Friday, 26 September 2008

A night's sleep

It’s four in the morning and I’m working a night shift when my pager goes off. I pick up the phone and dial the number on the screen.

“Hello, staff nurse speaking.”
“Hello, it’s Michael here – anaesthetics – were you paging me”
“Yes, it’s staff nurse on the colorectal ward. Do you know Emma?”
“No, I’ve not met this person.”
“Well, she’s a patient on the ward who had a bowel resection yesterday evening. I’m calling you because we’re having trouble with her epidural. Over the last hour or so she’s been complaining of pain in her abdomen and it’s been getting worse. I tried to go up on the (epidural) rate, but she’s now saying that she’s in agony. I was wandering if you could come up and review her please.”
“Is her blood pressure OK?” I ask
“Yes,” comes the reply. “The last one was 115/70”
“And has this epidural been working at all since she got back from theatres?”
“It seemed to be earlier on, but, like I say in the last hour or two, she’s been complaining of more and more pain.”
“OK, I’ll come up and see her.”

I pick up my coffee (coffee is a god-send when you’re working through the night) and wander across to the surgical wards. I take a detour via the intensive care unit to pick up a vial of bupivicaine – just in case.

The staff nurse I spoke to greets me as I walk up to the nurse’s station and shows me where the patient is.

Emma is lying stock-still on her back and is grimacing. It’s four in the morning and this woman really should be sleeping. I ask her a few questions, check her observations and tell her my plan.

“What I think is best is that I give you a top-up injection down your epidural and that may well take the pain away. We’ll check your blood pressure a couple of times afterwards, but hopefully you’ll be much more comfortable. If it doesn’t work, then we’ll try something else. Sound like a plan?”

Emma nods at me and I inject 5ml of 0.25% bupivicaine down her epidural. I wander back to the nurse’s station and ask the nurse to check her BP in 15 minutes’ time. I sit down and chat to the nurse for a bit while scribbling something in her notes.

After 15 minutes I go back to see Emma.

“How are you feeling?” I ask. “Has it made any difference?”
She looks up at me and gives me a big smile. “Much better now thank-you. I don’t have any pain at all.”
“It’s gone completely?”
“Yes, thank you so much.”
The nurse checks her blood pressure which reads 121/75.
“Your blood pressure if fine, I’ll increase the rate that the epidural is running at. We’ll check your blood pressure again in about a quarter of an hour and after that, you’ll hopefully be able to get some sleep tonight”
“Thank you again, so much” Emma says to me and I wander back to ICU smiling to myself.

I think part of the appeal of anaesthesia is that just about everything you do makes a tangible difference to the patient. Whether that’s “big” things like an A&E trauma call, or “little” things like giving an epidural injection so a woman can get some sleep the night after her major surgery, you always feel you’re making a difference to help people.

(I think some credit should go to the staff nurse here too, stuff like this is much easier to sort out if the nurse is sensible and knows what she’s doing.)


madsadgirl said...

Makes getting the call at that time in the morning worthwhile, doesn't it? And the satisfaction that you get must be wonderful.

Tazocin said...

Is it because of EWTD there are no house officers mentioned in this post?

Dr Michael Anderson said...

MSG - yeah, you're right, Emma was having a much rougher night than I was!

Tazocin - I don't think that it's anything to do with EWTD. I think there is an attitude of "if a patient with an epidural has pain, then call the anaesthetist on call." I don't think the ward houseofficers would really know what to do with a poorly functioning epidural infusion, simply because they don't get trained about them - which is a shame really. After all, what I did was hardly rocket science was it?