Today started with having to rush around tying up the loose ends of last nights fiasco (I shall tempt you, but I shan't tell you)...which meant I had to run the lenght of the hospital, without even a breakfast in my belly for stamina, in order to make it to handover, only to find out that nothing had gone off on my ward...but that was a good thing.
The rest of my morning was fueled by chocolates brought in as a thank-you by one of the patients I had looked after during my shadowing*. Unfortunately the patient died, but it was not unexpected, and possibly a merciful release.
The calories were much needed as I was the only one of my team (all the rest were in clinic) and had to do all the paper work, chase any blood results, check up on any patients about whom there were concerns and call around arranging appointments and making referrals.
Then came lunch, when my brain and body went on strike. Twenty minutes later I was back again, and I didn't leave the ward or stop for a break until 7.15pm, when my SHO who is on-call tonight threatened to bodily throw me off the ward! I still had not finished the TTOs - I had had five to do, but each took me roughly half an hour, not counting the number of interruptions to prescribe this, sign that, see so-and-so...so unfortunately for the person on this weekend, should two of the five patients leave this weekend, they will have to write a letter to a GP about a patient they do not know. Not to say that I know the patients really well after three days in the job, but that said, I am amazed at how much I do know about the patients.
The worst part about today - which is worse than what happened after I left the hospital last night (still not going to tell you) - is that I think I commited what is possibly, or maybe probably my first fatal error. And for the first time since starting, I'm actually feeling some emotions on the job - and those emotions are not very good - cos they are of distress...and I still am distressed.
There was a patient who is generally quite a pleasant person, but early this morning, the clinical support worker told me that he was being stubborn and refusing to put down his breakfast or straighten his left arm, in order for them to take a blood sample. This gentleman has a brain tumour and metastases in his brain, and he has also been in the hospital for a while and nothing is really happening as he and his wife (more his wife than him) were unable to decide whether or not to investigate further. So I thought that he was either feeling down and just not in the mood to be poked, or that he was having a headache and again not in the mood to be poked. Either way, my suspicions were not aroused, so I left it, agreeing to take the blood sample myself later on. However, with the mountain of things I had to deal with, it got pushed further and further behind. The nurses did not mention anything either. Then come the ward round in the afternoon, his family were present and they raised their concerns - that he was sleepier than he had been the day before and that he was not moving his left arm - at all. Examination left the consultant worried enough to rush up to radiology and request an urgent CT. A little while later the patient was whisked up. The report when it came a while later was not good - the patient had a massive bleed in his brain.
This is where my conscience starts stabbing me. Had I seen the patient in the morning, could something have been done sooner? And this gentleman had been on a medication to thin the blood, but at the ward round, the consultant asked to reverse the effects of the medication, but then later on when I was in the middle of a TTO, the nurse came by with the drug chart to authorise another dose of the blood thinner.....and I signed it! I dont know what I was thinking, in retrospect I wasnt thinking, and although he was given the drug to reverse it at the same time, and therefore would not have had any effect, it is really not an excusable mistake to make. I have a feeling I am not going to have a peaceful night tonight.
To get back to the patient, it has been decided that should his heart stop beating, he would not be resuscitated, and he has been given medication to reduce some of the swelling in his brain. His family has been informed that the outlook is bleak...I think they knew it even before the scan.
Thinking about this case, were this patient my father or grandfather, I probably would not have even considered investigation, and would have taken him home, as he had lost the use of his legs and there was not much of a chance of treatment making too much of a difference to his quality of life. But people are different and have different opinions: maybe if I was actually in that position (and God forbid, I hope I never will be) I would act differently and none of the others on the team agreed with me either.
And with that my week comes to a close.
*Shadowing - a week or two spent prior to starting work, where you shadow the person whose job you will be doing from the 1st of August. Its really useful for helping you get to know the layout of the hospital and the workings of the ward and the team. Unfortunately it is only for the first rotation of the first job.
No comments:
Post a Comment