Wednesday, April 07, 2004
Through rain, and hail
It hailed yesterday. Heavily, for fifteen minutes. And I thought it was coming up on spring.
First day of work, I forgot to bring my stethscope. Portents of Doom?
And yet I got by okay. I stayed up the kiddy end, where stethoscopes are decorative implements and the appropriate tools for diagnosis are paediatric referrals. :D
Yesterday, my consultant drew me aside and asked me to attend the nurse teaching.
It was excellent. If we'd been taught like that in med school I'd have got my honours.
It was also salt in a nearly-healed wound. But I suspect she knew that. Cocaine and chest pain.
I saw a 26 yr old male a few months back who presented with a typical history of chest pain, and barndoor ST elevation inferiorly.
He admitted to cocaine use, but he claimed he hadn't smoked it in a week.
I asked the nurses to standby thrombolysis (earning me dubious stares) because I didn't want a delay if we had to go to that, then tried to contact the medical SHO. I also run him through the checklist of contraindications, and warn him about the risks and potential benefits. I tell him to take his time thinking about it.
Someone else tried to contact the medical SpR. Wires got crossed, I accidentally hung up on the SpR.
When she came back to me on the phone, she was angry.
I apologised and rushed the story by her, 26 yr old, acute chest pain, barndoor MI on ECG.
She cuts me off. So why the hell are you calling me? Why should I review him?
I figure I must be missing something, and her attitude makes me defensive, and I make a huge mistake. I get angry. "Because he's coming to you anyhow"
"Just Thrombolyse him!!"
"Fine!" put down the phone.
Prepare for thrombolysis. The medical SpR said to.
Sister steps in, and rings her back. There's a lot of shouting.
Oh, now apparently she's misheard me. She says I said he was 46 years old.
Yeah right. Some piece of work.
Many phonecalls later, the cardiology specialty hospital says to thrombolyse him. He's had enough time to weigh the risks and benefits I presented to him by now. He's terrified, and refuses.
All the nurses are looking at me funny. This inexperienced SHO who was too gung-ho and would have thrombolysed on his own incomplete authority. (But the Medical SpR told me to...)
The damage is done.
*****
Angio subsequently shows normal coronaries. But his troponin is 17.
Vasospasm.
*****
The deluge of hindsight, the constant reminders that these guys do get accelerated atherosclerosis but beware vasospasm.
I can take that. I knew that already.
It was my fault. I shouldn't have got angry.
But reading the papers back home about the 30 yr old guy who needed the bypass. And reading the literature (and how come nobody remembers that Harefield Hospital wanted to thrombolyse?) : It's not that simple. He might have needed the thrombolysis.
It just wasn't my call to make. Or even the medical SpRs.
I accept that. So, being reminded for the umpteenth time, I'll just grit my teeth. I won't do it again, but you can remind me as often as you want.
And the nurses can think ill of me. That's okay.
At least I got the day off, and had excellent teaching about pneumothorax to boot. More fool them.
It hailed yesterday. Heavily, for fifteen minutes. And I thought it was coming up on spring.
First day of work, I forgot to bring my stethscope. Portents of Doom?
And yet I got by okay. I stayed up the kiddy end, where stethoscopes are decorative implements and the appropriate tools for diagnosis are paediatric referrals. :D
Yesterday, my consultant drew me aside and asked me to attend the nurse teaching.
It was excellent. If we'd been taught like that in med school I'd have got my honours.
It was also salt in a nearly-healed wound. But I suspect she knew that. Cocaine and chest pain.
I saw a 26 yr old male a few months back who presented with a typical history of chest pain, and barndoor ST elevation inferiorly.
He admitted to cocaine use, but he claimed he hadn't smoked it in a week.
I asked the nurses to standby thrombolysis (earning me dubious stares) because I didn't want a delay if we had to go to that, then tried to contact the medical SHO. I also run him through the checklist of contraindications, and warn him about the risks and potential benefits. I tell him to take his time thinking about it.
Someone else tried to contact the medical SpR. Wires got crossed, I accidentally hung up on the SpR.
When she came back to me on the phone, she was angry.
I apologised and rushed the story by her, 26 yr old, acute chest pain, barndoor MI on ECG.
She cuts me off. So why the hell are you calling me? Why should I review him?
I figure I must be missing something, and her attitude makes me defensive, and I make a huge mistake. I get angry. "Because he's coming to you anyhow"
"Just Thrombolyse him!!"
"Fine!" put down the phone.
Prepare for thrombolysis. The medical SpR said to.
Sister steps in, and rings her back. There's a lot of shouting.
Oh, now apparently she's misheard me. She says I said he was 46 years old.
Yeah right. Some piece of work.
Many phonecalls later, the cardiology specialty hospital says to thrombolyse him. He's had enough time to weigh the risks and benefits I presented to him by now. He's terrified, and refuses.
All the nurses are looking at me funny. This inexperienced SHO who was too gung-ho and would have thrombolysed on his own incomplete authority. (But the Medical SpR told me to...)
The damage is done.
*****
Angio subsequently shows normal coronaries. But his troponin is 17.
Vasospasm.
*****
The deluge of hindsight, the constant reminders that these guys do get accelerated atherosclerosis but beware vasospasm.
I can take that. I knew that already.
It was my fault. I shouldn't have got angry.
But reading the papers back home about the 30 yr old guy who needed the bypass. And reading the literature (and how come nobody remembers that Harefield Hospital wanted to thrombolyse?) : It's not that simple. He might have needed the thrombolysis.
It just wasn't my call to make. Or even the medical SpRs.
I accept that. So, being reminded for the umpteenth time, I'll just grit my teeth. I won't do it again, but you can remind me as often as you want.
And the nurses can think ill of me. That's okay.
At least I got the day off, and had excellent teaching about pneumothorax to boot. More fool them.
