So we had a difficult patient to contend with this week. A 23 year old man who had come in with generalised abdominal pain and apparent urinary retention. He had a tendency to roll around screaming in "pain" until someone gave him morphine, which was "the only thing that ever works".
He had several ultrasound scans of his abdomen, all of which were normal. All of his blood results were normal. He already had a urology outpatient appointment booked. We could not find a cause for his pain and were keen to discharge him but last night he kicked off after all of our team doctors had gone home and refused to leave, screaming that we had called him a liar and we had "promised" to find the cause of his pain and urinary retention. He was given some more morphine which kept him quiet until ward round the next day. My registrar asked me to get the urology registrar to come and review him before sending him home.
So I bleeped the on-call urology reg who was of course, scrubbed in theatre. Cue a three way conversation via a nurse ending with him saying he would bleep me back. He recommended we get a contrast CT of the patient's abdomen just to rule out absolutely anything and then discharge him. So I dropped the request form down to radiology, fully expecting it to be refused given the high dose of radiation it would incurr for such a young patient.
Sure enough, I get phoned at 1630 by a radiologist on the warpath:
- Who am I speaking to?
- This is one of the surgical house officers.
- Oh god. [in possibly the most dismissive, unimpressed sounding voice I have ever heard, bar the cardiology reg I pissed off in my first week] Is there nobody senior there?
- No. My registrar is in theatre.
- Well, no offence [some taken] but you dont know this patient.
- Actually I have seen this patient every day for the past week, would you like to hear the story?
- Why are none of your seniors available?
- My seniors are in theatre.
- Right well, this is a massive dose of radiation to give to such a young patient [in a very condescending tone as if I couldnt possibly have known this myself] and all of his other scans are normal so this might be a totally unnecessary investigation. What are you hoping to achieve?
- I understand that, and I agree. We are not expecting the scan to show anything and are hoping to discharge this patient, but the urology registrar requested this scan before discharge.
- Well this is ridiculous! [quite clearly blowing a gasket on the other end of the phone at this stage] We cant just go around pumping radiation into people unnecesarily!
- I understand that. Please can I give you the urology registrar's bleep number so you can discuss this with him?
- Yes that's a good idea. Did he come and see the patient?
- No he did not. [I start to feel slightly uncomfortable that I may be getting the urology reg into trouble here, he'd been really nice to me on the phone, although he really should have come to see the patient]
- WHAT!?? [silence. I'm concerned he may have just ruptured a berry aneurysm and died] Does the patient have a psych history?
- Yes, he is on quetiapine.
- So you're asking me to scan a young man with unresolving abdominal pain with normal test results and a psych history??
- PLEASE can I just give you the urology registrar's bleep number?
So I give him the number and he slams the phone down on me. How unreasonable!
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