Saturday, April 02, 2011

Shaking What You've Got

Another interlude. Typing on my iPhone, so may be shorter than usual. It's awkward, and the events herein upset me.

On how things go wrong, and on not knowing.

The patient, hypothetical as always, might have been middle aged and in renal failure requiring regular dialysis. Imagine they present with a nosebleed. These are the patients who carry a burden of hindsight with them. It is neatly packaged, and in my experience you won't see it unless you're careful.

Patients with open fractures, overdoses, an overcrowded Paeds Department: all of these things might get in your way, might cloud your vision.

Suppose the bleeding starts again. It's obviously vigourous; despite packing, blood continues to flow freely, from the other nostril and from the mouth, obviously coursing down the back of the nasopharynx. Threatening to choke her, but not quite making good on this threat.

Imagine you can't see anything to cauterise; more packs? A foley to tamponade posterior bleeding? Something I've not done much of. Will it make it worse?

Patient is stable; call ENT. You will tell yourself it makes the most sense; you have other patients, this one is ok (now) and needs an expert.

Half an hour later, you're bagging the patient; the airway resembles an abattoir. The tube goes in ok, and maybe 10 minutes of CPR will get him back.

But your patient came with a nosebleed, and arrested while you watched.

Could I have done more? Should I have?

I feel like I'm burning out

These patients, hypothetical as they are, are the ones that will challenge your very soul.

If you still have one.


Rissa said...

Of course you still have one. Else you wouldn't be bothered by this. Wouldn't have written this post. Wouldn't HAVE this blog in the first place.
Of course you have a soul.

night tech said...

Have seen that scenario before. Coag numbers through the roof ... keep dumping blood products in, FFP, PRBC's, PLTS...can't stop the bleed...WTF....from epistaxis to full arrest. Major suckage.

Doesn't sound like you have much support in the department?

I'm thinking you're working too much. Money's nice to have but sanity is ultimately of greater value. I haven't worked full time in 11 years. (damn...has it really been that long)

night tech said...

Had some time to ponder your existential crisis this afternoon whilst driving about the local mountains with a friend.

Not an easy discussion even in real time buts let's give it a try.

Why Medicine as a career?

Specifically, why Emergency Medicine?

Is the problem with the actual practice of your speciality or the environment you find yourself in at your place of work?
How's the "corporate culture" at the hospital? Do you feel valued at work or are you just the paid help? Are you working too much...seriously, how many shifts a month are you doing?

Don't overlook that you're in a high stress job in a even higher stress environment.

I've been there. Changed jobs, less toxic environment. Happier me.