Posts Tagged ‘patients’

Alongside all the up-in-the-airness of the last few weeks, paediatrics has been really quite lovely. I love children. A baby can get me smiling when frankly, little else will. I had a nice week on neonates, essentially following a doctor and sticking my pinky in babies’ mouths to comfort them whilst they got prodded and poked – and loved it. The hard side of paeds, is, of course, when children get exposed to things they shouldn’t be, whether that’s a serious illness, family hardship and disputes, or more sinister things like abuse. We see all of this – and nothing makes me question those big questions about life and fairness and morality, quite like an abandoned, disabled baby with a history of neglect, does, and such complex needs that few fosterparents will consider them. Some people just are not born with fair chances. I hate that.

One of the things people associate with toddlers and small children are the temper tantrums over trivial things – but for me, this is a good thing. Firstly because I’m patient and young enough that screaming children don’t put me off and don’t make me love them less – but also because when a child is crying because they didn’t get their choice of ice-cream, or DVD, or jumper, or whatever – it means they’re still shielded from the worse parts of the world. It means they are still innocent from the badness and hardship that happens to everyone, eventually. When a child doesn’t cry at those things, because they are frequently  beaten, or hurt, or demeaned, and used to real pain, that’s so much worse. When they stop crying when you take blood because they’ve been through so many painful procedures, it’s so much worse than when they do. It’s difficult, seeing these babies with what the professionals call ‘frozen watchfullness’, before they’ve learned to smile. It’s hard, hearing the sound of a baby withdrawing from methadone, which is the most heartbreaking thing I’ve ever heard. It’s hard, seeing the photographs and hearing the stories about the depths to which human cruelty can reach.

We all ‘grow up’ at some point. When I was at school, I remember being jealous of all the other kids who didn’t have a father that drank himself silly or was always on the cusp of violence. I envied their freedom and security. The petty disputes meant less to me, as I had so much more to handle. The arguments over boys, meant less, when I was spending evenings visiting in rehab, or hiding the whisky bottles, or making sure my younger brother was ok. I sometimes think that I grew up far too quickly, and missed a lot of milestones due to my families difficulties, and then started going backwards once I hit 21, and tried to see if drinking the same as everyone else would make me feel less different. It didn’t make me feel less different. It made me feel more alone, as no one else struggled with it as I did. Both drinking and not-drinking isolated me for a long time. My early experiences coloured everything and made me see things in a different light.

I have a happy-ish medium now, in that I am confident in choosing not to drink when I don’t want to, but can also enjoy a glass of wine occasionally without starting to panic about following in family footsteps. This has probably been the single best thing that’s happened this year, as having a healthier attitude towards drinking makes so many things easier. And yes, my early experiences do mean that sometimes I find it harder than others, and that I’m not comfortable around people who have drank a lot, and am actually quite scared of them – but I get by. I’ve found a vague balance.

I was back at the GP’s today, and she really is a good, lovely doctor. She asked me if I’d had bouts of depression before, and now, it’s easier to see that I have had periods of low mood, probably since I was sixteen, if not longer. And when she asked why I hadn’t seen anyone, all I could say was that my family was preoccupied with other things, and no one noticed that I was fading into the background. No one noticed at all. As for me, I thought it was normal, and it wasn’t until recently that I read my old journals, that I realised just how sad and lost I was, so determined to escape. It wasn’t until I came away that I realised just how hard my family life is.

I don’t remotely suggest that my own childhood even comes close to some of the things unfortunate children go through – but I do mourn, when I see that something has stolen their childhood from them irreparably, I do mourn, when I see that they are forced to grow up too soon and act in ways beyond their age. I wish that all every child had to cry about, was the wrong sort of icecream. I wish that all every teenager had to worry about, was whether some boy knew their name. We don’t live in a world of fair chances.

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Mixed experiences

This post has two parts: a light-hearted part, and a pretty heavy part. Here goes.

I am working in my city’s accident/emergency department at the moment. It’s great, as I’m getting to do lots of skills (I am the ‘cannula monkey’, apparently), and see lots of things – but I also had a shock this week, on my first day, when I was called to the resus room over the tanoy, and then asked if I could start chest compressions on an elderly man whilst the team got stuff ready to shock him.

