fight on stage

*ssshwooop* there it goes

another friday night disappears. and guess what i was doing. not out. not with people i love (well not till the dying hours.) not relaxing. not even on call. but yes i was at the hospital.

we have a ninety year old. he's a bit fragile. he hasn't been able to eat anything for a month because a peculiarity in the anatomy of his oesophagus (food tube from mouth to stomach) means that food isn't going down.

as a result the protein levels in his blood are very very low. as a result of that any fluid that goes into him as drips doesn't stay in his blood vessels but pours out into his arms legs abdomen lungs etc. similarly not a lot of blood is going to his kidneys and they are failing.

i had to put a large drip into one of the big vessels going into his heart on tuesday night (after work) because he was too swollen to get a normal drip line in anywhere else. however despite this the only way to get him any better is to get the protein levels up in his body and the only way to do this is to feed him. however every effort to get a feeding tube of some kind into him is failing.

he has one last chance. one of the clever radiology doctors (a top bloke as it happens) reckons that he can get a feeding tube into this man. this is scheduled for monday morning. in the meantime my patient continues to deteriorate.

there are lots of ethical questions. "did you say 90 dr D&C? have you gone out of your handsome little head?" how much should you do for someone so elderly and so fragile? there have been many occasions (see lady in last post) where we've pulled out. my man, despite his body being so weak, is completely with it. i've had about four or five chats with him along the lines of "how much do you want us to do?" and each time he says he says he's "quite up for a go with the tube through the nose."

we don't think that he's confused or lacks "capacity" and so our options are to give any therapeutic options a go (provided they don't harm him any more) or... well... to let him starve. the team sat down and had a bit of a discussion about this. despite my harsh impenetrable exterior, i found myself advocating for the "we've got to give him a chance" approach.

the problem then arose (on friday at 3pm as always) that we have to keep him going through the weekend. it could be argued that if he hasn't fed for so long is another two days going to make a difference. i always feel that if you make a plan to pursue a certain management plan, you do it completely, without fudging, and properly. so in order to get some protein into him we organised intravenous nutrition for him.

to provide this, my man needed ANOTHER big drip going into his heart. i elected to stay back after work with one of the other doctors to put this in, partly because i have more experience.

it was bloody hard. i haven't failed getting one in for a long long time but for whatever reason, it didn't work. my colleague had a go but also couldn't get it. i tried again. no joy. at times like this the anaesthetists are the people to call on and sure enough we did. by this time it was 830pm. i sent the other doctor home because 1) it's courteous to wait around for your help to thank them and explain the situation and 2) there was no point two of us being there.

the anaesthetist failed three times. finally at about 930pm it went in. my man started his feed.

by the time i got home it was late, i was exhausted and not even a cheese and tomato toastie could save me. not even johnny depp's peculiar cockney accent in From Hell either.

i'm not sure what i'm moaning about really. i'm not too fussed about failing the procedure as it clearly was a tricky one. i don't know if it's about staying late either. i suppose it's more that some of the doctors in this system actually do give a shit. i just don't think that managers/royal colleges/the daily mail/the department of health really care. management would have had a go at us for staying so long after our end of shift. they would have said we should have handed this all over to the night team. you can't just dump complicated situations like this on other people. maybe i'm trying to convince myself that i'm still a "nice person" and have some humanity left in me.

the flip side of this i'm starting to wonder why i bother. if/when i fail this exam in a few weeks time i'll think what is the fucking point? there are hardly any jobs available for february. if i'm unemployed then i'll also think what is the fucking point? if the change in training screws me over i shall also wonder what is the fucking point?

i guess if it give this guy a chance to get better then there's my answer. but, in the scheme of all the other crap in the NHS, i don't know how long "finding happiness in helping people" will keep me going.

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on a lighter/darker note, i did laugh to myself when i checked the sitemeter the other day and realised that most visitors to MOADD arrive by a Google search for "i hate medicine."

[i am off to see the brian jonestown massacre on sunday night. here's hoping for a fight.]