Even as students we are required to work “on-call” or night shifts. It means working quite closely with a doctor through the night and therefore there’s a good chance of receiving good ‘1 to 1′ bedside teaching, doing useful jobs and not feeling as inept as medical students usually do.
I paged the registrar on duty, who called me back. “It’s MSL, one of the medical students on Dr Bigwig Consultant’s team, I’m joining you on call tonight if that’s OK?”
“Come on up MSL” came the reply. It was Dr Helpful, who I’d met before and who was always friendly. I made my way over to the respiratory ward accompanied by my footsteps clicking on the polished floors and the faces of eminent doctors looking down at me from their portraits. (With few people around, parts of the hospital can be spooky at night-time.)
“Let’s get you clerking Mr A. Don’t look at his notes, take a history, perform an examination, then page me when you’re done and we’ll compare your findings”
Mr A was in a single patient room, his infection status clearly indicated by the big sign on his door and confirmed by the boxes of protective equipment outside. ‘What has this patient got?’ I wondered and if there had been a rack of military grade biohazard suits hanging up, I would have gladly jumped into one. Instead, I put on a (slightly less protective) paper face-mask, plastic apron and some rubber gloves – and stepped in.
I saw a man in his fifties propped up in bed, emaciated and perhaps breathing faster than he should have been. A quick history revealed that Mr A was having a long run of bad luck, separated from his wife, jobless and sleeping on the streets. He was falling asleep during the history, waking up with a start at each new question. At least the lack of chit-chat made the examination easy. He was so thin that the diaphragm of my stethoscope bridged the hollow spaces between his ribs. He was also feverish and sweaty with a raspy cough.
‘Night sweats, fever, weight loss? That could be malignancy or TB… oh wait, TB?!’ I thought, suddenly even more glad of the mask. When I finished I thanked Mr A and went to present my findings back to Dr Helpful “…and erm, my preferred differential diagnosis is pulmonary tuberculosis” I said hopefully.
We checked his notes and pulled up the chest x-rays and there it was, a “small cavitating lesion with infiltrates” – apparently, at the top of his right lung. To me it resembled a white wispy circle, darker in the middle almost as if a smoker had blown a little smoke ring that had settled over the computer screen, right where the image of the lung was getting white and patchy.
It feels contradictory to hope that a patient has the diagnosis you suspect, particularly if it is serious, but as a medical student and if you get it right, it also feels reassuring to have proof that you do (sometimes) ‘know your stuff’.
Dr Helpful decided Mr A needed an ABG (arterial blood gas test). It involves taking blood by inserting a needle into the radial artery in the wrist, is quite painful and can be hit and miss. I’ve performed a few ABG’s before, but it needs practice and I was hoping to be given the chance so I was disappointed that Dr Helpful decided to do it.
* * *
“Sharp scratch coming up” explained Dr Helpful.
As the needle pierced Mr A’s skin, he suddenly reacted by jolting his hand back, knocking the needle out of his own wrist and a split second later into Dr Helpful’s glove. Our eyes met over our face masks, a look which said “Oh F&*k!” We both knew the implications. Ripping off the glove, there was a superficial but visible needlestick puncture in the skin of the thumb.
We scrambled outside, Dr Helpful went to deal with the needlestick and I carried on with my list of tasks. The electronic records showed that whoever admitted Mr A had correctly sent his blood to be tested for HIV, Hepatitis and other blood-borne diseases already. The results were not yet on the system although due anytime. I continued to check in the morning. At lunchtime I spotted Dr Helpful at the other end of the ward. Before I’d got to within speaking distance, the patient’s HIV & hepatitis status were obvious.
Thumbs up, an eye-roll and look of relief as Dr Helpful turned to deal with another patient.
In hindsight, I think I can rename Dr Helpful to Dr Fortunate, I think I was also fortunate since it could have easily been me. Lesson learnt.