Medicine "oop North"

[M Clayton]

And it didn't.

Mr T made hung on long enough for the gasmen to put him under, for the 6 surgeons (count em) to get scrubbed and for them to make the first of the groin incisions. At that point, he gave up the fight and his BP crashed for the final time. A rushed laparatomy was made more difficult by masses of scar tissue from the first op and found an aortic graft surrounded by a huge abscess. The disaster was completed by a 3cm communication between the aorta and the duodenum - it's a wonder Mr T had held on so long.

Questions are going to be asked and, for the next few weeks at least, we're going to super twitchy when it comes to post op temperatures in our AAA patients. The sad reality is that we probably couldn't have done much differently and a lot of folk are going to be getting a lot of unnecessary antibiotics.

In other, unrelated news, I've started my week on a high - no senior cover again today. The SHO is on nights, the reg is on holiday and the staff grade had a tough night on call. Surprisingly, the med student and I managed to survive the day without issue and we got free food from a drug rep (yay!).

In less positive news, I burned myself on my dastardly NHS iron tonight. In the spirit of such old time classics as "kitchen cam", i've decided that I will track the progress of the wound in "Burn Cam".

That is my arm, by the way... Notice how I've been unable to resist the urge to pick off some of the burnt skin overlying the raw area. It currently stings and is oozing serous fluid. Interesting stuff.

[M Clayton]

I've returned to my spiritual home this week in that I'm covering in Upper GI surgery. It's a huge relief to have a respite from the barely organised chaos that is the vascular firm although I will miss the spectacle of Grand Round tomorrow. Nowhere else in medicine will you encounter a surgeon as self consciously Old School as Mr Bastard (not his real name). He really is a product of another generation and provides endless hours of amusement. Now then, what has this to do with the one morning of the week where decisions are made (ie Grand Round) I hear you ask. Mr Bastard is usually on fine form during these sessions and plays to the crowd. Observe, if you will, as a fly on the wall during a recent post round coffee break:

Mr Bastard: So chaps, what are we all having this morning?

A chorus of tea and coffee orders is relayed. Mr M, a fellow vascular consultant, has a cold and is feeling under the weather.

Mr M: I'll have a hot chocolate please Mr Bastard.

Mr Bastard turns round in wide mouthed awe.

Mr Bastard: HOT CHOCOLATE?! That's a bit of a homosexual drink isn't it Mr M?!

Mr Bastard has no time for those he thinks will waste it and has been known to shush a patient during a history if they begin to stray from the important nuts and bolts of their vascular problem - he certainly has no use for "Ideas", "Concerns" and "Expectations" and many a student has had such airy concepts bounced back at them with a brusque "If I wanted to know what Mrs X thought, I'd tell her!"

In spite of all this, and some truly bizarre encounters with their number ("Stitch, Bitch!"), the nursing staff love Mr Bastard. They lap up his insults like, well, they defy description. It truly is awe inspiring to watch and, do you know what, I'm going to miss it when I become an elderly medicine house officer next month.

For those of you that might have been eagerly awaiting Wound Cam, I've decided to shelve it as a concept for now. This has nothing at all to do with the fact that I can't get my camera to focus sufficiently on the wound... it's clearly a concept that's ahead of its time

[M Clayton]

Upper GI hasn't been quite the relaxed firm that I remember... The last two weeks have been pretty stressful at times, depressing at others but, by and large, I've had a good time. It's good to be home

Just one more week to go as a surgeon - next week, I get to deal with the never ending supply of "off legs" and "general deterioration" that is elderly medicine. Wish me luck!

[M Clayton]

Sob.

I am no longer a "house surgeon". As of 9 am (woo! lie-in!) tomorrow, I become a house officer in elderly medicine. Instead of days filled with complicated post op nightmares, I will endure the endlessly soul destroying affair that is the "Social Admission" and "Off Legs". Occasionally, I will be blessed with a NOF but the majority of my patients will be of the "General Deterioration" variant. Essentially, behind all the fancy terms, I will be dealing with a ward full of bed bound, crumbling old folk in a race against time - will I manage to get them a bed in a nursing home before their next CVA/MI/UTI lands them back on the list of people that need additional work?

