And we finally enter the hospitals! Not for our official rotations but for nursing attachments to see how the nurses work, what they do and how the hospitals work in general. 7am starts meant we were up at 5.30am as we made our way to Charles and found out exactly where our wards and nurses we follow are. I was in the Respiratory ward on the 5th floor. At 7am we get to see the nurses handover their patients from the night staff to the day staff, this is basically where they a ll sit down with a printout of the basics of the patients condition and then update the printout and include any personal information or specific things to follow up on throughout the day. I felt a little out of it as we were bombarded with abbreviations and terminology i hadn't heard or become accustomed too but i felt so professional even just sitting there pretending like i knew what they were talking about! I had a mountain of questions afterwards which i asked the nurse i was following, a lovely lady called Hazel and learnt so much throughout the morning.
I started off in the high dependency ward in a room of 6
patients who needed constant monitoring and care. There was actually 7 due to an overflow from the ED department so one poor lady was on a bed in the entrance way but another man was being discharged that day thankfully. The morning mainly consisted of following Hazel as she prepared all the morning medications for the patients, both IV and oral. I saw a subcutaneous injection of clexane and the next time one was given i gave it!! Tick! my first injection :) it was done in the stomach of my patient, i was a little nervous because clexane can sting but it went well.
learnt about capillary blood gasses or CBGs which are more popular than ABGs as they are less invasive, but they are tricky as you use a diabetic prick needle on the earlobe and have to 'milk' a small amount of blood out and collect it in a tube, and it has to be done with precision or else the BG machine will not register the blood and the blood gasses will not be read.
Apart from observing the nurses work the other thing i actively did was help showing a patient, i wish i could have done more such as the routine observations or 'Obs' the nurses did to every patient - blood pressure, respiratory rate, oxygen saturation, temperature and pulse i was quite keen to get involved! This morning was a difference experience, i was able to see a patient who had terminal cancer which had metastasized from his lungs, he is a rather lively and intelligent man but is refusing palliative care. It opened my eyes to how different patients come to terms with these situations where they are facing their own mortality. He would open up to the nurse i was with this morning, you could see he was almost battling in his mind what to think of his situation. His wife died of the same condition (please no one smoke!!) 2 and a half years ago and that was when he said his life ended. He was refusing medication such as strong pain killers, but talking to a doctor he is now in the mindset that he regards his body like the military. His symptoms are like the opponent, when they attack is when he wants to act and now that he is becoming symptomatic he is willing to take charge and fight the cancer with radiotherapy. It is the mindset that is helping him deal with his condition and ultimately his decision, in other cases the doctor could use this view and say that sometimes we need to take the opponent by surprise and hit it before the symptoms/attack comes to prevent the effects of the symptoms. I was a little disappointed that the doctor did not try to relate to the patient in his views of the disease but rather diverted what he said back to symptoms and the biological point of view, there is nothing wrong with that but it is important to see the whole picture and take into account the patients perspective and thoughts more to guide treatment decisions, i thought this doctor was lacking this but who am i to judge as a medical student. I know when i am a doctor i want to make sure i spend time to sit down and talk to my patients and MAKE SURE i have the time.
The scenario tied in well with a lecture we then had this afternoon on 'End of Life'. it was quite heavy in the sense that we were asked questions about how we perceive death and our thoughts on how we would like to die - acute and quick or chronic over time. I put my hand up for chronic but 60% said quick and acute. I know you can suffer more in a chronic condition, but when it is my time to go i don't want to go unless i have a chance to fight what is taking me down and a chance to choose my treatment and how i spend the last part of my life. I would want to make sure i can say goodbye to everyone and if i have anything i need to do or say before i was to go then i would do them to 'die peacefully' as they say. I know i tend to be a bit of a fighter and take challenges to try get the most out of my life and that is how i would want to go and with those i love around me. We watched an interview of a patient with pulmonary fibrosis who dies 2 weeks later which was emotional for everyone and made us think how strong the person was to come to terms with his mortality.
The nursing attachments have been a great experience but i have no doubt the rotations will be even more experience which will leave us both exhilarated and overwhelmed at the same time! There is so much in medicine and life to learn.
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