Burn One Down

Well, after five nights on the trot, you'd think I'd have something clever to write; or something intelligent; or thought provoking. Not really. My last few shifts have passed more or less without incident.

Instead, departmental politics are once again at the fore. I have yet to hear what the Management Consultants who were prowling about have had to say. The breach targets are once again getting maximum billing. The next few months requires an extra big push. One more push, lads, and it'll all be over by Christmas!

(Foundation! Foundation! Foundation! Arbeit Macht Frei!)

The upshot of this appears to be that we are asked to organise referrals for our patients increasingly early. Not, and this must be emphasised, in a way as to compromise patient care however. I am becoming increasingly disillusioned with this. I like treaing patients. It's what I signed up for. But there seems to be an increasing drive to postpone any but the most essential treatment until 'they get to the ward'... aside from the fact that I think we could and should be instigating treatment as soon as it is feasible, the increasing admissions rate is putting yet more stress on inpatient teams who hardly had it easy to start with. So it leaves me with little confidence that the treatment will be started 'when they get to the ward'.

I suspect that actual incidents of patient harm are few and far between, but it feels in general as if we're offering a slightly worse service. But how many times is too many?

My patient with a leaking aneurysm who nearly ended up on a medical ward because somone decided to book them a bed, so they wouldn't breach..?

My patient with low potassium, and attendent ECG changes, referred for admission as not safe to stay on the obs ward, then placed on the obs ward while waiting for an inpatient bed, so they wouldn't breach..?

Maybe I'm just too cynical.

One of my patients over the weekend was a young girl who had taken her second overdose of the past few days. Mostly fairly benign drugs, but enough to make her pathologically sleepy. She deteriorated suddenly, requiring a brief dash to Resus. Her father and sister were in constant attendence, calm and collected. I wondered how many times they'd been through this before. I offer the usual explanation - first we treat the physical, then the psychological. In her case we need to watch her while she wakes up, make sure she doesn't vomit and choke on it, stop her following Jimi Hendrix's example...

As if on cue, she begins to heave; she has enough presenceleft to slide sideways. At first I think she's trying to brain herself on the side rail, but it turns out she's just aiming over the side. She scattergun splatters the floor; her dad has reacted fastest, and has a bowl under her mouth. I'm impressed - he and I started from the same point; standing start and he beat me to it. Maybe he has done this before.

We clean her up as best we can, wiping her mouth, blowing her nose. Then she heaves again; this time her sister lunges forward. For a second, I don't see what she's reaching for. We've got it covered, haven't we? Almost; she brushes a lock of her sister's hair back; it was dangling right in harms way.

The devil, it seems, is in the details.