The race is not always to the swift…

“Ag man look at this, it’s disgusting! How’s a person supposed to read this?” Andries said, pointing to a note someone had made on the patient’s ICU chart, “And you guys are always giving me a hard time about my handwriting!” “No Andries,” I replied “When you’ve made notes we have to pass the file around in order to get some sort of a consensus on what it is you wrote.” “Nonsense man, when did this happen??” He asked looking shocked. “Every single time you make notes for a patient” I said, and at this point I could no longer keep a straight face and I may have broken into a giggle. “Ag piss off man!” He said when he realized I was having him on.

Andries is quite a character, somewhat of a legend actually in PE circles. When he was with in ICU with us I found working with this guy like trying to run alongside a fast moving train. He seems to have an endless supply of energy, doing everything at a 110%. If one didn’t know him one might describe him as brash. “Listen here, I don’t care I’m a surgeon I just want to cut!” He once said when I asked him about a patient’s electrolytes. That is obviously not the case, he does care very much about his patients. I used to hear stories about this guy before I came to Livingstone hospital. During my community service year at Dora hospital an intern once told me a story about how once when he was on call in surgical admissions he telephoned Andries for some advice. “Where are your seniors?” Andries asked. The two registrars both happened to be in theatre, operating. “Agg no man!!” Andries replied, uttering a few choice expletives. He proceeded to go to the hospital and on a day when he was not on call and should have been at home, he saw every single patient in surgical admissions with the intern and wrote out a plan for them, much to the junior doctor’s surprise and relief!

Then there’s Jonathan or Jon as we know him. Originally from Kwazulu Natal, schooled in Cape Town and now here in Port Elizabeth for the last 4 years or so, he is the archetypical coastal boy I suppose. His main interest like me, is internal medicine. He is quite literally one of the most intelligent people I have ever met. Insight, and lateral thinking are what come to mind when I try to describe him. He says things on the ward round that give the impression that he is thinking further than what has been presented about the patient. All of this is tempered by the fact that when dealing with Jon one on one I have found that it is always good to have one’s guard up, if only ever so slightly. This is because there is always a small possibility that Jon might be taking the piss.

He once walked into the doctor’s tea room and told Sashelin that there were three patients on their way down to ICU right at that moment, two of them medical and one surgical. They had been discussed telephonically earlier and needed to be admitted. Sashelin is another one of the doctors in ICU, he was on call that day. Jon delivered this message in the afternoon, just as the rest of us were getting ready to call it a day, leaving Sash on his own for the night call. Three ICU admissions all one right after the other is quite a bit of work for one doctor to have to get through on their own. One generally hopes to have that many over the whole night maybe, along with having to look after all the other patients already there.

“What the…?! Tell me a bit more about the cases?” Sash said, a little bit worried. Grinning Jon said “Had you a little worried there eh!”

Also, Jon has two accents: most of the time he sounds like himself, the coastal laid-back ZA boy, but every now and then when he is excited or wants to emphasize something he breaks out into what he thinks is a black African accent. Asides from being incredibly inappropriate it is a little funny at times, in doses. He’s a good guy though, we get along. In between work we’ve had a few good convo’s about the meaning and purpose of life, rugby and other such deep topics.

Sashelin is another character all together. Everything about this guy just screams linear and organized. Including the way he presents patients on the ward round and his approach to answering questions from consultants. He is also a budding surgeon. When he and Andries aren’t arguing about some or other surgical topic they can be found giggling (yes giggling) about something that is only clear to the two of them. Their respective personalities offset each other. Andries will typically storm into a room and exclaim “I just saw this patient,” and he’ll scrunch up his face “Absolute chaos, complete disaster!” While Sash is more calculating.

As one would expect from a perfectionist Sach thinks that anything that any other doctor does is below par. “They did what?…Slacking!” He’ll say while shaking his head disapprovingly. “You’re a slacker!” He’ll say to Andries, “Ja, jou bastard!” Andries will return.

I have mentioned before that I find it hard to (that is to say I don’t) write when I’m not inspired. This translates to not wanting to write when I’m unhappy. So I am much more likely to share the good bits about my Eastern Cape experience than I am to divulge on the times that are not so good.

