I had stopped blogging for the past 1 months... my domestic problem is less nowadays, in fact life was better than ever, but I had been lazy and focused on my POMR project instead...
Finally I got the POMR working.... no smiliar product in the market after a search over google. I had discussed with my brother and he is gonna look into it and see if it is gonna be a product...
Well, a head knocking incident happened on one of my patient 2 weeks ago. He was a case of Down Syndrome and epilepsy. Bed-ridden for the past 10 years and resided in a nursing home. He was admitted for diarrhea and placed under my service. I saw him on Thurdays and noted some rash over his scrotum on Friday. I prescribed some oinment and went off. It was a long weekend break and I returned on Monday night.
I usualy asked the nurse about the condition before I approached the patient. I asked the nurse, " was the scrotum better ? " while walking toward the patient. Well, I got a confusing answer, " it did not get better, the swelling was still there..". What swelling, I mumbled, I didn't recall any swelling when I went off....
When the nurse open up the napkins, I was shock for a second. Swelling was noted over the prepruce instead of the scrotum. I started my "interrogation" while examined the penis. It was paraphimosis, well, a wound was noted. The answer from the nurse and nursing aid were more striking - "
0.A urine condom was used as the nurses didn't want the scrotum to 'soak' in urine
1. it was noted on the night shift of Friday, some reckless nursing aide tied the condom too tight.
2.all the nurses and nursing aides knew about it
3.no doctor was informed about the condition - because the attending physician(thats me...) knew about it and ointment was presribed for it [ fxxkxxg lies and irresponsible presumption]
Hack, I glanced through my ordering sheet - I wrote down scrotum , specifically. Well, the spelling of scrotum , prepruce, penis was so different- and I did write it properly... No record about the wound/ swelling was noted on the nursing note....
I told the nurse to informed the head nurse stat and I want names on the next day. I was in a ass full of shit condition. I turned to google and finally came up with this emedicine webpage who provided 3 solution for my ass full of shit condition - manual reduction, needle puncture and surgery.
I went back to the patient and tried manual reduction and I was lucky I reduced it.... there was a ulcer over the prepruce - due to prolonged constriction. I was lucky the glan was not in a gangrene state , or else I would need to explain to the family about debridement or an amputation(worst case senario)
Well, I was in a ass clean of shit but still asshole stuck with shit condition then. The next day, I asked the head nurse and I got a asphyxia / strangulating answer - " the prepruce was reduced , aint it ?" that was the answer I got. The last straw which crushed my pillar of restrain.
Well, I went to the nursing office and tell the matron and nursing director that I would start writing "bull shit" order which would make the ward nurse busy like a fly without a head if any further similar malpractice occured.
I got another bang 2 days later . I caught them redhanded - another gangrenous leading urine condom was tied on one of my patient. I did not shout and yell - I just tell them to releas it and walk off.
I am not the only attending physician who was victimized by such reckless care, our fellow chest physician(Malaysian...5 of us in this hospital) V suffered the most - newly developed pressure during in patient care. That was axxlixkxxg kind of embarassment ; the family usual response would be, " hey, we had taken care this patient (in the bed) for th past few year [ and we are not professionaly trained] , yet no pressure sore was noted and only 1 week in your setting, the buttock looks like monkey ass...." . As a attending physicin, one would have to show a smiling face and tried very very hard to pacify the family to avoid any medicolegal suit.
My patient was retained for another 10 days - and the wound was not completed healed when I discharged him...
I remembered one of teaching by this consultant grade infectionist X in Kaohsiung - "treat your patient just if they are your family/relative" : he means when you prescribed antibiotic please prescribed as needed/according to the guideline. No cefazolin and gentamycin combo if the diagnosis is Pneumonia, No lofatin if you suspect noscomial infection.
I remembered those words (I did not work under him, he did not have a good reputation .... treat his subordinate badly...) and vows to practice it....but now, I am stucked with some reckless people which I cannot control...
I still need the answer(names) of coz - I would squeezed it out on the next patient safety committee meeting...
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