March 2005

Home alone on the wards

It's been said that if patients really knew what went on behind the scenes in hospitals they'd never set foot in one. Well, they would have run a mile one recent Saturday if they knew I was working without a resident covering call with me. I was running the wards entirely on my own!

I tried calling the program director at home to schedule shift changes, worrying with each page I received that one of them would eventually be way over my head.

I was paged for Kao tube placements, EKGs, exacerbation of heart failure, warfarin orders, low and high blood sugars. I managed to nab a staff internist who happened to be rounding to ask about a potassium level of 6.1. "Repeat the potassium in a heparinized tube, check the creatinine for dehydration and consider Kayexalate," Dr Leonard suggested. "But I didn't tell you that," he added quickly. "I don't know the patient so I can't take responsibility."

This is what really shocked me: none of the doctors I encountered seemed that concerned about me taking care of ward duties on my own. I would have expected them to offer me more support. Instead no one seemed to want more work, and most especially they didn't want to be responsible if something went wrong.

SOMEBODY ELSE'S PATIENT
I was paged about four times that night to see Larry, a 21-year- old admitted non-acute patient in emergency with a DVT in his left arm. "This gentleman just wants someone in a white coat to come and tell him what's going on," the nurse told me.

"Wouldn't it make sense that the person admitting him would have explained all this?" I asked her. "Yes, it would," she replied, "but we've tried paging Dr Wilkins and he's not getting back to us, so you'll have to do it."

I would have told the nurses to keep paging Dr Wilkins except for one little thing: he was one of my preceptors and I still needed a reference letter from him.

When I finally made it down to emergency, Larry's mum made a beeline for me. "Are you Dr Suende?" she fumed. "My son's been waiting for you!"

I wanted to scream, tell her I'm just a med student without any backup and that I hadn't sat down the entire day. I wanted to shout that I hadn't eaten since breakfast because the nurses kept paging me to write orders they can't process because they're not co-signed — and I really felt like mentioning that my feet were damned sore. I wanted to hurl some accusations back at her. Why did she wait until the weekend, when many doctors were off, to bring her son in — though his symptoms started Tuesday? But I bit my tongue.

That night I had an epiphany: we doctors have to empathize, explore our patients' feelings, care. But our patients don't have to care about us.

RELIEF, AT LAST
Eventually the resident arrived, explaining that he hadn't realized he was on call and that he'd take all the calls after 10pm. But I had one last page to deal with before I could go to bed.

I entered the room of the patient I'd been called to see. Her relatives were lined up along the wall, waiting for me. I felt for a pulse and checked her unresponsive pupils. It was almost a ritual. The patient was obviously dead, but under the watchful eyes of the family, I still put on my stethoscope and listened for any breathing or heart sounds. There were none. I carefully draped her, looked up at the family and said, "I'm sorry for your loss."

As busy as the hospital is, there are always pockets of quiet. That was the second pronouncement I'd done, and it was strangely calming. How odd, I thought, that a death and a teary-eyed family could so quickly wipe away all the day's drama.

(NB: Names of doctors and patients have been changed.)