Thursday, 21 July 2011

The nights of the obturator nerve


To the non-medical reader you may want to click away now!

Tuesday morning would start early, it was our receiving day on the seventh floor the third medical unit, the second busiest day to be on-call after Monday, which was the fate of those working for the second medical unit on the sixth floor.

We would start out on the ward with a quick wiz around, checking the sickest, and taking the bloods, making our way in the underground tunnels to the pathology laboratories in the specialist building, and returning to split the day between the two of us, myself and M (another of the so called acute rotators i.e. in his first year of the medical rotation, but from another university and way too laid back for my liking), we needed to cover both the ward patients, and anyone presenting to the medical emergency room, so the day was split into four 6-hour periods, and we would alternate ward and emergency room, neither of us sleeping for the next thirty six hours at least.

Running down the stairs, and entering the emergency room with the team which consisted of the first year board students, a few years older than us, much more knowledgeable but still very approachable and keen to learn and teach, they would come down armed with their polystyrene cups of coffee (and occasionally the packet of cigarettes) and their trusty textbooks; Harrison’s textbook was the commonest, but S preferred Cecil’s and A would bring down his red and blue Anderson’s, we carried our handbooks, or occasionally Davidson’s.

There were still a couple of patients left over from the night before, and we would take over from the exiting team exchanging tales of woes at how busy the night had been, and receiving reassurances that the lady in the corner would be ready to go home soon, and that the young man was definitely a tenth floor patient, his discharge card attesting to the fact and the team were informed and preparing to receive him.

Going through the early morning preparations, checking the equipment, the cardiac resuscitation trolley, the glucose monitors, the venous cut down sets.

And then the work would begin, tens of patients would pass through the doors, the barely alive cardiac patients who would take up the attention of everyone for a while and whose arrival would be the trigger to summon help from the coronary care team, once they had stabilized him or her they would take the patient up to the unit using the separate guard-operated lift back to the coronary care unit on the eighth floor, through to the diabetics in ketoacidosis, who would tax our mathematical abilities working out exact doses of insulin and fluids (we did not have continuous infusions of insulin and had to check sugars and administer doses of insulin every hour for however long it took to stabilize the patient) , to the silly girls who had had an argument too many with husband or mother in-law and decided to have some sort of nervous attack, these usually presenting with pseudo faints or unconsciousness, or occasionally elaborate pseudo epileptic attacks, they would almost invariably be accompanied by a frantic often abusive husband (if argument with mother in-law) or brother (if argument with husband), these I found particularly time wasting and to my eternal shame I offered them no sympathy whatsoever and occasionally very unkind treatment.

I preferred the second shift, around lunchtime, and with a new set of board students this was a quieter time, and as the seniors were third year board students, and not based on the ward they generally had more time and patience to teach us and go through the limited number of cases in more detail.

With the evening came the visitors, and the occasional couple of people who would pop into the outpatient department whilst visiting to have those swollen ankles sorted out, only to be whipped across to us with a note from our fourth year board students suggesting we listen to the heart for the classic mitral murmur.

Slowly going through the patients, either discharging, or admitting to the counterpart on the ward, and occasionally pouncing on the tell tale white card sticking out of the medicine bag that was the clue to their prior visit, their prior diagnosis, and most importantly the team that would now be called down to sort out their returning patient.

More often than not, we would have our regular odd patient, I am not sure what his diagnosis was, but to anyone stationed at the medical city at the time he was a benign, occasionally amusing regular, in his stripped nightshirt and hat, carrying his plastic bags, and demanding his saline drip (which we usually obliged) or occasionally demanding he have a urinary catheter placed (which we usually refused) he would be humored for a while if the room was quiet, and then discharged in a hurry once the flow of patients started to pick up once more.

Through the night the trickle of patients would continue, and as morning arrived we would start shifting the last few of our intake for the day up to the final beds or couches, and going through our notes carefully making sure all necessary test results were available for the consultant ward round, climbing up the stairs wearily now, and sitting down in the doctor’s office to write out the forms for the blood tests, the drug cardexes, the instructions for the nurses, and waiting patiently for the ladies from the canteen to start bringing up the patient’s breakfast trolleys, knowing they would never pass the weary doctors without passing us a tray with hot tea, a roll of bread, butter, cheese and possibly a hard boiled egg.

At some point during this day we would have done some reading, everyone was studying for some exam or other, the board end of year exams, the board finals, the foreign exams, usually membership of British royal colleges, and in our case an opening to take the American License exams, we used the patient note paper, and studied our craft, making notes as we read.
The image is one such page, with reminders of the nerves of the lower limb, including the obturator nerve.

saminkie said...
the nights of the obturator nerve is very clever nice brain storming title....from where you got that abitlity to creat such a nice title....3eeraqimedic I think you are creative....
know something....those days of rotation will always be on my personality changed while I was doing rotation.....thank you for such a nice post...(obturatur nerve....waow...nights of obturator nerve...I congragualate you again for such a nice title really)...
02 December 2007 14:50

3eeraqimedic said...
Dear Sami
Glad you liked it!
Yes the rotation changes one, entering a little hyperconfident inexperienced student we come out less confident more realistic slightly more experienced doctors.
03 December 2007 05:48

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