http://www.youtube.com/watch?v=_N0w2rORwSc
I have just finished my rotation in surgery - general surgery, but specifically colorectal. I have also done "surgical take" - where patients come in with usually bellyache but pretty much anything that could be a surgical problem. This happens in the "Surgical Assessment Unit". There is a room there, for seeing patients initally. This room contains a bed, a sink, a table, three boxes of assorted sized gloves, and a box full of bottles of KY jelly. Many people who come in with abdominal pain - in fact, almost all - should have a rectal examination and this is the place it's done. Regulars to the SAU know the room. One such man - with a colitis that keeps him returning - I've seen a few times over the four months. He makes a joke of it each time. "After all this, I'll have to buy you dinner sometime."
Saturday, August 8, 2009
Swine Flu abounds
http://www.telegraph.co.uk/health/swine-flu/5990603/Girl_dies_of_meningitis_after_swine_flu_diagnosis.html
So, a little girl has died, after swine flu was diagnosed, by a paramedic. She, in fact, had meningococcal septicaemia.
Yes, meningitis is missed sometimes, and it's awful every time. But, from what I have read, this little girl was not given much of a chance to be properly assessed.
Children will still get meningitis despite the pig death. Shouldn't they be assessed and treated in the same way they always did? Is this going to happen again? The SWINE LINE - non medical people prescribing medication after someone ticks some boxes on a computer detailing non specific symptoms - seems to indicate that it would be suprising if it does not.
So, a little girl has died, after swine flu was diagnosed, by a paramedic. She, in fact, had meningococcal septicaemia.
Yes, meningitis is missed sometimes, and it's awful every time. But, from what I have read, this little girl was not given much of a chance to be properly assessed.
Children will still get meningitis despite the pig death. Shouldn't they be assessed and treated in the same way they always did? Is this going to happen again? The SWINE LINE - non medical people prescribing medication after someone ticks some boxes on a computer detailing non specific symptoms - seems to indicate that it would be suprising if it does not.
Monday, April 6, 2009
Surgery
I started surgery on Thursday at 7am. So of the last 108 hours, I have been at the hospital, working not sleeping, for almost 70 of them. I counted.
EWTD my arse! Tee hee! I'm not a fan of reducing doctor's hours really - we need the training, especially in things like surgery - but why the huge pretence? My hospital hires locums for the weeks that we are being "monitored" and then suddenly stops hiring them when the clipboards have left. If we give in a form saying we have gone over hours we are called into an office and told to change it to say every minute extra we spent is of our own accord for learning purposes as "we are not being told to stay". They don't seem to realise, or care, that it's actually jobs for patients that we are filling our time up with. If we don't do them, the patient might as well be at home. Why bother with all of these silly forms and hours monitoring? What's the point of all the deception?
EWTD my arse! Tee hee! I'm not a fan of reducing doctor's hours really - we need the training, especially in things like surgery - but why the huge pretence? My hospital hires locums for the weeks that we are being "monitored" and then suddenly stops hiring them when the clipboards have left. If we give in a form saying we have gone over hours we are called into an office and told to change it to say every minute extra we spent is of our own accord for learning purposes as "we are not being told to stay". They don't seem to realise, or care, that it's actually jobs for patients that we are filling our time up with. If we don't do them, the patient might as well be at home. Why bother with all of these silly forms and hours monitoring? What's the point of all the deception?
Saturday, March 14, 2009
Melanie Phillips ...
... makes me spit blood.
http://www.dailymail.co.uk/debate/article-1160511/MELANIE-PHILLIPS-Doctors-struck-denying-patients-right-die-What-sinister-distortion-medical-ethics.html
Dear God. Is she taking the piss? It's like she is desperate for something to say against doctors, but the best she can come up with is the fact that doctors have been told to comply with their patients wishes when it comes to withdrawing treatment? There are so many problems with the NHS and healthcare and doctors that she could talk about and bring people's attention to. But oh no, she goes for doctors listening to patients wishes about the end of their lives and complying with them. What she says does not even make sense. She says
"It has always been an important medical principle that no patient should be forced to have treatment against their will. Patients have always had the right to refuse treatment, whatever the consequences to their own lives."
And then in the same breath to say "the terrible truth is that doctors will now be struck off and may be sent to prison for refusing to kill their patients. How on earth did this country arrive at such a monstrous situation? And how can the medical profession go along with such a betrayal of its deepest ethical principles?"
