This is my third day of training to be a country GP, and I’m slowly starting to get the hang of how to log on to the computer. Which makes me enormously proud. I’ve also managed to get my card activated to let me though the security doors onto my own ward. Which is a real bonus. I’ll leave the whole ‘mastering medicine’ thing for another week. That’s the easy bit.
Time to look back to my third EVER day of being a doctor, when my first patient tried to die on me…
I’ve now been a doctor for three whole days. Which doesn’t exactly equip me for the nurse grabbing me urgently as I show up on the ward in my lycra bike gear at just after 8am, in the hope of getting some work done before the madness starts, and hissing, ‘Mrs F’s blood pressure is plummeting – 70 over 45. You need to do something now.’
So in I run, take a look at Mrs F, who is lying quietly, with a blissful look on her face. This is a woman who punches anyone who comes near her and screams ‘YOU FAAAHKKING CAAAHHHNT’ in your face. She is 78. She is being sweet and gentle. This means she’s almost a goner.
I have a vague memory that if someone’s blood pressure goes down it usually means either sepsis (widespread infection) or bleeding. Either way the first thing to do is fill someone with fluids. All of which is very well – but firstly you have to get a cannula into an old woman’s veins who’s dehydrated to Sahara levels, and has no blood pressure to speak of. It doesn’t help that your hands are shaking so violently, that you can barely hold the needle.
But after 4 tries, I hit the jackpot – the thrill of blood swooping down the tube that signifies you’ve found a vein, or ‘flashback’. Hallelujah. I ask the nurse to put up some fluids, while I desperately attempt to find a vein in the patient’s other arm, so that I can take some bloods and send them off to see if she has an infection. Unfortunately by this point the patient is feeling a bit better, so has enough energy to start swatting at me with her other arm. Finally I locate a vein, and draw off more of the red gold, to send to the lab in the hope that they will give me some magic answers.
Next it’s time to rule out the other reason someone’s blood pressure plummets – bleeding. Less blood in the system of pipes that comprises your arteries and veins, means less pressure in the system. So I do a quick once over to look for any obvious signs of bleeding, then it’s onto the abdomen, to look for any bleeding inside the body (which causes the patient severe abdominal pain). Then finally it’s time to put your finger up the patient’s bum to check they’re not bleeding from their lower intestine. Which, lets face it, is not a prospect to relish, especially when your patient is doubly incontinent and wearing soaking nappies.
Nine times out of ten, an elderly patient who has ‘gone off’ is suffering a urinary tract infection – which in a healthy young adult would cause a bit of discomfort and feeling rubbish. In an elderly patient it can be fatal – the infection takes hold and spreads to the rest of the body like wildfire, causing the patient to become dangerously septic.
This patient is smelling distinctly urinary – and when I ask the nurse to dipstick the urine, she comes back with the telltale ‘positive for nitrites and leucocytes’ which usually means the patient has a UTI. So it’s a stat dose of IV antibiotics for a week, and a delirious elderly patient to serve up on a plate for my consultant ward round.