Nights, blah....

*sigh*

On nights, ho hum. Not a bad lot so far (though I've probably just jinxed myself by typing that). Steady for the first few hours then a lull until around 6am when the same dude from ward X wakes up with chest pain (he has a soft tissue sarcoma, and as a consequence has two large masses in his chest, and they hurt, unsurprisingly - as far as I can tell there's nothing wrong with his heart). I'm hoping his team have managed to sort out his pain medication by now so that when he wakes up later this morning he's not in pain for once.

I had a call about half an hour ago regarding a patient who was having rigors. She's just had a nephrostomy inserted because she has a big pelvic tumour which is blocking off one of her kidneys, and probably has a (fairly severe) urinary tract infection. They wanted me to prescribe pethidine for her rigors. Pethidine is fucking horrible, a dirty little drug which is nonetheless used (mainly by the surgeons) for pain relief. I've never heard of it being used in rigors, and it's not licensed for that in the BNF. Anyone come across that one?

Anyway, call me old-fashioned but I tend to give people paracetamol if their temperature is so high they're shaking uncontrollably, followed by a thorough examination to establish the likely cause of the infection, some blood and urine cultures and finally a dose of intravenous antibiotic. The patient's nurse was not happy about my refusal to prescribe pethidine. 'But she's had the paracetamol now and she's still rigoring...'. Yes, that's because she's still got a raging infection and rigors are a consequence of that. They will stop eventually, they're usually pretty short-lived, and you're not helping matters by jumping around like a cricket in front of the patient when I'm trying to reassure her that the rigors will stop, that they're unpleasant but not dangerous and that she's just had her first dose of antibiotic which will take a little time to start working on the infection. For fuck's sake.

Other jobs have included writing up laxatives ten billion times (why do they not notice that someone hasn't opened their bowels for 5 days until 11 o'clock at night?!), refusing to write up an anti-hypertensive for a patient with a slightly raised BP who looked and felt absolutely fine and re-writing drug charts (why, why, why do my colleagues never notice that there are no more days left on the drug charts and just bloody well re-write them during the day?).

Boring, routine crap mainly. Once I'd finished the boring, routine crap I watched 'The Apprentice' on iplayer (love iplayer, love it!), and checked emails etc. It's 0320 now and I could try and get some sleep, but the trouble is I can't stand being woken up by the bleep. I think it's partly a hangover from my very first house officer days when being on nights scared the hell out of me, and the sound of the bleep sent a bolt of pure terror through my heart. 'Oh God, I have to go see a patient, and there's no one else here to ask for help if I don't know what to do....'. That terror has long gone, thank God, but I must have developed a sort of Pavlovian response to the sound of a bleep. Also, it's never nice to be jolted out of a deep slumber by a piercing noise, particularly a piercing noise that means you're going to have to get up and do some work.

Technically, we're not allowed to sleep on nights anyway, as we're now shift-workers like nurses rather than being on call for 24 hours straight like in the bad old days. The managers at my old hospital used to get very shouty when they discovered blankets in the doctors' mess left over from the night - 'You're NOT supposed to be SLEEPING!'. Actually, it was fucking cold in the mess because the heating didn't work, so even if you weren't sleeping you needed a blanket just to sit in there having a cup of tea at 2am, but that's beside the point.

The managers think that being on night shifts is just like being on day shifts, it's just a simple matter of reversing your sleep cycle and...hey presto, 3am feels just like 3pm does in a normal work day. Well, it fucking doesn't. For a start, it is extremely difficult to sleep during the day for a number of reasons. Even if you are fortunate enough to be able to get a good 6-8 hours of sleep during the day (which I usually am actually), it is not the same. The body is not built to do that. You feel fucking knackered all the time, especially if you do several nights in a row which we do. So why the hell shouldn't we be allowed to snatch a couple of hours' sleep if there's no work to do? I'm sure it improves performance not to be quite so utterly knackered. 'It's not fair to the nurses - they're shift workers too and they're not allowed to sleep on nights either...'. Well, they bloody well do, or they do everywhere that I've worked. They have breaks, and during those breaks many choose to snatch some sleep. Difference is, they won't be disturbed 5 minutes into their slumber by that piercing sodding bleep....

*yawn*