If Only I Can Split Myself into Two

Exactly....it is impossible....well, not entirely, it can be done, only that I have to lose my life.... *yikes (that's not ideal!)

I really do love my job. I really do...trust me. The only thing I struggle with is trying to be in 2 different places at the same time. I am sure many other doctors out there will agree with me. This situation is made worse when you're in an on-call shift, where you are IT. You are THE ONLY doctor on-call for the wards...in charge of looking after more than 100 patients during that shift.

I found myself caught in a dilemma over the weekend. The situation was:

• a patient was scoring a EWS of 12?!
• a patient complaining of chest pain
• a man who had more than 1 litre of ascitic fluid drained from him, and now hypotensive
• a patient with pyrexia
• a patient who has disseminated malignancy in severe pain (despite being on really high doses of opioids)

Now, I received these many calls within 10 minutes. HELP!

I told myself...prioritise....prioritise.....breathe....breathe....dun panic.

So off I went to see this patient with a EWS of 12. He was really really sick. After performing a few resuscitative measure, I quickly walked across to the opposite ward to check on the ECG for the patient with chest pain.

Great! Now he is in uncontrolled AF! A quick assessment was done followed by giving him a rate limiting medication.

Then, I rushed back to that sick patient....still very ill.... did a few more things for him....but he was too ill to be left alone. So I called the ward to ask about the hypotensive patient...who apparently looked "washed out" according to the nurses. I told the nurses to give him a fluid challenge to see if it would help.

The patient I was with was now scoring a 14. !!!!!!

I actually did contact my SPR for some advice...which he did provide...but clearly none of them was working. He needed HDU/ITU support. I called my SPR again...it took him such a long time to come review this ill patient (it wasn't like he was busy in the MAU!).

Anyhow, in between all these chaos, the poor cancer patient has been left in pain....I felt so guilty. I told the nurses to give him some IV morphine...but none of them could cannulate him... so I told them to give it s/c instead.

Finally the ill patient went to HDU. I was now able to leave him to carry on with my other tasks....

*sigh.... it was certainly a challenging day. I was so exhausted in the end. To add to that tiredness, was plenty of guilt. I felt that I was not doing a good job. The poor cancer patient was left in so much pain....in fact, he was in pain for nearly 9 hours, before I could sit down and calculate how much morphine he requires in a syringe pump.

Imagine if one of my family members were left in so much pain.....that would be horrible...I would not be happy to leave them in pain for so such a long time! Luckily the cancer patient and his wife were so understanding.

SIGH. Another sigh.

Glad I am not on call for the rest of this week.