Wednesday, July 20, 2005

Fuck-ups I have made

Well, big night last night at Florey.

What is happening all over the nation at the moment is the changing of the guard. Like geriatric adulterers, or fornicating tortoises in a cold spell, doctors in hospitals can change positions only a few times a year.

Half way through the year is a big changeover. So and so from anaesthetics goes to paediatrics. That guy with the spiky hair goes from paediatrics to surgery (and loses the spiky hair). That cheerful Kenyan girl goes from surgery to psych (and loses the cheer).

And Florey ED is losing several of the doctors from the "People we can put in charge overnight" list, and those places have to be filled, so that means people like me, Dr Longstocking (a cheery, very smart and deeply decent human being who is fast becoming my favourite co-worker), Dr Iskandar Hassan (who was there when we saved the Snow Maiden back in April) , and Dr Maad (a recent arrival from Saudi Arabia who is having a few problems with the nursing staff).

And we (individually) are going to be in charge overnight. In charge. Of one of the three biggest emergency departments in the state. Overnight.

You know, I'm not as scared as I would have been a while back. I still can't say it to anyone face-to-face, but I can type it into the electronic ether: I am good at some things. I'm one of the best in the ED at dealing with psychiatric patients. I am getting better at dealing with my fellow staff members - at being able to say "excuse me, and you may think this is presumptuous, and I do apologise for speaking, but is it not remotely possible that that woman with the chest pain that I asked you to see to admit but that you are sending home will die in the carpark?"

I'm pretty good at being safe. In four years as far as I know I have completely stuffed up the management of only two patients: there have been two where I failed to do something or see something and they suffered. One was an elderly lady with a broken wrist that I completely missed spotting - at four AM in intern year I somehow looked at an Xray and said "no worries there" when there was an obvious fracture. She never got it fixed and now she's got arthritis. The thing that chills me about it is I don't remember it, and I don't understand how I could have made the original mistake. Both bones in the wrist, like a dinner fork.

The other one was the prototype of what I later started calling "SLOP" syndrome: "sweet little old person". These are elderly people, (a lot of them seem to be British, but that's how immigration went around here in the fifties) who come in at three AM and say "Don't worry about me doctor" and describe "a bit of a niggle" in the tummy. An hour (if they survive that long) later the pathology lab rings you to ask if it was blood or chicken soup that you sent up, and the Xray of their abdomen looks like an octopus having an orgasm. Usually you go off to see someone who is complaining of twelve out of ten pain (but turns out to chave something mild) and meantime the sweet little old person is dropping like a rock.

What the autopsy generally reveals is that the blood supply to their intestines has been cut off. If this happens in the hezart, it's a heart attack, in the brain it's a stroke, in the intestines it's called mesenteric ischaemia. Twelve feet of dead bowel inside you is not compatible with life, and I know now that even if I'd diagnosed him as he was wheeled in the door I would not have been able to save him. Moses couldn't have saved him at this stage.

But anyway. Two, while too large, is not a large number. I don't want to add to it in the next few weeks. And weirdly, I'm not that sure I'm going to miss two of the senior registrars who have left: one in particular made me feel less confident rather than more. I know I'm slow, and overcautious (which may sound like a virtue, but can actually be a danger, because an overcautious doctor means an overful ED which means mistakes happen), and there's a lot of the minutiae that I need to get up to speed on pretty damn quick, and I'm going to live in the resus room between now and Wednesday fortnight... but I'm not terrified.

We shall see.


Blogger Stoic Stranger said...

Well now, there are fuck-ups and there are fuck-ups. A job where one of the criteria is the ability to handle the knowledge that ones actions will wind up killing someone is pretty heady. It's also why doctors should get paid the big bucks. Hang in there, and play to your strengths, you have a lot of those.

3:24 PM  
Blogger Benedict 16th said...

I remember telling a patient mid-January this year that they shouldn't bother going to the public hospital tonight and pay the $160 and go to the local Hilton-on-Anzac... Also phoning the diabetes clinic outpatients to get some advice from the diabetes nurse for a specific patient, after trying 3 times I finally get someone who answers and she states they are just starting to see the afternoon patients (it was 4:45pm).
That is the big switch... Interns become RMO, RMOs suddenly become senior registrars and those scared little things in the corners with the Anime eyes are the NEW interns.

Break a leg - John,
I'd rather have you in charge than some of those dudes we worked with at the King George!

I heard some more horror storys about the Shipman Memorial the other day, the occluded Femoral and by the time they got to the Royal not saveable...

Just remember -
"We all have photographic memory, just some don't have film"

6:01 PM  
Anonymous Camilla said...

Can't think of anyone else I'd rather find in charge if I were to be wheeled in on a stretcher one night. Go you! :D

2:10 AM  
Blogger Foilwoman said...

Personally, I plan to travel to your corner of Australia to have any psychiatric, emergency, or other medical care. And I'm a difficult person. Not a sweet little old person. More of a mean middle-aged matron (who is 6' tall). I think you can deal.

4:53 AM  
Blogger Bronze John said...

Thanks to everyone for their comments. I think sometimes I write these when I am a bit low, and it's very therapeutic to look back on some of this and see some of the things people write.

And good blog, too, Foilwoman. Consistently interesting.


11:51 AM  
Blogger Foilwoman said...

Thanks, Doc (I normally use abbreviations, but calling you BJ just seems wrong). And there wasn't even the implied clause ", but deeply disturbed" following the "consistently interesting." It cheers me up whenever I see Australians on my sitemeter, so keep visiting.

3:56 AM  

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