tag:blogger.com,1999:blog-73410757651712396752024-03-13T10:25:27.335-07:00Must be mental...my time as a young doctorDochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7341075765171239675.post-49624459823123601832012-03-05T08:04:00.001-08:002012-03-05T08:04:44.867-08:00A 'royal' visit<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Motivation is something that you soon loose after your first
couple of 100 hour weeks. Don’t get me wrong, you don’t mean to loose this
motivation and it isn’t because of you not caring, it is simply because you are
too tired to even stand up. This doesn’t matter though, you have to keep going.
It doesn’t help with your motivation when you have a ‘difficult patient’. I’m
the first to admit that I can be moody when I’m not well and I am very happy to
allow for this when people are admitted. Hospitals aren’t nice places at the
best of times, if you then add in being scared or in pain then I think you have
a good enough reason to forget to say please and thank you. Every now and then
however, you come up against someone who you just can’t seem to get it right for.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It was on my thirteenth day working out of a fourteen day
stretch that this happened to me for the first time. Mrs Jackson was a 58 year
old lady with a history of asthma, eczema and coeliacs as well as a long list
of allergies ranging from penicillin to wool. She was morbidly obese and spent
most of her time either sitting in a hospital bed or sitting on a sofa at home.
She had spent more time in hospital over the past few years than the average
NHS employee and she felt she deserved special treatment due to this. It
started the moment she was wheeled onto the ward.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As the porter manoeuvred the bed into the bay Mrs Jackson
was to be placed in the problems started. She let out a shriek that made me
jump to attention, instantly assuming that someone had collapsed or maybe died.
I made my way to the source of the noise only to see a very red faced Mrs
Jackson bombarding the porter with abuse vaguely wrapped in a veil of polite
language. From what I could make out, she was refusing to go into the bay as it
was not the one she had stayed in last time. She was a superstitious person
apparently and she informed us all that if she was not placed in the same place
as last time then it might mean she was going to die. This bay was the worst
possible option as on her previous visit there had been a crash call to this
part of the ward and she took great delight in retelling the gruesome tale of
someone’s demise in her hushed, dramatic tones. </div>
<div class="MsoNormal">
“So you see, I absolutely cannot stay in a bed that someone
else may have died in! What kind of an effect will that have on my recovery?”</div>
<div class="MsoNormal">
I thought it was probably best not to tell Mrs Jackson that
most of these beds had probably had someone die in over the years so I let that
one slide.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All this time, her focus had been firmly on the porter and
one of the staff nurses who had been in the wrong place at the wrong time but
then she saw me – fresh meat for her complaints. </div>
<div class="MsoNormal">
“Doctor!” She called out as she her hand shot towards me as
if grasping for my intervention. “Please, doctor, don’t let them put me there.
I need to be in Bay C, that’s where I went last time and everything went so
well. I can’t go here, what if I caught what killed the last lady in that bed?”</div>
<div class="MsoNormal">
I desperately wanted to tell her she was being ridiculous
and she was much more likely to catch something from the lady with the hospital
acquired infection in Bay C than the disinfected bed that someone died in
several months ago, and in reality, the beds had probably all been moved around
since then anyway. Instead, I found myself reassuring the hyperventilating lady
in front of me that we didn’t mean to upset her but also explaining it wasn’t
up to me where patients were placed. In the end, Mrs Jackson agreed to sit in
the wheelchair in the day room while we discussed the problem amongst
ourselves.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The office was engulfed in a cloud of swear words as the
ward staff vented their feelings about Mrs Jackson’s readmission to our ward.
Apparently she had made a student nurse flee the ward in tears last time she
was here and had managed to fill one of the nurses’ night shift with a constant
stream of complaints. The sound of her bedside buzzer was enough to drive the
sanest member of staff running and screaming for the exit. A debate over where
Mrs Jackson should be placed was held with such intensity that you would think
we were trying to place a member of the royal family. In the end it was the
voice of reason, our ward sister, who decided she should go in the bed that was
originally intended for her. It would be wrong to ask someone else to move for
her as that would show preference of one patient over another and anyway, the
bay she wanted to go in was on the verge of being quarantined anyway due to an
outbreak of hospital acquired pneumonia. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The news did not go down well and Mrs Jackson had clearly
decided that we should all suffer. The window wouldn’t close properly and so it
was too cold. The sun was bright in through the windows and it was giving her a
headache. There were not enough blankets. The pillow was too hard. The
nebuliser being used by the patient next to her was too loud. The lady in the
bed opposite was confused and kept talking to her… the buzzer didn’t stop and
it wasn’t just the nurses having to deal with it while at the same time see to
the twenty other sick patients. No, I did not escape her sharp tongue either.
