Thursday, July 28, 2011

The Pathology(cal) Inflammation

Ok, I'm sleeping in the side room while on-call. It's around 3am & I have this woman shaking my knees vigorously. "Anyplace else, any other woman", I pray half-asleep "Please let this be a part of my dream too". But, my resident doesn't find any of my mumbling funny & says, "Trace this patient's CBC & RFT report... STAT"

I've never liked this term - Stat! The only place it has any real use is in prescriptions or in nurses' orders meaning the meds have to be given immediately. But, this being a country of over-usage & customization, the term is now used as freely as a 14Fr Foley's; people have just stopped thinking. Some of the many improper uses I come across daily: 'Come back from dinner stat', 'Collect this patient's sample stat', 'Make this patient abscond stat', 'Finish reading this stat', 'the Head's coming up in 10 minutes stat' !?!

But I, as I so often do, am digressing. I slap on my shoes, put on my puppy-dog face & move to the lab which is around 300 metres away, but it sure does seem like miles. I look at the on-call technician & plead, beg, implore, beseech & request, then demand I get this report! I hate reports. That tiny piece of paper makes me want to dip into my family's savings & buy myself cell counters that I can carry around. Just imagine, patients queuing up in front of me every morning, bloody arms et al, being given STAT reports (Note the correct usage). And if I'm not tracing reports in the middle of the night, I'm definitely doing it bright and early every morning. But, my Intern Avatar is now 6 months old & I've learnt a few tricks to bypass these depressing situations altogether.

Here's a list of things to do to make sure you never get sent out to trace ever again:
  1. Forge a report!
    I know this sounds kinda insane but there're times when you know the result (usually via phone) but can't get your hand on the signed report. Don't be afraid to forge it, there're plenty of desks in these labs with report sheets lying around. Better yet, call the friendly "private" path lab fellow & have him make you one instead.
  2. Over-diagnose
    Never be afraid to write a 'killer' diagnosis. And it must be absolutely horrendous if you aren't going to go deliver the sample yourself. Here're some of the ones I frequently use:
    HIV induced encephalopathy (?Query) with past h/o STI
    Acute drug-induced Hepatitis (preferably due to ART or AKT)
    Acute necrotizing glomerulonephritis with patient to be given Mag.Sulf (100% success rate)
    Incomplete abortion with post-curettage hemorrhage
    Septic peritonitis with hepatic encephalopathy
    ? MDR-TB
  3. There's a budding actor in all of us:
    I usually start panting as soon as I get to the blood bank or emergency-lab, ask the technician to run the sample. I put on my sternest, most constipated face, and mumble, "Didn't even have time to write up a request form". Thank them profusely and run the hell outta there.
  4. My newest book's title: "Letters to the the E-lab"
    Dear on-call E-lab technician,
    Kindly send reports of patient xyz in Wd.123 urgently as the patient is already being induced & we need to know the counts before we start blood transfusion. Also, the patient has developed drug toxicity requiring steroids, we could use the LFT, RFT reports as soon as you can process them.
    Thanking you,
    (Senior Resident under Dr.ABC)

Another useful piece of advice from my recent misadventures; whenever on-call, sleep in the adjacent ward. The residents are usually too lazy to go call you themselves & the cellphone reception in our hospital is horrendous to say the least (God bless broken promises by cellphone operators).

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