Friday, 15 August 2014

The good, the bad and the ugly


I am sorry for not posting in some time. There are a number of reasons for this - first and foremost that sadly I am very busy at the moment. Another reason is that I have been reminded of the GMC guidance for doctors a few times over the last few months (the GMC monitors and regulates doctors working in the UK), and this guidance states that (and I quote) "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name." This guidance can be found here under point 17. The GMC also makes lots of other recommendations such as not revealing any patient identifiable information (I re-iterate that I mix and match, and change patient information so none are identifiable at all).

This is obviously concerning to me as I have worked hard to be working as a doctor, and I enjoy it a lot, and don't want to lose it because I am breaching this guidance. The option of losing my anonymity as per the guidance seems to be an even worse option, as I feel this could impact on patient confidentiality. If people knew where I was working.studying then does that make it easier to identify people I may have seen?

Some thoughts for me to ponder on, while I leave you with some thoughts to ponder on. The great Junior Doctor Switcharound has been and gone, and I am now working as an FY2/SHO/TLA in a large teaching hospital. This whole period seems a little Mad Hatter's Tea Party-esque where all junior staff up and leave their jobs on a Tuesday and start work on Wednesday. You have the evening to move to a different house, and work out what the new job requires. I am sad to be leaving behind my old hospital, I felt as thought I knew most of the people who worked there and whenever it was a tough on call or night shift there would always be a nurse or two on each ward that I knew who would kindly (or not so much as you will find out!) brew me a tea/feed me cake/tell me interesting stories to keep me going! I have now moved to a much larger hospital, so I am sadly expecting it to be a little less friendly, with less of a community feel, but I am hoping to be proved wrong!

The real reason for this post, general natter aside, is to say that I think that key hospital events fall into 3 (or sometimes 4) categories. Good, bad, ugly and occasionally miraculous. I will give some examples from my last month as an FY1/HO that may make interesting reading  

A few weeks before this event, a lady came to our ward who we diagnosed with very advanced breast cancer. My consultant - who is a very straight talking man - advised her and her partner that if they wanted to get married now was the time, as they didn't have much time left to decide. A few weeks later she came back into the hospital getting sicker much more rapidly, but with her wedding planned for a few days time. Sadly she was far too sick and couldn't make the wedding that they had planned. I worked with the hospital chaplain and we organised a wedding in the ward for them. We turned the clinical room into a bridal room for her to prepare, and many of the other patients got involved. A wonderful experience with a bittersweet ending, as she sadly died the next day. Letting the couple share that moment of happiness didn't take any medical skills, but meant the world to them. As Robin Williams' Patch Adams said:

"You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome."

I was talking to the lovely lady who I mentioned in my previous post with heart failure and she mentioned that she had been getting recurrent abdominal bloating and had lost a bit of weight recently. The consultant had already ordered a CT scan of her chest, and I asked him if it was worthwhile adding a CT of her abdomen to the request to look into this. He said he didn't really think it was, but I did it anyway - and now she has a diagnosis of advanced ovarian cancer. Since I explained this diagnosis to her she seems to have lost a lot of her fight and I had to leave the hospital before she was discharged, though it looked like she was getting worse. The fluid build up in her lungs had been due to the ovarian cancer. I am not sure if she will manage to leave the hospital, and in part I feel like I am deserting her moving hospitals, but I know that is silly.

During one of my on call shifts over the weekend I had worked from 8AM to 6PM without anything to eat due to the never-ending stream of jobs, and the nurses on my normal ward took pity on me and when I arrived to do the jobs they had asked me to do, they instead took me to a side room and fed me tea and a slice of birthday cake! I was famished so I quickly devoured both, spluttering thanks (along with cake crumbs) to the nurses. After I had wolfed it all down, I asked them where the cake had come from - was it one of their birthdays?
No. It turned out that it was a cake which had been given to a 94 year old naturist on our ward who was very sick with hospital acquired pneumonia (more likely than pneumonia caught outside of hospital to be caused by unusual weird and wonderful bugs). [On a side note, this 94 year old wandered the corridors every night, naked after taking her clothes off, and pressed herself to the windows of the nursing station to look at the people inside!]

