Overtime

Twice in the last four days I've gone into hospital out of rostered hours to check up on patients of mine that were a little sicker than most. My reg and my fellow intern would probably roll their eyes if I told them that. We have this on-going joke that if it's my afternoon off, they know they can still hand me work to do at 4:45pm. I'm weird about taking afternoons off. My reg assures me that that is a passing phase.

One of these patients had been under our care for about a week. When she first came in she was a little wary of us, and we thought she was a little weird too. I think we had all pegged her as someone who might retreat into the sick role and give us some trouble in terms of refusing tests, procedures and just generally be someone we couldn't get along with.

We found that she was, in fact, a real trooper. It probably helped that she was getting opiate analgesia four times a day, but she was a good sport about our repeated failed attempts at getting intra-venous access and the multiple blood tests and radiology tests we needed to essentially tell her we weren't sure what was going on.

Yesterday, after a week of tests, fate pushed the agenda, and her bowel perforated. We rushed her to surgery yesterday afternoon. My fellow intern and I assured her that she was in good hands and that we'd see her after the Anzac day holiday.

Today I called the hospital just to see how the surgery went. The ward told me, "She's not here, she's just in recovery after her procedure and she's going to ICU soon." I didn't like the sound of that. What procedure? She couldn't have gone til today without having her surgery, which meant this 'procedure' must've been something else entirely.

I padded into the hospital, feeling somewhat naked without a tie or stethoscope, and far too comfortable in sneakers.

I found her in the recovery ward. She lay there with multiple arterial and venous access lines, and her breathing was assisted by a large ungainly BiPAP mask. Being a public holiday the rest of recovery was entirely empty, and the mechanical Darth Vader like hissing from the mask created a surreal mood.

I quickly flipped to the last entry in her notes.

CT Pulmonary angiogram: multiple pulmonary emboli. 1st and 3rd segment of some artery in some lobe or somesuch. Even if had known what they meant I had stopped registering the words after "multiple pulmonary emboli." They are, for the non-medical, blood clots in the lung, the same entity that drove the media wild back when they bayed about "economy class syndrome."

They are a complication in surgical patients we try to aggressively prevent.

I explained what was going on to our patient. She could hear me, despite the fairly heavy analgesia that was running in her veins. She seemed to take it well, the trooper that she was. I stood by her bedside for another 20mins while the nurses got things ready to move her to ICU. Before they moved her she looked up at me and I gave her a crooked smile. I was wondering whether I had done all the right things to prevent this, whether we could have picked it up earlier, whether she'd be okay.

She reached up for my hand and I gave it a little squeeze. It might as well have been the other way around.