the (un)kindness of strangers

so there is this woman on the ward who is a month down the track of an ercp complicated by pancreatitis and multisystem failure requiring a prolonged icu admission. shes making slow recovery and spikes a fever one night while on meropenem. the only new thing i find is a murmur. this is potentially very bad. so the septic workup is negative and blood cultures are pending as usual. the team orders an echo and leaves her on meropenem. two days later i get paged about her having another temp. i ask the nurse over the phone to take some blood cultures from the picc line and give her some panadol, and i'd review her and take some blood cultures peripherally myself (because she has no veins) after sorting a few things out in ed. but oh no, if only it was that simple.

nurse: we can't use the picc line.
me: why not?
nurse: i don't know. i was told we can't use her picc line.
me: but she's on meropenem. does she have another iv access? how are you going to give it?
nurse: oh i don't know.
me: well... can you find out?
nurse: (silence)
me: hello?
nurse: anyway i can't take blood from the picc line.
me: why not? is it blocked?
nurse: we don't take blood from the picc line.
me: well, we need to because it could be the source of infection. can you get someone else to take it?
nurse: okay i'll take the blood cultures from the picc line.

anyway, so i get to the ward a bit later to find 1) the blood cultures haven't been taken, and 2) the patient is now receiving meropenem through the supposedly unusable picc line. nice. after explaining to the nurse why we need to stop the antibiotics and take blood cultures while she is still febrile (while trying to resist the overwhelming urge to strangle her), she says anyway she couldn't take the blood cultures because i hadn't physically written up an order form for them.

AARRRRRRGGGHHHHHHHHH!!! DIE YOU STUPID FUCKING BITCH!!!

the cultures finally get taken. and the next day the lab rings the evening cover about positive cultures in two out of two bottles. the picc line had been removed and the tip sent for culture. a toe was being organised to conclusively rule out endocarditis. and the patient was restarted on vancomycin.

vindication is a sweet, sweet thing. sigh. why can't people just do their job? pete is right. i've been sucked into the abyss again, just a few weeks back. there is no why. there is just the shit that comes with everything. deep breath and move on. it's not me, it's them. blah blah blah. if only it was so easy! i think im going to need that annual leave...