Dr Doctor - last MAU days

Back after 3 days off to my last set of MAU day shifts. Very long day today, I wasnt assigned to a bay so floated between all of them, doing jobs and clerking an endless stream of patients with chest pain, PR bleeding, abdominal pain and jaundice, the ubiquitous collapse?cause and 'general unwellness'.

Clerked a dear old man earlier, thought he might be delirious so applied the Abbreviated Mental Test Score (AMTS) before taking the rest of the history (a consultant once advised me that if they score really badly - as in have no idea where/who/when/what they are - then the rest of the history can be a lot shorter as everything they say is likely to be inaccurate). One of the components of the AMTS is to remember an address. Most questions I asked this chap thereafter were answered with "42 West Street" and there came a delighted screech of "42 West Street!" whenever I approached or passed the bed.

Spent a significant amount of time trying to track down a covering letter for a GP admission which had arrived with a different patient's admission letter from a different GP surgery. Finally got on the phone to the correct surgery:

- Hello, this is one of the doctors calling from MAU at the hospital, hoping to speak to one of your doctors about one of your patients we've had admitted.
- Which GP is it?
- Dr Jones.
- He's dead.
- He's dead!?
- Yes, has been for several years.
- Er..

Wasn't expecting that one!

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.