What Have I Done Wrong?

The sarcasm continues today....in fact, it has been going on all week, and it has really killed me over, I think.

It was ward round day. My boss has not seen anyone all week because he has too many duties and chores to attend to. So this was his first time meeting all his beloved patients. We had alot of patients, and the ward round dragged on till 2 pm.

At the end of the ward round, I was physically tired, and more importanly, I was filled with shame, zero confidence and unhappiness.

Today, nothing I did was correct...somehow, he had something to pick on. Every patient we saw, I didn't seem to have done the right thing.

I told him that this particular patient (who was admitted via the renal unit) needed to be on IV antibiotics for 14 days as advised by the renal doctors. Ok, well this patient was admitted under his care, but the renal team has also been involved because they are quite particular about what antibiotics their patients get etc. Anyway, he asked me, "Why does this patient need such a long course of antibiotic?" I said, "Patient has a positive blood culture and the renal consultant wanted such a long course." Before I knew it, he said, "Oh come on, don't give me such crap"

I was like O K. Indirectly, he was implying that renal was being unreasonable and I was being stupid to listen to them.

The other situation was when one patient with progressive cancer and chronic leg oedema, developed acute renal failure. I told him that I had discontinued the patient's nephrotoxic meds, which included her diuretics, for a few days to allow her kidney function to improve. Now that it has stabilised I have restarted her diuretic at a lower dose. He told me later that, "You did the wrong thing. I don't give a shit about her kidney function. Her urea can be 50 and her creatinine can be 400. She's dying. You should have kept her comfortable by continuing the diuretic to allow her oedema to settle. Now, look at her legs, they are so swollen and puffy to the extent that they aretoo heavy to lift up." "Now, if it was your grandmother, would you like her legs to be so puffy?" I thought to myself, "well, of course not, but I do not want to accelerate her death by speeding up her kidney failure." I remained silent.

Sigh...We went on to another patient. This patient has newly diagnosed enlarged kidneys. I told him that I had spoken to the urologist and they were not going to decompress the kidneys and would not get involved in her care unless her kidney function deteriorates. Before I could even proceed, he went on to talk about the case and pointed out, "Why is the patient now on the list for a cystoscopy? That was not what you told me. You said they were not going to be involved."

I was thinking to myself that I haven't even finish my explanation earlier...and now you're telling me that I am contradicting myself? He didn't even let me complete my previous conversation.

Sigh...I totally gave up halfway during the ward round. I felt so vulnerable, and stupid. I started to wonder whether I'm made for this job...my confidence level went down to zero. I am still pretty upset about it all. I know I am learning, and I honestly do not mind being told I'm wrong. But somehow, I felt that this was unjustified. Oh, I know I should not be sour....it could be worse, I guess. I'll get over it after a cup of tea and a bottle of wine......