The last couple of weeks on Upper GI have been truly, extraordinarily, maddeningly busy. At one stage last week, we had 50 patients on the list, with more to come in. It would have just about been manageable if there was something approaching a firm but when it's just the HO, one reg and 2 consultants, it ceases to be a safe environment for the patients. There's a hardcore of 8 or so patients that refuse to get better, no matter what we do to them and I've had a hard fortnight trying my damndest to sort each of them out. It's actually gotten so bad that the surgical HDU on ward 16 now only has patients from the Upper GI firm in it.

The first few days of last week were cardiology days - all of the big problems were related to intra-operative MIs, post op chest pains and a never ending supply of new onset AF. We had all varieties of rhythm disturbance - slow AF, fast AF, atrial flutter, fast AF with circulatory compromise. It actually got so silly that I stopped asking the med reg for advice on management - everyone ended up being shoved onto amiodarone/digoxin and, by and large, they reverted to something approaching sinus. One particularly stubborn bugger refused to get better despite whacking doses of chemical cardioversion so we admitted defeat and let the med reg take him upstairs to CCU and get the shock box out. With laudable confidence, he asserted that the DCCV would be the solution and the chances of slipping back were small. My consultant wasn't so sure but let them get on with it anyway.

6 hours on CCU later, mr refractory AF arrived back on surgical HDU. He was still in AF although, somewhat surprisingly, claiming to feel much better. The 14 miles of defibrillator rhythm strip attached to his notes like toilet paper said otherwise... never mind though. He tolerates this rhythm remarkably well (oh yes, he's still in AF a week and half later) so we've given up trying to sort it out for now. We're just dosing him with fragmin in an attempt to stop him stroking out on us. Clearly, we'll have to pass him onto the cardiologists at some point but, for now, his surgical problem takes precedence (I forget his exact issue - it was something about a bomb having gone off in his abdomen...).

The latter half of last week saw another major organ system being the big issue. Sticking with the chest theme, we had a major faff on with pneumonia, bronchitis, PE, pleural effusions and iatrogenic pneumothoraces. It came to a head on Friday when we had to site no less than 6 chest drains (albeit, not on the same patient ). My poor student is stuck in goole, but if she'd been with us, she'd have become an ABG expert - I got so sick of having to go down to ICU every 5 minutes with the bloody things that she'd have been doing them.

Alas though, that's all ended now. Tomorrow begins a whole new chapter. Wish me luck!

[M Clayton]

Elderly medicine was always going to be touch and go but the first three days haven't been what you might call successful. In the three days since changeover, I have lost 3 patients. In the event that you're unable to manage the maths, that's one patient per day. Not great odds really. I'd like to believe that the fact that I'm based on an elderly care ward is the reason behind the body count but, in actuality, I just don't.

Wednesday was difficult. The biggest challenge was coming to terms with the fact that I'm now based on a single ward. In surgery, I'd been attached to a specific firm and that's exactly how it'd been done at every one of my hospital placements as a student. So why on earth do the geriatric bods think it's sensible to stick me on one ward for 2 months? You could argue that it allows me to get to know the patients. In fact that would be a very sensible argument indeed, except for the fact that the elderly are moved about with as much ceremony as, well, as something that doesn't require dignity. The population of patients is as fluid as that found on the surgical admission unit and, really, it's all very difficult to get a handle on. Another big thing that medicine lacks is the daily ward round - obviously, the elderly stay relatively stable for much of the time and it's, therefore, felt that a couple of rounds per week is acceptable. Bear in mind that we had 2 or 3 rounds a day on the surgical firms and I hope you can see why it's all a bit disorienting.

Somewhat surprisingly, nobody died on Wednesday. It seemed I was being given a day’s grace.

