Sarah picked up a bit during handover. She still felt unwell but felt that she could cope. Patients were assigned and she wrote up her morning planner (who needed what and when) and began to get her patients’ morning medications ready. Standing in the enclosed medication room she suddenly felt hot and dizzy, there was no airflow in the little room, it was full of appliances and the lights were bright. She took a few deep breaths and looked at the chart she was holding on the counter in front of her. The patient was due to have Digoxin (an important cardiac medication). The ordered dose was 187.5 micrograms and the tablets were 0.125 milligrams. She looked at the tablet packet and back to the chart. Her brain went blank. She couldn’t figure out the dose. She had the same patient two days ago and had given them their tablets that morning but nevertheless she could not remember what she had given. Brenda, one of the other ward nurses came into the room.
‘Brenda’ Sarah asked quietly ‘can you give me a hand here please?’ Brenda came over and looked at the chart.
‘What’s up?’ she asked cheerfully
‘I can’t figure out this dose! I don’t know why, but I’m not feeling so good either’ Brenda looked at her concernedly.
‘Ah this one is tricky, I had him yesterday – the tablets are in milligrams so you just move the decimal place and .125 equals 125 micrograms then you divide the dose by stock strength so 187.5 is one and a half tablets.’
‘Of course it is!’ Sarah exclaimed, she could see it clearly now. Then the room began to close in. ‘Um, Brenda, I’m really not feeling well’ Brenda looked at her closely, you look a bit pale, what’s the matter?’
‘I’m dizzy and my head hurts’ Sarah said quietly as she held tightly to the counter to keep herself upright, darkness closing in on the edges of her vision.
‘Let’s get you to a chair missy, you look like you’re about to pass out!’ Brenda helped her to a chair at the nurse’s station. Sarah sat there and gently rested her head in her hands.
A few minutes later Jenny, the ward manager came over and took Sarah to the handover room. ‘What’s going on Sarah?’ she asked gently
‘I don’t know’ Sarah groaned ‘I feel nauseated and my head hurts and I feel like I’m going to pass out!’ she explained what had happened the day before and how she had thought she would be ok for work until she woke up but by then it was too late.
‘Well that’s silly’ Jenny replied, ‘I know we all hate it when people call in sick late but really I’d prefer you weren’t here if this is going to happen! You have to take care of yourself Sarah. Last week you explained to me what was going on and that you were sorting out your hours but until that goes through you’re just going to have to have leave without pay on the days you can’t work. Just try and call in as much in advance as possible so we can sort out a replacement for you on those days. But right now I think you need to go home, can your doctor fit you in? Or actually, I’d probably prefer to send you down to emergency to get checked out then leave your car here and get someone to pick you up or take a taxi home. You lie here a bit and I’ll find a wheelchair for you.’ Jenny turned out the lights as she left and Sarah groaned to herself as she lay on the floor – utterly pissed off. Every time she opened her eyes the room spun around.
The feeling reduced a bit when they were closed so she kept them closed. 10 minutes later the door opened again, it was Jenny with a wheelchair. ‘Ok my lady, your chariot awaits!’ She grinned from the doorway ‘can you get in or do you need help?’ She gave Sarah a hand to the chair and put her handbag on her lap. ‘Lets go!’ She pushed her through the corridors of the hospital. Sarah was embarrassed to be in a chair in her uniform and she received more than one puzzled look or cheery wave as they passed hospital staff on their way. The triage nurse was cheerful and patient. Being a small private hospital the emergency department was very quiet; only a few cubicles were filled and there was nobody waiting. Jenny made sure she would be ok and then headed back to the ward. ‘Look after yourself Sarah and let us know how you get on’ she waved and disappeared up the corridor.
Sarah gave her medical details to the nurse in exchange for a specimen jar and the nurse pointed her to the bathroom. Afterwards she was led to a cubicle and given a gown to change into. She was cold, nauseated and the room still insisted on spinning despite her politely asking it not to. Ten minutes later another nurse came in to check her vital signs. A further ten minutes later a man in a white coat walked in. ‘Hello, I am Doctor Mali, I am a locum doctor just filling in today so I am not usually at this hospital. What has brought you here today Miss Henderson?’ Sarah explained what had been going on in the last 24 hours. When she had finished Dr Mali checked the notes the nurse had written up, looked at her eyes, ears and throat, ordered some blood tests, an anti-emetic and some intravenous fluid and left. The nurse had trouble finding Sarah’s veins but was successful after 3 attempts and filled the 4 test tubes Dr Mali had ordered. She hooked Sarah up to the fluids and gave her an extra blanket then began to extract the anti-emetic from the vial.
