Pethidine Pleasure

Thursday fracture clinic was the first time I saw my own patients as a doctor in clinic and then have to dictate letters on them instead of writing notes. FREAKY!!!! It's such an unpleasant experience having to speak coherently into a computer.... and then hear your own terrible voice being played back! I sounded like a drug addict talking stupidly slowly with this monotonous voice that would put an insomniac to a deep sleep. Then I think about the team secretary having to listen to me blabbering like a fool because I obviously have no idea what I'm talking about. Then there's also the parts where I'm talking and then suddenly forget what I'm trying to say... *stunned silence*... then I get annoyed with myself and blurt out "OH SHIT! oops sorry far out geeez... good grief!!!!" Fortunately there's also a way of going back and deleting some of the mistakes...

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On Saturday I picked up a short notice locum for ortho ward calls. During the day I noticed not may of the bloods had been done! At 6pm I discovered that all of the morning blood forms were still not collected by the phlebotomist! When the nurses called to find out what had happened, it turned out that the phlebotomist in the morning had gone directly to the nurses station to look for the forms, despite the fact that they have always been kept in the doctor's area, found no forms and simply walked off the ward! How stupid is that?? Wouldn't you think that it's just a little bit odd that nobody on the entire ward needed blood tests?????

Anyway, despite the blunder, the phlebotomy service refused to do the bloods because it was afternoon and they're not supposed to do morning bloods. I can understand this rule because it discourages doctors from just adding tests willy nilly during the morning. However I felt they should do them as this was an exceptional circumstance because I hadn't added any bloods and it simply was the bloods that their service failed to do properly in the morning!!!

Later on I saw a phlebotomist on the ward and asked him if he would do the bloods. I had even selected the ones which really needed doing and it was only 3-4 people anyway. Our conversation went something like this...

Me: *explain the situation from the morning*... so can you do them for me please?

Phelb: No I'm too busy

Me: Well I've been busy doing the bloods all day which your service were supposed to do this morning!!!!

Phelb: Sorry I'm too busy

Me: Busy doing what?

Phelb: Busy doing IV lines... and bloods...

Me: So are you able to do these bloods please?

Phelb: No, I'm too busy. I'm only supposed to do afternoon bloods and not morning bloods

Me: OK! So I don't have any morning bloods that need doing now, but I have some afternoon bloods which need doing!

Phelb: No you cant' do that!!!!

Then we both sulk and pout and go our separate ways. Then I had to do my own phlebotomy round. It was SO stupid because I was already flat out reviewing patients and having to take bloods from PICC lines... which is equally stupid even though it is my job.

It turns out that the phlebotomists aren't able to take bloods from PICC lines because they aren't certified to do so and it's not safe. Somehow it's so much safer for a doctor fresh out of med school who has never touched a PICC line before to search the hospital intranet and Google to find a PICC protocol, read up on it and take the bloods without supervision on a weekend with only skeleton staff in the hospital. WOW doesn't that make you feel safe in hospital!? At least I didn't need to use wikipedia...

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On another note, I saw a patient on Saturday who was unwell in the afternoon. I didn't do much for her because I decided to just follow the advice from the medical team and keep an eye on things. Later on in the evening she wasn't getting any better. I couldn't figure out what exactly was going on but her vital signs were just starting to go off a little and I felt that the current management plan wasn't working and we were losing this battle. Then I called the med reg and gave a very clumsy explanation of the situation because I was tired from the long day and also confused about why she seemed so sick. I then went home because it was way past the end of my shift.

This morning I found that she had died. What a yucky feeling. Suddenly I thought... what did I do wrong? Did I miss something? Should I have called for help earlier?? What happened!?!? Is my indemnity insurance up to date!?!?! So many thoughts spin in your head in a microsecond. In reality you can't save everbody and sometimes these things happen in hospitals. I realise that. However you also feel really helpless and wish you could do more. One of the other house officers said I'd get used to it after a while. I probably will but right now it doesn't stop me from thinking that it could have been something I did, or didn't do, that caused a death. What a yucky feeling.