Thursday was less gratifying although I did feel slightly more settled on the ward. I’d come to terms with the fact that I will now never have fewer than 30 patients (and, conversely, I will never have more) on my list but I’d also realised that the blood taking and IV fluid load would be significantly less than that encountered on surgery (old people don’t need daily bloods or IV fluids it would seem). Things moved on relatively well – there was a ward round that lasted forever and managed to see just 15 patients (compared with the 55 patients we managed to see in an hour last Friday) and then there was a long and relaxed MDT meeting where we discussed how unlikely it was that we’d ever discharge the majority of the folk on the ward. All good so far. And then, at 4 o’clock, I got a bleep from the rota co-ordinator. She never bleeps unless there’s a problem and she didn’t disappoint this time. Essentially, I was being told to cover the elderly medical on call for that night and there wasn’t much choice in the matter. All fine but it would mean that I’d have to work til 5 on my ward and then go straight to the Acute Medical Unit to pick up the on call bleep and cover the wards and all elderly (i.e. >75) admissions til 10 (in theory).

Four admissions were waiting to be clerked and the wards began bleeping for thankless tasks at five past five. One of the SHOs handed over that a patient needed an urgent cannula for an infusion of glucose and insulin – presumably because she was hyperkalaemic – when asked if the patient had decent veins, she replied in a positive sense. This did, of course, beg the question as to why she didn’t just do it herself but I let it slip and dutifully added it to my ever growing list of mundane tasks to be completed after I’d finished with the admissions. None of the new guys were even remotely surprising or interesting – an “off legs” here, a “falls” there – very typical elderly medicine admissions. I handed them over to the reg only to be told that I’d have to make sure I found the consultant before I did anything else since “you clerk them, you present them”... Cue much fruitless searching for the on call consultant and an eventual decision to abandon it in favour of doing real work.

The cannula came high on the list of things to be done – despite what the nursing staff seemed to think, a warfarin prescription can actually wait ten minutes but an infusion to fix hyperkalaemia probably can’t. I arrived with all of my paraphernalia including, overconfidently, some greens and a handful of pinks and quickly realised that I’d been royally set up by the day team. The lady in question was absolutely delightful but warned me quickly that I’d have almost no chance of getting anything into her veins since the “lovely lady doctor has already tried 6 times tonight”. Shit. Needless to say (needless almost looks like needles – ironic that) I failed miserably to get anything approaching access – the veins were the most thrombosed I’ve ever seen and it meant that even when I was confidently within the lumen there wasn’t a hint of flashback. I made a relatively quick decision not to prolong the agony and dutifully handed it over the SHO. She was less than impressed and stormed down to show the F1 how cannulas are done.

She failed too.

And so did the reg.

At that point, I stopped feeling bad and left them to organise an anaesthetic review while I got on with the multitude of silly jobs that had been called in. I think I must have spent the majority of my time trying to find the wards – some of which I was absolutely certain didn’t really exist. I’d never even heard of such weird and wonderful places as SSW and ASU before and that made finding them somewhat interesting. It was a bit like orientering only less fun and with lives on the line...

The first of my elderly deaths came out of the blue at just after 11 although I did spend 45 incredibly frustrating minutes trying to cheat The Reaper beforehand. It had been called in as a routine "patient unwell" but the nursing staff weren't particularly concerned. I asked them to pop the lady on some O2, get the notes and make sure an ECG had been done by the time I arrived. In honesty, I wasn't overly worried and I wandered up to the ward with no great sense of urgency. On arrival, it seemed that the nursing staff shared my lack of worry since they were both sat at the computer on facebook...

Initial appearances of the lady were not encouraging. She'd been attached to oxygen, as I'd asked but not at 100% despite her sats continuing to be low. The notes had gone for a walk and the ECG I was presented was an utterly useless mess of movement artefacts. A quick look demonstrated a pink cannula in the left antecubital fossa (WHY?! Don't put a pink one in there) and a huge mass of oedema that meant getting anything in elsewhere was a job in itself. With the oxygen ramped up, I had a quick listen to her chest and convinced myself I could hear crackles - she looked wet enough that pulmonary oedema had to be a problem. 80mg of furosemide was doled out in rapid sequence and I hoped she'd start to get better pretty soon.

