My first In patient. Do Doctors work only where they work?

I wake up with a sweat at one am and I wonder 

I wondered whether the patient I had admitted from the outpatient  with TIA ( layman term as mini stroke) is ok in his room. It was my first admission after I joined my neurology residency. I had come back to my room and read about TIA in detail. Patients can get a major stroke after TIA.  With this devastating information I had slumped on the bed exhausted with all medical jargon running in my dreams. 

Now sitting up alert,  I wondered. 

I wondered whether I had forgotten to write any medication  in the prescription chart. 

I wondered if the nursing attendant has given all the injections in their due time. 

I wondered whether I was too quick to leave him at the bedside and whether he had many more complaints to tell me. 

I wondered whether the nurse had collected all the test reports. 

I wondered if there were any abnormal test results and she had informed the doctor on duty. 

I wondered if the duty doctors pager was working well 

I wondered whether the patient had developed any new worsening symptom and forgotten to inform the staff  

I wondered whether the patient is still alive!! 

I couldn’t help wondering about the patient so I dressed up and ran to his room 

My steps competed with my racing heart. 

“Sister how's the patient I admitted yesterday”

“I am not the assigned staff”, came the prompt answer, we most doctors are so familiar. Even now I stand amazed as to why we always have the unassigned nurse in front of us when we need them.  

I rushed to his room and my heart collapsed to see the empty bed. I ran out to the corridor. There was no staff visible.  I stared at the empty bed and concluded that all I had wondered were not just my thoughts. They were indeed happening in real life. God was continuously giving me signs and I was just sitting on them  I could have got up and checked in on him earlier rather than sitting there and wondering. 

How can I be so foolish. 

Shoulders dropped, eyes damp, visibly devastated I started walking out of the room. 

And then I heard the most beautiful voice on this earth 

“Doctor Saab”

I turned back to see my first admitted patient all beaming ear to ear. I almost went and hugged him

“ Doctor Saab you did not sleep yesterday? I had a good sleep. As you told me not to worry. I was relaxed after all the medicines which your nurse gave. The food was bland though. My brother has gone down to see if anything else is there in the canteen Ha Ha but must be same food there also ! But why are you here now? Your friend, the other  doctor had come sometime back and checked me again and told all my reports are normal except some slight sugar. He asked me to collect urine for testing. I was doing just that. Doctor Saab, You see the food is not good here, so can I go home tomorrow?"

He did not realise. It was my redemption ! 

His verbal diarrhoea was like musical notes to me then. 

I tried not to look over anxious lest he gets scared and diverts his attention from the bland food to an unwarranted fear of an impending stroke. 

“ I had come to check on another patient so thought will look on you as well”

“Thank you doctor Saab. Where should I keep this urine vial? “. I made the necessary arrangements and started back to my room. @drbindumenon

I am now more than two decades in my journey of clinical care. And yet I find myself on and off calling up the doctor on duty or the nurse to find out about a particular patient. Sometimes I smile inwards when the relatives ask me “ Doctor you had seen him yesterday during rounds. How is he now? “. I wonder again whether they know how much I am updated in the information about their patient.  In fact I even know how much water he drank and how much urine he passed after I last saw him. 

Medicine is the most challenging profession. Every complaint of the patient needs the same attention and care whether it is a devastating disease or a minor headache. I have nurtured in my practice and become more resilient and listen to all their complaints.  I then gently assure them that this is probably not a disease  to be worried. At times there is a tug of war between us while the patient asserts and tries to convince me that he has the horrible disease which his neighbour had and had passed away. While I try to show my knowledge by clear cut terminologies and medical dialogues. I win in most cases. However, they too win occasionally by getting the needed investigation to prove their medical diagnosis.  I let them do so as it is needed for them to understand their illness. They heal themselves that way. @drbindumenon

Most Doctors in their long practice develop a gut feeling about a patient. Now this is different from the worry which I had for my first patient which has now translated to a sixth sense ominous feeling which I get in some particular patient. Rather that it being a sixth sense, I feel this has developed over the years of sleepless nights, rushing in the middle of the night to check in on the patient, making calls to duty doctors or nurses and troubling them in their hectic exhaustive duties to know about my patient. Everyone has been kind and helpful in this journey. As we all are collectively working for the best care we can for the patient. 

I always believe that apart from what I diagnose, or what my gut feels, whats worrying for the patient should also be prioritised by the treating physician. Because what makes him worry will be harmful for his mind and that will never help him to heal. 

Over the years, I have inculcated a resilience to listen to the endless woos of patients and their caregivers. I do sometimes falter to complete the listening after my needed questions are done like any other normal human being. This is essentially because of the unwanted digital and neighbourhood information the patient and family tend to get from various sources and they instantly jump and tell us the diagnosis rather than the symptoms.  

The practice of medicine is fast changing. Artificial intelligence(AI) tools will make way as medical companions to many of our patients. But AI will never have the gut feeling and wake up and run to see a patient at 3 am neither pick up a phone and call the duty doctor at 2 am. 

Because I will always keep working even when I am asleep. 

I will always score there.