When You've Earned a King Cone
Monday, September 18, 2006
On Sunday I did a twelve-hour call in Casualties as part of my Family Medicine rotation. It's a rotation I'm really enjoying for several reasons. The first is that it's really fun to work in Casualties: we see a very wide range of patients, with diverse problems. Most of them are actually sick, and so we see a lot of interesting pathology: from people with trauma and other surgical problems, to medical and gynaecological cases: they all start at Casualties and are first screened by a Casualty Officer which, for the last week, has been me. (Well, sort of.)
Secondly, the doctors of the department have been so incredibly nice to us. I know this sounds like a silly and wussy reason to like a rotation, but it's a big factor. Over the course of the last three years, I've discovered that the kind of person I dislike most is the Doctor-kind. From arrogant surgeons and abrasive orthopods to bitchy gynaecologists, sulky cardiologists and snooty neurologists, I've been shouted at, humiliated, abused and slave-driven by registrars from almost every conceivable specialty. Maybe it's because of the fact that most of the doctors currently in the family medicine department are young ones - community service doctors and medical officers who only finished a few years ago - and maybe it's the fact that the older doctors in the department got into family medicine because they're nice people who actually care about other people in the first place, but we haven't experienced the same kind of interpersonal stress that we usually do when faced with our seniors in a new rotation. The doctors listen to our patient presentations with respect, and don't sigh or crap on us when we suggest an inappropriate investigation or forget about another one completely. They give us time to to take tea and have meals, and even thank us for our hard work at the end of the day. They listen to our opinions and are happy to teach, and never seem to get impatient when we ask them to help us examine a difficult patient or perform a tricky procedure. It's really nice.
And then came Sunday evening. In all fairness, by 7pm, after a long, hard, busy call, I was rather grumpy. We'd had some difficult patients, like the Bronze Lady. She was a woman with emphysema who had been lying in the female medical ward all day, hurling abuse at whoever happened to walk past her. She was sort-of yellowish, and scrawny as anything. The history she gave was one of fifty years worth of heavy smoking and drinking. Every time she stood up, she fell over, and every hour or so her son would escort her out of the unit to have a cigarette. Upon return, she would scream hysterically at her son 'I'm going to fucking bite you! Help! Help! This man is molesting me! I'm going to fucking bite you!' The other patients giggled deliriously through their heart failure and stomach cramps and burning urine at the crazy white lady and her obliging son every time he brought her back into the ward.
And so, at five minutes to seven, the night shift came on. I'd just finished presenting a patient with stomach cramps (oh, stomach cramps! The bread-and-butter of any emergency department) to one of the doctors on day shift, who gave me a plan of action. I then tried to hand over the patient to one of the night-shift doctors, telling her I was just going to go and draw the blood that the day-shift doctor had told me to. And then, at 7pm, home time, night-shift doctor said 'Let's go and examine this patient.' I had already examined the patient very thoroughly, leaving no system untouched, including her genito-urinary one. Night-shift doctor proceded to do another vaginal examination (which made me cross - nobody wants more than one vaginal examination in an evening), and re-described the adnexeal pain I had already told her about. She then turned to me and snapped 'Draw those bloods and put up a drip.' She tossed her gloves into the bin and marched off. By this time, all the rest of the day-staff had left.
I assembled my phlebotomy and infusion equipment, only to dicover that my patient was the Veinless Woman, who also shrieked and prayed in French every time I came near her with a needle. After examining every inch of her arms, I went and told night-shift doctor that I wouldn't be able to get a drip up, but would draw the blood. Night-shift doctor sneered. I then succeeded in pricking my patient three times without so much as harvesting a drop of blood. I went back to tell night-shift doctor that I just couldn't get blood on the patient. She glared at me and said, 'Draw femoral. I'm going to labour ward.' By this time, it was 19:45. I should have been eating my supper. I returned to the patient's bed, to discover that she (a midwife herself) was attempting to draw blood from her own foot. And it was just as she was pulling back on the plunger that the Bronze Lady stood up and, yes, fell over, right onto my patient.
AAAAAAAAAAAH!
I helped the Bronze Lady back onto her bed, and asked a sister to dress the abrasions that had started to ooze on her right arm. As I pointed them out to the sister, Bronze Lady spotted them too, and started screaming hysterically. Begging her to stop, I pointed out that it was just a tiny bit of blood oozing up through an old scab, and that we would dress it nicely for her and give her something for pain. Turning back to the Veinless Woman, I nearly cried with relief when I saw that she'd managed to fill a syringe with some of her own dark blood.
Why is it that it's always at home-time that we find ourselves in the most frustrating situations? Or is it the very fact that it's home-time that makes some situations so frustrating? From the rude doctor, to the two screaming patients, to a woman who only seemed to have 2.5ml of accessible blood in her entire body, it all just seemed like too much to bear. I bought myself a giant chocolate King Cone on the way home. And it was good.Labels: Casualties, difficult patients, doctors
posted by Karen Little @ 4:26 PM,
4 Comments:
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At 11:01 AM,
said...
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thats murphy's law - everything is smooth sailing until you need to go and then it all goes out of control... You so earned that King Cone:)
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At 2:18 PM,
M. Dyspnea said...
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This was fantastic. Thanks for writing it.
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At 9:36 PM,
Miette said...
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Wow, what a crazy night, you definitely earned about five King Cones for remaining sane and professional throughout the whole ordeal!
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At 11:43 AM,
neko said...
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that sounds horrible! you handled it well.
i believe it being so close to home time is the major cause of frustration. i get very difficult if anyone comes to me with work after 4pm.
its just not nice!
