Insignificant middle man

I had a bad call yesterday. Didn't get even a minute of sleep. And I had only 3 critical patients.

One was a 12-year-old girl with a thrombus (blood clot) in her left leg, and she was in agonizing pain the whole day yesterday. The first surgical team that saw her planned that she was to be heparinized (blood-thinning therapy to dissolve the clot) for a day and if that didn't work, they were to proceed with surgery.

So I was the intern to monitor her heparin infusion, and take her blood every 2 hours to check for clotting time. And the poor girl was very uncooperative because she's been poked too, too many times. A skinny, scrawny girl with a failing heart on top of her blood clot in her left leg.

That was fine because she became my main focus the whole day.

The second surgical team came in at 10pm at night and was very unhappy with the plan of management.

"What the hell are you guys doing with this patient?" He yelled at me.

I was a little taken aback, because as far as I know, I'm just following the surgeon's plan. So I explained what the other surgeon ordered.

"I'm not angry with you Sharon, but seriously, what are you guys doing with this girl?"

So his team changed the management and went agressive with heparinization. So I had to switch mode and set a new target for the patient.

But guess what? the following morning (this morning), the first team that saw her took a look at the plan drawn out by the team from last night, and thought that it was not good enough, and changed it again. Fuck. I seriously don't care what they think is best, or which school of thoughts they follow. Just do right by the patient. Fucking assholes la.

But for now that's not my problem. I've handed it over to the intern oncall today. Poor girl. I just will follow up on her tomorrow morning.

Then when all the other interns who were not on call left for the day, the Urology (study of the urinary system) team handed over a lady with blood in her urine. She was not bleeding as heavily when they were around... but when they left, she started to bleed very heavily, the bottle that was collecting her flushed bladder was turbid with blood. And the staff nurse alerted me that the patient complained of diziness. So I assessed her, and she was tachycardic, and very pale.

Shit. I quickly went through her notes and noted that she was already tranfused 5 pines of packed cells in a district hospital before she was transfered to Queen Elizabeth.

I quickly took her blood for Hb level and to cross match some blood because I knew she had to be transfused. The irrigation that she was on was not stopping her bleeding, somewhere in her urinary tract, the Urology team still hadn't got a clue what her problem was.

I called to inform my MO, and he sort of dismissed me as a little over-reacting, even laughing a little when I toild him that I cross-matched 5 pines of packed cells. (Her Hb level in the District Hospital dropped to 4.0! So I don't think I was being over-reacting) He came only like 5 hours later. And when he finally saw the patient, he was upset with me. He said,

"Sharon, the patient's not doing well. She's tachycardic. Transfuse her tonight. You should have done something for her earlier" (It was already 3am when he came). I guess he was also a little panicky because he had to answer to the Urologist come morning if anything had happened to the patient.

Like fucking what?! I can't just transfuse her without the green light from my MO, especially when she's already been transfused so much for the last 3 days. My MO could have come earlier when I called him to assess the patient, so something could have been done earlier.

But anyways, I suspect if I had transfused her without the ok from my MO, I wouldn't have been praised either.

But it's all for the patient, I keep reminding myself. Do right by the patient. I feel better already just thinking about that.

The other consolation. My MO was a hot one. :) So when he was lecturing me, I just concentrated on his facial features. Yummy. Muahahahah!

The 3rd patient was a case of interstinal obstruction. I have managed a few since I started working, so I was not so worried about her. But it was the timing I guess. Came in around 3.30am. Had to run around getting her worked up to rpepare her for emergency surgery.

It's tough because I needed to make sure that the heparin infusion for the 12-year-old was given acurately and on time because we were puzzled as to why she remained unanti-coagulated fro 12 hours despite continuous infusion and a few boluses. The nursing staff are nice, but they don't have the concept of how certain things are urgent and some of critical. To them, extra work means extra work.

My surgeon would be calling me several times through the night to ask me trace her results and asking me to make adjustments to her heparin doses. and Then finish each call by saying, "Sharon, go get some rest."

??? How ? It's the thought that counts.

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So post-call luckily today is public holiday so I had the afternoon off after morning work is done. Got home, slept couple of hours, and then wanted to swim. The condo pool was being serviced, so can't swim there. Drove 12km to Likas Sports Centre to swim, it's closed. I forgot, it's Monday. Shit. Close tomorrow also. Wednesday then la.

And I'm oncall coming Friday. Luckily. I can't face another oncall if it had been sooner. Last week was oncall every other day. So fortunately this week only 2 days.

So since I can't destress with swimming, I drove to this internet cafe just to destress. :) And it's working, thank God.

Now hungry. Want to eat Japanese, Italian and McD. How? And I want to pee but I wearing my swim suit under, a bit hard to pee.

Other than work, I'm perfectly fine. My left toe reminds me constantly that I need to slow down. And I want to learn to be more relaxed. I don't actually feel panicky, but I get people telling me to relax, to chill. Is it my face ang\d my actions, or is it just how panicky feels like?

Other better key off now. It starts getting dark around 6.30 freaking pm here in KK. I need to find food.