Not only had the nurses fed me this geriatric-cake, but they had actually seen her blow/slobber our her candles over a few minutes (those lungs weren't too good, due to all the pneumonia). The family had kindly given the nurses half the cake, but the nurses were not too sure how safe this cake was, so had decided to test it on me. These were not even random people I didn't know - they knew me well as I had worked on their ward for a few months. It was all meant to be a joke, but sadly this joke ended up with me eating some super-bacteria-infected-victoria-sponge. Fortunately I didn't get too sick. I felt a little man-flu-ish over the next few days but nothing worse.

A similar incident happened to me over a previous weekend on call - one of the respiratory specialist nurses I knew well from my previous rotation was doing bank work as a ward nurse, and asked me to come in and see something 'urgently' as she was worried about it. It was a very large boil on a man's back, which I dutifully (with gloves on) began to inspect it. Unfortunately after touching it, it started squeezing large amounts of pus out of it, like toothpaste. This was very unexpected, and of course I had to deal with it professionally. I got some gauze and made sure all the pus came out (once I had started I had to finish) while this nurse and the HCA sat their giggling at me. The man thought it was hilarious as well - he must have been in on it. The persecution I suffer while just trying to carry out my house officer duties like re-writing drug charts!

A brief mention at the end for a miraculous event. There was a lovely man on our ward who used to foster children throughout his adult life - he would have different visitors every day who would all call him uncle (calling foster parents mum and dad was discouraged as the kids already had a mum and dad) and come from all over the UK to visit him. He had a number of problems, but while he was on steroids to treat one problem, he ended up with a perforated bowel and systemic sepsis due to the contents leaking into his abdomen. I tried to get the surgeons involved, but they felt that he was far too sick for surgery and said that they couldn't operate. Without an operation to close the leak, he was almost definitely going to die. He was unconscious with a GCS of 3 when I left him on Friday. I considered writing up what would have been the medications used on the Liverpool care pathway (but now are not after it was phased out) but decided that because he was not in pain or suffering I would just write them up 'as needed' rather than as a continuous infusion, which would remove any discomfort but likely hasten the dying process. I left him on intravenous antibiotics to try and control his fevers. When I came back on Monday I was very surprised to find that not only was he still alive, but he was now awake, though still confused. Over the next couple of weeks he improved dramatically to a point where he was medically fit, though still needed rehabilitation to get him back to the independent self he was before he was admitted to the hospital. He was discharged to a smaller, rehabilitation hospital. His perforation must have sealed itself, and the antibiotics done their work on the infection. The ever-reliable wikipedia I linked above for 'perforated bowel' states that "Surgical intervention is nearly always required" - this must have been one of those few cases where luck wins out.

So, 4 categories and more stories than I could possibly write here. I have now moved to working in A&E, so more (non-patient-identifying) stories to come hopefully!

P.S - This is an amazing set of tips from another blog by halfadoc (now 100% doc) for future junior doctors which I had to link, as they are both true and hilarious

Thursday, 12 June 2014

All the small things


I have just come off of a long day's work and thought it was worth sharing an observation based on a couple of patients today.
I have noticed that it seems to be the small things that make patients happy and thankful, rather than the big things that we think matter the most in the medical profession. Take the two patients below.

The first patient is a 35 year old woman who has an aggressive, metastatic cancer. She was in under us a month ago and my consultant hinted to her long term partner that perhaps they could consider getting married due to the poor prognosis. She came back to us this week, much sicker and more poorly, sadly having planned her wedding this week, and having to miss it as she is in hospital, sick. We have been trying to get on top of the infection she has, and the cancer, to give her more time, but this is difficult. We are not sure she will be able to make it out of the hospital, and I have started trying to organise a wedding for her inside the hospital. Since this planning started, she has become a different woman; much brighter, much happier and much more healthy. All of the complex medical procedures and drugs we have been using for her haven't really made much of an impression, but this small idea has made her a different person. Every time I see her she thanks me for the idea of the wedding and the plan, but never thanks the consultant for the chemotherapy or for the complex surgical interventions that have been used. 