I’ve done CPR once before, as a very green 16 year old lifeguard, when to be honest, it was such a shock to have to drag someone out of the pool that we were all on autopilot. Then, it was a fifty year old man with an unexpected heart attack – it made sense to try. This time, however, was different. He was 87, with three previous strokes, and a previous heart attack. We stopped after about ten minutes of compressions from me, then a further stint using the automatic compressor (which is officially the most horrific thing I’ve ever seen), and I could hear his ribs breaking. He was brought in so quickly, and the ambulance staff left so quickly, that none of the doctors knew his name. He should have been allowed to die at home, peacefully, but instead, ended up bruised and naked, in the ER. He was allowed to die, at last, whilst we watched his heart trace finally flatline. I held his hand. Not the good death, we are supposed to aim for. CPR is actually much less effective than most people know. Only around 5% are brought back – and of those, many end up dying in ITU, or similar. I ‘m not saying it’s not a wonderful thing – for some patients, it’s a true miracle. However, for most, it’s futile, and barbaric.

This was the first of what I know will be so many deaths I will face as a doctor – but unlike my first successful cannula, or blood gas, or intubation, this is one first I did not look forward to, at all. Sometimes, I think that so much is wrong with how we approach these things – GP’s have targets for managing so many symptoms, yet don’t have to make sure that appropriate patients have DNAR orders. This man probably did not want the treatment we gave him; his wife certainly didn’t. I want to be a doctor who protects rights to a good death, as much as rights to a good life. I want to help my patients die where they want, surrounded by family. I don’t want them to end up cold and broken after a trainee cracks their ribs. I want better for them. As I was doing CPR, my eyes drifted to the clock on the wall, and it was midday – which is when, according to my church’s current project, we are all supposed to pray. And at first, all I wanted was for him to open his eyes and start breathing. All I wanted was a heartbeat. But then, I realised that I truly wanted what was best for him, and that is what I prayed for. I believe, that God delivered on that. I believe he heard me.

Since then, I’ve been a little shaken up; long hours, and particularly bad sleep at the moment make me short tempered and tearful. Counselling on Monday was harder than it’s been for quite a while. I’m a bit overstretched. I’m partly mourning, for a man I did not know.

On a lighter note……..

My other ‘first’ is that tomorrow I am going on an official, real-life, bonafide date. With a boy (or more specifically, a young man who teached maths at the same school the former conductor of my choir also teaches at). I know – who’d have thought, eh? We met at my conductor’s wedding celebration on Saturday, and after a lovely chat, agreed to meet again.

I have never done this before. ‘Terrified’ doesn’t quite cut it, to be honest. My only other ‘serious’ relationship started after I’d known the guy for eighteen months – we didn’t need to do the whole dating, sit down and talk about music and childhood nicknames thing. We knew each other. This, is so different, so strange. Part of me wonders if it’s a good idea – I’m still so wobbly, and have so many ups and downs, that even the scent of a relationship seems badly placed. But on the other hand, it’s nice to be asked – I’m not the sort of girl who turns heads and gets a lot of interest from lads. Most of the ones my age, are a bit intimidated by me. I’m a hopeless romantic, but also often wonder if I’ll ever find someone who matches me, challenges me, but will love me for all my discrepancies and hidden issues. I’m often not that convinced he exists. And being faced with a possibility, no matter how slim, no matter that this is informal and friendly – is a bit scary. I’m not sure how ‘good’ at dating I will be. I’m not sure how ‘good’ I want to be. Here goes.

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I’m on a general surgery attachment this month, and am with the emergency team this week so have been spending long days clerking patients and following surgeons as they charge round the hospital. As ever, I’ve had a high volume of patients with serious problems induced by alcohol, which longterm readers will know is something I struggle a lot with. This time, however, I’ve literally been the first person to assess them before I’ve handed over to my seniors, and there’s a responsibility, and opportunity, that comes with that.

Something I’ve noticed is that ‘problem drinkers’ tend to fall into one of two categories; they either are completely adament that they are ‘not an alcoholic‘, that they can stop when they want, and that this somehow makes them ‘better’ than others they see labelled in that way – or, as soon as you meet them, they tell you that they are an alcoholic, in this defeated way that suggests that they kind of know that not much is going to be done, aside from patching them up and shipping them home again. It’s as though the second group think that if they own up, we’ll tar them with a coat of hopelessness, and give up on them. We won’t fight for them. We’ll leave them be to carry on, which is probably a lot easier and less scary, than sorting their problems out. Sadly, this is often what happens; most healthcare workers only see the problem of the ‘revolving door’ patient, who comes in again and again, and never seems to change, regardless of whether it’s an issue of access to help, or ability to ask for it. I want to be someone who has time.

