So I haven’t blogged recently, this is mainly due to the
fact that I have worked manically for the last 3 weeks, as has Dan. It’s been an interesting time. We changed rotations last week which for me
meant saying goodbye to my surgeons.
They have become a bit like pets to me, or perhaps children. Over the last three months I’ve learnt what
they like and don’t like, how to calm them down when they are frustrated and throwing
their toys out the pram and how to calm myself down and implement self preservation strategies which have
stopped me from losing my cool with them on many an occasion. I summed up my rotation with a card to say
thank you, on the front of which was Dorothy (me), the lion, the tin man and
the scarecrow all skipping along- just like our morning ward rounds. These rounds generally involved calming down
Mr E who gets very wound up about- well anything, checking all Mr A’s patients
are on his very specific, and slightly odd, pain relief regime, encouraging Mr
C to make decisions and (praise God for small mercies) basking in the knowledge
of Mr S who is always thorough, always calm and just generally quite
wonderful! Mr S worked as a trauma surgeon in the British
army and used to operate in a theatre with an unexploded bomb lodged in the
ceiling; unsurprisingly those operations were swift and efficient. What a hero (quote Dan). As an
RMO (resident medical officer) my job is to look after the patients on the
ward, I oversee their care, advocate for them and am generally the person who
actually knows what’s going on with their care.
Yet sometimes I reach points of frustration where I need someone else’s expertise,
I can diagnoses the surgical problem but trust me you don’t want me operating
on you! Our knowledge is always being tested,
our patience often stretched and our skills challenged.
During night shifts there is one doctor in the hospital,
covering A&E, the wards and being a point of reference for nurses at satellite
centres as far away as three hours drive north and south of Greymouth. On my first night one of the first patients
who came in was someone with a dislocated shoulder. They were quite drunk which
is these situations can be quite handy as alcohol is a good pain killer! I diagnosed the dislocation, confirmed it
with x-ray and checked the neurological and vascular supply to the arm. I then called the orthopaedic registrar in
Christchurch three hours away, who provide our orthopaedic support, to confirm
the plan. Relocate the shoulder. Simple.
Well yes, and no. It can be a
simple procedure there are many techniques which can be used to try and pop the
shoulder back in place, however if the patient isn’t relaxed or the first
attempt is unsuccessful the muscles around the shoulder tighten and the
procedure gets more difficult. I put it
out there to the orthopaedic Registrar “I haven’t actually relocated a shoulder
before”. In theory there should be
someone on back up I can call in, but guess what, there was no one on the
rota. Meanwhile the ambulance crew
bought in another patient who was drunk and had a fluctuating conscious
level. Great. I checked
the second drunk person was safe and went back to my shoulder. I called the registrar again “there’s no one on
back up, what do you want me to do”. The
shoulder needed to go in that night so I resorted to my trusted and faithful
backup – Dan. Having done A&E for
six months Dan has performed relocation procedures and I quote “if you get
stuck just call me”. So I did, it was
half twelve and the phone rang and rang and rang... Up until this point I had felt quite calm but
now my heart started to thud, I really was on my own. I had a frank discussion with the patient and
explained why I hadn’t relocated the shoulder, I had never done it before and I
wanted to get someone to help me, this however seemed not to be possible. My only option was to use gravity and a
little manipulation to get the shoulder in, this and a lot of prayer. There was only one technique I felt safe to
use as it didn’t require harsh manipulation so no chance of damaging structures. The patient sucked on gas and air and I lay
them on their tummy, the dislocated arm flopped over the side of the
couch. I gently manipulated their arm
(as per the internet diagram I had seen).... clunk.... the shoulder popped back
in- praise God! This was my first two
hours of 70 that week- I will say no more on the matter.
Dan organised an end of rotation meal to which over twenty
of the medical ward staff signed up to attend.
All the nurses love Dan. I know
what you are all thinking- it’s his Dashing good looks and warm smile which
produces these warm fond feelings.... actually I think it is he constant
singing and his hyperactivity which make him an amusing and endearing work colleague. We turned
up to the restaurant and although we didn’t fill it, we quadrupled its
numbers. It was a wonderful meal, food
was eaten, wine was drunk (not by me as I drove), and there was much laughter
and jokes and then........ the unexpected Sri Lankan dancing! The consultant who came to the meal was the
wonderful Dr U who is slightly mature and very well known in Greymouth. At the end of the evening I think he had
consumed a moderate amount of alcohol, enough to dis-inhibit his dancing gene,
and boy did he dance! There we were in a
little restaurant with our consultant pushing back the tables and for want of a
better phrase “dancing his butt off”. I’m
pleased to say we have video evidence...
Life is always eventful and there are many many more
stories, particularly about work, that I could share. What I will say is that doctors are
human. We live, breath, cry and make mistakes
like everyone else. Our mistakes have
the potential to cost lives and that is why a safe doctor isn’t the doctor who “knows”
everything, because trust me they don’t exist; a safe doctor is someone who
knows what they don’t know and seeks advice from other professionals to make
sure they are giving the best care. I didn’t want to relocate that shoulder by myself
and I set a limit on what I was happy to do.
If I hadn’t relocated it the patient could have had nerve damage and
complications so did what I could and was lucky it worked. So next time your GP says “I’m not sure about
that, I will look it up”, don’t sit and think “what an idiot” be thankful that
he is looking it up and being honest about his knowledge and expertise.
Happy Mother’s Day
Sarah xxx
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