Did she bollocks.

She continued to go down hill and I'd excluded all possible causes for this nightmare. She was in big trouble and I didn't know what else to do. So, I stood there. And then I asked a nurse to fast bleep my seniors. In the meantime, I busied myself with trying to look like I was doing something useful - this meant multiple failed attempts to get decent access on the right. All the while, I had the massive feeling of inadequacy - I've really never felt like such a total waste of a brain. I just couldn't deal with the rapidly developing shit storm and my defence mechanism (ie: calling for help) hadn't worked. My SHO was in handover and couldn't make it - she sent the chest pain nurse specialist instead. Did anyone mention chest pain?!

Long story short - we continued to faff about with trying to get lines in and blood out. None of us really knew what we were treating so I'd defaulted to asking for simple stuff - catheter, ECG, recent bloods, the rest. None of this actually happened because all present were flapping. What we needed was a leader and, shamefully, that wasn't me. Nor was it the SHO.

Eventually, the consultant arrived on scene and made a rapid assessment. Reading through our notes, she decided that the obvious answer was overwhelming sepsis and ARDS. We were to stop playing and let the woman die with dignity. But what does that actually mean? In this case, it meant taking a step back and doing only that which removed her distress.

It still feels like failure though. There's no such thing as a dignified death. I don't care what the palliative care nurses say - death is a horrifying, wrenching experience. It is frequently smelly. Very messy and always emotional. It is never dignified.

[M Clayton]

I've lost track of where we are in the great story that is life as a foundation ho...

Ok then, last Thursday was the on call nightmare that left me feeling like the world's shittest doctor. Friday served merely to strengthen that feeling with a further 2 bodies on the ward. In my defence, one chap was expected and had been placed on "The Pathway" (sounds sinister, no?) the previous evening, but t'other one was a bit of a surprise, especially when you consider that he hadn't even been on the ward when I left for lunch.

I'd popped into a bay to pronounce the first chap formally and I happened to notice that the bloke next to him also looked a bit, well, dead. A cardiac arrest call was put out and we played about a bit - he was intubated and we actually managed to restore an output. Some frantic discussion between the consultant for ICU and the consultant geriatrician took place and it was decided that this chap wouldn't go down to the unit but would be left tubed and breathing spontaneously on the ward (I know, bizarre) so that his family could say their goodbyes. I'm not sure I'd be keen to say my goodbyes if it were my family member with the tube in their throat but ho hum.

Thankfully, this week has been a much less stressful one. I've been based on the short stay ward with a staff grade and our job is, esentially, to kick out everyone at 72 hours. They either go home or they go to a medical ward. It's really that simple! Each day, we discharge 10 or so of the 30 folk on the ward and the rest have a bit more assessment or move on. It's actually quite a lot of fun - very busy but I see all sorts. Today, for example, we had a patient with severe mental health problems who took it upon themselves to attack their carer. I had to do a very quick assessment and dredge up a suitable dose of subcut lorazepam before security arrived to subdue them. Who'd have thought I'd have that sort of faff on in geris?

In the afternoon and early evenings, I cover the Acute Medical Unit and see all the patients over the age of 75. Again, busy stuff but I'm seeing a lot of acute, bread and butter medicine. And, just occasionally, I make an excellent catch and win the praise of my seniors (simple fall? nah, looks to me like an acute presentation of Parkinson's Disease...). It's all good fun.

[M Clayton]

I don’t have the means to access my blog while I’m typing this so I can’t say with any degree of certainty how long it’s been – I reckon a fortnight or so sounds like a reasonable length of time...

