Dr Samar Mahmood, an F2 at Lincoln County Hospital, recalls how working in haematology can teach you a lesson or two when you least expect it
It’s Friday morning and I’m looking forward to the weekend, but there’s still a ward round and day of haematology to get through – so I’ll hold that thought. Our team, led by the consultant, moves onto the first patient of the day. I start to present the case. “This 65 year old lady was admitted feeling unwell after chemo. She… ”
Despite the bad news, the patient – like most haem patients – remains upbeat and optimistic
My consultant knows the case well; he can take it from here. “Yes, she had her second cycle of chemo seven days ago. Her haemoglobin last admission was never more than 8.5 and neuts were always around 0.02, even after GCSF. Check she hasn’t had a temperature.”
As I reach for the obs chart, amazed yet again at how my consultant knows every one of his patients and their blood results inside out, he begins the consultation. “Good morning, Ann,” he says. She replies cheerily, addressing the consultant by his first name – one of the privileges held by patients on this ward.
“I’ve had a look at your CT scan and unfortunately your tumour hasn’t shrunk much since we started treatment,” he tells her gently. “We’ll try a different chemo regime but it’s like I said before, there might come a stage where we run out of options.”
Despite the bad news, the patient – like most haem patients – remains upbeat and optimistic. “We’ll just have to hope I get lucky next time round! Thank you for everything you’re doing,” she smiles.
We continue to see patients and review their haemoglobin and neutrophil counts: never before had a set of numbers (with the exception of junior doctor working hours) been cause for such detailed discussion.
Four hours and 18 sets of blood results later, we’re still on the ward round. Slowly losing the will to live, I hear the sound of my bleep going off. An excuse to leave the round for a while. I answer, "Hello, it’s the haematology SHO here.”
“Hi, I’m one of the ST2s in gen med. Just wanted some advice about one of our inpatients, please.” He tells me about a lady with cellulitis and CML, whose platelet count has shot up and possibly caused a thrombosis.
There’s a long pause on my end. “ST2 did you say?” Would it be unprofessional to suggest that the ST2, soon-to-be medical registrar, must know more about haematology than I ever will and that his phoning me is useless?
As the SHO, the expectation is that you know what you’re talking about
“It’s probably worth me running a decision past my reg,” I say, trying to imply that I know the answer and simply want a second opinion. “Okay, just bleep me and let me know.” He doesn’t sound convinced.
This is one of the things I find hardest about being an F2 – you are, ultimately, an SHO. When it comes to being on-call, taking referrals or seeing patients in clinic, your mere F2 status doesn’t excuse you from having a lack of experience. As the SHO, the expectation is that you know what you’re talking about.
It’s not all bad, though. Bleep requests have changed from being abrupt and mundane as in F1 (“I need fluids and a cannula for a patient”) to polite and, on occasion, interesting (“I’m sorry to bother you doctor, could you kindly review a patient with thyrotoxic storm?”). Okay, I exaggerate.
After a non-stop afternoon I finally have the chance to check the time – 5.45pm. Already running late (fortunately not a regular occurrence), but I'm almost done. Just then, I see an elderly gentleman being wheeled onto the ward by two paramedics. Everything seems to go in slow-motion, as does my heart as it starts to sink – I know exactly what this means.
My registrar tells me he would like me to clerk in this new admission. “He’s got AML and has been spiking temperatures all week. He’s been refusing to come into hospital until now.” Yes, refusing until 6pm on a Friday night.
I think sometimes we doctors can learn a lot from our patients
So I, somewhat begrudgingly, go to see this next patient. By the time I complete my work-up, two things are apparent – one, the patient has neutropenic sepsis, and two, gone are my plans for an evening out – I was supposed to be meeting a friend at 6.30pm.
“What’s the verdict, doc?” he asks me. “Can I go home?” “I’m afraid not. You’re going to need to stay iin over the weekend for intravenous antibiotics.” He looks visibly upset. “There goes my holiday then,” he says. “I had the hotel booked and everything.” Then he shrugs his shoulders. “Never mind, I’d sooner get better now than run into trouble later.” There it is again, that optimism. I think sometimes we doctors can learn a lot from our patients.
I finally leave the hospital, exhausted (after the nurses have opportunistically roped me into doing random ward jobs). It’s nearly 7pm, but I feel surprisingly happy and optimistic – I still have Saturday and Sunday, after all.