I have been going through somewhat of a lull at work. I spent about four months working in ICU full time, and the last two months in the renal unit, while still doing my calls in the ICU. It has been quite an experience. My brain is constantly racing, or flailing I should say. Much more appropriate.

Too. Much. Information... Image obtained online from rainnamail. files.wordpress.com

Too. Much. Information… Image obtained online from rainnamail. files.wordpress.com

It is quite something to be in a ward round or sit in in a discussion where after every few beats I’m thinking “Wait, what was that? Wow is that what we think it is, ok… but what does that actually mean, and how on earth did we get to a point where we’re considering a diagnosis of..? Man I’ve gotta read that up (picture scrunched up face emoji). So as I mentioned before I made lists, of topics. EVERY. DAY. It was crazy. I tried to keep that up. The list is as long as my arm right now (and I have long arms!) I can’t honestly quite say how far I am with that…

It’s one thing to look up something but quite another to know it. I very much doubt that I’m the first medic to wish that I could read something once and know it (If only!) You have to see a case, discuss it, go read up about it, see that same case again then see another similar case again later, be reminded of what you read, have the discipline to go back and read it again. This may be over a period of a couple of weeks, months, maybe even years and then, only then can it maybe be said that you know a few things about said condition, maybe… And even then there’s knowing something and there’s knowing it, with all the nuances that it can’t go without. I say it’s advanced HIV and the response is “Stage it, three or four? then I know exactly what we’re talking about…” I say it’s nephrotic syndrome. “No, it’s renal dysfunction with nephrotic range proteinuria, not quite the same thing…”

'Don't over-think it' just doesn't apply here... Image from clipartof.com

‘Don’t over-think it’ just doesn’t apply here… Image from clipartof.com

Herein lies my little conundrum. I have been comparing myself and my level of knowledge (or lack thereof) with the guys that I’ve mentioned above and others like them. We’re all roughly about the same age but they all have at least a couple of years on me in the profession. Sash and Andries have both recently written and passed their surgical intermediate exams and are well on their way to becoming surgeons. Jon has worked in the renal unit where I am currently and in ICU previously and he has just started a masters research degree in anticipation for starting as a registrar some time soon. I finished my year of community service just a few months ago. The difference in experience, and my lack of it, goes a long way towards explaining my sense of inadequacy.

“The first 2 months you’ll feel like you have no idea what is happening, then the next two months you’ll think you know what’s happening but the truth is you’ll have no idea what you’re doing and the next two months you’ll carry on, you’ll feel much more comfortable and you will know exactly what it is that you don’t know…” This was my buddy Gareth breaking down the phases one goes through when starting in a new place of work. “It’ll take you like three days to get into it…” one of the consultants said before I started. “You’ll be fine in about three months…” another doctor had assured me. I had admitted to feeling a little nervous before starting in ICU. Take all of those estimates, average them out and add in the ‘slow learner’ factor and the fact that my learning curve in ICU was truncated after four months and you might get an idea of my slight sense of disorientation and not-knowing. “You don’t have to know everything bru, you just need to have an approach.” Jon said once…

Screenshot_2015-07-27-19-43-20-1

I read somewhere that to live a creative life we must lose our fear of being wrong. In the art form that is medicine however we prefer to be as exact as possible. Given what is at stake most medics would prefer to get as little wrong as possible. This comes with time. With time there is more learning. With time there is experience. I can say with absolute certainty that I am a better doctor today than I was about six months ago when I first arrived at Livingstone hospital but even so I am far, very far from the finished product. The further one goes in the profession the less we can be forgiven for not knowing. The buck stops at the specialist really. Ideally once they have spoken there should no longer be any need for continued discussion about the diagnosis right? Yes, and no. The time factor still plays a role I think: The difference in experience and exposure between the specialist physician who qualified a short while ago one who qualified a few years ago (and continued to learn-it must be added) means that there really will always be some room for a question or two.

