Yesterday, my grandmother had a bad accident whilst cycling. She fell off a causeway down a 4m drop and landed on her back and head. She was in absolute agony until she was given a shot of morphine. The emergency services took 25minutes to reach her, by which time she was overcome by the pain in her back and neck. Because of her awkward position (down a sea wall on the mud and rocks), it took two ambulance crews and the coast guard to get her onto a back board and up to an ambulance before she received any pain relief, about an hour and a half after her accident.
Once she arrived at hospital she was cleaned up and taken for x-rays and a CT scan because of her back pain and head injury. We arrived at the hospital just before she was taken to x-ray and she was calmer but very worried about her back and neck, as were the doctors.
She was given the all clear as far as spinal injury and got away lightly with a few broken ribs and a head and leg injury. The doctors are currently keeping her in hospital for a few days for observation due to the nature of her injuries.
Through this process I saw the other side of medical treatment in a hospital setting - the side of the patient and of the family. The staff were very reassuring and gentle with both Grandma and my family. They kept us well informed of what was going on and were very efficient, even giving time to talk to us and explain exactly what was going on. It was nice to see a hospital 'from the other side' again and the nurses' and doctors' attitudes towards patients and family were caring, efficient and professional, great examples of how anyone in the healthcare profession should be!
Charlie x
Sunday, 9 September 2012
Wednesday, 29 August 2012
Epistaxis project
While I was at Salisbury hospital doing work experience, Dr Khan (an ENT doctor I shadowed) suggested that maybe I should write a research paper and that he'd be willing to write one with me. So after exams I got back in contact with him and now we have started a paper. It is still very much a work in progress and is having to fit around my more pressing engagements like personal statement writing but will gradually come together and I hope that it will be published by the new year at some point. I know that through a doctor's career it is important to write a series of case reports and research papers in order to have successful career progression. I thought that it would be a good idea to get a head start, which works perfectly as I find the whole process of medical research and writing papers really interesting. I'll keep you up to date as the paper starts to come together more but I am very excited to be working on a piece that could actually be properly published and will also have the official 'tick in the box' from a doctor in whose position I hope I will end up some day!
Charlie x
Charlie x
UKCAT!
Finally! UKCAT done and dusted on the 18th August at 10am...Phew - stress of the summer over! I ended up with 665 which isn't as good as some of my mock exams, but still above average so not too terrible. At the end of the day I scored 850 in the decision analysis section so I'm pleased with that one and the others weren't too shockingly awful so I hope it'll do! It seemed to take over the start of my summer holiday, so my advice to anyone else for next year - do it right at the start of the summer holiday or beforehand. That way you've had a break after summer exams but your holidays aren't either taken over by revision and preparation or tarred by the guilt that you think you should be revising rather than enjoying the sun (or lack of sun!) like everyone else. Anyway, one more milestone down... gradually creeping closer and closer!
Charlie x
Charlie x
Work experience at Poole Hospital
Can't believe I haven't written about this before, but I've been so busy!!
From 9th to 13th July I was lucky enough to spend the week at Poole hospital in many different departments. I wrote a letter to a friend of my father who is a consultant gynaecologist at Poole and he invited me to come and shadow him, as well very kindly finding me others to shadow around the hospital too.
On the first morning I was straight into gynae surgery. There were a series of prolapse repairs as well as some TOT and TVT procedures to stop/help incontinence. It was so interesting to see the different procedures conducted, and to make things even better, there was also a 4th year medical student attached to Mr Hillard while I was there, which meant that I always had someone who could explain exactly what was going on and answer (most!) of my questions without interrupting Mr Hillard during surgery. I found it very interesting learning about how the actual procedures were carried out, so afterwards I did some internet research and found a document https://intermountainhealthcare.org/ext/Dcmnt?ncid=520693039 which is meant to be for patients who are undergoing either of the procedures, but also gave me a simple explanation of what was going on and the background to the cases which I saw in theatre.
In the afternoon Mr Hillard had organised for me to shadow Dr Crowther in the endoscopy department. I saw a few endoscopy's, and the thing that most caught my attention was the calming and reassuring role which the nurses played in the procedure. I saw how important this was to the patients, and it reminded me yet again of how it isn't just the science side of medicine that's so important, the people skills are just as valuable and essential. Dr Crowther explained to me how an endoscope must be positioned with care, and how one of the most crucial parts is to not let it create loops within the bowel of the patient. Again, there was a medical student present too who was willing to explain to me what I could see on the screen, he said it was also useful revision for him to have to think more to answer my questions while observing the procedures!
On the Tuesday morning Mr Hillard took me on ward rounds on the antenatal ward. He spoke to each of the ladies who were waiting to give birth and advised them as well as carrying out the necessary check-ups. Next we visited the patients from surgery the day before to check that they were recovering well and had not had any bad turns, Mr Hillard consulted with the nurses who had been observing and looking after the patients and this again reminded me of how important inter-professional communication is within the medical setting. Then I sat in on a menopause clinic for women with premature menopause. Mr Hillard explained their strange hormone levels and asked the patients to offer any other information which could help me learn about their conditions in more detail.
