Day 1:
06:00 Once again I've foolishly made my body clock go nocturnal and my forced early bedtime has led not only to some pretty trippy dreams but the disjointed sleep means I'm not feeling particularly awake AT. ALL.
08:00 It's ward round time. I haven't a CLUE who any of the patients are, what with the having been on holiday and everything, but somehow I get the job of looking after the medical students as we go around.
08:05 I'm relying heavily on the handover sheet to inform me of what the hell is going on. Though I attempt to hide this fact from the student I fear she can see through me like a sheet of glass.
"So this is Mr Smith, as you can see from the piece of paper" I seem to say "and, as you can see from this piece of paper he is suffering from something called "Tonsillitis", I'm unsure as to exactly what that is but if you look at this piece of paper it tells you he's on antibiotics. Any questions? If so, just look at the paper"
08:30 I'm growing suspicious that, given it's clearly superior knowledge, the medical student recons the piece of paper to be a dreamboat and is on the verge of asking it out on a date.
"Stupid f*cking know-it-all paper, thinks it's so f*cking special" I mutter under my breath.
09:00 Ward round is over and it's breakfast time with Sri. It's shaping up to be another relaxing day on ENT and what's better still is that most of the department are actually around to help me if all hell breaks loose. Nothing can possible go wrong (FORESHADOWING FORESHADOWING)
11:00 "So do you think my kid's ear infection might pass onto my baby, I'm pregnant you see?", questions my ward attender. The mere mention of the word "pregnant", which is horrifying enough to any man, causes me to have flashbacks to my Obs & Gynae rotation.
"No please, I don't want to look inside any more vaginas. They're all gooey and they smell funny" I plead, as memories of getting my shoes soaked in amniotic fluid an being told off for being too nice to patients invade my consciousness. Just as I'm about to curl into a ball and start shaking, Kat relieves me of the horror by ringing the O&G registrar herself and establishing that no, the baby will be fine.
12:30 The lack of a proper night's sleep is really getting to me, I've been working on the same discharge summary for about an hour and haven't got past "Mr A. Patient was admitted to the hospital on 21/8/11 with episodes of...". It doesn't help of course, that I don't know Mr Patient at all and his discharge summary probably aught to be written by someone who's actually seen him. Unfortunately for him and for me, both such people are on holiday. I ponder just making something up that sounds good.
"...with episodes of Eastenders written out in hebrew and tattood on his chest. We uncovered that his mother was actually also his brother and that his sister is in love with his best friend who got her pregnant on his stag do last month. He underwent a bilateral salpingoophrectomy which went without incident and he was discharged from the ITU 8 days later having suffered only minimal brain damage. Could the GP please make sure that he gets his anti-thrombolytic medication regularly as he is at risk of thrombotic thrombocytopaenic purpura."
13:00 My students arrive, as organised, but just as they do I'm told I have to go and see another patient in the treatment room. She has a quinsy, which ordinarily would excite me (please see previous blog) (no seriously PLEASE see it) however the medical students have better things to do with their lives than watch me clerk a patient.
13:45 "Do you mind if one of the students does the cannula, she's very good" I say, with absolutely no knowledge of whether or not the med student has even seen a cannula in her whole life.
"Sure" says the patient, doubtless relieved by the fact that, as I've already stuffed a camera down her nose and then attacked the back of her throat with a GIANT NEEDLE, things can't possible get any worse.
14:30 "I'm sorry, obviously you have terrible veins" I soothe "as otherwise the student wouldn't have failed on 6 attempts. But don't worry I'll do the next one"
In order to look flash I decide to use a HUGE cannula. As I remove it from it's packaging one of the medical students gasps in amazement. The other faints at the very sight of it.
"Don't worry, kids, I'm using local so it won't hurt"
And it wouldn't have hurt, if of course the cannula hadn't gone straight out of the other side of the vein and into her radial nerve.
"OWWWWW" she cries
"I'm sorry, you must have very... neurological... veins"
15:00 Eventually I give up with cannulas (possibly forever) as the F2, having walked in on the horrible blood fest, slides one in first time.
16:00 I've at last finished giving the students some real teaching that might help them pass the exams. I worry that all their faith in me is lost after the abysmal cannulation but frankly I don't (pretend not to) care (as I cry inside).
16:59:59 The routine bloods on one of our nosebleed patients who is totally fit and well are back at last, this is relieving as it's important that I leave before 5 because Sam needs the car tonight for a show.
Potassium: 6.9 (Normal Range: 3.5-5.3)
SAMPLE NOTE: POTASSIUM EXTREMELY ELEVATED, LIKELY TO CAUSE SERIOUS CARDIAC ARRYTHMIA. YOU = THE F*CKED.
