Tuesday, 13 November 2007

The Weekend from Hell

Last weekend I was on call. It was so horrendous that I've only just recovered enough to write about it. I was doing my week of surgical take and on top of that was expected to provide ward cover for all of the surgical wards in the hospital (in my hospital you are either on take with just a reg or with an SHO and a reg. If you are on your own with a reg, another F1 also works the weekend and does the ward cover stuff but if you have an SHO you are expected to do ward cover as well. I'm not sure about the reasoning behind this because the SHO generally just goes to theatre all day and doesn't actually help with any of the ward stuff)

I was working from 8am until 8.30pm on both days and basically didn't stop working for the whole 12.5 hours. I didn't have lunch on either day (missing lunch is pretty much a given when you're on call) and didn't even have time to have a drink during my shift. As a result I was utterly useless by the end of the day. My ability to put in venflons was somewhat undermined by my hands shaking contantly due to hunger and I couldn't even remember which patient was which when the SHO asked me about the new admissions when he got out of theatre. People always tell you to make sure you take a break but it really is impossible when you're being constantly bleeped and harrassed by the nurses.

Thankfully we only had about 8 new admissions over the weekend (which is pretty quiet) but even so it takes me at least an hour to see each new patient if you take into account all of the mundane crap like writing up drug charts/fluids, filling in all of the blood forms and bottles, filling in the x-ray forms, calling radiology to book the x-rays, scouring the entire hospital to locate a pod to sent the bloods etc etc. It's really frustrating that however efficient your clerking is you just can't seem to cut down on the overall time it takes to admit a patient.

Most of my time was taken up by ward work. I think I must have put a new venflon in every single surgical patient in the entire hospital. Several patients had two new venflons and one lucky man actually had three new ones in one day (they apparently kept 'falling out'). I must have written up enough IV fluids to fill a swimming pool and prescribed enough warfarin to kill a hell of a lot of rats. I rewrote at least 10 drug charts despite the fact they could easily have been done during the week if the nurses had had the forsight to ask the patients' normal teams to do it (they had filled in the shaded boxes at the ends for the last two days and only called me when they physically ran out of space to sign off the drugs).

You get called about the most stupid things at weekends. I'm not sure whether nurses understand that you are looking after ALL of the surgical patients, not just the ones on their ward, and should really only be called about things that need to be sorted out immediately and can't wait until monday. I was called three times about a patient who had a hoarse voice, twice about a patient whose eye was a bit red and was asked to see multiple patients who had been noticed to have a rash (and no it wasn't a drug reaction or something that I could actually do anything about). I was called several times about a patient who had a blood pressure of about 170/100 (longstanding hypertension in a 90 year old with chronic renal failure who was already on a beta blocker) and the nurses were incredulous when I was unwilling to prescribe another antihypertensive. I had to write a whole essay in the notes about why I was not prepared to start any more medication since 1) I am an F1 in surgery and am not an expert in controlling blood pressure in people with renal failure and 2) I have never met this patient before and this is something that can be managed by her normal team.

When you're on call the most frustrating thing is not being able to do anything without being constantly interrupted by your bleep going off. You can't get through a 20 minute clerking without having to excuse yourself to answer your bleep at least two or three times. It just makes everything take so much longer than it should and when the calls turn out be about something that you really shouldn't be being bleeped about anyway it's enough to make you scream. I narrowly escaped losing my rag on several occasions when I was bleeped for the second or third time about patients with some minor ailment or something like cold hands (no honestly, that was a real one, which I miraculously cured by putting the patient's hands under the blanket) even though I had already promised that I would come to see them as soon as I had a chance.

Amazingly although I was a little short tempered at times I managed not to shout at anyone. I think perhaps that's the best you can hope for from a weekend on call. You just have to get through it. If nobody dies and the nurses are still speaking to you at the end of the weekend then you've done ok.

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