Where's Wally? (stuck in ED!)

I'm very sorry.

It's been a long time between drinks and I must sincerely apologise for not writing earlier.

To quote my registrar: "We've been raped!" (metaphorically, referring to our team list exploding, not literally)

The last two weeks have been hell... exacerbated by the fact that yesterday was 6/6/6 which can only really mean badnesss all round.

Came back form my ADO-weekend off to find that my boss had been 'turfed' all these patients from the general surgeon Dr T (who-I-have-now-decided-is-a-big-pilonidal-sinus-aka-pain-in-the-bum-because-he-turfs-everyone) and that due to their having been 3 theatres running at once my list had exploded from an average of 3 per day to 14 per day.

So I found myself on the "Urology" team managing:

a) a 87 yr old Jewish man with chronic proven cholecystitis who came to ED complaining of abdo pain... ED clumsily rammed a catheter into his willy and caused it to bleed and so Dr T 'turfed' us this obvoious gall stone pt because he thought the haematuria was not due to the IDC but to some rare cause of painful haematuria. (Pt is now sitting on ward for almost 2 weeks awaiting Nursing Home and hitting on all the nurses cos he's too well to be in hospital)

b) a 77 yr old morbidly obese (read:180kg) lady who came to ED with rapid atrial fibriallation and chest pain on a background of diabetes and chronic leg ulcers. An obvious cardiology/geri's admission? No way! Because this patient had a cystoscopy 4 days prior, the med reg insisted that this was a UTI exacerbated problem and needed Urology admission even thoguh the MSU was negative, the white cells were normal and the patient was afebrile. (pt is now awaiting geri's transfer and hallucinating about cats and ants running around her room)

c) a 83 yr old male came in with a simple urosepsis but deconditions in the 25 hours (literally) it took for him to become afebrile. Now he 'cannot' walk and needs long term physio rehab after only 24 hours of a UTI. However because he once had a superbug infection 4 (that's F-O-U-R) years ago he needs a seperate room a the rehab hospital and so we cannot transfer him until that bed becomes available. (Pt now hitting week 3 of 'waiting')

All these non-urological pt's are really annoying the crap out of me. I don't mind looking after a pt if we can DO something about them. But these ones are not our territory... we can't do anything more for them. And yet the med teams refuse to take them.

The ED is full. We get daily reminders telling us to discharge any patients who are well (as if we like keeping them for fun?) on our pagers. And yet the bedblock is due to the fact that stupid people keep dumping us with their patients. Grrr!

I have relabelled bed 3 in the ED cubicles the "Urology bed" because we consistently have a new pt in that bed waiting for a ward bed because there is no room in the inn. I even know the nurses down there pretty well now cos I'm asking them to manage the pt when I'm not there!

It all came apart yesterday when ED asked my reg to take care of a patient. She suggested it could be a joint admission but that we would NOT be turfed and would NOT take primary care of them. Later that day the patient was admitted under us.
Reg goes to ED.
Reg screams (I kid you not!) at ED reg and ED reg gets all sooky and stroppy with my red faced, red haired reg who is about to kill someone.
ED reg calls 'other' Uro reg and pt ends up admitted under different boss but Dr J the long suffering Uro intern still has to deal with the pt.

Fini