Sunday, July 24, 2005

A tale of three Wongs and a Wan Tan

Wow, that's the worst pun I've ever made with people's names. It's just a joke, don't kill me. This post is about my night call yesterday, so it's going to be totally jargon-filled. You have been warned.

Anyway, night call was unbelievably exciting. Number one exciting fact: I went to check the on-call list and found that the registrar on call was none other than Dr. RW again! This is fate, I tell you! What a coincidence. At that moment I started having tachycardia and hyperventilating, and almost fainted out of sheer bliss. I was in the library reading my book (and later Davidson's, because everyone was mugging and I felt guilty) until about 4.10 p.m., when I left to get something to eat before night call, because I kind of expected that I wouldn't be having dinner again. I called Dr. RW about 4.45 p.m., and he asked me to follow his MO, Dr. AW, so I gave her a call, and she asked me to go over to Ward 53 to find her.

Not a good start to things, because when I got there she told me about this new admission of this patient with bicytopaenia (i.e. low TW, low Hb) and asked me for causes of bicytopaenia. Of course I don't know what causes bicytopaenia, hello, I haven't even heard of it before. Anyway it was a highly tortured affair, with me wracking my brains and not being able to think of anything even remotely right, besides bone marrow pathologies. Bleh. But the thing I love about night calls is that it constantly reminds you of how much you don't know, because when you clerk cases that you're comfortable with every day you tend to forget about the others that you've never seen before. And life isn't going to give you things you know the best, so you just have to know everything. Woe. Then she asked me to examine the patient, which admittedly was pretty awkward because I had to go look for a nurse to chaperone, and people kept popping in to talk to the nurse which wasn't nice for the patient at all. And it was my first time examining a female patient too. Shock and disbelief. But I managed to pick up the signs (haha she pointed out her own koilonychia to me, otherwise I wouldn't have seen that). I still can't tell the difference between an ESM and a PSM though, I thought her murmur was a PSM.

Dr. AW told me that she wasn't going to do anything, and asked me to call Dr. WYC, her HO, instead. I called him and got the reply, "I'm really really busy right now, and I don't think you can follow me, why don't you call the other HO instead?" Fine. The other HO, Dr. RT, is a really really nice person, and he was more than happy to let me tag around, though he and his MO, Dr. SW, asked why I was doing night call on a Saturday night. It's unbelievable, isn't it. And they schedule night calls on Sundays too, how awful. So I followed him around as he took bloods and set plugs, and taught me how to do those procedures. It's amazing how many things people don't mention about the intricacies of procedures, but if you take note of those things it makes the job a lot easier.

Then, the next climax of the night. There was an elderly lady crashing from Gram-negative sepsis and DIVC in Ward 62, and we rushed up to find that it was mostly under control with Dr. SW and two nurses looking after her, but her BP was 71/55 mmHg, how shocking. She was still quite alert though, so things were stable for the moment. This was when Dr. RW came up to assess the situation, and when he saw me he was like, "Oh, were you with us before? I remember you." and I was all "OMG he remembers me!" glee. Okay back to non-fluffy stuff. So they decided to send the old lady to the ICU where she could be placed on round-the-clock surveillance and perhaps be intubated, because she had metabolic acidosis with somewhat inadequate respiratory compensation. Dr. RW, wonderful as usual, said that I should stick around to watch them transfer her to the ICU. Incidentally he seems to think that M3s know a lot, and keeps looking shocked when I tell him, No, I haven't watched a transfer before, I haven't seen intubation before, I haven't seen so many things before. Oh well.

I tagged along as a nurse and Dr. SW transferred the patient to the ICU, and ended up standing there for about one hour as I watched the ICU doctor, Dr. JP, set an arterial line (with Dr. RW providing an explanation of the Saldinger method for setting a line) and intubated the patient. I don't really like to stand around in the ICU because everyone's just so busy and purposeful and efficient in their movements that you can't help but feel like the most gigantic obstructive object even just standing around, and you know you definitely can't help because they can do anything a lot better than you can. The nurses are quite nasty too; they badmouthed the nurse from Ward 62 because she wasn't doing anything to help. It's an equally amazing and scary place, the ICU.

I went back up to Ward 55 to join Dr. RT again, and we went to take bloods and set plugs. I did a venepuncture for blood culture and bloods, and it was pretty successful. Of course Dr. RT was really encouraging and patient, taking care to explain lots of things to me, and I'm really infinitely grateful to him for his nice-ness. Compared to some other HOs, it's amazing how there's such a gigantic difference in how nice most HOs are in general. Hopefully I'll end up being the nice variety when I become a HO.

Then we had this patient who had fainted after surfacing from a dive, and subsequently had become rather confused. When we saw him he was thrashing all four limbs about and was quite unresponsive, and Dr. RW had to come up to take a look. He thought it was probably type II decompression sickness, and called up the consultant on call (which makes it a pretty big matter), and then got in touch with the hyperbaric treatment facility in TTSH to power up their hyperbaric chamber so we could send this patient over. Meanwhile I helped to hold him down - and he was really thrashing around pretty badly - while Dr. RW looked at his tympanic membrane, and found the right one to be perforated, which means that he probably ascended pretty fast and all. And I also held him down as Dr. RT catetherised him. Quite amazing stuff.

Basically after that we were just waiting for the ambulance to come and take him to TTSH for the hyperbaric therapy, and continued to do the usual blood-taking stuff. I decided to take the ambulance to TTSH along with the HO, because how many times in your life do you encounter a patient who has decompression sickness and has to be sent to another hospital, while thrashing violently, for treatment? And Dr. RT was like, "You really should go home, you're not obliged to stay and follow us to the hospital, you know." which was really nice and considerate of him, but I was pretty insistent on going, haha. The ambulance trip was pretty uneventful, thankfully, and once there it was just a matter of getting him transferred to another bed and restraining him so he wouldn't flail around that much. I saw the hyperbaric chamber, which looks like a large glass capsule. I had imagined it to be slightly bigger though, quite like a vault, but it was just big enough to admit one adult on a bed.

Really, a very eventful night call. Good for me, not so good for the HOs, MOs and registrar on duty. Dr. SW kept saying jokingly, "It's all your fault la, how come all the weird things happen when you're on call with us!", and when I left, she joked again, "Oh good, now that you're gone hopefully there won't be any more funny things happening.". She's really quite animated and funny, and she was very nice to me, despite everything. Yet again I'm endlessly thankful to her and Dr. RT for making the night call such an enjoyable one. It's so nice to work with nice people.

Gah, unfortunately by the time I got back from TTSH and said good-bye to all the doctors it was nearly one, and I had to take a taxi home, which set me back by 16 dollars. And I had so much adrenaline in my system I couldn't get to sleep properly, and the entire night I dreamt of transferring patients and running along hospital corridors. Which was pretty unpleasant, admittedly.

Avaris / 7/24/2005 03:45:00 PM

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