Doubting Myself

I just completed a set of night shifts. I was really frustrated last night...because of A nurse in this haematology/oncology ward. I am happy if she wanna tell me what to do...but to say that she's not happy with my instructions until i speak to the consultant? now....does she think i'm rubbish? or what?

There was a very sick young boy last night. I told her I was going to check his blood gases (ie, to check the oxygen level in his body). And this nurse said, "Oooh...no...you cant do blood gases. It's not appropriate in these patients...we do not do blood gases in this ward."

I was like what? How can you say that? How do you know its appropriate or not? It isn't very helpful to say such a thing especially when somebody is so ill. Blood gases are indicated if a patient is extremely short of breath, and is not able to maintain his own oxygen saturations such as this poor sick boy.

So then, I thought, right, maybe I'm not doing it right....I doubted myself...which was so silly of me. Anyhow, I contacted the consultant to inform him about this ill patient, just to inform that about what I have done so far and if he has anything else to add. He also advised me to check his blood gas....

Later, she refused to give this poor gentleman paracetamol until I speak to the consultant first?! Now....i think that's just taking the mickey. Apparently this man has been sneaking some paracetamol of his own, and has been told against doing so. But that story was a good 3 days old. If worried about an accidental overdose, his LFTs and coagulation screen would be off by now. But they aren't. His temperature has been sky high all day and night...clearly he hasn't taken any! She said she's not happy to give him paracetamol, unless the consultant gives the heads up. Luckily it was nearly 7 in the morning when this incident happened...and I didn't feel too guilty contacting the consultant. Imagine, making the phone call at 3 am???

We were all trying to work in the patient's best interest, but I didn't understand why it didn't feel that way.

Would You Like An Eye Opener?

It was 8.30 am in the morning. I was on-call overnight, and was just trying to get things ready for the morning ward round.

While looking up a patient's blood results, a heard a patient calling me.

"Doctor, doctor, can I go home?" said patient G.

I turned around to see who that was...and soon realised that patient G was admitted overnight with an impulsive overdose of his epilepsy medications. He was drowsy initially, but he had obviously improved.

"No, not yet. The consultant needs to review you first."

"Oh ok. Errm, can I get a bottle of vodka please?" asked Patient G.

"Errmm...no. This is a hospital. You can't get vodka in here. Would you like a cup of tea instead?" I replied.

"No doctor, you don't understand. I need my vodka. I normally drink some first thing in the morning," added patient G.

It was very unprofessional of me to chuckle to myself after he went back to his bed. But, I found him really amusing, because he was really honest about needing an alcoholic fix.

This is a classic patient we normally see in the hospital. He clearly has an issue with alcohol dependence....and he would score a point with the CAGE questionaire, for needing "an eye opener" to steady his nerves in the morning. With the help of a nurse, we managed to sit him down, and offered him chlordiazepoxide instead. Unfortunately, it didn't work very well...and he started to pace up and down the ward. We had to give hime some benzoes to calm him down before the consultant finally discharged him home.

Unexpected!

All of us at work were really shocked to learn that one of our patients, XX, collapsed and died the morning after XX's hospital discharge.

XX has been in the hospital for nearly one month. XX was diagnosed with multiple PEs. We had organised various investigations to find a cause for her multiple PEs, as she was very young. All investigations were negative. As XX was clinically better, we discharged her, with follow up arrangements.

Who would have expected XX to die the next day?

No one.

Maybe it was purely coincidental. Maybe XX was going to collapse the next day, and it could have happened in the hospital, where we could all jump on her chest and start resuscitation. But somehow, one could not help but wonder whether we have all missed something, or under-investigated her.

RIP.

Please Give Me a Chance to Speak!

Oh dear....this job is really emotionally challenging at times.

Today, I spent 1 hour on the telephone just trying to explain to an extremely dissatisfied, and misinformed daughter of a patient about her father's care.

I mean it is alright if she does not have a clue about medicine, or she has no idea about what tests we are doing to investigate the cause of her father's initial presentation.

But what I really could not understand was how could someone not even attempt to listen to what I have to say! I mean, come on, no matter how unhappy you are about any part of the care, just please, give me a chance to explain and provide you with more information.

She was extremely unpleasant to me over the phone, which, is fine, I mean, I can tolerate that. However, whenever I tried to say something to explain the situation, she just spoke over me.

