On Call Blues

It's a public holiday today and I am on call. Sigh. It's terrible being on call on a holiday. Not only because I am stuck within the confines of the vicinity of the hospital, the day seems to drag on forever and ever. It's almost 6 pm now, and there's another 14 more hours before my on call duty is over. Did I mention I have to do the rounds tomorrow?

The day started badly. Right on the dot at 8am, I got a page! It was from a House Officer from the Orthopaedic Department (see, my claim has been justified....read my article on 'Sheer Arrogance'). On the other end of the line was a very terrified sounding HO trying to refer a patient to me. Poor fella. He must have been pee-ing in his pants.

I confess I was not very kind to him. First he gave me the wrong patient's name (which resulted in me looking for the referred patient in the entire ortho ward later); then he mumbled and fumbled through the entire referral. I was not told the patient's age, or her background. He took a long time to read the patient's meds and actually asked me why the patient is on such and such a medication! I had to literally dig the reason for the referral out of him.

The reason for the referral? Uncontrolled hypertension. The patient was admitted yesterday morning for an elective surgery on her right knee on Monday. She is a known case of hypertension, post-thyroidectomy hypothyroidism on L-thyroxine and also a case of Exogenous Cushing on replacement therapy with hydrocortisone. She has been on a single anti-hypertensive agent for the last 3 months. (I got this history myself, not from the HO).

They noted that her BP was high yesterday and decided to refer to the medical lecturer on call. The point is, the patient was admitted yesterday morning and the decision to make a referral was also done then; why is it that the referral was only done today, on a public holiday, leaving the patient with high BP overnight? Things like these makes my blood boil. And the next morning (ie: today) they make the poor HO make the referral! I am sure at 8 am in the morning, there are more senior doctors around in the ward and yet none of them have even the slightest courtesy to call and make a decent referral. And these are the people who demanded arrogantly that only our consultants can refer to their consultants! (see my article 'Sheer Arrogance' on 5/5/2006)

The HO asked if I would like to see the patient then (read: immediately). I answered "No". I said I was busy in the ward (one of my patient took a turn for the worst) and I asked him to tell his MOs to start something first. The reply was typical and anticipated. He said "That's the problem, they don't know what to start"!!!

I told him to tell them to "figure it out". After all, it wasn't exactly 'rocket science' and all of us have been through medical school and we were taught basically the same things. Starting a anti-hypertensive agent need very little gray cells.

By the time I was free to see the patient, her BP was already well controlled. Some one actually 'figured it out'! If only they would bother to read her old appointment card, they will realise that she was also on Amlodipine which she hasn't been taking for the last 3 months simply because the last doctor who saw her 'forgot' to prescribe it to her. Sigh! A totally unnecessary referral.

Ward round thereafter was horrible, what with the one patient going steadily down hill and a constant stream of relatives that disrupted the smooth running of the rounds.

I tried to sleep a little after lunch (power nap mah) but was repeated paged by the medical MO running the emergency room downstairs (poor lady). She has one complicated patient after another.

I just hope the evening will be better. There's another guy with a heart attack to review, and another woman who just came in with high fever and confusion. I have a bad feeling about this.

It's 6.10 pm, another 13 hours and 50 minutes to go...