This is acute kidney injury secondary to new onset sepsis. It will resolve with the systemic infection. A week or so of antibiotics. Me thinking last week while we were going around seeing the renal in-patients with the consultant. I smiled and claimed a personal victory (however small it may have been) when the consultant looked up from perusing through the file and voiced out loud almost exactly what I’d been thinking. There is something very satisfying about nailing a diagnosis. “The patient was on Tenofovir though,” (a nephrotoxic antiretroviral) I hadn’t picked that up. But the creatinine levels had been normal before the infection…

We each of us run our own race. Some will fly out of the blocks and we may not even see them along the route because they’re so far ahead. They may have been blessed by nature with the right combination of traits that make them really fast, or they may have had a look at a route map before setting off making them better prepared. Others may find the course a little more challenging, what with the hills and other obstacles (those that are part of the route and others that we make for ourselves๐Ÿ˜‹) Some of these strugglers will learn along the route, gaining momentum as they go, gathering pace. A marathon I have found-is all the more enjoyable once one ‘finds a rythm’ so to speak.

The tortoise wins this one we all know that, but what if these two characters were each running their own race? Image from quoteinvestigator.com

The tortoise wins this one we all know that, but what if these two characters were each running their own race? Image from quoteinvestigator.com

We each of us run our own race. At the road races I am one of that crowd that starts out fast. I lose pace the further I go, and I have to fight to finish with a nice time. In life however (at work-in medicine more specifically) I have found the converse to be true, a typically slow start with a slow but sure upward trajectory.

It is probably not entirely correct to liken running to a career as a medical doctor but hey each to their own-frame of reference. I love my job, and I love my running so here goes: It took me over four years of road running to figure out what I had to do to get my body to a level where I could do a sub-4 hour marathon and along with that a sub-5 hour 50km race. Once I had done that it changed the whole game for me, I broke 3hrs 40mins just the other day, but more on that later… I have come to understand that it is going to take me longer than four years to get to a point where it is being said that the buck stops by Pascal, he’s the go-to physician in these parts, no need for a second opinion.

Advertisements
Standard

Same old brain, same old heart…

Down and around on Sparrow drive, left onto Villiers, right onto 14th, right onto Water rd, all the way down untill it turns a sharp right into 5th, then left onto Prospect rd, right into 4th, left into Fordyce, right into 1st then left into Heugh rd. It eventually becomes Walmer Boulevard drive and I have to decide between taking a right onto Forest Hill rd which will take me past the airport then back toward home for what ends up being a 16km run. Alternatively I could keep going on Walmer Boulevard and eventually turn right onto Humewood road and run along the beach front into Summerstrand for what ends up being a 24 or 25km run. Either way I usually end up back on Villiers pushing along the last 3 or 4km, a very slight uphill to the end of my run.

I live in Walmer now, still in Port Elizabeth. It is July and effectively the 3rd month of a new year for me. So new beginnings, new running routes, new legs (kinda feels like that ๐Ÿ˜Œ). Same old heart…

It takes me a little over an hour and a half to run a half-marathon (1hr 35mins is the best I’ve ever done). By contrast it took about a year and a half of studying before I felt ready to write the College of Medicine Part 1 exam (Primaries). It wasn’t a full on effort for that entire period of time. I made the decision to start preparing a year and a half ago. Deciding is one thing, executing is another thing altogether, but I did translate mentation into action, albeit intermittently at first. I spent the first two months of 2014 (the end of my time as an intern) studying like my life depended on it. The renal and endocrine chapters of Ganong’s Review of Medical Physiology were put away with aplomb. I then ran out of steam and seemingly motivation. I did continued, though at a more measured pace. I was on and off over the next few months, days and weeks went by when I was very studious, and other days and weeks passed when I was less so. I finished my internship at end of April 2014 came down here to Port Elizabeth for my year of community service. I continued to study intermittently. In about November of last year I pressured myself into making a decision about when to actually sit for this exam. ‘When I’m ready’ was no longer adequate. A definite time line would also serve to put me under a bit of pressure. After the new year I became a little more consistent, measuring my time more and more by what the amount of reading I had or hadn’t done.

