Reflections...

So... 2 months later, I return. With no great increase in blogging ability, but a slight degree of hyperness from M&Ms and a new shiny blue inhaler *excited puffing noises*



I'm back at uni for second year, and it's a big leap. The drudgery of 9-4 days packed with lectures is still there, but finally it's clinically relevant (sometimes) and intermingled with seeing patients! 2 hours of ward time a week is hardly something to write home about, but it certainly seemed like being thrown in at the deep end to start with. Our consultant isn't exactly big on teaching - I think he's an oldschool "see one, do one, teach one" kinda guy. Except without the "see one" part. I didn't mind particularly, seeing as I was one of the "lucky" guys who got Communication skills in the first block, so I was pretty confident in introducing myself and getting a history underway.

I feel so bad. I don't even remember who my first patient was. I could tell you anything about any of the people I saw over the summer in Surgery, but on my real uni placements? Zilch. I remember the last three, vaguely. Gastroenteritis, cellulitis, pneumonia. With 3 social histories and interesting backgrounds, because these are people, not diseases. We'll ignore the fact that my surgery notes are all '92YOF (L) #NOF -> CHS (GA)'.



Fact: I'm not a great people person. I can get a good history, even with my limited experience. I can chat for hours about grandkids, holiday destinations, and the bloody awful weather.



Fact: I would much rather be shoving a large dose of propofol into their veins in order to whack a great tube down their trachea and start slicing their limbs open. It's who I am.



This term so far in numbers:

Weeks - 5 (6 including Freshers/audit week)
Patient Histories taken - 4
Patients examined - 1
Examinations taught - 4
Surgeries observed - 21
Surgeries assisted in - 4
Patients cannulated - 1
Patients intubated - 1
How confident I am that I could now do a CHS by myself - 85%
Days spent as a patient - 3
Days off uni - 5

As can be seen from those last 2 items, I've had a change of perspective recently. A week ago, I was fine. Coughing a little, noticing a tonsil getting a bit bigger, you know the drill. Sunday, I was on the phone to NHS 24 complaining of increased shortness of breath, a MAHOUSIVE anterior chain lymph node, and some haemoptysis. Obv, OOH GP app (I love NHS acronyms - ooh!). The 15min walk to the hospital took 40 mins.
Acute SOB on arrival to the point of sitting in the consultation room for over 3 minutes without being able to utter a word.
Decreased air entry on R side, no creps, no crackles, no rubs.
No temp, no cyanosis.

That bloody 'no temp' got me a hospital admission for ?PE. I am a 20 year old female of normal weight, with mild hypertension and no FH of embolism (or any vascular disease, bar an AAA). Grr.
It was an experience though, one that I am (retrospectively) grateful for. Whilst the medical school are uber keen for us to understand the perspective of nurses, physios, pharmacy staff, midwives, you name the rest of the MDT, there hasn't been much focus on the patients. Except for 'take a patient centred history'.
I don't feel that my admission was entirely explained to me beforehand. I understood that I was going over to the main hospital (OOH being in the hospital grounds) for an xray to confirm infection. If it came back negative, we'd consider the ?PE idea.
I arrived on AMAU (Acute Medicine Admissions Unit - the clue was in the name, really, wans't it?) with my referral letter in my hand and was shown to a bed. A little bemused, but we'll run with it. Next, there's a nametag on my wrist, and a nurse is asking for my next of kin details and trying to strap me up to a monitoring device. Jeez, I walked the 100 yds here without dying, chill out.
Bonus event - reasonably cute F2 came to clerk me *be still my tachycardic heart* I criticise his clerking skills, pout at his 'NAD'ing of the systematic enquiry, and shamelessly flirt my way through an examination of my heart, lungs, and abdomen. ECG looks... like a sheet of squiggles. He assures me it's fine, and stabs me. Three vials later, I am nursing a bruised ACF.
This was supposed to a reflection, not a narrative. Um... Rob-the-F2 really put me at ease. He took me seriously without making me feel that my condition was uber serious. He made it ok to ask inquisitive questions and give honest answers, even for the questions we expect patients to lie about (alcohol intake, etc). At the end of our talk, I knew the best and worst outcomes and the plan of action either way. I was prepared. We built a great rapport in the first few seconds, just by him knocking down the doctor-patient barrier - sitting on the bed, chatting to me instead of firing questions. He made me forget that I was an inpatient with a potentially fatal condition - I could look back and analyse how he communicated with me and I know he would tick all the boxes of open posture, eye contact, etc, but more than that - I felt that he cared.

