Reflection. It is the dreaded word in healthcare. Why? Because it is uncomfortable and tedious. Imagine selecting the most boring film you know and watching every excruciating minute of it. Now imagine watching it with the most critical person you know. Does that sound fun? Reflection isn’t meant to be fun. But it is vital for creating a better health care service. Continue reading
A week ago I met with a patient who was staying in hospital for a few days after having had bowel surgery. He was upbeat. Telling me about plans for when he would go home. Telling me about various events in his life. I took a history. In medicine, ‘taking a history’ basically means finding out as much as you can about a patient, as efficiently as you can, so that you can plan their treatment and hospital stay optimally. It requires practice and there is a technique so I thought I’d get some practice in. I was feeling quite happy by the end of the chat. The patient was jovial and I had done my duty. I got up to leave, smiled briefly and he went back to reading his newspaper. I went home that night, narrated my experience to my family and thought nothing more of it. Continue reading
Paul Kalanithi was an American neurosurgeon who, in his dying moments, wrote a sort of autobiography of his personal and professional life. This book took two parts. One in which he was the doctor. Treating complex brain pathologies with a fervour of success. Aspiring towards pioneering research, at the brink of stepping into a life-long dream. Only to be diagnosed with lung cancer which would eventually kill him. Forcing him to turn his 20 year life plan into more of a 20 month plan. The second part is about his journey from diagnosis onwards. The courage and persistence he must have shown in the face of death isn’t something I can possibly even begin to imagine. And yet as a future doctor it is something that I will not only have to begin to imagine but see daily. Emotions are always running high in medicine. There’s always something going wrong and death is inevitable.
Many doctors I know have told me that in light of so much pain and misery the only way to escape is by becoming resistent. Putting up a wall. A front. So that every time you see a mother crying for her unborn baby, you don’t too break down and cry. When you see a sister’s tears for a brother who will never speak to her again, you do not also think of your own sibling and feel dizzy at the thought of loosing them. Death is part of life. But when you are a doctor, you’re the one who must hold in the tears and emotion and offer solutions and maybe even hope. Or at the very least clarity and the truth. It’s not your sorrow to share. Emotional blunting some call it but I think it is a form of survival. How else would you be able to get through day after day of telling people they have incurable cancers and disorders that no medicine will help them survive?
My issue though is that I’m not just a future doctor. I am also a human being. I’ve also been granddaughter who has lost a granddad, a niece whose lost an uncle. And that excruciating pain of sorrow never dulls. Its terrifying. Its not unique. My issue is that I know I should be able to separate my own pain and that of the patient’s but how can I? Empathy and sorrow seeing other people’s pain is what makes us human and yet it is that very quality that can run away with you and turn a perfectly good doctor into an emotional, distraught mess.
This book explores the journey of a doctor as he becomes a patient to his own disease. It is a very difficult book to read. But one that reaches into your heart and pulls it right out. It explores death from a different perspective – from a person who has experienced it both for his patients and for himself. As said in the book: ‘dying in their fourth decade is unusual now, but dying is not’
Dying is part of life. Death surrounds us. But it isn’t always dark, depressing and terrible. Sometimes, some people only start living when death is in sight.
That’s all for now.
Stomach pain -or as they are medically known – abdominal pain is a very common complaint and one that almost all of us must have had at some point in our lives. There are many kinds of stomach pains. We can categorise them based on how they feel: eg. dull, sharp, burning, crampy. We can do one better and categorise them on location: upper abdominal, lower abdominal, right upper, left lower. We can even categorise them based on how long the pain has been there for: seconds? Minutes? Days? Years!? By doing this we can already start to form what sorts of things are probably going wrong in the abdominal area. This is called a focussed history taking of a patient. Not that I’m an expert but I’m going to attempt to discuss a particular case of a woman with abdominal pain and through that case, hopefully highlight to you how important a good history is.
In the hospital, crash call alarms are the single alarm that you both dread and look forward to. It’s the one time doctors and nurses (and anyone who is available) get closest to being a paramedic. On one hand its terrible because a crash call means that something bad has happened to a patient for which ALL HANDS ON DECK are needed to get that patient back to a stable state. And that’s sad. Because the patient is sick. However it’s also adrenaline rush inducing. The atmosphere of the whole ward changes. Everyone is focussed on the patient. From the most juniour members (us medical students) to the nurses and juniour doctors, right up to the consultant. There is something for every body to do.