On 31 April in the early afternoon I walked out of the medical ward at Dora Nginza hospital for the last time, having completed my one year of community service. I have now done my ‘Zuma years’ as some would say. I no longer owe the government anything in the way of being fully recognized as a medical practitioner. Nice I suppose, and following that, if I wanted to tomorrow I could open my own private practice. Naturally I’ll do nothing of the sort. No I have a much less comfortable, far less glamorous future in mind. Picture a medical registrarship, long hours and an unreasonable work load at Chris Hani Baragwanath hospital. Picture having ample time to read but way too much material to have to cover and master. Picture HIV and TB, and more HIV and TB. Picture me being able to conjure up obscure spot diagnoses in response to a long convoluted set of signs and symptoms blurted out by a fellow medic on a grand ward round. Picture that. That’s my kind of life.

I had a week-long holiday of sorts at the beginning of May. I spent the first weekend in Johannesburg with my girl, Meryl. We set up house so to speak, at a cool little backpackers on Doris Street in Kensington for 4 days. We spent the days studying believe it or not, she for her midyear exams, the first of which was the following week, and I continued to slog through Ganong’s. I then went across to Centurion, Pretoria to spend a couple of days at my parents’ house.

10 May, 8.05am. I was up. Much earlier than I normally like to be out of bed on a Sunday morning. There were church bells ringing (literally) not too far away, the sun was out and beating down hard. If Long street was a person he, or she (we’ll settle on ‘she’) would be elderly, not frail but hardened and somewhat jaded, with that seen-it-all thousand yard stare. On this particular morning she looked calm, expectant. Breathing easy after the shenanigans that she’d played host to the previous night. I was standing on the corner of Long street and Longmarket street waiting for an Uber. The car pulled up and I jumped in.

Long street, Cape Town

Long street, Cape Town

Grote Schuur Hospital, Cape Town

Grote Schuur Hospital, Cape Town

I had been in Cape Town since the previous Thursday evening for a refresher course for the Primaries organized by the University of Cape Town (UCT) department of medicine at Grote Schuur hospital. A friendly summarized version of ‘everything medical physiology’ with a sprinkling of pharmacology, microbiology, statistics and some other need-to -know stuff. All squeezed into 3 days of back to back two-hour lectures. What we do for kicks eh! ๐Ÿ˜Œ

#geekmode

#geekmode

Difficult thing to get used to again, sitting in a lecture hall and having to maintain concentration. It took me right back to medical school, dosing off every now and then, not due to lack of interest but just sheer inability to pay attention for such long stretches of time. “Let’s hope something something sticks…” Dale had said on Friday morning as the first lecture had started. He and Alex, my Dora-mates and fellow Witsies had made the trip down too.

Seagull. Harbour.  V n A Waterfront, Cape Town

Seagull. Harbour. V n A Waterfront, Cape Town

Caught a little bit of comedy on one of the nights

Caught a bit of comedy on one night

Back in Port Elizabeth after that weekend I started a new job, in the ICU at Livingstone Hospital (LVH). It has been a continuous, seemingly non-ending learning curve this last month or two, and I’m really enjoying it, surprisingly. While being quite challenging, working in the critical care unit at LVH has not been as scary as I had thought it would be before transferring across.

It is a high pressure environment with a neat set of rules and regulations. If A happens then we must respond with B. If C happens then the patient must receive D, if X then Y etc… Protocols. Know what to do, how to do it and when it is appropriate to do so. Not so intimidating when looking at it like that but the thing to do obviously, is to determine why or how X happened isn’t it? That is the real art of what we do as medics. The lady is in low output heart failure, she has a valvular lesion. She has had it for many years, so what is different now that has caused her to tip over, caused her to decompensate…? There is a lobar pneumonia and she is in sepsis. What is the offending organism? What is the appropriate antibiotic? If we decide to initiate… Can we wean her off the inotropes? Get her well enough to get off the ventilator? The gentleman in bed 5. Severe pancreatitis, most likely due to years of excessive alcohol. Now a couple of days post-op, and in respiratory distress, tachycardic. Septic markers inconclusive. Antibiotics? Nope. No real temperature spikes, blood cultures haven’t yielded anything. Is there a fungal infection, maybe…

I’m only a few weeks in and am admittedly a slow learner. The goal is to get to a place where one understands rather than just knows the protocol, why do we do B when A happens, and Y when X etc… I have the rest of the year more or less, to get comfortable and to get better. I am definitely enjoying myself and who knows, perhaps I’ll become an intensivist one day after I deal with this minor detail of qualifying as a physician that is :-P. Oh and while we’re on the subject of my current situation, regarding Eazy in the EC: ‘One year in the Eastern Cape’ has turned into two…

In between all of this new learning at work I continued plugging away at the material for the Primaries. I finally got down to doing some statistics (my favorite! ๐Ÿ˜ฆ ) Research is how medicine and hence patient care moves forward these days. One can’t be a medic and not have at least a basic understanding of statistics, to my chagrin.

