Dr Doctor - MAU Days

Back to day shifts this week. Handover at 8am then the FY1 gets stuck in the MAU discharge lounge with the most stable patients that are waiting to go home. Left feeling demoted back to a secretarial role having completed 7 TTOs (discharge summaries) by lunchtime. BORED.

Sneak into Bay 1 to find a Stressed looking SHO juggling three sick patients with 3 others to be seen. Excellent! Patients with Stuff Wrong That Needs Sorting! Park myself in Bay 1 to relief of Stressed looking SHO. Clerk adorable elderly lady with COPD, possible infective exacerbation thereof but patient says she's not more SOB that usual (despite sats of 78% on admission and PO2 of 8 on the ABG), and doesnt have a productive cough. Spot a pleural effusion on the CXR (no recent weight loss/haemoptysis/sweats). Increased white cell count and CRP (inflammatory marker) but recent course of steroids (could raise WCC) Hmm. Consultant comes to review and is also unsure. Cover her with antibiotics for a chest infection (tablets EVERYWHERE!)

Bleeped back to the discharge lounge by nurses asking me to do stuff I've already done. Escape to the mess for a morale restoring cup of tea. Run into a second Stressed SHO running around Bay 3 and jump at chance to help her out. Offered choice between another possible pneumonia and a large PR bleed. Choose pneumonia.

Clerk adorable elderly gentleman with COPD, he's been more SOB than usual, and has a productive cough, sad to hear that the sputum has changed colour to "obviously pink" with some flecks of blood. He's lost 2 stone in weight over 6 months. Hmm. He was ex Navy, had smoked 40 a day for about 40 years, and kept telling me amusing stories about his life. Treat for COPD exacerbation, but suggest needs further investigation for underlying malignancy.

Handover at 8pm and back to hospital accommodation for something instantly cookable.

Dr Doctor - MAU Nights 2

Currently spending the weekend recovering from MAU nights. At least I think it's the weekend, have been genuinely unsure of what day it is for some time now. Have decided one benefit of living on hospital grounds is the 30 second commute to work, but you do have to sleep through the noise of all the wailing ambulances during the day.

The last three nights have gone fairly well, with good variety of patients. Some of the most interesting included a gentleman in post renal renal failure with a urea of 50 and creatinine of 2550 (catheterise, IV fluids to match urine output plus 50mls to counteract post obstruction diuresis) whose creatinine had resolved to 250 by the end of the night. Another chap had come in via A&E with chest pain and been treated as an acute coronary syndrome despite no ECG changes. He was anaemic with a haemoglobin of 6.9 (further questioning revealed he had been GI bleeding for a couple of weeks) and actually had anaemia related myocardial ischaemia (stop antiplatelet meds and clexane, X match, transfuse, OGD).

The last night saw my bay turned into a secure unit - two known violent psych patients both admitted with shortness of breath, one from a forensic unit with two reassuringly large psych nurses guarding him was for male only  nursing and doctoring due to his tendency to attack women. He was actually no trouble, but the other one caused issues demanding oxycodone in the middle of the night on top of his tramadol and co-codamol. Given that he had been admitted significantly hypoxic with a blood gas that showed a PO2 of 8 and type 2 respiratory failure I wasnt about to administer any more opiates no matter how loudly he yelled at me (because they can cause respiratory depression and oxycodone and tramadol are both quite strong anyway). The cynic in me wasnt convinced that he was truely in pain, or at least not the sort that would be aided by drugs - "where does it hurt sir?" "all over my body doctor" ..as he sat looking comfortable at rest. 

The patient wasnt taking no for an answer from me so in the end I went to find the biggest SHO I could and got him to talk him down. Was quite reassured when he completely backed me up, explaining to the patient that I was doing the safe thing by not giving him the oxycodone and managed to calm him down.

Further 3am tutorials on liver disease from World's Most Enthusiastic Med Reg were made bearable by tea and cake, and we all made it through our final morning handover, me with three sick respiratory patients to present to a slightly grumpy highly seasoned respiratory consultant, and retired to bed delighted to have finished nights.

Dr Doctor - MAU Nights

I have once again been thrown in at the deep end, starting my placement in MAU on nights. I'm currently unsure what day it is. Having never done nights before this was all very new.  Main concern was how on earth I was going to manage to stay awake for 12 hours in the busiest department in the hospital and practise medicine to a reasonable standard on all the really quite unwell GP and A&E admissions.

Strategy for first night shift was to wake up mid morning, do lots of exercise to knacker myself out and then sleep for a few hours in the afternoon.

8pm handover resulted in me being assigned an entire bay of 10 patients to look after, and to clerk, treat and triage any new admissions to that bay. I also got handed an SHO bleep, and a crash bleep.

Patients in my bay included a paracetamol overdose (check levels, continue acetylcysteine), a young diabetic ketoacidosis (repeat blood gas, monitor blood glucose, continue fluids and insulin), a seizure ?cause (check bloods, arrange urgent CT and report), 2 young patients with severe community acquired pneumonia (for IV antibiotics), a tall thin young man with a pneumothorax (chest drain in situ) and one chap with terminal cholangiocarcinoma presenting with gastric outflow obstruction, vomiting and hypovolaemic shock (arrange erect CXR and AXR, NG tube on free drainage, antiemetics, fluid resuscitation, keep seniors well informed).

We also had three confused gentlemen, one of whom escaped from his bed around 2 am and, gown flapping the breeze, buttocks defiantly on show to the ward, pulled back the curtains of his neighbour and proceeded to relieve himself thankfully beside his bed and not onto him! "OI!! He's pissing at me! Bastard! NURSE!"

Around 3pm our bright eyed and enthusiastic Med Reg insisted on giving all the juniors a formal powerpoint tutorial on upper GI bleeding. Thought it was a nice touch that he made us all a big pot of tea to drink while we sat and tried to stay awake while he talked about the most recent papers in the field.

Around 6am the crash bleep went off so the Med Reg and I ran across the hospital and up three flights of stairs to find a proper cardiac arrest in full swing on one of the surgical wards. I joined in with chest compressions. The patient was in VF and was shocked 5 times before going into asystole. Resus continued and somehow he went back into sinus rhythm with an output. This was short lived however as he then went into VT. 7 shocks, many antiarrhythmics and some potassium later his heart decided to stay in sinus rhythm and the patient went to ITU. Apparently an echo showed a massive ventricular aneurysm, probably secondary to a huge heart attack, so sadly he probably wont recover from this.

8am handover involved presenting the sickest patients to the day team and then home to bed. All in all a good first night.

Dr Doctor your ear!

Was amused by the following exchange between one of our more deaf patients, and a nurse:

- Hello Leonard! I've got your hearing aid, can I put it in your ear?

- My rear? No you may not!

- Your ear, Leonard, YOUR EAR

- Yes, I know I'm here. Now what do you want?