12.10.2011

medical marvels

Once again, I'm warning all of you. Do not land yourself in the hospital if you can prevent it. You will be surrounded by incompetent nincompoops, especially on weekends. Just take a peek at these pieces about UK hospitals. It's old news, really.

I'm most likely offering a skewed view so indulge me and share your thoughts with me after you hear out my tales. All names are fictional in this context.

***

Teddy, the ICU registrar receives a call on the Outreach phone, a dedicated line meant for consults by the rest of the hospital. His side of the conversation goes something like this:
"Yes, I remember Mr Connors. Uh huh. ..you're concerned about his heart rate?"
*long pause accompanied by a myriad of facial expressions ranging from bewilderment to utterly lost*
"So you're the team registrar?"
*another long pause with the facial accompaniments*
"So you're the intern?"
*a slightly shorter pause*
"So you're the nurse? Um.. why don't you call the resident looking after your floor to review the patient first, and if they have issues, they can call the medical registrar to review. If the med reg thinks the patient needs ICU to get involve, they can call us then."

For those of you who don't work in a hospital, the ridiculousness of this might be lost on you. I don't mean to sound elitist, but am just stating how the chain of command works. Ward nurses aren't supposed to MAKE referrals to any team - it's not the job they were trained to do, it's not their call to make. If they were concerned, they should refer to the doctor responsible for the patient they're worried about. If they're still concerned for the patient's safety, there's a MET call/Code Blue system in place to get senior help FAST. There was absolutely no role for them to call up the ICU registrar to request a review, yet this particular one was quite indignant that ICU hadn't reviewed this WARD patient (who was NOT in ICU) in two days and why not?!


****

The Outreach phone rings again.
Jack starts to talk to his counterpart, another registar, on the other end of the line.
The full story emerges after Jack hangs up the phone with a very bemused on his face.
"There's this paranoid schizophrenic patient down at the psychiatric unit who's refused to eat for the past two days now. They want us to bring him up here to ICU, sedate him and give him IV fluids"

... where do you even START?!

First of all, the patient is mentally ill and is a scheduled patient, basically classifying them as an involuntary in-patient. Therefore, as a doctor (they obviously forgot what that entailed), the psych team is legally allowed to implement any and all treatment/evaluation deemed appropriate to the benefit of the patient. That translates to "go and restrain him so you can put in an IV cannula to start the fluids through, you nincompoops"

So the ICU Outreach team troops down to the mental health unit to review this patient, made sure he was all ok and document that the medical ward is perfectly capable of having patients with cannulae in situ, and if they required any help to insert lines, to call the anesthetic team. The medical team hadn't even reviewed the patient yet, as Jack had advised over the phone.

As the ICU team troop back to the unit, Jack gets a call from some manager up in hospital administration, saying that it was unsafe to have the patient up in the ward. Honestly, medical admin, you're making that clinical call?! If you were so concerned about the patient, why don't you come and review the patient yourself to reach a decision, usurping both the medical registrar, the psychiatry registrar and the ICU registrar of their jobs?

Oh, the saga continues. After Jack finishes entering the review into the ICU database, the MET call/Code Blue pager goes off. Guess where at? No prizes for guessing.. the psychiatric unit. The reason? "The patient dropped his GCS a little." By the time the ICU team arrived again, the patient had his eyes closed. They flipped open immediately and the mouth uttered a very comprehensible "Yah, what mate?" as soon as the ICU registrar approached and tapped him on the shoulder. Decreased GCS - what utter crap!!


***

And then there were the phone calls - 3 so far in my two days at work this block of shifts. All kept asking about a certain patient in one of the ICU single rooms, inquiring about his health. Um, how do I put it without being blunt... "He died last week." It's like he hasn't let go.. his xrays are still around, random teams that have been involved with his care have been calling at random times (what consultant calls up on a weekend afternoon anyway!?), and even family have called. Awkward.

***

What about our Dancing Queen.. the one that's been in ICU for over 150 days and counting. The one that has stiffened up from being bedbound, intubated and ventilated for most of this time and has grown all sorts of bugs that can only be managed with nephrotoxic antibiotics that are reserved as a last resort? Now, do you think the family is being considerate, or being just plain cruel, to plaster the only wall she can see from her bed with enlarged pictures of the patient when she was well.. when she was leaning over balconies enjoying sunsets, or when she was playing with her grandkids. I call it cruel, especially if I was the patient sitting there with multiple holes in my abdomen from so many surgeries that I'm leaking everywhere. I wouldn't want to be reminded of what could have been, what was, what I could have done.. Yet, the family refuse to let her fade away in a comfortable, painfree manner but insist on us shoving tubes down the patient's throat and other awful maneuvers that wouldn't improve the patient's eventual quality of life.. if she made it out of ICU, let alone the hospital at all.

***

Oh, I could go on but my head hurts. So many other similar events happen on a daily basis. Add that to the incompetence of certain staff members on any given shift (or those with personality problems, or those that like the thrill of power struggles). Then add truly sick patients in ICU requiring medical attention. Then add the occasional procedure required like central or arterial lines. Factor in patients arriving and leaving the unit at any given time, plus the paperwork involved. All in a day's work. My head hurts =(

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