Back Into The Lion’s Den

Having spent 10 weeks in a busy medicine rotation, I am now on the dreaded ‘relief’ term – a term in which I could be in any department to relieve other resident medical officers who go on holiday.

What I absolutely dreaded was the idea of going back to surgery. The horrors of being in surgery a year ago were just too much. The idea of having to stay late, and to put in a tremendous amount of effort that largely went unnoticed was too much.

But having spent a week already in surgery, I’m actually starting to like it. The registrars are quite nice actually. The patient list is manageable at under 15 on most days (unlike the 30 patient list surgery constantly had last year). And the head of surgery from last year has left permanently (she tried to fail my mid term assessment for trivial reasons like having checked a patient’s bloods an hour late when they had a potassium of 5.0).

In addition, perhaps my skills really have improved. Last year, discharging 3 patients and managing the ward on my own was extremely challenging and stressful. I did all that a few days ago, with time left to help out at clinics, and then some more to attend a minor operations clinic.

I have just one more week of surgery, and there will be another person on the team, bringing the total count of residents to 5. Looks like next week won’t be too bad. After surgery – a few weeks of emergency medicine. I hope that goes smoothly as well.

All In A Day’s Work

For the past week, it has been extremely busy. I attribute this to the deck phone I’m holding, the patient load my team has, and just being unlucky.

Firstly, the deck phone; it’s a blocky black and grey phone, which vibrates, and plays a ring tone that makes me shudder in fear every time it rings. It’s constantly like a lottery, except it’s a lottery of bad luck. If I’m “lucky”, I might just get a call about giving a phone order for Paracetamol. If I’m “unlucky”, I might get asked to see a patient who has chest pains, or someone who is short of breath (as I was told to just this morning).

My deck phone is extremely efficient; at creating more work that is. For some reason, I’m always the one holding it, even though there is a registrar and another intern on the team. If the registrar borrows the phone to call someone, it will somehow always make its way back to me. Same with when the intern “borrows” the phone. It will be handed straight back to me. Perhaps the most amusing incident was this morning, when the registrar said to me “since you’re on phone duties, would you like to make the phone call for transport services to get this patient transported to the metropolitan hospital?” Since I’m on phone duty…. I never wanted to be on phone duty actually, but I’m always being handed the phone by you guys anyway.

On my first day on the team, I told the intern, “I’ll take the phone today, but let’s take turns holding the phones on alternate days.” Seems that somehow this conversation was forgotten. I suppose partly it is my fault in not enforcing this upon the intern.

Today was particularly bad however. As I got on the lift to see a patient downstairs, my phone rings. I need to put a cannula in a patient. The patient needs protective equipment used (gloves and gowns). Starting the procedure, and all gowned up, the phone rings. I am not allowed to answer the phone because I’m gowned up, and because I’ve already started the procedure. The phone rings once for about 20 seconds, and then hangs up. This is followed by another two times. I think that it must be urgent given how many times I was called. Is a patient dying? Finishing the procedure, I call back, only to find that I needed to write up some eye drops for a patient. 3 phone calls missed consecutively, just to write up some eye drops? My goodness, I am scared to find out how many times the phone would ring if I was unable to answer it, and it truly was for a patient that was sick/dying.

Aside from the deck phone, the patient load seems to be quite a bit lately. We’ve been getting a few patients with some being a little bit sick.

There was one patient that I had to see yesterday who was tachypneic. A very anxious elderly lady who was essentially palliative, having a left mid ureteric stone, urosepsis and end stage COPD. She was deemed too great an anaesthetic risk to have her kidney stone operated on. So, having tachypnea of 32, and then later finding out her phosphate levels were critical, and then later finding out her troponin was elevated presented a major nightmare. In addition, the consultant wanted CTPA (her kidneys were too shot to be safe for the contrast) and the patient had refused a V/Q scan. So not really knowing, I ended up just putting the patient on therapeutic clexane. But wait, the patient had haematuria a few days prior….