Towards the end of May and through most of June my life seemed to become ever more streamlined. Simplified if you will. Life became work, eat study, study, study, sleep. In that order, in ever repeating cycles. I went through an eerily familiar phase towards the end of June. Everything other than what I was supposed to be studying became interesting. On numerous occasions as I was about to sit down at my desk I would think “What was that thing they said on the radio earlier? Lemme google that, I can’t believe Kanye West would…” or I’d realise that I hadn’t been on Instagram for a little while and before I knew it I’d have spent a whole half-hour of my life perusing through images some pretty, and inspiring but mostly bland pointless and entirely non-contributing to my ambitioned future life as a specialist physician… Then I would eventually sit to study and I’d be quite productive for a while until I would think: “What if they ask a question about this…?” I would fret, and quickly look through my notes again, or “What if there’s question on this…?” and I would stop what I was reading and have a quick look at that too. All these questions about these little things. These little molecules, ligands and receptors, these pathways. “My brain is tired, my backside is sore, my back is aching… ” “My everything is everything!” I said to Meryl over the phone one night (insert sad, self-indulgent emoji) “Maybe I should stop studying and download a movie…” There’s a good way to spend this precious time!

This is not dissimilar to my pre-exam behavior back when I was at medical school. In fact the mental merri-go-round, emotions and sense of subdued-yet-bubbling-over stress I was going through felt exactly like it did when I was a hapless student. “That exam is quite soon isn’t it, you look so calm” my colleagues would say. It is most definitely just a look. People also said that about me at medical school, alas it is very different to what I’m going through on the inside. The older I get, I realise the more I still stay the same. “I wish I could redo the last year and a half with a different brain!” I found myself saying to a friend.

I still ran, but only about twice a week and when I did run I seemed to be squeezing it in between the studying. I’d get home from work and put in a couple of hours at the desk and get out onto the road quite late, knowing full well that it would be dark by the time I got back if I covered 15 or 16km as I felt I had to. I felt sluggish, barely ever able to push myself very far under 5min/km pace. Healthy body, healthy mind, a teacher once told me back in high school. But when the mind is preoccupied the body can but to follow suit.

On Saturday 20 June I ran the Heartbreak Hill 21.1km, organized by Charlo running club. 1hr 44mins and a few seconds. Not a time to rave about but I was coasting mostly. I didn’t hang around after the race, briefly said hello and cheers to some of my running club mates who I hadn’t seen in what seemed like for ever, and promptly went back home and kept at the books. On the following Wednesday myself, Dale and three other aspiring physicians sat in a classroom upstairs from the library at LVH and each of us worked our way through the 150 questions on physiology mostly, some statistics, some microbiology and pharmacology. I walked outta there at 12h02pm having handed in my completed paper, after using every single one of my allotted 180 minutes.

That afternoon I was to the airport to pick up Meryl. It had been 6 long weeks since I last saw her and she looked gorgeous!

That was last week. The Grahamstown arts festival kicked off yesterday. There’s a marathon on next weekend. I’m not in very good physical shape at the moment but I’m gona give it a go

Standard

Twelve phone calls…

Image

The first phone call I received was from the intern down at the medical admissions ward. She was telling me that a new patient had just been brought in, a young lady who had overdosed on iron tablets. “Alright,” I said. “You start seeing her and I’ll be there as soon as I can” It was Monday 16 June, Youth Day public holiday, and we were on call. It was 9pm approximately and I was upstairs in one of the male wards, having been called to see a patient who had pulled out his IV line. He was severely dehydrated, and the nurse in charge hadn’t managed to re-drip him.