A lot has happened in the preceding weeks – I’ve been, seemingly, eternally on call and when you couple that with the little matter of mid week Christmas I’m not overly sure what day it is. This doesn’t really matter an awful lot since I’ve changed wards and the old schedule no longer applies – ward rounds and MDTs will happen when they want to and, hopefully, my attendance at these things will be indicated by someone who knows what actually is going on.

So, on call. I’m not exaggerating when I say that it feels like I’m always on call; of the last 5 days, I have been on call for 4 and, yes, that does include Christmas Day. Saturday was, without doubt, the worst of the days with a staffing disaster meaning that I was left to fend for myself without the benefit of senior cover but more on that later... When not on call, I’ve had precious little time to do other things. I’m afraid to say that, aside from carol singing in the Minster and eyeing up waiters in El Piano, I’ve done naff all of interest. There was that brief foray into Christmas shopping (ended in a bloodbath) and the evening that I decided to re-take up jogging but, beyond that, my life has been nothing but care of the elderly and general medicine on calls. Ho hum.

The weekend before Christmas is, apparently, one of the busiest Granny Dumping weekends of the year. I know this to be a fact since I covered it as the on call HO for care of the elderly andmedicine. This unsatisfactory set of circumstances came about courtesy of my favourite part of working in hospital over winter - the ever lovely norovirus.

Over the past month or so, we've had to endure the saga of ward closures and staff shortages all thanks to that little bugger. The worst part of all was the need to take the most ridiculous routes around the hospital in order to avoid walking through an infected ward. For example, Ward 25 is next door to Ward 23 and Ward 27 (logic was a thing the builders of York were good at) and it takes all of 30 seconds to walk from the stairs at the end of 23/27 to the ward. But not when there's norwalk. Oh no. In that case, getting from the stairs to Ward 25 involves walking up to the 3rd floor, across Ward 36, through 34 and onto 33. At that point, you have to roll a six and beat the warlock before you can try and remember the 5 digit doorcode onto the secret back stairs. Descend a floor and you come out on... drum roll please... ward 23. This ward, you may remember, is closed but it's acceptable to come out of these secret stairs because they're right next to the door onto 25. In the time it has taken you to tread this ridiculous route of doom, the nurse that bleeped you has forgotten why she did and you've totally wasted your time. But, I digress.

Norovirus doesn't discriminate - it plagues doctors, nurses, porters, lab staff and even patients! It doesn't, yet, seem to have found a sensible route for attacking me but the majority of my colleagues are not so lucky. K, the HO supposed to be covering the medical on call last weekend was one of the unlucky many and succumbed to the filthy illness at some time on Friday. In order to make sure she spread the disease as far as she could, she came to work and did 3/4 of her shift and then she gave me a sloppy kiss on the cheek to be sure. By 3:30 on Friday afternoon, it was clear that there was no way that she'd be able to cover her weekend on call. The hospital then enacted it's policy of getting locum cov... no, wait a second. They didn't. In fact, they ignored the fact totally. Why bother getting a locum in when there's already going to be an F1 on site covering care of the elderly? Never mind that it means he's going to be covering 14 wards of 30 patients, many of whom are sick.

I didn't know that this was brewing and I arrived on Saturday morning blissfully unaware of the gathering storm...

Those of you with your eyes open (so all of you, yeah?) will have counted three bleeps on my rather capacious belt. If I were Rambo and the bleeps were hand grenades, such a get up would be more than acceptable. In fact, if I were Rambo and the bleeps were hand grenades, I'd be at a bit of a disadvantage since, as I'm sure you're aware, the average supervillain takes a bit more to stop him than 3 blee... I mean grenades.

The front bleep is the care of the elderly bleep - I know this because it's got slightly less unidentified sticky goo on it and (something you can't tell from the picture) it has the least reliable clip. The second one belongs to the gen med on call and is preceded by a five - this means it's on the arrest system and sits there quietly, full of malice until, just as you're making a cup of tea, IT EXPLODES into life with a piercing shriek and the call "CARDIAC ARREST WARD 16". The final bleep is the common (or garden) variety of PRHO bleep. It is the primary form of annoyance during the hours of 8 to 5, Monday to Friday.