She felt that catheterising her dad, who came in with acute urinary retention: "appalling."

The fact that we were not able to perform a 24 hour Holter because her dad was uncooperative (ie, kept pulling it off his body): She thought we were not doing anything.

She did not believe me when I told her that her dad was very confused and agitated. She said it was all because of the sedative meds we gave him. Ok, yes, we sedated him alittle because he was at danger of harming himself by trying to tug at different things.....But, the fact that the reason he was acting like that was due to underlying sepsis has been absolutely pushed away by her!

I dunno. I really felt like giving up at the end of the conversation. She was not listening to what I have to say, and I felt that there was not much point in even explaining things. I just wish, sometimes, people would just listen first, before jumping into any conclusions.

8 weeks into the job....and?

It has been just over 2 months since I've moved onto a new job. It is really strange, i know, but somehow, I miss the lack of staffing levels in my previous hospital, miss my old work colleagues, and miss all the banter.

I have been asked the same questions a few times over the past couple of weeks.

"So how do you find your new job?"

And my reply would be, "Its alrite."

Funnily enough, the person would say, "Why? You don't enjoy working here?"

hmm... I think using the pharse "not enjoying" is incorrect. In fact, I do like it here. I mean, I have a registrar who I can turn to, the consultants are so friendly, and almost everyone I have met so far has been extremely pleasant (apart from the odd few people).

I guess, most people think that working in this hospital is like a dream! Probably because it is a very big district hospital, with almost every specialty under the sun. But working in such a big space, means you dun get to know everyone well. I used to recall knowing all my fellow SHOs, which nurse is dating who, or what scandals there are amongst us doctors, but now, there is no such bonding. In fact, there is hardly anytime for that.

Everyone is just busy with their own jobs.

That aside, the job has been pretty hectic, and just like every other hospital, we are short of doctors!

?

I wonder whether I am asking too much out of life. Maybe I should try to be more understanding, or maybe I should just accept things as they are.

Come on, let's face the fact. You can't change the environment you are in, but you can certainly change the way you react to the surroundings. So if somehow hurts you, or if something bad takes over your life, you should really just take control of your emotions and act wisely. No point in throwing tantrums, or making yourself feel miserable about the whole issue.

Life is indeed a bumpy road. But somehow, you can only hope for that much to happen. The rest all depends on faith and fate.

I dunno. I am only ONE human out of the billions of us on this planet. But, I hope that somebody would appreciate me as I am, and not take me for granted, sometimes. I guess I can only wait and be patient; time will soon tell, but I hope that by then, I won't be tired of waiting.

Boiling Me Up!

I dun understand why some nurses can be so irrational!

Dun get me wrong, majority of nurses are fantastic. They know what they are doing, they care for their patients and understand the politics in hospital.

Yesterday, I was bleeped by a nurse from a ward at about 4.30 pm. She asked me to admit a patient, who was just transferred from A&E. I told her that I was in the middle of a meeting, and I would be unlikely to make it there by 5pm to clerk the patient. She repeated herself to me. Again, stating that there is a new patient that needed to be clerked in. So, I told her again, I understood what she was telling me. but I am unlikely to be able to make it there by 5pm. And told her that, it is probably best to get the on-call team to clerk the patient.

She put down the phone.

I finished my meeting at about 5.10 pm. Suddenly, I was fast-paged by the same ward again. Fast-paging is only used if there is a clinical emergency. So I answered the call. It was the same nurse again, and this time she said, " I'm calling about the same patient. She is now vomiting, and you still havent clerked her in."

I replied, "Is she unstable? Is she vomiting profusely for the past 20 minutes? Are her vital signs unstable?" She said,"I just wanted someone to write her up for an anti-emetic." I was like it is now past 5 pm, and I still have hundred things to sort out, why didn't she think of asking the on-call team to sort the patient out? and the fact that she has misused the fast-page just boiled me!

Anyhow, I told her nicely that it was probably best to get the on-call team to get her to prescribe the medication, and even gave her the page number. She was annoyed, and wanted my name, to file a complaint against me.

Now, I personally do not think I was doing anything wrong. The patient was not critically ill. The patient just needed some symptomatic relief. I do not see why she could not get the on-call team to sort it out. Moreoever, we all have to try our best to adhere to the EWT directive. I felt rather pissed off actually. It wasn't like I was sitting down drinking cups of tea, and ignoring my work! sheesh.