Saturday pm

Last night was the final night of call for me for the next 9 mos. Silly me, I mistakenly thought the Great Call God in the Sky would take pity on me and make it a routine (read QUIET) night, nope. I was awakened at 2400 by a call from the A&E doc stating that they had a patient known to our service with a blocked PD catheter. Peritoneal dialysis, as opposed to hemodialysis that is used in developed nations, is the preferred (read only) mode of therapy for renal failure here. A catheter (tube) is inserted into the abdominal cavity and fluid is infused that acts to exchange toxins across the membrane lining the cavity. It prolongs life but is VERY preoccupying and difficult, and life becomes all about PD in that has to happen 5x/day, each taking about 2 hrs.

Traditionally a blocked PD catheter is admitted to the medical ward whereupon we try, usually in vain, to contact urology to come and unplug it. This of course is nuts as we have nothing to offer the patient and because the passive aggression of the urology service is legion; they never answer their pages on the first page, preferring to use the common and hackneyed excuse that they are in the theatre (read OR) which of course is patent BS.

So I was called by a particularly sympathetic A&E doc last night asking if I would admit this guy, I declined and said it was a urologic problem and they should clean up after themselves. He agreed (!!!). I should not have been so naïve, silly me. I got a call about one hour later from the urologist on call that actually came in (!) and saw the patient and wanted me to admit him until he got around to fixing the catheter. That would have been mid next week. I stated so and then went to the hospital where the fight began. We had a rather animated conversation during which I pointed out the logic of admitting a guy to medicine that needed a new surgical appliance. Ultimately this guy admitted our patient to undergo placement of a new peritoneal dialysis tube for renal failure. If for some reason this doesn’t work he will need hemodialysis and this will be his death knell.

The urologist was so frustrated with my reluctance to admit him to an irrelevant service (medicine) and my insistence that he be cared for on the urology service, with our consultative input as needed, that he threatened to return to China (!?). Oh really and when might that be? Ooooohkaay, but don’t blame me.

Later this morning (about 0400) my MO got a call from the head admin guy for the hospital demanding he admit the above patient, as the urologist thought that he could make an end run around me. The MO was in on the situation and refused. This morning our patient was waiting for the urologist to act like one and take him to the OR to install another permanent catheter or concede that he can't tolerate another PD catheter (this might actually be the case) and we'll move from there.

This morning I climbed the tallest hill above Gabs and looked out over the city for about half an hour before I followed a secondary school class down the hill another way to a local mall where I met up with Lynne and then went to lunch. The vistas were breath taking and at the same time familiar…odd. Best to all, Mike.