Thank you...

to all the nursing staff who

1)didn't bleep me to come and prescribe paracetamol when it was already prescribed PRN
2)looked at all the drug charts to see if the fluids had been prescribed there before bleeping the Fuddled Medic
3)wondered if the FM had gone into AKI during her shift and made her a cup of tea
4)had an ECG done, taken some bloods whilst the FM was on her way to see the patient with chest pain
5)didn't get annoyed when the FM asked why a patient needed fluids or when she took five minutes to look at the U&Es
6)who bleeped the cannula nurse instead of me (as opposed to the FM asking down the phone if they had bleeped the cannula nurse)
7)who thought my request to await for a patients INR to come back before I prescribed warfarin was reasonable, as opposed to me "being funny."

Weekend

The Fuddled Medic agrees with the Medical Registrar on call that it would have been nice for his registrar to review the patient before calling the Med Reg, but is confused as to how useful the trauma and orthopaedic registrar would be in dealing with an acute stroke. Besides he was in theatre and wasn't answering his bleep

On call

How to survive an on call

1) Have a good nights sleep beforehand. Be tucked up in bed with a nice hot chocolate by 11:00pm.

2) Have a good breakfast, preferably involving kippers or bacon. It may be the last time you eat that day.

3) Keep a copy of the oxford handbook in the one ward you cover and the foundation programme in the over.

4) Buy the nurses chocolate, it really does work.

5)When calling the med reg be very clear what you want him/her to do. When on the phone they will be coming up with questions in the hope you don't know the answer to so they can tell you to go away and come back when you do know the answer.

6) When/if the med reg comes worship him. And have two pieces (at least) of clerking paper ready for him.

7) If you can, find the sho's/cts in anaesthesiae and butter them up so that they'l come and do a cannula for you.

8)When the cannula nurse agrees to help you with bloods, cannula's etc, have stuff ready for you. They'll remember it.

9) have something to EAT AND DRINK. At least so you don't have the irony have treating somebodies AKI when your technically in it to.

Cynical?

Am I right to be a bit annoyed and cynical about a colleague who was seen in a nightclub last night very drunk last night who did not turn up for work today? Especially as it doubled the workload for one of my colleagues.

Confidence and Careers

Starting work has been stressful, mistakes have been made on the whole (I hope) myself and my new colleagues seem to have done ok.

On call have been stressful and then the doubt starts to come in. Should I have reviewed Mrs X who track triggered or Mrs B who seemed just as sick first?

Did I do the right thing? Should I have seen this happening earlier? Did I miss something?

An FY2 colleague said to me - "Your doing fine. Everybody ended the shift hemodynamically  stable and those who weren't, you got a senior to come along."

Apparently this gets easier and you start to relax. Hope it starts soon

Radiology

Consultant Radiologist 1 - Asked me why I wanted a CTPA. I explained that we wanted to rule out a PE on a patient as he was tachycardic, respiratory rate of 25, desaturations to 85% and had spoke to the med reg who agreed a CTPA was necessary. Agreed to do it.

Consultant Radiologist 2 - Exact same picture as before. Told me that an FY1 should not be requesting CTPAs, shouted a bit, ordered me to speak to the Med Reg and get him to speak to him directly. Resulting in me wasting time getting someone more senior than me to speak with a radiologist to tell them exactly the same as what I did

ECG and orthopaedics

The Fuddled Medic is working (blundering through) as an FY1 in trauma and orthopaedics. This involves conversations like this.

My Consultant - How is the patient?

Me - Well they went into retention last night so we catheterised them. Also there kidney functions don't look so good so I've reviewed and increased there IV fluids and ordered a renal US. They also suffered a morphine overdose on return from theatre, so we reversed this with narloxone and this brought there respiratory rate back up.

My Consultant - I meant, how is the knee I operated on?

Or something along those lines.

I have survived a weekend on call, an evening on call and am cautiously optimistic. On the other hand I have forgotten how to read ECGs and am grateful to the passing Med Reg who kindly agreed to review one for me. As a result this weekend has been spent reading "ECGs made easy."

And as a result of becoming a doctor, I've only gone and joined the National Trust - how middle class can you get