Number 42

Number 42


There's something depressing about the quality of the sunlight in Glasgow; I'll admit that I'm a little out of practice with the camera, but the pervasive greyness is difficult to get round (without some extreme post-processing).

A Shift

So 4pm to midnight shifts are good for something - blogging!
I really feel like I need to take the camera out as haven't taken any photographs since...probably October 2008. (Mainly because a) Christmas 2008 was cancelled due to night shifts and b) it rains all the time in Glasgow) And it's sunny today! (It will probably start raining shortly now.)
Yesterday's patients were like a parade of Short Cases (patients in a Clinical Exam who have interesting or classic signs/ stories and that you have to see in 7 minutes).
Here's a selection:
- new diagnosis of Henoch Schonlein Purpura
- toddler with painless limp
- new diagnosis of diabetes mellitus (not in acidosis)
- teenager with headache and weakness in one limb
- teenager with headache and photophobia
- known asthmatic with moderate exacerbation of asthma
- known nephrotic syndrome with fever and heavy proteinuria
- known cerebral palsy with community acquired pneumonia
- infant with croup
- assorted snuffly and/or wheezy babies, including premature twins
Unfortunately, it takes a bit longer than 7 minutes to sort each one out in real life - things like examining the rest of the child (not just the body system in question), taking the full history, writing up drug charts, inserting lines and taking blood if needed, explaining things to anxious parents etc. means each patient takes about 30 to 60 minutes (divided between 2 to 3 doctors). They also have a knack of turning up 3 or 4 at a time, thus ensuring that anyone not critically ill has about an hour's wait during which to wind themselves up beforehand.
OK maybe that's just being cynical. It was a good shift.

Dramatic presentation

There is a lot of acting involved in medicine. I saw for the first time, in outpatients, a girl with precocious puberty. It's something I'd read about in books, but had never before encountered in real life. But I had to pretend I knew all about it (well, I did afterall know all about the theoretical aspects) and not let on that this was the first case I'd ever seen. The "it might be a brain tumour or it might be nothing" bit (obviously said in other words!) was particularly tricky to convey.

Last night was a particularly horrendous shift, not because of any of the patients, but because I developed a terrible headache on the way to work - it's a truly bizarre experience feeling car sick from your own driving. But there I was at work, and the day shift person was waiting to go, so I took a couple of ibuprofen and got on with it. They didn't do much for the pain, and did even less for the nausea. And then a teenager staggered in with diabetic ketoacidosis (DKA). He was pale, drawn and sunken-eyed, and retched continually as I spoke to him. When I leaned over to examine his abdomen (taking care to give the right iliac fossa a good prod), I felt like I might be sick myself. Luckily my brain clicked into DKA autopilot, and (with help from my SHO) we did the required blood tests, got lines in, and I even managed all the fluid calculations in between seeing a sick toddler who had arrrived at the same time. The hard part was again the acting - I imagine a doctor who looks like they've done it before (true, in this case) inspires confidence, but the danger lies in the temptation to "process" the patient by algorithm, thus failing to convey the seriousness of the situation.

My Weekend

Being a perfectionist by nature, I find it highly unsatisfactory when I am forced to do a job more shabbily than I would have liked. Last Thursday was my first proper day in the new job, so I wasn't too bothered that things didn't run as smoothly as they could have (had I had a computer password and known where various items such as tongue depressors and growth charts were stored). However, I was surprised to find that it was just me and one junior covering both the inpatients and the acute admissions, on a weekday. The junior (a house officer) was being used by the consultants as a one-man phlebotomy service for outpatients at the same time, with me having to step in for the 'difficult' veins. This meant that many routine jobs for the stable inpatients didn't get done until late in the afternoon, and waiting times for the admissions were dreadful.

How naive of me then, to imagine that the weekend would be any better (I reasoned that without the outpatients, I would have the house officer to myself). Saturday arrived, and as I started the ward round, I wondered aloud how the house officer could be so late. "There isn't one on weekends," said the nurse. The consultant wandered in to join me for a few patients, but then got bored and went home, because none of the patients was critically ill. "Call me if you're worried about anyone," she said. So that left just me, to finish the ward round, do all the jobs, take all the referrals and see all the admissions. Naturally things were going to be less than optimal. So I did my level best, and I am confident none of the patients came to any harm. But I did lose my rag at one point and snap at a mum who demanded to know why I hadn't come back with her daughter's blood result yet. Then I felt really guilty for being rude. I'm fed up with being human.

I'm also fed up with working weekends, that was the third one in the space of one month! And then this weekend when I am finally off, Mark is working. I hate my life.

Grump

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