Getting stale

A few weeks back I was faced with a post operative patient with low urine output. He was only making 10 ml an hour (normal is 30 ml an hour). Worse was he had crackles at the base of his lungs (meaning there was fluid in his lungs).

So I didn't know what to do because the treatment for low urine output is to give more IV fluids. But if he has fluid in his lungs, giving him more fluid will just go to the lungs and he'll be drowning in it (i.e. develop acute pulmonary edema).

Since general surgical registrars are always not there and hard to reach, so I asked the medical resident and he said he'd give a low dose frusemide with the fluids. So I did that.

Anyhoo, the vascular surg registrar was there seeing his patients and he saw my management plan. He wan't happy with it. He said the patient should get a 500ml fluid bolus (i.e. all in one go) even with crackles in his lungs. I said what if he goes into APO. He said, then later we'll treat it with frusemide.

Hmm okay. The nurses were surprised about the 500ml bolus; they thought it was too much. I dunno. But since he's my senior, I followed his advice even if it was risky.

The patient turned out good and now I know how to better manage a post op patient with poor urine output.

This was a long winded introduction. Heehee.

The main story is that vascular registrar on that night had told me good advice: you know nothing, so ask for help. I accepted it with open heart.

But then..every time he saw me regardless if it was in front of other interns and even patients; he kept repeating the same thing. You know nothing. You know nothing. You interns know nothing.

It is getting a bit stale. And becoming more insulting.

I admit I might not know much; but definitely not nothing. And to say it in front of patients is a little bit demeaning. They'll be wondering why is a doctor who knows nothing looking after me?

Anyhoo, because he helped me out even though the patient wasn't even his, I will just put up with it.