The second patient is a lady with heart failure and fluid build up on the lungs. We have been taking all this fluid off, and she can now walk properly due to being able to breath, and her legs not being all swollen all the time. This has made a huge difference to her, but today on the ward round, and yesterday on the ward round, she just wanted to say thanks to me for talking to her and listening to her worries. She is worried about her husband, and how he is coping at home without her, she is worried about her sister and her new diagnosis of cancer, and she is worried about her own heart. On Tuesday I had a sit down and chat with her while taking some bloods for 30 minutes or so, and now every time we see her she wants to thank us for being so kind and listening. Not for all the diuretics which have sorted out her lungs, or the ultrasound which diagnosed the problem. 

The problem I find with medicine is that moments like this; where you can sit down for 30 mins to talk to someone about their worries about their family; or where you can try and sort out a wedding in a hospital, are not usually possible in hospital medicine. I spend most of the time chasing my tail around with far too much to do. I like to think that, if we employed a few more people then we would all have more time to do things like this - things we all want to do.

I feel like I have had a really rewarding day because of these things, not because of the ascitic drains I put in today, or the clever diagnosis of rheumatoid lung I (might) have made, and the patients feel the same. It would be nice to have a system which let us do more of these things, but I will certainly do my best to try and do what makes a difference, clinical or not

Friday, 30 May 2014

Lord Voldemort


Firstly I would like to apologise for my last post. I realise that the title of this blog is 'Internal Optimist' and I also realise that the last post was not very optimistic at all! I had had a pretty rubbish week and it was cathartic to come online and moan about it. Thank you for your support though!

Since then times have been a bit easier - there have been some difficulties - for example the SHO post where I work has been empty because the SHO who is meant to fill it is on maternity leave, and now one of the registrars and one of the consultants from the team has left the hospital to pursue other interests. This has left our team somewhat depleted, and the workload a bit higher than normal. Despite this there are positives (as well as the fact that I am currently on nights for a week so have escaped the increased workload of the day team!) - Anyway this is in danger of becoming another mopey post like the last one, so I will just tell some stories of what I have been up to / some interesting observations.

The last few weeks have been quite emotional. There have been quite a lot of deaths on my ward, which has been quite upsetting. I think this is partially because the gastro ward I now cover has a lot of sick people on it, lots of end stage liver disease and the like, and I also think I have its been very unlucky that recently there have been lots of people who are very sick. One of the most emotional moments with all of this came the day after a patient with decompensated alcoholic liver disease died. He had been in for about a month and I had got to know him and his family very well over this time, as they visited every day. He was requiring regular ascitic drains to keep his abdomen from filling with fluid, and kept fluctuating between being relatively well and acutely sick. Finally, sadly, he died due to 'SBP' - a bacterial infection of the fluid inside his abdomen. The final time I saw him was when he had started spiking temperatures and his markers of infection in his blood were rising. I went to take blood cultures from him and start antibiotic treatment, and explained the situation to him and his wife in a friendly way. We had a few laughs, I went home and when I came back the next day he had died overnight. 
The next day I had to go down to the bereavement office to fill in the death certificate. As I left the office, his family were sitting out there in a group, tearful, waiting for his possessions and the paperwork. His wife, tears streaming down her face, gave me a huge hug and an outpouring of thanks. Thanking me for being so kind, so caring and fun. "he really enjoyed the last month because of you"... It shocked me and I couldn't really think of anything to say other than 'thank you', and 'sorry for your loss', but I spent the rest of the day in a contemplative mood. Death is not something I like at all, but it is something I had been getting more used to, given all the sad things which have been happening in the ward recently. Being exposed to the relatives right afterwards was not something I was used to, and I think it bought home to me a little more that the patient isn't just an isolated person in hospital who you see. They have their entire family, friends, neighbours, children. All of who are heavily affected by the events. It sounds obvious but its not really something that was in my mind before.

To lighten the mood a little, one of our other patients (a Romanian man) came to our ward telling us that he had serious problems with his liver. The story was that he had developed a yellow tint to his skin but without any other symptoms (painless jaundice makes you worry about pancreatic cancer), and his GP had sent his blood for some tests. 2 weeks later he had called his GP, but been told that it routinely took them up to 4 weeks to get the results and report them to him. Not satisfied with this, he took a plane back to romania, got his blood taken privately in a hospital there, got the results printed, then came back to the UK and came into hospital with the results to get treated. I think it is pretty shocking that our system is less efficient than travelling to a different country (one we tend to see as much less developed than our own) to get the results and bring them back with you! Sadly, on further investigation, he did have a pancreatic tumour. Medicine seems to rarely supply happy endings!

