Tuesday, September 30, 2008

ortho internship, 3

thus began the 3rd week of my internship, wherein my previous intern left to become a resident, and i got shunted to the infection side of the ward (see previous post) to help for a few days before the new rotations take place.

the past 2 days have been a whirlwind, i somehow made it through chaotic morning rounds (there aren't proper rounds in ortho, apparently. the attendings just come one by one and you grab the case notes and run after them madly and try to scribble down their orders desperately whilst hoping that someone else is with whatever other consultant may come along).

tuesday was especially bad because i'd woken up at 440 am, checked my clock, realised i had to wake up at 530 am instead and fell back to sleep - and i MISSED MY ALARM COMPLETELY. omg. thankfully my hall master gave us a lift down to hospital! i have never loved staying in hall so much, ever. :)

and just on time too, i reach the ward station just as the 1st consultant (one of my favourite too!) has finished the first file. i managed to catch the rest of his orders :)

rest of the day is pretty uneventful. i've grown to love the long-stayers, they're like my own!

there's this old man with MRSA in a ward cubicle by himself (he has to be isolated), and his 2 grown daughters (old enough to be my grandmas!) hover by his bedside protectively all day. if i should even approach his bedside with a kidney dish for blood taking, they jump up protectively and start giving me the evil eye, and demanding to know exactly what i am doing and why so. whilst i do appreciate their concern, i don't exactly speak their language and i can't explain myself very well.
i understand that their father has been in hospital for over 2 months now after a fall, resulting in an NOF #. shortly after hip replacement, he managed to dislocate his prosthesis in hospital and developed MRSA and has been bed-bound since. the infection isn't clearing up (we've been doing vanco troughs and infection markers religiously, hence the blood taking). in a bid of desperation (perhaps out of seeing the patient everyday), the attending decides to schedule a "closed KIV open reduction of Left hip posterior dislocation" in the OR that day, and leaves it up to me to tell the family. i break the news none too gently (i'm really crap at this) and the daughter bursts into tears promptly.
it's pretty sad, isn't it? i really do feel sad that their dad has to be in hospital for so long and has so many bad things happen to him.
on the other hand, i wish they would just let me get on with my work and stop unloading all their emotions on me. it's very frustrating, and it makes me hate them unintentionally.
just yesterday, i was ordered to do another septic workup on him and bemoaned the fact endlessly. as i walked into the cubicle, i was super pleased not to see any of his relatives around, and managed to do my work fairly quickly. i was feeling really pleased with myself then, but also guilty.

it's not like we're subjecting him to extra tests that needn't be done, we do need to track the decreasing trend of infective/inflammatory markers and the vanco levels to ensure he's getting proper treatment. but as an sub-intern/intern, there's nothing much we can do other than that. the attendings have no clue about medical management, they refer widely and loosely. i have written some of the shortest and crappiest referral letters ever (read: dear colleague, thank you for seeing this patient. pls refer to attached summary and advise. thank you). sad to say, this is the standard in ortho. i initially tried to write decent letters with a short summary and relevant points and investigations but gave up after my intern told me to forget it as the medical people reviewing the letter usually just ignore the summary because it's so poorly written.

it's quite appalling, the general lack of care. the attendings only seem to want to get into the OR, they dont' really seem to notice the patients

just the other day, i was confronted by a very angry Infectious Diseases (ID) attending, demanding me to go through the file with him. i cringed as he pointed out each and every mistake in documentation - chief ones being:
1. "wound is clean and dry" - attending
this was followed by "wound is oozing haemoserous discharge" - intern
and "milking of wound soaked 3 gamgees and gauze pads" - nurse clinicians

2. "pls review for possible infection" - attending
and no labs for blood/fluid/tissue cultures or septic workup of any sort was initiated.

3. days worth of not seeing the patient yet documentation shows that the patient is unwell

etc etc

i couldn't help by cringe as he berated the surgeons. he ended it off by saying, "even if you beat me to death, i won't come here if i need ortho surgery!" and "don't EVER be like them if you want to be a surgeon in the future!"

quite mortifying. i'm seriously thinking harder now.

and of course, how can i end a post without talking about the resident drug addict?
he's been admitted in and out of hospital, has had 20 over operations in ortho, has lodged more than 20 complaint letters against interns, residents, nurses, cleaners etc.
and has been walking up and down the wards demanding for morphine injections and raising a hell lot of noise in general, being rude to everyone.
the irony of it all? in his complaint letters, he calls everyone rude, and himself a defender of the wrongs, the righter of injustices etc etc. quite ironic that he mentioned sueing his own brothers in the same letter.

on the bright side? (there's always a bright side). i had to set a plug on an 85 year old gent with a shoulder carbuncle, and he entertained me lots, kept quiet whilst i set the plug, joked with me afterwards and generally made me feel lots better :) when doing his post-op review, he was still cheery although in lots of pain, and politely asked for a jab to stop the pain. what a gentleman! :)

patients. love them? hate them? you decide.
but like i said, i still love my job. :)

1 comment:

brazilian md said...

i always read your blog and i love it!! keep posting!