My Nights Oncall

Medical Admissions Unit

I'm finally back from my night duties. I rarely want discuss work, yet I have always wanted to at least once write about my experiences during oncalls or a day in the wards for anyone curious on what working here is like. So here is an account of my oncalls.

Upon arriving to the Medical Admissions Unit I was greeted by the day oncall team for handover of remaining duties. Shockingly, the PRHO gave a loooong handover of jobs! (I'm sure you are not, but just in case you are reading this, sorry! I'm implying that it was a busy day, hence the long handover:p). What I thought was extremely funny was that later, close to midnight, she bleeped me from her room to give me more instructions! I'm not at all complaining as I didn't at all find the tasks difficult to do. But I did think it was funny and slightly amusing.

PRHO's List

I was put on duty as the "Ward SHO" meaning, I was in charge of looking after around 300 of the medical patients in the hospital. Although a lot happened, by far the three most interesting cases I sorted was:

1. A lady investigated for an insulinoma. Presented to hospital for recurring episodes of hyperglycaemia. Part of the investigations were to measure a 24 hour serum glucose (meaning a blood test every 4 hours, poor patient!) and I was the unlucky vampire who had to disturb the patient's sleep to obtain the samples.
2. Manage a very poorly neutropaenic patient (neutrophils of 0.8) with an unresolving chest infection. Learning point: Gentamicin and Timentin are the antibiotics of choice, remember that! The story is much longer, unfortunately I cannot tell it here.
3. Manage a patient with an infective exacerbation of COPD who desaturated to 77%. I did the usual: back to back nebulisers, change antibiotics from oral to IV, arterial blood gasses and titrate oxygen using a venturi mask, IV hydrocortisone 200mg stat, and ordered an urgent chest xray. As the patient still did not improve, I also started an aminophyllin infusion. The patient still did not respond (I watched as the oxygen saturations dropped and dropped). What made this case interesting for me was that we then had to set up non-invasive ventilation, which is rare in our small hospital (in fact, the number of available non-invasive machines are VERY limited, less than ?five). So setting up the machine was another learning experience for me.
4. You guys probably don't want to hear in detail about the continuous cardiac arrests we had to attend to, so I'll stop here.

In terms of interesting cases, well, hmm. I saw:

1. A patient with epilepsy coming in with a rash identified as erythema multiforme probably due lamotrigine. This is only my third time seeing a real patient with erythema multiforme (pictured above, credit: emedicine.com), so it was interesting.
2. This is a learning point: (Hemiplegic) migraines could ABSOLUTELY mimic a stroke. First time I've seen a hemiplegic migraine in action (infact, there were two cases last night).
   
3. I got to do a lumbar puncture on one young patient with severe headache and left sided palsy. (Normal CT scan, Consultant diagnosed a hemiplegic migraine). By young I mean the patient was in her late twenties.
   
4. Someone treated for a chest infection with erythromycin, coming in with severe abdominal pain (?mimicking pyelonephritis). Urine dipstick was very positive for blood and protein and the Consultant thought it was a severe reaction to the erythromycin. But just in case, we were to rule out pyelonephritis.

Overall, I was happy with the two nights oncall. Almost all of my team members on Naseby were oncall as well (?coincidence) so it was almost like a big get together. My team mates laughed seeing me wearing a proper tie and shirt to work at night; "like going to a meeting" and made a fuss on how my "dress code is always pristine". The answer guys is: I don't have good tolerance to cold weather so I hate wearing surgical scrubs!

I also thought the long handover by the PRHO was really funny, especially when she had to call again to add further jobs!

Random quote: "The best thing about doing nights is finishing them."

Definitely! To me , the best thing about doing nights are: having breakfast at the end of a shift, and going to bed afterwards!!

Breakfast and coffee, yum.

Note:

1. See why I hate discussing about work? I have a hard time talking without being too technical. Sorry if you guys find it difficult to understand.
2. List was GIMPed to remove patient names.