A few interesting observations from the hospital:

There seems to be a war of wants between the nurses and doctors, and the bed managers. Bed managers come around every morning telling people to discharge more people, the calls go up that they are not safe to go home, but we need the beds. What are we meant to do? We keep people in hospital until they are safe to go home (doctor/nurse want) but then we have nowhere to put the new patients that come in via A&E (bed manager want). It seems hospitals just don't have enough beds in them. It is a shame that this seems to create opposition between the bed managers and the doctors, rather than letting them work together for an outcome they could both be happy with.

I am not sure if anyone else has noticed, but medical professionals seem to hate the word 'cancer'. We always seem to take about "Breast C.A." or "Bowel C.A" rather than saying 'cancer' or 'malignancy'. It reminds me of Harry Potter where they characters don't want to mention Lord Voldemort, instead mentioning him as "you-know-who" or "he who shall not be named". I am not sure why people say "C.A." instead of cancer (its the same number of syllables) but I agree with Dumbledore - instead of being scared of the name, taking the power from that name is an important part of the fight! 

Sunday, 13 April 2014

Deaths, difficult families and the worst day yet


The last week was a terrible week. Very busy and a lot of difficult conversations with families when I didn't feel I had the time to give them the attention they wanted. My new rotation is gastrointestinal medicine, and it is very busy. The last week seemed to have someone dying every day. Many of these people were people with end stage cancer or other serious conditions, but this didn't make it any easier for me at all. The last 8 months or so I have been very fortunate and only had a couple of patients die - now it is terrible.

My week started off on call, where among others I clerked in a lovely gent who was in his 60s and had the same birthday as me. He had a pneumonia (I am still pleased with myself when I get a diagnosis, even one as barn door as this - makes me feel like a 'proper' doctor rather than a glorified PA) and his oxygen saturations (the measure of the amount of oxygen your blood is holding) were about 80% instead of the normal 95-100%. Other than this, he seemed pretty well. With pneumonia it is common to use something called the CURB-65 score to estimate how severe it is, and plan your treatment. This man scored 0, but I started him on the treatment plan for 'high risk' pneumonia (normally a score of 3 or more) because of his poor oxygen levels (not included in the CURB-65 score). A CURB-65 score of 0 suggests that this patient should have a 0.6% chance of dying from the pneumonia, but sadly 2 days later he had passed away. After having a good time joking with him about sharing a birthday, I was quite upset by this - especially as it had been so unexpected. I am pleased I had started treating him with intravenous antibiotics (as high risk) rather than oral antibiotics (as you normally would for a CURB 0 patient) as otherwise I would have felt as though I hadn't treated him properly, but I still felt upset over this. 0.6% still gives you that slim chance that someone may die...

Sadly the week got worse from there, cumulating in Friday which was the worst day I have had since I started work last August. It started off like a normal busy day, our ward works with 2 consultants who take it in turns to accept all new patients, and Friday is our day, so there was quite a lot to do. Part way through the ward round (up on the 2nd from top floor of the hospital) we get a bleep from the surgical ward (ground floor) saying one of our medical outliers has some chest pain. This happens a lot (invariably nothing) so I ask for an ECG and break off from the ward round to go down and check it out, expecting to be able to go back and join in a few minutes. I arrived on the ward, to be shown an ECG with good going ST elevation

ST elevation in an ECG from wikipedia 

I was panicked - what to do? ABC! MONA?! or should I be preparing him for PCI? I started treatment and then bleeped the cardiology registrar. No answer - I bleeped the other 3. No answers, so I dragged my registrar down away from the ward round to come and help me out. Fortunately it all went well, we continued ACS treatment (so many TLAs!) and the ECG changes went away, the patient didn't need PCI today (and he is still doing well)

Sadly, because my registrar and I were pulled away from the ward round (which the consultant completed on his own, as he needed to run a clinic in the afternoon) we were not too sure about the jobs that needed to be done. The SHO is in nights, and the registrar had to go to the consultants clinic in the afternoon, leaving me to work out what needed doing.