She had come in on a day when there was no senior ward round and so I was
making my way from one end of the ward to the other seeing the patients myself
to make sure everything was ticking over alright until the consultant came
around the next day. I made the mistake of starting in the bay that Mrs Jackson
had been placed in.</div>
<div class="MsoNormal">
“Young man, what time will your consultant be seeing me?”</div>
<div class="MsoNormal">
“There’s no consultant round today Mrs Jackson so you’ll be
seeing me. The consultant comes around tomorrow morning.”</div>
<div class="MsoNormal">
“Is this a joke? What kind of hospital allows a patient to
be admitted and then wait a whole day to be seen by a consultant?”</div>
<div class="MsoNormal">
I tried to explain that seeing as she had been admitted via
MAU, she had been reviewed by their consultant just a few hours ago so
technically speaking she had been seen by a senior that day and my ward round
was simply to check that any tests or investigations requested by that
consultant had been carried out. She wasn’t listening to anything I had to say.</div>
<div class="MsoNormal">
“Who do I speak to about the food?”</div>
<div class="MsoNormal">
“I’m sorry?” </div>
<div class="MsoNormal">
“The food! Or should I say the rubbish your chef serves and
calls food! I had supper here last night and I can tell you, it was far from
palatable!”</div>
<div class="MsoNormal">
“I’m sorry to hear that but unfortunately the food choice is
limited. If there is a specific allergy you could talk to one of the nurses…”</div>
<div class="MsoNormal">
“Allergies! You know about my allergies I take it because I
have a list written down in my bag if you need it.”</div>
<div class="MsoNormal">
“We have a list from MAU that…”</div>
<div class="MsoNormal">
“I do have a lot of food intolerances so I want to make sure
that you are aware of them all.”</div>
<div class="MsoNormal">
“I’ll make sure everyone is informed Mrs Jackson and then…”</div>
<div class="MsoNormal">
“Now about my X Ray. I was told they wanted me to have a
chest X Ray, I want to have it in the morning because I’m tired and need to get
some rest.”</div>
<div class="MsoNormal">
What are you supposed to say to a request like that? How
best to remain professional?</div>
<div class="MsoNormal">
“I’m sorry Mrs Jackson but as I’m sure you appreciate, the X
Ray department has to work around any potential emergencies coming in through
A&E, so while I can assure you that you’re scan won’t be done in the middle
of the night, I can’t book a specific time for it to be done.”</div>
<div class="MsoNormal">
Well done, I thought to myself, that could have been read
from a textbook.</div>
<div class="MsoNormal">
“Clearly you are not nearly high enough up on the ladder for
me to be talking to!” She barked back at me. “If you can’t do a simple job like
arrange me a civilised time for me to visit the X Ray department then you
clearly aren’t capable of doing your job. Fetch me the consultant!”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This was going to be a long day.</div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com12tag:blogger.com,1999:blog-7341075765171239675.post-57108417144693850832012-02-17T10:22:00.001-08:002012-02-17T10:22:11.095-08:00A Time to Die<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Nights were finally coming to an end and I had almost survived,
that was the important thing to remember. I hadn’t made any stupid mistakes (as
far as I knew) and no one had died because of me (as far as I knew). You see
that was the big thing about becoming a doctor, at some point in your career
someone was more than likely going to die because of you. They may have died
anyway but they might die a few hours sooner because you gave them too much IV
fluid or maybe you didn’t write them up for the medication they needed in time.
People die on hospital wards and that is just the way it goes but until you get
use to that, you always worry that they died because of you. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Part of a junior doctor’s role is to confirm death in
patients on the ward who have recently passed away. Not everyone expires in a
flurry of activity with crash alarms going off and people jumping up and down
on chests, this is in fact more of an unusual way to pop your clogs while in
hospital, some may argue anyway. Being resuscitated is an undignified, messy
and violent way to die and if it can be avoided at all, it should be. Why would
you want to have the ribs of your elderly granny fractured into pieces and
tubes rammed down her throat if it was unlikely to help her in the long run
anyway? Depending on which article or study you read, only 10-15% of crash
calls are successful. That is why when a lot of elderly patients, or maybe
those at the end of a long terminal illness, are admitted the have a piece of
paperwork signed by a senior doctor stating that they are “Not for Resus”. This
is a decision made between the medics and nurses as well as taking into account
the wishes of the patient and their family. We are not being ageist or
discriminating, I feel we are being kind by sparing them a terrible ending that
would probably have little effect on the outcome anyway. If I was at that stage
of life, I would happily sign the form.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It was on my final night shift that confusion struck me. It
was around 5.30am and it had been a
terrible night. The bleep had never stopped going off and every ward had been
hit by one admission after another of very poorly people. We were all exhausted
and were praying for the end of the shift. I had finally found a moment to sit
down and get something to eat for the first time since the shift began the
night before. I hid myself away in an empty office at the end of the deserted
admin corridor hoping that I could have half an hour undisturbed break where I
could recharge my batteries before the final burst of energy that would get me
to the finish line. I was halfway through my second chunky kitkat when my bleep
went off. Now I’m the first to admit that when tired, my brain does not
function correctly. What should be incredibly simple suddenly becomes a
terribly complicated task and no matter how hard I try, I just can’t seem to
get my head around it. This was the perfect example of one of those times for
both myself and the harassed nurse on the other end of the phone line.</div>
<div class="MsoNormal">
“Doctor, you’ve got to come immediately! Mrs Jennings has
stopped breathing!”</div>
<div class="MsoNormal">
“Why are you calling me? Put out a crash call!”</div>
<div class="MsoNormal">
“No, she’s not for resus.”</div>
<div class="MsoNormal">
“So she’s dead?”</div>
<div class="MsoNormal">
“No, she’s just stopped breathing and I can’t get a pulse.
You’ve got to come, we need help.”</div>
<div class="MsoNormal">
“But she’s dead?”</div>
<div class="MsoNormal">
“You need to do something, it’s urgent.”</div>
<div class="MsoNormal">
“I’m really sorry, I’m very tired and very confused but if
she has stopped breathing and she’s not for resus, then she is dead.”</div>
<div class="MsoNormal">
This was met with silence on the line and I could almost
feel the embarrassment seep down the phone to me. I knew from past experience
when I had done similar things that the poor nurse just wanted to hang up and
pretend the conversation had never happened. Many time as a medical student I
had dug myself into holes deep enough to bury a small horse in through my lack
of engaging my brain, either through exhaustion or stupidity. I had been sent
from theatre on numerous occasions with my head hung in shame and my cheeks
burning red. On this occasion however, the nurse couldn’t hang up as despite
the patient being dead, we still had a job to do.</div>
<div class="MsoNormal">
“Yes,” her voice broke the silence, “that’s right. She’s
dead. So it’s not urgent.” </div>
<div class="MsoNormal">
She sounded absolutely exhausted, probably just like I did,
and I’m sure she was waiting for some arsey retort over what had just happened.