This arrangement was to be the source of all my pain over the next 48 hours. By 11 am, I had a list of jobs that spanned 3 A4 sheets and the bleeps kept coming. To add to my misery, the elderly SHO on call had also called in sick and AMU was stacked up with admissions. The only SHO and Reg on were stuck and I was left to fend for myself.

Amazingly, nobody died. Well, nobody that hadn't been expected to die did anyway. I actually pronounced 3 and stuck another 3 onto "The Pathway". Countless other patients needed urgent care and, by the looks of it, I didn't screw up too badly. The majority are still alive today, as far as I can tell.

My miserable week didn't stop with the weekend from hell. Oh no, that was just the beginning....

[M Clayton]

It finally happened. My months and months of accident free medicine have ended. Yes, I sustained an "innoculation injury" (aka needlestick) at work today. The shame.

More annoying was the manner in which I sustained said injury. I'd spent close to twenty minutes fighting (and that's probably the most accurate way to describe it) a confused, septic LOL in order to get the prerequisite 4 bottles for blood cultures and managed to walk away with my ego relatively intact and no more than the puncture mark to our little old lady. To emphasise that; I'd been alone in a dimly lit bay and had managed to successfully obtain 30mls of blood with minimal injury to the patient while she attempted to bite me and struggle out of the bed (don't dare suggest that this means there wasn't consent - there wasn't but it was definitely in her best interests). A difficult venepuncture, I'm sure you'd agree. You might also agree that it was a little bit of a risky one but a risk worth taking in the context of the clinical situation.

Whatever.

The next stage of the procedure involved transferring the blood from the plain monovette tubes into the glass culture bottles. This is something I do very frequently and is unavoidable while our hospital insist on using kit that's for two incompatible venepuncture systems. Essentially, I was required to spike the top of each culture bottle with a new, clean needle and transfer an aliquot (good word, no?) of blood from the plain tube. No problem but it did mean that there were 5 needles in circulation. No matter. I was in a clean, well lit treatment room and I was still wearing gloves....

I speared myself as I removed the final needle from the culture bottle. There's a small amount of spring in the rubber gasket and as I removed the needle, it sprung back and jabbed into my thumb. Annoyingly, it pierced the glove and made me bleed rather swiftly.

I had to go through the hugely drawn out sharps injury rigmarole of filling out an incident form (dear risk and management dept, I am an idiot), getting on the blower to occy health and then attempting to consent a delerious patient for HIV testing. Luckily, I was able to abdicate that responsibility when reporting the injury but I couldn't avoid my medical student's brutal advance with the needle.

Next time I get a needle stick, I'll let another doctor do the stabbing. I'll schedule the next accident for a day when I'll be able to get a GP appointment...

[M Clayton]

Death forms a major part of my life at the moment. It's fair to say that, as a House Officer in Elderly Care, I might expect to have more of my patients pass on than, say, a paediatric House Officer. However, this week (such as it is - 2 days isn't really enough to call it a week, maybe more a we-) has really taken the piss. We lost 4 patients in a 45 minute stretch yesterday morning and there are another two currently circling the drain. I'm actually getting quite bored of filling in death certificates and don't get me started on crem forms - the guys over at the crematorium are going to be on the phone to the police any time soon:

"Erm, officer, looks like we've got another Shipman on our hands..."

And I can see where they'd get that idea. At 65 quid a pop, it doesn't take too many little old ladies before you've enough for that dream holiday to the Seychelles...

But I digress.