This is when the real trouble started. One of the patient's on the wards bloods came back with a high potassium, which means that they need certain intravenous medications (like insulin). I prescribed these medications while talking on the phone to one of the F1s from the acute medical unit. They wanted to transfer a sick patient to the ward from there, but needed a medical handover to do this. He explained that this patient was for palliative treatment due to her breast cancer which had spread extensively throughout her body, and she was too sick to be transferred to a hospice. He said she was already on a syringe driver with medications such as morphine to take away any pain or suffering, and just needed some TLC on the ward. I accepted all this and said I was happy for the transfer to happen. 

As I come off of the phone and hand the prescription chart to the nurse in charge of the ward, one of the other patient's relatives want to speak to me. He has end stage liver disease and is too old for a transplant, he currently has a bacterial infection in his abdomen which we are trying to treat with antibiotics, but not very successfully. It turns out that on the ward round in the morning, the consultant had been exploring the idea of going down a more palliative route with this man and his family. The thought being that the infection was only getting worse, and we couldn't give him a new liver to replace the old one that the alcohol had destroyed. It seemed that the way he had done this was leaving the family and patient (who was not well enough to process information) to think about what route they think would be best, as continuing active medical treatment would involve a central line, a nasogastric tube and more invasive treatment. Having thought about this from the morning, the family felt quite put out by this and felt that they were being asked to make a decision about whether the patient should 'live or die'. We were always taught at medical school that these sort of decisions should be made clinically, then the decision communicated to the family with their agreement - it isn't fair to leave this decision to the family, so I agreed with why they were so upset. I felt this was a decision a little too advanced for me to have to deal with, and went to pull my consultant out of his clinic to talk to the family, which he wasn't too happy with. It is decided that this patient is for full active treatment, and I need to find the 'IV team' who are the team who can insert central lines and suchlike. As it is a Friday, if I do not get these in today then we will have to wait for Monday, which means no antibiotics or fluid over the weekend, as we cannot get any venous access on this patient, which would not be good.

On getting back to the ward, a nurse told me that no-one had been able to give the treatment to the man with a high potassium, as the man had no cannula in to give intravenous drugs. It is about 5PM now and my official time to end the shift. I went to start setting up the equipment to insert a cannula and my bleep went off. I decide to answer it before putting in the cannula, as leaving it would mean they would keep bleeping me while I was inserting this cannula. It is the radiologist calling through an urgent report on one of my patient's scans. This lady has suspected bowel cancer (but not proven), and had been feeling a bit dizzy and faint so we had done a CT scan of the head. This CT scan had shown a very large mass in her brain which was squashing the brain up and starting to lead to coning within the brain (where the swelling squashes the important parts of the brain that control breathing and can lead to death). This needed urgent neurosurgical input, so I prescribed intravenous dexamethasone (a steroid to reduce the inflammation) and called the neurosurgeons to talk through what they wanted me to do. While on the phone to them, the nurse comes to tell me that they still cannot give my treatment for high potassium or the dexamethasone as no-one is trained in cannulation on the ward. I ask if they could call one of the other nurses from another ward to help out (though the neurosurgeon is not happy to be interrupted)! The neurosurgeons want an urgent MRI scan before deciding what to do.

I go to get the equipment to insert these cannulas when a very angry man storms into the nurses station and starts shouting that he needs to speak to the doctor in charge. I am the only doctor on the ward, so am asked to speak with him. He is visibly distressed and shouting about his mum; the lady with breast cancer who had been transferred to the ward a few hours ago. He is shouting things like  'why are you killing her' and 'What is this sh*thole anyway', and physically threatening staff members. I tell him I will happily talk to him at his mum's bedside, and go to look at the patient's notes to prepare myself for this conversation. By now it is about 7PM and I am left in the ward on my own. It seems that this lady with metastatic breast cancer has been known to the palliative care team for some time, and has accepted her diagnosis and the fact that she is dying. With this knowledge I go to speak to the son, at the patient's bedside. Her husband is also there. Her son is very angry, and stands with his face about an inch away from mine and shouts at me. I think about asking the nurses to get security, but decide that it might escalate the situation. It is understandable that he would be upset given the problem with his mum, and I don't want to make things worse. It seems that before the patient left the acute medical unit it was not explained to her son (who was not there) that she was dying and the decision had been made to make her comfortable, as there was nothing more we could do. In addition to this, she seemed very distressed when I was at the end of the bed - the medications she had been put on before transfer were at too low doses to alleviate all of her symptoms. I am stuck behind the curtains with this man accusing me of killing his mother, the poor lady who is visibly distressed and her husband who is just crying. The nurse pops her head around and reminds me that the two other patients are still awaiting cannulas, and they cannot give the steroid to the lady with the swollen brain, or the man with the high potassium (which gives him a risk of arrhythmias and death). I feel so out of my depth, but there is nothing I can do.

