Not so nice part of work II

It pains me to write this but it's important to reflect. Here it continues.

I clerked him in. He was admitted through the respiratory clinic for a few days of fever and cough and was relatively stable apart from the lowish blood pressure. Pneumonia is pretty bread and butter stuff for us in medicine. The previous doctor seen him has given him lots of IV fluid to help with the BP. But when I saw him, his lungs were full of fluid suggesting overload and renal function was bad, so I stopped it. He was able to tell me that he was admitted because of the worsening diabetic foot ulcers. I spotted what looked like DVT, went down to radiology to request for US doppler to confirm it, but evil radiologist refused to do it (even after I asked twice). During day time the primary team (my MO, reg and specialist) saw him and still very undecided about whether we should give fluid or not. The nephro MO said he looked damm dry and ran 2 pints of fluid through, and the BP picked up. However, when we inserted a CVP line in, the central venous pressure was through the roof (20cm H20, normally between 8-12) and ABG showed worsening metabolic acidosis. He needed dialysis. In the meantimes, he deteriorated - could see it in front of my eyes - gasping, colour draining off, BP not picking up, every blood I took subsequently showed worsening. That night before was a bad call - I spent 4 hrs waiting around in HKL just to transfer a stable patient (we had to accompany the patient from our hospital, pass over at the emergency department, wait for ortho to come down to review the patient, then send to x-ray and push the patient to the ward ourselves). When I arrived back at my hospital, there were 7 new admission waiting for me to clerk. I did not sleep and was able to squeeze only 10 minutes for myself to freshen up quickly in the morning. I only finished my last clerking at 7:30am. In hindsight probably should have thought about inotropes, inserting a CVL and inform my MO earlier. The ward was extremely busy as we were post-active that day with 8 new admissions and everyone was really stressed up (I hate days like that especially when post-call) I could sense that coherent thinking was on the low. I had to deal with another of our patient lodged in another ward downstairs with haematuria and ?intracranial bleed (also one I've clerked in last night and forgot to realize that new confusion might = ICB and did not off the anticogulant) - so had to go down to radiology again to request for an urgent CT brain, just after I've been down to radiology for nearly an hour pleading for several US doppler and CTA brain (it's ok, I told myself, it's only consequence of my own action). You can imagine that how the rest of the old patients and even the new admissions who are reasonably stable might feel left out on days like these. Anyway, alas, this pneumonia man was transferred to HDW and subsequently deteriorated and died from presumed multiorgan failure from H1N1 infection. I feel personally responsible and that's not a good feeling.

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