Sunday, 25 January 2009

Dr Thunder: The Lazarus Project

Posted by: Dr. Thunder

May I take this opportunity to wish you all:

A) A happy halloween

B) Happy Christmas

C) A happy new year.

Retrospectively, of coure.

I haven't been blogging since late October. Not because nothing has happened. Not even because I'm lazy. 

I've just been tired, grumpy, overworked, and unmotivated.

We've recently gone through a very busy period in the paediatric department. We were really snowed under, and everyone was pretty miserable. This had the effect of causing 2 of our doctors to resign.

As a result, the rest of us were even more overworked...and grump.....and unmotivated.

I started working every day of the week, with the occasional weekday off. I worked pretty much every weekend, and all my shifts were long and unsociable hours.

So, I guess the blogging suffered because I was miserable in my job, and just didn't want to talk about it.

But things are better now. I'm getting 2 days off a week, and I have some wekeends off, plus we have more staff.

That has had the effect of improving my demeanour somewhat, which is lucky. Lucky because Mrs Wiley turned up with her toddler today. Mrs Wiley is a "heartsink mum". That means that as soon as she walks in the door, everyone looks the other way, and nobody wants to deal with her.

She brought her toddler, James, in to see us, as she has done every couple of weeks since he was very young.
Mrs Wiley is extremely worried about high temperatures in her son. Someone once told her that high temperatures in a little person suggest meningitis until proven otherwise.

So, she takes his temperature every morning and night.

If it creeps above 37.5 degrees, she comes straight to hospital. 

So, the consultation usually involved a happy,playful toddler with a temperature of 37.8 degrees, a rageing mum who's angry at having to wait 3 hours with her meningitic son, and a bemused doctor. The key here is that, while the temperatures tend to be just above 37.5 degrees, they're not signiciantly elevated.

I've seen James a few times. Initially consultants got involved, in order to allay mum's fears. We also wrote to her GP, and arranged health visitors. Nothing worked.So now we've given up, and we just see the kid each time.

Yesterday he looked as well as he usually does. I think he's geting to know me, as he offered me a rusk when I was listening to his chest. I politely declined, and continued the examination.

I told his mum that he looked fine, and gave the standard advice about temperatures to her. She wasn't happy. I had a chat to her, and explained the symptoms of serious illnesses, such as meningitis, and explained why i didn't think james was unwell.

She was unhappy because we "never do blood tests". This, to her mind, meant we weren't taking her seriously.

I don't know what else to say. I tell her I'm not going to do blood tests. We argue. She goes away unhappy, and says she's going straight to her GP. I think that's a good thing actually, as I think she could use some help.

It's a difficult situation, and an akward one. But what do I do? Investigating this well child is a waste of resources, and it will just foster the culture of dependence even more.

I rang the GP and told him that James was on his way. Social services are involved in a superficial way, and he's going to broach the subject of counselling.

I hope it works. I hope mum gets some help. But I suspect we'll be seeing  alot more of James and Mrs Wiley in the future.

*all names used in this blog are fictional.
Dr. Thunder

1 comment:

  1. OMG! I feel like all my Christmases have come at once!

    I almost choked on my coffee when I realised you were actually back. I wuz worried, I wuz...

    All I can add in response to Mrs Wiley, is God help little James. That poor child will need rescuing from his mother soon if she keeps smothering him like that. You should call her bluff one day and tell her that James needs major surgery. I betcha she'd grab James and run out of the place like a scalded hen! She needs help and the sooner the better by the sounds of things.

    The first clinical director posts were announced by HSE today. €50,000 extra on top of consultant salary. Tempted?