last nights of fy2
done!!!
I'm not done with medical nights just yet, but I rather enjoyed this set of nights – good team, good reg, and while staffing was lighter than usual, our ward cover overnight is ridiculously good for similar hospitals.
there were some very unwell patients, with a variety of pathologies, and we as a team did deliver some genuinely lifesaving care (this can be rare!)
there was also the usual frustrations: unprofessional behaviour, people trying to shift risk and blame to doctors for no discernible reason, not getting any rest with back to back emergencies. The latter, of course, being unavoidable sometimes; the former, systemic problems with no single solution.
sometimes it's about winning colleagues over to the side of the evidence. The temptation to just do something about asymptomatic hypertension is great. I have been guilty of succumbing to the “5mg amlodipine in the middle of the night”, a medication that will certainly not take effect by the time the nursing staff next take the poor patient's blood pressure. And yet, it's a strategy that just makes the healthcare professional feel better for having done something.
Sometimes, though, there's a glimpse of the type of medicine that compelled me to go for emergency medicine training.
Joining a colleague at the bedside of an unwell patient, and just getting stuff done. Putting the evidence together to try and figure out what was going on and how to improve their physiology.
And sometimes we (the medical team) actually arrive to a patient in the middle of a life-threatening pathology, have the means to correct it and can immediately see the result.
What a privilege it is! this is the meat and bones of acute medicine and it is brilliant when it works.
(the heart and soul, of course, being rather different. I'm sure I'll talk about it one day, it's very Pratchett)