The weather in Stornoway has taken a turn for the worst.
The weather is absolute shite.
It's probably the worst weather I've seen in my four years in Scotland.
The wind is howling, the rain is pelting and the days are getting shorter and shorter.
I just hope that we can get off this island in 3 weeks time. The ferries to the mainland have been cancelled for the past 3 consecutive days.
I am now at the computers in the nurses library in the hospital doing a night shift. And there's nothign happening.
I just scare away all forms of emergency. sigh....das ist sehr schlecht.
Anyhoos, since I have the time whilst I'm waiting for the bleep to go either for somethign in A&E or a cardiac arrest, let me tell you about the greatest tale of love that I've experienced so far in this hospital.
The characters in this tale are M and C.
M is the sweetest old gentleman that I have ever met who is a long term resident in my dementia ward and C is his wife down in the medical wards.
They are both in their late 90s and they are both very unwell.
But along with that they are both still very much in Love.
When I first saw C during a medical ward round she was anxious and desperately telling the doctors that she wanted M back home with her and that she would look after him. She was desperately concerned for her husband's health stating that being in hospital would do him no good because he was an intelligent man who needed mental stimulation and that he would miss his gardening desperately. She was literally begging us to let her bring him home with her. And it was truly disappointing that we could not fulfil her wish.
On Saturday whilst on my night shift, we were called to see her on the ward as she was experiencing a panic attack. On arriving we saw this frail old lady, sitting upright in her chair, very cold to the touch, tachypnoeic and literally verging on hyperventilating and in between her gasps of breath she was saying '' I want to see him. Why won't they let me see him.''
3 days later on tuesday when I was on the medical ward doing some bloods, the nurses told me that she had suddenly demented over night and was now placed in a side room. But at night she still continues to moan, shout and cry. Regarding this, my registrar who uses the oncall room next to hers can vouch for.
Whenever I go onto the dementia ward to check on jobs to be done and to see my patients I always see M pacing up and down the hallway. With M, you can just stop and say hi to him and chat away and he will always have something to chat to you about or even teach you something new each day in gaelic. He is so sweet and gentle, he's just the perfect grandfather that any little child could ask for. But I suppose that for all the laughs and smiles he brings to us, our hearts go out to him whenever we see him wondering through the rooms and looking at each resident and asking ' Where is C? Where can I find her?'' or '' I'm waiting for C, but she doesn't seem to be coming''
To put all this into perspective, you have to add the medical implications to this tale.
C had a recent bout of infective endocarditis ( infection of the heart valves ) and basically her heart valves are all knackered and she is not fit for surgery. She is frail and doesn't have long to live. She cannot look after M even if she gets him home because she can barely manage to look after herself. Care packages will not be able to provide the 24h care that they both will eventually need.
M is severely demented. He needs constant monitoring otherwise he may just wander off and hurt himself. Although he is physically well for now, his mind and memories are rather jumbled. However, through this haze, the one thing that rings clear in his mind, is his C.
The nurses have been pushing for them both to be on the same ward. And I can see their point. These 2 have been together all their lives. And it is a right shame that we cannot let them be together in the final stages of their journey. The saddest and most infuriating of it all is that, by the time we get all the administrative and logistics sorted to get them in the same ward, C will most probably be dead or too ill for care on the dementia ward.
All it takes is compassion and sympathy and to let all this bureacracy and pushing of patient responsibility take second place in our patient mangement. It seems so strange that at the end of the day, all of us in this profession proclaiming care and compassion are seeming scared into submission by legalities and logistics and indemnity that even though our hearts know what is the APPROPRIATE thing to do, we let our minds guide us to do the RIGHT things.
A few days ago I was having my usual afternoon chat with M.
Me :"M, do you miss your garden at home?''
M : ..... " I miss watching my wife working in the garden.''
That would the most beautiful sight ever to see both of them in the garden together. But until we can overcome the weeds that have overgrown this bureatical healthcare system then perhaps can their little piece of heaven bloom.
Thursday, October 2, 2008
Sunday, September 21, 2008
Clinic with Dr. W - 12/9/08
Dr. W is the consultant psychiatrist on the dementia ward Clisham. He is a strange, enigmatic gentleman. He towers over everyone and with a stature as great as that it’s amazing that you don’t feel intimidated or threatened by him. Why are we not intimidated by Dr. W? Well, that’s because he’s nice and he’s seemingly hyperactive restlessness and stuttering repetitions just destroys the image of a ginger haired sasquatch with OCD.
Anyhoos, I was sitting in with him for clinic on Friday. This would probably be my first full length encounter with the man apart from the hellos in the corridor and the short introduction on Monday. So we head into his consultation room, he sits down, glances at the clock and goes ‘’ Oh no, we are 5 minutes late for our first patient.”
