today would've been a good day. i still think it turned out alright just because i got to leave before 6pm today and didn't need to stay back to deal with the uber-pear-shaped mess that wasn't my fault. no really. not my fault!
fracture clinics are always great. get to follow up patients post-op and don't have to dictate letters! sometimes, like today, we finish early after our little teaching session and i get to stop by town to the local organic vegetarian cafe for lunch - yay =) then the day started to suck. nothing we decided on during ward rounds this morning got communicated to the nursing staff. then, the garbled messages that did get through got even more garbled as it got passed along to the bed manager. i would've irritated the hell outta switch calling back several times within the hour just asking to be put through to the bed manager but hey, they couldn't give me a direct line either so really, i maintain it wasn't my fault.
and then came the ED reviews. the poor guy that the ED locum had misdiagnosed as having osteomyelitis had been on IV antibiotics for the past 24 hours, but his red and swollen elbow had just grown bigger in that time. the ED locum was a tad worried by this stage and thought he'd give me a call. alarm bells rang when he mentioned a normal xray with a red swollen elbow of sudden onset associated with direct trauma and full range of motion at the affected joint. that's not fricking osteomyelitis!! a septic joint, i can understand as a misdiagnosis, but i can't fathom how the hell he came to conclude the guy had osteomyelitis with a normal xray to boot. olecranon bursitis, you toot. burrrrrsitis.
anyway, that was just frustrating but easy enough to sort out. then came the guy who cut his arm with a sheet of steel and had decreased sensation. fair enough.. manageable. what wasn't manageable was dealing with trying to slot all these cases into theater. then came the other guy of similar age that went and confused everyone else because there were too many cooks spoiling the broth and all the messages got garbled again between ED, the bed manager, the theater nurse unit manager, the team leader in theater and me. and then the surgical ward nurse manager wanted to join the fray too.
but this guy.. man, i should've taken a picture when i had the chance. he was a guy in psychiatric high dependency unit who had escaped from his locked unit during an interview. it took six grown men to pin the guy down as he tried to bolt. the guy nearly made it but got himself tangled in some barbed wire fencing and cut himself all up. he also lost his pants in the process as someone tried to grab his legs. he's now in his wee undies, sporting a splendid muddy gaping hole on the flexor aspect of his wrist that spans a good 3 - 4 inches in diameter with random strands of mangled skin stretched across and little blobs of fat. took me about 2 hours to sort him out logistically because theater staff flipped about having some psychotic guy on suicide watch being anywhere near theaters. i don't really blame them but he was a staffing nightmare to enable him to get the wound washout in theater that he really needed.
looking back, it wasn't too bad. the bit that irritated me all day was the fact that all the messages weren't getting through to everyone that needed to hear them, causing a ton of miscommunication with people "updating" others with old information and confusing everyone. that, plus bed block and coordinating theater times. my only consolation is that i get to go home and sleep in peace with no fear of getting woken up in the middle of the night if and when the psychotic patient decides to make a bolt for it again!