It was a stark comparison to the consultant. It was clear that he was there to see me purely because consultant review was compulsory, not because he felt I deserved his visit. In the mere 30 seconds he deigned to spend with me, I failed to catch his name (and ending up assuming he was the consultant, since I could not imagine any other member of medical staff being so aloof), had a cursory respiratory examination in which the stethoscope barely touched me, and watched, shocked, as he gave his report to the nurse rather than to me directly, and swept out, leaving her to translate.

The nurses on AMAU were great. Despite caring for an ever changing group of very different patients (the only thing we had in common was being female!), they always knew who we were and what was wrong. I wasn't subjected to unnecessary interventions just because of protocol. For example, bedtime obs weren't taken - I was clearly well and busy studying. Only twice while on AMAU that evening did I become slightly short of breath again, and they were immediately there, ensuring I was ok and not requiring assistance. Not a complaint did I hear about patient requests for food, water, commodes...

At 2100hrs, having been admitted at 1800, I was taken to X-Ray. Having seen porters treat patients like a parcel that needs delivering, I was impressed to find two caring people who spoke to me, instead of over my head to each other. At X-Ray, radiology were prompt in attending to me, discreet in letting me change my bra and tshirt for a gown, and clear in their instructions. Whilst it was mildly uncomfortable to compress myself against a cold plate, they continued talking to me even whilst the images were being taken - other X-rays I have had have left me feeling alone in the imaging room while staff hide silently behind the screen.

It was not long after my return to the ward that my nurse, Jenny, came to inform me that the CXR was entirely normal. John returned the favour from Beerienteering in coming to sit with me for hours on end, devouring the fruit from my tea, and keeping me highly amused (and breathless with laughter). The staff were awesome in letting him stay way beyond visiting hour was over and ignoring my constant mobile phone activity :)

Finally, at midnight, the bloods came back. Negative. Normal white count, normal CRP, negative D Dimer. So, no infection, no clot. Suddenly I feel like a massive waste of NHS time and resources. At least no one is mean enough to discharge patients with no transport at midnight, so I was transferred to Short Stay (Medicine) for a short nights sleep.

Supposedly. Sleep on a hospital ward is like asking for ice in hell. On settling into bed (no extra pillows, dear, just keep raising the head of the bed. It's vertical? Oh.), I was hussled out of it for obs. Surprisingly, yes, my sats will drop if you force me out of bed. The corridor lights shine all night long, the cardiac monitors beep away, the IV pumps scream shrilly at the end of their saline supply - not to mention the snoring of old dears. I counted the hours with the arrival of the nurse to do hourly BM's on a lady who stayed resolutely asleep throughout. At 4am, the bed next to me was occupied. At 6, the obs machine did another tour. At 7, the cleaners arrived. 8, breakfast (soggy or cold. What a choice!). All in all, not conduicive to recuperative rest.