I look up the guidelines, knowing that this guy is in renal failure and hope to see something like. "In renal impairment, 1st line treatment is to head home and let your housemate use the care". Instead I see
"In renal impairment you MUST contact the Renal department before doing ANYTHING". This may not sound like a huge biggy but that particular specialty at our hospital are the most horrifyingly scary people in the world whose sole purpose in life is to make junior doctors cry (with a secondary objective or sorting people's kidneys out). Usually it is possible to survive such an encounter providing that you have both a firm grasp of the management of renal disease (which I MIGHT have) and an in-depth knowledge of the patient's history (which I certainly DO NOT have).
Given that the entire team including the omniscient piece of paper (probably shagging the student in a cupboard somewhere), seem to have mysteriously disappeared I decide it is most likely time to panic and after running around the room Zoidberg style for a few minutes I ring Kat, tell her to get shiny metal ass up here and then run off to find the ECG Machine.
17:20 I return from taking what can only be described as the most beautiful ECG ever taken (I'm not even kidding it was amazing) to find that everyone is back in the office so I hand everything over to them and head home. This doesn't feel particularly right to me as my patient could well be about to die horribly but there is little I can do, my housemate DOES need my car after all.
Day 2:
07:55 Kat is growing ever weary as the level of innuendo in the room reaches critical mass. I'm also feeling bad as I totally forgot to hand over one of my patients to her, what with all the potassium flying around the place yesterday, so she only discovered them by accident when a nurse asked a question.
08:10 Turns out I also failed to order a CRP on the patient.
08:15 Turns out I also forgot to check with pharmacy about something my consultant wanted yesterday. Presumably some diamonds he was smuggling in from Liberia. Sri looks at me disappointedly and I want to cry, unfortunately I am a man and so only cry MOST OF THE TIME.
08:45 I spend a good 10 minutes banging my head on a table "Why. Do. You. Suck. So. Much. Geoff."
09:00 I haven't seen the aforementioned consultant in quite a while so I ask Matt and Kat (who sat on rat, having a chat) whether it's OK to go to clinic. They respond with looks of "Fuck youuuu Geoff." but I go anyway because I need the change of scene.
11:00 The consultant has me doing my own clinic, which is great because it gives me something to do and also is an excellent learning experience but I can't help but feel bad for the GPs with 30+ years experience who are sending patients in for an expert opinion who then get seen by an F1 who has been doing ENT for about 5 minutes.
(WORRY NOT DAILY MAIL READERS, THE CONSULTANT WAS CHECKING UP THE WHOLE TIME TO MAKE SURE THAT I WASN'T KILLING THEM).
12:30 It's time to dictate my letters (thats right, people in the NHS don't have to type their own stuff that would be far too much like hard work). I am horribly incompetent at this. The ideal style would be as follows:
"Dear Doctor, thank you for referring misses P. Rhinitis who has been suffering with a runny nose for 6 months. On examination her inferior turbinate was engorged, however application of topical Co-phenylcaine reduced the side and a nasal examination reviewed no other abnormalities. This would be in keeping with a diagnosis of seasonal rhinitis and so I would be grateful if you could prescribe Avamyst Nasal Spray 27.5micrograms once daily. We will review her in 3 months after we receive results of the allergen testing we performed today. Yours sincerely Geoff Burnhill F1 Doctor to Mr Archer"
Instead I stumble through my sentences like Rainman
"Morning Mate, could yo-""Dear Doctor. Thanks very much for having this patie-"
"Dear Doctor. We reviewed the patien"
"Dear Doctor. Thank you referring misses P. Rhinitis who has been suffering with Rhinitis. Her Rhinitis was relieved by Rhinitis relieving medication and so would be consistant with a diagnosis of Rhinitis."
"Dear Rhinitis. Your doct"
and so on.
13:00 Central Teaching. There is little to say about this. Except I learned EXCITING things about Paracetamol that you wouldn't BELIEVE. Not much of any interest happens during the rest of the afternoon.
Day 3:
10:00 We're still in the mess drinking coffee after our super-quick ward round. It is particularly nice because the registrar paid for all of our drinks and is now giving us tips on how to do well in medicine.
10:30 Horrified, I realise that a work experience student was supposed to be shadowing me this morning and must have been waiting on the ward for hours!
10:31 Breathless, I arrive on the ward and ask where my student is. He's not there. He's never been there.
Bloody scrote, wasting my precious time and my precious ATP.
11:00 The reg and I decide that if the student ever arrives we're going to go all hard line on him.
