Sitcom?

Hi,

This has been a crazily hectic week, with my ward seeming more like the set of a sitcom than a hospital. We have had a psychotic patient setting off fire alarms, angry grannies stealing other's zimmer frames and pushing the users to the ground, the 85 year old man who starts each day with 40 press-ups (even after his stroke) and many more. As if this cast wasn't enough to fill up my week, I have also had a busy week for learning, certifying my first death after one of our patients died, learning about the complexities of the social service and trying to get patients out of hospital, and even impressing a VIP with my diagnostic skills!

OK, so quite a good spread of things to talk about, but I will try and keep things short and sweet. Looking back on some of my blog posts, they do tend to ramble a bit, and have some 'flight-of-ideas' elements. Don't section me yet!

The ward I am on has a lovely community feel to it. Because many of the patients are there for a month or two, they get to know one another, and each others families really well. This makes the morning ward rounds, and the jobs afterwards really nice to do, as they will be chatting away with one another, and able to tell you how the patients who are unwell have been doing overnight. 'Jobs' involve all the things that need to be done each day for each patient. These actions are usually decided by the consultant who leads the ward round, and then left to the junior doctors (and medical student!) to sort out over the day, so the results can be presented to the consultant the next day. These can range from taking and monitoring blood results, to organising complex scans and calling nursing homes and relatives to get the patient out of hospital. 

When a new patient comes along, they seem to bring their own personality into this ward environment (assuming they are concious), adding to the friendly atmosphere. The elderly man who does his push-ups at 6.30 every morning who I mentioned before is one example of this, as is the older women who goes around stealing other people's walking apparatus as they are using it. My favourite is the anxious man who has an old tracheotomy which is still healing, and an ulcer just below. For some reason, he has been given 'larvae therapy' (maggots) to help clean this ulcer out, but he is petrified that these maggots will climb down his tracheotomy hole and into his lungs. He seems to be living in constant fear of his lungs filling with maggots (it really doesn't sound nice!). Some patients are more adorable than others, but each brings their own personality to the ward, and adding to that 'zany' sitcom feel. 

Unfortunately there was some trouble with the patient who last week was involved in the shouting match with the grieving relatives while he was having hallucinations. We were having some trouble discharging him, as his wife and family had turned off their phones so we couldn't get hold of them. When we finally did, they admitted that they didn't want him at home, so were trying to keep him in hospital for as long as possible. Before we managed to get him discharged, he managed to set off the fire alarms in this wing of the hospital and escape in the following commotion. Early this week we finally discharged him, only for his family to bring him into A&E a couple of days later as he was 'insufferable'. I am not sure that this is a medical condition, but despite this he headed right for our ward, saying we were friendly, and kept trying to get in to get into one of our beds. He had clearly forgotten me getting him in trouble with the grieving family, and he tried getting into the ward for most of a day before he left. We haven't seen him yet. I hope the family get the help they need, but trying to stick him in hospital really isn't the right thing to do!

A number of the patient's in the ward are nigh on un-dischargeable at the moment, because of their GP situation. Both of these patients had a stroke some time ago, and are now medically pretty well. They both need some rehabilitation to help them learn to cope at home, but there is no reason for them to be in an expensive hospital bed. Sadly, we cannot get rid of them. One of them moved here from Poland 15 years ago, and despite being a GP resident still hasn't signed up for a GP. The other one was recently kicked out of his house by his "scumbag ex-wife" and is now living in a shed behind a pub. His GP is now in a different county to his address. It seems that both of these people will not be accepted into some sort of rehabilitation programme by the community because of these reasons. The man without a GP cannot really leave hospital until he has this rehabilitation, but cannot have this rehabilitation until he has a GP, it seems a little catch 22. The other man will not be accepted by either counties community workers, one because his home address isn't there, the other because his GP isn't there. It seems that a lot of these complaints are delaying tactics, used to delay the need to take patients on. It seems pretty silly to me, as a hospital bed is much more expensive than having someone cared for in the community, but everything seems to be political...

I have a couple of fantastic 'on-calls' this week, which I spend shadowing the junior doctors. learning about their job (which I will have to do next year!) and helping out where I can. I start of learning that chlorpromazine is a fantastic cure for hiccups, but from then on, things seem to get more cynical. The junior doctors are discussing their pay and the hours that they have to work, and things do seem somewhat unfair. They are upset that they have to work a lot longer than their contracted hours to give the care that patients need, but are only paid for the basic hours. Both of the juniors I am spending the evening with are seriously considering changing careers away from medicine. Its a big shame, as they are both lovely people. I am not really sure what needs to be done to keep people happier in the cash-strapped NHS, but I suppose that is why I am not going into politics! 

Towards the end of the on-call, the junior doctor is bleeped to certify a patient dead. As this is something I haven't really encountered before, she gets me to go into the room and do all the relevant examinations to show that they are dead (things like testing the reflex of their pupils, and listening for their heart for one minute). Certainly a good learning point, but very strange, as you need to be in this room for a good 5 minutes to perform all these tests. The both of us in a side room with a corpse was a little creepy, but I can imagine that when on your own, at 2AM, having to walk into rooms with dead people in them, look into their eyes and sit with them listening for sounds of life for minutes could be very strange.  Definitely not something I am looking forward to!

Hopefully not, but you do hear of it happening...

To finish on a more positive note that that morbid image, I can tell you about my great success of this week. I was at an event put on by a group who gave me some funding for my medical elective this weekend, and there were quite a few important rich people there. I was circulating around and chatting away, answering all the usual 'medical student' questions, when one man asked me if I could diagnose a condition that he had. Its pretty common for people to ask me if I can diagnose things, and its even more common for me to have no idea what the answer is, but I said I would give it a go. He told me how he had tooth pain and went to the dentist, who diagnosed him and took out a molar. The pain continued, so he went to the dentist, who took out another tooth. I interrupted him here, and told him that it sounded a little like trigeminal neuralgia. He was incredibly impressed, telling me that he had 4 teeth removed before he was referred to a neurologist, who then managed to make this same diagnosis. I didn't tell him that this was a pretty 'barn door' presentation that we are taught about in medical school - with people sometimes coming to the doctor having had all of their teeth removed, to find out what is causing the pain. Perhaps I should have asked this rich gentleman for a job, given the moaning of the junior doctors I have spent this week with, or even better, charged him £100s for a 'consultation fee'! 

The trigeminal nerve causes trigeminal neuralgia, meant to be one of the most painful things a human can experience!