Xiao's Blog

I just blogged about the doubts the registrars and consultants have against an Intern working in an Emergency Department. Well, today, I just gave another reason for their case. It’s regarding a 4 month old baby girl. To those who really hated paediatrics during their medical student years, I hope they yet to pop the champagne, for, albeit not having to do a Paediatric rotation as an intern, you will still come across them during the Emergency rotation. Same applies for O&G and psychiatry.

Back to my patient. I still can’t grasp the art of listening to a chest of >50 breaths/min accompanied by the baby’s cries. I called a “bilateral crackles” on her and increased work of breathing. The paediatric registrar clearly had not been impressed with my work, writing and emphasising the words “NO increased WoB, CHEST CLEAR” in the patient’s notes. No wonder my consultant called a “Fever with no focus” on the patient, she didn’t mention anything about my examination findings as well. Alright, fast forward a little bit, the X-ray of the 4 monther showed something not very reassuring at all. A widened mediastinum, coupled with a 2/52 of fever and raised WCC with normal CRP. That’s not reassuring at all. It points towards something really bad and cynical. Let’s hope it all goes well for her.

Maybe I am glorifying the Emergency job here a little bit. But really, starting out in the Emergency as a new doctor is a very steep learning curve. Especially there isn’t exactly a clear line between General Medicine and Specialty medicine and sometimes between the various specialties. I can almost imagine this conversation taking place in the ED.

~.~.~.~.~

Xiao : Hello, I am Xiao, one of the interns from the Emergency. I am looking for the nephrologist.
Doc : Yes,speaking.*yawn* What can I do for you?
Xiao : I’ve got this patient …..*yada ya..*
Doc : Wait wait. Why do you refer this patient to me?!?! Shouldn’t he go under Gen Med?
Xiao : I’ve spoken to them, they think this patient should come under renal.
Doc : If they think the patient should come under renal, THEY should talk to me. Get them to talk to me! *click*

~.~.~.~.~

Xiao : Hello, I am Xiao, one of the interns from the Emergency. I am looking for the nephrologist.
Doc : Yes,speaking.*yawn* What can I do for you?
Xiao : I’ve got this patient …..*yada ya..*
Doc : Wait wait. Why do you refer this patient to me?!?! Are you sure this is not a UROLOGY problem? You’ve done a CT KUB yet?
Xiao :CT KUB can only be done earliest tomorrow morning.
Doc : Then do it in the morning then speak to me. *click*

~.~.~.~.~

Xiao : Hello, I am Xiao, one of the interns from the Emergency. I am looking for the nephrologist.
Doc : Yes,speaking.*yawn* What can I do for you?
Xiao : I’ve got this patient …..*yada ya..*
Doc : Wait wait. Why do you refer this patient to me?!? This’s obviously a problem of the PROXIMAL tubule. I’m a DISTAL NEPHROLOGIST. You should get in touch with the PROXIMAL nephrologist, not me! *click*

~.~.~.~.~

Maybe some of the scenarios I painted above may not make medical sense. Oh well, I am a bit too tired to take note of it. In actuality, the seniors and the registrars here are generally very nice. However, everyone got their bad days. Even on their bad days, they are not even half that mean to slam the phone on me. Hehe. I’ve always keep this in mind:

If shit happens to the patients you see in the ward, you can always call a MET.
If shit happens to the patients you’ve discharged in the Emergency, you call your indemnity lawyer.

Arrivederci.

This entry was posted on Saturday, March 21st, 2009 at 2:55 am and is filed under Day-2-day, Med Talk.