Monday 8 August 2011

#54 - No Exceptions


#54 – NO Exceptions.

If our staffing gets any leaner, I think I will have to close the clinic and go fishing.  The Boss was still not back today, and Lynda our receptionist flew off the island.  There is only two of us now, and I’m a little nervous.

Those that know me would probably think I was fairly confident n my abilities to work independently.  I think I am, but when there are less colleagues with which to bounce things off, then you do second guess yourself.  That is a little unsettling.  A woman came in today with chest pain. Now for those in the game, you would know that chest pain is one of those “bread and butter “ presentations, and that there are strict guidelines to follow, and the assessment and management of chest pain patient’s is mapped out for you.  Well some of this process was challenging today, as there is no Istat machine to look at blood tests here.  The ECG machine was fresh out of the box yesterday and took a heap of time to get functioning and configured (more on that in a minute).  The patient was hypotensive (low blood pressure), so I couldn’t give the chest pain medicine…a tablet called glyceryltrinitrate (or GTN for short).

If GTN is given to someone with low blood pressure then it can make the BP worse.

So what did I have?  … A woman with chest pain needing an ECG to be done, no way to check cardiac markers (blood tests) and no GTN up my sleeve (or under her tongue).  So I explained to get that I would need to take a heart trace.  But being a man, it was ‘too shame’ for me to do that task, so I am stuck.  No, I was annoyed actually.  People come to me for help, yet wont let me do the assessments I needed, or give the treatments required.

Another patient came today complaining that his bum gets sore when he takes a certain medication.  Now I looked up the clever books, Bumpain isn’t listed as a side effect of this drug, so I tell him, that it might be a host of other things.  I tell him that I will have to take a look at his motop to see what is going on.  I just might add that this is not my favorite assessment!!!  Well he refuses, tells me it is not that much of a problem, and flees, muttering something in language under his breath.

Another Aka (grandmother) brinks in a small child, perhaps 3 years old, covered in impetigo (school sores), and weeping oozing sandfly bites.  The kid has a fever , I swab the lesions for microbiology culturing and start the explanation about this awful Group A Streptococcus germ that is suspected in the wounds on the little pumpkin.  First of all I am to learn that pumpkins are not what we call children in the Torres (lost in translation), She thought I was ballsing up ‘pikinini’  which is their word for child.

Second, the treatment, which as you probably have guessed by now, is that nasty big white needle.  I explain that I will need to jab the kid, and she refuses to let me, telling me that she has been a ‘gud gal’ (good girl).  The premise was that she thought that the needle was some sort of punishment, when infact, it is the kindest option.  That took some explaining, but she wasn’t buying it, and they left with a box of bandaids and a prayer.  When I get a call at 2 am on Wednesday morning with a critically ill septic PUMPKIN, I wonder if they will let me treat her with what needs to be done?

Back to my chest pain girl.  I ring the doctor, and the call goes something like this:

“Hi Dr… This is Rob Timmings the CNC on Yam Island.  I have a 30 year old woman with 24 hours of chest pain.  (jargon describing symptoms / vital signs and other information that you don’t need for the story).”

“Um…well no I haven’t given her any GTN Doc, she is too hypotensive”
“Well no, I don’t have an ECG to fax to you doc, she wont let me take one”
“Yes I understand that Doc, but if the patient refuses an assessment what am I to do”
“Ahhh… Good question Doc, um….no I haven’t taken bloods because there is no Istat”
“No Doc, I don’t know why there is no Istat here.”
“well I know that MI (heart attacks) are diagnosed on ECGs and Bloods, but we cant do bloods and she wont let me do an ECG”.
“Sure doc, I will do that.  Thank you ”

So I hang up from a phone call that was mist strange.  I turn to the patient, and say, “the doctor asked me to give you an Aspirin tablet to reduce the clotting in you blood, then you can go now that the pain has settled.  If it should return I need to come back to the clinic, Day or night, and I will need to do this ECG test.

The girl looks at me and says.  “Oh, I cant take Aspirin, it makes me have a rash” !!!

Now you see, this sort of frustration happens in the big city hospitals too, but there is always a colleague that you can bounce off, and when the going gets like wading through mud, then there is often a tag team, to release you.

My hypotensive chest pain patient, came into my care, had no oxygen, no ECG, no bloods taken, no GTN and no Aspirin.  I sent her home, and have to pray that her pain resolves and that this is a non event, and I have to face my nursing students agaqin with a straight face, and tell them, “now when chest pain patient’s come in, this is what you must do!!!”

Then I have to look at all those keen to learn faces, that take my words for gospel, and give them that convincing look, that says…

“No Exceptions!” 

3 comments:

  1. Replies
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      Email him: AKHERETEMPLE@gmail.com
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