I simply told her I would finish my coffee and head over shortly to confirm
death. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This was going to be the first time I had confirmed someone
as newly dead. I had seen dead bodies before, I had even cut one up in our
anatomy classes at Medical School
however they had been dead for some time and held little resemblance to a live
human being. The only other time I had seen a recently deceased person was when
I went to see my grandfather after he had passed away in hospital when I was a
small child. This was clearly different. I had never met Mrs Jennings while she
was alive, I knew nothing about her, I didn’t even know if she had family as I
walked on to the darkened ward. I made my way towards the nurses’ station which
was the sole source of light in the pitch black ward entrance. A health care
assistant sat behind the desk filling in paper work. She looked up and smiled
at me warmly. Her grey hair reflected the light and cast what looked to me in
my delirious state, like a halo around her head.</div>
<div class="MsoNormal">
“You’ve come to see Mrs Jennings.” She said more as a
statement than a question.</div>
<div class="MsoNormal">
“Yeah, just to confirm the death.”</div>
<div class="MsoNormal">
“Laura, the staff nurse, is on the phone to the family
asking them to come in.”</div>
<div class="MsoNormal">
“Oh, okay. Do I need to talk to them when they get here?” I
asked warily.</div>
<div class="MsoNormal">
“No, not unless you want to. We can deal with everything
tonight and if they have any questions we can point them in the direction of
our own team when they get in at nine.”</div>
<div class="MsoNormal">
“That’s great.” I said with a sigh of both relief and
appreciation.</div>
<div class="MsoNormal">
“Busy night?” She asked as she moved around to my side of
the desk.</div>
<div class="MsoNormal">
“Very.” I said humourlessly. “At least it’s my last one.
Feel like I could sleep for a week.”</div>
<div class="MsoNormal">
“You got much time to recover?”</div>
<div class="MsoNormal">
“Two days, then I’m back doing long days.”</div>
<div class="MsoNormal">
“You must love it here.” She said with a wink.</div>
<div class="MsoNormal">
“Must do.” I said as I rolled my eyes. “Either that or I
really have started to loose it!”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
She led me down the black corridor towards a side room that
had the bedside light switched on and pointing down towards the floor giving
the room a softer glow than the usual burning overhead strip lights. </div>
<div class="MsoNormal">
“She’s in there love. I’ll leave you to it, let me know if
you need anything.” She said as she turned and made her way back to the
paperwork.</div>
<div class="MsoNormal">
“Thanks.” I said, wishing that she would come in with me.</div>
<div class="MsoNormal">
I entered the room and was instantly struck by how peaceful
it all seemed. Mrs Jennings was laid out in the bed and the pillows and sheets
had been arranged neatly around her. All around her there was evidence of life,
Photos of relatives stood on the bedside table filled with smiling faces
looking down on the departed elderly lady. Next to these stood various ‘Get
Well Soon’ cards and a big bunch of flowers. Her book and glasses had been
placed neatly next to her wash bag, all lined up and in order. For some reason
it was the book the captured my attention. I just kept thinking that she would
never find out how the story ended. I moved closer to the bed and reached out
to feel for a pulse. The skin was still warm but there was no steady rhythm of
the pulse to be found. I reached over to check the other wrist – still nothing.
I looked up to the face which displayed no hint of emotion, no pain or distress
was evident. I gently moved the eyelids up and shone my pen torch into her
eyes. Fixed and dilated. Finally I placed my stethoscope against her chest and
listened for any evidence of breathing. This was the hardest part because the
body is far from silent in death. The gurgling of escaping gases and the
creaking of relaxing muscles filled my ears but no air swept into her lungs.
They had been switched off for the final time. This lady was dead. I should
have felt something as I stood over the lifeless body but all I could think was
how nice it was to be in a quiet room for a few moments in the middle of such a
hectic shift. I suppose that is what makes us good doctors, not getting over
involved. I was going to see many dead bodies over my career and I would see
many of my patients die and if I were to become emotionally involved with each
one of them, I wouldn’t last long in the job.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I made my way back down the darkened corridor to the light
at the end. Someone had already laid out the notes for me to make my entry;</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Asked to see patient to confirm death. Noted by N/S to be
non responsive at 05.15am.</div>
<div class="MsoNormal">
Pupils fixed and dilated.</div>
<div class="MsoNormal">
No breath sounds present and no pulse palpable.</div>
<div class="MsoNormal">
Patient confirmed as deceased.</div>
<div class="MsoNormal">
Rest in peace.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I signed my name it felt like I was ending this person’s
story. No one would write after this entry, the large volume of notes had come
to and end. I looked around to see if the nurses were around but everywhere was
quiet. I thought she was probable avoiding me after our awkward conversation on
the phone.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The final ward round of my weeks of nights was just as bad
as the shift had been. It was getting closer and closer to 11am and there was no sign of an ending just yet. We were
seeing a patient who had been admitted after a first seizure. Due to the busy
nature of the night shift, this lady’s bloods hadn’t been written in the notes
before the round so I had been sent to the computer to download them from the
results server. It may sound very high tech being able to ‘download’ results –
it wasn’t. The connection was terrible and the sever would reset at least five
times before you could even log on and then, if feeling temperamental, the
computer may decide that it didn’t like your password, even though it was
right, and send you back to the beginning again. It would have been quicker to
just phone the lab but we couldn’t do that. Since the results server was set up
the staff in the lab had been banned from giving the results out over the phone
and so we all had to curse and shout at computers for half the working day. It
was half way through this process I must have fallen asleep. One moment I was
waiting for my password to be accepted, the next I was being shaken awake by
the ward sister. I jumped out of fright at waking up so suddenly when I had
been unaware of being asleep and managed to slam my knee into the underside of
the desk with such a thump that I almost screamed. The ward sister was trying
her hardest not to laugh.</div>
<div class="MsoNormal">
“He’s waiting for the results and getting more pissed off
than usual so you better hurry.” She said with a chuckle. “I’ll tell him the
computer crashed but get a move on and then you might be able to get home!”</div>
<div class="MsoNormal">
I limped back to the round with the print out in hand. The
Med Reg had a look of confusion on her face as she noted my limp.</div>
<div class="MsoNormal">
“What did you do?” She whispered. “Was that crashing sound
you?”</div>
<div class="MsoNormal">
“Yeah,” I mumbled quietly, “I had a fight with a desk.”</div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com6tag:blogger.com,1999:blog-7341075765171239675.post-66434992883313304552012-02-11T04:05:00.001-08:002012-02-11T04:05:55.167-08:00Difficult Decisions<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Nightshifts are hell. There is no other way to describe the
way they completely wreck your internal body clock, deprive you of natural
light and take away all social contact from your life. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When I started this job we still did seven night shifts in a
row each lasting twelve hours, however in reality you were often there for
thirteen or even fourteen hours as you couldn’t leave until the Post Take Ward
Round was over. In my hospital, this round starts at 8am run by the consultant on call and reviews all the
patients that were admitted the night before, which on a weekend night could be
over fifteen people. The one good thing about leaving work a bit later was the sunlight.
