As expected, yesterday was a day where some really important decision were going to be made.

The first one was the patient with the failed duodenal stent, and it turned out that during the gastroscopy some malignant gastric ulcers were found and despite not having solid oral food for more than a week large food deposits were found. The procedure was therefore stopped and unfortunately there is nothing more we can do.

One of our consultants did the ward round and I had arranged for the Next of Kin (NoK) to be present at the ward round.

Giving bad news can be done good or really bad and I have to say that my consultants overall are pretty good. He explained everything to both the patient and the NoK.

And when the discussion turned to treatment options he explained that all options are exhausted. The conversation then turn into the patient going home with some medication which keep the patient comfortable. The TEP form got updated, the JiC meds were sorted out and discussion with the discharge team started to ascertain if equipment is needed prior discharge.

Our pancreatitis patients are a mixed bag. The patient – who on paper is the worse of the two – is actually doing well. We started to correct the electrolytes and got some food into the patient (via the NJT) and during the ward round the patient was feeling much better. We were waiting for a CTAP to keep an eye on the necrotising part of his pancreatitis (maybe need to write something about that in a later article).

The other pancreatitis patient we currently have – on paper less severe – is not doing so well. Spiking temperatures during the night, increased O2 requirement and fluid in the wrong spaces the patient is in a heap of trouble. The patients’ White cells and CRP are through the roof therefore we decided to request another CT scan to check if the pancreatitis has got worse (necrotising) or if there is something else going on. By the time I left the CT was arranged for later that evening and the patient was handed over to the on-call team and to keep an eye.

The “Best Interest” meeting happened for the patient suffering from MND. Talking to the Neurologist prior the meeting he explained that due to the nature of the disease patient to get frequently offered a PEG and that the average life expectancy from onset to death is roughly 3 years. However, I assumed that this would be much less with our patient.

The outcome of the discussion between, the patient and the NoK, Gastroenterology team and the Neurology team was to go ahead with a PEG – which I was delighted about. I requested the relevant procedure on our requesting system, organised some blood tests which would be needed for the procedure and held the Enoxaparin (having learned that from prior problems).

One of my consultants later that day said to me that we performed a MIRACLE as we managed to get a gastroenterologist AND a Neurologist in the same room at the same time to talk to each other.

All of the above took ages to sort in addition to the usual bleeps from the nursing staff and/or other health care professionals.

Day off and weekend off and back to work on Monday – Post on-call weekend. Until then I’ll just enjoy the weekend as I did work just shy of 60 hours despite only working 4 days.

Climbing and other weekend shenanigans are in the next entry.