5 minutes late....5 minutes late.......goodness....5 minutes late is NOTHING compared to the times when I’ve seen consultants waltzing in for their FIRST patient an HOUR late.
Then he goes about setting up his laptop and stuff. And begins his lecture on why he TYPES his OWN patient letters DURING the consultation so that the letters can be sent out faster instead of rotting away in a little cassette tape waiting for a secretary to return from a never ending holiday to get it typed and sent away.
Alright, so the principle behind this modus operandi is noble and laudable but seriously, if you’ve ever seen a psychiatric assessment clinic letter, they’re lengthy, you could probably get away with 2 if not 3. Ok...but to be honest this is not the reason why I was appalled by this. The reason soon became appallingly apparent during the first consultation.
Do you know those people who type with 2 fingers? Yeah...the people who are snobs who believe that stabbing at the keyboard with 2 index fingers can do the job of the ten fingers that God so graciously granted us. Well, yes, you could achieve the same, but probably at like twice to thrice the time, or for some, never. Yeah....so Dr. W isn’t exactly that bad. He types with 4 fingers.
It’s quite interesting to watch him type. Using different permutations of 4 out of the ten available. Oh yes, did I not mention that he’s a big man? Yeah....so u have this giant hunched over a fujitsu lifebook, daintily stabbing out his letters.
Most of you lot will feel my pain. It was just so infuriating watching him do that. At one point I wanted to just help him type his letters out. Unfortunately, he found good use of me which granted him more time to catch up with his typing.
Yup, I was mental state assessor of the day. I can probably memorise the MMSE forwards and backwards by now. Give me a couple more tries and probably the Addenbrooke’s Cognitive Examination as well.
Yeah..so whilst I was busy trying to get my dearly beloved gramps and grans to tell me what day, date and month it was and which island and country they were in, and getting them to repeat words after me ( yes. I admit that towards the end I was funmbling over how to pronounce hippopotamus in the ACE test), there was Dr. W happily stabbing out his letters and quizzing the bewildered relatives.
So all in all it was a good clinic. Good opportunity to revise and practice mental state assessments. As well as to realise that my carefully groomed Scottish mainland accent of 4 years doesn’t work so well on these islanders especially when it somehow has an American tinge to it and when they are native Gaelic speakers and ‘slightly’ deaf.
But believe you me, someone please give the man some typing lessons for Christmas along with the black faced Jacobs sheep that he wants for his newly acquired croft.
Anyhoos, I was sitting in with him for clinic on Friday. This would probably be my first full length encounter with the man apart from the hellos in the corridor and the short introduction on Monday. So we head into his consultation room, he sits down, glances at the clock and goes ‘’ Oh no, we are 5 minutes late for our first patient.”
5 minutes late....5 minutes late.......goodness....5 minutes late is NOTHING compared to the times when I’ve seen consultants waltzing in for their FIRST patient an HOUR late.
Then he goes about setting up his laptop and stuff. And begins his lecture on why he TYPES his OWN patient letters DURING the consultation so that the letters can be sent out faster instead of rotting away in a little cassette tape waiting for a secretary to return from a never ending holiday to get it typed and sent away.
Alright, so the principle behind this modus operandi is noble and laudable but seriously, if you’ve ever seen a psychiatric assessment clinic letter, they’re lengthy, you could probably get away with 2 if not 3. Ok...but to be honest this is not the reason why I was appalled by this. The reason soon became appallingly apparent during the first consultation.
Do you know those people who type with 2 fingers? Yeah...the people who are snobs who believe that stabbing at the keyboard with 2 index fingers can do the job of the ten fingers that God so graciously granted us. Well, yes, you could achieve the same, but probably at like twice to thrice the time, or for some, never. Yeah....so Dr. W isn’t exactly that bad. He types with 4 fingers.
It’s quite interesting to watch him type. Using different permutations of 4 out of the ten available. Oh yes, did I not mention that he’s a big man? Yeah....so u have this giant hunched over a fujitsu lifebook, daintily stabbing out his letters.
Most of you lot will feel my pain. It was just so infuriating watching him do that. At one point I wanted to just help him type his letters out. Unfortunately, he found good use of me which granted him more time to catch up with his typing.
Yup, I was mental state assessor of the day. I can probably memorise the MMSE forwards and backwards by now. Give me a couple more tries and probably the Addenbrooke’s Cognitive Examination as well.
Yeah..so whilst I was busy trying to get my dearly beloved gramps and grans to tell me what day, date and month it was and which island and country they were in, and getting them to repeat words after me ( yes. I admit that towards the end I was funmbling over how to pronounce hippopotamus in the ACE test), there was Dr. W happily stabbing out his letters and quizzing the bewildered relatives.
