Day 1: HAN fail

The nurse had said the patient looked sick, but the first clue we had as to the specifics was a slightly unusual noise followed by the sight of the consultant's skirt and blouse awash with projectile vomit. Prior to the 10.30 meeting, there had been some mention that HAN (Hospital at Night, i.e. the team of doctors and nurse practitioners who staff the hospital between the hours of 10pm and 9am) had seen - let's call him Mr Emmett - overnight. At one point a nurse approached us as we were going round with the reg to say that he wasn't looking too well, but the reg decided to leave it till later - which was now, 11.30. Our consultant was admirably professional in soldiering on, vomit notwithstanding, with sorting out Mr Emmett's immediate problems and providing a model of good medical documentation before remarking that she might go home and change now.

However, it fast became apparent that a rather monumental balls-up had occured overnight. HAN had indeed seen the patient. What they had failed to do was document anything in the notes whatsoever. One makes jokes about getting marks in GCSE exams for writing one's name at the top of the page, but they had failed even to do that. In fact they'd taken an ECG too which, after the consultant had gone, we found buried, unfiled, in an inappropriate section of the notes. They had likewise failed to give the ECG even the most cursory glance with the brains of a 3rd year medical student behind the optic nerves: as well as the tachycardia (accompanied by tachypnoea and low sats, according to the obs chart) it appeared to show right axis deviation. Oh dear. Fortunately for Mr Emmett, one or two things about leads I and III didn't quite add up and a more likely explanation was that this HAN team member had got their left and right confused when putting the leads on. We confirmed this with a repeat ECG and all was once again well with the world.

The thought of the alternative, though, was rather chilling. What if Mr Emmett - an already very ill man - had had a large PE after all and ended up in ITU or worse as a result of a lack of prompt treatment? I think this HAN team member might have found him/herself seeking alternative employment. What's even more frightening is that this wasn't a green FY1, but someone who'd been a doctor for at least a year, perhaps more, or an experienced nurse practitioner. And then you think to yourself: could I ever do anything this ridiculous? Will I?