Recent Junior Doctor discussions on sleeping on duty brought back memories for this retired Child Psychiatrist. When I did my first House Job (residency) in Internal Medicine I was on for two nights out of three and three weekends out of four as it is busier weekends and more of us would be needed.
We have three Internal Medicine Units and I am in Medical C for want of a creative name or a rich donor. We need to be on after acute take as these were our patients. It provided for continuity and training. Then we are off for one night when, if we do go to the cinema, it would be a waste of money as we fell asleep within minutes. We have 36 beds and bed 1 is with bed 36 behind the nurse station. Nurses tried not to use bed 36 so that the Houseman could catch some sleep. I once fell asleep on one of the those rare nights when everything went quiet at about 2 am. I was catching up with history from a wife at the nurse station. The wife stood across the highish station and the next I knew was that an hour or so went by. I fell asleep holding my pen.
The wife of the patient just said: You must be tired, doctor.
No complaints and she did not walk off either. I was so grateful. Medicine the way it should be. In Hong Kong.
©2013 Am Ang Zhang
Then I remember my Bed 1 patient:
T
|
ime and again I have been asked why I decided
to pursue child psychiatry as my career. This question was often posed by my
juniors who were at the point of their life when they had to choose their
career path. It would have been dishonest of me to tell them that I knew
exactly why. In life certain events seem to just happen and hopefully they gel
together well enough so that one does not have to say at the end of one’s
working life that a wrong decision was made.
After passing my finals, I did my
internship in Internal Medicine and Obstetrics and Gynaecology.
In our final year the first reports
came through of cures in Leukaemia.
People’s hopes were rekindled and Medicine moved into a new era.
Needless to say cancer touches every
family in more ways than one can imagine and especially when it hits at one’s
prime in life it is a highly emotive thing. In other words, no one is immune,
not even if you are a doctor. At the time of my internship we had to deal with
all those over the age of twelve and a number of inpatients were young Oncology
cases. One of the boys I can remember was having the full VAMP treatment.
Someone had a dry sense of humour to borrow from the word Vampire and with good
reasons. Blood samples had to be drawn often and it was years later that I
appreciated the work of some psychiatrists who recommend the limiting of daily
blood drawing to before 10 A.M. every morning. This simple enforceable rule
greatly reduced the emotional stress of the children involved. Patients were by
and large compliant and they knew that the blood drawing was important. When they were able to work out that it would
not happen after 10 A.M. they had at least a good ten hours of relative peace.
I had this highly intelligent boy on
the ward with Leukaemia on treatment. He was barely thirteen and looked
nine-ish. He was my most helpful assistant and would follow me on the lab
trolley when I was doing my blood sample rounds. He would fill in the forms and
match the numbers on the sample bottles. He never made a single mistake as far
as I can remember. Most of my
contemporaries had some pet patient like that. How else could we have got
through the day’s work? Most sisters and matrons turned a blind eye and the
consultants and professors had been there so they did not mind either.
Considering that we were then spending the major part of our waking life on the
ward, we got closer to these patients than to anyone else in our life at that
point.
This boy was beginning to show the
effect of VAMP and he had some of the most frightening nightmares when he
would scream in the middle of the night and nothing much would comfort him. He
would sit up and say something about going to the moon and that was probably
the only thing of which anyone could make some sense. The regular night nurse
who had children of his age was most fond of him and would give me detailed
reports of the timing of such occurrences. At other times I could see her
playing her mother rather than nurse role and just holding him while he sobbed.
He had the Number 1 bed which was right
by the nurse’s station and it was a rather cosy one as the bed opposite was
generally the last one to be used. If I had not been on call, he would give me
a quick run down on who was new and who was unconscious and who had insecticide
poisoning from suicidal ingestion. In any case, one could smell the insecticide
as one walked in as these survivors breathed it out.
We all so hoped that the cure would
extend to him and he would certainly make a good doctor or a good nurse.
One day when I returned from weekend
leave – the one in four weekend that we got to catch up with our sleep, our romance and our family – I could smell something but it was
not Malathion[1].
Something was wrong. All his things were gone and the bed was now stripped
bare. Night nurse was still around, waiting for me to turn up.
“He has gone to the moon,” she said.
Oh no. He had a massive bleed in the
brain and passed away during the weekend. His last words were: I am going to
the moon.
I more or less decided at that moment
that although we were brought up on the first day of Medical School
The Cockroach Catcher
Can it be that it was all so simple then
Or has time rewritten every line
If we had the chance to do it all again
Tell me - Would we? Could we?
The Way We Were
A Chapter on Anorexia Nervosa,
Anne of Green Gables
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