So all in all it was a good clinic. Good opportunity to revise and practice mental state assessments. As well as to realise that my carefully groomed Scottish mainland accent of 4 years doesn’t work so well on these islanders especially when it somehow has an American tinge to it and when they are native Gaelic speakers and ‘slightly’ deaf.
But believe you me, someone please give the man some typing lessons for Christmas along with the black faced Jacobs sheep that he wants for his newly acquired croft.
Friday, September 19, 2008
Road trip around the Western Isles
On Saturday, me, liz and anne rented a car and decided to do some road tripping around the western isles after the persistent bugging of our consultants and Leila our registrar to ''See the islands!'' , " Enjoy the scenery!", '' Don't stay in Stornoway all the time''. Yes, my dears, the amount of advise we get to '' Go out and enjoy yourselves whilst your here." is much greater than the amount of instructions we get to '' Go make yourself useful on the wards" hahaha...that's Island life for you.
YEah, so bright and early on Saturday we set off for the South of Stornoway covering the Isle of Harris all the way to the southernmost tip of Levenborough. It was a really rustic and breath taking drive. I'm sure I've said this once before but I just have to say it again but the scenery in Scotland, particularly here in the open mooreland, highland and countryside is just amazing. Even the houses here are quaint, sturdy and to me an exact replica of the houses I read about from the Enid Blyton books of my childhood years. 
We arrived in the little fishing town of Tarbert just before noon and had a wee walk around. Tarbert basically has nothing much accept for a ferry pier, a tourist information centre and overly priced souvenir shops. but wait! They also have.... an INFLATTABLE PUB! YEs, a most interesting sight indeed.
After Tarbert, we headed along the west coast of Isle of Harris and went to Luskentyre Beach. Yes, Thank you Dr. Welsh that suggestion was indeed superb. It was low tide when we arrived with a slight drizzle upon the beach, so basically we were greeted with a BEAUTIFUL expanse of sand decorated with little treasures of the sea such as conch shells and well polished pebbles.
After luskentrye, I decided to take over the wheel of our little ford fiesta. and believe you me.....the roads on the beyond of NOWHERE are DANGEROUS.
Not only do you have to be aware of sheep that are found just about anywhere and anywhere but you have to be aware of cars, trucks, and bloody bikers that appear just about anywhere and everywhere as well. The worse bit of it is that you have to dodge and giveway to this whole lot of 'things' whilst your on a SINGLE LANE PATHWAY that looks like a road for the better part of the way but can look just like a narrow strip of CONCRETE at certain areas. Blimey....drving down to levenborough was like tempting fate all the way down for me, a person who's so used to city driving with proper traffic lights and dual carriageways. I swear sheep are really cute, but when they decide to WALTZ across the road as and when they please or just lie in the MIDDLE OF THE ROAD staring at you through the windscreen with their insolent black faces ... it just makes you want to go on a one year feast of lambchops and to wear SOLELY wool just to reduce their numbers.
yeah...so somehow i managed to get everybody to levenborough in one piece which is always good. We visit St. clements church which was in Rodel which was quite nice, except for the fact that I pulled my hamstrings climbing up these horrendously steep stepladders to the loft in the church which in retrospect was a good thing because it put me out of the role as designated driver for the rest of the day.
Levenborough is really really rustic. AKA....there is NOTHING. literally NOTHING in this town. Save for a few houses, a post office and a shop selling groceries. There is basically nothing here. For us city chicks, it was a case of " Wow....this is so 18th century." " oooh look at that wheelbarrow and the well....." and then stamping down on the accelerator and zooming off towards the 'nearest' post of civilisation.
YEah, so bright and early on Saturday we set off for the South of Stornoway covering the Isle of Harris all the way to the southernmost tip of Levenborough. It was a really rustic and breath taking drive. I'm sure I've said this once before but I just have to say it again but the scenery in Scotland, particularly here in the open mooreland, highland and countryside is just amazing. Even the houses here are quaint, sturdy and to me an exact replica of the houses I read about from the Enid Blyton books of my childhood years.
We arrived in the little fishing town of Tarbert just before noon and had a wee walk around. Tarbert basically has nothing much accept for a ferry pier, a tourist information centre and overly priced souvenir shops. but wait! They also have.... an INFLATTABLE PUB! YEs, a most interesting sight indeed.
After Tarbert, we headed along the west coast of Isle of Harris and went to Luskentyre Beach. Yes, Thank you Dr. Welsh that suggestion was indeed superb. It was low tide when we arrived with a slight drizzle upon the beach, so basically we were greeted with a BEAUTIFUL expanse of sand decorated with little treasures of the sea such as conch shells and well polished pebbles.
