I’m on a morning ward round in the Intensive Care Unit and we’re discussing a patient I’d admitted the day before. Mrs Patel is a lady in her sixties with really bad respiratory failure due to a particularly nasty pneumonia. The previous afternoon I thought that if we gave her non-invasive ventilation (NIV) and adequate intravenous fluids, she may just turn the corner and start to get better.
Unfortunately, I was wrong. She continued to deteriorate and quite soon after she arrives on the ICU, her oxygen levels were still dangerously low despite the NIV so in order to prevent her from dying then and there I had to put her into a medically-induced coma, intubate and put her on a ventilator.
So there I was the next day, recalling this story to the ICU consultant, SHO, ward sister and staff nurse. We look at her blood test results, ABGs, chest X-rays etc… and it’s apparent to all of us that whilst this lady will probably get better, it’s going to take a while and she will need to stay on the ventilator for at least a couple of days.
I turn to Richard, the SHO, and say “Could you change her sedation to midazolam & morphine.”
“Sure,” he says as he picks up the drug chart. He crosses off the propofol & alfentanil and writes up what I requested.
(Basically I’ve asked him to change the drugs that are keeping Mrs Patel in a coma. Propofol & alfentanil are shorter acting, but much more expensive. Because we were going to keep her in a coma for a few days, I changed to the longer-acting but much cheaper midazolam & morphine.)
After scrawling the new prescription (it’s so true what they say about doctor’s handwriting) Richard says, “It won’t make any difference, you know.”
I raise an eyebrow. “What do you mean?”
“I mean, it doesn’t matter how much money we save by doing stuff like this, they’re still going to cut our pay.”
“True enough,” I concede.
“Well, if the other lot get in, they’ll dock our pay even more!” pipes up Julie, the ICU ward sister
“Could we please save the politics for the coffee room,” comes the irritated voice of our consultant. “Now, could someone find the result of this woman’s most recent ECHO?”
Suitably chided, we get back on with the job in hand.