Friday, 9 March 2012

Last day of Medicine block

You know, I'm actually a bit sad to leave my Respiratory team. I've been acting as junior doctor whenever my FY1 has been away or on nights. Now the thought of starting my job isn't so bad. For once, I actually felt like I was a member of the team and have been useful, especially as the consultant and registrar have both been on leave for weeks until recently.

Finals are closing in and my Surgery block is next. I caved in yesterday in between revision to watch Junior Doctors on iplayer for the first time. The Chelsea girl didn't know how to certify a death and had to borrow a nurse, I thought back to earlier this week when the CT2 and I were running the ward round and had to certify a patient that had been with us for weeks. He had a brainstem stroke so poor prognosis anyway, but so far in my medical school career, the dead that I have seen haven't been patients that I've helped to take care of. It felt strange to be there when he was pronounced dead. 

Another patient came in with chronic heart failure and ischaemic lower limbs, his bloods were deranged and after investigation, he got diagnosed with myeloma whilst he was with us. It was really sad, I remember talking to him about his great granddaughter, he always had her photo by his bed. He was bright and chatty before, and got steadily quieter and more poorly until he no longer talked. I didn't see him on the ward today and thought he might have died, I asked the nurse and thankfully, he had actually been transferred to a hospice. We had been working to him discharged for a while, I felt happy it actually happened.

Another junior doctor on the TV programme told a patient that he was about to put in a chest drain on her, but it was his second day as a doctor and he had never done a chest drain before. Speaking of which, there was a patient causing a bit of havoc on the ward the other day when he went into the toilet and used a lighter to burn through the tube of his drain. Apparently he was waving it around on the ward afterwards and singing. Alcohol withdrawal.

Another patient on the ward is both blind and mute, illiterate and does not sign. Every time the ward round stops by him, I wonder how lonely it must be, to just sit there and be so cut off from the rest of the world. 

On a Respiratory ward, there are always lots of end of life discussions. To ventilate or not, what about resus, where do patients want to die, how much they would like their family to know etc. I think as medics, we get a skewed view of old age. There are plenty of healthy elderly people out there but we see so many sick people who are not suitable for invasive ventilation or ITU, ones who have accumulated so many different conditions over their lifetime, so many hospital admissions, their family can't cope with them at home, or they have no family, they can't walk anywhere, can't dress themselves... the list goes on and sometimes, it's just plain depressing.

On the flip side, because of being in hospital, any patient below say 60 is young. So I'm going to hold onto that thought and keep smiling. Today is a lovely day, and I am really grateful for my life. Some day, I will become an old lady and with any luck, I aim to still be smiling then.