When you run out of ideas

So this week marks roughly the first two and half months as a junior doctor. Where did that go?! Oh hang on, I know – in hospital.

The last five days has been the usual melting pot of chaos, confusion and fatigue. Mind you, it’s funny how you get used to it so fast – the chaos, confusion and fatigue. So much so in fact that I even managed to get myself to two social engagements in the evenings…miracles do indeed happen it seems.

So what brought the chaos and confusion this week? Well since I was covering the urology team in the first half of the week – therefore seeing me constantly with patients genitalia in my hands as I try and pass a cathether into their bladder to relieve a urinary retention, I was not the happiest of chappies – as well lets be honest, that’s not how I like to spend my days! The second half of the week saw me back to my usual team – the breast and general surgery teams. This is much more in my comfort zone – less genitalia more appendicitis, pancreatitis, diverticulitis and cholecystitis (bascially anything hollow in the abdomen that can get inflammed and infected!). However the dream was soon shattered when my colleagues were struck down by illness and well, secretely planned annual leave – and as a result I found myself with 48 hours of being the only junior doctor on the team…and the on-call surgical house officer! That latter part basically means that when the senior doctors on-call need help seeing patients in accident and emergency I go down to A&E and see them for them…and as a result your “on-call bleep” can go off at any point of the day and shatter your plans for all your usual patients! And of course…the on-call bleep went off constantly…Lucky me!

There is however one patient I want to tell you about. She was, what I like to call, my “character building patient of the week”. This lady had been with us for some months how having had major abdominal surgery for a ruptured bit of bowel that had then given her sepsis (widespread infection throughout the body and blood). An elderly lady she never caused any problems and was always happy and smiling and helpful.

Until today.

On that dark dark day (ok, it was sunny outside but I am trying to build the suspense) I get a bleep from one of the ward nurses telling me that this particular patient is MEWSing (check last week’s blog if you have no idea what I’m referring to!) and that can I please come and assess her. Off I go. The conversation went a little like this:

Me: Hello, Mrs X, what’s the problem?

Patient: Oh it hurts everywhere!

Me: everywhere?

Patient: Yes everywhere!

Me: Can you be a little more specific? I can’t help you as well if we can’t narrow down, ‘everywhere’..

Patient: My chest! It’s a crushing pain!

Me [in my head]: Sh*t she’s having a heart attack

Patient: And my tummy is so tense and I can’t poo or pass wind!

Me [Again in my head]: Double sh*t she’d having a heart attack and has intestinal obstruction and possibly sepsis!!

Me: Does it hurt anywhere else

Patient: Oh my legs and my arms…

Me: So we are back to it hurting everywhere?!

Patient: Yes everywhere!

At this point, guys, I can tell you I am fast running out of ideas. Essentially I was stuck looking at a patient who may possibly be having a life threatening heart attack and abdominal sepsis OR just being a little dramatic. Fact is you have to think worse case scenario and so I proceeded to examine her fully, do an ECG, urine sample, abdominal x-ray, erect chest x-ray, arterial blood gas on her wrist, take bloods to see if she was indeed having a heart attack or infected (but, not actually taking any blood…), call the cardiologisys, my surgical team and the outreach team (a team of expert nurses who float around the hospital helping doctors with very unwell patients)! Oh and the best part was that she refused any kind of blood test or cannula. I mean it was so frustrating – I had a lady who need “access” i.e. a tube in her vein so we could give her emergency fluids and drugs if indeed this was a worse case scenario…and she was point blankly refusing it all.

I had truly run out of ideas.

And as with this job a lot of the time…you know what it turned out to be..

CONSTIPATION.

What a day….

Right all, have a great week and we’ll speak then.

Dr Nick

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