When I saw the patient yesterday with her daughter, I explained to her about her deterioration, and why I was giving her IV phosphate. She asked me if I could euthanize her yesterday. She still asked me if I could euthanize her again today. I had to politely explain to her that in Australia, euthanasia was illegal, and I certainly was not going to euthanize her. I ended up phoning my consultant for further management, and spoke to the ICU reg in regards to placing the patient on CPAP. I suppose the patient appreciated that I was doing what I could to help settle her SOB and tachypnea, and when my consultant came around, she told him “this doctor is really good, he’s been running around everywhere to help me”. That was perhaps one of the more uplifting moments for today for what was a relatively crappy day.

It was about 3:45 pm, and my back was aching from the busy day. Just one more patient to see. But upon seeing the final patient, they seem to have had it for me. The patient had been on isolation precautions, given that she could have had respiratory viruses. Having been visited by masked nurses, and told to stay in bed likely, I can understand the patient’s frustruation. I was just unlucky enough to come in and get blasted to smithereens by this patient’s frustration.

When it comes finally time for home time, I decide to check my email and find out the new updated roster. The person doing the rosters had decided to put me working on Sunday now, without contacting me at all. It’s almost like I’m indispensable, and not doing anything on Sunday. I email her, and tell her that I already had plans on Sunday, and to schedule me in on such short notice, the very least she could have done was call me first. Yea, I doubt I’ll have this coming Sunday off. Best crappy end to the day of a very busy day.

Now, onto the dreaded tomorrow; the intern will be off tomorrow, so it will be just me and the registrar…. I really need that Sunday off….

Second Sick Day Off, After Weekend Cover

I usually don’t take sick days off unless I really need them, but today seems to be one of those days that I have decided to call in sick. It is the second time I have called in sick in these last 1.5 years of work. I feel a little guilty however, since I’m not like actually dying, and could probably still go to work even though I would be extremely worn out and inefficient.

I suppose I was actually sick yesterday too, but decided to go into work anyway. Being a public holiday yesterday, and with two and a half pay, how could I not go into work? I wasn’t really that sick yesterday morning though, but late afternoon, I started sneezing and had terrible joint pains. Come the end of the day, and I was exhausted.

Being a public holiday, there were only 4 medical doctors on; the day consultant, an admitting registrar, the ward registrar, and the ward RMO (resident medical officer). My job was to see mostly well patients on the ward, while also getting called for ward jobs and reviews of patients that may need some attention on the ward by nurses. In total, I saw about 16 patients, did 4 cannulations, did two urgent discharge summaries, and attended to several other odd jobs like rewriting medication charts and the like.

I just churned through the list, and took my time to just have a chat with patients to identify any issues, and just a basic exam; all patients I saw got a chest, heart and abdominal examination. Mind you, many of these patients were actually well and didn’t have many issues, but needed some monitoring and review for things like bloods, hence that’s why even a lowly RMO could see these patients.

My shift started around 8 am, and ended at 8:30 pm, but I had pretty much seen all the patients by about 6pm, and then had to do other odd jobs that I had prioritized as last priority (which included rewrite of medical chart, and certifying a dead person). Certifying the dead person was actually quite spooky in a sense. The patient was in a body bag when I turned up, and had been dead for over 2 hours. On unzipping the body bag, and throwing the cover back, I came face to face with a ghastly pale and yellow face, with eyes closed. He felt cold to touch. On opening his eyes, I thought I could see the eye lens. HIs pupils were dilated, yet I could make out a slight shimmer, as if it was the lens of his eyes.

On finishing all jobs, I met the night RMO, and handed over just 3 easy jobs – essentially to chase bloods. I quickly headed off to one of my favourite restaurants (they close at 9pm), and got myself some Mexican food, and finished it at home. Switching the TV on, a movie was on; Freddy vs Jason. I watch for about half an hour, thinking to myself how ridiculous the movie was, with villains magically materializing from dreams. There’s nothing better to watch, so I just watch a bit more, and make my way to bed after a well deserved day (of working 12 hours).

Now I’m just looking forward to my upcoming pay check 🙂