Monday, 8 October 2007

Global Warming + Cutbacks + Night Duty = Grumpy Nurse

Well hello to anyone still there!

First up an apology.........2 weeks ago I spent a fantastic week in Lanzarote, doing nothing more than reaching for another beer or ordering another steak sandwich, since I got back I've been easing myself back into the daily grind and my obligations to the blog suffered too.

So I go away, and the weather here is pretty good, relatively warm and sunny for the time of year. Step off the plane in Lanzarote and spend a week in the balmy temps and generally get very brown. Come back, and in the space of a week......Ireland must have become member of the Baltic States Alliance. I thought it was supposed to be getting warmer. Now maybe my hypothamalus was needing a bit of time to re-adjust but in the past 2 weeks I can't get the heat into me......unless, I'm in work, which brings me nicely into the current condition on the ground in the Irish Health Service.

Some of you may be aware that recently the organisation that runs the public health service in Ireland has had to tighten its belt considerably as its facing a budget overrun of about €250 million for this year. With that in mind they've pulled back on a number of things to try and save money. Mostly their action is based around a total recruitment freeze. No staff of any grade or function to be taken on at all. Initially this was meant to last for a month, but as most of us expected its been extended to January. Supposedly, this will not effect patient care, and our glorious Health Minister has gone on record on this, though over the past week or so the news has reported several incidences where this is most definitely affecting patient care and service delivery. I've also heard that we're now at the stage, were nurse to patient ratios are rising, mainly because wards access to agency nursing staff to cover sick leave etc is being severely curtailed.

Basically we're all suffering now for the ineptitude of the service administrators and managers. Is it only a matter of time before patients conditions start detoriating and heaven forbid maybe die because the system is failing yet again. How long before we see large numbers of staff leaving, unable and unwilling to deal with the pressure and stress of the public service. Lured by the shiny and pretty well funded private sector hospitals that seem to springing up with increasing regularity around the country. Already 3 of my workmates are either leaving or in the process of interviewing for such places. If we start losing our brightest and best, where will that leave us?

I'm sure over the next while things will develop further, hopefully not for the worst, time will tell I guess. I'm starting a week of night duty now, so depending on how well behaved the patients are you might get another post this week. If there happen to be any regular readers who'd like to ask anything in particular, just leave the comment and I'll see what I can do.

Thursday, 4 October 2007

Does a wrong cancel out a right?

This week I did what every doctor hates doing. I missed a diagnosis. I don't mean I missed an ear infection. I mean I missed seriously ill kiddy with a serious heart condition.

I was on-call for neonatology this week, and was called to labour ward for a delivery. They called me because they were using instruments to deliver the kiddy. When I arrived, the obstetrician was there, trying to haul this baby out of mum with a suction device. But the little one wasn't for coming. It took an age for him to come out. It was pretty horrific to watch. But i had the luxury of being able to stare at my feet, while mum was crying out for morphine.

Anyway, the baby eventually decided to pop out. Delivery had been long and difficult. Morphine had been given, which often has the effect of producing a sleepy baby at delivery.

This baby was indeed sleepy. His colour wasn't great either. But he was breathing, and had a good heartbeat. I needed to give him a bit of oxygen to pink him up, which worked a treat. Dad asked me why I needed to give his newborn oxygen. I replied cheerfully that the kiddy was just a bit stunned by the rough delivery, and the morphine had muted his natural responses. No probs, I'll have him right as rain in no time. And I did. I gave him back to his proud parents about 5 minutes after all the drama. Happy days.

Until the following morning, that is. One of my colleagues was on-call the next day. He was called to the post natal ward to see a newborn that the midwives were a bit concerned about. They had every right to be concerned. the baby was blue. Not a nice sight to be greeted with first thing in the morning.

So, everything kicks into action at this point. There's drips, there's lots of drugs, there's heart scans. Cardiologists turn up, and ventilator machines are rolled in. The parents were inconsolable.

It was the baby who's delivery I'd been at. I cowered in the corner. I couldn't look mum or dad in the eye. It was, shamefully, a relief to me when they were on their way to the local kiddies cardiac unit to be assessed for surgery. I don't know if I should have picked up the diagnosis at the delivery. I still don't know what the diagnosis is. I don't think there were any hard signs or symptoms at delivery. But would somebody else have acted differently? Would somebody else have referred this baby to the cardiologists earlier. Who knows? What i do know is that I didn't.

Later, in the same on-call shift, I was called to A+E to see a small baby. The GP thought he had reflux, and the A+E doc agreed. But he wanted me to see the kid "because mum is anxious and I'd like you to reassure her". I agreed. I always agree. I shouldn't, but I do.

The child had been vomiting for the last few weeks. He was now vomiting everything that he was taking in. He didn't look well. I made him nil by mouth, put in a drip and took some bloods. I suspected a condition called pyloric stenosis. I suspected he was in the very early stages. Pyloric stenosis is a condition where the muscles in the gut become so thick that food or liquid can't pass by them. It's a very serious condition, but with surgery, the outcome is very good. I did the tests, and my suspicion was right. So, I sent him off to the surgeons for his operation. Que 2 very grateful parents.

So, there we go. In one long long day I see a kid who's parents will forever regard me as the pillock who didn't ever notice their baby had a terrible heart problem, even when she needed oxygen. Then we have the parents who will regard me as the only doctor to take them seriously when their child was ill.

Can I really be both these things? Does my missed diagnosis cancel out my early diagnosis of the pyloric stenosis? Does that make me a doctor of "neutral" abilities?

At the end of the day, it's not about me. It's about getting it right most of the time, and making sure everyone gets a fair crack of the whip. I think we do that most of the time. But when we don't, it's the worst job in the world.