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.
Then I remember my Bed 1 patient:
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 steroids 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. 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
to confront death, this just might be too much for me. Dealing with the death
of a good friend’s father following a cerebral haemorrhage was hard enough but
the passing of a young thirteen year old was going to leave its mark and I did
not want too many of those. Medical School
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