0600 Alarm sounds, swear, hit snooze a few times before getting up and falling into the shower.
06.30 Make sure all the cat food bowls are full and the water is fresh. Spend 10 minutes wrestling with said animal in an effort to get him to take his morning tablet. Rinse bites under the tap and spray with the Chlorhexidine spray I have by the sink for exactly that purpose.
07:00 Leave the house and drive to work-
07:30 Walk into my Ward-office and catch the night-nurses before they go off shift; no-one can give you a more accurate update on how your patients are doing than these guys. Find out that one of my ladies has become short of breath overnight and is complaining of painful legs. One examination and some medication later (not possible to give more detail than that) and she’s breathing easier.
08:00 Grab a cup of extra strong coffee and get on with some paperwork – three patients are scheduled to go home today and there’s lots of paperwork required to make that happen – not including the obligatory phone call to the GP to discuss the changes I’ve made to their tablets (if I have to argue the toss about wanting to start bone-protection on another 80 year old patient with several broken bones in the last 12 months just one more time I swear I’ll scream)
08:45 Pick up the Crash-bleep from the night doctors, I’m on call from 09:00
09:01 My shift officially starts and we get busy with the ward round. The typical round involves a recap of every patient’s case with the consultant including a review of their latest test results and medications. The ward round is where improvements and changes to a person’s treatment are decided. Its the event which leads to breaking bad news or telling people they’ll be going home tomorrow. The classic television imagery of a ward round as a consultant-comet arcing through the ward with a tail of junior doctors and general hangers on is pretty accurate. I’m not on top form today and manage to answer one of my consultant’s questions incorrectly. The very arrogant house officer pounces on this like a kitten on a feather and finds the correct answer; sad to say but doctors, like all apex predators, are really only attacked by their own species…
13:00 Ward round finally finishes and my attendance is ‘requested’ (read mandatory) at one of the many lunchtime meetings. Nominally these are a way to sort out the business of the day with a decent lunch thrown in. In practice the meals are paid for by drug companies to promote whatever wonder-drug has just been released. All of which means that, if you’ve made a decision not to accept drug company gratuities, including meals, that you have to sit through a presentation that takes up the only opportunity you’ll get to eat today whilst watching everyone else is acting out a scene from a chimp’s tea party.
13:45 A reprieve; for me at least, when the Crash-bleep goes off. Its a patient on the other side of the hospital and their heart has stopped. I get myself there as fast as I can and resist the desire to borrow the patients oxygen mask for myself as I get my breath back. The patient’s heart has been in arrest for several minutes and no-one has managed to get venous access. I try the saline-push technique that one of the anaesthetists showed me last year. A flash of red in the line and we’re in. No time to tape it down, hold it in place, adrenalin – push, relax while the other carry on pumping the chest. A loud crack signifies another rib has broken; the medical student who’s watching the crash-call as a learning exercise throws up into his mouth and is pushed out of the cubicle by one of the nurses.
Pump the chest 30 times, squeeze the O2 bag twice, pump, squeeze, adrenalin push, rhythm check, no heartbeat, keep going…
Half an hour later its all over – the writers of that ‘Casualty’ show really need punching; far from the 90% resuscitation success rate they depict the real number is more like 5%. The family are waiting in the relative’s room and I go and break the bad news to them. Perhaps unsurprisingly, the conversation doesn’t go well…
15:00 Back on my ward and I spend the next two hours getting through the jobs which were generated on the ward round. Lots to get done, scan requests to chase up and referrals to make. One of my patients gets tearful when she’s told she can go home in the morning and tells me she’ll miss me. I even get a hug, which brightens my day no end.
17:00 The ward jobs completed, I head down to the Medical assessment unit to start my evening stint as the admitting SHO. Every time I walk into that human zoo I’m reminded of the bar scene from Gremlins.
I start admitting patients – there are 3 doctors and 15 patients waiting to see them with 9 more on the ‘incoming!’ list; it justifies the exclamation mark, believe me. Having said that, there is always good banter on admissions and its nice to actually be working with other doctors instead of on my own. Despite the backlog we make some good progress with the patients queued up on trolleys.
20:30 Two heart attacks, one pneumonia and a fellow who wants to kill himself but changed his mind because he couldn’t find the right CD to play while he did so, later, and I make a dash for the vending machine – I don’t care if its junk, I need to eat something. When I get there I buy a marathon bar (stuff your snickers, we know what the thing’s called) and wolf it down. Halfway through dinner I notice that the machine is crawling with silverfish – I spit out the chocolate and swear, loudly. Suddenly, I’m not very hungry.
21:50 10 minutes to go and my replacement is nowhere to be seen. I finish up my paperwork in anticipation of a prompt getaway.
21:58 My Crash bleep goes off – a patient in A&E has stopped breathing. I get running one more time. It’s only a short dash this time and I arrive in pretty good shape. Fortunately, an anaesthetist has already arrived, has intubated the patient and started breathing for them via an O2 bag. We all take turns with the bag while we arrange an intensive care bed for the patient.
22:40 I get back to the admissions unit and hand over my Crash bleep. Its a huge relief to get rid of the thing.
23:00 Arrive back home and give the cat his night time tablet. No bites this time.
Watch TV for a while and grab something to eat
00:30 Bed; try to drop off quickly, a new game starts in a few hours.