Ignorant until proven guilty

(This post was alternatively going to be titled “Public Hospitals: You get the care you pay for”)

Well after listening to Jeremy talk about the stress of being responsible for ICU patients in the last few weeks, I got to experience it first hand last week.

My registrar got cellulitis from a scratch on his leg from kayaking, and was away for 3 days, and so I got something of a field promotion to pseudo-registrar.

Now the problem with ICU patients is two fold. Firstly they are (as their location suggests) genuinely quite sick (as opposed to the apparent level of health you see in some of the other people you see around the hospital, some of whom appear to see it almost as a nice little holiday). They need intensive care, and so require more technical support and more detailed knowledge to be able to manage them successfully.

The second problem is that while, in the first 2 years of being a doctor, I have generally become rather blase about what I can get away with on the care front (the old adage that Medicine mostly involves amusing the patient while nature cures the disease actually turns out to be remarkably accurate – most people tend to get better in spite of what you do (or the relative ineptitude of your methods of doing it), rather than because of what you do)) ICU patients are still surrounded by that aura of mystique, and I haven’t quite shaken off my tendency to be generally scared to do anything to them in case they should suddenly and catastrophically collapse in a heap as a result.

So the first day of being responsible was rather petrifying really. The nurses would ask me to rewrite some fluids, and I’d spend 5 minutes deliberating about the type of fluid, the rate, additives, other meds that may be needed as well, possibly implications for the ventilator settings, and a million other (in the end probably unnecessary) things before I eventually just wrote them up for more of what they were having before.

By the end of the 3rd day however I had settled on 3 general guiding principles, which had made my life considerably less stressful. Firstly, run almost everything past the bosses. They seemed happier when I asked than when I didn’t, so I just asked a lot. I’m sure that in a few weeks they would have gotten sick of it, but for a few days they were quite happy.

Second was to listen to what the more senior nurses said, and when they said “Can you change this for me” or “you should do this” I willingly went along with them, because they know far more about ICU than I do (at this stage).

Finally I learned that the first question in any unfamiliar situation should be either “what do they usually do here” or, more importantly, “Is there a protocol for that?”. More often than not there was already a protocol, and so you just followed it and almost never needed to worry about having to figure stuff (slowly) out for yourself, or being wrong.

Anyway, I managed to bumble my way through 3 days of it before my reg came back and I got shunted back into my largely superfluous most-junior-doctor-on-the-ward position, and no-one even died.