Monday, 24 September 2012

Faking death


Hi,

Another slightly late post, but hey, I am kinda busy... :) This was my last week on my elderly/stroke medicine ward, before changing rotation. We have some fun with an alcoholic who wants us to provide him with special brew in A&E, a 'cardiac arrest' which turns out to be a patient who is holding her breath (...seriously), along with the slightly less serious but much more taxing challenge of how to give a drug called movicol to a patient who is only allowed to drink thickened liquids.

To start with, though, has anyone else read the House Of God? This is a somewhat cynical take on hospital life in the 70s, based around a intern's first year working in the hospital, often described as the 'Catch 22' of medical books. Well, I would definitely recommend it, very funny. I mention this because the 4 weeks I have spent on this stroke unit seem to be getting closer and closer to the world painted by the book. In the book, medicine is not about treating people and getting them better, so they can leave, it is much more about 'Turfing' them to another speciality or a nursing home (as chronically sick people rarely get 'better'). Working in stroke medicine, a lot of the patients on the ward are not expected to make a full recovery so a lot of the work the doctors do seems to be based around trying to get them into nursing homes or other less acute hospitals for rehabilitation. Unfortunately these homes and hospitals don't really want more patients to try and look for, being busy enough already, and try and avoid taking the patients, making it difficult to get rid of them. You can try and transfer more annoying and long term patients to other wards if you find other problems with them. For example, the lovely "BUGGER" lady who is still around is getting a little bit on everyone's nerves. If she were to catch a severe pneumonia from the hospital, then the ward staff would be able to transfer her to the respiratory ward. Fortunately it has not yet come to the tips offered by the 'House Of God' which include putting a patient's bed up very high, so when they fall off they break a hip and you can 'Turf' them to orthopaedics...



For anyone who has read the book.

Moving onto what I got up to this week, the introduction is a good summary of the bast parts. A man was admitted to A&E for a possible stroke, which was why I went down with the registrar to see if he could be thrombolysed. He had a severe weakness all down one side of his body, and could barely walk. After examining him, it was decided that he needed an urgent CT scan. The man was not happy about this, and told us he couldn't wait in the hospital as he really needed some beer. We could obviously not prescribe beer for him (though perhaps we should be able to...) so he started trying to hobble out of the hospital with his one good side. We stopped him, and put him back to bed while he muttered about his special brew, and went off to sort out an urgent CT scan for him. By the time we got back to his bed, he had disappeared and run away from the hospital under the guise of going to the toilet. If we could prescribe alcohol we could stop addicts from running away, and actually give them the care they need. Not sure it would work well in practice though, as I can imagine a lot of patients (and doctors) might take advantage of this... Interestingly enough, you can prescribe alcohol to patients (or children) who drink antifreeze, as it is an antidote... Perhaps useful knowledge to store for an excuse...

While we were in A&E, there was a cardiac arrest call, which involved all the acute teams bleeps screeching at them, and lots of rushing to the bedside of the patient to SAVE A LIFE! I went too, to see what was happening, and was greeted by a rather embarrassed looking junior doctor and a red faced patient. It turned out that the patient had  (for some reason) decided to hold her breath to see what happened, and the doctor had panicked and decided that she had died... You would think that these sort of things only happened in scrubs...

I did spend some time on my ward this week as well, spending a lot of it with the nurses to try and get some of my clinical skills signed off. Carrying out procedures went fine. The main problem was when we were trying to give movicol to a stroke patient. Movicol is a treatment for constipation, and works by keeping water in the poo in the bowel, making it runnier and easier to pass. Stroke patients who have problems swallowing cannot drink watery things, as there is a risk that the water can get into the lungs and cause an aspiration pneumonia, so there are thickeners that can be put in water, tea, and all other food stuffs to make them thicker and easier to swallow. Movicol comes in a sachet, and is meant to be mixed with water before drinking. It turns out that this osmotic effect of movicol cancels out the thickener effect in the water, and heaping thickener into a glass of water makes no difference as it stays watery, meaning the patient cannot take the drug. Feeling cunning, I suggested that we mixed it into the patients porridge, meaning he could eat it this way. Unfortunately the movicol turned the porridge into water as well. After many failed experiments with different food stuffs, my answer was to ask the doctor to prescribe a different laxative. Who knew that the nurses job could be so scientific!

5 comments:

  1. Technically doctors can actually prescribe patients alcohol! It's not a black listed item and therefore doctors can prescribe it. It wouldn't be on the hospital formulary however so you wouldn't be able to get hold of it in hospital, but if it was prescribed in the community, the pharmacist would procure it and be able to supply it to the patient. It doesn't happen often, but I once heard of an elderly palliative patient being prescribed a glass of white and red wine on alternating days as it helped with the patient's pain relief!

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  2. I know you're the med student & all, but movicol is most definitely NOT a treatment for diarrhoea..... it'll cause it though!

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  3. @ Anon1 - You are right! I remember a lecture a few years ago about things that were black listed and not, seems a very strange way to do things; for example the lecturer was saying that the gold blend of a certain instant coffee was banned, but the normal wasn't... Alcohol does have its uses, though, so hopefully should be on the hospital formulae - ethylene glycol poisoning being one I mentioned, and drowning your sorrows after a long shift being another :)

    @ Anon2 - Cheers for the spot, I meant to say constipation... Changed now though :)

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  4. breath holding patient is hilarious!!that junior doctor must have been embraced to death..poor fellow!!

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  5. Great blog post by the way! I believe I agree with you on the beer as a prescription thing. I am sure our life would be a little easier if you could prescribe a nice cold one to the patients. Just a though keep up the good work I have a nephew that is thinking about getting into the medical profession and he always mentions your blog

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