the surgeons managed to shit on us today. however it was not us who suffered in the end. it was the patient. who died.
i was hovering on one of the surgical wards where one of my other patients was going a bit nuts when i got a nudge from one of my house officers. he informed me that the surgeons were referring back a patient to our care (even though our boss had not been informed) and oh yes by the way his blood pressure is crashing.
i put on my stroke my beard glove and stifled my need to tell him that we should only see patients that have been officially referred to us and that he should not be accepting patients without running it by a senior. but i held my tongue and wandered over to check out what was going on.
this old man was not a very good advertisement for health (or a very good advertisement for disease depending on whether you're a half empty/full cup person) he was six days out of an operation to remove his right lower leg because of very shit blood vessels not being able to provide his limbs with enough oxygen and nutrients to stay healthy. furthermore amongst his huge list of problems, his heart beats in a rhythm called atrial fibrillation. Dr Crippen has written at length on this topic. whilst it is very common the problem with this rhythm is that blood pools in the heart, forms clots and then there is a risk that these clots fire out of the heart to other parts of the body.
well he was in shit. he had a crap blood pressure, his breathing was awful and his tummy had swollen up and was very tender to touch. he had stopped peeing and was vomiting bile. it didn't take a lot to work out that what had most likely happened was that a clot had fired off into the blood vessels supplying his bowels thereby interrupting the blood flow to his gut. his bowels were now complaining as they slowly died of no oxygen.
myself and the house officer proceeded to resuscitate the patient but the only way to treat this condition is to operate. i called down the on call surgeons, the vascular surgeons who had operated on him in the first place and the high dependency unit. i was bounced from one to the next to the next and then back again. finally after four hours the surgeons decided that they would operate but only after a CT scan.
but by then it was too late and he died.
and no-one was really bothered. no-one would take any responsibility for the patient. except for us and only because we happened to be across the corridor at the right time.
would it have been different if he had gone to HDU? maybe. but there were no beds. so he stayed in the sideroom on the ward vomiting up more and more bile.
another nice happy ending.
[i am listening to black and white by the upper room]