Wednesday, September 24, 2008

ortho internship 2

this week has so far been a mixture - there was a tonne to do on monday!

my overflow ward actually had many things to do - my intern was actually happy that he could pass his time usefully instead of bumming away in the lounge reading the papers. and we finished everything in our usual slow and languid fashion by 1245, just on time for him to go post-call at 1 pm. :)

after a long slow lunch (everything is long and slow in ortho, i have realised), i head over to the infection side (septic arthritis, MRSA, osteomyelitis etc) to help my friend with some bloods.
after we get yelled at by the ID consultant ("don't let the files touch the table! don't touch the curtains! wash your hands! blah blah blah"), and realise just how unsterile and unclean we are and feel ashamed, we balk in horror at the amount of blood tests he has ordered - 4 culture bottles (2 sets) and 4 tubes (including a coag studies and a cross match) = more than 20 mls of blood in all.

and this patient has cardiac and renal failure (really really oedamatous hands) and is BMI +++ (obese is right) and has MRSA pneumonia and really really really small tiny bad veins.
:( :( :( :(

so we prep culture sets and sterile gloves and mournfully head to her bedside and beg her into letting us do our work. to our great surprise, she hardly flinches when my friend does an arterial puncture (we thought it'd be kinder than waiting for her small tiny veins to drip 25 mls of blood slowly), and i try to rouse her to ensure she's not coded on us!!! so scary.

and the arterial puncture doesn't work - we try on both radial arteries and still NO BLOOD. dang.
so we look for femorals but with BMI +++ it's a little hard to feel (since we are so inexperienced and new) so i suggest to my friend we use the PICC line instead (peripherally inserted central catheter - for long term iv abx use, costs about $700 to insert. ack). after getting permission from the nurse, we try our hardest to draw blood, but NOTHING COMES OUT!!!! :(

i run to the nurse and tell her we can't get anything from the PICC line, and she freaks out and comes with saline to flush the line. and whilst she does it, i watch and realise that : you have to UNCLIP the PICC line to give the saline flush.

after the nurse leaves, i quietly tell my friend that "hey, we didn't unclip the line!"
and he is right in the middle of a 3rd radial puncture.
and both of us look at each other and burst into hysterical laughter, right in the middle of the ward, right in the middle of the procedure.
we can't help ourselves, we've just spent 1 hour trying desperately to draw enough blood!
i think everyone thought we were mad but really, we were so suepr relieved when we used it and it worked. THANK GOD!!!! :D

after this, when i stood up from the patient's bedside, i was whoozy! goodness me.
so i thought we could go home - it was 5.20 pm and our day ends at 5 pm!
but no, the intern says to clerk a new case (with active pulm TB!) and the 2 of us are ready to faint. hahaha.

well, all is said and done, but i still love my job. i walk the hallways knowing that there are crappy days and there are good days, but i still love my job :)

on the bright side, yesterday and today was bliss!!!
i took off at 1pm yesterday and went to watch mamma mia (fabulous!!!) with my friend who was post-call (i wasn't post-call but my intern said i could leave) and we didn't even need coffee to stay awake! :D

and today my precious stethoscope died on me :( there goes $700 :( i hope it's under warranty!!!!
but we ended real early too and i'm back here typing this at 530 pm :D

bliss :)


HM said...

wow ditz! sounds like an eventful afternoon. I'd had been sweating buckets if it were me.

Hope the steth's under warranty!

Dragonfly said...

You mean that patient isn't diabetic? Good grief.....the luck! :-) (Thank goodness they had a PICC in though).