Thursday 3 September 2009

Not exactly a piece of cake.

So, the first on call. Started well with a quiet afternoon, leading in to a quiet evening (I had time to come home and bake a cake, not something I've ever done before on call. But pretty useful as I took it in to bribe the OPD nurses. Some things really are international). Pottered back in about 9 to sort some things out and agreed with the nurses in OPD that they would ring me if anything urgent came in, or once there were 5 or so pateints waiting (not for "every Tom, Dick or Harry". Their phrase not mine). I would then come back at 5.30 to mop anything up before they hand over at 6. Came home, went to bed. And there it started to go downhill. A phonecall at 10 that I managed to deflect, then a call at 11.30 for a pregnant lady haing contractions and ?ruptured membranes. Went to see her, unsure of the baby's position so took her to scan and discovered one of the delights of the OPD at night; as many of the patients live a long way from hospital, if they are going elsewhere for an appointment the next day, they will come and sleep in the OPD the night before in order to catch the 5am transport. So to do the scan, I have to kick about a dozen people (including babies and elderly patients) out of the scan room. Wonder how sensible it is for the MDR TB patients to be sleeping in the same room as the babies. Fortunately baby is the right way up (or down really) so I send her off to the midwives. Deal with the minor injuries waiting and head back to bed about 1. Called again at 1.30. A really sick and gasping patient, GCS 7, massive ascites and hepatomegaly, previous diagnosis of ?a heart problem ?a liver problem. The neighbours accompanying are unsure of HIV status. So I jump in with a plan to do some obs (the nurses sometimes take some encouragement), send some bloods and get some x-rays. And discover that what appears to be limited resources during the day is non-existent at night. No bloods. No x-rays. It really is all on clinical judgement (guess work). Discover a blood sugar of 1, head in with some dextrose and he perks up a lot. Chuck in some diuretics and iv antibiotics for good measure and cross my fingers. Then do some stitching on the knife attack patient in the next bed (head and chest, I leave the hand for theatre in the morning). And it's now half past 3. Renegage on my originally agreement of half past 5 and tell them to ring me at 6 if there are any patients waiting. They ring at 6 to tell me there aren't. And my alarm goes off at half past to start the day. A morning of OPD (reviewing all the patients that I lodged overnight) followed by a well-earned afternoon off!
Apparently this does count as a busy on call (phew- I'd been thinking that if they were all like this I wouldn't survive the year!). Let's hope this weekend (my first weekend on) is better.

Apologies to non-medics for medicalisation of this post but I'm sort of hoping some clever doctors might be able to send me suggestions of what else I could have done for the poorly patient. He's now alert but still massively swollen up with an ECHO (USS of his heart by me) that suggests poor contractility.

5 comments:

  1. I would suggest operating on him

    BW

    O (clever surgeon)

    xx

    ReplyDelete
  2. Hi Caroline,

    Sorry it has taken me til now to log onto your blog but have very much enjoyed reading though the last couple of pages...it sounds so exciting...makes my nursing seem positively dull!! :) maybe africa ahould be my next stop when i graduate too.

    Sounds like you are doing amazingly and I am pleased with myself for keeping up with (nearly) all the medical jargan woohoo!

    keep writing
    miss you heaps
    helen x

    ReplyDelete
  3. Well, I can assist with a resection of his vestibular schwannoma if that's any help. Or maybe a cervical decompression.....? examine him again and see if he needs either of those operations and I'll pop over. Otherwise, why not try an ascitic tap (do they have a lab that can analyse result?), at least then you have more of an idea if it's something failing or infection etc.....but really not sure if that would change management at all.....

    Caroline, it sounds so utterly amazing, good on you. Just remember to look after yourself too. You're only small!! And don't get any infectious diseases.

    Lots of love. Fxx

    ReplyDelete
  4. Oh. also, if you tap the fluid it might make his breathing easier. But there's something about drawing off too much fluid at once as well isn't there? can't remember what exactly, but need to be careful about fluid balance or something I think - check the book. Fx

    ReplyDelete
  5. Never mind the medical jargon, I had to google OPD.... Jules x (and I still can't make the comments come from me)

    ReplyDelete