It's all small stuff except when it ain't

Right now my frustration meter is pegged in the red zone. The morning began with a conference with some docs from the ministry of health, a matron (head nurse) from another hospital, and the sister of one of our patients on the private service. Like a lot of places with medicine that is accessible to all, at government cost, the line can be be shorter if you pay as you go. This patient was a transfer from an outside private hospital because they had run out of ideas and he had had a fever for a month. His sister was politically well connected.

We have him on broad spectrum coverage and, of course, did the one remaining test yet to be performed at the outside hospital, an HIV. Which was positive. See you can be getting top of the line antibiotics, but nothing will happen in the absence of an intact immune system. They seemed to understand but that will be an officious 90mins I'll never get back....Why weren't we doing more blood work; because the bleeping lab looses the blood or the ordering system has changed back to the computer system so anything ordered for the last two days manually is ignored. Why don't we get a CT scan; because it won't change the management and takes a week for OB to dethrone and condescend to allowing and reading it. What about outside lab; not needed as the HIV is the most revealing test and no other tests are necessary, other then time.

Then back to the ward where we had a somatisising guy in his mid 30's who allegedly had hip pain, or was it leg pain, or was it buttock pain. So I stood him up to the deeply inhaled chagrin of the team and low and behold, A MIRACLE, he can stand....Anti-inflammatories and get this guy off my service.

We have a high needs cubicle of eight or more beds and one of the guys in there is HIV+ (OK they all are) with a big peri-rectal abscess. During rounds I checked on the site that had been drained by the surgeon only to find that it was awash in stool. Deep breath....clean the stool, retract the packing to show no stool and re apply the nappie (adult diaper), all of this as three nurses stood around watching this. As I asked for an item, it took multiple requests to get their attention. I lit up (our kids are rolling their eyes as they read this) and said how this wasn't cooperation or help and was beneath all of us that a nimrod like me was doing all of this solo. And of course that got me nowhere, and with a headache and worsening reflux to boot. I know, there is a lesson in there for me. To my credit, meager though it may be, this was the first time I blew it.

On to the next patient on whom we got a chest X-ray yesterday only to find that ALL the films were under penetrated that were taken yesterday and are of no value, we of course were kept quietly out of that loop. Arrrrgghhh!!!! So home he went without a CXR that would document that we had done a bloody thing for him.

I've been here long enough to appreciate the difficulties of practicing here, not how to creatively solve the hindrances to good care. It will come.....