After luskentrye, I decided to take over the wheel of our little ford fiesta. and believe you me.....the roads on the beyond of NOWHERE are DANGEROUS.
Not only do you have to be aware of sheep that are found just about anywhere and anywhere but you have to be aware of cars, trucks, and bloody bikers that appear just about anywhere and everywhere as well. The worse bit of it is that you have to dodge and giveway to this whole lot of 'things' whilst your on a SINGLE LANE PATHWAY that looks like a road for the better part of the way but can look just like a narrow strip of CONCRETE at certain areas. Blimey....drving down to levenborough was like tempting fate all the way down for me, a person who's so used to city driving with proper traffic lights and dual carriageways. I swear sheep are really cute, but when they decide to WALTZ across the road as and when they please or just lie in the MIDDLE OF THE ROAD staring at you through the windscreen with their insolent black faces ... it just makes you want to go on a one year feast of lambchops and to wear SOLELY wool just to reduce their numbers.
yeah...so somehow i managed to get everybody to levenborough in one piece which is always good. We visit St. clements church which was in Rodel which was quite nice, except for the fact that I pulled my hamstrings climbing up these horrendously steep stepladders to the loft in the church which in retrospect was a good thing because it put me out of the role as designated driver for the rest of the day.
Levenborough is really really rustic. AKA....there is NOTHING. literally NOTHING in this town. Save for a few houses, a post office and a shop selling groceries. There is basically nothing here. For us city chicks, it was a case of " Wow....this is so 18th century." " oooh look at that wheelbarrow and the well....." and then stamping down on the accelerator and zooming off towards the 'nearest' post of civilisation.
On the way back we visited th Harris Tweed factory outlet near Tarbert. Right Harris tweed is the thing that you have to get when you're on the Western Isles for a holiday. Because here in the Hebrides they boast of this pure wool material that is handwoven by the islanders. And believe you me, the clothes, accessories and stuff made of Harris Tweed is REALLY PRICEY. but it's good quality stuff and really well made and so, well, I would say a good investment to make. I made an investment in a smart looking bookbag which i'm preety pleased with so yes, that's me sorted with a souvenir for this journey.
So that was the main places we visited on Saturday.
On Sunday, we did the regions North of Stornoway.
First of were the Callanish stones.
So that was the main places we visited on Saturday.
On Sunday, we did the regions North of Stornoway.
First of were the Callanish stones.
Anne was telling us that they are one of the top three things that you have to see before you die.
and I think they most certainly are. Seeing these ranks and circle of stones standing on top of the hill against a back drop of rustic farmland, a loch and skies of cotton candy makes is truly a sight that you will carry with you for life. The air was so clean and fresh, and the sun was just rising over the moor so it was indeed rather spectacular.
After spending a good hour there, we headed off for the black house village. This is a little settlement that has been depopulated for some time which shows you the true essence of country living. From the thatched roofs to the fireside to the peat stacks in the back of the cottages. It just makes you so appreciative of what you have with your internet, your computer, your ELECTRICITY. But itwas really very interesting to see this little settlement in the middle of nowhere. But then again, which such a beautiful beach and cove at your doorstep I'd think pple would be rather happy with that as opposed to the unreal 2 D images from some computer generation.
After that we went all the way to the northernmost tip called ' The Butt of Lewis"
It was just Amazing. The coves here are a superb example of nature being the most talented sculpture of all. Just standing there watching the swirl of white as the blue waves crashed upon the rocks was just breathtaking. I could stand there for a whole day and watch this poetry in action. haha...but apparently we werent the only ones watching, because soon we had a seal come along and watch us from its bobbing position in the sea. I think the butt of lewis has to be the most spectacular point in our travels that day.
After this we drove back and stopped along the way to enjoy the numerous beaches along the east coast. The western isles may be an isolated set of islands in the middle of nowhere, but the compensate for its peripheralness, it boasts one of the best collection of beaches that I've seen anywhere. Clean, cold, clear waters. White, pristine sandy beaches. The perfect place for a nice stroll as the sun comes down.
Yes....so that's basically the gist of our roadtrip on our first weekend in Stornoway.
Of coures reading about it is not as great as experiencing it. But oh well, if I even managed to let u have an inkling of how it's like....then that's great. If not, a short trip to the western isles earns a 4 star recommendation from me. You can only blame the sheep and the heart attack inducing roads for that near miss of a perfect score.
Tuesday, September 16, 2008
Night shift in the Western Isle General Hospital - 11/9/08
After having done a day on psych and such as can be seen from the above entry. I decided to turn in for night shift as well seeing that I was getting fidgety after having done no major clinical management so far.
