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.