Map from website ‘Strait through: Magellan to Cook and the Pacific’
It was the day before Christmas. Matt was an FY2* working in an acute Trust. His registrar explained,
‘Our job, today, is to set a course for each of our patients, make sure their treatment is right, resuscitation and escalation decisions considered, frequency of reviews agreed and handed over…’
‘We’re only away for a couple of days.’
‘I know. Easter is worse actually. But the hospital won’t be running at full tilt between Christmas and New Year, and I’m taking one day off, Suzy’s seeing her family in the States – she was lucky to get that agreed but her Mum’s ill I think – and for good or bad, it’s the sickest ones that will get most of the attention. So go to it! I’m in clinic, but I’ll check in afterwards.’
Matt and the FY1 saw everyone and made clear plans, but late in the day he picked up a few complications and serious developments. He left at 7.45PM and found the roads deserted. Most workers were home already, but he had a three hour drive ahead of him. As he drove he thought about two patients for whom he had prescribed new treatment, one with pneumonia, the other with renal failure and dangerously high potassium levels. It was still quite a novel experience for him to make a firm diagnosis and start treatment without direct supervision, but by quarter to eight on Christmas Eve the wards were not exactly overrun with seniors. To be fair, at 6.30PM all had seemed settled, and he had said goodbye to his registrar with confidence and goodwill!
When he woke up on Christmas morning, in his parent’s house, the first things to enter his mind were the two patients he had treated just twelve hours before. Both should have been reviewed at around midnight, the one with renal failure requiring a repeat potassium check, the one with pneumonia a blood gas. Matt had handed both tasks over, but he was concerned. When he made the hand over call, the evening SHO was being gradually buried in last minute requests as each team tried to leave for the holidays. Matt went downstairs and joined his two siblings, one older and one younger, and his parents for breakfast. This would be the last year that they spent Christmas together – there were babies and partners and houses and grown up comittments coming. He enjoyed the meal, but the thought of the renal failure patient kept nagging at him. He must have appeared distracted, for his father commented,
‘What’s on your mind son?’
‘Well, you’re off now aren’t you. The poor sods who are in today can deal with it.’
‘Yes…but…’ and he didn’t go into it. His father was not in healthcare, he had been a sucessful businessman who’s company seemed to shut down entirely for two weeks over Christmas. Matt remembered that he had brought work home for the holidays, and, thinking about it, there must have been worries and concerns that niggled even though the doors were closed. But his father had always hid them well, committing himself fully to the time the family spent together. Perhaps Matt had to learn the skill – that of closing out his professional life for a couple of days and appearing relaxed. Perhaps he would learn not only to appear relaxed, but to be relaxed!
They had lunch, and the two glasses of Prosecco spurred him into a mood a convivilaity, but as he sat down on the sofa at 3PM and let his eyelids fall, a fluorescent green line flashed into his mind’s eye and scurried across the dark field. His renal patient, in cardiac arrest! It was now time for presents. Again, he must have put on a poor show, because his sister took him to one side and asked,
‘What is it? You look miles away.’
Matt told her. She was unimpressed,
‘It’s not your concern. You’re off now. Come on…’
‘I’ve got to know what has happened to him.’
‘You’ll find out when you go back won’t you?’
‘I suppose so.’
He went back into the lounge, but fifteen minutes later said he was going to the loo and went upstairs. Covertly, in a whisper, he used his mobile phone to ring the hospital switchboard. He waited eight minutes and 47 seconds (his mobile display ticked over silently and patiently) to get through. He guessed that many relatives were trying to contact wards to check that their interned loved ones were alright. After another five minutes the on-call house officer answered her bleep. Matt asked her if she had seen his renal patient. She hadn’t.
‘Hang on…’ she said, ‘I’ll check the computer for something, the name rings a bell.’ A pause, keyboard taps. ‘He’s on intensive care. Oh yes! I remember, I heard all about it when I arrived this morning. He was reviewed at 2AM and his potassium was over seven or eight something…the house officer on overnight called ITU, they came to see him, and an hour later he was on a filter. He’s fine. Good job he was reviewed. Could have done with being seen a bit sooner probably…his ECG was horrible, they think he was two hours away from arresting, he was so acidotic too. Was he your patient?’
‘Yes…I arranged the review…’
‘Good thing you did…’
‘Thanks. Thanks for answering.’
‘Why are you ringing, it’s Christmas day?’
‘I just…wanted to know…’
‘Relax man! We’ve got it covered. Go and get drunk.’
And he did. Later he dreamt of ships arriving in harbour, their cargo safe, all hands present.
* FY2 = doctor who has been qualified for 1 year
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