The drive in to the hospital at 6 am on a frosty morning is not one I’m overly fond of, however by 6:30 am with coffee in hand, I quit pondering about how good an extra hour or two in bed would have been and get about preparing for the work day ahead.
An orthopaedic rotation can be a busy one. The first task for the day is getting ready for rounds which means looking up blood test results and observations charts for the patients to see if there were any changes overnight. While most patients tend to be fine, a few anomalies end up being flagged. This includes Paul, a man in his 80s, who I’d gotten to know quite well over the course of the preceding week. Paul was recovering in hospital after an operation to replace his hip joint after a fall he had had. Reviewing his blood tests, I made a note of his supratherapeutic INR, and adjust his warfarin dose accordingly.
At 7 o’clock we have morning handover, we discuss the patients that have come in overnight, the operations from the prior day and anything that may have occurred overnight which requires further investigation or management by the day team. We start our morning round, which in a surgical rotation, generally consists of seeing patients who are pre and post operation and monitoring their progress and recovery.
After morning rounds, it’s a balance between prioritising jobs from the morning and dealing with tasks that come up throughout the day. I’m paged by a member of the nursing staff to inform me that Paul has had an episode of melena. When I go to speak to Paul, he tells me he is quite concerned because his father passed away from bowel cancer and asks me if that is what has caused this. I reassure him and inform him that while possible, in this situation, it is unlikely and a much more likely to have been caused by the warfarin.
After assessing him and sending off blood tests, I let him know that is currently stable but will need to be seen by the gastroenterology team. I request the nurse monitor his observations more frequently, and after requesting the gastro consult, head back to work my way through my to do list for the day. The rest of the day consists of a variety of tasks which include discharging patients, prescribing medications and reviewing patients. It also includes a lot of teamwork and collaboration on the parts of various individuals. In Paul’s case, I liaise with the social worker about getting supports put in place for him and briefly catch up with the physiotherapist about his progress with regards to mobility.
At the end of the day on my way out of the hospital, I popped into Paul’s room to see how he’s doing. He tells me that he has not had anymore bleeding and that he has been told his blood tests were encouraging. We spend the next 30 minutes sharing stories about family, and he tells me about his co about the work he used to do and he tells me about his family, While each day brings lots of variety and is interesting in lots of different ways, its moments like these were I get to spend time with patients and hear their stories that makes the day to day rewarding.
Dr Zaheer Jayhoon
The Canberra Hospital
Published: 03 Jun 2019