Throwing in the towel

Yesterday was one of the worst days since I have started working.

 

On call the night before was not particularly heavy. But one of the new patients had a seizure requiring urgent CT brain, and another was vomiting and bleeding fresh blood (with other issues like extremely difficult vein and relatives who refused to let me poke her to save her lives. Acutely ill patients like this takes up a lot of my time and energy, leaving less for the rest of the jobs. As well as that, I had to deal with two of my usual patients in my ward – one wanted to discharge himself and another wanted me to write letter of a summary of his condition for financial help (which was not urgent in my book, can wait). Also at the beginning of the oncall, no one could contact the other HO – so I ended up doing several jobs for him as well. I did finally get a chance to have my dinner at 3:30am. My last 3 admissions arrived after 5am. Usually if I am still having lots of unsettled jobs by 6am I start to panic because it is my experience that if I don’t start my usual ward job by 6:30am, everything will be delayed in the day. After clerking the last patient at 7am, high dependency (HDW) started calling to ask me to take blood. I only finished the new patient clerking by 7am. Imagine the shock when they tell me that I have to take blood from all of the patients there. HDW patients’ bloods are not easy to take as they are usually very sick. I was still doing bloods there at 8am. Really really stressed up then thinking that I still have to shower, morning bloods at wad warga and 2 hours late for my ward work, and I just couldn’t hold back my tears and snouts while actually poking a needle in the patient. Luckily Debbie and the medical students were super efficient that morning to have finished all the bloods by the time I arrived. Such is the usual arrangement that the oncall person has to do the morning bloods for HDW and wad warga (as well as CCU, CRW sometimes) as they don’t have house officer there and I feel really being taken advantage of. Do they not realize on normal days we have to start our regular morning blood taking as early as 6:30am to avoid running behind?   

 

Prof was in a bad mood yesterday. Everyone got some bullets from her, from the medical student right up to the registrar. Even I was unusually alert (normally I am half asleep in rounds post-call). So many new patients. My registrar was amazing and helped me out and didn’t take forever to review the patients. One of the patients was from Debbie’s side – so many things not done – so I had to pick up the pieces and answer when prof and the other specialist demanded to know why things were not done. Usually my MO follows round on my side but she left half way today – so I had to be totally in charged of all the jobs for the patients on my side.   

 

Half way during the round, a nurse from the other ward called me. In a very fierce tone, she demanded to know why had I not prescribed the medication for a patient admitted last night. Really? When she told me the name, it didn’t even ring a bell. I left the ward round and went down to that ward anyway. The specialist in that ward started questioning why have I not clerked the patient, and the nurse started asking if I’ve not clerked the patient who was it who wrote in the notes? Looked at the notes – no one clerked the patient; in fact the nurse did not inform me that patient had been admitted. They called the nurse on duty the night before – indeed she admitted to have forgotten to call the on-call doctor to clerk the patient in. OK. Scolded for nothing of my fault, but nevermind. I hate nurses in this ward.   

During round also, the patient from the night before who wanted the letter for social welfare became really angry and shouting around saying that I have not given him what he wanted. The registrar kindly sorted out the problem for me, and the patient apologized (all very civilized after), but still didn’t stop me from feeling very incompetent and that all was my fault. 

 

Then in the evening I was doing a discharge at the other ward, Debbie called me and spoke to me and Mandarin, asking if I have made a referral to gastro, which I did, and said the MO told me to come back here immediately because he was very angry. I rolled my eyes. OK OK I made a late referral. Nevermind there was a 2 hour Friday prayer break, nevermind that I was given passed around 3 people before being passed to the right gastro person for referral, nevermind that I had 1000 other more urgent jobs to do including helping Debbie with an extremely difficult blooding taking, nevermind that whenever I tried to do referrals nurses or some other people would snatch the patient file away from me, nevermind that the phone is constantly being used. It’s my wrong. Always. Stressed out, I cried again. I told the nurses my eyes were red only because I was tired.     

 

Looking after 12 patients (from yesterday 16) may sound easy. Sometimes, but usually not. There are always so ill that they shouldn’t have been in the general ward. A patient on BIPAP (breathing support) needs bloods every few hours. There was once when three doctors were spending 3 hours inserting an IV on one patient. Do you know how much work could have been done by 3 doctors in 3 hours for the rest of the 27 patients? As houseman we are the ones responsible for the unpleasant job for poking people, and I just get so much complaints and abuse every time I approach some of these patients. It is not me who want to poke, I am nothing but a slave. And because I am around all the time, relative comes to me to discuss about the patient just when I am rushing to finish through all my discharges. And nurses would call you to ask about insulin doses, prescribe drugs, do IV lines, see acutely ill patient etc etc. I know it is important to know the progress of the patient for the relative and attend to ill patients, but it is even more important that I get through my 7 discharges this evening without interruption.  

 

So yesterday was a really bad day. I went home at 11pm (40 continuous working hour in hospital) and still there were 4 referrals not done, one phone enquiry not done, many forms not filled in, 2 blood cultures not taken etc etc. Patients are staying in hospital unnecessarily long because the houseman is too incompetent to sort out all the jobs in time – and I do deserve to be told off sometimes. Making referrals and requesting for radiological scans especially, we needed to be very clear of the patient history and progress, and know exactly why we are referring a patient and have the necessary investigation – trouble is I don’t always know. The workload is so heavy that I needed to work at bullet pace. There is no time to think or discuss why things are happening or needed to be done, no time to read or check things up. That’s why I’m still so blur with regards to the management of common medical conditions. I have been working for 6 weeks now and I am still so unorganized – I really doubt that I would ever be up for the job.

 

It is nice when my senior says things like ‘Of course she’s good, she’s my houseman’. Yesterday a sister said ‘O… you are Dr Tan. One of the senior doctors said you are very good’, and I told her ‘OK. But I don’t really care.’ Now I have started not to believe people when they tell me I am doing a good job or anything like that. I don’t want to be complacent even for a bit. Can’t afford to because I know I am not.

 

Now my parents are also angry at me because I am leaving home earlier and earlier and going back home later and later everyday. And they get upset if I tell them that I haven’t been to the toilet all day or haven’t eaten anything all day (especially when oncall, can go by without lunch, dinner, breakfast and lunch on the next day). So, I avoid telling them anything of this sort now. It is physically and emotionally draining to be parents of houseman.

 

Stages of bereavement: Denial – Anger –Bargaining – Depression – Acceptance  

I am still at the denial stage.

 

Finally learnt how to apply for leave yesterday. Might get a day off or two soon.

 

 

.