On the other side of the doctor-patient relationship

For the 1st time in my 28 years I am hospitalised.

For the first time in my 10 years working in hospitals, I am now on the other side of the Dr-patient relationship.

And it’s bloody scary.

Since mid-day yesterday, I started getting persistent, uncomfortable palpitations in my chest. I remember sitting in Cafe Nero trying to do some revision on my lovely bank holiday Monday (the start of my 10-day long stretch of annual leave) when I felt my pulse and found it worryingly irregular. Concerned that this could be something potentially sinister like AF, I decided to present myself at the Royal A&E to check this out with an ECG. I was pretty sure they would tell me that I had a couple of benign ventricular ectopics and then discharge me home with some reassurance.

Unfortunately, my initial ECG showed a sinus tachycardia with T inversions in leads II, III, aVF and V3-6, as well as a large number of ventricular ectopics.

After my initial ECG, I was triaged to “Majors.” I got put into a cubicle where the nurse then told me to strip off everything but my underwear. She wanted me to put on one of those hospital gowns that you have to tie 2 tiny knots at the back– yes, the very same ones I often see my patients walking around and flashing their bottoms in. That piece of cloth that does nothing for your dignity.

The wait to see a doctor was a long one. As I sat waiting, I tried to distract myself from my fear by doing some revision… and then doing some marking of other people’s homework for writer’s club. I sat around and thought a lot. I fretted over ending up in the hands of an inexperienced A&E SHO and prayed that God will send me an angel instead.

You know what, God heard my prayers. I had just come out of the bathroom when I bumped into my good friend Cat on the AMU corridor. On seeing me in my silly patient’s gown, she burst out laughing. However, it quickly dawned on her that I was not in hospital in my capacity as the Anaesthetic or ITU registrar that day, and that I was a terrified patient. Being the senior Medical registrar on call, Cat promised to swing round and clerk me in ASAP. She took my history, examined me, sent some bloods off, then went off to discuss my case with her medical consultant as well as the cardiologist on-call. From what I understand, they were all uncomfortable with the abnormal looking ECG and so a decision was made that I needed to be admitted for telemetry and probably an inpatient echocardiogram.

I was not prepared to be admitted to hospital at all! In fact, I have never been admitted to a hospital ever! This made me really very scared. All of a sudden, I felt so intensely alone.

1. Who will be my next of kin? My family members are so far away from me and there is no point putting their names down because there is nothing they can do for me in an emergency. I have no relatives in this country.

2. Who will be able to go home and get my stuff for me? I live alone. I don’t really have any particularly close friends whom I can just ring and say “come hither, help me out” (yes, yes, this sounds so pathetic). The person I trust most– Cat, is on call in hospital and looking after me here!

3. The very people I really want to be by my side are on the other side of the earth. I also have to ring them to inform them of my hospitalisation– how can I put it so that they don’t worry themselves sick? How do I let my parents know without my own voice breaking up as I then start crying from my fear and loneliness?

4. Is there anyone else in this city who cares enough about me that would warrant me informing them of my hospital admission? Somehow it didn’t feel right to be in hospital with nobody else knowing.

I felt so lonely and vulnerable… and anxious as to what the cause of these horrible palpitations are.

However, I am thankful. Thankful that the Lord had put Cat in the right place and at the right time and in the right position to see me. She prayed for me, reassured me, and ensured that the people she knew would be looking after me were advised to take extra care of me. Since my admission, she has been texting and popping in and out of the ward to check on me…. She has made me feel that I am not un-befriended. I also thank God for HS, who randomly texted me that day to ask if I wanted to go out for dinner. However, upon realisation that I had been admitted, she quickly made her way to the hospital to stay with me and keep me company. She kindly agreed to be my next-of-kin, and even went home to get all my stuff for me. Seeing that the hospital dinner looked pretty grim, HS also bought me a subway sandwich. I am so thankful for her kindness.

Indeed, my God is an amazing God, and He has put these people in my life just when I needed them the most. I am so incredibly thankful for that.