If you do these shifts in the winter, it is completely possible to never see the
sun. It hasn’t risen by the time you get home and go to bed and it has set by the
time you wake up. Let me tell you, this is beyond depressing. Leaving at 11am at least meant that I could walk home with
the sun on my face, not that it was exactly strong in the north of England
in November time. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Despite my complaining, by night three you do start to slip
into a routine. You get home around 11.30am
and get straight into bed feeling too tired to even think of having something
to eat. The alarm then goes off at around 7.30pm.
I would force myself out of bed, shower and eat whatever was in my fridge that
didn’t require much preparation. At 8.30pm it was time to set off for work
again, on the way I’d stop at the corner shop and stock up on cheese and onion
crisps, chunky kitkats and Pepsi to keep me going through the shift and then
handover started at 9pm. There was no time for friends, fun or any type of life
during this week and seven days like this can really drag.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The best part of nights for me was getting to know the
nurses on the different wards I covered. They were always the first ones to
make the coffee when I looked about ready to drop, the ones with a funny story
when my mood lowered and the only other person to ever offer to answer my never
ending bleep for me when I had my hands full. It was this week of nights that
made me realise that the nurses weren’t to be feared like we were led to
believe at medical school. As long as you weren’t an arrogant idiot (which
unfortunately couldn’t be said of all my colleagues) and were able to take a
joke, the nurses could be one of your closest allies as a junior doctor. God
help those arrogant idiots however! I think they forgot who had access to their
bleep and if you were going to be rude, then that bleep wasn’t going to stop
all night. I always thought it was amazing how stupid these people could be,
they never seemed able to put the two things together. They would just assume
it was the same for all of us. I never corrected their assumption. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Nights always gave you access to the crazy side of the
patients as well. I don’t mean true psychiatric illness by this, I wouldn’t be
so simplistic as to label this ‘crazy’. No I mean the type of elderly patient
who by day is lying in bed with a smile on his face offering Toffees to the
staff, patients and visitors and then by night turn into a weapon wielding maniac.
On night four I was bleeped to go and help a ward deal with one of these
situations. A 79 year old man being treated for a chest infection had woken up
at 2am and become confused as he did not recognise where he was, this confusion
melted into fear which led him to feeling the need to defend himself. He had
jumped out of bed, grabbed the drip stand at the side of him and started to
swing it around like a sword, in the process he had pulled out the other end of
the drip that was attached to his hand and sprayed blood over the wall and floor.
As I arrived on the ward Mr Thompson was standing by the nurses’ station,
holding the drip stand in an attack position. There were two nurses on each
side of him trying to calm him down in a gentle voice and behind them they had
a security guard each. Security stood there looking suitably gruff and angry,
as you would expect from 6ft of security guard. Every time someone got too
close to Mr Thompson he would swing the stand towards the perceived threat
using all the energy left in his frail body. I have to say, I was impressed
with the energy and power behind the swing. I wasn’t surprised to learn later
that he had been in the army for much of his working life. </div>
<div class="MsoNormal">
“Mr Thompson?” I asked. “My name is Dr Randal and I’m the on
call doctor tonight, can we have a chat?”</div>
<div class="MsoNormal">
“Fuck off!” He barked back at me.</div>
<div class="MsoNormal">
“Do you want us to disarm him?” Mr Security Guard asked with
a glint of excitement in his eye.</div>
<div class="MsoNormal">
“No! He’s not a professional gunman! He’ll get hurt.” I
said, a little shocked at their gung-ho attitude.</div>
<div class="MsoNormal">
“Mr Thompson, have a look at my ID badge, I’m a doctor and you’re
in hospital.”</div>
<div class="MsoNormal">
“I can’t see that!” He said as I passed him my badge, just
ducking in time to avoid the stand as it rushed over my head. “I want to go
home!”</div>
<div class="MsoNormal">
“You’ve not been well sir, you need to get back into bed and
let us look after you.”</div>
<div class="MsoNormal">
“I want to call my wife.”</div>
<div class="MsoNormal">
“It’s 2am.” One of
the nurses pointed out calmly. “You don’t want to wake her up and worry her at
this time do you?”</div>
<div class="MsoNormal">
“Rubbish, you’re just saying that!”</div>
<div class="MsoNormal">
I edged around him, all the while fearful that I was going
to have to explain to my SHO that I was going to have to go down to A&E
after receiving a head injury from an elderly patient with a drip stand, and
switched on the TV at the side of the nurses’ desk, turning the channel over to
the all night news feed that had a clock at the side of the screen. Mr Thompson
watched me and came over to see what I was doing. He stared at the screen.</div>
<div class="MsoNormal">
“Terrible,” He said as he placed the drip stand on the
floor. “no fluids on a flight. I like to bring a drop of scotch with me to Spain
each year, but now…” </div>
<div class="MsoNormal">
It took me a moment to realise he was commenting on the
story being shown on the news. He turned to look at me and smiled; “Any chance
of a cup of tea?”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Difficult decisions have to be made on nights. Not long
after I had left Mr Thompson, my bleep went off. A ward at the far end of the
hospital had a middle-aged gentleman, admitted the previous day with chest pain,
who had just started vomiting large amounts of fresh blood. His pulse and blood
pressure had started to fall and he was still vomiting. At the same time, a
ward at the opposite end of the hospital informed me that a 28 year old woman,
admitted due to poorly controlled asthma, had started having an asthma attack
fifteen minutes ago and there was no sign of it easing. She was fighting to
breathe and her oxygen levels were falling. What should I do in that situation?
Once again, I found myself dealing with something that Medical
School had never taught me, how to
choose between two life threatening situations in two separate parts of the
hospital. Everyone will have an opinion on what to do but when this happens at 3am on your fourth night shift, you can’t always
think through every option and you just have to do what you think is right.
