Posted in Blog, Medical, Medical School, Medical Student, medicine, Uncategorized

Care of the Medical Patient – Week Three

Wow , two weeks left of this block. Scary

Monday

Bank holiday

Tuesday

We decided to not attempt the ward round before teaching at 11:30am today. It was the day after a bank holiday, and you just know it was going to be chaos. That did mean however we were roaming the hospital car park for 40 minutes trying to find a space. We were in one car park when I witnessed a doctor scale a grass bank in their 4X4 and park neatly ontop of the bank.

My KA and I were not even going to attempt that.

We eventually got a space and were only 2 minutes late which in medical student speak, is bang on time. We had an hour on palliative care and then had a free afternoon which Klaudio and I were determined to fill.

We ended up in Respiratory clinic as we had not had that much exposure to lung related things thanks to COVID-19 (closest I have been to a Resp ward was on the day we got taken out of placement and were sent away within two minutes). I really enjoyed the clinic and it was good to see other areas of medicine and look at x-rays in clinical context.

The consultant also wrote with a fountain pen which I have not seen being used in forever. I’ve tried to get back to using a fountain pen but alas, has not happened due to having weird handwriting and a lack of patience with them!

I felt good. We ended up leaving at 6pm but you know what, it was a productive afternoon, I learnt a lot, and thats all I can ask for.

Monday was also the debut of my bumblebee scrubs – of which I love to pieces.

Wednesday

Our first day without anything pre-scheduled for a while. We headed up to our other ward Beauxbatons (can you get the theme I am going with here) which we normally steer clear from. However, today was changeover day and we were hoping to get some new F1’s to adopt us.

And we landed a JACKPOT. i walked into the doctor’s office and 70% recognized the FY1 sitting there. She started talking and yep , it was B who I did Revue with !! (It’s hard to confirm identities under masks).

The rest of the doctors began filing in and we knew this ward was now going to be one we could rely on. Klaudio and I joined in on the ward rounds which were super quick as there were various welcome meetings to get to. We had a patient who was scared and worried about dying. The ward round moved on but I couldn’t leave them like that. I grasped their hand and said that it was going to be ok and that they were not going home to die. They smiled and seemed to relax a bit. I believe they had dementia so just that little hand hold meant a lot to them.

After the ward round ended we tried to get some bloods but if veins were opposing magnets to needles, this patient certainly had them. They were more than willing to be a human pin cushion but that isn’t what we want for patients. So the standard two tries later and we left it to the doctors. It was so frustrating as these veins were incredible…

In the afternoon we tried to get into another clinic. This time ENT. I seem to have an affinity to this speciality, but that is purely because of my medical history. I was excited and we hung around for half an hour because we were early, then time for the clinic arrived but no consultant. We checked the notes to make sure there were face to face of which there were but still no consultant.

We waited half an hour before deciding to call it a day. It was frustrating but what can you do. The HCA’s were lovely at updating us but I felt sorry for the patients who were hanging around with the possibility of their appointment being cancelled.

We treated ourselves to ice cream for our patience:

I only have two weeks left to make the most of this ice cream bar ….

Thursday

Wow, it was so hard waking up today. Despite having Monday off, we are both shattered and feel like we have done a whole week already. it was time for our ILS course which is Intermediate Life Saving.

Basically, we had covered a lot of this already, but it was a step-up from just carrying out an A-E approach to MANAGING a crash call.

I really enjoyed this day. I LOVE simulations and it gives me a chance to practise what I have learnt and feel just that little bit of a professional. Thankfully, only one five minute lecture for the whole morning and we were off learning how to manage airways and ventilate an unconscious patient.

We then got to learn how to use the defib, how CPR felt in real life (my arms are still not right typing this out on a sunday) and how difficult a one handed jaw thrust and mask holding is. We also got some free snacks which I am always more than up for.

Klaudio and I had our OSLERS in the afternoon which step up this year. We get assessed based on final level. I wanted to get off on a good foot, but I did keep in the back of my head that I am literally 3 weeks into the so called “learn management” year so not to hate myself if it goes badly.

I got a patient with a good history, but I was hit with the classic chatty patient. My history was 15 minutes long which was frustrating. It’s just a skill I really need to hone down. As much as I am interested in the patient, I just need the information I need out of them before I find out what their great uncles on their dads side employment was….

It was an unusual presentation. Though arrhythmias are meant to be our bread and butter by now, this particular one I had not seen before in a clinical context. It was hard coming up with the management and I defiantly stumbled my way through this.

I think I did ok. Results are still to come in, and they don’t matter with regard to the degree but the Type A personality of mine want’s to do well, naturally.

Friday

End of the week at last. I think Klaudio and I only managed to drag ourselves out of bed due to it being the end of the week and we are going back to Hogwarts ward.