Right, so few things to clarify. In this hospital, night shift means....one SHO ( senior house officer), one junior doctor, one nurse practitioner a reduced bevy of nursing staff and just to make the mix more interesting.... One medical student.
Well, as you all know by now....Stornoway is a small town. The isle of Lewis is even smaller. And basically, on week nights...nothing much go on. But naturally, on weekends, particularly Friday and Saturday night...that when things get busy on night shift. Or at least you hope so.
So was basically on night with Chris ( the very friendly , though merrily cynical surgical SHO), Aruj the quiet FY1 and me, the appenditure for the night. Yes, mateys....medical student are on first name basis with all ranks until we encounter a consultant.
So it was basically a quiet night...lotsa query TIAs, CVAs possible intestinal obstruction due to adhesions and ....yes....we all know we’ll get one of these...bad side effect to antibiotics.....seriously. Oh yes, and septicaemia in the wee hours of the morning when all was wont of giving up on anything happening and everyone’s life history had been told round robin in the pantry of A&E.
Yeah, so basically I would say the interesting bit of my night shift would be:
1) Being on the move and on the job for 20 hours and the niggling thought that u have a clinic the following morning but can’t bear to leave in case ‘something interesting’ comes through the doors.
2) Listening to the banter amongst your seniors. Honestly, the amount of dirt and juicy morsels that gets dished out is just amazing. Never again will you be able to view a consultant in the morning without chuckling after having seen him through the reality shedding glasses of the night shift.
3) Mr. K the locum surgical consultant asking me this INFERNAL question after Chris had introduced me and said that I was interested in traumatology
*smirk*‘ Do you think you can fight with the boys?’
‘I think I can definitely hold my ground.’
‘No, you cannot only hold your ground, you have to be able to fight.’
‘Well Mr. K, if need be, I can definitely bring the guns out.’
4) Mr. K saying that when Breast Surgery is an area of surgery that women would be most suited too. Well, far enough, I don’t mind that , because I also find Breast surgery interesting. But honestly....the number of female patients I see wanting a good looking male breast surgeon managing them ....I think business would be slow, once again, for a female breast surgeon.
Yes....at this point in time...A&E in a big hospital is looking more and more enticing...but....I think my guns are still aching for a fight so will have to see what time will show.
Sunday, September 14, 2008
11/9/08 - The blood sucker
On Thursday, after a drought of having done nothing clinical I finally struck gold in being able to bleed patients after a morning tutorial with our beloved local phlebotomist. After the morning supervised tutorial me and Liz were let lose as unsupervised bleeders.
On this note, the afternoon found me being ‘invited’ to practise bleeding one of our dearly loved on the Clisham ward. Bless his soul, the man had really undetectable veins. Didn’t help that the nurse assisting was both nice and sympathetically condescending at the same time. After half an hour, working without a proper tourniquet (I had forgotten mine, and thus had to rely on the nurse as a manual tourniquet...which probably didn’t help the situation on retrospect), and minimal supply of butterflies and uncooperative veins , I finally threw in the towel whilst the nurse left to pilfer more butterflies from the neighbouring stroke unit and decided to do things against protocol. Thankfully, the man was well sedated and hopefully unaware to what we were doing to him.
Yes, so fed up with the touniquetless situation, I did the one thing that I recalled from watching ER, grabbed the largest pair of gloves and tied it around the man’s arm and starting tapping fervently on all his venous pathways as I could recall from my distant anatomy lessons. And lo and behold I find two possible sites for bleeding. And when nursie returns, he goes....’ shouldn’t the gloves be on your hands?’ I was like .....whatever, I had an extra pair anyway....
Seriously...everyone does this! And do you honestly want to continue standing here like this for another half an hour subjecting this poor man to incessant stabbings because we can’t tourniquet him properly!
Anyhoos, managed to draw blood without incident and so left the ward with the prized samples for the lab feeling utterly smug and with a sense of achievement that is probably 2 degrees below how I felt after having passed my fourth year finals.
On this note, the afternoon found me being ‘invited’ to practise bleeding one of our dearly loved on the Clisham ward. Bless his soul, the man had really undetectable veins. Didn’t help that the nurse assisting was both nice and sympathetically condescending at the same time. After half an hour, working without a proper tourniquet (I had forgotten mine, and thus had to rely on the nurse as a manual tourniquet...which probably didn’t help the situation on retrospect), and minimal supply of butterflies and uncooperative veins , I finally threw in the towel whilst the nurse left to pilfer more butterflies from the neighbouring stroke unit and decided to do things against protocol. Thankfully, the man was well sedated and hopefully unaware to what we were doing to him.
