Small Victories?

I heard a patient say to his wife “She’s really good!” after I left the room.

I would have taken it as more of a compliment if it hadn’t been immediately after a DRE.

My delirious paranoid patient interrogating me on anything I try to do.

They were also accusing us of destroying their kidneys and forcing them into ICU and not letting them leave. No ma'am. That was the diabetes you just woefully ignored.

One of my residents at work (dementia) pooed in his chair and all down his leg, then blamed me for ‘planting it’ on him.

Winning Admission of the Day

“Patient admitted for rhabdomyolysis and AKI after prolonged running during psychotic episode related to meth overdose.”

Dear med students:

When it’s 4am and the ED is dead and the residents tell you to go home.

FLIPPING GO HOME. Stop arguing with us. You don’t have to ‘finish your shift’. Just go while you can.

You know what I would do now for someone to tell me to leave early? Lordt.

Who r u ppl?

My classmate (also ex boyf) on IM did this every day. I wanted to fucking kill him.

This frustrates me. Also when medical students say they “didn’t have time for lunch” or a break. You do. I have never missed a break or lunch because if you say to the consultant/nurse/other healthcare professional that you need to grab something to eat before whatever it is you have next, they are totally fine with you doing it.

Journal comic.

This needs about 100,000 more notes.

Do you know the signs of Christmas disease? https://artibiotics.com/blog/christmas-disease

Not entirely a surprising revelation, though it’s worrying that the extent in many hospitals is this significant. As I’ve said frrequently before, many of us work on rotas with gaps, we’ve become to understaffing as a part of our work environment. But there could be huge implications for the quality of care that patients are receiving and will receive.

This past week in American Healthcare during residency:

-My co-resident and a GI fellow were unable to secure a woman in her 40s a liver transplant or even a spot on the transplant list because: money. Insurance company denied her because she can’t pay for it. That’s it. She meets all medical indications. She is a citizen. But every hospital heard she’d never be able to pay for this transplant and got spooked. Her average life expectancy without transplant: 3 months. 

-My oncology fellow spending most of yesterday on the phone or emailing a pharmaceutical company trying to get what is called ‘compassionate usage’ of an immunotherapy drug for a 25 year old woman who has no traditional chemo options left. She has a genetic mutation that is targeted by this particular immunotherapy drug and could potentially recover a significant amount of function, albeit she will not be cured of her cancer. Median life expectancy at this time: 2 months. Based on current trial data on this immunotherapy drug, median life expectancy: 1 year

-My newest patient lost his insurance because he was diagnosed with nasopharyngeal cancer and could not work in between rounds of chemotherapy. He came to the hospital I work at because we are a safety net hospital so that we could resume his chemo. He has a localized mass and once he completes chemo, he can get surgical resection, do adjuvant chemo, and be potentially cured and live a normal life. Without any treatment, median life expectancy: 1 year or less. 

ARGH.

This is dangerous. Scary. Crazily self-important.

See this is my problem. Everyone who reblogged this (other than shrinkrants) seem to be LOOKING UP to this as an ideal. That’s insane to me. This sounds like willingly destroying your own psyche, your own humanity. Why do all the other premeds want this? Am I not cut out to be one of them, since I don’t want this?

No that doesn’t make you not cut out to be one of them. We need to change practice and attitudes like this, who wants a surgeon (even the most skilled) doing a complex operation when they have less than 4 hours sleep? Driving whilst tired is more dangerous than driving drunk, so imagine the impact when doing fine-tuned and difficult surgery.

Not only are you putting patients at risk, but you’re putting your own health at risk and priming yourself for burnout.

You know what I think would help junior doctor morale? Offices.

My life would be made so much easier if I had an office. Even a cube in a shared office would be fine. My own desk, computer, printer, phone. That’s it. A space to leave my coat and bag that isn’t a scummy 3x5 metre changing room used by over 100 other staff and burgled every once in a while. Just somewhere I could do all the mandatory extra work (audit, teaching, online learning, portfolio, reflection, exam revision) that doesn’t involve taking hours of work home every week or borrowing someone else’s computer.

(BOH was the same too - of the 19 wards I worked on, FOUR had a doctors’ office. If you were lucky, you got a tiny cramped room for 5-10 doctors, with 2 computers, one phone, and about as much clutter as an episode of Hoarders.)

