Tuesday, October 03, 2006
Not the real post-call, I had mine on Saturday (yes, Saturday). Possibly the one call I'll never forget. Some stuff I learnt:
1) Patients somehow end up in a chorus vomit/hypotension/chest pain session once all the team doctors go home. I can't fathom how this internal bioclock works. Once the clock strikes a certain time, bam! While you're tending to 1 vomitting patient, another goes into hypotension, and 10 minutes later the patient beside the first vomitting patient vomits and while you're trying hard to find the artery to draw blood from, some nurse calls and recites a list of results (including 4 patients with simultaneous hypokalaemias) that requires your immediate attention.
2) There actually is a Vacutainer holder that you can use for blood cultures. More on this later. The Carrie episode.
3) If you insert a syringe into a Vacutainer and the blood doesn't come out, don't force it. KIV Carrie episode.
4) Beware obese, dark-skinned and oedematous people. Alas. My first 3 plugs had to be done on them. What a morale-booster.
The Carrie EpisodeIt's not funny. Imagine this - for some strange reason, the call turns out to be a 100% failure type of call. Difficult venous access on all patients (geri and oedema), and when you find that thread-like vein, you end up going through and through. After 3 hours of that, I did a blood culture. The patient's blood was ODDLY thick. It literally oozed out into the syringe - and then the patient went into a coughing fit with my needle still in the vein, and CRIPES. It went right through. Oh hell, I have 5mls, that'll do for 1 bottle. So I plunge the syringe into the culture bottle, and hey - the blood doesn't come out! I didn't realise it had coagulated in the space of 3 minutes, and as I pushed the plunger, the needle separated from the plunger body, raining a shower of blood on my shirt, the curtains, the patient, the procedure trolley, the floor.
Great. JUST GREAT. I really needed that, after a whole night of failures.
MO was alarmed, but I didn't get any of the stuff on my face, let alone my eyes. Still, it was quite a sight, and people were staring. Reminds me of that show, Carrie. All covered in blood.
*****
You know, while I may joke about loving patients with peripheral neuropathy for plug-setting since they don't feel the pain, right on the other end of the spectrum are those who are clinically unresponsive. i.e. GCS score of 3 kind of patients. And if you think that you can f* these up just because they don't scream at you, you're dead wrong.
One of those extremely difficult patients I had to do on call was like this. Totally unresponsive, and caregiver confirms it and says that patient had been like these all these years. Took a look at the veins - OMG. Oedema (AGAIN), not-so-thin (being PC here), and non-existant veins at all. Was so on the verge of calling my HO and telling him I can't do it, but I thought, heck, I'll give it a go. At least she won't scream at me.
Took me 2 whole minutes to find the vein, and I pierced it right through. SHIT. So I tried a second time. And a third. And all the while just going by pure palpation since the veins aren't visible. I'm trying really hard, but it just keeps failing, and failing and failing. I finally call it quits and call my HO, and as I was packing up, I saw tears in the corners of her eyes.
Unresponsive? I think not.
Felt so lousy about causing the poor patient so much pain that I wanted to go curl up in a corner and cry. It's such a torture, being awake but not quite alive. If she ever gets well some day, I hope I have the chance to apologise for that night.
When your conscience weighs heavily on you on top of having an absolutely incompetent night, this makes for one bad call.
Wenky
7:06 PM
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