Being in hospital is pretty rough though. Having to share a bay with 3- 5 other women means that I have to put up with an insane amount of noise. The constant shouts for attention by the lady next to me, the intermittent cussing by the alcoholic across the bay from me, the never-ending shuffling of patients into and out of the bay…

I remember being shipped out of the AMU to the Heart Emergency Centre at about midnight by a couple of nurse practitioners whom I know (FYI, for the short distance of the in-bed transfer, my damned motion sickness acted up and I thought I needed to puke!). After being settled in HEC, there were another 3 ladies who were admitted after me. The nurses kept ramming their beds into mine as they attempted to manoeuvre them into the bay so I kept getting jolted awake. There was constant noise from their identity & next of kin checks, falls assessments, MRSA swabbing etc… and then there was even more noise from the staff having to deal with the patient next door and her chest pain, or shortness of breath. Being a doctor, I could not help but listen to their conversations and coming up with my own little list of differential diagnoses & plans behind drawn curtains. I hardly slept that night- I tossed and turned on the uncomfortable hospital bed. I wondered how many people have died on the very bed I was lying on. I considered how filthy my hospital pillow was under the thin piece of cloth we call a pillowcase. I pondered what questions I needed to ask the cardiologist when I saw him on the ward round the next day…

It was soon 8 am in the morning. Having had a restless night, I could not wait to get up, get seen on the ward round, get discharged. I was determined not to take on the “sick role,” so I went and got my teeth brushed and changed out of my pyjamas into normal clothes. I sat out on a chair and twiddled my thumbs waiting for breakfast, for my bed to be made by the HCA, for the ward round….

Finally, at about 11am, I saw the cardiology consultant Dr Ruzsics. It was funny how he greeted me– “Ah! You are THE registrar! I was told about you yesterday.” He was extremely patient and spoke to me using the medical lingo that I felt I needed to be appropriately communicated with. I did feel like I was being treated especially well because I was a colleague. We discussed the potential causes of my ectopics, and he revealed that everything from my electrolytes, TFTs, troponin to my D-dimers and CXR have come back normal so far. We agreed that I will have an urgent inpatient echocardiogram today, and if it is normal, he could potentially discharge me home with an outpatient cardiac MRI and 24h tape. He has also started me on a small dose of bisoprolol 1.25mg od. I was very concerned about being on beta-blockers for fear of bradying down to syncope when I am at home alone. However, following a fairly in depth discussion, he managed to convince me that it would suppress the ectopics and palpitations that were totally doing my head in!

After the ward round I was quickly whisked away for my echocardiogram. I was really keen to walk to the cardiorespiratory department, but the nurses would not let me. I had to go on a chair, and be pushed around by the porters (whom I kindly requested for a nice, smooth journey for fear of my motion sickness kicking up again, considering last night’s transfer shenanigans)– I was thankful that I did not see any colleagues along the way. The echocardiogram was done by a technician, and it was really quite painful how hard he had to press the probe onto my chest to get the desired images. I am reminded today to be more gentle and careful when poking and prodding my patients with both sharp and blunt objects in the future.

I think I make a terrible patient. I keep looking at the doctors working behind the computers and thinking that that is really where I ought to be. I got so bored at one point that I started pacing up and down the unit. I hassled the nurse to pull up my echocardiogram report so I could read through it myself. I even asked if she would show me my telemetry recording so I could work out just how frequently I was having my ectopics. To be fair though, I did try my best not to be difficult… I apologised if I got in the way, and even tried to sleep the afternoon away (somehow the other patients made less noise in the afternoon than they did in the middle of the night). I remember putting on a DVD (the Korean drama “Playful Kiss”), headphones in place, and then staring at the screen of my Macbook Pro until I eventually produced some ZZzzzs.

I have to say though, that the nursing staff at the HEC were ace. They were genuinely quite caring, and always concerned that I had my emergency buzzer at hand. They answered all my questions and were patient with me. They offered hot chocolate, tea and biscuits regularly. One particular nurse, Georgie, was very helpful and kind. I am so thankful for their care… and I am determined to treat my patients better in the future. All too often, it is so easy for us to let the pressures of work chip away at the amount of gentleness and patience we approach our vulnerable patients with. May the Lord help me to be empathetic, and remember that patients are often “difficult” because they are scared. May the Lord fill me with compassion as I look after my patients in the future.

Anyway, I finally saw the consultant and his registrar (seperately) that evening. As my echocardiogram was normal, they were happy to discharge me. I am still having my palpitations though, but I am hopeful that they will disappear soon. I really really really want these ectopics to go away FOREVER. The frequency with which they are occurring is really scaring me. I hope all is normal, and that at 28 I will not receive a diagnosis of heart disease. Dear Lord, please cure me. Please be with me and reassure me. Please take this discomfort and anxiety away. I need you. Amen.