Today morning, a crash call alarm went off on the ward I was on. We were in the middle of a ward round and suddenly the two doctors around me and a bunch of nurses ran to the place where the alarm was coming from. I, along with the other two medical students, rushed along too. From the peripheries I could just make out that the patient was on the floor – not responding. The doctors and nurses worked together in a calm yet fast manner to get bloods, a cannula in and IV access. The patient’s vital signs (blood pressure, temperature, blood glucose levels, heart rate and respiratory rate). were all normal This was important to check because people don’t just fall down and loose consciousness for no reason! I helped too by running to the labs with the blood to check for any abnormalities.
Whilst this was all going on, the rest of the patients in the ward had to also be looked at. Normally on a ward round in hospitals, you have a few doctors checking each patient, every day. Well today, the crash call meant that only the consultant was available to carry on. I went along with the consultant – intending to help with small things like getting the curtains around the bed, opening up the observation charts and holding the notes. The actual doctoring part, I normally leave to the professionals. But we were low on doctors and that meant I had to write the patient notes myself (DISCLAIMER: This was obviously checked and signed off by the consultant!).
It certainly was an interesting morning…and just made me appreciate how unpredictable working in a hospital is!
Medical dramas on TV were my favourite because I always imagined myself to be like Turk from Scrubs – cool and smart, or Dr. House – grumpy but loveable or Meredith from Grey’s anatomy – dramatic and brilliant, her hair always perfect.
This was me Monday morning: Stethoscope falling out of my bag, having no clue where the patient files are kept and forgetting my water bottle so that by 5:30 pm on my first day on emergency medicine placement, I looked more like a drowned rat than a medical student on placement.
Placement is essentially practical, hands-on experience at doing what doctors do. Except I know less than half of what the most juniour doctor knows and I’m pretty sure that I’m getting in the way more than I’m actually helping. Not to mention being a medical student qualifies me to be able to do exactly nothing on my own – and patients know this!
Take this morning, for example. I was sat in an acute ambulatory unit in the acute medical unit, waiting to take blood samples (venupuncture) for the first time ever on a real patient. Previously I’d always practiced on a mannequin. The first patient just flat out refused. The second one looked a little dubious but agreed in the end but his arm kept shaking, revealing his inner doubts on my ability (not entirely misplaced!). The thirds patient was eerily calm. That was good and I managed my first ever independent venupuncture. There was red stuff coming out…pretty sure it was blood!
Hospitals are busy places. You have acutely sick patients. Porters moving beds and patients around the wards. Nurses caring for their patients, doctors doing this that and other. And the bustling wards are a beautiful place to learn about the weird, common, rare and simple interesting pathologies of the human body. A sick heart can make so many sounds. Just a quick listen can illicit if somebody has a pleural effusion or more like a pneumonia. A quick chat to a nurse will tell you whether the patient is a returning patient or a new admission. The juniour doctors always know what management plan a patient is on. You simply can’t get bored. I do feel selfish in the knowledge that whilst I am here I’m really only helping myself learn.
But there’s always a moment that you remember. And I think for me today it was a small fraction of a second that sealed the deal for me. We were on ward and I wasn’t doing anything particular. All I did was look up whilst I was examining a patient and smile. I apologised for taking so long and not letting the patient finish a sudoku puzzle.
The patient just smiled back and replied: ‘you are the future. You’ve got to learn somehow’
It occurred to me quite suddenly that placement is fun and enjoyable and really exciting. But at the same time I’m not just learning for myself. By ensuring I know my medicine properly today, I’m having an impact, however small, on the lives of real people. They’re not just a disease. They’re a person.
I walked out from the ward whilst relatives were visiting. And as I walked near the doors, the patient from this morning recognised me and said ‘goodbye’.
I don’t know why but it made me smile. I might not be Turk or Dr. House or Meredith. But these small moments make me feel even more cool and smart and on top form than any doctor I’ve seen on TV.
After all, TV is fiction and hospital medicine is reality!
A couple of months before my 15th birthday, my mum took me into the doctor’s surgery. The following weeks revolved around concerned parents, blood tests, lots of doctors including paediatricians, gynaecologists, endocrinologists and even radiologists and finally a diagnosis of PCOS.
PCOS, short for Polycystic Ovarian Syndrome, is an endocrinological disorder which affects the hormones oestrogen and testosterone. It results in multiple small follicles (eggs) in the ovaries which struggle to mature. The main result of this is irregular periods. The high testosterone results in male pattern hair growth and skin problems. Continue reading