To all our avid readers!

Two Weeks will be returning soon

Personally life has taken over for a few weeks, but within days you'll be happily (?) reading your latest post from us

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.

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.

Hey, Mr duck, giz a bite of yer sandwich!

posted by Dr. Thunder


So, week number 1 down. New Zealand is great. Weird great, but great nonetheless. We're short staffed. Nothing new there. We have 4 registrars at the minute. We should have 7. Bummer, you'd think. That's me doing a 1 in 4, you'd think.

But no.

Here, when there's a shortage of staff they do the following.

1) They ask if anyone fancies a few extra quid doing extra shifts

2) If that doesn't work they try to find a locum

3) If that doesn't work, the consultants do the shift!!!!

So, my consultant is on nights this weekend, because we don't have a reg. That, I must say is a culture shock.

I have less patients than I had in the UK, and by and large they're less sick.

That is, except for the Maori population.....


They get REALLY sick.

I thought deprivation was as bad as it gets when I worked in Glasgow. But last night I saw a 14 month old girl. She lives in a small house with 15 other relatives!!! She was covered in boils. She has a skin infection. She had a shocking mouth and gum infection. She also has bilateral ear infections, and both ears are bleeding.

This was the first patient I saw in my first out of hours shift.

I have seen dehydrated kids before, but this was a particularly sad story. This little girl was in so much pain, she simply couldn't eat or drink. End of story. She was so thirsty, she desperately tried drinking the bath water before she came to hospital. She was literally trying to lap up the the soapy water like a cat laps up milk (I don't think she gets a lot of baths, but like so many people, she had to have a bath before she saw the doctor!). Also, there are wild ducks where she lives. Yesterday she was chasing them to try and get her hands on the pieces of stale bread they'd scavenged from her back yard. She succeeded in one case. Thankfully, she was in too much pain to eat it!

Anyway, we put a nasogastric tube don her nose and into her tummy, and gave her lots of milk overnight. We also gave her painkillers down the tube. So, she's a lot happier now.

They also "nurse" on this side of the world. There is one dickhead who wanders about with a power-suit and a clipboard, but like most (insert word) specialist practitioners, we don't know what she does. But the important this is that she keeps out of my way. There are more nurses here than I've ever seen in my life. The nurse:patient rations are good, and the nurses themselves are good. Certainly my hospital is an example of how basic nursing done well is as important as any other role int he hospital.

So, so far so good. No disasters yet. I've a few complicated patients on the ward. But, I have time to think about them. I feel like I give better care here then I do back home, where I'm always under horrendous pressure.

Plus the weather here is better than back home.

Anyway, I'll sign off. I'm off to enjoy my weekend.

My 1st day (ish)

Hi there. Apologies for the long delay in posting. I've been moving my ass halfway round the world from Ireland to new Zealand over the last couple of weeks. I've relied on internet cafes on the way to keep up to date with emailing. But it's not really condusive to proper blogging. I've just gotten to New zealand, and am in an internet cafe right now. But, the shock of today's "meet and greet" session at my new hospital has prompted me to tell you all about it.

Basically the following happened today:

1) Human resources were very pleasant and very well organised.

2) Human resources were expecting me when I arrived.

3) I've known what I'll be paid since I aplied for the job

4) As I walked in the front entrance of the new hospital, a random porter wished me a good morning. He would have no way of kknowing I was a new doc.

5) My rota was ready and waiting for me. they apologised for not posting it to me earlier.

6) The docs' accomodation is really nice, and costs only 70 dollars per week (35 euro, or roughly 27 pounds sterling).

6) There is an on-call room

7) As I was walking out of the hospital, some random meber of staff engaged me in conversation in the car park about the weather.

8) The taxi driver who brought me to the hospital told me how highly the locals think of the hospital and it's staff.

None of the above may seem like a big deal for those of you who have never worked in a British or Irish hospital as a doctor. To those who have, you can see why I felt a little dizzied by the experience.

Like I said, I've no at-home internet service yet. But I'll try to keep up the posting from the local internet cafe. I start work on monday in the new job. You'll be the first to know how it goes.

Wish me luck.

Dr. Thunder

Revolution

Good Morning to one and all, your friendly neighbourhood nurse here, coming to you after a short hiatus. Apologies to anyone who was holding their breath for the next nurse authored post, but even I gotta work, and have had a marathon session of that lately, all because I want 2 weekends off in a row before my holidays! How dare I!!!!!!

So how was my past week? Well crap really, sleeping on my feet, towards the weekend I was running totally on autopilot, surrounded by leaking catheter bags (not pleasant) and crazy old men, but I survived.....just.....

Now I know, a lot of medics reading will be thinking "But sure we work like that all the time" and I agree, non consultant doctors do horrific hours. I make it a point to be nice to the interns mainly because I think they get an awful time of it, sure over time I'm nice to some of them because we genuinely get on well or they're hot but thats a different matter. I'm talking about in general, with interns or other junior docs that I don't really know.

It makes me wonder though, why don't the doc's rise up against this sort of thing?

I love my job, i enjoy being a nurse but to be honest I never really thought I'd end up doing it. I actually wanted to be a doctor from a very young age but growing up and having friends in training put me right off so I looked into nursing instead. Now, unless someone let me walk right in at Registrar level, there would be no chance I'd even entertain the thoughts. This strikes me as a bad thing really, not because of any personal reasons but surely there has to be a better way. I know the doctoring world is very like the nursing world, in that your not meant to raise trouble and keep quiet about things but really if all the interns in the whole country got together what could they do? So to all the doctors out there I say REVOLT! I'll organise nursing support and I'm sure I have a few links with other departments. Lets lock ourselves in the treatments rooms across the country and not come out til we sort out the mad hours, the intolerable pressure and the general shittiness that is being a junior doc, because its not fair and tarnishes what is a wonderful job when its going well.

Ok so rant over......time for a few nicer bits


Firstly big thanks to the Dr Rant team for the ongoing mentions. Their blog is funny, informative, cutting when needs be and a very good read. I do notice though that you haven't a nurse on the team tut tut guys.....you need someone to keep you in check! Who'll remind you to chart the warfarin for the weekend before you head off into the Friday evening sunset!

Secondly, I'd like my part of the blog to be a bit more interactive. I don't really want it to be a selection of my overtired ramblings and not much else, so please readers, if you've got something that you'd like my opinion on, or want to see written about leave a comment and I'll see what I can come up with.

Finally, to Comrade Thunder.........

You'll be missed on this side of the world, hope your having a good time over yonder and look forward to your first homecoming for a round of Nurses V Doctors in the pub!

Thats it

The sound of tumbleweed

Hi there. Remember me? ;)

Sorry I haven't posted anything in a while.

First off, i had connection problems at home in Ireland (This is not a reference to impaired neurological functioning, may I add). Secondly, I'm currently enroute to New Zealand in the economy section of a cargo ship. The captain has insisted on stopping off in Hong Kong to buy some hookie watches and handbags for his family back home.

I've just popped into Kowloon's most glamorous internet cafe to post this, in order to escape the sweltering humidity. It's almost as hot out there as a Glasgow Geriatric ward.

I won't be settled in Mew Zealand and in my new job for about another 2 weeks, and probably won't have internet access for most of that time. Mind you, I've no patients at the moment either, so I wouldn't have much to post about.

In the meantime, I hope DrIndy and Ain't no angel can keep you guys occupied.

However, I hope to be back online, polluting the blogosphere with tales of combined doctoring/sunbathing/womanising from New Zealand within the next couple of weeks.

Hope you're all keeping well.

Dr. Thunder