It's really rather scary how blase I've become about the whole end of life thing. As the only doctor based on the ward permanently, I get to know all of the patients pretty damn well and I'm the primary source of medical info when it comes to MDT meetings. At most MDT meetings, we review the resus status of the patients (it probably won't surprise you to learn that the majority are DNAR) and I've come to the conclusion that I need to be careful what I say... I seem to be the first to express an opinion and nobody ever challenges it. Consequently, it feels like I have the power of life and death! Worryingly, I don't think twice about writing people off on the grounds of futility or quality of life. Of course, the notes say it's an MDT decision but I know that when sweet Mrs X arrests, it's down to me that she gets a relatively quiet death rather than the ever so exciting Holby City ending. Is this necessarily a bad thing? I really don't know any more.

[M Clayton]

I was clearly not wrong when I mentioned in my last entry that death forms a major part of my working life. Since then, the ward that forms the majority of my workload has been transformed from a mixed acute-rehab ward into Heaven's Waiting Room. It's been a truly horrendous couple of weeks and I'm choosing to blame it on our old friend Mr Norovirus (ah, Mr Norovirus, we meet again...).

Our hospital had been pretty much virus free at the start of the year. We'd had the Christmas mess up with over half of the wards being closed to admissions and then things got better. The smell of bleach and cheap pine disinfectant hung in the air, replacing the curiously fishy odour that pervades a ward infected with Norwalk. The bays shone and lots of disposable blue curtains had replaced the naff fabric. In short, we were once again cooking on gas and the bed state dropped from red to amber for the first time since October. Things looked encouraging.

But then Winter (capital letter implying some sort of anthropomorphic entity) hit back with fury and, once again, the majority of acute wards are closed. We've been "lucky" so far in that 24 hasn't had a case and, as such, is operating much as normal. Yes, our staff are being farmed out to cover sickness on other wards and yes, we can't get hold of basic equipment such as butterflies and green venflons (try walking onto a closed ward to obtain such goodies from the store and see what the infection control nurses do to you) but it's business as usual. Unfortunately, being infection free now means that we're the only ward able to accept elderly admissions once they've been admitted via A&E/AMU. They took away all my boring, chronic, "never go home" patients and dumped them somewhere (Madagascar perhaps?) and then replaced them with a veritable army of shuffling undead. I say shuffling, the majority of the new guys were so sick that they lay there obtunded (good word, no?) until I popped along to stick a needle in them... at which point, they became full of beans and vigour and piss and vinegar and whatever else it is that means a LOL who weighs not more than 4 stone wet through can succesfully fight off a man a quarter of her age.

Rather unsportingly, the bed managers also assigned us a lot of folk that weren't expected to survive their first 48 hours in hospital. This is normally the domain of Short Stay but they're also swimming in shit at the moment so it fell to us.

This would all have been just about manageable if there were a couple of doctors to deal with the numbers but there weren't. My SHO was on nights and the others were either off with Norwalk or working on wards that were closed (meaning they couldn't go onto a clean ward). The turnover rate meant that I was seeing 3 or 4 new patients every day as opposed to seeing 3 or 4 new patients a week. They were all sick and they all needed me to run around organsing exciting investigations. Inevitably, our death rate climbed. 3 on Monday. 2 on Tuesday. 2 on Wednesday. 2 on Thursday and another 3 on Friday.

Those of you that posess basic skills in numeracy will have worked out that 12 patients died under my care last week. Am I not the shittest doctor you've ever seen? Echoes of Shipman perhaps? In fairness to myself, all bar 2 of the deaths had been predicted and even those 2 couldn't have been called prime specimens. Filling in death certificates and crem forms did get a bit tedious and I will admit that I put off pronouncing a patient formally for 3 hours just so that they wouldn't fill the bed with a new sickie til I was on my way home (I failed badly at that, by the way. I was still there when the fellow arrived and the nurses conned me into seeing them with a story about low BP...)

At times, I got snappy with the nurses. At times, I got snappy with my colleagues on call (WTF do you mean you didn't review the CXR?! It was the one job I handed over to you!?!). At times, I felt like having a good old cry. But, I got through it. As did the majority of our patients. Now that the worst seems to be over, I can even smile when the mortuary ring me up and ask me "how many rooms I'll be needing today".

But bloody hell, I don't want to have to do that week again!