Avoidant

 
Something bizarre happened to me recently which I'm still trying to wrap my head around.  Here's the gist of it:

I got a call about a patient that sounded a bit dodgy, so I went and checked him out and came to the conclusion that he might have condition X, but the decision about this and any subsequent management was in any case above my pay grade, so I called the X-ology registrar.

There was a fair bit of back and forth involved with this registrar, but here are the lessons that he imparted to me, along with some sarcastic interpretive remarks by yours truly:

• If you suspect that a patient has a serious medical condition, don't document this in the notes, because if you do, the relevant expert will have to review the patient rather than simply dismiss your concerns out of hand over the phone.
• If you do get the relevant expert to review the patient, don't document this in the notes.  Instead, you should document their findings and recommendations as your own, because clearly an intern is the guy whose opinion you should trust about this stuff.
• Similarly, do not mention to anybody else on your team that you are getting the relevant expert to review the patient, or the long-suffering expert will be forced to write his own documentation and actually sign it, and ink is expensive these days.
• When you are documenting things, write as little as you can, or even less, or else people will think you are incompetent or retarded or trying to hide something. It will also ensure that subsequent clinicians will be able to start afresh in their own assessments, free from bias or preconception.

So yeah, the guy basically was happy to go out of his way to try to get me to stick my neck on the chopping block and assume a totally inappropriate level of responsibility.  Unfortunately I had already broken all his recommendations so he was forced to actually do his job.  So I'd say that I did mine too.

Medical magic

If medicine was a role-playing game, it would need some sweet magic items for us players to hunt.  Here are some suggestions:

• Gloves Of Probing - these mighty gauntlets, when donned, will magically extend from the finger-tips to the shoulders of any basically human-sized doctor.  They automatically exude a slippery lubricant which allow the user to probe into any orifice to palpate within, up to a depth of twice the user's height.  The lubricant makes it impossible for the wearer to manipulate hand-held items.
• Pager Of Silence - this small black box from the dawn of time bears a powerful enchantment which enables it to be perpetually silent and never emit the slightest noise, no many how desperately someone is trying to contact the user.  Legend has it that only registrars can use the Pager Of Silence without suffering the effects of a deadly curse.
• PTR's Everfull Cracker Box - no matter how many times crackers are taken from this box, somehow it is always full the next time someone looks within.  This item only works when you are not rostered on to take advantage of it.  More specifically, it will never work between 2 a.m. and 7 a.m.
• Stethoscope +5 - this mystical stethoscope imbues the wearer with the ability to distinguish between crackles (fine and coarse), crepitations, rhonchi, rales, wheeze, sneeze, cough, choke, stridor, and blitzen.  This item is totally ineffective if the patient is armoured with Blubber Of Concealment.
• Roster of Homecoming - this patient roster with attached list of your jobs is enchanted to fly back to its home in your pocket when a magic word is spoken.  The enchantment is effective against being left beside the ward computer, on the patient's bed, in the doctors' common room, in the cafeteria, in your car, in the operating theatre, or any other location where rosters may be mislaid.  If the magic word is spoken whilst the roster is already in the user's pocket, the roster will attempt to move to the other pocket, causing the user's pants to twist around back to front, causing a -4 penalty to hit in combat and automatic failure of any seduction attempts.

Any other suggestions?

Blogging vs internship

Blogging - sheesh!  Who knew it would be such hard work?

Actually it's not hard work, I just never seem to get around to it.  Which is annoying because working nights is fertile ground for a blog such as mine.  There is no end of bizarre stuff that happens in hospitals after hours, and as the cover intern it falls to you to deal with it.  At least two or three times per day I think to myself, "Now this is prime stuff, PTR, don't forget it!"

But of course, by 4 in the morning when it starts to quieten down a bit, the last thing on my mind is to jump on a computer and do some blogging.  I just want to curl up on the couch with my seven vegemite sandwiches and read mindless pulp sci-fi whilst crooning softly to myself.

The weeks off are no easier.  The Hatchling is at a great age where she's learning new stuff minute by minute, she's heaps of fun to do stuff with, she careens around like a pinball bouncing off everything, and by the end of the day I just want to curl up on the couch with my sixty-three cheese sandwiches and read back issues of wargaming magazines whilst breathing through alternate nostrils.

Blogging just never seems to get a look in.  Which is a shame, because I keep having ideas.  Just yesterday, I thought, "Hey - what if you were to rewrite the plots of famours adventure movies but set them in hospitals instead???"  And sure, that's a stupid idea, but in the past I would have actually done it.  But now I just dwell on it briefly and then fall asleep on my toothbrush.