"Where have YOU been? I've been here since 7AM saving children's LIVES. What's your excuse?!"
"I'm afraid this is going to have to go in your permanent record, and will probably affect your application to med school".
However a) we realise that we're not massive dickheads at Addenbrooke's and b) he never turns up so we don't get to have the fun.
16:00 After a VERY quiet afternoon the nurse comes in to tell us one of our patients, Mr Skinface has a heart rate of 160bpm (which is a lot).
Now, usually doing medicine is absolutely nothing like the medical programs you see on TV (particularly shit UK ones like Holby, Casualty and Junior Doctors: Your Lives In Their Hands) but this patient is making everything different as you will see.
This particular guy had come out of an operation at the weekend and been very agitated since. He's also suffering from a change in mental state, loss of short term memory, hallucinations and delusions and is generally worrying everyone.
16:05 Someone decides he might have an infection in his heart (despite there being no evidence at all for this) and we are required to organise a billion impossible to organise tests. While this is going on the lad runs out of his room in an attempt to escape because he thinks that we're trying to kill him.
16:10 We have to put the ward on lock down to stop him from getting away and the medical registrar suggests that we get an LP.
This is all becoming worryingly similar to an episode of ER where there was a young agitated patient, they couldn't work out what was wrong and they ordered an LP. At which point Carter forces Lucy Knight to do it and the patient, who is schizophrenic in this case, thinks that she's trying to steal his thoughts or something so STABS HER WITH A BUTCHER'S KNIFE WHEN SHES ALONE WITH HIM.
Carter later gets stabbed as well.
As such I am less than keen to perform the procedure, suggesting the med student goes in so that at least they can get stabbed first. Furthermore none of us know how to actually DO a lumbar puncture so the reg has to do it instead. HA, no death for me.
16:40 There are literally 10 ENT doctors in the room. It would be appropriate for at least one of them to grow some stubble and grab a cane as various diagnoses get bandied around.
"I think it's Waterhouse-Friedrichson syndrome" I suggest
"No you IDIOT", says the consultant, "his cortisol is normal"
"No no it must be EBV Encephalitis", someone else suggests
"D'uh he has normal lymphocytes"
"Well then how about post ICU psychosis?"
"Doesn't fit the time frame"
"What about Sheehan syndrome?"
"Not a women, not been pregnant, still has normal cortisol and we don't. have. any. LASERs.".
The consultant sends two guys off to break into the patient's house (perhaps to discover some kind of insect living in the walls, which has inoculated the guy with a fat-soluble toxin that only became dangerous as he burned off calories with his recent illness, as suggested by Matt) while he heads to oncology to chat over something irrelevant with his best friend in the hope that the diagnosis will magically crystallise when he does.
19:30 Piotr Wizneiwsky shouts at us all alot and moans about what a terrible day he's had. Given that he does around 3 hours work a week it's unlikely that he's EVER had a worse day than anyone in the West Bridgford Operatics Society but we put up with his misery anyway. For some reason
Day 4:
08:00 Turns out that Brodie and the Med Reg did an LP on the very ill guy last night so with any luck it'll be him that gets stabbed horribly.
08:20 Two doctors are called by a consultant to go and carry some crisps and drinks for him. In a filing cabinet somewhere their medical degree certificates cry a single tear.
09:00 I'm called down to theatre STAT (he actually used that word) to help my consultant out in theatre. I'm also instructed to bring him coffee. From costa. I hand Matt my bleep and he reminds me of the similarity in the current situation to that in our (fucking waste of time shitty) MTAS papers.
"You are an F1 on a busy ward. A colleague hands you his bleep and asks you to cover while he goes to theatre. This is the 2nd time this week that he has done this. What do you do?"
I remind him that whatever he does he'll probably still only get 1/10 for the question as he's actually a very clever and talented doctor and that seems to be exactly the kind of person the MTAS allocation system hates.
09:05 There are no unlabelled theatre clogs in the changing rooms. This is an ongoing issue with theatre and one of the ever growing reasons why I hate it. Essentially everyone has to change into plastic shoes when they go to theatre, lest we muddy the floors, however there are only around 3 spare pairs and the rest all have people's initials on them. It is unfortunately impossible to know whether that person is working on that day, or that week or if they even work in the hospital anymore but taking monographed clogs runs a heavy risk of being bollocked by the owner. What's most irritating is that these people all have lockers (unlike us) but seem to avoid putting their clogs in them, perhaps as some kind of test. When you do find unmarked clogs, there is usually only one of them so I invariably end up tottering into theatre like some kind of streetwalker wearing one clog too small and one too big.
