I think I’ve been blessed to have a few defining “doctor moments” during my internship. Not all of them have been great, but the experiences themselves are what will end up making me a better doctor in the future. A big lesson I’ve learnt these last few months, is about advocating for your patients.
We had a patient, Mr X, who was admitted to the surgical ward for workup for obstructive uropathy. He was also in renal failure, and regardless of whether or not it was from the obstruction, the man was incredibly sick. He was weak, pale and one bad day away from uraemic encephalopathy. Somehow, we managed to send the patient to our referral hospital, a tertiary institute where they would be able to do cystoscopy to determine the exact cause of his illness.
A diagnosis of a neurogenic bladder was made, and the patient was sent back to our hospital to be inducted into the chronic renal program for dialysis until his return date to the tertiary institute. On arrival to our hospital, the patient was re-admitted to the surgical ward. Now, as any doctor will readily know, medical and surgical wards have major discord. The smallest wounds are sent to the surgical ward, regardless of the symptomatic CCF that the patient has been admitted for. Pro-BNPs are done on the regular to prove CCF, in order to send them to medicine. With this patient, the same issues arose. Although he was being seen by Urology, the patient was referred to Internal Medicine, who refused the patient on account of him having been seen at Urology. I disagreed and insisted that the Internal Medicine senior doctor see him. I initially asked the doctor who worked at the renal unit, who directed me to the doctor in Internal Medicine. After contacting her, she asked me to do a long list of blood tests and eventually agreed to accept the patient to her ward. However, two days later, she told me that the patient was not a candidate for the chronic renal program. She sent the patient back to my ward. I reviewed the bloods: they were within the specifications for the chronic renal program.
I was furious.
How could they refuse this patient? Mr X had no contraindications for dialysis; in fact, he was being referred specifically for dialysis. What was the hold up? One of the doctors from our team had made the suggestion that the patient go home to wait his return date to Urology. I stopped him and outright refused. Sending the patient home was a death sentence. With a creatinine of 2000 and a urea of 100, that patient would go back to the tertiary institute worse off than when he left, or worse, die while waiting for his return date. To me, this was unacceptable.
It had been a week since the start of this saga. I decided to push my senior doctor to contact the doctor working specifically in the renal unit. Somehow, he agreed and came to put up the dialysis catheter. I was chastised for not coming to him sooner… I had to remind him that I had and had been directed away (had a big eye roll about that one).
Long story short: that afternoon, Mr X had his first round of dialysis.
I ran into him about 2 weeks ago, and he is looking so much better. During that last admission when I saw him, Mr X was unable to walk, he was tired, and pale as a sheet. Following the dialysis, he has some colour, he was able to walk on his own and was even smiling!
Although the only thing he wanted to know was when he would be able to go home, for me, it was possibly the most rewarding moments of my internship.
I had a small part in helping this man get better.
I walked around the rest of the week with a massive smile on my face, knowing that, in whatever small way I could, I had made a difference.
the rural doctor 