Tuesday, 13 May 2008


Yesterday I chronicled the problem of telling one patient to stay on ward at all costs. I found out today that this was downgraded from 'must' (which is, I understand after a prolonged discussion with DGN, unenforceable due to the fact is not a secure ward/unit) to 'should' to 'can go off the ward with someone'. I felt this was a little more considerate. The original problem, however - being stuck in hospital when the patient doesn't really need to be - is still there. The patient is therefore grump-tastic.

So, this patient didn't escape.

A different one did.

Now, as mentioned, we're not a secure unit. Patients can discharge themselves whenever they like. The patient who left is someone I was looking after for the day, but that one day was the only time I'd spent with them. The patient was due to go for an angiogram with the possibility of an angioplasty whilst they were inside. Nothing unusual, I explained. I talked them through the procedure, gave them one of the British Heart Foundation books (which are fantastic, by the way) and the patient complained of not being able to see a video about the procedure up on their previous ward, so we even showed them that. An hour later I clocked off. Coming back on in the morning, it appeared the man had hopped it somewhere between the late shift finishing and the night shift starting. Phone calls shot out to all kinds of people until the nurses on duty trapped down the brother, who the patient lived with. Apparently, the patient had turned up at the pub. They otherwise refused to speak to the nursing staff, but the message was clear. Didn't want any angriogram/plasty, thankyouverymuch. The nurses communicated how vital it was to, at least, go to their GP to pick up the vital cardio-medication and that was that.

I consider myself a decent judge of character, and didn't really see it coming. DGN hadn't looked after the patient, but asked me a few questions about the patient, how long they'd been in etc. DGN then guessed it might have something to do with the patient being an alcoholic. In hospital for the first time in adult life for a few days, and then straight to the pub? Interesting, as ideas go.

This bizarre bay continues with another patient I can't quite get a bead on. In their 60s, the patient has had a rather strange renal reaction to the dye from an angiogram. The medics are umming and ahing and doing other investigations, especially into a very mucus-y cough. The patient is a little... odd. I've been told that they have memory problems early on in the morning, although they're pretty lucid when I'm around. Lucid, but quite strange. Obtuse, even, but I can have a giggle with them. We brought up the memory issues and general feeling of confusion with the medics who spoke to him. The main doctor I spoke to (who is, for the record, the sort of person who would not be attractive if they weren't a Doctor. Come on. You know the type) didn't think the patient was confused, but made getting a more detailed personal history off of the patient's spouse a priority. It was only then that I was told the patient had a stroke/TIA in their history. Surely this should've been on the handover, I asked? Apparently so. But it wasn't. Strange. So this patient, I personally think, has probably always been a bit of a kook in their own way, but not helped by the effects of a recent stroke. But lots of the staff have wrote the patient off as a weirdo, which is a bit harsh, I think. You just need to break through.

I like DGN more and more, especially since I got to work underneath them today. We discussed one patient who is in need of rehab/nursing home care and how they should not be in an acute medical ward bed and share opinions, which is awfully nice. DGN works me nigh constantly, which is awesome compared to some nurses who treat perfectly capable student nurses with kid gloves. It turns out I'll be joined later in the 10 weeks by some third years, which will be interesting. I like being given a run for my money.

Thanks to my efforts none of our patients left the ward for the pub today. I am most proud.

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