Friday, 18 February 2011

12 all out

An hour ago I handed over my on-call bleep to a (disgruntled) SHO about to start her night shift. This act signalled the end of a 12 day stretch of shifts. I should be pleased (indeed I am), but right now I don't have the energy to celebrate too much.

The Monday before last, I came into work with a smile on my face, full of enthusiasm. We were one SHO down on our team as she was working nights but we would manage just fine. The consultant ward round that day went smoothly and the jobs were done by 6pm - a good finishing time.

The next day we were without a registrar, but we coped. I even had some excitement, correctly diagnosing a benzodiazepine overdose and reversing it with flumazenil, impressing the nurses and medical students in the process.

As the week wore on however, we started to flag. The work load was increasing, patients seemed to stop responding to our treatments and our finish times were becoming later. By Friday I was well in need of a rest. The "Friday feeling" was very much evident on the ward that day - everyone looking forward to the weekend. Everyone, that is, apart from my team, as we had a weekend on call approaching with alarming speed.

So the weekend was spent on EAU, clerking the new medical admissions. I love this, it's medicine at its best. Be the first doctor to see a patient, stabilise them, do some initial investigations and start some basic treatment. Any problems and you have EAU consultants and 2 registrars to give you advice. Saturday was chest pain day. Lots of ECGs and troponins were done, but I made no diagnoses of ACS. We had 19 patients on the post-take list. Sunday was less busy with 16 patients clerked, but we had some proper sickies. I went off to see a ?NSTEMI on our cardiac care unit, only to find that it was actually a STEMI and needed thrombolysis. Very exciting stuff.

The weekend itself was alright but I was well and truly shattered on Sunday night. Unfortunately I had to do it again on the following Tuesday, on call with another team for the day - my 3rd 13 hour day in 4. This was also my birthday and so I was hardly pleased to spend the majority of it in EAU.

Our list wasn't getting any smaller and our next take was getting ever closer. Thursday I was on the ward alone whilst my SHO and registrar went back to EAU to clerk some more patients. They even stole my med students, who (unsurprisingly) found the prospect of clerking new admissions more exciting than ordering scans and bloods for me on the ward.

Miracle of miracles, we managed to get rid of all our patients that we took yesterday (short stay cases stay under the EAU consultant) and our list remained at 25 patients. And so roll on Friday - day 12 of 12. Registrar-led ward round, we finished by 1pm, but we had a LOT of jobs to do. This afternoon was utter chaos. I've removed 3 chest drains, pleurodesed another drain, done 3 cannulas, taken 7 sets of bloods, discharged 3 patients, done 3 TTAs for the weekend discharges, checked 6 chest x-rays and made 2 referrals.

And, just to finish off the stretch, I had another 13 hour day today. Ward work finished, I headed off to switchboard to pick up the ward cover bleep, being the first point of contact for 9 medical wards from 5-10. Luckily it was a quiet night. My biggest concern was a hyperkalaemic patient with poor IV access but we sorted it eventually and he got his calcium gluconate and insulin before he had chance to develop any funny cardiac arrhythmias. Come 10pm I practically threw my bleep at the poor night SHO.

So yeah, right now I'm drained. I literally have no more to give. I love this hospital and the town it's in, but I need to run far away to recharge my batteries. So at 6am tomorrow morning I shall be on the first train back to Manchester where I can go and think about something other than medicine.

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