I’ve never even had a locker at work. And apparently extra changing rooms for staff is “not a priority”. How do we expect doctors to give their best when we aren’t provided with halfway decent working conditions?

Actual proper offices? God, that’d be like winning the lottery. I completely agree. Between med school and doctorhod, I’ve seen a lot of hospitals, and it’s almost always the same. I’ve been in new shiny hospitals, and they are sometimes the worst; nobody seems to remember that docs and nurses need team rooms, and need communal spaces to work, or to rest. Half the hospitals I’ve worked in have had really shoddy doctors’ offices on the wards. If you are a junior (FY1, SHO, registrar)yYou get a shared office for your department, if you are lucky. Nowhere near enough computers. Nowhere near enough space to work. You can try to borrow the computers on the ward, only there’s nowhere near enough of them, either. They tend to be slow (Windows XP is still a thing in the NHS; welcome to the past!) . The computers on wheels usually don’t work. Plus they are always at an awkward height no matter how you adjust them, so it’s not great for your back.  And you’re always getting told off by the ward clerk or the ward sister for pinching their computer, when the only reason you’re borrowing it is to do the discharge paperwork they are incessantly hassling you to do. Sometimes you’re made to feel as if you’re an inconvenience for needing a computer to do your job. I know they need computers to do their job, but so do I. And it bugs me that they get a computer, but I have to vie with far too many other people when all of us need access to technology to look after our patients. As for printers,  good luck trying to find them. Or keeping them stocked, unless the clerk has let you know where supplies are hidden. I’ve never had a locker. I know what they look like; I even had one in school. Marvellous inventions! I’ve seen them in hospitals, but they always seem to belong to someone else, and even if they are there for doctors, the last lot have walzed off with the keys, so you can’t use them anyway. Nobody really cares about making sure your stuff is safe. I keep all my valuables on me in a little bag, and my relatively inexpensive proper ladies’ handbag basically only holds my lunch. That stays in the doctors’ office, but only because I doubt anyone would nick it. However, thefts can and do happen in hospitals, because as you can imagine, there are a lot of people walking around. Sometimes it’s even a struggle to find staff toilets. Again, nobody tells you where they are, either. They’re usually sort of hidden so well you’d never even guess they are there. I personally love when the wards in a hosptial are all clones of each other. Apart from the fact that it’s really disorientating when everywhere looks the same (I love colour coding floors or wings of a hospital for this reason; takes the guesswork out), because then you know where the treatment room is, or where the doctors’ room is, or where the toilets are. And as for knowing the codes, again, nobody tells you any in advance, so your oncalls will be a frantic flurry of documenting codes for getting into toilets and treatment rooms etc for each ward until you memorise them all. As for phones, doctors’ offices usually have one, and it’s far better to use that one than any of the ones on the ward, for the simple reason that if you’re waiting for a bleep back, you won’t end up stuck fielding lots of calls that you can almost never help with. Whenever I end up at the front desk and answer the phone, I end up running around looking for the nurse who actually can sort it out. Rather than whatever it was that I was meant to be doing, which is probably more urgent or important. I’ve never had access to on-call rooms in the 3 years I’ve worked as a doctor. Working overnight and hit a quiet patch? If you want to snooze, you’ll have to pick the mouldy sofa, or the office chair. Perhaps if you’re lucky, you can borrow one of the clean patient blankets if you feel cold, so long as you chuck it in the wash in the morning.  And it’s worth noting that some trusts threaten to report you to the GMC if you fall asleep on nights when there is nothing to do. Even though you’ll be bleeped if you’re referred a patient or if the nurses need you to do something. And I think that says a lot about how much some hosptitals care about their doctors. We’re meant to have access to hot food any time night or day, but this is rarely provided. Some hospitals have hot food vending machines, which gives you the option of a ready meal that you heat up in a microwave provided. Hospital canteens sometimes close really early (earliest I’ve seen is 7pm, haven’t they heard of dinner?), but what about all of us staying overnight? Most canteens are locked overnight, so even if there are vending machines there, you can’t access them. The worst thing is, in recent years, there’s also been a clampdown on vending machines for sugar tax reasons. In the name of being healthy, they’ve basically stripped the only food and drink we actually have available on night shifts. It’s just needlessly grim. We should always have the option to buy food or drinks readily available to us; I don’t even care if they put in those pretentious ‘healthy eating’ vending machines. As for doctors Messes; they can be nice, but it really depends. I’ve been in messes that always had tea and coffee, milk, food and snacks. But many are grim and poorly stocked, and as a result nobody goes there. Which is a shame, because a good mess is a place of community and bonding. It’s somewhere where colleagues support each other after a bad case, and where you learn a lot about being a doctor from your peers and seniors.  A hospital without a good doctors mess that doctors want to go to, is a hospital without a heart.  We pay mess subscriptions to our hospital so that our mess committee (usually a few FY1s) can buy food or put on events. But so many doctors’ messes are grim, or tucked away so far from where the doctors need to be, that they rarely go. Hospitals never really put any effort into keeping their doctors’ messes clean, or well-stocked. If it doesn’t affect patients or the CQC won’t see it, who cares? It’d be an absolute dream if we definitely had a space where we could work. Or better messes. I wouldn’t even mind sharing. I don’t think it would ever happen, for the simple reason that the NHS is so, so broke. I think the environment set out for us to do our job is usually far from optimal, and junior docs have just sort of put up with poor conditions to the point where it’s basically expected.  