Both of these people needed a doctor with them, straight away, and I could only
go to one of them. The best way of getting a doctor there fast at this time of
night was to put out a crash call. I asked the nurse who I was speaking to at
the time to hang up and call for the crash team as I was already on my way to a
patient in need. What else could you do?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I ran down the corridor towards the vomiting patient my
bleep went off informing me of the crash on the ward that I had just spoken to,
so I knew they had done what I asked. I ignored it and kept running towards the
patient vomiting blood. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When I got there, I saw that the ward nurse hadn’t been exaggerating.
Fresh blood covered the sheets and pooled in vomit bowels scattered around the cubicle.
The patient looked as pale is ice and was fighting to catch his breath. Every
few seconds he would heave as if he was about to vomit again but nothing came
out. I slipped into auto pilot and did what my training told me to do. I got a
line in, took out blood at the same time, cross matched his blood to prepare
for a transfusion and set up fluid to keep his blood pressure and pulse up
while we waited for the blood. All the time I was praying that this wouldn’t
turn into an arrest situation as well as I knew the crash team were already
busy and it would leave me totally on my own here to deal with it if it did. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There is no clear line between who belongs to medicine and
who belongs to surgery. If you have ever worked in an emergency department you
will have seen the debate over who the patient belonged to on many occasions.
The surgeons insist it is not their problem and so refuse to admit the patient
to one of their beds, have you tried the medics? The medics insist it is not
their problem and so refuse to admit the patient to one of their beds, have you
tried the surgeons? In our hospital, vomiting blood most definitely counted as
a surgical problem. I bleeped their team and asked for immediate assistance and
I got no argument back, in fact they were more help than my own team. Maybe my
opinion on surgery was completely wrong! They were so helpful. I was starting
to think that all my views on the hospital teams were wrong. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
By the time the surgical team arrived on the ward we had stabilised
him. His vital signs were no longer falling and the lab was getting suitable
blood ready to replace what he had lost. (My urgent bloods had shown a massive
drop in haemoglobin since they had been checked earlier in the day.) The
surgical registrar even said “well done” to me, which took me by surprise. They
wheeled that patient off to theatre to find the cause of the sudden bleed and I
made my way back towards Medical Admission to explain what had happened to the
Med Reg. It felt good to have managed a situation like that, the patient was
stable and another team were now going to investigate. I had done all this
without having to get help or advice, maybe I was learning. As I entered MAU
and saw the anger on the face of the Med Reg, that all came crashing down.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Where the hell have you been?!”</div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com4tag:blogger.com,1999:blog-7341075765171239675.post-32409275151276854692012-02-04T08:58:00.001-08:002012-02-04T08:58:07.644-08:00The Night Shift Ghost<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Fear. Cold hearted, steel gripping fear. That’s what I felt
as I crossed the road towards work on my way to my first ever night shift. I
was now a month and a half into my first job and I was starting to get the hang
of it. I was basically a glorified secretary spending my time filling out
paperwork and making appointments. I was given an order by a senior doctor and
I carried out the task. Simple, it didn’t take a medical degree to do most of
what I had to do. The few times I got to give my brain a work out were my
weekly long day shifts. On these days, after 5pm
I would cover all the medical wards until 9pm
dealing with any urgent problems that came up and couldn’t wait. It was here
that I was given the chance to practice medicine, interpreting blood results
and examination findings, talking to patients and relatives and working with
the nursing staff to keep things running smoothly. For some reason, going home
at 9pm meant that those shifts didn’t
seem so bad. It was only four hours and even I could hold things together for
four hours. Nights were another story. It suddenly went from holding things together
for four hours to doing it for twelve hours while the rest of the city slept.
That was a daunting challenge. I knew what I felt like if ever I had to be
awake in the early hours of the morning and it wasn’t a pretty sight. I was
terrified that this would be when everyone would see me for the impostor I
really was. I wasn’t good enough to be a doctor, by some miracle I had
completed my course and got the degree but I couldn’t cope with twelve hours of
making life and death decisions, I was much better with the paper work.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I had already heard the horror stories from my friends of
the constant bleeps, numerous new admissions and lack of senior support that
made up a night shift and these stories just added to my anxieties. So, the
facts? I was to cover ten wards, all with approximately twenty five beds and
the Medical Admissions Unit of twenty beds. If any of the wards had any
problems, new admissions or emergencies, I would be the first point of contact
for them and on top of that, I was also a part of the dreaded crash team. How
hard could it be? How many things can go wrong in just twelve hours, and
shouldn’t everyone be asleep anyway? </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The day doctor looked on the verge of tears. He handed over
five new admissions waiting to be seen, two sets of bloods awaiting review and
an elderly man who hadn’t passed urine in the last two days, had a bladder the
size of a football and would require a catheter to drain this. He also warned
me of an outbreak of vomiting on one of the elderly wards and advised that if
at all possible, I should avoid that ward and try to put off any problems until
their own staff arrived at 9am. Just
the way you wanted to start a Friday night? No, not me, you have the wrong man,
I wanted to be down the pub, on my third pint with a pizza or maybe a kebab
waiting for me at the end of the night. With my heart sinking into my shoes, I
set off towards the nearest ward that needed my help. It was then that it
started - the bleeping. The constant, high pitched, incessant bleeping noise
that would invade my dreams and turn each sleep for the next week into a
nightmare. Anyone who has been a junior doctor will know just how painful the
constant sound is and what it can do to your sanity. Friday night had turned
the wards into chaos and suddenly, everyone needed me at once but I couldn’t go
anywhere or do anything because I was stuck at the desk in the doctors’ mess
attached to a phone, answering my never silent bleep. The list of jobs grew by
the second and all I could do was try and reassure the nurse at the other end
that I would be there as soon as possible and yes, that noise was my bleep
going off again so I better go. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My list now included;</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
1. A 33 year old man with chest pain wanting to self
discharge as we wouldn’t allow him out to the pub for an hour</div>
<div class="MsoNormal">
2. A 79 year old delirious woman who had tried to get into
the wrong bed, realised there was someone already in the bed and thrown herself
to the floor in fright and now couldn’t move her left leg</div>
<div class="MsoNormal">
3. A 55 year old man who had started vomiting on a ward
without the vomiting outbreak</div>
<div class="MsoNormal">
4. An IV drug user who appeared to be now withdrawing from
alcohol as well as heroin and needed detoxing</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The list went on and on and on…</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I don’t know how many of you have been to a hospital in the
middle of the night but my view is that a hospital at night is very different to
one during the day. The corridor lights were set to dim and the wards
themselves were cast in darkness with just a glow being emitted from the
nursing station. The thing that I hated the most at first was the silence. It
was unnatural, these rooms and halls should never be so quiet but as you race
to an emergency at 3am, all you hear
is your own heart beating. By the end of the first nightshift however I had
grown to love the silence and found it a welcome break as I walked from one job
to the next.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The old part of the hospital I worked in was rumoured to be
haunted and these storied hardly surprised me. I have already mentioned the
gothic architecture of the ward I’m based on, well the entire wing of the
hospital looks the same. The main entrance hall of the wing is dominated by a
sweeping stone staircase overlooked by a stern statue of the hospital’s founder.
