Tuesday 22 July 2008

Happy just to relax


Dr Genesis has wanted to be a doctor since watching Sam. I suppose he wanted to be a hero. And to be well versed in human physiology. I suppose I am now, although sometimes my knowledge of the human body seems too simple. But then compared to the average Joe in the street, Dr Genesis' knowledge is vast. Most people don't even know where their liver is. I thought at medical school that once I qualified I would know a lot about the body and have a zest for knowledge. But now I find that I'm not that interested in esoteric diagnostic medicine. Most of it isn't thought-provoking. A lot of it is just running dozens of tests and hoping one will come up positive.

So when an elderly lady came in, having fallen over, with a few cuts and bruises on her legs, Dr Genesis didn't take blood. The lady was in her 90s, with advanced dementia and had been bed bound for two years. What would the bloods show? Mildly impaired renal function, a slightly high CRP, a mild anaemia? I knew it was cheeky. How would I explain myself at the ward round the next day?

As it was, in the morning I found that Mad Female Medical Registrar (every hospital has them: they are single, irate, not that attractive, totally obsessed by detail and unlikely to ever settle down with a husband and children, even though that is actually what they really want...) had taken blood from the old lady at 1am. Guess what they showed?

Wednesday 16 July 2008

Life: as fragile as a petal blowing in the wind

Difficult day. Emotional day.

An unfortunate, previously well, late middle aged gentleman had a brainstem haemorrhage. Just doing what middle aged men do...a bit of DIY. Then his voice went slurred, he fell to the ground and started fitting. A quick scan showed a burst blood vessel in the most important part of his brain: the brainstem. This is why Dr Genesis doesn't do DIY.

Unable to talk, swallow, see or move, he lay there breathing through the tracheostomy that the ITU doctors had put in before he came to the ward. To a side room.

Three weeks later, he was still breathing. And was being fed through a nasogastric tube.

The wife and family were in agreement: Dad wouldn't want to be like this. He was such a fun-loving guy, always doing things in the garden, always active. He wouldn't want to be a vegetable. Dr Genesis always finds it a coincidence that people who are seriously incapacitated used to be remarkably active beforehand. The family never say "Dad was actually a bit lazy, he probably would quite like being grossly neurologically impaired."

We decided to pull out all treatment avenues...and allow him to die. It fell to Dr Genesis to do this, it was too much to ask of the nurses. He took out the NG tube easily enough. But removing the tracheostomy. That was tough. That was an active removal of the route of breathing for this man. Even Dr Genesis' confidence buckled and he administered some sedation to the patient. Why sedate a man with a Glasgow Coma Score of 3? To calm the doctor of course.

He continued to breathe for the next 36 hours. The family were very grateful for Dr Genesis' help. They knew there was no hope. They knew as soon as he came into hospital.

Tuesday 8 July 2008

New role for the Isle of Wight

The average appearance of Dr Genesis' patients

Dr Genesis has had two weeks off work. He slept for the first two days. Then he remembered what it is like to be human again. Any junior doctor knows how he feels. You forget there is a normal world outside the hospital walls. A world where people aren't continually abrupt.

Dr Genesis came back to work today. Within 15 minutes of the ward round, Dr Genesis was despairing. There were a couple of middle aged people with acute medical problems which we could actually treat. The rest were over the age of 85. And this isn't even an elderly care team. Most of them had minor medical problems, consistent with old age. Normal. In any other country they would be tucked up in bed by their family and fed porridge. Then they would die in a few months, peacefully, with their family around them.

But in the UK, death is an avoidable pathology. It must be delayed as long as possible. No stone must be unturned to discover why a patient's sodium level of slightly lower than it should be. Or why their CRP (a marker of inflammation/infection) is slightly higher than it should be. The patient must be cannulated, catheterised, fed with intravenous fluid and antibiotics, bombarded with radiation and "coded".

Then and only then can they be allowed to die. With their dignity strippped from them.