#the shifts can be rubbish but I'm honestly going to miss it far more than I thought I would

[glorious-blackout]

Summary of Junior Doctor Life - Part Nine:

Got a call at 3am from the Advanced Nurse Practitioners who do rounds of the hospital at night. They basically wanted to make sure I wasn’t snowed under, which was lovely of them. So lovely in fact, that I didn’t have the heart to tell them that the reason they’d missed me during their rounds was because I was holed up in the Doctors’ Room watching ‘Derry Girls’. 

Good news can feel like an anomaly on some days and miraculous recoveries are as rare as you’d expect, but they can happen. By the end of my first night-shift I had two patients who were very unwell and had shown no improvement despite being given appropriate treatment. One of them had gone to ICU in the hope that he might ultimately pull through, but my registrar received a call at 7am informing him that nothing more could be done. The other patient was a lady who was only appropriate for ward-level care (anything more would likely be futile), and we ultimately had to start her on morphine via a syringe-driver to provide comfort because she was so breathless. I left work that morning feeling rather deflated and expecting both patients to die during the day. The man sadly did pass away in ICU, however I arrived at work to find that the woman had remained relatively stable. Two nights later I was taking her off her syringe-driver because she frankly didn’t need it, and two weeks later we’re now thinking of getting her home. Not the most common outcome for someone who at one point was knocking on death’s door, but certainly a welcome one!

During a rather busy night, I got a call twenty minutes into my break asking me to come back to the ward immediately. When I tried to get some information, the nurse barely managed five words before resorting to “Just come to the ward!” Turns out one of the patients had managed to disconnect the attachment to his cannula, meaning there was nothing stopping his blood from leaving the vein and escaping into the outside world. By the time this was discovered, his bedsheets were almost completely red and his blood pressure was in his boots, to the point where we needed to pour a litre of IV fluids into him as quickly as the machines would allow. 

He was ultimately fine and cracking jokes before we’d even got one bag of fluids into him (including, but not limited to, “I thought I’d had a wet dream!”). What made him more problematic, however, was that he’d been admitted in the first place with chronic anaemia, which blood loss obviously doesn’t help. It wasn’t long before we were arranging a blood transfusion on top of the IV fluids we’d already given him. 

Got called to prescribe some IV fluids on my last day of nights, at the tail-end of what had been a rather hectic shift. In the hopes of grabbing a break, I asked if there was anything else needing done that I could quickly power through, only for the nurse to say she didn’t know. I must have looked about as rotten as I felt, because her friend immediately came to my rescue and said “Well go and check, the poor girl wants to sleep!”

We’ve had a couple of patients recently with horrendous kidney failure leading to fluid overload because they can’t produce urine, so now several nurses are acutely concerned with how often patients are peeing. It’s not an unfounded concern, but the patients they make you aware of tend to have perfectly normal kidney function on their blood results and very little urine in their bladder on an ultrasound scan (we might worry about urinary retention if they were holding over 600mls). The kicker is that on particularly busy shifts, those same patients are often managing to pee far more regularly than we are.

Confirming a death tends to be more of a box-ticking exercise than anything else. Often the nurse will do a quick check themselves beforehand and they may even leave it a while before contacting a doctor to give the family space to say goodbye. Ultimately, by the time we enter the patient’s room it tends to be obvious that they’re gone before you even check for a pulse, and thankfully none of us have had a Monty Python-esque “I’m not dead yet!” moment so far. 

One of my colleagues came close though. After being asked to confirm an expected death of a palliative patient, he walked into the room only for said patient to turn his head when he announced himself. Apparently he managed to recover from his mini heart-attack just in time to blurt out “Just wanted to see how you were doing sir!” and perform an impromptu review, despite wondering what the hell was going on and why he’d been asked to confirm the death of a very much alive man. He got his answer upon leaving the room, when the nurse rolled her eyes and said, “The next room, you pillock!”  

I spent my night-shifts with a genuinely lovely registrar who was always available if I needed to page him and managed to put me at ease even when we were dealing with really sick or dying patients. He was such a reassuring presence that the two hectic nights (out of four) didn’t necessarily feel like bad nights. In contrast, the girl who did her night-shift after me got a registrar who was sick (and therefore made her examine every patient on his behalf), complained very loudly about the fact that he was at work, looked rather pissed off at me when I dared to go home (despite the fact that my back-shift should have ended half an hour earlier), and proceeded to spend eight hours of a twelve-hour shift sleeping on the mattress in our Doctors’ room so my colleague had nowhere to go to rest. It’s luck of the draw which registrar you end up with, but if our positions were swapped I probably would have spent my night-shifts craving the sweet release of death.

My registrar’s quirk is that he has a weird love of taking blood from the femoral artery (accessed via the groin) in patients with horrendous venous access. To be fair, there is a certain logic to this - it’s far less painful than taking arterial blood from the wrist and if you can get into the femoral artery, you’re more likely to collect a large sample so you can run more tests. It’s just always amusing to witness an enthusiastic Spanish man declare, “Let’s go for the groin!” when he finds out we’re struggling to take blood from a patient.

We’ve finally found out what jobs we’re getting next year! My FY2 is going to be spent between Geriatrics, Neonates and Obstetrics/Gynaecology so there’ll be a whooole lotta babies 😊 Still not too keen on Geriatrics, but I’m delighted about the Neonates job and Obstetrics is the only surgical specialty I actually like so I’m pretty thrilled overall. Though I imagine my poor sister - who happens to be a neonatal nurse - is going to be subjected to a lot of texts which basically boil down to ‘Help!!!’