Great arched windows flank each side of the stair case casting the corners of
the room in shadows and creating shapes out of nothingness. Many of the wards
have high ceiling which cause an echo as you walk down them at night that would
not be out of place on a sound effect CD for a horror film. I had been
rewriting several drug charts on one of these wards and as a thank you, one of
the nurses had made me a cup of coffee. I sat at the ward desk with the two
night nurses drinking my coffee, hoping it would give me the motivation to walk
to the far side of the hospital to see an old lady with recent onset diarrhoea.
The nurses decided that this was the perfect time to fill me, the ‘new recruit’,
in on the ghostly goings on that they had witnessed in their time on the wards
at night. They spoke about hearing a crying baby in a room a new mother took
her own life in, about feeling a hand on their shoulder whenever taking vital
signs from a patient who is about to die, even of a patient being admitted who
vanished into thin air once they got into bed! They told me the stories with
such conviction I was completely drawn in to them. How was I to know they were
having a laugh with me?!</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Later that night, as I was walking down one of these old
corridors, my mind started to go into over drive. The main lights were all
switched off leaving just the occasional side light to illuminate my path and
they left large parts of my route in complete darkness. The pipes above my head
had started to rattle and the vacuum tubes that were used to transport bloods
to the lab started to grown, normal noises in an old hospital but with my head
filled with ghosts and ghouls, I could feel my heart rate increasing and let me
tell you, as the clock reaches 4.30am and you’ve had only 10 minutes to
yourself since you started at 9pm the night before, there is no logic left in
your head! I felt myself walking quicker, pushed on by the tricks my exhausted
brain had started playing on me. It was at that point I started to hear
footsteps behind me. Now I realise looking back on this I was acting like I was
some kind of extra in a bad horror film but this was not what I was thinking at
the time. I decided to break out in a light jog, aiming for the far end of the
corridor which would open out into the nice new state of the art, modern wing
of the hospital. It was then that my bleep decided to go off. The noise was so
sudden and so piercing as it echoed through the darkness that I jumped about a
foot in the air, landed in a pile of clean bed linen sending it all crashing to
the floor and shouted out “Fuck!” This was met with a roar of laughter as the
source of the footsteps behind me ran over to check if I was alright. It was the
nurse who had fed my head with ghost storied earlier that night. She was on her
way back from the canteen with several rounds of toast and was not in fact a
serial killer preying on junior doctors lost in the darkness of the old
hospital. She found the sight of me sitting in a heap of bed sheets so funny
that she dropped her toast. After helping me to my feet she finally stopped laughing
and asked me if her horror stories had made me paranoid. She clearly decided
that my denial was a lie and promised to make it up to me the next night be
ordering a pizza and letting me share it. She told me it was a Saturday night
ritual for her if ever she was on nights and told me that I was always welcome
to join in. Feeling more embarrassed than I ever thought possible, I thanked
her, told her I loved the sound of pizza and then ran off to answer my bleep.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Doctor, I’m sorry to bother you but you have to come
straight away. That patient you saw who was withdrawing from alcohol, well he’s
picked up one of the nurses and he won’t put her down…”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I made my way over to the ward that had called me. The whole
way there all I could think was how stupid it was that medical school had never
prepared me for a patient refusing to put down a member of staff. What the hell
was I going to do about it? Surely it would have made more sense for the ward
to call security? When I got there I was confronted by the withdrawing patient
not only holding the poor Filipino nurse over his shoulder but also standing on
a rather insecure looking chair and occasionally letting out a small scream.
