I’ve had a day off yesterday which is normal for me during the week. It does tends to be Wednesdays however depending on how my wife works it could be any of the other weekdays.

Dropping our son off to school this morning a text message arrived explaining that our cover F1 is off sick. Luckily we had one yesterday – when I wasn’t working!!

My registrar is then texting me as the list needs to be printed and our patient computer program is down. The whole hospital is suddenly paralised as we don’t have any access to patient’s documents.

So, we start the day late with no patient list and and both of us weren’t in yesterday. 3 referrals from other teams to be seen as well.

Luckily the computer system decided to start waking up and I was able to print the list and found my reg. The patient list wasn’t huge but the patients we have are sick: Post ERCP patient with pancreatitis and retro-peritoneal perforation (NGT insitu and waiting for NJT for feeding), The patient with MND did not get the Liver cyst drain and decision for no PEG as to high risk of complications, Patient with gallstone pancreatitis being NJT (NasoJejunal tube) fed and problems of getting pain udner control. Our patients who are in “best shape” our two patients which are 90 odd year old.

Making our way around the wards it quickly materialised that patients are still quite sick. In addition the acute pain management were looking for blood as the cross cover F1 yesterday “went slightly rogue” with the pain medication prescription (prescribed something against the Pain teams advice) and they felt “disrespected”. I tried to smoothen out the problem and after some fractic messages back and forth with the F1 it became apparent she looked at the pain management advice and then went ahead and prescribed something different – not sure why. Datix en route.

The patient who sufferes from MND – who had a NGT inserted at the beginning of the week – has had her NGT “accidentally” removed when she was transferred from the commode back into the chair. I do worry sometimes that these things happen to patient who clearly rely on enteral feeding and some carelessness means they have to go through the process of having a tube stuck back into their nose.

Thats the issue when nursing staff don’t know how it is going through a traumatic incident like having a tube inserted into your nose for feeding. When I was a “wee little Nursing student” I’ve had a NGT inserted “for fun”!!!

In case of any judgement here – I agree – not the best thing to do with your time however at least I relaised what I am going to do to the patients I am going to looks fater.

Anyhow the above incident then cause a discussion with the patient of re-inserting another tube as the PEG is off the table. Unfortunately the patient isn’t keen on the tube (although tolerated it quiete well). No nutrition means no fuel for the body and having lost a lot of weight already the patient really can’t afford to lose more.

Due to the Easter weekend nothing would be happening for 4 days and that’s how I argued with the patient and that it would be in the best interest of having that tube back in. The question of intravenous feeding (TPN or PN) came up but I did explain that this is out of the question.

All of the above is just time consuming and chasing patients scan and/or reports. It was just exhausting and probably not being in top form currently might not help. Not sure why really but I think I am ready for a holiday.

Good Friday tomorrow and I am working and helping the post on-call out. Hopefully I will get out by 4pm-5pm and then I am actually off on annual leave next week as our son is off school for a fortnight.

The other question: What did I do on my day off? Well, I played some board games at a mates house 7 Wonder Duel (lost badly) and then we played a 3 player game of Kutna Hora which I did win (for the first time in 4 attempts.