Building rapport

Three times a day

We were still on training wheels despite being doctors in our own right. Every morning soon after handover meetings we head off to our respective wards and mine was labour ward. Here we review patients and write our plans and notes. The registrar on call for the next twenty four hours then comes in and reviews the patient again and adds to or takes away from our plans. If a consultant decided to show up in the ward then the patient is reviewed a third time. I've never heard a patient complain about the number of times they've been reviwed though, most of them seem rather happy that we pay so much attention to them. 

The words delivery suite plastered at the entrance of labour ward is very deceiving. Not all patients admitted will go on to deliver as some of them are not even in labour. Then why admit them? for better monitoring apparently. Some of our mothers have severe complications like pre eclampsia which means they have very high blood pressures and could potentially be life threatning. I was reviewing one such patient, her blood pressures are not behaving and I decided we needed to add a second antihypertensive (a drug that lowers blood pressure). Now I know which drug to prescribe but I had forgotten the dose and so I flip through the guidelines and prescribe the correct dose of the drug on the patient file. I realize too late that opening the book of guidelines infront of the patient was a mistake. To her credit she says nothing, but she is petrified, I can almost hear her thoughts 'does this doctor know what she's doing, should I really take these drugs?' 

Spoiler alert ; she doesn't take the drugs and suffers the consequeces.

I informed one of the midwives that I need to see the bloods for the same patient. She was in the middle of a delivery herself but acknowledges my request. At our facility there is no computer system that tracks down bloods. It is a manual task that requires someone to physically go to the main lab and wait in line to collect the needed blood reports. I was told on my first day that labour ward has a porter who does the trips to the main lab and back and was emphasized that it was not part of my job description as an intern medical doctor to run to the lab for all my patients. 

An hour has passed since I began to review patients and the registrar on call has come for her ward round. Which means we now go from patient to patient and present each of them to her. We are now standing by the bedside of my pre eclamptic patient and I start presenting my case while she orders one of the students to check her blood pressure. I am half way through my presentation when the student returns with a terrified expression on her face and an even more terrifying blood pressure reading on the machine. (yes this is the same patient)

The patient has a dangerously high blood pressure. My registrar immediately springs into action and calls for the senior midwife. I watch on the sidelines as they push hydralizine (an emergency blood pressure drug) through her IV cannula. I feel very dissapointed in myself when the registrar asks for the blood reports of the patient as no one had actually followed them up. A student luckily volunteers to run up to the lab but she too returns to say the samples never reached the lab, and so the patient was pricked for a second time this morning.

The final decision made by the registrar was to induce the patients labour. Induction of labour is done by giving a certain drug every four hours upto 4 times until she starts to have contractions. The first dose of the drug was given to the mother by one of the students. My rapport with this patient was already tarnished and I doubted that she would want me to be the one to give this drug as well. 

The registrar pulls me to a side and says 'we don't just write orders, we see them through. Next time, you make sure all your patients have their bloods, and have taken their drugs before I come to see them. I want to see blood pressures recorded atleast every two hours on all your patients.' 

I found the porter whistling down the corridor while pushing a wheelchair. On the wheelchair he has all the blood samples we've collected and handed to him two hours ago. When asked he says 'why I should go to the lab ten times when I can just wait for all you interns to give me the samples and bring all the results back at the same time'. He has one job, and I realize sadly that I will also have to do his job.

Lesson learnt the hard way : if you really want something to be done, do it yourself. 

Further down my internship this lesson was releant as ' if you want something to be done right, do it yourself.'