Monday, April 03, 2006

Grand Rounds -- NHS (UK)

Boy, they don't call it "Grand" for nothing.
It's been a while since I looked at a Carnival of [Topic here] or one of the US Grand Rounds, a collection of doctor blogs.
I forgot how impressive some of these presentations can be. This one I barely scratched the surface, and I have to tear myself away so I don't spend the next hour or so drilling into the links. Wow! LINK here to NHS Doctor Blog, Grand Rounds Vol 2 (27)

(I'm just glad Dr. Bob has my attention. One or two doctors is about all I can handle, and he is the gold standard for me.)

Here is a powerful piece of writing from a doctor reflecting on a patient who died. I'm glad I don't have his job. And I'm glad he does. The blog is Sunlight Follows Me.

Okay, this is an extension of my previous post. I was going to write about it earlier, but I needed some time to really think about it.

When I was looking after that lady who collapsed, I had about 30 seconds to assess her, in the presence of her relatives, before further help arrived. In fact, one of the patient's daughters was still holding her in her arms, in order to stop her from falling to the floor. Her other daughter and grandaughter stood behind me.

I saw her take only ONE breath during this time. One breath in thirty seconds is not a good sign.

I said out loud, "She is still breathing." This was a lie. One breath is not "breathing". And I could also tell that it was not an effective breath.

I was also feeling her pulse which stopped *whilst I was feeling it*. I remember thinking at the same time that the patient's daughter was still right next to me. I could feel the eyes of the other relatives on the back of my neck.

And I said out loud, "I can feel a pulse." This was also a lie.

I lied twice. Why? Why? Because I didn't want to alarm her family? Because I didn't want them to panic? Because I was 'buying time' until I had more help, more time to think? Because I didn't trust my hands? Is that a good excuse?

We had to pry the daughter's hands off the patient. She was in shock - she nearly fainted. The grandaughter became hysterical and started to scream. This happened because my registrar and two nurses ran into the bay, and the registrar immediately said, "There's no pulse, get her on the trolley."

The reason why I wrote the previous post was because I felt really bad, not because I had lost a patient, but I had lied to her family. And in doing so, had I wasted precious seconds in dealing with the patient? I could have started CPR twenty seconds earlier, and it may have made a difference.

What have I done?

I must watch my mind and guard my tongue more closely.

Anybody who can now go read his previous post and remain unmoved has a heart of stone.

Somebody please tell me how heartless medicine is in the UK.

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