I ask the nurse who has popped in if she can give some more midazolam and morphine to this distressed lady, and continue trying to explain things to the son. He isn't having any of it, though, and has decided that I am too young to work there and he wants to speak to someone 'proper'. He wants to know which consultant made the decision for palliative care, so I tell him the name of the consultant who saw her in the acute medical unit. He storms off to talk to the consultant, and I try and explain things to her husband, but he is too busy crying. 

I put in the two urgent cannulas, and call up radiology who are not interested in performing an urgent MRI as it is now far too late. I have to explain to the lady with the mass in her brain that she probably has metastatic cancer which has spread to her brain, as she keeps asking the nurses why she has been started on dexamethasone - trying my best to not rush but to take my time and explain things gently. The acute medical consultant calls me up, not happy that I sent an irate patient down to bother him when he is busy. I am too tired to protest, or care.

It is now about 9PM, 4 hours after I was meant to leave. I still have most of my jobs from the day to do. The day on call has now changed to the night on call. I call up to let them know about the sick patients on my ward, and then get on with finishing off my day jobs. It would take longer to hand them over and explain the situations behind each patient than just doing them myself.

Before I leave, I check on the patient with metastatic breast cancer to make sure she is more comfortable. She is sleeping soundly. The son had gone home hours ago. The husband is still there, and he gets up, shakes my hand and just says "Thank you so much. For everything." The look in his eyes is all apology, he is so guilty for what his son was doing and saying.

I leave for home, physically and emotionally drained, but that handshake at the end made the world of difference to my week.

Monday, 3 March 2014



Just completed a set of nights, and I am still unsure as to whether I enjoy them. The positives are that there seems to be a good team attitude of 'we are all in it together' from the other doctors and nurses during the night, and you get to see quite a few ill patients, which means trying to work out what is wrong with them and hopefully putting things right. This is a lot more active for the brain than my daily job, where the consultant does most of the thinking and decisions, while I spend time following orders and filling in paperwork. Sadly there are negatives as well: I get really tired, and then after the nights I cannot sleep properly for the next week or so as my body clock has flipped; there are very few seniors in the hospital to help support with the above decision making, so if several people get sick you are going to have to be confident in your initial management as it may be an hour or two until someone more senior can come and review the patient; there is also the flood of menial jobs from the wards which have been forgotten by day teams (like writing up regular medications) - sadly all of this cumulates in very large sentences...

While I was on call over the week, there were quite a few sick people on the wards, sadly 2 of these people died. It was difficult to try and manage multiple ill patients as it involved heading between different wards to try and manage each patient while trying to answer the random bleeps that kept coming though (such as one patient who kept having 4-8 second pauses on his heart tracing without any symptoms. Very scary!)

Parts of the ECG for the asymptomatic patient with the pauses. In the end the cardiologists put a pacemaker in, but scary stuff (for me, he didn't seem to notice) overnight!

The craziest part of the night was when I arrived on the gastroenterology ward to write up a new drug chart, as the old one had somehow been lost when transferring the patient from another ward. While sitting at the table trying to work out which drugs the day team had put the patient on during their stay, and which had been stopped (harder than it should be!) I noticed one of the patients had a defibrillator attached to them. In my experience defibs are only usually attached when someone is having some form of cardiac arrest (or you are worried that they are) so seeing a patient lying still in bed hooked up to one of these really confused (and scared) me... I jogged over to the patient, and saw they were breathing  (good start) and looked asleep (to be expected as it was 5AM) so I asked the nurse why they had the defibrillator on them. Supposedly the day team had wanted cardiac monitoring for the patient, but the cardiac monitor that the ITU sent up didn't work - so they had just hooked up a defibrillator to use the tracing that it produces instead. I was confused (and a little concerned - what if someone changed the settings and accidentally shocked the patient). On the plus side, at least if the patient started getting more ill there would be no delay in initiating monitoring and treatment during resuscitation...

