Saturday, January 17, 2009

Double Or Quits

Some days it feels like you can't do anything right.

Last night started benignly enough, but midway through the night came to a unpleasant crossroads. Resus had been the stopping off point for a couple of teens who couldn't handle their beer. They both came round fair enough, with one taking a little longer than t'other... I still think he was on drugs, but I guess that's his business.

The Ambos broke the reverie of the ethanolic miasma by bringing in a young diabetic, unwell and sinking fast. His diet, eschewing food for vodka and coke, not helping. He was pallid, restless and crispy dry, reminding me all too well of the last diabetic I had in resus. Ketoacidotics are unwell, for sure, but there's degrees of unwell.

This fella was first class unwell; sick, with honours, if you will. He started vomiting shortly after arrival, great heaving spasms, spewing forth small volumes of coffee coloured fluid. Now this might be the result of gastric stasis, a feature of DKA; but it might be him trying to bleed to death.

Getting ready to focus all my attention on him, contestant number two arrived. A young woman, known to suffer non-epileptiform seizures, brought in, perhaps unsurprisingly, fitting. A complex case, for all sorts of reasons, and one that I'm still not convinced I manged well, or in the right way.

I tried, tho'. Tried to do right by them both.

And failed.

I'm furious with myself.

Sometimes, you will tell yourself, sometimes, I just need a break. I need for these patients not to be going off at the same time, I need for the department not to be heaving at the same time, I need for the fact that waiting times are skyrocketing to be on my mind.

However, that is not the way life works. I get paid to cope under pressure, to manage a busy department, to multi-task. To make everything work, to make everyone better.

In the cold light of day, it's all too easy to review the cases, to see what should have been done.

Last night I was fired in the crucible, weighed in the balance, and found wanting.

It is a sobering experience, and one it will be a while before I can forget.

I only hope that's a good thing...


TLP said...

Don't be too hard on yourself. I am sure that you did all you could for them.

Just wondering about the first patient. What might have caused the coffee coloured fluid? A mallory weiss tear?

DrShroom said...

Maybe; I'd have expected a bit more bright red, tho. My first thought was simple gastric stasis, but I expect it was a good going upper GI bleed - ulcer/gastritis, etc