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Monday, August 29, 2005
Strolling happily along the corridor, the doctor wanted to say bye to this particular patient. She's a 29 year old lady who just had an anterior resection 6 days ago for rectal cancer.
Stepping into the ward reception area, “Doctor, I think you better see your patient NOW. She’s had chest pain and abdo pain NOW.”
In the doctor’s mind, she was thinking “Shit… don’t tell me she has a PE (pulmonary embolism aka blood clot in the lungs).” She has a high risk of clots as she also has Factor V Leiden, a clothing disorder.
“What are her obs?” Nurses mumble some numbers. The doc checks her pulse and RR. Then felt the tummy which was tender all over and not relieved by morphine.
“She’s seems stable. Get me an ECG on her STAT. Where are the ABGs?”
“Don’t know. Perhaps SAU might have,” one of the nurses mentioned while going out of the room.
Her brain was thinking “what the heck… what do I do next? Should I call my reg? He’ll most probably think I’m an incompetent fool. Oh what the heck… let’s just call…” (Considering her SHO was on study leave, the Reg had left the hospital, the buddy firm’s HO is on annual leave, buddy SHO is somewhere in A&E, buddy Reg is in theatre.)
“ Will, Mrs P-A is very poor. She’s etc etc etc….” Telling him the obs and the fact that ECG was normal, and that she was about to do the ABG, but thought she’d call him first and let him know what’s going on and ask for advice.
“ Well, she’s either having a PE or a leak from her anastomosis. Where is Mr Wegstapel?” “He’s in the office doing some work.” “Well, I’m afraid you’ll just have to interrupt him. NOW.”
One week into meeting the consultant, and she has to interrupt him in his work for a sick patient? She didn’t know what to think. So, she decided to do the ABG first before contacting him. However, as luck has it, 2 mins later, she got bleeped by the secretary for something else then, and at the same time, she asked her if the consultant was in the office and did he know about one of the patients being very sick? “Yes, he knows. Will just called, and Mr Wegstapel is on his way to the ward now.”
So she goes into the room to do the ABG. Now, she has never had much luck with ABGs, only in 2 or 3 attempts, and sometimes, even unsuccessful. While feeling the radial pulse, she was hoping against hope that the first attempt would be successful. And thankfully, when she saw the syringe filling itself, she thanked the heavens for letting her get that and not causing the patient even more distress than she was already in. By then, the consultant had arrived. It was decided that she was peritonitic. He went down personally to the CT suite to arrange a CT scan of her abdomen/pelvis, to check if there’s a collection.
There was. The patient went to theatre for an emergency laparotomy. The PRHO had to explain to the husband what was happening, and where was the patient was headed to after surgery – ITU.
How do you answer the question “is she going to die?”
Third week of work
This week was not like previous weeks. Manic, but still enjoyable. Even though I’m looking after 2 teams’ patients (coz my buddy PRHO is on annual leave), I thought it wouldn’t be that busy. Thought monday would be lax, but apparently not. I was on-call, and thought that I would only do ward work. But it was not to be. Since there wasn't much ward work to do, said I would pop in to SAU later in the morning. If they needed any help, they would bleep the HO on call anyway. And boy, was it a "good" choice.
We were swamped. There wasn’t just a trickle on Monday morning. They came in, 3 at one go. There were 3 RIF pain, ?appendicitis, when 1 had a history of ovarian cyst on the same side. And there were 2 AAA which came in at the same time. That was bad. Madness. And at the end of our on call shift as well. =/
After that, I distressed by going to the gym, and a couple of us went for the urban funk class! It was quite fun, but not as fun as the time when I went to Pineapple at Covent Garden. Maybe because during that time, Sharon, the babe, was there with me, and the classes was so much fun with her!
Tuesday. We had a quickie ward round. Then outpatient clinics for the whole day. Usually, it’s the SHO and Reg and consultant who does them, but I went as well. Because the SHO wasn’t around this week, the number of patients were lesser, but I got dished out a couple of patients to see as well. In addition, I was bleeped continuously to do pre-op assessments for my consultant’s patients, as well as my buddy firm’s patients. That was good fun.
Wednesday, was the dreaded problem with my almost-discharged patient. Left late. Depressing day. Didn’t go to Bluewater with the rest of them in the end. Thank goodness, she’s now out of ITU and transferred back to the wards under my care. =)
Thursday. I went on a ward round with my buddy firm’s SHO and Reg, and doing the jobs, as I wanted to know the patients before everyone (buddy SHO and my Reg is on nights starting Friday, and buddy Reg and consultant is in all day theatre) disappeared. I knew I would more or less be alone on Friday. Then 4.45pm comes, and I was preparing to go home after checking bloods on all my patients, when a bleep comes from theatre that ‘could Mr Wegstapel’s house officer please come to theatre now. Mr Wegstapel needs you to scrub up’. Before that I had to tell a the second patient that her operation for caecal cancer may not go ahead that day, and the first one was still ongoing. Dear lord…. And so I scrubbed up, assisted, only came out of theatre at 8pm, had to cancel going to the gym with one of the girls there, and then headed back to the wards to make sure my patients were all alright. I left at 9pm. Shattered that night.
Friday. Yes! It’s Friday and it’s summer bank holiday, so I have 3 days break from the hospital! But it was a longggg day. Being the only one in the 2 teams contactable, and on the wards, while everyone else is away or in theatre, is not good. I’ll be glad to give back my buddy’s patients when he’s back this Tuesday! But anyway, it was a busy day, and ended up finishing only at 7.30pm.
Am glad to be out of the hospital. Now back in London, good old tooting.. chilling with friends. Oh yes, and my new love, Subway. =) Spent Saturday just chilling. Had lunch with John at Colliers Wood, then we went for drinks. Yeah… in the afternoon. Haha… Joel came over in the evening, and we talked till the wee hours of the morning. Haiz… study life is so free. =P
Dee arrived from Singapore on Sunday! Went to check out Notting Hill Carnival (nothing much, just lots of loud music and shaking of bumps and great smelling food, but maybe because we caught the end of it). Had lots of yummy gelato, chilled in Hyde Park for a bit, then headed to Mandarin Garden for lobster noodles. The lobster was good, the rest of the dishes were just mediocre. But well, what can you expect….
MN came down to tooting and dee and us 2 went to jaffna to have some Indian. Good food, and now, my junior is cooking dinner for me, so heading over there before going back to Medway. =)
More later… =P