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.
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