Tuesday, November 11, 2008

Get Ready To (G)Rumble

Am basking in a well-deserved break, after stressing myself out these past few weeks over a project proposal for MOH. Had to forgo a visit to the cineplex to catch Quantum Of Solace ( am very PO-ed about that ), and discovered a lone strand of silvery white hair on my scalp this morning. My second, I believe.

Also worked 4 days straight over the weekend and Monday, which wore me down considerably. Not just because of the incessant ambulance diversions - at times every hour, on the hour - but due to the unbelievable number of super-sick patients we saw.

However, we made a number of good saves, which helped defuse the exasperation I felt.

In one case, my registrar was astute enough to suspect a rare but life-threatening condition in a young woman with severe dyspnoea. A bedside ultrasound confirmed the diagnosis, upon which we rang the relevant specialist, Dr. X, for an urgent consult. Dr. X then proceeded to interrogate the MO who made the call, asking what model of ultrasound machine we use, what views we obtained, whether we're CERTAIN it's what we think it is, etc. Obviously Dr. X has no regard for ER physicians' skills in this area.
So when Dr. X brought a nifty portable U/S from the ward to repeat the scan, I stood beside the patient to wait for the verdict, which was grudgingly given but confirmed our initial findings. The lady was then whisked to the ICU for an urgent procedure.

And FYI, we did the scan using a 5-year old relic of an U/S machine, with a probe that's been dropped so many times the image has degenerated into an almost unintelligible haze.

But we still made the diagnosis. :D

For the 2nd patient, it was a suicide attempt which caused severe airway compromise, confirmed on a bedside nasoendoscopy which I performed. The MO-on-call for the department we were admitting to irritated me with the first words she uttered, "Are you a nurse or a doctor?" - in a haughty tone, might I add.
This necessitated a need to pull rank, which I did, explaining the patient's CRITICAL condition and need for immediate attention. Instead of saying, "Okay, I'm coming down now", she decided to bombard me with queries about the extent of the injuries, how the patient was found, etc. I mean, what difference does it make, if I TELL you to come down STAT?!
Another medical junior who thinks the ER is full of idiots, I suppose.

I cut the conversation short, told her to "come down now and SEE THE PATIENT", and hung up on her.
The anaesthetist was then called, a registrar who PROMPTLY came to the resus room, no questions asked, and pushed the patient to the Emergency Operating Theatre for intubation within 5-10 minutes.
Now THAT'S what real medicine is all about.

In the final case, another resus patient came in febrile with abdominal pain and active bleeding. She had just been discharged from the ward earlier the same day. While my registrar attended to her, the MO assisting made a call to the relevant specialist team, speaking to a fellow MO - let's call her Dr. Y - upstairs. I happened to be sitting right next to my stressed-out MO at that moment, and heard him stammer while presenting the history and physical findings.
It was easy to tell that Dr. Y was giving him a hard time. One of the first things he told her was how ILL the patient was - actively bleeding, hypotensive, just discharged from Y's ward that morning - but she kept asking a slew of questions, refusing to come down and do something pro-active.

After 3 minutes of eavesdropping, I asked my MO to pass me the phone.

Me: Hello, this is Dr. spacefan, A&E [ my rank ].

Dr. Y: Oh, hello.

Me: I believe my MO has informed you that the patient is hypotensive and actively bleeding. I don't see a point in asking him so many questions, can you come down now to see her? If you need more information, you can look it up in the computer discharge summary.

Dr. Y: Uh, okay, can I have the patient's IC number?


Dr. Y: Okay, I'm coming down.

Me: Thank you.

After placing the handset on the receiver, I turned back to my PC to continue typing.
My MO leaned towards me and whispered, "Thank you, Dr. spacefan."
"Next time, don't let anyone bully you," I replied. "When a patient is critical, be firm and make the doctor come down immediately. If you have any problems, get an A&E senior to help you."

It's only the 2nd week of the MO changeover and I've already intervened in 2 instances of unprofessional behaviour. Hospital core values my ^&*%$@

On A Lighter Note

Here's some movie hype I'm caught up in. Will be acquiring a rental copy of the novel later this week.

Vampires fascinate me. Anyone remember the TV series Dark Shadows starring Ben Cross? Also highly recommended: The Lost Boys -- something I've watched countless times since childhood, and still never tire of.

Another great film I watched on HBO last week - Recount, starring Kevin Spacey. Check out this great scene, one of many in a truly excellent account of the 2000 Florida elections disaster.

Spacey is, as always, superb. He gracefully juggles the role of campaign manager Ron Klain, playing leader, confidante and take-no-prisoners ruthless.

The best part isn't featured on YouTube - a few minutes alone in an office, where Klain takes the pivotal call from Al Gore, with the latter advising him to stop fighting and let Bush win. Spacey breaks down but camouflages it with a forced, steady voice. He implores Gore repeatedly to change his mind, but the decision is final.

Bravo, Mr. Spacey. What a powerful delivery!

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