The plan is to use it as a diary throughout the week. May recount some of the work issues/problems or just pure fiction – who knows.

Whoever is going to read this at some point might be disappointed or find it refreshing.

What tend to be the usual disclaimer when watching something: The story, all names, characters, and incidents portrayed in this production are fictitious. No identification with actual persons (living or deceased), places, buildings, and products is intended or should be inferred

I better stick to this and hopefully this still makes a good read for some people:

First day back at work today after a 3 day weekend for me as I have had yesterday (Monday) off. We are on-call this week which means that every patient who is going to be admitted under the surgical on-call will be under my care on Friday. They will be added to our list on Friday.

This means that one of my UGI consultants will see all of the on-call patients plus our other patients which are already on the list (elective patients mainly and patients we took over from other specialties).

After the ward round this morning I went to the surgical admissions ward to see if they need help when I noticed that one of the patients was harassing the nursing staff.

Trying to see what’s going on I started talking to the patients who then shouted at me (considering we just met for the first time) that he needs to see the doctors and then wants to go home as we are useless in helping him and he needs to go back home to his “mentally ill” wife and their kids.

After I figured out who he was and calmed him down a bit I looked into the medical notes only to realize he had been seen by the doctors and he was waiting to be seen by the cancer nurses. He came in with 2 weeks of lower abdominal pain and some weight loss and the CTAP showed potential pancreatic cancer with metastases. Reading this I did give him some slack however still no reason to be rude and offensive to the nursing staff.

I did then ring my UGI cancer colleagues they hopefully would see him shortly. I did explain this to him after I spoke to him although he already had made arrangements for his parents to come and collect him. He then also wanted some stronger analgesia as he doesn’t like Oramorph (liquid Morphine).

After explaining to him that Oxycodone is out of the question he then explained to me that Codeine would be sufficient – happy days. Unfortunately the next hurdle was to get some anticoagulation (blood thinners) prescribed as his CTAP not only showed a cancer but also a splenic infarction and a splenic vein thrombus.

Going to his room telling him that his discharge would now take some time as I need to discuss his case with the Haematology team due to his CT findings he started shouting again. I did remind him that I was here to help and that shouting would not speed things up and if he is not calming down I will escort him of the premises myself – by that point his mum (who had arrived 10 minutes earlier) managed to calm down her son.

Luckily my SHO was at hand and she kindly spoke to Haematology whilst I was sorting his discharge papers out. I prescribed the meds as per hematology advice and requested them.

Once the discharge letter was done I spoke to the nurse and explained he could be sent to the discharge lounge and he can wait for his medication there.

After I then did the UGI MDT referral I left the ward only to receive a bleep from the nurse to explained to me that the patient left the hospital without his medication – 🤦‍♂️

You just can’t win with some patients.

Phone call to the GP – explaining the current situation and ensuring that the patient will get his anticoagulation.

The workload lightened for the surgical on-call team – boy what a mess that was!!!! 😦