The interesting thing is that often these patients, in either group, don’t have the right label for themselves, at all – dependancy, afterall, is a syndrome, characterised by both physical (such as withdrawal symptoms) and more psychological aspects (such as narrowed repertoire, and salience of alcohol over other substances and past-times). I ended up having a long conversations with two of my patients, one of which lead to him realising that he does in fact have a dependancy on alcohol, and is quite a long way past the ‘social drinker’ he had classed himself as – and the other with someone who is a longstanding ‘known alcoholic’, trying to get to the bottom of what else could be done to help, and work out why it is that he’s got such a poor view of himself that he didn’t think anyone would bother to help him sort his drinking out in the first place. I guess a learning point here is that often we don’t have accurate views of ourselves, whether by lack of awareness, denial, or selfloathing. We sometimes need another perspective to get things straight. We all do this to some extent.

As always, I found talking to these patients hard to do, – and as always, every time I speak with a person with substance misuse issues, I think of my dad, and the years we all lost to his drinking, and all the hang-ups I’ve garnered from them – but I was also glad to be there, as someone  supernummary who has a bit of extra time to spend with patients, and doesn’t just fob them off as a no-hope case. I was glad to be there, getting the story out in the open, listening to the reasons they had drank more than usual, and being able to answer honestly, about what they were doing to their health. I was glad to be there to stick up for them when I reported back, as I like to think someone might have stuck up for my dad when he was at his illest, and not just stuck him in a corner to sober up. If we don’t stick up for them, they will never get the help they need. If we don’t stick up for them, they’ll keep that revolving door swinging until one day, they die before their time. I know that it’s so easy to get ‘compassion fatigue’ when you’re working in a busy unit with a high turnover, and are always on the go, but I want to help combat this.  My dad probably wouldn’t be alive today, if someone hadn’t help us get him into rehab, when they did. He’s alive because someone had the time to help and the time to care. I don’t want to find one day that I have someone’s blood on my hands (figuratively, but possibly literally given my line of work) – because I didn’t care enough. I want to make sure other people get another chance. As a Christian, I’m only too aware of how much we all need second chances. The God I follow, is a God of second, and third, and seventy-seventh chances. If I’m going to follow, I need to be a person who gives these chances too, as well as receiving them.

I know that it’s likely I may always have shaky moments when I’m managing these sorts of patients. I know that sometimes, when I’m already fraught and tired and emotional, it may break me a little, for a while, and make me cry in a corner somewhere, for a while. It’s one of my struggles, one of my wounds. We all have them. It reminded me of this post here. But I also know that I’m learning, all the time. I’m learning. And sometimes, I think that’s the best we can hope for, the best we can aim for. As long as I keep learning, I’ll be fine.

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I have a lovely friend who has just finished their first full year as a doctor. He is one of my biggest role models – he’s truly kind, very calm, and practically, a brilliant doctor for his stage. We met for a drink earlier and it’s really perked me up. One thing we talked about was the (grim) topic of declaring and certifying patient deaths, which is a task that often falls to junior doctors. At present, doctors get a small additional payment for every certificate they fill in – a small perk for doing a miserable task.

My friend donates all the payment he gets from filling in death certificates to charity.

Other people might go and buy a new handbag (though not my friend!), or put it towards a holiday or a car. He gives it away. He uses the benefit he gains from someone else’s passing, to help someone else.

He is one of my every day heroes.

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This is my first full week on my medicine of the elderly ward (MOE) and to be honest, it’s been a bit hit and miss. The consultant I’m assigned to is never in, there’s a lot of staff changeovers, and the junior doctor on my ward is in her own words ‘not a big fan of keeping an eye on students’ – so to be honest, I was feeling quite demoralised, at a loose end, and not really able to learn much. Half of my marks for this module come from ‘continuous assessment’, which is a bit problematic when no one is taking an interest. I’ve also realised just how big a hit my confidence has taken when it comes to medicine (and frankly, everything)- and I know, that this is irrational, as I’ve passed everything, well,  have been working at this hospital as a volunteer for two years,  have worked with people with communication difficulties most summers since I was sixteen, and am generally a good student – but I still feel as though I can’t do it, as though everything I was and did before my depression is invalid and counts for nothing. I felt a lot more emotionally labile yesterday than I have in quite a while, and it doesn’t help that every time I feel weepy, I start wondering if the depression is coming back, so soon after I finally got rid of it. It’s this horrible feeling of vulnerability, of the ability to be grievously wounded, of being open to being bruised at the core, that I so hate, that seems to be coming a lot at the moment. I’m a bit more hedgehog and a bit less lion, at the moment. I was quite excited about today as I was scheduled to sit in with my consultant in his clinic at the other end of town – but when I got there this morning, he’d cancelled it, so back across town I went, back to the ward, still not having met him. Grrrrrr.

