Thursday, April 20, 2006

i don't want your sympathy; i just want my johnson

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]


Kate said...

At least you tried.


Anonymous said...

Poor old bugger.

Vegas said...

He would have had a much beter chance of surviving in a decent health system. If there were enough doctors and nurses, he could have had the appropriate care on the ward then been rushed straight into theatre (with an immediate CT scan if so desired) and operated upon. The dead bowel may have been removed and he could have lived. I imagine that he did not have close monitoring as the nurses were busy washing other patients/administering drugs/filling in paperwork. He couldn't have an urgent CT scan (which seems a waste of time to me) because there aren't enough technicians and porters to organise it, and he couldn't have urgent surgery because there aren't enough doctors and theatre assistants to cope. They are too busy cutting down the waiting lists so that the hospital maintains its funding. Arise, the right honourable Mrs Hewitt. This gentleman died and I hope you are sleeping well. I would suggest that if you are ill you utilise your private health insurance and stay the f*ck out of the National Health Service because it is falling to pieces.

Vegas said...

Sorry, but "poor old bugger" is just not good enough. I am getting more and more frustrated by the gradual demise of the NHS.

I was looking after a woman recently (previously fit and well) who had come in with a suspected PE (clot in her lungs). She was transferred to my ward, and was put on heparin. We could not get a CTPA scan and had to wait for a V/Q scan, which they only do twice a week at my hospital. The day before her scan was due, she arrested and died. If she had had a CTPA on admission, she may have been thrombolysed and survived.

If a certain Health Minister came in with a similar problem, would they have to wait 2 or 3 days for a second-line investigation? No.

Anonymous said...

It was me who said 'poor old bugger' - and no, the state of the NHS isn't good enough. I work in it too, and can also see it falling apart. I'm equally angry, to the point that, I'm wondering whether, when I qualify, I should actually look for another job or not a) because the NHS won't last much longer at this rate, and b) because I can't bear seeing what's happening to patients and staff.

Vegas said...

If it isn't too late to switch, look for another job. I am close to getting my exams so I feel tied in for the foreseeable future at least. Hewitt is going to make us all redundant soon anyway.

The Venial Sinner said...

Looks like the old geezer wasn't the only feeling a bit bilious, Vegas is positively overflowing with the stuff.

I've got a patient at the moment who is perhaps understandably a little irked by the fact that he was left to deteriorate into near paralysis while he waited for a bed here in Supercity Hospital to become free so he could be transferred across for an EMG. Seems the team over in Sticksville DGH decided that 'await bed at Supercity' was an adequate enough plan for 3 days whilst he infarcted his entire nervous system from presumed (and now confirmed) vasculitis. Ooops. Well, I suppose at least he didn't actually _die_ of waiting...maybe he should count himself lucky!

MsD- uknow curry4sale person said...

hey I'm back...
I moved countries and have left teh old laptop in teh old country so I had to google to find u again.
I guess nothing much has changed in your life in teh last months...u seem to be pissed off...STILL. The NHS seems to be the same old crap...and well New Labor sux.
I don't have a current blog...well...that's a lie....i do...but it's all about how my in-laws suck....and i don't think u wanna read that...well...not that u ever read any of my previous blogs...
but yeah... if u r up for that curry...lemme know..
btw u must be damn hot or damn ugly...either way i MUST know NOW....for the millionth time POST UP A PIC!!!!!!!!!!

The Venial Sinner said...

MSD - I can tell you, ain't a pretty sight. I have to pop a strong anti-emetic just to go out for a drink with him.

Bella said...

Have read your blog a few times and though it may seem on the surface you're constantly pissed off, it really does worry me that this is the NHS I am going to enter (if indeed I get a house officer job that is). Stories like this really do worry me and really sometimes make me wish had studied something else at uni for which I would be working long hours in the city but at least earnign some money and not ranting at the shit state my so called workplace is in.
But as someone said, at least you tried and that's very important as it shows you still care even if no one else does.

Anonymous said...

V/Q scans only done twice a week... Yikes. Makes me gald I picked a halfway decent hospital to go to with my suspected PE. I got a V/Q scan within 12 hours.