We got told a consultant who loves to grill us would be there today so we were a tad nervous but it ended up being our favourite consultant AND a doctor we had already worked with on another ward. So shaping up to be a good morning !

We have also discovered that although we cant get onto the PC’s (because even though we have logins, we get get onto the system) we have access to the printer. We took FULL advantage of this and photocopied the ward notes (IE – handover sheets) so we could follow along on the ward round but of course made sure to dispose of them before we left.

The ward round was brilliant. The male bay ended up being the weirdest round as all the patients were up in their chairs having a good old chat between them with some even moving around to chat perched on the end of beds. There were some BRILLIANT murmurs including the classic one you expect to hear on wards and some sweet patients.

I was helping a lovely patient put her socks on after the consultant took them off and she asked if I was a doctor or a nurse. I was shocked. No one had ever asked that before. They just assume I am a nurse and call me so. I giggled and said I was TRAINING to be a doctor. She said ” oh that’s nice, I never know what to call you lot”. I said orange badges mean students and how nurses have uniforms etc but said I was really grateful for her asking.

I don’t mind being called a nurse. They do such amazing work and I admire the way they can handle all bodily fluids. I am a whimp and even the sight of flem sends me retching. I suppose it’s just annoying but not too much of a fuss with patients. They are ill afterall.

I made sure her toes were cosy and carried on with the ward round. The team were so lovely and we felt so included and were sharing the giggles and teaching.

We then ended up in the last bed which was in a side room. The TV was on in the background and we checked on the patient and had a discussion about his care.

However, something was distracting me. On the TV behind the consultant was BBC news. Prince Phillip had pictures being shown in a weird montage that was slow and fady. I remember thinking he was either dead or it was his birthday. I couldn’t see the writing though and the news reporter was only wearing a black jacket and not all in black.

However, it soon went to breaking news, and I was able to read he had died. We all knew it was coming but it’s so sad with him being weeks off 100. This day was getting more packed by the minute.

In the afternoon our amazing consultant spent a good half an hour (probably more) teaching us about Aortic Stenosis and my brain was on fire. This was incredible. However, he did assume we were second years so wasn’t teaching us management. It was a good 15 minutes in before I got an opportunity to correct him. I wish we had different badges or lanyards to denote year groups like other medical schools instead of resulting to my technique:

That afternoon I went to get my second jab at the place where it all started, UHCW !! I was excited to go and turns out the BBC are filming at UH for the new series of Hospital (my favourite programme):

All my sign offs completed !
These bump devices were used to maintain social distancing

And that was the end of a looonnngg week. Im thankful I left my jab till last thing on the Friday as the side effects came out of NOWHERE. I was knocked out for the majority of Saturday sleeping all day bar a couple of hours. My joints ached, I had the headache of a lifetime and was shattered. However, one sleep later and I was good to go.

What a week.

Posted in Uncategorized

Medicine Block – Week Three

So, you know I said last block I would have a shorter blog? Well, the timing of that sentence wasn’t quite right. This week was the week when I returned to being an actual full time medical student.

Monday

Thankfully just some tutorials today that started at 10am, BLISS! These tutorials are meant to help us pitch our own work right and if you are lucky, complete the work for you. We had a full day of workshops so it was just sat in a virtually empty lecture theatre all day.

There’s not really much to write about apart from the fact it was BOILING outside, this was of course, the week of the heatwave. However, to end the day off in the right direction, Kaludio and I took a trip to the infamous Gelliot Ice cream bar. Yes, it is amazing as it sounds:

Berry sorbet and bubblegum ice-cream

Tuesday

Tuesday brought a bit of a weird half day and a first for us. When learning clinical skills in the last block we had an afternoon of teaching and then a couple of weeks later (when you have normally forgotten everything), you are assessed. This time round it worked a bit differently. We were sent online learning modules and I self-taught myself ECG’s (OK, I basically knew that already) but NG tubes were something I really was not expecting to learn on my own and go and be assessed on the next day. (NG Tubes are feeding tubes passed through the nose, down the back of the throat and into the stomach. They are not pleasant to have inserted but can be the difference between life and death in serious cases).

Nasogastric (NG) Tube Placement - Oxford Medical Education

Thankfully the nurses running the TDOCS were lovely and supported us through each one so it was the highest mar I have ever received for a TDOC (lets ignore the fact everyone got a perfect score).

We had nothing for the rest of the day so I decided to get some tests done of my own. I had been “prescribed” and X-ray before lockdown for my hip and it was starting to hurt again so I took myself down to get it done. It was weird sitting there as a patient in the surgical gowns, especially when you are trying to get something to stay shut at the back which isn’t designed to stay shut at the back.

Did you wear a gown if you didn’t take a picture to prove it?

After I thought I had my outpatients appointment for my ears but after an hour of sitting in the sun I suddenly realised I had not only got the wrong day, but the wrong week. Nice one Abbie.

