualified doctor is. As a Foundation doctor, I was as far down on the food chain as you can get, in fact, the security dog was probably several levels above me. I had no problems with this, as I had said before, I felt very unprepared for my job as a doctor, so to be told on many occasions that we are there to do as we are told and to ensure the mundane ward jobs were done, was fine by me. The main role of a junior doctor appears to be paperwork. I spent a majority of my time filling out request cards, writing referral letters to other teams, or filling out discharge summaries, known as TTOs on the ward, not that I know what that stands for, even now. My other role was to be told off. I was constantly being bleeped by one person or another, telling me that the treatment my team's patient was receiving was not right for them for one reason or another. If it wasn't Microbiology telling me they were on the wrong antibiotic, why didn't I wait for the cultures to be reported (several day later), it was Pharmacy telling me that the dose of the patient's medication was wrong, why hadn't I spoke to the GP (which normally I had attempted to, but have you tried getting past their reception team?!). As well as being told off over the phone there was the ritual humiliation of being torn apart by the Radiology team every time I went down to request a scan. They would quiz me on the exact reasons the specific test had been chosen, which half the time I just didn't know. The Ice Queen was not someone you questioned after all, it was my job just to carry out the sometime bizarre and often illogical whims of the consultant. So by the end of my first month, I was getting quite good at apologising and I was a master of the paperwork. To be honest, it all became routine quite fast. There were few life or death emergencies, the only blood I saw was that I was taking in small bottles, and very few people were dropping dead on me. I started to relax and realise that maybe I was over reacting, I was able to do this medical thing. It was when my first set of night shifts could be glimpsed on the horizon that I started to think that just maybe, I had come to the conclusion a little too quickly.

5 comments:

  1. "As a Foundation doctor, I was as far down on the food chain as you can get, in fact, the security dog was probably several levels above me."

    ROFL oh you know just how to make me laugh. Whilst drinking Coke. I'm forwarding my bill for a ruined keyboard to you, thankyouverymuch.

    Also they were TTA's on my ward, and I was told that stood for To Take Away's (don't look at me).

    Chin up and know that you're not alone in the vale of tears!

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    Replies
    1. Sorry about the keyboard, maybe you could steal one of the MRSA detecting ones from work? Do you have those? They flash at you when they need cleaning... Hmmm I wonder if TTO is To Take Out, makes us sound like the local pizza place!

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    2. I think I remember reading that it *is* To Take Out, referring to the meds which are dispensed by the hospital pharmacy rather than as a prescription for the pt to pay for at their local.

      Delete
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    ReplyDelete