Go Ahead, Make My Day (or rather, Night)

Today was one of those days.

I work in the ICU and being one of the “seniors” (not really in age, but in time worked here) a lot of the pressure, if work gets hectic, invariably falls on me… But me being under pressure, is not what this rant is about.

I was off duty during the day and had to go to work only at 9 pm and so the “day” per se was all sleep and relaxation and I was hoping the night at work would be peaceful too.

Dr. A.C.C. was the head of the department of surgery at my hospital a loooooooong time ago - In his own words to me “before you were born” (ooooooooh, right?)

I have never heard of him, so whoever he is and whenever he was working here, he must’ve been a very nondescript person; not terrible, but not spectacular either. I deduce that, because in my workplace if you’re either, i.e. terrible/spectacular, you get talked about. A lot…

Anyway I’m rambling again…

So… He was brought by his son to the ER with complaints of high grade fever, altered sensorium and bladder incontinence. As is the norm in my hospital, elderly people with complaints like these (where a neurological cause is suspected) are ALWAYS admitted to the ICU. The plan was to keep him there for overnight observation and if he stabilised to shift him to the ward in the morning. So that’s what was done.

I got to work at 9 and by then he was conscious and well oriented (as reported to me by the nurses) and fast asleep. His fever had also subsided. My provisional diagnosis was a septic encephalopathy (total count – 16,200) with the focus being either a urinary tract infection or a lower respiratory tract infection. I know I’m getting too technical here, but bear with me for a bit.

Since he was stable I just gave instructions for the reports to be followed up and informed to me, and then I moved on to other, sicker patients.

Now before I say anything else I must clarify something about my hospital. We have this concept of “VIP” patients. I don’t know if it’s coz they wear that brand of underwear, but I think it’s mostly because they’re “important” people. That translated into plain English means, people who have a reach into our admin, or the law, or politics. To me they’ve always been just “patients”, but everyone else here seems to make an occupation out of jumping through hoops for them. So this guy, was a VIP I was told, and that meant that I had to be extra polite and take special care of him. This was highlighted by the fact that our Director of Medical Services called at around 11:30 pm and asked how he was doing, etc… with an extra “be very kind and nice to him” (I guess he said that because he realised it was me on duty!)

Moving on, there was one other patient who was sick, so I did a detailed examination and changed some medication orders, etc. Then there was a new admission, an elderly lady with breathing difficulty.

Finally, at around 2 am, after having dinner and settling a patient with pancreatitis who was in pain, I decided it was time to sleep for a bit. I was woken up at 4 because a patient needed ventilation (and I don’t mean the “open the windows” sorta thing).

Then at 5 AM, I was woken up on account of our resident “VIP” – yeah you guessed it, I’m finally getting to the point.

His first statement to me was that he had been a department head at this hospital even before I was born. I've noticed that almost all the retired, old; ex-professor Bengali doctors do this dialogue marofying thing. It’s like I should fall at his feet because he “was” something. Don’t get me wrong, I respect my seniors. I just don’t think old = know it all. I think it’s sad that people, when they get old and retire, become so insecure that they feel the need to assert authority even where it really doesn’t make a bit of a difference. Whatever you "were", you’re still, at this particular point in time, my patient. That’s all you are to me. So it doesn’t matter.

Anyway… This was his problem- He had asked for water and the nurse who gave it to him neglected to cover the glass (from where did he want me to produce a glass cover). Next, he said that he had been calling for ages because he wanted to shit and no one had paid any attention (this was definitely not true). Then he said that he couldn’t use the bedpan and wanted to go to the bathroom (which we definitely could not allow, given the nature of his condition). Then he said that he had told Dr. J.B. that he wanted to be admitted in the executive ward (and would’ve probably died there). Then he told me that in “all his years of experience” he had never seen a urinary tract infection producing such an elevated total count (Huh?? His TC was only 16,000 – I’ve seen UTI’s with 20-30,000 counts in my 3 years!). Then he asked me which college I’d passed out from (my answer shut him up for a bit – that happens a lot! :O).

When I finally got a chance to speak, I said to him, “Sir, I’m sorry but we don’t have glass covers so I can’t help you on that one. Next, there’s a bell for you to press if you needed anything, and the nurse was right there next to you anyway. Third, I cannot let you go to the bathroom coz you may fall, hit your head and die so the maximum I can allow is that you use a bedside commode. Fourth, you are not admitted under Dr. J.B. who is a surgeon, but under Dr. M.B. who is a physician because you presented with fever, and your consultant is of the opinion that you need to be here for overnight observation and will be transferred in the morning if you are stable, so what you have said to Dr. J.B. doesn’t really matter.”

Whew! That was a lot to say in one breath.

Now the old man started arguing with me about the definition of “morning”, the whole 12 AM shit!

I’d made the entire above speech in a surprisingly civil tone but here, I lost my patience. I told him categorically that we could argue about that all night if we wanted, but by morning I meant “sunrise” and a “non god-forsaken hour” and I would make sure he was transferred out before my shift ended (8 am). And I walked out of that conversation.

Told the nurse to get him out of my ward by 6 am, settled another patient and then tried to go back to sleep but by then it was past 6 and everyone was awake and hence sleep was banished for the time being.

So this poor, frustrated old man, with urosepsis, who had been a department head “before I was born”, made my night what it was.

Sleepless and crappy.