Wednesday 30 December 2009

Killing in the name of?

Mondays on call are officially the worst. And Monday on calls between Xmas and New Year are surely up there in the top worst Mondays.
The evening started fairly steadily with the clearing of OPD but led in to more and more patients arriving until I announced at 9pm that I had to go home and eat before I actually ate a patient. 10 minutes of furious eating later and I was called back to a patient who was fitting. Then to maternity for a woman in labour who was 'failing to progress'. A c-section later and there was a healthy baby boy. I then finished up in OPD and headed home at 1am. As I turned out the light so the on call phone went off; the lady from the c-section was bleeding. I spent a very unprofessional 2 minutes trying to persuade the midwives that they could handle this but at their insistence got redressed in my still warm clothes and headed in to find her lying in about 2 litres of blood and with a haemoglobin of half of the level it had been. A rapid return to theatre revealed no obvious cause for the bleeding but as we'd used up all 4 units of blood that we had in the hospital the helpful consultants at our referral hospital accepted her for transfer (not without the shamefully small voice that had to admit that yes, I had done the caesar). Fortunately when she arrived there 6 hours later she had stabilised (well, probably we had stabilised her, not sure that a ride in an ambulance over a bunch of pot holes is that stabilising) but we all agreed that although unneccessary the transfer had probably been the right call.
But for me, this does raise the question as to whether it is appropriate for untrained juniors to be performing operations overnight, when accessing help in the event of problems is quite difficult. We were lucky that this woman survived and I certainly thought that that wasn't going to be the case at one point. Would her death be something I want on my conscience? On the flip side, without the c-section her son's death would have been there instead. There probably isn't a right answer.

At 5.30am I was called by male ward to inform me that a patient who had been lodged had died. Lodging is what we do with patients who are essentially well but live far away and who either need investigations and have arrived out of hours or who have to await transport home the next day. This was a 38 year old male of unknown HIV status, who had come in in the evening with chest pain, shortness of breath and a cough. With his completely normal observations and examination I had lodged him for bloods and an x-ray. 12 hours later he died. We can only guess that there was a rapid change in his condition, or that I missed something. Probably the latter.

The frustrating thing is that with a lack of feedback I'm struggling to learn from these episodes of poor judgement. And am left merely with a nagging feeling of guilt.

1 comment:

  1. Caroline my dear you've got to reign back on the constant guilt trip and belief that it's all your fault.

    The fact that the guy died is not always down to you missing something or 'poor judgment'. People die all the time. What is more, I've been called (or more accurately my boss has and I've wandered along and held retractors) for post Caesar bleeding requiring hysterectomy and tying off the likes of the internal iliacs in the UK, with CONSULTANT O and G's who've performed the Caesar on otherwise well women.

    So PLEASE stop giving yourself a hard time, and believing that it's all your fault.

    O xx

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