My ward is the best I’ve seen for a doctor’s office.

There’s a staff room with a sofa, a microwave, a hot water boiler and the nurses lockers.

There’s also the ‘MDT room’ aka doctors office. There’s a cupboard just for doctors to put their bags and coats in. There are two computers (a third when the discharge coordinator finishes at 3pm) and three phones. And a fan which is crucial because that room is an oven.

We even have a staff toilet on the ward. It only took a month for me to find that out!

We (colorectal juniors) have a doctor’s office that we share with upper GI. That means 6-12 people sharing an office with 3 chairs… probably designed for 2 people. There’s no place to put our bags. Someone on my ward has had their phone stolen (or they left it somewhere, but they swear it was stolen from the doctor’s office).

Deserted but not Alone.

It was one of those shifts. One that dragged on and on and was mostly spent with the nurses huddled together at the station, giggling over something ridiculous a patient said.  It was low-key and low drama.  Perfect for seasoned nurses; a real bore for new ones.   Our manager, a gem of a lady, came through handing out shots of expresso to boost us.

We were all laughing and having fun when my charge nurse said quietly, “ Do you think we could move this group into bed 7?”  

I looked at her surprised.

“How come?” I questioned immediately.  Her response was equally quick.

“He was just made comfort measures, they are starting morphine … and he has no family here or that’s coming.”  

We all immediately stopped lounging and got up.  Our orientees dogging our steps, we filed into the room.  All 9 of us on the floor.  We took turns murmuring our hellos or simply squeezing his hand.  He peered at us and nodded.  He had been on our unit for a few weeks and we had all, at some point, encountered him.  He was simply adorable.  His wife had severe dementia and didn’t know him anymore.  His only son was estranged.  His neighbors had already said their goodbyes.  

One of the nurses who had him the most leaned over to him and said quietly in his ear.

“Your wife is ok.  She will be taken care of…” she paused and squeezed his hand, “You’re with friends now, ok?”  

He opened his eyes and looked around glassy eyed as his oxygen levels dropped.  9 figures in blue surrounded him.  He nodded briefly and closed his blue eyes.

“My friends.” He repeated to himself over and over.

Tears clouded every eye in the room and the ones closest laid a hand on him as we watched silently as the color drifted from his cheeks.

The new nurses looked around nervously as death came into the room.  The rest of us were stoic with shimmers of tears threatening to spill over as we watched the last bit of life drain from his face.

I stepped back and discreetly surveyed the room.  All eyes were either looking down or at him.  Bittersweet smiles on their faces as they knew he was at peace.  9 nurses, side by side, grieved for this man whose family was unable to do so.   It was in that moment that I could see how lost the hospital would be without nurses, how sterile and heartless it would become.   I stood with 9 of my coworkers who work short staffed constantly and nearly half have been hit or bitten since I have worked with them.  They are degraded, ignored and yelled at by patients, families and staff… and yet they are the most humane, sincere group I have ever known.

This patient died without family.

But he did not die alone.

You know medicine has ruined you when you see the name of this pasta and instantly think of ECGs…

Today I delivered my first baby! The patient cried, then I cried, then the baby cried and I got shat on.

Important to the Medblr and Nurblr community - as well as the other hardworking women who are both a mother and a professional.

You don’t have to feel guilty about pursuing your passion while raising a family.

This is why the Cabbage is so great.