Dr Doctor - how to accidentally save a life.

So this weekend on call has been my last two shifts in Elderly Care as an FY1 and it's been quite a weekend.

Yesterday was a very up and down day. It began sadly, with my first job being to certify a death. I then learned that we had also lost one of my favourite patients the night before, a dear little old lady with end stage renal failure who I'd spent a lot of time on Friday trying to make a little better - she had been vomiting and was feeling rubbish all day.

Apparently she had had a cardiac arrest overnight and the crash team had been called, resuscitated her long enough for her to see her husband to say goodbye. Her last words to him were "it's time to go, my love" before she promptly had another cardiac arrest. Heart wrenching stuff. Most of the medical team were in floods of tears at the time.

So I was feeling kinda sad around lunchtime. Sat myself down to sort out some bloods from a patient I had been reviewing when the crash buzzer went off in Orange Bay. Cue much running of personnel towards the room, including myself. It was only when I got to the patient's bedside and rounded the curtains to find three nurses hauling a very floppy looking patient back into bed from her chair that I realised I was the only doctor.

- Does she have a pulse?
- I dont think so, she just went all unresponsive on me, her BP was really low.

I stepped up to the bedside, frantically observing for signs of respiratory activity and felt for a central pulse. Neither were present!

- Is she for resus?
- Yes I think so.

So I started chest compressions.

- Lets get some oxygen on, can someone find me a defibrillator and stuff for IV access!

Miraculously oxygen, cannulation equipment and numerous extra pairs of hands arrived. Suddenly the Ward Sister rounded the curtains brandishing a DNAR form. While still doing chest compressions I confirmed that it was a form for this patient, and that it had been signed by a consultant.. so with a sinking heart I stopped.

However, the patient appeared to be breathing, and even better, she had a radial pulse!

- Er.. lets stick in an oropharyngeal airway and get some IV access, take bloods and get some fluids going..

At this point the Med Reg appeared - hurrah!

- Er.. so this patient just had a brief loss of output, she is DNAR but she got a few chest compressions from me before we realised that and now she's breathing again.

He smiled and asked for the notes. Repeat obs showed she had a systolic BP of 121 after half a bag of stat gelofusine, and 5 minutes later she was responding appropriately to voice!

I half thought she might pass away overnight, but was delighted this morning to find her sat up in bed, eating breakfast heartily and complaining to anyone who would listen about how her husband had had to go have a lie down the previous afternoon (not surprising given that all this kicked off at the start of visiting hours!).

She had no recollection of the event, and was very surprised to hear that "the doctor had to press on your chest to get your heart going again".

Dr Doctor, Swallow Ass!

During the morning ward round all the junior docs tend to split up and join either a consultant or pair up with another SHO, to write in the notes at the bedside, find the latest set of obs, note down all the jobs for each patient and either do them as we go along or write them on the jobs list to do after the ward round.

After the round I found two of my SHOs discussing the jobs on the list:

-  For Mrs Green  you've written "Swallow Ass", what are you trying to do to her?! Dont you know she's 92!!

- 92 really? That's old. She still needs a swallow ass.

- Little old ladies dont swallow ass very well, especially when they're deaf.

- Her GCS isnt that low though, she should be suitable for swallowing ass.

They didnt understand why I had dissolved into helpless giggles at their conversation about swallow assessments - standard practise in all new stroke admissions!

Dr Doctor - actually a phlebotomist.

On Sundays in elderly care (unlike most other departments in the hospital) there are no phlebotomists. So while the SHOs busy themselves reviewing any sick patients after 8am handover the FY1 has to tour the 8 elderly care wards in search of blood forms and bleed all the patients. This often involves a bit of detective work, and there are inevitably surprise forms left behind by phlebs from the day before with excuses such as "patient unavailable" "patient being washed" "unable to locate site" or my favourite so far which looked something like "patient called me an arse-wipe" which probably actually said nothing of the sort..

Today it took me approximately four hours to bleed 11 patients, cannulate 2 patients, fail to bleed one patient and fail to cannulate another (who yelled "NO NO I NEED MY ARM" when I asked to borrow it to take some blood and flatly refused to comply). I carry the blood taking stuff in a tray with attached sharps bin. One of the more batty little old ladies eyed me suspiciously when I entered her room and asked what charity I was collecting for!

Sat down next to my SHO having sent off the last blood of the day.

- I'd be happy if I never ever had to search for another vein in my whole entire life!
- What do you want to be when you grow up?
- Hmm.. maybe an anaesthetist?

Dr Doctor it was very large!

It's always reassuring to see the successful results of a treatment that has been implemented. One of the tasks in today's doctor's job book was listed as "please review laxatives".

So I went to the bottom of this chap's bed and enquired at standard elderly care level of decibels:

- How are your BOWELS today sir. [It is the sort of word that requires emphasis]
- Oh very good doctor, you should see what the nurse wrote about them. [Beams with pride]

I looked at the nursing stool chart.

Day 1 - smearing
Day 2 -  Type 6 stool - small amount
Day 3 (today) - Type 6 stool - Offensive. VERY LARGE.

- Er.. well done sir.

See also Bristol Stool Chart/ Hull Stool Offensiveness Chart