 

 

The second phone call was from my consultant calling from the comfort of his home (a privilege that comes with being a qualified specialist), telling me what I already knew, that there was a an iron overdose in admissions, “How long are you going to be in the ward Dr Mukenge?” “Maybe 20mins doc” I replied, ย “I have to put in a central line, Nurse in Charge is just preparing everything.” His concern was that we should give the patient deferoxamine as soon as possible. Deferoxamine is a siderophore drug that can be used as a chelating agent that removes iron from the body, preventing it from being absorbed in the gut. “You may have to transfer her to Livingston Hospital, if we don’t have any deferoxamine…” he said. “Sure doc” I hung up and got down to the business of the central line. I was inserting an intravenous line into the femoral vein in the patient’s leg, adjacent to his genital area. Back in my intern days halfway through my internal medicine rotation the head of my unit at the time once asked me if I knew how to put in a central line. At the time I didn’t, and he was displeased. He explained that being able to insert an IV line into one of the large central veins could be the difference between saving and losing a patient. That was then. These days I can insert an IV line into any one of the central veins with one hand tied behind my… no, that’s being unnecessarily flippant ๐Ÿ˜› And besides, I digress…

 

The third phone call was one that I made once I got back down to admissions, I called the physician on call (POC) at Livingston hospital to ask if they had any deferoxamine in their admissions ward. “Ja hold on, I’ll have to ask the nurses” she said, before hanging up on me.

Image

 

I had a thorough look through the drug drawer in our emergency trolley, then took a walk to casualty down the corridor and had a look in their drug cupboard and emergency trolley just to make absolutely sure that what we needed for this patient wasn’t right there under our noses. No luck. I then walked back to medical admissions intending to make another phone call. When I got there another new patient had arrived. She would need to be seen. She was a lady who had been referred to us earlier by the surgeons at Livingston hospital. They expressed, over the phone that they were somewhat aggrieved (read here: pissed off) at having been tricked by the casualty doctors from our hospital into accepting this lady as a bleeding peptic ulcer. She was most certainly not they claimed, her chronic rheumatoid arthritis was her main problem and she had to be seen by a physician (ie yours truly, on this specific night). After assessing her I had to admit that I agreed. There were no special findings on examination. She had very typical arthritic changes of the hands, almost textbook in fact, and she complained of pain in the joints. These are not reasons to go to hospital in the middle of the night however, so what was wrong I wondered. I logged onto the computer to check her blood results and there was a big clue, deranged liver enzymes with an obstructive picture. Some sort of drug induced liver injury? She wasn’t jaundiced, so what was up with her…? I quickly admitted her to be reviewed by the consultant in the morning. She would at the very least need an abdominal ultrasound. Then I went back to the phone calls.

 

 

Phone call number 4 was one I made to the doctor on call at the intensive care unit (ICU) at Livingston hospital to ask if they had any deferoxamine. Reluctant to assist me as she probably realised it might mean transferring the patient to her, she suggested I call the pharmacist on call. Pharmacist on call eh? Hmm… “Nurse do we have a number for the pharmacist on call?” I asked, “There is a pharmacist on call?!” she replied incredulously, “That’s exactly what I thought” I said. “Haibo!” she muttered, as she scuttled off to that secret place that nurses go to find things that doctors are incapable of finding. She returned, sure enough with the telephone number of the head of pharmacy. By this time it was approaching 11pm and I was getting somewhat irate on behalf of the patient. The signs and symptoms of iron toxicity start out fairly benign and patients initially appear quite well apart from some abdominal discomfort and vomitting, but over time it can progress to a full-on gastroentiritis type picture, with bleeding of the gut, metabolic acidosis, and eventually neurological ย findings, including decreased consciousness. Not a pleasant condition.

 

 

So phone call number 5 was to the pharmacy HOD. His phone was off, the call went straight to voice mail. I then explained myself to the matron in charge that night (phone call number 6). She gave me the direct cellphone numbers of 2 of the pharmacists who work at our hospital. I called the first (phone call number 7), and after ringing for what seemed like ages the call was finally answered by someone who was either drunk or very groggy from sleep (I’ll give him the benefit of a doubt, it was probably the latter!) It took a good three or four minutes of convoluted conversation for 2 things to be cleared up: firstly, he was not the pharmacist on call; and secondly, he was perfectly willing to give me the number of the person he thought was on call for the week. Having done that, I apologised for waking him up at such a ghastly hour, and we both hung up.