The healthcare assistant came over to me with a look of sheer panic on her
face. She informed me that the patient woke up screaming about spiders and when
the nurse went over to check on him, he had grabbed her and made his way to
higher ground. The nurse did not look happy. Fair enough, the patient hadn’t
taken a bath in weeks and the smell of the street living mixed in with stale
alcohol was enough to make me feel nauseous at a comfortable distance so I
could only imagine what it was like for her being so up close and personal with
him.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Hello sir, I’m the on call doctor tonight, I need to ask
you to come down off the chair and let go of our nurse.”</div>
<div class="MsoNormal">
“Can’t do that.”</div>
<div class="MsoNormal">
“Why can’t you do that?”</div>
<div class="MsoNormal">
“The spiders will get us, can’t you see them? They’re all
over the floor, they might be dangerous.”</div>
<div class="MsoNormal">
“I can’t see any spiders sir. I think you’re not feeling
very well because of not having a drink today. If you come down, we can get you
some medication to help with that.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It took ten minutes and a visit from security to talk him
down. He let go of the nurse and was given enough sedatives to drop a charging
rhino. I went over to ask the nurse if she was okay and offer my assistance in
anything that she needed but within minutes my bleep was going off again
summoning me to the far side of the hospital. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Doctor one of our ladies is having trouble going to the
toilet, she’s in quite a lot of pain.”</div>
<div class="MsoNormal">
“I’ll be there as soon as I can.”</div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com8tag:blogger.com,1999:blog-7341075765171239675.post-65825776388799397652012-01-30T09:19:00.000-08:002012-01-30T09:19:41.996-08:00I'm Switzerland!<!--[if gte mso 9]><xml>
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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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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. <br />
<br />
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.<br />Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com6tag:blogger.com,1999:blog-7341075765171239675.post-76984472522065881602012-01-26T05:18:00.001-08:002012-01-26T05:18:42.647-08:00Running like a mad man<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
When a crash bleep goes off on your first day you know there
is only one explanation. You’ve been cursed. That’s it, must be the only
option. A crash bleep goes off to inform the on call team that a patient
somewhere in the hospital has died or is about to die and it is the crash team’s
responsibility to get to that patient as soon as possible and attempt to bring
them back. Nothing too complicated then. For me, that happened shortly after
the ritual humiliation of my first ward round. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The consultant had spent two hours quizzing me on why
patients hadn’t had tests ordered and why medication hadn’t been started. He
seemed to be completely oblivious to the fact that it hadn’t been me that
admitted the patient and in fact I wasn’t the same person that had been on his
ward round the morning before and no, my name wasn’t Dr Sharma. He wore a sharp
pin striped suite, white shirt, bright red tie and matching pocket square. His
glasses were perched on the end of his beak like nose in a way I always thought
only teachers could perfect. Also along for the ride was The Medical Registrar,
or Med Reg as he was called by the team. He was the second in command and some
might say the most important doctor in the hospital. Our Med Reg looked thoroughly
fed up with this role. His bleep must have gone off at least once a minute during
the round and each time he came back looking more and more aggravated and when
he wasn’t on the phone he was correcting the various mistakes made by the
junior staff and apologising to patients for the major flaws in the Consultant’s
communication skills. The worst of these flaws came when the boss told a lady
who had taken an overdose after having a miscarriage that she should remember
to be ‘thankful for her health’ in situations like these. That will surely be
enough to stop her wanting to harm herself. Then there was the SHO, the doctor
directly above me, and the ward sister. It was the two of them that steered me
in the right direction as the morning went on and let me know what I needed to do
next to escape the wrath of the Consultant when he returned for the evening
round. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
After the morning round had finished I was sent to the X Ray
department with a handful of request cards. I had been given the instructions
by my SHO that I mustn’t just leave them in the request tray, I had to speak to
one of the staff there and stress the importance of these requests. The SHO had
fed me phrases like, ‘to get them home’ and ‘we’re out of beds’ and suggested I
try to use them as much as possible to try and encourage our X Ray colleagues
to give into my demands. It was as I walked through the department doors that a
screeching noise came from the brick like bleep attached to my belt followed by
a voice shouting ‘Cardiac Arrest, Ward 34’ again and again at me. For a split
second I felt like I was the one having a cardiac arrest and then the
adrenaline kicked in for the second time that day. I threw the request cards
down on the reception desk and raced back down the corridor in the direction I
hoped Ward 34 would be found. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Racing down a hospital corridor is not glamorous. Within 30
seconds I had hit myself in the face with the stethoscope around my neck at
least three times, one of them hard enough to leave a bright red mark on my
nose, my list of jobs had flung itself from my pocket in a bid to escape and my
bleep had crashed to the floor spilling its batteries in the process. I did not
look like a professional at all as I tried to scoop up my dropped possessions.
As I ran around a corner I collided full on with the SHO coming in the opposite
direction with a smack that echoed all the way back to the main entrance. Both
our bleeps went flying, our stethoscopes became tangled and his knee landed
firmly in my crotch.</div>
<div class="MsoNormal">
“Where are you going?” he barked at me, breathlessly.</div>
<div class="MsoNormal">
“Ward 34.” I whimpered back at him.</div>
<div class="MsoNormal">
“Shit, I thought it was this way.” He said pointing in the
direction I had just come from.</div>
<div class="MsoNormal">
“You’ll know better than me.”</div>
<div class="MsoNormal">
“Don’t bet on it, this is my first day in this hospital too!”</div>
<div class="MsoNormal">
It was at that moment a porter came into sight. He both ran
at him shouting “Ward 34?!”</div>
<div class="MsoNormal">
“Keep going that way,” he pointed in the direction I had
been running, “and it’s on your left.”</div>
<div class="MsoNormal">
I may not have a clue what to do when I get there but at
least I was running in the right direction. Result!</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We got there a few seconds later and I can say that there
was no comedy about that scene. It was horrendous and it does not need to be
spoken about here. After that day, crash calls became second nature but the
first one I ever attended, the first time it was my responsibility to bounce up
and down on a person’s heart will never leave me. He didn’t survive.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There was no time for a chat, no time for a coffee, no one
asked if everyone was okay. It was straight back to work. As I walked back on
to the Admissions Unit I picked up the notes belonging to the next patient
needing to be seen. I stepped through the curtain to be greeted by a smiling elderly
lady and a nurse who turned to me before announcing to the frail patient that “The
doctor is here now…” I turned to look over my shoulder to see if my SHO was
following me in and then realised she was talking about me. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It was on the evening round later that day that I remembered
the X Ray request cards dumped on the department reception desk.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Now, let us have a look at Mr Oaks’ Chest X Ray.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Shit. </div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com5tag:blogger.com,1999:blog-7341075765171239675.post-51320168567408512672012-01-25T10:07:00.001-08:002012-01-25T10:07:23.436-08:00The First Day<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
‘The week to stay out of hospital.’ ‘Death week.’ ‘Don’t get
sick today!’</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The newspapers just love to turn this day into a circus,
they do it every year. It might be because, as we reach the first Wednesday in
August, there isn’t normally much else going on to report about and so the slightest
chance for those reporters to whip up panic can’t be passed by. I mean, there
are only so many times you want to report on the lack of summer sun reaching
record levels if you don’t want to be held responsible for a mass suicide. It
was those kind of headlines I saw as I made my way past the shop by the front
entrance to the hospital on that first Wednesday in August. That was the day
that hospitals up and down the country were to be hit by something much more
dangerous than any government reform, more lethal than any super bug. What
could it be? I hear you scream as you clutch your chest, panic stricken. This
is the day every year that the leash is finally taken off and hundreds of newly
qualified doctors are unleashed onto the wards for the first time. Five years
at medical school did nothing to prepare us for that first day.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Luck was never on my side. That first day also just happened
to be the first time I was ‘on call’. This meant that there would be no nice
cushy induction for me with my new team, no coffee and a welcome chat with my
new consultant, no I was plunged into the chaos that is a Medical Admissions
Unit in a busy inner city hospital. This was not enough of a trauma however, as
well as being lost in an alien environment of this busy department, I would
also be stuck here for at least the next twelve hours. No leaving at 5pm for me, I was going to see the day through,
one way or the other! Maybe the papers were right, this is the day to stay out
of hospital.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I took the bleep off the exhausted looking night doctor,
I realised he was me one year from now. The handing over of the on call bleep
marked the end of his first year working and from the look in his eyes, it
could not have come quicker. The clothes were crumpled, the hair was dishevelled
and the bags under his eyes looked like you could take a nap in them. He put
his hand on my shoulder, like a fallen captain passing on the baton to his lieutenant,
he wished me luck without quite finding the energy to smile and turned around
and left before I could even say thanks. It was at that moment that I realised
how unprepared I really was for this. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Medical School
had been hard work. Don’t get me wrong, there had been a lot of fun but the
parts that stick in my mind, when I wake in a cold sweat at 4am, consist of hard work. Getting up at 4.30am to travel over two hours on various
buses to get to the hospital I had been sent to on time for the Midwife
handover just to be told they were too busy for me to join them that day.