Yes, so fed up with the touniquetless situation, I did the one thing that I recalled from watching ER, grabbed the largest pair of gloves and tied it around the man’s arm and starting tapping fervently on all his venous pathways as I could recall from my distant anatomy lessons. And lo and behold I find two possible sites for bleeding. And when nursie returns, he goes....’ shouldn’t the gloves be on your hands?’ I was like .....whatever, I had an extra pair anyway....
Seriously...everyone does this! And do you honestly want to continue standing here like this for another half an hour subjecting this poor man to incessant stabbings because we can’t tourniquet him properly!
Anyhoos, managed to draw blood without incident and so left the ward with the prized samples for the lab feeling utterly smug and with a sense of achievement that is probably 2 degrees below how I felt after having passed my fourth year finals.
Rural medicine tutorial with Prof
Goodness....it’s great to be all enthusiastic and such with your chosen speciality especially when you’re the single expert in rural medicine in the entire Scotland. But honestly Prof...making us poor medical students already experiencing the complexities of being sent to a hospital in the periphery first hand, an hour long tutorial on TUESDAY afternoonS from 4-5pm is just too grating.
Multicoloured graph after multicoloured graph quoting figures of times for accessibility to healthcare services is really not accessible to our tired and overworked minds. I suppose some bits of it are interesting especially things like choice of destination for airlifting being determined by the amount of fuel in the air rescue helicopters.
Ah well...the long and short of it was that miraculously halfway through a particularly longwinded discussion of YET ANOTHER coloured graph I happened to get some grit flying into my eye as I was shifting around in my chair trying to get comfortable. So I asked to be excused and our dear prof just had to quip ‘ Are you alright? You know where A&E is right?’
No prof, all I need is the toilet, clean running water, and some paracetamol for my headache. And whilst I’m at it perhaps a perforated ear drum will make me blissfully deaf to another explanation of a self explanatory graph.
Multicoloured graph after multicoloured graph quoting figures of times for accessibility to healthcare services is really not accessible to our tired and overworked minds. I suppose some bits of it are interesting especially things like choice of destination for airlifting being determined by the amount of fuel in the air rescue helicopters.
Ah well...the long and short of it was that miraculously halfway through a particularly longwinded discussion of YET ANOTHER coloured graph I happened to get some grit flying into my eye as I was shifting around in my chair trying to get comfortable. So I asked to be excused and our dear prof just had to quip ‘ Are you alright? You know where A&E is right?’
No prof, all I need is the toilet, clean running water, and some paracetamol for my headache. And whilst I’m at it perhaps a perforated ear drum will make me blissfully deaf to another explanation of a self explanatory graph.
Tuesday, September 9, 2008
First day on the wards
8/9/08 - First day on the wards
After a pleasant and laidback weekend getting to know my housemates and a little bit more about the island it was time to settle back into reality and start off on the wards once again.
The Western Isle General Hospital is a small hospital that serves a catchment area of the outer hebridean islands. Though small it is well equipped to provide for the general needs of the population though often it is necessary to fly some of our patients of to the mainland and Raigmore hospital in Inverness but I think we deal with our ‘problems’ quite well.
Ok so for a small hospital I’m impressed. Why?
Firstly the staff are wonderfully friendly to one and all. In general, I think Stornowaynians are a really friendly bunch. Everywhere you go, everyone you pass by you’re bound to get a hello or at least a warm smile. As we were discussing over dinner on Sunday, if we started doing this in ARI ( Aberdeen Royal Infirmary) we would more or less have earned ourselves a one way ticket to Royal Cornhill hospital just down the road. Yes, that’s our beloved and esteemed mental hospital.
Secondly, the hierarchy that distinguishes medical students from FY1, SHOs, Reg seems to be much diluted. Everyone is on first name basis. The consultants are friendly and nae so hoity toity ( at least the ones I’ve met so far). Although the medical students have undoubtedly not mustered the courage to call our consultants ‘Tim’ or ‘Allen’ and feel more comfortable with ‘Excuse me Mr Robinson...’ at least here the consultants actually remember our names and take our opinions in patient management into consideration and are patient enough to answer our queries. Nae any of that ‘ Me consultant, you insignificant bottom feeder. You must lick my boots and do everything I tell you’. This actually seems quite fantastical to me....I hope this is not just a dream. But, so far so good.