I'm only a baby in the medicine world. But already I know that sometimes letting a patient die peacefully, especially when the patient in sound mind has said that that is what they would have wanted, is sometimes the ethical, humane, human thing to do.
http://www.dailymail.co.uk/debate/article-1160511/MELANIE-PHILLIPS-Doctors-struck-denying-patients-right-die-What-sinister-distortion-medical-ethics.html
Dear God. Is she taking the piss? It's like she is desperate for something to say against doctors, but the best she can come up with is the fact that doctors have been told to comply with their patients wishes when it comes to withdrawing treatment? There are so many problems with the NHS and healthcare and doctors that she could talk about and bring people's attention to. But oh no, she goes for doctors listening to patients wishes about the end of their lives and complying with them. What she says does not even make sense. She says
"It has always been an important medical principle that no patient should be forced to have treatment against their will. Patients have always had the right to refuse treatment, whatever the consequences to their own lives."
And then in the same breath to say "the terrible truth is that doctors will now be struck off and may be sent to prison for refusing to kill their patients. How on earth did this country arrive at such a monstrous situation? And how can the medical profession go along with such a betrayal of its deepest ethical principles?"
I'm only a baby in the medicine world. But already I know that sometimes letting a patient die peacefully, especially when the patient in sound mind has said that that is what they would have wanted, is sometimes the ethical, humane, human thing to do.
Friday, January 9, 2009
Sigh
Sorry, bit of a rant.
Working on the gynaecology wards. We have such a major bed crisis that operations have actually had to be cancelled. This is because the hospital cannot get its head around the fact that if it doesn't have as many beds as patients, there will be problems.
Working on the gynaecology wards. We have such a major bed crisis that operations have actually had to be cancelled. This is because the hospital cannot get its head around the fact that if it doesn't have as many beds as patients, there will be problems.
Very expensive suit comes striding up to me brandishing some notes.
Her: "XXXX, directorate managar. Why hasn't this patient gone home?"
Me: (thinking she had the wrong patient or something) "Becuase she had a hysterectomy yesterday afternoon."
Her: "So she can go home."
Me: "No. She can't. She had a hysterectomy yesterday afternoon."
Her: "FINE - can she go tomorrow?"
Me: "I really don't think she'll be ready tomorrow, patients usually stay for at least two full days after an abdominal hysterectomy, usually more."
Her: "Well nothing's going to delay her discharge. Don't you know the hospital's in a bed crisis?"
Me: Smiling politely but wondering what she is going to acheive with the note waving.
Her: "XXXX, directorate managar. Why hasn't this patient gone home?"
Me: (thinking she had the wrong patient or something) "Becuase she had a hysterectomy yesterday afternoon."
Her: "So she can go home."
Me: "No. She can't. She had a hysterectomy yesterday afternoon."
Her: "FINE - can she go tomorrow?"
Me: "I really don't think she'll be ready tomorrow, patients usually stay for at least two full days after an abdominal hysterectomy, usually more."
Her: "Well nothing's going to delay her discharge. Don't you know the hospital's in a bed crisis?"
Me: Smiling politely but wondering what she is going to acheive with the note waving.
Wednesday, October 29, 2008
Compatibility
The boyfriend says to me: "I love it when I clean my teeth after you, you squeeze the toothpaste tube out all nicely for me." We are so perfect for each other!
Friday, October 10, 2008
Stone cold sober and very aware of it
I have been doing cover this week - my usual 9-5ish and then covering the wards until the night staff begin at 9.30. Last night I was bleeped.
"Hello, this patient is not looking well, will you come?"
"Umm, sure, where are you?"
"XXX ward."
"OK what's the patient's name? What's wrong with her?"
"XXX. She had a pleural tap earlier, and she's looking so pale, and she's not breathing right."
"What's her respiration rate?"
"Er, not sure, but not much..."
(Giving up) "OK, if you could get a set of observations now, I'm on my way."
