Last day of medicine

Postcall. 9 admissions, two unwell patients, slept 1.5hr last night, which was luxury for house officer. I think I am getting better at managing my call jobs, like having a quick rest while waiting for IV lines and blood taking to accumulate first, then go and do them all at one go. Also getting more efficient at clerking new patients. I'd like to think that MOs like being oncall with me because I'd usually have done everything that needs to be done and sort out the patient before I call them. He/she would just come along examine the patient, look at the investigations results and just add on any management plan that I'd missed out. I still can't quite accept the sleep deprivation part, also why some wards with 3 house officers still manage to leave 8 IV lines for oncall to do, but overall feels much more in control of my job and is spending less time running around like headless chicken.

I'm now at the nephro ward. So far it's been much nicer than my previous general medical ward in terms of the pace, intensity and the work load (and the nurses). Expected the day to be quite relaxing because I am starting my ward work early (7am). Only two bloods to take this morning on my side. Haha, even better. Then at 8am, the other ward house officer messaged me to say that he's taking emergency leave today. Aghrrr! Should have just done the rest of the blood taking this morning then. OK, not to panic. It's still early. So I started the bloods and finished by 8am. Just when I finished and about the send the bloods off, a staff nurse told me that a patient has collapsed at dialysis. I attended stat - no doctor there yet, just nurses doing CPR. Can I hide? OK, again not to panic. ABC. Airway airway. I started bagging the patient, but he started vomiting... noooo don't vomit on me. Laid him to the side and suction suck suck, and continue bagging. Then another house officer arrived, also looked as scared as I was. OMG what to do what to do. I asked for a laryngoscope and an ET tube, the other HO looked at me. Just when I was about to stick the scope into the poor guy's mouth, a familiar senior figure appeared (a surgical registrar whom I met yesterday). Yes! Would you do this PLEASE? I could have hugged him when he said ok. I carried on with the other resuscitation. Sadly after 20 minutes there still wasn't any output, and I suddenly realized that he was actually a surgical patient (and they have enough doctors there already), so I quietly went back to the ward for the more pertinent ward round. (Later I learnt that the patient died).

My MO, registrar and specialists started appearing in the ward. Darn! Haven't finish updating the charts yet. And why are there 3 specialists in the ward today (maybe it's Chinese New Year eve)? Nevermind. More importantly, why why are there only 1 MO and 1 HO in the ward today? When there are 7 patients to discharge and at least 3 central lines to put in? Luckily there wasn't too many referrals, phone calls and scans. My MO and I fell silent when our specialist said he wanted bronchoscopy for one of the patients TODAY. We could only nod without any promise as requesting (begging) for one itself is a mountain of a task, whatsmore one TODAY. Alas our charming specialist said he would call the respiratory physician himself for the bronchoscopy, and we rejoiced in our heart. After ward round, it was just work work work. No time for lunch. Carry on working. Taking out femoral cath is one of my least favourite jobs as I waste so much time (up to half an hour) on compression, and I have 3 of them today! And to go to radiology to get perm cath date and later off to request for CT brain. I hate going down to radiology lately as well because they keep me there for ages and then will tell me that the scan is not indicated and will not do it. Pharmacists let me down today. First it was a Bactrim dose - I doublechecked twice with a pharmacist from the Drug Information Service and yet she gave me the wrong information 4x, until another pharmacist called me up to clarify the dose at 6pm. Luckily the medication wasn't served yet. One of our patients needed to be discharged with an injection, and we called up the pharmacist to come and teach the injection technique several times already, but still at 6pm no one came. Alas, the staff nurse had to demonstrate the injection to the patient. Whilst with my patient after taking off the femoral, I overheard a grumpy old man complaining about why he still cannot go home. Sorry uncle that you are late for you reunion dinner but discharges are on the list of my jobs, after scans, femorals, referrals, prescribing etc etc. Alas, a nice registrar helped sort out that discharge for me. Could have hugged her also.

Sigh sigh. Cheer up Yen! and don't fall asleep. Alas, I finished for the day and passed over. Home for reunion dinner and the start of my two weeks break and the end of my medical posting!

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