Wednesday

Nice normal day back on the ward today. Well, I say normal but this was a heatwave and our scrubs really do not allow the body to breath so within 5 minutes of getting onto the ward I felt soaked through. The ward temperature was nearly 30 degrees Celsius and we were just melting on the ward round.

Kaludio and myself managed to duck into the air-conditioned equipment room to gain some body regulation at one point and walking out of there to the ward felt like we were getting off the plane in Spain. I couldn’t understand how patients were sat there with blankets on. We also had the nicest consultant that day, they were teaching us around the ward round and at the end offered to do our sign off’s for the block. RESULT. He also insisted that we should not be in the wards but outside enjoying the sun, something which our F1 agreed on.

We stayed to put some cannulas in the patients that morning as most were going to need IV fluids to prevent Acute Kidney Injuries developing in the next couple of days. I had a patient who’s veins were just beautiful so my job was easy. The ward was also treated to ice-poles which was just the best thing to ever happen:

we were beat to the blue ones but red is a good substitute !

We finished our jobs at 12pm so we decided that Ice Cream was also needed – cue Ice Cream trip #2 of the week:

Lemon Crunch and Bubblegum

Thursday

So very close to the end of the week. I am so tired, I don’t get how I was pulling the ridiculous hours I was during Speciality block AND keeping up with three presentations a week off the list.

However, today was significantly cooler as we had an incredible thunderstorm the night before which just lit up the entire nights sky. We had the ALERT course we were originally meant to do back in March. It was good as it made you aware of why we do the A-E assessment but it wasn’t until the afternoon that I realized just how far I had come along. We got free food and drink throughout the day (que me panicking as I watched my calorie budget drop due to the sandwich I ate which was nearly 1/3 of my daily count).

In the afternoon we were ran simulations of a deteriorating patient where we had to conduct an A-E assessment. My first one was a bit shaky but my second one I just got praise and advised to be a bit more flexible with my diagnosis as I can be a bit narrow sighted.

I felt like I could have been an F1 in A&E and that evening I went home with the biggest confidence boost I have ever had. I was finally beginning to feel like this was going to happen, I was going to be a half competent doctor one day.

We didn’t get the full plugged in version but it was helpful to remember things by just placing our hands on the body.

Thursday was also the day the whole A level thing kicked off but I will dedicate another post to that as it deserves more than a paragraph.

Friday

END OF THE WEEK

I made an agreement with the rest of my car share to have a half day as we were pretty tired. Oh what dreams we make.

You quickly find out that when you plan to have a half day, you end up having the longest days ever on placement.

We rocked up to the ward round and were asked to prep the notes for the two newcomers. I toddled off and wrote up basic history and recent investigation tests and once I was finished I toddled back to the nurses station. Whilst I was gone the F1, CT1 and PA had all arrived and asked me to present the case back to them.

The consultant turned up and God did my anxiety rocket. I had to re-present the patient back to her and discuss some points (tip for future Abbie – trends are as important as numbers) for treatment. The consultant then went, go and sort her out then. I stood there. What do you mean?

Well, go and have a chat – take some bloods so we can check how she is doing, document it and I’ll catch up with you in a bit. I stood there flummoxed but equally excited. I got to play F1 for an hour.

I know I have a problem with my anxiety levels but boy I did not realise the extent of them until this time.

I interviewed the patient, did their bloods, got everything ready for sign off (turns out I could put my own signature on them as they “never check the signatures”) and presented back in time for the regular ward round. It was a straight forward case but god was it a rush. I felt like a capable human for once in my life.

We stayed and did some more cannulas and bloods before lunch (one of which we had to get the reg to do as it was so difficult) but we were hinted at the possibilty of NG tubes after lunch.

Coming back we had two patients who needed NG tube insertion. Klaudio did the first who had lost capacity so was difficult, but we later found out he had managed to nail his first NG tube!

Mine, well mine was slightly more difficult. The patient had mobility issues and some movement issues, so it was more difficult to place the tube. They also kept giving and removing consent and there was a big decision to make if they had capacity or not. We tried to find this out but it was proving very difficult.

After two attempts (both consented for by the patient) we gave up as it was not sitting properly and I didn’t want to cause any more distress. IT was left as a weekend job as it was not getting done on the Friday. We ended up playing a weird medication quiz as our F1 wrote up the drug chart for another patient with our ward pharmacist adding the sound effects and it was just an hilarious way to end off the week.

It hit half five however, and my hip began to signal it was time to go home. I got back at 6:15pm and was exhausted. I’ve been suffering with hip pain for a while but hopefully that X-ray will show something that I can fix !

It’s weeks like these you have to hold on to as you will end up with weeks when everything just goes to pot and you give up. I really did feel like I was going to be a doctor after the end of this week. Let’s hope Covid doesn’t screw up more than it has done already.