Thirdly, I think that in general, being a final year medical student in this hospital is a great booster for your confidence. And to a varying degree to your ego. For one thing the nurses are rather friendly here and are actually willing to aid the medical student. Many a traumatic occasion can I remember being so terribly peeved by a gaggle of nurses going ‘ Oh Anne, THIS medical student can’t seem to find her patient, patient notes, obs chart....blah blah blah ..’ . Well, Anne, all I can say is that if you’re not going to note on the ward board where your patient has been sent to and decide to sit on stack of notes whilst you yak about your unfortunate date on Saturday whilst the rest of the medical staff are searching for them, then you’re just going to be ‘’ THE nurse who.....” in the doctor’s room. But yes, forgetting Anne, in ARI and in most hospitals i’ve experienced, the nurses rule, and the top of the sisterhood would be the alpha female called ‘Sister’. And as a medical student, if even one of them is nice to you and helps you out with something, you praise the lord and be thankful that you might have actually done something right.
So after four years of this traipsing around the hallowed order of nursing ( okay, not all nurses are bad. I do have my nurses who are my allies on some of the wards in ARI ) I was pleasantly surprised this afternoon. In between seeing patients in clinic, my friendly SHO on the psych ward asked me to go off to the dementia ward to give 2 patients the ‘once over’ as the nurses had reported that they were experiencing spiking temperatures. Yeah, so basically I was to go over and assess them, check their obs and see if they were REALLY ill and needed immediate senior attention. So off I went. First day back on the job so could feel the adrenaline coursing through my veins. I found a nurse who brought me to the lassies and this is where I experienced the joy of being a final year medical student.
Let me clarify this distinction. Last year when I was a fourth year, I was pointed to where a patient was by some unhappy finger from the nurses station. Now, I am led to the patients bedside. Instead of having to be introduced to the patient and have consent to be seen by a student begged by someone, I just go and do what I have to do. Last year, I would be struggling to manipulate a 80 pound bloke by myself, today the nurse does it for me. Last year, I would be busy running between the medical records tray , the end of the bed for the obs chart and other bits of bobs for cannulation or whatever, today I ask a question and it sends the nurse running off to get what I request. And for once, I actually got a feeling of how it is to be the one asking the questions and seeing the uncertainty and anxiety flash across the face of the person on the receiving end.
“ Has Mrs X moved her bowels today or at all in the past few days?’’
“ Em....I wouldn’t know. I’m sorry. But I could go and check for you. Would you like the obs chart?’’
‘’ Yes please.”
(30 seconds later.....)
“Em....it says she hasn’t moved her bowels in the past week” ( panic starting to set in )
“ The past week....was this mentioned to the medical team and laxatives requested?”
“Em...no....I’m afraid we didn’t pay much attention to this.......”
“Okay...thank you , i’ll let the Reg know about this.”
Okay, to be fair this nurse was ultra nice. And it just felt good that I could carry out a nice patient management chat without being dismissed as being ‘just another medical student’.
However, I do have an inkling of a feeling that this may just be nurses in this hospital. I think I would be mauled if I tried something like this in ARI. I don’t think the conversation would actually go far. It would probably have ended with a “ You doctors should know your patients better.” Or “ I don’t know. I wasn’t on shift that day” What bollocks.
And it was also nice to be able to document your findings in the notes. And then report back to your reg. And I actually felt the pressure of growing responsibility after this encounter with the two patients. Upon returning to the doctor’s room and presenting my findings the reg was like
“ So tell me your general impression of the patients. Do you think they are really ill? Do you think I need to see them urgently or can I just wander along later on this evening?
"Goodness! That’s so unnerving! What if my examination findings were wrong or I missed something?!!! But well, I think I was kinda boosted by the earlier encounters so I just told her that I felt that although one of them might need senior review I didn’t feel that there was a requirement for any emergency intervention as yet as they were not acutely ill with florid symptoms.
I sure hope that nothing happens to those two old lasses. Oh well, I suppose I’ll know the outcome of the senior review at the ward round tomorrow. Hope that their much better and that I have not committed my first ‘professional’ misjudgement.
After a pleasant and laidback weekend getting to know my housemates and a little bit more about the island it was time to settle back into reality and start off on the wards once again.
The Western Isle General Hospital is a small hospital that serves a catchment area of the outer hebridean islands. Though small it is well equipped to provide for the general needs of the population though often it is necessary to fly some of our patients of to the mainland and Raigmore hospital in Inverness but I think we deal with our ‘problems’ quite well.
Ok so for a small hospital I’m impressed. Why?
Firstly the staff are wonderfully friendly to one and all. In general, I think Stornowaynians are a really friendly bunch. Everywhere you go, everyone you pass by you’re bound to get a hello or at least a warm smile. As we were discussing over dinner on Sunday, if we started doing this in ARI ( Aberdeen Royal Infirmary) we would more or less have earned ourselves a one way ticket to Royal Cornhill hospital just down the road. Yes, that’s our beloved and esteemed mental hospital.
