Thursday, 12 April 2007

Boredom and drama in unequal measure

Sorry for the lack of posting of late people, surgical shadowing is actually busier than I thought!

We start at 8am, do a surgical ward round [read: wave at the patient from the end of the bed and say 'ok today? good, see you later'], do the jobs from the ward round - which is mainly taking the bloods the phlebotomists won't do, which on a breast surgery ward is most of them because most of the patients have had mastectomies and so have oedematous arms and they leave all the bloods for us - then do the admissions for the day.

Because the patients are mostly coming for elective surgery, they are usually pretty well, so they end up looking at me blankly while I ask about lots of symptoms they don't have, then sometime interject 'but am I supposed to have these things, doctor?' I reassure them that no, they are not supposed to have them, and that saying no to all these symptoms is a good thing, then I examine them, find nothing, take some bloods, which are normal, fill in an ECG form (or in fact take the ECG myself) for an ECG which is usually normal, then fill in the Kardex and get someone else to sign it all. Not the most intellectually stimulating job, but it keeps me out of trouble.

There have been two moments of drama though - firstly, an elderly lady who started making funny breathing noises while we were doing the ward round in her bay (good timing!) - she was pretty unresponsive and in her chair, so while we were all rallying round trying to figure out what to do and how to get her onto the bed, when one of the auxillaries runs over and just scoops her off and dumps her on the bed - it was impressive! So no output, we are all getting a bit stressed, the arrest call goes out, we start poking about in the groin looking for a femoral pulse, grab the arrest trolley. We put the pads on her chest, start thinking about chest compressions, and just as we do, she opens her eyes and goes 'oh, hello, I felt a bit funny!'

Phew!

The clever doctors arrive at this point looking flustered, see the two regs, two JHOs, two 5th year med students and about six nurses, not to mention the now-talking patient, and we look sheepishly at them - sorry guys, false alarm. I end up staying with her sticking pins in all sorts of vessels, sometimes successfully and sometimes not - my JHO ended up getting blood out of the brachial artery, it was impressive.

Today on the ward round, she was sitting up eating her breakfast. As our colleagues Across The Pond would say: Go figure.

Second dramatic moment was this morning - we were one doc down so the only one with prescribing abilities was getting autograph-fatigue. He went off to shout at CT about a patient who was having to hang around in hospital for five days waiting for a scan, and while he was away, one of the patients got sick. Let me tell you a tiny, non-confidentiality-breaching something about this guy: he's come in for surgery, but he's really not very well, and we think he might die before he gets to theatre. Not the most cheerful of cases. Anyway, while OnlyDoc was away debating intensely with CT, this man desaturates to 69% on room air. Now, for non-medics among you, this is Not Good. If I were Dr Shroom, I would day that this is not something you want your sats to be.

Unfortunately for this chap, I am the nearest thing to a doctor on the ward at this time. One of the student nurses comes and asks to borrow me for a minute, and I take a look at the patient, and my most insightful first-uttered phrase is, yes, you've guessed it........'Hmmmm'.

I kid you not. Smooth, Joey.

Thankfully, the second thing was 'bleep OnlyDoc', so all was well. Once more, much sticking of pins ensued, again with occasional success. When I left today, he was still alive, so that's good I guess. Think there might be a resus status discussion tomorrow.

So there's a little insight into my life on this block. Ah, crap, I've just remembered I have to create some kind of learning plan to show my supervisor tomorrow, and I'm midway through a great episode of House. Grrrr. Let the creative writing begin.

2 comments:

Stuart said...

where there is cyanosis - there is life... just

Faith Walker said...

Blimy- your day sounds a lot like mine last week!

And yes, auxilliaries are EXCELLENT at moving patients. I speak from experience, as i am one and all...

Although, I shat my pants (almost) at my first crash call!