Tempus Fugit

Time Flies…

   Jun 28

The Ward Call Commando Course….

Five hours in theatre.

Pus abounded.

Most impressive was the cottage-cheese butt-volcano…. a multiple headed pus-filled monster of an abcess.

Plenty of caseous discharge prior to it’s incision and drainage.

I recall the famous words of my micro lecturer….

Never let the sun go down on undrained pus

The anaesthetist who I was shadowing decided that I should learn much by doing….

So I had to do everything whilst he sat back and directed….

Yummy drugs to administer….fentanyl….sux(amethonium)….midazaSLAM(sic) and good ol propofol….

I got to insert some LMAs (Laryngeal Mask Airways) today. Difficult to describe what these look like to the uninitiated…..but it might help if you recall the conversation we had the other day about “a man in a rowboat”… The LMA is inserted by pushing against the hard palate of your mouth and then it slides down your throat where it protects your airway whilst you are under an anaesthetic.

Much learnt. Fun to be had.

But that doesn’t explain the cryptic title of this post…..

After the list finished this afternoon… I went to do ward call with Jandy.

WTF is ward call I hear some of you ask?

Well… picture this… come five o’clock…all the doctors go home…leaving a lowly intern to deal with all the problems that arise until 9:30pm when the night reg comes on. Instead of a single ward to cover….the ward call intern covers maybe 5 or 6 wards. These wards page the poor sod when there are things to be done…..the pager is your enemy…it signals a call to battle…like a bugle on a battlefield.

….things like intravenous cannula resites…..drug orders….crumbling patients….fluid orders….anything that the teams have forgotten to do during the day or that arise out of hours.

Typically you either get paged at once by all five or six wards (it’s difficult to be in six places at once….) or you don’t get paged.

….so you get paged….and you are summonsed to the ward….and it’s like running the gauntlet…

I have images of the lone intern dressed in scrubs with camouflage paint on his face appearing in a misty hallway whilst the theme from the good, the bad and the ugly plays…..the doors to the wards open menacingly and you enter the lion’s den armed only with a stethescope, a drug-company-sponsored pen and perhaps a tendon hammer…

So the lowly intern enters the ward like a lamb to the slaughter…..the nurses …smelling new intern flesh…descend upon the hapless sod like shrieking hyenas with hundreds of tasks to be completed.

It’s a very highly sought after skill (for the intern) to be able to penetrate the ward and make it to the nurses station without being ambushed by half a dozen nurses wanting med charts rewritten, cannulas resited and bloods taken.

Add to that mix there is three or four concerned patient families wanting to speak with a doctor (any doctor…doesn’t even seem to matter if that doctor has even met their loved one).

We orchestrate further mayhem by including the hysterical patient who only feigns exquisite pain when her family is around (chatting up the guy in the next bed when her family is not around), and the poor gentleman with multiple fractures and pain that is not responding to opiates both singing a mournful duet of agony.

As if this menagerie was not enough, the zoo is augmented by a few delerious elderly patients wandering around the ward like zombies (sundowning), semi-naked being chased by wardies or family attempting them to get back in bed. All the while they’re shouting at the top of their voices “No No No No Noooooooo I’m not going to go back to jail” or “The two lovely ladies promised me a good time if only I phone my wife first”.

So in order for the ward-call intern to escape this modern interpretation of “Dante’s Inferno”…the nine levels of hell, he or she must navigate through this mine-field of problems – preferably without killing any patients or pissing off any nurses (Nurses have the ability to make life sheer and unadulterated hell if you piss them off).

Assuming the battle-weary intern makes it through the shift…and hands the baton onto the night-registrar….the best they can look forward to is a dreamless sleep only to return the next morning to face the zoo again.

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2 Comments

  1. says:

    You watch Scrubs, don’t you? If you don’t, you could clearly write scripts for it.

  2. Paradox says:

    roflmao! Very well written Jer and scarily you hit the nail on the proverbial head! Having experienced all of the aspects of a crazy evening shift that you described I got a huge laugh out of this entry. How much are we NOT looking forward to working these shifts next year?! ARGH.

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