Internship - sheesh!  Who knew it would be such hard work?

Once upon a midnight dreary

Lest you think that this blog has turned into a monologue on the idiocy of people other than myself, I have a story for you about my own idiocy.  Read on, gentle reader, and remember me in your prayers...

In the middle of the night I trundled off to a distant ward to review the person in bed 3 who was, according to the taskboard, mildly hypotensive and thus warranting a breeze-by from myself.  I got there and took a quick look at her observation chart, and was surprised to see that if anything she had been mildly hypertensive.

I grabbed a nearby nurse and asked if perhaps the most recent obs hadn't been charted, but they had.  That nurse was also surprised that I was there to review the patient in bed 3 and suggested that perhaps a mistake had been made and that someone had meant me to review the patient in bed 4.

"Choh! Typical!", I said, "Choh!  Lucky it wasn't an emergency! Choh!  Can't believe anything on the task board these days!  Not like the good old days when I first started, last Monday!  Choh!", and so on and so on.  (This may surprise you if you're under the impression that I'm basically a nice guy - I'd like to think I am but at 3 a.m. I get pretty damn self-righteous.)

But then when I got the chart for bed 4, he was pretty much the same.  No hypotension there.  So I grabbed the nurse again and pointed this out to her and started out again on my "Choh!" routine whilst unfolding my taskboard printout to show her the errant job that had all these errors in it.  Wrong patient, wrong vitals...

... and I got that awful sinking feeling that you get when you realize that you're the dickhead.  I was on the wrong ward.

A brief post illustrating in a few pithy sentences many of the issues which I feel permeate modern medical institutions with their excessive attention to hierarchy and acceptance of imbalanced power relationships between people who should see themselves as colleagues rather than master and servant

Today's oxymoronic utterance from a senior doctor:

"Don't do anything unless I tell you to!  And I need you to anticipate what I want."

Alfalfanumeric

 
You may or may not be familiar with warfarin, a drug that patients sometimes refer to as "rat poison" because it is used to poison rats.  Like most drugs, it was discovered when someone's cows died after eating mouldy clover, using a scientific process that is opaque to me, but undoubtedly involved much glassware.  The dose is often tweaked up or down each day depending on the results of that day's blood tests because otherwise the after hours cover intern would have nothing to do on the weekend.  Getting it wrong might mean that your patient bleeds to death internally or perhaps has a massive stroke.  No pressure.

So when I was called to the ward one day to clarify the daily dose of warfarin, I thought, yeah - fair enough - nobody wants to stuff this up, and doctors' handwriting is actually even worse than it is reputed to be.  But when I get there, the nurse points at the drug chart and asks, and I am not making this up, "Is that a '6' or a 'b'?"

I mean - like, totally, huh?  How could you prescribe someone 'b' milligrams of warfarin?

Not even I am nerdy enough to prescribe in hexadecimal.  Although if I was, I'd make sure that I did paediatric prescriptions in octal and neonates in binary...

Broken Arrow

 
When you're on night duty, you carry at least one pager.  If the nurses need to contact you they can page you and you respond as fast as you can.  Or they could use the online message board which you check at your leisure and prioritise yourself.  In theory, the message board is for non urgent tasks, while the pager is for urgent things.  In practise, this does not occur.  I got a page the other day, to which I duly responded urgently, and the subsequent phone call went like this:

Nurse

Hello?

PTR

Hello - you just paged me, what's happening?

Nurse

The man in bed 4 is having a hypo.

PTR

What's his blood glucose level?

Nurse

We haven't done that yet.  He just said he feels funny.

PTR

I see.  Why don't you measure his blood glucose and call me back?

They did not call back.  So I went round to the ward, wondering if perhaps they were too busy resuscitating the guy to call me.  They were sitting casually at the desk,  I picked up the patient's chart and saw that his blood glucose five minutes prior to me being paged was 7.9.  I said nothing but waved the chart at the nurse with what I imagine was a look of gentle inquiry on my face.

PTR

So?

Nurse

Oh, it turns out we'd done it but I didn't know about it yet.

This is an exciting development in medicine.  I look forward to being paged urgently to manage hypotension for which no blood pressure has been taken, catastrophic haemorrhage with no bleeding, and syncope with no altered consciousness.

Father's Day

Yesterday was Father's Day here in Owstralia.  I began Father's Day by calling someone in the early morning, waking them from sleep, and telling them that their father is dead.  I hope that your Father's Day was better.