On this occasion, as it's an emergency, I just ram on some poor suckers clogs and go through to the theatres.
09:10 "Well I don't really understand" says the scrub nurse "because we're not even sending for the patient until 10:45"
Assuming the scrub nurse is mistaken I wait around, and wait around and wait around.
09:30 I am starting to get really very pissed off now.
09:45 My consultant arrives.
"I'm afraid your coffee is probably cold", I say, barely able to consume my irritation
"Oh hoi there, bru, I didn't see you. Ahr you helping me today?"
"Yes but I have to go by 11 as I'm doing teaching"
"Oh dear well the surgery doesn't stahrt until 11, bru, so you'd best go back to ward eh?"
FUCK.
11:00 Medical Student teaching.
I'm really very impressed with these particular students. Not only do they have super cool names but they clearly have their heads on straight. Fortunately there is much that they do not know about Renal examinations so I can still show off a little.
Though the memories of Monday's cannulation fail, I fear, are yet to fade.
"No you have to expose the patient nipples to knees" I remind the male student as he examines his female colleague.
"You could at least buy me dinner first" she DOESN'T reply, because people aren't that funny in real life.
15:00 Skinface is continuing to be a big problem. I feel terrible for his parents who have been with him round the clock but are unfortunately a large part of his persecutory delusions. As a result they are forever being screamed at to leave his room and then begged to come back in a few minutes later.
15:30 Just as Skinface goes running down the corridor shouting obscenities at his parents, Mr Complex rears his ugly head "Nuuuurse, nuuuuurse, please help me nuuuuurse" he asks me whilst standing, perfectly fine, in the doorway.
"Oh for gods sake, I don't have time for your shit today, just sit down" I say to him
(THOUGH OF COURSE I DO NOT BECAUSE DESPITE THE FACT PATIENTS ARE ALLOWED TO BE HORRIBLE TO US WE MUST ALWAYS BE LOVELY TO THEM).
16:00 Skinface's CT report is back. We isolate the problem as an evil face in his brain image, most likely representing some kind of evil spirit. For confidentiality reasons I can't upload it but here is an artists impression we drew.
Day 5:
08:00 The F2 turns up looking like death.
"I... I... got home from the mess at 4am... I can't do ward round" he blurts before going off to sit down somewhere.
Apparently it is possible to have a life and be a doctor, so I can't use that as an excuse anymore.
10:00 Nothing much at all is happening on the ward except that Skinface has ripped his cannula out. I decide to use the ENT Deus Ex Machina that is the peripheral access team.
"Hi, it's one of the ENT doctors, we have a patient whos in need of good access but is needlephobic and keeps taking his cannulas out" (Read: We're all too shit at cannulas to have to keep stabbing this mentally unstable guy. Remember Lucy Knight, Remember Lucy Knight)
"Oh right, well that makes sense, what medication is he on?"
"Oh superbadassacillin and virus-o-kill"
"Well then it's IMPERATIVE that he has a line put in by us as the pH of virus-o-kill is enough to melt his very skin"
YES!!! Score one for the Geoffster!
"Oh but you do have to explain the procedure to him and gain his consent"
SHIT!!! He's very confused there's no WAY he'll say yes.
13:00 I pluck up the courage to talk to the guy and, amazingly, he's totally lucid and thinks that this new line would be a great idea, saving him from all the needles that he's been having.
Lesson From Today: Even the scariest patients can surprise you
17:00 It's officially home time and I'm horribly tired but I've got to go and do a stupid pharmacy assessment module that, when you get something wrong, just quits out of the browser and makes you load it again rather than just giving you another go at the question. Not that I get things wrong of course...
We also have another 100 investigations for Skinface to organise that were requested on a whim by the neurology registar despite the fact they won't help us treat him in any way and are horribly expensive. I imagine the registrar, knowing that it wouldn't be HIM organising the tests, was fully aware of these facts but didn't really care. One of these assignments involves ringing Psychiatry who, inexplicably, are only available AFTER 5pm. And by available I mean their phone goes straight to answer machine rather than just not ringing at all. Man they're good.
19:45 I get home at last and have dinner at my next door neighbour's because she is awesome. She also plies me with wine which is exactly what I need!
Tune In Next Week For More "Trust Me, We're putting radioactive contrast into one of our patients on Monday so by the weekend I might have SUPERPOWERS"
Thank you so much for this. I'm an O&G F1 over at Leicester, and we seem to be living parallel lives. I'm told it gets better?
ReplyDeleteCannulas. Bane of my life. We have to use grey ones.