Standing in theatre as an eye was being removed trying desperately to look
interested while at the same time fighting off waves of nausea and the sudden urge
my body had to collapse right there on the floor in front of everyone. The
exams; spot tests where you had to point out anatomical markings on a cadaver,
slide shows were vague images were flashed over computer screens for you to
comment on and diagnoses, or worst of all, the clinical exams, where you had to
show off as much of your knowledge as possible in front of an examiner with an actor
as a patient, all of these done while the clock was ticking. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I had survived all of that, could tell you the meaning of
ADME, which blood vessel supplies the Latissimus Dorsi and the name of the
cells to be found in the kidney, yet I still felt I hadn’t a clue how to be a
real doctor. Three weeks before the newbies start work we get to ‘shadow’ the
person doing the job we will be starting with. All these three weeks did
however was to work me up into even more of a panic. I was ready to learn the
best way of getting blood from an obese patient and how to react to a medical
emergency on my ward, what I wasn’t ready for was the politics of being a house
officer. If I wanted a CT scan I had to prey for a certain radiographer to be
on duty as she might say yes, if she wasn’t there I had to go down and offer to
sell my left testicle to get the scan done and I had to do it before the hordes
of other house officers from every ward in the hospital arrived to do the same.
If my consultant asked for a CTPA, Chest X Ray or even MRI, it was not my job
to ask why it was needed, no matter how unclear his reasoning was, it was however
my job to know why when filling in the request card as – ‘consultant said so’ apparently
isn’t a valid reason. Then there was phlebotomy, the blood takers, they would
do a round every day but would get there at 7am, two hours before I started
work, so I had to remember to get the blood cards in before I left the night
before otherwise three hours of my day would be spent bleeding the twenty
patients I had on the ward. These were simple compared to the incredibly complex
etiquette involved in communication with the nurses and ward clerk. Some
examples of this;</div>
<div class="MsoNormal">
<br /></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;">Nurses
are boss and junior doctors were to remember that. The consultant liked to
think he was boss, he was wrong. </li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;">Never
get cocky or rude with a nurse, they can easily ruin your life if spoken
to in the wrong tone. </li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;">Never
sit in the ward clerk’s chair, that is her chair, it is not and never will
be your chair. </li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;">Don’t
ask a nurse to make you a coffee but always offer to make them a coffee
and comment on how busy they look. </li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;">Always
remember please and thank you, never shout and never, ever play the doctor
card with them. </li>
</ol>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Yes, I had spent time on wards before, I had spoken to patients,
taken blood and put in cannula but before as soon as the going got tough, all I
had to say was – ‘I’ll just get the doctor for you.’ I couldn’t do that anymore
though, now I was the doctor. What if I make a mistake? What if I can’t get
blood out of the patient? What if I can’t think of the dose to prescribe? What
if someone dies? The thoughts started racing through my head at such a rate I
thought I was going to have a full on panic attack. The adrenaline started to
surge and my body got ready to respond – fight or flight? The age old question,
but right now it wasn’t a Woolly Mammoth attack I was braced for, it was much
worse, this was a post take ward round with a team of people who had no idea
how incompetent I really felt. Into the valley of death…</div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com6tag:blogger.com,1999:blog-7341075765171239675.post-2684819720331817842012-01-25T08:20:00.001-08:002012-01-25T08:20:26.795-08:00The doctor will see you now...<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
Welcome & thanks for stopping by. When I started work several
years ago as a junior doctor, I thought my life would change for ever, and I
was right – it did, just not in the way I thought it would. I always pictured
myself running down corridors with my white coat billowing in the wind just
like they did in Holby City.
In the picture I had in my head, patients would thank me and colleagues would support
me. I couldn’t have been more wrong. From that first day I stepped onto the
wards and to this day, the rollercoaster never really stopped. There is nothing
quite like the ice cold grip of fear the first time you hear the crash bleep
screech out at you at 4am, or being confronted by a sword wielding, intoxicated
drug dealer in A&E three hours after your shift ended, or the palpitations brought
on by the constant fear of getting something wrong and maybe, just maybe,
someone drying because of something you didn’t do – or worse, did do! I rotated
through the hospital departments seeing everything from birth to death before
settling for psychiatry as my career path. From there it went from the bizarre
to the ridiculous. On my way, I saw bullying worse than anything you might see
in a school yard and politics more complex than Westminster.
At times, I found myself in very dark places because of the things I saw and
the pain I went through. It took a lot to drag me out of this hole. I did
however drag myself out because of the fun, love and support I would find in
surprising places. I always joked that I could write a book about the things I’ve
seen and that led to this blog. No offence is intended and no names or places
are real but everything I write really did happen and it might have happened in
a hospital near you.</div>Dochttp://www.blogger.com/profile/10333221602531330717noreply@blogger.com1