Last Night on Call

To code or not to code

Every time I go to work with the intention of not allowing chaos to influence me, the universe laughs. 

On a particularly pretty morning, with flecks of white cotton wool against a autumn blue sky, I walked into the hospital and breathed deeply. This is just a job, I reminded myself. Just a job. I can do this job with level-headed calmness. I don't have to be frantic about anything I do. It saps far more energy and often saves no time. 

I took deep breaths as I climbed the stairs. I felt the blood flowing through my veins, waking my metabolism. This job is not worth my mental health, I said in my mind. I am a better doctor to those is distress when I am not distressed. 

"Did you see ECTracker?" Belle asked me as I walked into ward 4. 

"No, why?"

She hesitated. "It's busy." She shrugged with false calmness. "Don't worry, it'll be fine."

"It will be fine," I said in my mind as I opened ECTracker and saw ten patients already on the referral list... at 8am in the morning. No chaos, I reminded myself. Panicking doesn't take patients off the list. I would simply see the... nineteen patients in the ward first.

The universe laughed. 

An hour later a message came through on the work group.

"Please note that EC is currently as 500% capacity."

The universe cackled. 

There's a very different energy in the team on the day of a call; a kind of crackling, sharp energy. It's the senior I'd been stationed with at the time, she changed on the day and took on extra urgency - it felt like mania. She didn't ask a question, but rather demanded an answer. When I came to her to discuss a patient, I prepared for a barrage of things I didn't do, and if I did them, there would be some other things I didn't. It was a wild adrenaline surge for 26 hours.

Luckily on that day, some of the doctors from other units pitched in to help in EC. By the time the day shift was ending at 4pm, my mind was swimming with the 19 patients in the ward and how quickly I felt I had to race through seeing them. I was on the last one when she texted, 'are you even going to see one patient in EC before the afternoon round?'

I just saw 19 patients on my own and I've been a doctor for 6 weeks in total.

Very few things hit motivation like that. It manifested like a wave of fatigue. 

**

I was clerking (seeing, taking a history from) this man who had come into the EC, let's call him Mr. P, and I was astounded by him. His chief complaint on arrival was a cough. He was a textbook candidate for TB - an HIV positive man who had defaulted treatment, with a very low CD4 count (a count of the cells that HIV attacks). He had the look of someone who had been ill for a long time. Every time he took a breath, a throaty, phlegmy sound reverberated from his throat. 

His x-ray showed a pneumonia, but whether it was TB or not could not yet be confirmed without testing of the phlegm. But he had been confirmed with TB a few months ago, so he was already wearing a face mask to protect those around him. When I examined him I noticed that he also had a fungal infection in his mouth (advanced HIV can do that), and my senior noticed sores on his lip (most likely herpes).

My head was now spinning a bit from all the things here that were wrong. I wrote the script and moved on to clerking the next patient, a man who was in the next bed. As I was about to start my senior called my name from the patient I had just seen, Mr. P. She was about to insert a catheter and noticed a white discharge from his downstairs region. I sighed and wrote up the antibiotics for an STI, likely gonorrhea. Yet another pathology in this man. 

Back to the second patient (let's call him Mr. John): he immediately struck me as a bit strange. His manner of speaking was animated and agitated, and he kept standing from the bed. At first to go to the bathroom, and then I'm not really sure why. He had emphysema (a chronic disease of the lungs caused by years of smoking) and was now presenting with what looked like a bad pneumonia. 

We took blood for some tests and started antibiotics immediately. He was moved to the overnight ward, a small ward next to the EC usually for short stays or an in intermediate between EC and the wards upstairs. 

My night went on with more patients and more drips and more medications, until the list of people to see stilled, and I was allowed an hour or two of sleep. 

However, my night was not restful.