‘What’s that one?’ Sarah asked her.
‘It’s metaclopromide’ the nurse replied tapping the bubbles out of the syringe.
‘Oh, I’m so sorry,’ Sarah said, ‘I actually can’t have that one intravenously, I react to it so I’d really rather not have it!’
‘Oh really?’ the nurse looked at her curiously. ‘I’ll let Dr Mali know’ and she walked out.
Two hours, half a bag of fluid and still no anti-emetic later Dr Mali returned. Sarah had spent her time staring at the ceiling willing the room to stop spinning but it still ignored her. She distracted herself for a while listening to the complaints of the elderly woman in the next cubicle who seemed to think she was in a hotel not a hospital but nothing could distract her for long. He pushed aside the curtain without calling out to alert her to his presence. ‘Your blood work looks fine and your blood pressure seems to be ok. Is there any chance you may be pregnant?’
‘No I don’t think so, and I tend to have a postural drop in my blood pressure occasionally. It’s usually fine when I am lying down.’
‘Are you sure you couldn’t be pregnant? I’d like to do a pregnancy test to be sure’
‘No, I assure you that’s not necessary’ Sarah replied, irritated. She was consistently on the pill to treat her endometriosis so only ever menstruated every 3 or so months when she forgot to take it. Peter always wore protection and they hadn’t discussed having children, their relationship was not at that stage yet. Also she didn’t think she could cope with kids while she was unwell. On top of all those issues they had either been too busy or she had been too tired or unwell in recent months to be any more intimate than the odd snuggle. There was no chance she could be pregnant and she was getting annoyed with the man for not listening. He clearly had preconceived ideas about what would be wrong with her and was not prepared to explore other avenues.
‘Miss Henderson it’s very common for women to not realise they’re pregnant then have an episode like this one. I really would like to test you just to make sure.’
‘No, it’s really not necessary, in fact if I were pregnant it would be a miracle.’ He frowned.
‘Ok then, lets have a look at what you’ve done today, what have you had to eat and what medications are you on.’
Sarah listed what she had had for breakfast and its accompanying medications. ‘Phentermine? That’s an appetite suppressant right? That can cause dizziness and headaches, I think that will be what’s caused this.’
‘Doctor Mali I have been taking the Phentermine for 4 months now, surely if I was going to be having side-effects from it I would have had them by now.’
‘Not necessarily. Yes, I’m sure that’s what it is, you should stop the medication now and you will be fine. Ok? Yes, now you can go home, do you have anyone to pick you up?’ She told him she would catch a taxi. Sarah was annoyed, after her experience with Dr Harman she didn’t want to ever get another hopeless, unsympathetic, unimaginative and set in their ways doctor ever again but it seemed she had. All she wanted to do now was go home to bed and feel sorry for herself and maybe call her mother, a GP, to see what she suggested.
15 minutes later she had been unhooked from the drip and had dressed herself with some difficulty. Holding on to the reception bench top she worked her way around to the front and settled her account. The receptionist called a taxi and showed her the waiting room seats. Sarah had only just sat down when Dr Mali called her over from the desk. ‘I have that medical certificate for you Miss Henderson’. She got up slowly and carefully walked towards the desk with her hands out to balance. ‘Are you ok?’ he asked walking around the desk to meet her half way. Sarah gritted her teeth in irritation and said nothing. ‘Do you want to lie down again?’ Concern finally written on his face.
‘No!’ Sarah replied shortly. ‘All I want now is to go home to bed and call my mother who is a GP and will actually listen to me and take care of me when she finishes work for the day.’ He looked surprised and slightly embarrassed as he handed her the certificate. She headed back slowly to her seat and he hovered anxiously nearby probably to make sure she didn’t collapse and then report him she thought bitterly. Finally the taxi arrived to take her home.
Word count today is 12953 – over 1/5 of the way there!
Walking For Wisdom 