Days of self-doubt

I must admit that I have grown more confident of coming up with diagnoses and drafting up a management plan. My confidence has also been gradually building on reviewing patients whom I have no clue about. But despite all that, there are still days whereby I feel completely crap and doubt my competency.

I reviewed a patient today as the nurses were concerned about her being very dehydrated. She is VERY peripherally shutdown, and it was HELL trying to cannulate her. She didn't look very unwell at all, and even though her oxygen saturations weren't detectable, she wasn't huffing and puffing. Blood pressure and temperature was fine. Hence, I had no reason to suspect anything more than dehydration after examining her. I focussed AAAAALLLLLLL my thoughts on cannulating her so that she can have a drip going in fast. If it was of any consolation, I actually managed to cannulate her halfway before her veins collapsed...lol. I gave up after a few attempts and seeked senior assistance.

Being mega busy today and having my pager going off once every less than 5 minutes, I missed the fact that this patient had a temperature spike yesterday even though it was shining right into my face. If I had concentrated more, the thought of sepsis and a pending septic shock would have come into my mind. Dehydration wouldn't have just been my diagnosis, even though it was correct in a way.

Fortunately, I did pester my senior to review her, and he had agreed with me that this patient is very dehydrated and fluids are needed to be given quickly. However, that spike triggered thoughts of an impending septic shock even though she looked deceiving well. More investigations were being done, and the results were so bad that she was transferred to the high dependency unit immediately. A central line was placed instead since my seniors thinks she's impossible to cannulate after they failed to do it too.

Then not too long later. A new patient who was seen by the Registrar on call arrested in the same unit. I ran quickly there. Good thing I wasn't the first doctor there, or else I would have been thrown completely into a fluster. This patient was so unwell on admission that he was sent to the high dependency unit immediately, and before he arrested, he had numerous lines placed into him already. It was a complete mess around him with so many leads, wires and lines around him. It was impossible to tell which line is for what in a critical situation. Everything was in control with the presence of the ever-so-calm anaesthetists (I think I should never ever be an anaesthetist) and all I did was CPR. First time doing it on a real proper and goodness, it really isn't as easy as how I thought it should be. I don't think I'm a weak girl to begin with, but it is tiring compressing someone's chest. I was in sweats already by the time I finished one cycle.

My mind was in quite a blank for a good 2-3 seconds when I arrive. All I know when I realised that it's asystole was CPR, after the airway, breathing and circulation are secured (if that's of any consolation). I think I do know what to do (will be a separate issue if it's something shockable since I think I've gone rusty on when to administer what meds after how many cycles of CPR) if I was the first person to arrive at the scene, but I definitely would go blank for 2 seconds first. I will need to be really calm the next time if it happens. I guess I'll need to have more cardiac arrest experience (real ones of course). Anyway, this cardiac arrest did make me feel a little crap at the end too.

Argh. I will need to revise more and consolidate everything more. 2 more mths to end of housemanship, and I don't think I'm worth being forgiven if I can't even manage a patient well.