Monday, July 14, 2008

Settling in...

I'm finally settling into my job as a lowly intern. 90% of my job involves paperwork - filling up the drug chart or writing a discharge prescription; writing up admission management orders; booking follow-ups; writing admission notes or discharge summaries. The only thing that differentiates me from a nurse is my signature. Most nurses I know are experienced enough to know the bureaucracy of our health care system and how to navigate through it but require my signature for the authorization to do anything. I get through 90% of my paperwork without any mistakes but it is nice there is somebody like a nurse to correct me. Unfortunately none of the nurses at my current hospital are sexy.

All this mind-numbing copying of previous notes and orders has left my brain dull. Most of my clinical sense has gone out the window and I'm afraid without it I might kill a patient. I nearly did on Sunday. A patient developed a fever at 6 am. I diagnosed it as pneumonia and did what I normally would do - take blood for culture and laboratory tests plus gave her oral antibiotics. At 9 am she developed a low blood pressure. I ordered IV fluids & antibiotics for her and basically was about to leave before somebody reminded me what her blood pressure actually was. After looking at her blood pressure and nearly freaking out, I eventually called the medical officer on call. Before long the patient was sent to the Special Care Unit because of septic shock. I just hope I develop back my clinical sense so I don't kill another patient.

Doing procedures is starting to become much easier for me now. I almost proficient in venous blood sampling but my arterial blood sampling is still in need of practise. I had to take an arterial blood sample from a patient today. I'm fortunate the patient was in a state of stupor, since I had to poke her a few times before I could take enough to perform an arterial blood gas. I'm also relieved I could catheterise a patient's bladder without any major hitches, even though the last time I performed an urinary catheterisation was a year ago... on a dummy.

What surprises me most is the number of deaths I had to certify. In a convalescent hospital , we don't get many emergency cases. However we do get a number of terminal patients with "Do Not Resuscitate" orders. Yet it seems my luck that I had to certify three deaths in a four day spell, all of them when I was on call. Compare this to the other interns in the hospital, who haven't had any, and you start to think you have a black cloud following you.

I'm not looking forward to my next call on Friday if this keeps happening.


Yesterday I had afternoon tea with two of my best friends at the Peninsula. I was quite surprised that we had to queue for something like this. The food was actually very good. I loved the scones with clotted cream and strawberry jam. How I miss English food! And the tea was very good - it didn't need milk to be enjoyed. I was disappointed they didn't have any cup cakes or french fancies but you can't have everything.

Of course I'm going to whine that I could all that at home - serve tea with scones and everything else. But I have to realize not everybody could do that and sometimes the experience is more important than the food itself.

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