in which I find myself standing upon the cusp of a totally different world.
This is my first week, where I fumble remembering which of the kindly old patients was admitted for a urinary tract infection and which came in gasping for oxygen, at the merciless hands of an unrelenting health-care associated pneumonia.
I look through figures and decimal points of assorted electrolytes and proteins, trying to connect the dots and trends. Invariably, I pick up an SIADH, but I fail to notice downtrending Haemoglobin.
I drop my kit and check in 7, and start on my first case.
It is 8am and I have yet to examine the patient, mired in the tangle of trying to consolidate and prioritise her issues.
It is now 2pm on a fine Wednesday afternoon and my eyes are closing after a plucky pesto pasta. The abandoned Malay lady goes through a rollercoaster of blood pressure fluctuations.
No one thinks to check her haemoglobin, or do a PR.
I have answered this question before in a tutorial, somewhere, someplace, but it does not hasten when summoned.
I have, in another universe, just killed this patient.
Picking up the SIADH does not feel so good anymore, any more than intellectual degustation does.
It is 5 mins to 8 the very next day, and the new transfer complains of some epigastric pain.
I check that she’s stable and try to stay afloat amongst her lab results.
For reasons unknown, the tidy line of yellow flags beside her liver panel does not arouse my suspicions.
Acute gastritis seems to be the prevailing diagnosis, and I subconsciously chuck “An Approach to Epigastric Pain” out the proverbial window.
It is an cholecystitis, and I’ve just tripped and fallen over myself again.
It is now 9pm, and the curtains close before my very eyes, resolve building up to be better the very next day.