Survivor

Hi,

Back on vascular surgery, and back on the interesting cases. Unfortunately, with essays and the like to do (almost finished this essay), it is not possible to put as much time into going on the wards and into theatre as I would like. Still spending some time meeting patients and seeing interesting things, but passing assessments always has to come first.

This week I met up with the patient with cancer I mentioned some time before, I saw a patient presenting with an unusual swelling in her neck, baffling the doctors, and I found myself talking to a patient who had managed to survive a sequence of dangerous conditions.

The patient who had cancer, I mentioned some blogs ago and despite only mentioning her once here I had been following her through her whole treatment, visiting her once a week to see her radiotherapy and see how she was doing. The idea of this was to see how she coped with the increasing side effects radiotherapy causes on your life, and how she coped with the big life change that having to travel in ever single weekday for radiotherapy for 6 weeks could cause to her life. She finished the course a good month or two ago, and I hadn't seen her since, seeing as she has now gone of home. As I mentioned before, she is a wonderfully optimistic lady, who always has a nice thing to say about her position. I had managed to come upon (though somewhat sneaky means) the appointment time and place for her post-treatment appointment with the cancer specialists, so had decided to follow her here. While this sounds like (and definitely felt like) stalking her, I convinced myself that she would appreciate seeing me again, and anyway, its a valuable learning experience, seeing a follow up post-radiotherapy appointment, right? As is, I managed to persuade the nurses and doctors to let me see said appointment, though they were very confused as to why a 3rd year medical student wanted to be part of the morning, and for only one patient (at this medical school, oncology is not a 3rd year rotation). They were running about 2 hours behind, though, so I got plenty of time to sit and talk to this patient about how she had been keeping herself and how she was feeling. I was pleased to hear that she was feeling great, had no real abnormalities from the treatment other than a little hair loss around the site. She had more things going on in her life again, with someone in her family currently dying in hospital, but still maintained the same positive outlook and cheery demeanour that I remembered from before. Quite by accident I managed to get her appointment shifted forward so she was only waiting for about 30 minutes (I think the oncologists wanted to get rid of me). Not that that is right, as it just meant that others had to wait even longer, but it was unintentional, so I will not feel guilty. There are no signs whatsoever that there is any remnant of the cancer, so a cure is expected, though not guaranteed as who knows what remains in the microscopic level. Great news, and she was obviously very happy with this as well. After a touching farewell I left to return to a lecture. So I hope that I would get to see her again? If I am seeing her again, it will mean she is ill, either coming in with recurrence of her cancer or another medical condition. Its sad that you can see people leave and be unsure as to whether you want to see them again or not, but perhaps you can just hope for another setting, such as on a high street. Good luck to her, whenever I finished talking to her I would always leave with a smile, and I hope that other people who spend time with her give her the care that she is due.

I was spending some time in a clinic later on this week, and saw a good variety of patient presenting with problems with arteries and veins. Common things to see in this setting are problems with the venous or arterial circulation to the legs, stable aneurysms, and the like. One patient came in with a strange pulsatile mass in her neck. It pulsed with the heart beat, and overlay the carotid artery in the neck suggesting a carotid aneurysm (pretty rare). The patient had been referred via a duplex scan, which is an ultrasound scan which can create a picture of what is inside your body, and tell you where the blood is moving. The results from this showed a slightly swollen carotid artery, but nowhere near the size of an aneurysm, or the size needed to be clinically visible on the neck, which this lump was. The surgeons had plenty of questions for this lady, but none of her answers managed to give them an answer for this condition. What are they going to do about it? Are they going to prescribe her lots of invasive but clever tests? Will they admit her for careful monitoring and assess her as an in-patient? Nope. "Go home, and come back if you think its getting any bigger". Talking to one of the consultants after she had been discharged, he admits he has no idea what on earth it could be, but 'that's a bit boring anyway' and it didn't look life threatening. Fair enough, its like the GP option of see if it goes away, and come back if its worse, but that sounded like a bit of a cop out from a high level consultant. Where is the sense of curiosity? Do you not worry that it might be more dangerous than you think? I suppose he didn't want to put the patient though unnecessary, painful tests and waste her and his time. I'm only a medical student, I have no idea what's going on.
Clinics aren't all seriousness though. The surgeon had a good flirt off with a 97 year old woman who had come in with claudication. It started off with:

Doctor: "Don't worry, I will see to you right now"
Patient: :Ooh, I look forward to that, when can we get started? Do all these people have to be here"

And ended with information I don't feel happy about putting in a blog with unknown readership. Needless to say there are some very dirty minded older women out there! Its good to see this consultant not taking himself too seriously though. Makes you much more endearing to the patients.

Finally, on the wards I was talking to a gentleman who had been in hospital for 3 months or so. This is a long LONG time for an NHS hospital, which turfs people out as soon as possible. And understandably so - with bed prices for a night in hospital estimated at £800-£1000 A NIGHT, it is expensive to keep people in hospital longer than needed. That patient had been kept in for so long because he had had a series of problems befall him. he had come in with a AAA rupture (a different man to the one we saw come in with the same condition a few weeks ago), which has a chance of death or around 80% before you get to hospital. This had been operated on and repaired, the operation carrying about a 40% mortality rate (please note, these are very rough figures). In recovering from this, due to the immobility in the beds, he had developed compartment syndrome in his leg, infected with MRSA after an operation, which then progressed with deterioration in his health leading to multi-organ failure, which can give 80-90% chance of dying, with the number of organs he had involved. In and out of intensive care, this patient was still alive, chatty and happy with pictures of his extended family up around his bedside. All of these chances added together give the patient less than a 1-2% chance of survival. That is exceptionally small, especially given that the these figures account for a person who was healthy before, and didn't suffer from the previous insults to his system. All in all, a very impressive feat, and made you feel all warm and fuzzy inside when you saw all the smiling faces of his family on the walls, looking down at him as though they wanted him back home. He would make a lovely grandad, very cheerful and fun to be around, and I hope that he managed to make it out of hospital without encountering any more problems or infections. Surely he has used up all of his bad luck by now!

Relativity short blog today, as I spent the weekend at my grandmother's 95th birthday party. Lovely to see family I had never met before, but means this has been knocked out in under an hour... Have a great week!