CCE Specialties Week 3

Monday

So, back at it. Thankfully it’s a 9am start so it’s not too bad for getting up and on the bus for. We are on care of the elderly this week and to be honest, I wasn’t expecting too much out of it. (I was to be proven wrong). Got to the ward for 9am and we sat in the board round which is where they discuss every patient on the ward (essentially a ward round in one room on steroids). It was great to be sitting there because I was taking it on myself to pick up the lingo being used and decode abbreviations.

As we went along we were included in the discussions and I have a feeling I was being watched by one of the docs because I was scribbling like mad making notes and because I had my tablet – I was able to google and answer my own questions.

After we were assigned to a consultant who took us to see a patient. Since there were three of us we each did one of the history, general exam and focused exam. The consultant was also interested in the use of tablets (I’m single-handedly revolutionising the NHS). I had to do the general examination so was having to dust off the chest of OSCE knowledge which I don’t think has been properly opened since May…. It was ok, remembered most of what we had been taught. My main problem was getting the patient to answer the questions I had asked rather than going off on tangents. I felt too bad to keep interrupting so I’m hoping I develop this skill over time.

He then took us into the office and taught us important skills to remember in OSCE’s as he was an examiner (and I am half convinced he was my examiner for my abdominal station) so we were taught common mistakes and how to avoid them. I couldn’t beleive my luck, first day there and we had already been given amazing teaching.

We then were handed over to Another doctor who has one of the best reputations in my year for being a good consultant for medical students. We were pretty keen to get sign offs done so I had asked to take bloods which qualifies as a mini-cex (yup, second year brings it’s own new language). I was told to take bloods off a lovely old lady who I found a good vein on, inserted the needle and nothing. No flashback, no anything. I sighed. Obviously , I had done something wrong. I withdrew the needle apologising and then before I knew it, BLOOD EVERYWHERE. I panicked getting the flow to stop and silently cursing because apparently, I had indeed hit the vein.

I felt awful but I decided to hand the bloods back, the last thing she needs is me causing more pain. I had to leave after that as I had to get home for my driving test but I was still kicking myself on the train home three hours later.

Wednesday

Back again and after failing my driving test, I wasn’t exactly in the best of moods. However, we turned up for half nine and immediately jumped in to reviewing new patients with the doctors. The first patient I saw was someone who had collapsed at home and was suspected to have a bleed in their brain. It was interesting examining them as they had a positive babinski sign (a way to identify upper motor neurone lesions) which I had never seen before. My heart really did feel for her as she was alone (visiting hours were a while away) and unable to respond to any of the doctors questions or instructions.

We continued going around on the ward round and then after were treated to some F1 teaching. Our F1 was also an ex-warwick grad which is great because you do feel like there is hope at the end of the tunnel for us !

We then asked to do a case based discussion which I led as being off for two weeks, I was severely behind in my sign offs. We talked to a lovely lady who was admitted after a fall with low blood pressure but otherwise well. She had some liver, pancreas and bone problems and we were chatting about her family, her job and her medications. I was surprised as she said she was only on one which puzzled me slightly but I guess that’s medicine.

We finished off the history with a abdominal examination (as she said about her liver) and a quick chest just to check for heart and lung sounds. There was nothing really of note so we said thank you and goodbye and then toddled off to see the notes. Her daughter caught up with us at that point and asked if we had seen her notes. We replied no as I wanted to go in blind like I would do in an OSCE and the daughter filled us in with the correct history which changed a lot. I felt bad for the patient as she had hidden things from us for reasons which I could understand but having the full history made everything so much more easier to work through.

Over lunch Kaludio and I discussed her and went back to the ward early to go through her bloods and work out why there were the abnormalities there was. I loved learning this way as I know it’s going to stick and I can feel the improvement in learning in comparison to death by powerpoint last year. I guess clinical life is for me after all.

We then attempted another blood but this time we had the flashback, but no blood decided to go into the tube. It was frustrating as we had a lovely man but we slumped back to the desk annoyed. What was going wrong? Our F1 appeared behind us and we were telling him about the constant unsuccessful blood taking but he reassured us saying that elderly veins were difficult, you could find a good vein and it would wander out of the way before you got the needle into it. We were taught some techniques to get the blood to flow so Im hoping that I can practise this technique one more time before the end of our time on the ward.

We also received the result of the brain scan our patient had gone for earlier and it was the worst possible news. There was a tumor growing and my heart dropped. Im being careful what I say so I can’t say much else but it led to my consultant having to break bad news to the family and discussing future care with them. Whilst our consultant was there, we were waiting at the desk when all the doors in the ward were shut and a blue metal trolley was rolled into one of the side rooms. We both knew what this meant and went home that evening reminded of just how serious flu can be.

Thursday

Arrived back on the ward earlyish this morning to catch up with what was going on with the patients we had seen yesterday. I was intrigued to see if anything had changed with the three patients we had seen yesterday. It turns out not much had but we had some new bloods for one of our patients so I spent 15 minutes working through them as I was presenting the case today. It was a interesting case and there was a lot to get our brains going. It was also a bit of a difficult day as they were understaffed so we were asked to come back – perfect excuse for a mid morning tea.

We arrived back to do our case based discussion with our consultant which went well. We had managed to identify everything he wanted us to catch and then we had a discussion about further management. So, sign off done. We then were sent away again and to come back after lunch as there wasn’t much to do so came back and then managed to watch a cannula being inserted as we were both a bit apprehensive about inserting them before some quick teaching on hyperkalemia. The ward was ridiculously busy that day however so we left after to allow them to get on with their roles and to allow the 4th years to get sign offs done before their finals in a few weeks. I tried to get work done in the evening but I’ve got a feeling I’ve got a cold coming so I just went to bed hoping to be better for tomorrow.

Friday

Brain decided to get me in an hour earlier than I needed to be today, as if I wasn’t tired enough already. We decided to buy some treats for the ward as they had been so accommodating to us during the week which we checked before we left the ward at 12 and had been hovered up in the two hours we were there #beststudentsever.

We had tried to get a OSLER done but with the busyness of the ward, we thought it would be best to just leave it. It’s not fair to nag the staff when they are running around trying to get patient care done. I did meet a patient who was on the ward though who had learning difficulties. They needed some comforting and it was nice to sit there and talk to them as it reminded me of my uncle back at home. I’ve grown up surrounded by adults with learning difficulties so it’s second nature to me and I really enjoy it when I have the chance to talk to patients with these extra needs.

We then left UHCW early and I was keen to get back to do some of my presentation list. It was nice to be back in my flat , in comfy clothes just working through what we need to do. I much prefer this solo method of working. I am retaining everything more easily and I actually feel like a medical student instead of just learning information off a powerpoint slide for the sake of an exam.

I’m also making progress in improving my mental health. I’ve managed to pass on an audit which was causing me a lot of stress (even though it would have been good for AFP applications) and I am making sure I keep some of the day to myself away from Medicine (even though I may be spending too much time away from Medicine at the moment as I am so tired). I’ve got a doctors appointment to review my meds and I just feel a lot more fufiled in what I am doing.

So here we are, back in the swing of things , ready for clinical life to begin.