Friday, 4pm and a patients arrives on the ward from the Medical Assessment Unit. This man is as sick as a dog. Jaundice has turned his eyes and skin bright yellow and we look at his blood test results and his bilirubin level is about 500. This is very bad news indeed. He’s a homeless man and you didn't need to be a doctor to tell that he was seriously unwell. He was all skin and bones and he had the haunted look about him of someone who knew his time was at hand. He wasn’t fighting it.
This man wasn’t well enough to even speak to us anymore. For us to know why he was so jaundiced and unwell, we needed to scan his liver by ultrasound.
In hospitals, half past four on a Friday is the worst time to try and organise things. Departments are shutting up for the weekend and the staff are trying to finish up their workload so they can get to home/to the pub.
Luckily for us, our consultant (effectively our boss), was on site and he came straight to the ward and, after speaking to four different radiologists, found someone who was willing and able to scan this poor man’s liver. The radiologist pages me 16:40 and says “I’m in the ultrasound department, I need to leave at 5pm. If you can get the patient here in the next five minutes, we can do the scan for you.”
So I grab one of the nursing assistants and we wheel this patient on his bed, through the corridors of the hospital to the Ultrasound Department.
I have to say, this was all very dramatic and one of the few times I actually felt as though I was in an episode of E.R. or House or Holby City or any of those medical dramas where people are always running through corridors yelling “Emergency! Emergency!”
The radiologist is there waiting for us and the scan shows that this man’s liver is chock-full of cancer. This is why he was so jaundiced and this is why he was so unwell and this is why he was going to die. As doctors, there is nothing we can do to save this man’s life, but, because we managed to get a scan done, we’ve spared him from having further blood test, needles, catheters and all the other unpleasant things that we do to our patients in order to diagnose and treat their condition. What we can do for him is make sure his last hours are peaceful and painless, and from that we can take solace.
I’m typing this on Sunday evening and I will be very surptised indeed if he’s alive when I get to work tomorrow morning.