Like this, but the defib was manual so showed the heart tracing from between the pads

Saturday, 22 February 2014



Firstly I would like to apologise for taking so long to update my blog, and explain why this has been. One of my colleagues at work approached me a little after the last post and asked if I had a blog online. I asked her why she thought this (obviously not wanting to admit this as its confidential etc etc) and she mentioned finding the blog online while searching for F2 application information, finding it interesting reading a few posts and from them feeling that 'it sounded a bit like you'. On reading further she found more information about what I had been up to in my F1 life (such as laser tag) and linked it to me, she didn't recognise any patients, though, despite being on surgery with me. This worried me, as while I anonymise all patients I mention in the blog, changing and mixing facts about them, I don't really want this blog to be linked to me personally. This isn't because I say anything in it that I feel is inappropriate in the blog, but I feel that being able to link it to me makes it more likely I will censor the emotions and opinions I want to write about. A recent news article over a hospital worker who was disciplined over making inappropriate comments on twitter (anonymously) also scares me. This operating department practitioner said some pretty silly things (such as planning on using a patient's body hair to make him sideburns like Bradley Wiggins) and rude things about the executive board. I don't think I have said anything this serious, but this man was trawled through the media, and investigated by a professional body and cautioned. I don't want this to happen to me.

I have had a good think, and a chat to a some friends/family about what they think I should do. I think I will carry on posting but I will try and say a lot less, just little bits about what I have been up to and some funny stores. Hopefully by keeping things brief (and professional) I remove even more patient identifiable data, and minimise the information that people could use to identify me.

Over the last months so much has happened. Most importantly (to me) my favourite patient sadly died. This was someone who had been in the hospital for well over 100 days from when I was doing surgery. I have talked about them previously in the blog, and while on nights last week I was called to an arrest in the surgical ward. On arrival it was this patient who had arrested (completely unexpectedly) and we did all we could but couldn't restart the heart. I was really affected by this happening at 4AM, while I was trying to look after another patient on a different ward who was getting sicker and sicker (and subsequently died), and I had to go and sit down, have a little cry, and wonder if this was really the right job for me. Having had some time to reflect, this is the right job for me, but I am going have to get better at coping with things like this happening. I have been very lucky so far that not many of my patients have died, but things can only get worse...

And for some quick bullet points to get across some of the more eye-catching things that have happened since I last posted

- Homeless heroin user on the ward, complaining about the service that we could offer them. They are telling us on the ward round that 'they pay taxes too, and should get more methadone'. My consultant replies curtly 'there is no VAT on Smack' and walks off. Ballsy and it took some time trying to persuade the patient to stay in hospital afterwards, but very brave!

- On call repeated bleeps from 'outside lines' (often the consultant calling from home to make sure you are doing OK) actually turning out to be recruitment agencies trying to get me to join up. Lying through switchboard to get to medical people working then trying to sell. Not the best time guys!

- 30 year old obese man came to hospital with breathing problems, got stuck in his car in the car park and had a cardiac arrest: the paramedics had to dismantle the car to get him into the hospital. Fortunately he survived. It was thought he arrested because the getting trapped inhibited his already problematic breathing by putting pressure on his chest, leading to a respiratory arrest.

- A man I was clerking telling me he had a 'cauliflower heart'. Very confusing until I realised he meant he had had a Coronary Artery Bypass Graft (CABG or cabbage in medical slang)

- Behind curtains seeing one patient while another talks on their phone, unaware we are next door "get some of those chocolates for the doctors when you come in, they have been lovely.... No not those ones, they are too dear, get the 2 for £5 ones, then we can keep one" Then looking sheepish as we come to see them next on the ward round

- A patient telling me 'that was a really good session' after I performed a digital rectal examination on him. Needless to say I didn't go back and see him again, and left it to my colleagues instead!

My posts may take more of a vibe like the above in future (though more frequent, and less long). let me know what you think (if anyone is actually left reading this after this hiatus!