The final lap

Hi,

I am back, for my final year, and for some more posts. In the olympic spirit, this is now the final lap of my Farah race, certainly not a Bolt sprint! I had a nice summer holiday away from Uni, and I hope you lot did too! I will try to be a little bit better at posting this year, it seems I will be sepnding a lot more time in the hospital (more like my third year) and a lot less time on coursework. This can only be a good thing, as I really do enjoy going into the hospital (and I hate coursework with a passion!). All my exams from last year were passed, which is nice, and all that stands in the way of me and my Dr-ness is this year. Lets go!

For the next 8 weeks I am on a rotation in a small hospital, far far away. It is so far far away from my ‘home’ hospital that we are given accommodation, which is pretty funky. I currently sleep in an NHS bed, with hospital sheets and an NHS towel. Its as though you get to bring the hospital home with you (!) The hospital itself is very long, thin, and short. It seems to have been decided that building along is a lot more fun than building up, which means it is about ½ a mile long (I have been told this figure by many doctors since starting) which means you have huge long corridors ahead of you whenever you change departments, and it takes ages going places. I think tower-like hospitals seem a lot more efficient. Anyway, this long, yet small, hospital is my home for the next 8 weeks, where I am doing an elderly medicine and a general medicine rotation.

I am starting on an elderly medicine rotation, and am definitely thrown in at the deep end. My department deals predominantly with strokes, and employs a lot fewer doctors than it should, so it is always very busy. Despite this shortage of doctors (or perhaps because of it) there has been between 1 and 3 of the four doctors on the ward each day. I have been very busy trying to help out on the ward, and have ended up in the ward for over 12 hours most days. I suppose its preparing me to sell my social life for the junior doctor years!

The two doctors who I spent most of my time with are very good though. One F1, one CT1 (three years after graduating), they let me get very involved and over this week I go on call, where I see lots of problems and realise that being ‘on call’ seems to mean answering your bleep constantly and never having any time to see the mounting patient list, I get to look after patients in A&E when the come in, and I manage to get into a shouting match with a psychotic patient and a grieving family. At the moment, it seems that the smaller the hospital, the more you get to do and the more involved you get to be!

So, moving onto what I got up to this week, I spent most of my time following around the F1 or the CT1 and doing the jobs that they don’t really want to do, or don’t have time for. This does involve a phenomenal amount of paperwork, from blood requests to ‘TTOs’ (papers which let a patient be discharged from hospital) I definitely don’t look forward the paper-work-swamp that is a junior doctor’s life.

While I was helping my team out in A&E, I was asked to call a patient’s daughter to find out what had happened to him. He was pretty confused, and all the paramedics had been told was that he had had a fall at home. Falls in older people is pretty common, and comes with a barrage of tests such as 24 hour ECGs and head CTs to find the cause, and to make sure there is no injury. While he was being put through these, I called the daughter and found out that he hadn’t actually fallen, but had just felt unsteady and sat down. He was slightly demented, so we couldn’t get a good history from him, but this had been mistaken for new confusion, which had sparked the worry that he had hit his head, which was why the head CT was needed. Just a simple call could have saved all of these pointless investigations. I would love to say that I helped out by making that call, but it was too late, and he had already had many of the investigations anyway. Perhaps if I see someone like that again, I will make sure to get a proper history first!

I spent an evening-night on call with an F1, which involves holding a bleeper and covering all the wards in the hospital, meaning if they have any problems which need a doctor, they can bleep you and you are expected to go there and help them out. We were contacted about a whole range of things in the night, from patients falling over going to the toilet, to weird fits and strange ECGs; from massive prescribing errors made by the junior doctor normally on the ward (80mg Clexane twice a day in a little old lady, leading to an INR of over 5 as ‘DVT prophylaxis’) to disturbed levels of potassium in the blood. It seemed that half the patients in the hospital seemed to have suddenly developed problems with their potassium levels! The problem was that with all of these problems coming in thick and fast from the length of this ½ mile long hospital, there was no real time to go and see the patients, so this list got longer and longer and longer!

I spent some time on the ward as well, trying to help out the smooth running by talking with patients and family. It feels as though I would be a lot more use if I could, I don’t know, help a patient wash or go to the toilet, but I am not trained so cannot do that. I am stuck as a pretty useless medical student trying to help out however I can. One patient did present who I could distract at the end of this week, and this is what happened.

The patient was having alcohol withdrawal-based hallucinations on the ward, and behaving psychotically, interfering with the other patients, trying to take out their drips and so on. I decided that this was something that the medical student could have a go at helping at, and persuaded her to come to the ‘day room’ with me to watch a little TV. Here I should explain that the day room is a room off the ward with some comfy sofas (and a TV) where relatives can go to get away from the ward and have some time alone. Given the fact that this is an elderly/ stroke ward, there are a lot of sad looking relatives around, and I wasn’t surprised to see three people sitting in there in silence. I politely asked if we could sit down and turn the TV on, to which they answered “Suppose so”. Not the most positive of replies, but it certainly wasn’t a rejection, so I went ahead and turned the TV on as the hallucinating/crazy patient sat down. Almost straight away, the three people who were there before started shouting at the hallucinating patient and me, complaining about how insensitive we were, how their father had just died and they wanted some quiet time, and how we were ruining it. This was clearly not enough, so to add to the problem, the hallucinating patient started shrieking about how he was not right, and needed to be reset and wanted to be normal. I managed to get him out of the door as he was warbling “Reset me! Reset me! Reset me!” which put us right back into the middle of the ward where we were getting some very disapproving looks. An older nurse sharply told him to “put a sock in it” which lead to him standing stock still, refusing to move or interact, in the middle of the ward for the next hour or two. I went back to apologise to the family (their father had died 5 minutes ago, and I wasn’t aware that this had happened, though I knew that we had a couple of patients on the Liverpool Care Pathway), and while I made my apology grovelling and pitiful, it does feel a little unfair that they told me that they were happy with the TV going on before changing their minds. It would have been easy for them to say they wanted a little quiet, but I guess that when people are grieving they can behave a little less normally, and we should be as understanding as possible. Finally the hallucinating patient ‘unfroze’ and started causing problems again trying to help the other patients go to the toilet, for some reason, but in the end there was no damage from my little fiasco…

Sorry for the wall of text and no pictures, but my NHS accomodation doesn't have internet at the moment, so struggling!