Tuesday, 17 June 2008

Swings and Roundabouts

Today started off really well. I got to work with the Ward Manager who was happy to give me four patients to personally look after. Responsibility is something of a drug, sometimes, and I was drove on by this new challenge. The patients in the bay arguably like me a lot, so it seemed like a good day. Two of the patients caused a little trouble with insulin-based hilarity, but nothing we couldn't handle. Still, there's no such thing as a perfect day.

Doctors, chest pain and upset

One of the patients in my bay has been in hospital for a long time, awaiting a CABG (a heart bypass, essentially). Noone was really sure why the patient is in. The patient seldom scores anything on EWS and previously managed their own condition outside of a hospital setting. I pressed for weekend leave yesterday, which was accepted. Today, however, a consultant decided the patient was fine to leave and have their CABG done as an outpatient. The nurse in charge refused to give this news, much to the annoyance of one of our HOs (House Officer, not gangsta-type ho). The nurse in charge says that this is a medical issue, and leaves it at that. The patient is told, and is elated.
Obviously, this good news would be too lovely to happen without a hitch.

After telling the patient that they could go, the HO then decided to ask them about chest pain. I wasn't there, but apparently the patient admitted to having slight chest pain frequently, although it went away with medication. Ho went off to speak to said consultant. Guess what? Discharge denied.

There was some debate about this issue within the nursing team, inspired by yours truly. I frequently jump in on ward rounds and, considering the patient's history of cardiac problems, they are never quizzed about chest pain. I argue that it's a bit stupid of the doctors to give such news without having all the information, as well as the fact that they never quiz him about such pain on rounds. The nursing team ask patients about pain three times a day, and until now the patient has always denied any. Senior nurses argued that the patient was a grown human being and should've reported said pain off their own back. This, anyone in nursing may realise, is a big problem in itself.

Now, don't get me wrong. The patient isn't in the right 100%. But some more, let's say, old fashioned types can be hesitant to admit anything that they (or they fear others, perhaps?) could see as weakness. Doctors should be aware of this. Whereas one (including me) could argue the patient has lied to the nurses about experiencing chest pain, at least the nurses asked. The doctors did not. This - on top of the fact the doctors revealed the news of a discharge without getting all the pertinent information - puts them slightly more at fault. I was upset, but have cheered up a little bit since. The saddest part is that the patient is not only in a terrible mood, but has admitted that they will never tell the truth about chest pain again as they believe it'll keep them in hospital more. This breakdown of trust between the patient and the MDT is probably the worst fallout I could think of.

Burning everyone out, even the young?

Hot Third Year, a sometime reader of his organ, is the latest in a long list of people on my current ward suffering with burnout. The sad thing about said ward is that it makes people feel deskilled. For an idealistic young first year like myself, it's fine. But for people who are actually good at their jobs, it can be a motherbastard at sucking away confidence and love of the job. There are good days and bad days, clearly, but I know, for example, Hot Third Year had one of the latter today. I'm too inexperienced to have been onto one of those bad days, yet, but I'm not looking forward to them.

As of today, I'm feeling a lot better. As observant readers may observe, I'm home excessively early from working a long day. Getting let out early is lots of fun. And despite the challenges today, I feel psyched still. On the whole, I looked after my four assigned patients as competently and well as could be expected. Hell, more so, even. I've even put a couple of spoke placements in the pipeline. Productive, eh? To paraphrase Sgt. Apone:

Another glorious day in the 'Core! Day in the Nursing Core's like a day on the farm: every meal's a banquet; every paycheck a fortune; everyformation a parada - I love the core!

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