The Daily Rhino

Thursday, March 20, 2008

The Renal Angle

Originally published in the March issue of Medical Student Newspaper.

I'M desperately trying to avoid writing about the rhino sitting on the elephant riding a unicycle in the room, again.

You’re bored of my ramblings about jobs, applications, unemployment and emigration. OK you’re bored of more than that. You’re bored of my tangential offal, lazy similes, dull subject matter and self-endulgent banter. But you’re still reading so haha up yours in your face pwned roflcopter lollerskates lmaonade lollercaust lollergeddon!!!!11!!!one

Hence I will endeavour to side-step my impending joblessness by telling you about the joys of renal medicine. Stop laughing.

I started this job having been a doctor for sixteen months and the step-up in responsibility was immense. I cover all renal, access surgery, dialysis and transplant patients and much of the time there is no registrar on-call with me. Just me and one of the country’s biggest renal units. Uh oh.

Getting used to dealing with critically unwell patients is part of being a hospital doctor and after my A&E resus experience I am feeling more confident. However an unexpected duty has been the referrals and calls for advice I have received from several other hospitals and local GPs.

At first I was apologetic and bumbling when GPs asked basic questions but as my ego grew in stature, I became more confident. Patients may still refer to me as ‘the one who doesn’t look old enough to be a doctor’ but on the other end of the phone my tenor tones could be anyone.

Recently I took a call from a teaching hospital, where an A&E SHO had seen a dialysis patient and wanted to arrange a transfer as he was ‘due dialysis’. It transpired he was septic and far too unstable to transfer, so I was surprised this doctor hadn’t sent him to ITU. Secondly, when I asked if he needed to be dialysed, she had no idea how one would decide this.

I walked her through the basics of fluid assessment and electrolyte control, much as I do with third year medical students. It was only when she gave me her name at the end did we both realise she had been an SHO at my previous hospital, several years above me and signing my DOPS.

Roles do often reverse when rotating around medical specialties. From the A&E grunt making the referrals, I am now taking them. I fight my natural tendencies and try not to be an arse, as I know how unpleasant referring to a dickhead is.

I don’t mind being called by house officers - I remember what it was like and I remember not needing to study much nephrology to pass finals. So I try to emulate the specialists I’ve enjoyed talking to and take time to explain renal physiology or the concepts of dialysis.

However when a surgeon calls, I have a little fun. Like the cardiothoracic consultant who asked his SHO to call me due to a rising creatinine. I suggested perhaps the new prescription of trimethoprim and the gentamicin level of 29 (aim <10)>

“Is the renal function normal?”
“Yes.”
“So it sounds like a urology problem, not a renal one.”
“But it’s renal colic.”
“No, it’s urology colic.”

A big poster at work tells me to ‘Save a Life, Give Blood’. Right on. Clearly some people think this is a cop-out. In light of the recent kidney-harvesting ring rumbled in India, I discovered a phenomenon I had never previously known about.

Donating a kidney is amazing. Doing this for a loved one is understandable, but I was immensely impressed when I first met a guy who was giving a childhood friend his right kidney. Yet nothing prepared me for the ‘altruistic donor’.

This is normally a man (in my experience) who wakes up one day and thinks “you know, I have too many kidneys”. He decides to undergo general anaesthesia and have half his piss-making equipment chopped out - for someone he will never meet. It’s quite astonishing - even a curmudgeonly git like me can be impressed by truly generous people, however loonie I think they are.

Labels: junior doctors, Rohinplasty articles

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