Secondly, the hierarchy that distinguishes medical students from FY1, SHOs, Reg seems to be much diluted. Everyone is on first name basis. The consultants are friendly and nae so hoity toity ( at least the ones I’ve met so far). Although the medical students have undoubtedly not mustered the courage to call our consultants ‘Tim’ or ‘Allen’ and feel more comfortable with ‘Excuse me Mr Robinson...’ at least here the consultants actually remember our names and take our opinions in patient management into consideration and are patient enough to answer our queries. Nae any of that ‘ Me consultant, you insignificant bottom feeder. You must lick my boots and do everything I tell you’. This actually seems quite fantastical to me....I hope this is not just a dream. But, so far so good.
Thirdly, I think that in general, being a final year medical student in this hospital is a great booster for your confidence. And to a varying degree to your ego. For one thing the nurses are rather friendly here and are actually willing to aid the medical student. Many a traumatic occasion can I remember being so terribly peeved by a gaggle of nurses going ‘ Oh Anne, THIS medical student can’t seem to find her patient, patient notes, obs chart....blah blah blah ..’ . Well, Anne, all I can say is that if you’re not going to note on the ward board where your patient has been sent to and decide to sit on stack of notes whilst you yak about your unfortunate date on Saturday whilst the rest of the medical staff are searching for them, then you’re just going to be ‘’ THE nurse who.....” in the doctor’s room. But yes, forgetting Anne, in ARI and in most hospitals i’ve experienced, the nurses rule, and the top of the sisterhood would be the alpha female called ‘Sister’. And as a medical student, if even one of them is nice to you and helps you out with something, you praise the lord and be thankful that you might have actually done something right.
So after four years of this traipsing around the hallowed order of nursing ( okay, not all nurses are bad. I do have my nurses who are my allies on some of the wards in ARI ) I was pleasantly surprised this afternoon. In between seeing patients in clinic, my friendly SHO on the psych ward asked me to go off to the dementia ward to give 2 patients the ‘once over’ as the nurses had reported that they were experiencing spiking temperatures. Yeah, so basically I was to go over and assess them, check their obs and see if they were REALLY ill and needed immediate senior attention. So off I went. First day back on the job so could feel the adrenaline coursing through my veins. I found a nurse who brought me to the lassies and this is where I experienced the joy of being a final year medical student.
Let me clarify this distinction. Last year when I was a fourth year, I was pointed to where a patient was by some unhappy finger from the nurses station. Now, I am led to the patients bedside. Instead of having to be introduced to the patient and have consent to be seen by a student begged by someone, I just go and do what I have to do. Last year, I would be struggling to manipulate a 80 pound bloke by myself, today the nurse does it for me. Last year, I would be busy running between the medical records tray , the end of the bed for the obs chart and other bits of bobs for cannulation or whatever, today I ask a question and it sends the nurse running off to get what I request. And for once, I actually got a feeling of how it is to be the one asking the questions and seeing the uncertainty and anxiety flash across the face of the person on the receiving end.
“ Has Mrs X moved her bowels today or at all in the past few days?’’
“ Em....I wouldn’t know. I’m sorry. But I could go and check for you. Would you like the obs chart?’’
‘’ Yes please.”
(30 seconds later.....)
“Em....it says she hasn’t moved her bowels in the past week” ( panic starting to set in )
“ The past week....was this mentioned to the medical team and laxatives requested?”
“Em...no....I’m afraid we didn’t pay much attention to this.......”
“Okay...thank you , i’ll let the Reg know about this.”
Okay, to be fair this nurse was ultra nice. And it just felt good that I could carry out a nice patient management chat without being dismissed as being ‘just another medical student’.
However, I do have an inkling of a feeling that this may just be nurses in this hospital. I think I would be mauled if I tried something like this in ARI. I don’t think the conversation would actually go far. It would probably have ended with a “ You doctors should know your patients better.” Or “ I don’t know. I wasn’t on shift that day” What bollocks.
And it was also nice to be able to document your findings in the notes. And then report back to your reg. And I actually felt the pressure of growing responsibility after this encounter with the two patients. Upon returning to the doctor’s room and presenting my findings the reg was like
“ So tell me your general impression of the patients. Do you think they are really ill? Do you think I need to see them urgently or can I just wander along later on this evening?
"Goodness! That’s so unnerving! What if my examination findings were wrong or I missed something?!!! But well, I think I was kinda boosted by the earlier encounters so I just told her that I felt that although one of them might need senior review I didn’t feel that there was a requirement for any emergency intervention as yet as they were not acutely ill with florid symptoms.
I sure hope that nothing happens to those two old lasses. Oh well, I suppose I’ll know the outcome of the senior review at the ward round tomorrow. Hope that their much better and that I have not committed my first ‘professional’ misjudgement.
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