I get there. There's noone around so I just head to the patient. She's on her bed, slumped back, looking pale and limp. Her husband is next to her, not doing anything, just looking a bit worried. I ignore him. I put my hand on her shoulder and ask her if she's ok. She moans and pauses for ages and ages, says she's tired. Her respiratory rate is 8. I put my head around the curtain and get an obs machine. I do the sats first. They're 89 - not terrible, but less than they should be. By this time a nurse - a good one, not the one that called me - comes in to the curtain and asks if I'm ok. I ask her to get some oxygen. Her blood pressure and pulse are ok. Her pupils are small. I do a quick examination of the rest of her, concentrating on lungs, but find absolutely nothing wrong. The nurse comes back. She says "How much oxygen do you want doctor?" I am taken aback for the smallest of seconds at the fact she's asking me with such sort of respect. "10 litres." I say with confidence, not for any particular reason. She puts the mask on and her saturations very quickly come up to 99. I check the drug chart. She's been given 60mg of morpine in the last hour. A lot for a little lady. I go out, interrupt the nursing handover (ah, the reason why noone was with her) and ask the lady's nurse, the one who called me, to draw up some naloxone. "Na ... naxalo ... what?" "Naloxone, you know, the antidote to morphine." "Naxalone?" I get the BNF and open it at the page and give it to her, and write it on the drug chart and give it to her. "I'll check, I don't think we have any ..." "Umm, I really think you do have it, any wards would really - might you go and check?" She goes. I bleep my SHO, cos even though I'm pretty sure it's a morphine overdose, I have never dealt with it before and I was scared. The SHO says she'll come straight up. I go back to the patient. She's still so drowsy. The nurse comes in with the little vial. I'm thinking should I give it? but then my SHO comes in. She does a quick exam. "Yeah, give the naloxone." she says, not really looking worried. I push it in. It's amazing. The lady takes some deep, deep quick breaths and starts getting all jittery, as if she's been switched on. "What is this? I'm feeling so sick, what is this? What did you do?" I reach for a vomit bowl, put it under her face, and I smile. It was so fun. I explain to the lady and her husband what had happened, and said I was sorry for ignoring him earlier. I said we'd keep a close eye on her, but she would be fine. She thanks us. It was fab! Maybe next time I won't need the SHO... ;-)
"Hello, this patient is not looking well, will you come?"
"Umm, sure, where are you?"
"XXX ward."
"OK what's the patient's name? What's wrong with her?"
"XXX. She had a pleural tap earlier, and she's looking so pale, and she's not breathing right."
"What's her respiration rate?"
"Er, not sure, but not much..."
(Giving up) "OK, if you could get a set of observations now, I'm on my way."
I get there. There's noone around so I just head to the patient. She's on her bed, slumped back, looking pale and limp. Her husband is next to her, not doing anything, just looking a bit worried. I ignore him. I put my hand on her shoulder and ask her if she's ok. She moans and pauses for ages and ages, says she's tired. Her respiratory rate is 8. I put my head around the curtain and get an obs machine. I do the sats first. They're 89 - not terrible, but less than they should be. By this time a nurse - a good one, not the one that called me - comes in to the curtain and asks if I'm ok. I ask her to get some oxygen. Her blood pressure and pulse are ok. Her pupils are small. I do a quick examination of the rest of her, concentrating on lungs, but find absolutely nothing wrong. The nurse comes back. She says "How much oxygen do you want doctor?" I am taken aback for the smallest of seconds at the fact she's asking me with such sort of respect. "10 litres." I say with confidence, not for any particular reason. She puts the mask on and her saturations very quickly come up to 99. I check the drug chart. She's been given 60mg of morpine in the last hour. A lot for a little lady. I go out, interrupt the nursing handover (ah, the reason why noone was with her) and ask the lady's nurse, the one who called me, to draw up some naloxone. "Na ... naxalo ... what?" "Naloxone, you know, the antidote to morphine." "Naxalone?" I get the BNF and open it at the page and give it to her, and write it on the drug chart and give it to her. "I'll check, I don't think we have any ..." "Umm, I really think you do have it, any wards would really - might you go and check?" She goes. I bleep my SHO, cos even though I'm pretty sure it's a morphine overdose, I have never dealt with it before and I was scared. The SHO says she'll come straight up. I go back to the patient. She's still so drowsy. The nurse comes in with the little vial. I'm thinking should I give it? but then my SHO comes in. She does a quick exam. "Yeah, give the naloxone." she says, not really looking worried. I push it in. It's amazing. The lady takes some deep, deep quick breaths and starts getting all jittery, as if she's been switched on. "What is this? I'm feeling so sick, what is this? What did you do?" I reach for a vomit bowl, put it under her face, and I smile. It was so fun. I explain to the lady and her husband what had happened, and said I was sorry for ignoring him earlier. I said we'd keep a close eye on her, but she would be fine. She thanks us. It was fab! Maybe next time I won't need the SHO... ;-)
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