Just after 9, the lone consultant prowled the ward, trailed by an Advanced Nurse Practitioner (sounds like an expensive F1 to me). I was impressed. The doctor had clearly read my notes, noted my medical student status, and actually treated me like a healthcare professional instead of using dumb lay words. She knew all my test results, knew the admission story, and had a plan formulated, ready to adapt it to my latest nursing obs and my side of the tale. I was in mild pain, felt like shit, and could barely muster the energy to sit up enough to eat my cereal. I was flopped on my pillows, supported semi-upright by the adjustable bed head, and managed a weak handshake. My sats were fluctuating at 95% on air. In telling me I was staying another night, she managed to convey sympathy and understanding through her tone. I bartered, begged, pleaded to be allowed to escape at lunchtime for my patient interview assessment, but my inability to walk across the room unwinded closed it. In my upset, she made me see that all the preparation I had done for my assessment could be used for all patient contact, and that assessment of my skills today would show me in a poor light. I felt reassured that I was in the right place and that the team were doing their best for me. I was booked for a V/Q scan later that day, although the concept of the scan wasn't explained in detail - I think she assumed I knew what it involved - falsely, as I had only heard about it for the first time in the previous week's lectures!

That afternoon, I was wheeled down to Nuclear Medicine by an exceptionally cheerful porter, who told me the greatest skill in working in a hospital was not pissing off the porters. Another gem of knowledge for later... Largely fed up of being wheeled about by this point - I understand that letting an SOB patient walk to the other end of the hospital is ridiculous, but not being allowed off the ward at all without a chair and an escort? There are no vending machines on the ward! Anyway... I was deposited in a hallway, like a package, small tag explaining my purpose an all. Shortly after, my wheelchair was rudely grabbed and pushed back down the corridor, with no introduction or explanation of our destination. Once parked in a small room, a short form and a pen were thrust at me. Nope, not a consent form, just an "are you pregnant?" form. I, in my anxious state [needlephobia], piped up, wanting to know risks, complications, side effects of the radioactive media, consequences, etc. Informed consent this was not. "There aren't any". Yeh, gamma radiation, supersafe. Let's give it to kids to play with. Firstly, you're making someone with poor lungs inhale an unknown substance. At least tell me what it is! Reassure me that you've put some oxygen in there so I don't become hypoxic! Secondly, you're gonna put a needle in my vein. No risks, no complications? How about infection, nerve damage, nicking the artery as some starters for ya? And since the stuff you're injecting is in a lead barrel, you can't even draw back to check you're in the vein.

Inhalation of unknown radioactive substance complete, I was wheeled (backwards this time. That's not wheeling, that's dragging) back up the corridor, into a large room. Somehow I was telepathically supposed to know that I should get out of my chair and onto the 'bed'. Thankfully, mardy woman was joined by someone slightly nicer. Strapped to the bed, I was slid towards the machine. Cue James Bond flashbacks of laserbeams about to slice me in two. House images of the crazy robotic dream episode where he slashes a patient open. Fun times. Up to my hips in large, white doughnut, there's a large flat plate coming closer and closer to my face. 1 inch away, it stops. Now what? No one explained that I just had to lie there while it (silently) detected my gamma radiation through it's lead colander (hehe... collimator, I know). Plate moves out a few inches. Rotates around me. Repeat. Fifteen minutes later, extract me. Tourniquet applied without warning. Sharp scratch. "Sharp scratch.." Bit late, bitch. Apparently my vein is pulsating. That's such a comforting comment to make in front of me. Sure you didn't just make my arteries glow?

Repeat on the claustrophobic plate thing. Extract, Return to wheel chair. Deposit in hallway like lost baggage.

Another lovely porter, who regaled me with how embarrassing it's gonna be for him having a bladder investigation done here where he knows everyone, as a 'one up' on every medical student seeing me in my pj's in a wheelchair.

I would now like to reflect on the behaviour of certain nurses/HCA's on Short Stay. While some (Kristina) were absolutely wonderful, some (no names) were plain rude. Just because the old dear didn't hear you the first time, there is no need to loudly sigh, mutter about her, and roll your eyes. Also, to the nurse who disliked being asked to do something, it's your bloody job. Thankfully, when you woke me at 6am for obs, my brain got you confused with a dream and there was a large hairy gorilla doing my obs. It amused me for the rest of the day.

That was a shit reflective piece. However, I got everything on paper/screen, so I can actually write a decent reflective piece later. And edit this crapola.