Screenshot_2014-06-19-16-44-55-1

 

I finally got through to the pharmacist on call (phone call number 8). By contrast he sounded fresh and very willing to help. What does a pharmacist do when on call? I wondered. Stay up all night at home waiting for one of the on-call doctors to call needing an emergency drug? Surely not. How often does that kind of thing happen anyway? More likely, they stay home and hope the doctor does not call! I don’t know, I must ask a pharmacist friend or colleague at some point. Anyway, he had what we needed. He rushed over to the hospital, asking that someone be there to meet him at the pharmacy. Nurse in charge sent one of the male nurses over. A little while later the pharmacist called me again (phone call number 9) saying that he was at the pharmacy, he had the drug but there was no one there to meet him. At the same time the nurse who had been sent to meet him called Nurse in Charge (phone call number 10?) saying that he was at the pharmacy but couldn’t find the pharmacist (I’m not making up any of this stuff! ๐Ÿ™‚ )”He’s there apparently” I said to the pharmacist, “Have a look outside, he’s looking for you.” And it took 2 more irritated phone calls (Calls 11 and 12) from the pharmacist before he decided to just come to us himself and bring the 10 ampules of deferoxamine. Here I must explain, Dora is a relatively large hospital, as I’ve mentioned before, and the pharmacy is way on the other side. One literally needs to drive from medical admissions to get there. To make matters worse, ย my understanding is that the nurse ended up at one of 2 entrances to the pharmacy and the pharmacist was at the other, resulting in that comedy of errors. It was about 1.30am when were finally able to put up the deferoxamine infusion for this lady. She was patient number 12 in what turned out to he a total of 19 on this call, a relatively quiet shift.

 

Image

So there you have it. 12 phone calls in one night just to take care of one patient. Being a doctor can mean having to perform the function of a glorified receptionist.

Doctors have a funny relationship with the telephone. I was in one of the wards not too long ago and, reading a patient’s file I came across a note written by one of the other doctors I work with. It read: ‘The neuro surgeon on call says I must get my consultant to call him back because I don’t sound like I know what I want…’ After having a little laugh to myself I proceeded to call said neurosurgeon. We were seeking clarity on the findings of a CT brain report. Specifically, can we give this patient warfarin which will thin her blood, when there is a risk that the possible vascular malformation in her brain might burst and bleed? “Ah yes I think another doctor from your side there previously called me about this patient but she did not present the case as eloquently as you have…” He actually said that. Well my English teacher would have been proud (no I did not say that aloud! ๐Ÿ˜› ). In all fairness to my colleage though, one of our consultants (not wanting to make the call himself) probably asked her to call neurosurgery, and she not being clued up on the case, subsequently bundled the referral.

 

 

At every hospital I’ve ever been in, as a medical student and after I qualified I’ve always noticed that in a ward full of health care workers, both doctors and nurses alike will not jump to answer the phone. It’s a funny thing, we seem to always wait and let the phone ring for a good little while in the hope that someone else will pick it up or alternatively the person on the other end will give up! This I have realised, is because a phone call invariably means yet more work coming our way.

You can have a bit of fun with it though, I have discovered. “Nurse please just tell them I’m not here” is my most frequent grinning response to “Phone call for you doctor” The nurse will invariable have a quiet giggle (if she has a sense of humour that is ๐Ÿ˜› ) and pass me the phone. Imagine the medico-legal ramifications of the doctor on call refusing to come to the phone to accept referrals!

I was on call again not too long and as is always the case at medical admissions the phone was constantly ringing. Doctors from clinics or GP practises in the area call to refer patients to us. I picked up the phone and the doctor on the other end started rattling off at a clip “Hi this is Dr So-and-So, is that the physician on call?… Ok good. I have a patient here that I want to refer to you, he has a…” I interrupted him “Sorry Doc, where are you calling from?” and he answered “Motherwell Clinic, oh yeah!” I don’t know how I stopped myself from laughing out loud… ๐Ÿ˜€

Standard