However, I know that much of the success of this placement is down to me, and my attitudes, and in a way, the lack of guidance is good training for my first years as a junior doctor. After traipsing back this morning, I went to different wards until I found someone who didn’t mind me tagging along, did all of the paperwork the doctor had that I could do myself (lots of re-writing drug cards), and then offered to do all of the cognitive examinations that the consultant had requested, which are a bit of a pain to do as they take ages and can upset patients. I feel a lot better now, having been useful, and know that I’m just going to have to push through this, and that with time, my confidence will return, my skills will improve, and I’ll stop wanting to hid in the broom cupboard. Literally.

I’ve also been thinking a lot about my patients – I want to be a positive presence for them, someone who goes the extra mile to make sure they’re ok. It’s tough at times – yesterday I had quite a few patients die, and then found myself comforting one of the ladies’ daughters, feeling fairly out of depth – and I look at the patients I test, who are still aware enough to realise that they’re slipping away, and hate it, and are scared of what the future holds for them, and I so wish I could fix it. There’s so many men on the ward who, after years of being fairly active and caring for a wife, completely went to pieces when she died, started neglecting themselves, drinking too much, not eating, wasting away, after being left, completely bereft and alone, for the first time in half a century. It’s not easy, being old. Those golden years have so much heartache of their own.

I’ve also had some lovely surprises in the last few days – a friend I worked with in America at a special needs summer camp is coming to visit in November, which I am already (probably far too) excited about – she’s awesome to the extreme. The supervisor from my (fairly awful) research project also asked if I want to submit an abstract for a conference, which was a nice surprise as firstly, I thought that they would never want to contact me again (they were bad enough at keeping in touch when I was doing the work), and secondly, as I never thought the project was worth the paper it was printed on, let alone anything else. It feels good to be looking forward – last year, I didn’t really think more than a day in advance, as getting through that day was all I could ask myself to do. Suddenly finding myself looking three months ahead, and seeing a future there, feels good.

After a Psalm-40ish year (minus the patience but with a lot of trying to be still), I’m feeling pretty blessed at the moment – at the moment, I feel as though I’m finally on the same page as God, speaking the same language, painting inside the lines, by the right number. I feel like my faith suddenly has a bit more direction – I’ve come through my first dark night of the soul, and emerged, a new song in my mouth, still standing. I found a branch to hold on to. I’m not floundering in the dark, quite as much as I used to. I’m not saying it’ll be easy – but the sense of being on a map, being on track, is comforting.  Let’s see where it goes.

*PMA stands for Positive Mental Attitude!

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The last few days have been pretty busy – I’ve started a teaching week, with lectures and anatomy classes every day from nine till five – it’s difficult having so much to take in, after what feels like an age of functioning on such a lower level. Tomorrow, I have my last anatomy practical class of medical school, and it feels like a momentous occasion in some ways – five years ago, I’d never seen a cadaver, let alone stuck on a glove and got my hands dirty. Now, I am able to identify parts and reel off lists of facts. I can orientate myself when I get to watch surgery. I see my body in a different way, beautiful, a product of amazing design and evolution. Sometimes, anatomy reminds me so strongly of God – if you google ‘arbor vitae’, you will see that inside the cerebellum (bit of the brain responsible for motion control), it looks like a leafy tree. It’s perfect. Could this really be due to random selection? I don’t think it could be. I think that the priviledge of seeing the inner workings of humans, and animals, is another incredible gift.

Tomorrow will be my last time for some time (I hope!) that I get to learn in such a special way. I am so grateful for all the people who donate their bodies so that I can learn to be a doctor. Each year, my medical school holds a service of thanksgiving for these heros, and every year I think it’s not enough. I try to treat cadavers as both gifts, and also as patients – with the respect they deserve. I’ve learnt as much from these deceased patients as I have from my living ones. I want so much to make sure that their sacrifice and choice went to good use, that I obtain the highest level of skill I can to be the best doctor I can be, to as many people as possible. A lot of people have helped me to learn.

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