What a day!

I agreed to cover the medical wards on Sunday, so that the F1 who was supposed to be doing the weekend could do whatever it was he had to do.
It started off slowly - handover took half an hour and there was not much for me to do.
But soon I was being bleeped by most of the wards, with various things to do and promising that I would come, knowing that by the time I got there, it would be in a few hours time. But most of the time, it did not matter that I wasn't in a dozen different places at the same time as nothing was really that urgent.
That is until the ward that I generally work on called to tell me a patient was unresponsive. When I got there he still was not responding. I followed the ABC rule and as he was maintaining his own airway, I left it alone (though in hindsight, as his GCS was below 8 - it was 3 - I should have put in a oropharyngeal airway at least). I put him on oxygen and popped in a large cannula - but even the needle didn't bring any response from him. Then I had to take a manual blood pressure - as the machine was unable to pick up his blood pressure which is usually the case with low BPs) - and he had a BP of 60/40 - not good. as he was on a fluid restriction of 1 litre per day, i was scared to give him too much, so i gave him a small bag of fluid, and amazingly that did something - he came around, his BP rose to 97/57 and his GCS became 15! An ECG showed that he was in atrial fibrillation - there are a number of causes, but it is very common in the elderly who have suddenly become unwell. And his blood tests showed that he was rather anaemic, so I wrote him up for a couple of units of blood. A chest x-ray done on the ward was no different to his previous x-rays. This whole process included frantic phone calls to my SHO to check that I was doing all that I could do, and being told in turn to calm down!
And all the while I had a second patient on my mind - I had been told that he had a high potassium - this is dangerous as it can cause the heart rhythm to alter to the point that the patient can even die - ie very bad situation to be in. However, the patient himself was a little confused and refusing to eat or drink but the nurses felt that he was okay. When I got there, he was drowsy and still confused (but then again one of the reasons he came to hospital was that he was more confused). I followed the protocol to treat the patient and reviewed the ECG, and felt that he was alright. However later on when I followed the night registrar to review him, I found that I had not properly managed him, in that if he did really have a high potassium, he might have had a cardiac arrest despite my management. She felt that the high potassium however was spurious - the blood cells in the tube might have split, releasing potassium or the blood might have been taken from the drip arm.
Then there was the patient were I had two attempts to pass an NG tube - and failed (on the bright side, she is getting a tube through her stomach (PEG) to feed her today).
There was also the patient with cancer of the prostate whom the nurses asked me to catheterise at 1500, but I only got there at 2030 -half an hour before I finished - and had two attempts, but not only did I fail, but I traumatised his penis, and he was bleeding and in pain. Today I found out from the house officer who normally looks after him that the patient on two pervious occaisions could only be catheterised by the urology registrar - a person far more experienced in difficult catheterisations than I (this was only my second in a man - i've done at least a dozen in women). Whats worse is that the nurse knew of the difficulties and still asked me, knowing well that it would probably be futile.
Unfortunately some nurses can be rather unhelpful. I got called by a nurse on an orthopaedic ward who wanted someone from the medical team to review a patient who had been in a RTA and now had a headache. Honestly! The orthopaedic doctors have had the same training, if not more than I have, and around all the bones is a fleshy body - they should be able to deal with it. I told her I would come and review him sometime, but in the meantime she should get one of her doctors to come. I later found that this was her third attempt to get hold of a medical doctor - she had first gone to each of the two SHO's on call - both had told her to contact her own team and then she came to me, despite what they had said. I feel really bad for the patient who was in the middle of this tussle. In the end one of the SHO's saw him, only to find that the headache had been there since the accident and he wasnt really in any pain!
What made yesterday worse was the lack of support to do jobs that can be delegated, like bloods and ECGs - some wards have really good nurses who are trained to do these, while others do not. And sometimes, even if the nurses can do things or know someone who can, they don't offer - despite being asked. And when one has a stack of jobs to do, that cannot even be delegated it just makes it worse.
It came to a point yesterday at about 1930 when I just had to have a break because if not I would have started crying. After a cuppa, I managed to get through til 2115, when I handed over all my worries and my crappy jobs.
I suppose what they say is true: what doesn't kill you makes you stronger.