A colposcopy clinic was being held after lunch and one of Mr Hillard's colleagues kindly agreed to have me sit in. The ladies were examined for harmful matter which fell into one of three categories (mild, moderate and severe) all of which could potentially turn cancerous if not treated. These ladies had been invited to clinic because they had had unusual swabs when they visited the GP. I remember the procedure pretty accurately as I watched it so many times! 1) insert a duck billed specular 2) clean cervix with a saline swab 3) wipe cervix with dilute acetic acid 4) if it is clear, there is no problem, however if it turns white... 5) use pincers to take a biopsy of the cervix (feels like a small pinch) 6) cauterize the cervix using an instrument that looks a little like a pen 7) clean and finish. The doctor was very reassuring and listened to the ladies' reflections and made comments, I thought about how important listening to what the patient has to say is because they can give so much information rather than just a sheet of test results!
On Wednesday morning we were back in surgery again for a laparoscopy list. There were many cases; some ovarian cysts, some endometriosis, a fallopian tube joined to the stomach cavity by tissue. Again the medical student attached to Mr Hillard was present so I could ask him questions and learn from the teaching that the surgeons were giving him. I found the precision with which they carried out the procedures amazing, and also it was the first time I'd seen the insides of a real human, I was surprised by how vibrant the colours were: the yellow of the fatty deposits and the greeny blue of the veins. Some of the instruments they used were so strange! A corkscrew shaped tool was used for the TOT/TVT's to put the suspension tape under the urethra which was used by each hip bone and was inserted like a corkscrew into a bottle as far as I was aware! Endometriosis is where the lining of the womb grows on other areas of the body than the uterus and causes the woman pain. There is not too much detail that is known about it, but it looks like cigarette burns and the treatment is to cuarterize the area.
The afternoon was another antenatal clinic so I shadowed Mr Webster another consultant gynaecologist. It was ladies having last minute check-ups before delivery. Some ladies were breach, others were diabetic and others were allergic to aspirin or had other complications. They talked these through with Mr Webster and together formulated a birthing plan to cater for troublesome eventualities. I learnt about how it is important to include the patients in the decisions of their health treatment plans and make sure they are fully aware and satisfied with the conclusions and pathways chosen for them as advised by the doctor.
The cardiology department allowed me to see many of their procedures on Thursday morning. I watched a few stress echoes either with a treadmill or a drug that causes a heightened heart rate and blood pressure. Many find the drug very disconcerting and uncomfortable, but it is their only option if they are unable to get their BP and HR to the required level just by using the treadmill. Then the echo is taken and recordings are made of the heart at work and rest to check that it is contracting properly. The dark bits on the screen are the muscle under strain so it is good if the dark areas follow a constant pattern all the way around the contours of the heart. Then I shadowed in a few normal ECG's. the patients lay on their sides and had 3 electrodes attached to their chest with sticky pads. An ultrasound is taken (with care to avoid the lungs and ribs as these blur the image on the screen) and you can see the chambers, the septum, the valves and even the muscle fibres that hold the valves in place! The doctor conducting the ECG's told me about the collection of really good videos of ECG's he was making for his portfolio. This reminded me how training never ends for a doctor, and how self improvement and evaluation are such valuable skills to have and develop as I (hope to) have to use them for the rest of my career!
For Friday morning I shadowed Dr Battcock in geriatrics. He already had another work experience student who had been shadowing him all week (this made me think how lucky I was to have experienced such a variety of things, not just seen one department for the whole week!). We had ward rounds so visited the patients who were due to go home the next day, and assured them of their worries and advised them about how to cope at home to start with. The patients were all so grateful to Dr Battcock for his care, which showed how he must have spent time building a relationship with each of them as they had all been there for a significant period of time. Their gratitude showed how a compassionate nature even in a professional capacity really makes a difference in any form of caring environment to patient's experiences of being in hospital.
I want to again express a huge thank you to everyone who had me shadow them, explained things to me, helped me when I got lost in such a big hospital (!) and took the time to answer my questions. I really learnt so much while being at Poole, and the experience has once again concreted my choice that Medicine really is the right path for me!
Charlie x
From 9th to 13th July I was lucky enough to spend the week at Poole hospital in many different departments. I wrote a letter to a friend of my father who is a consultant gynaecologist at Poole and he invited me to come and shadow him, as well very kindly finding me others to shadow around the hospital too.
On the first morning I was straight into gynae surgery. There were a series of prolapse repairs as well as some TOT and TVT procedures to stop/help incontinence. It was so interesting to see the different procedures conducted, and to make things even better, there was also a 4th year medical student attached to Mr Hillard while I was there, which meant that I always had someone who could explain exactly what was going on and answer (most!) of my questions without interrupting Mr Hillard during surgery. I found it very interesting learning about how the actual procedures were carried out, so afterwards I did some internet research and found a document https://intermountainhealthcare.org/ext/Dcmnt?ncid=520693039 which is meant to be for patients who are undergoing either of the procedures, but also gave me a simple explanation of what was going on and the background to the cases which I saw in theatre.
In the afternoon Mr Hillard had organised for me to shadow Dr Crowther in the endoscopy department. I saw a few endoscopy's, and the thing that most caught my attention was the calming and reassuring role which the nurses played in the procedure. I saw how important this was to the patients, and it reminded me yet again of how it isn't just the science side of medicine that's so important, the people skills are just as valuable and essential. Dr Crowther explained to me how an endoscope must be positioned with care, and how one of the most crucial parts is to not let it create loops within the bowel of the patient. Again, there was a medical student present too who was willing to explain to me what I could see on the screen, he said it was also useful revision for him to have to think more to answer my questions while observing the procedures!
On the Tuesday morning Mr Hillard took me on ward rounds on the antenatal ward. He spoke to each of the ladies who were waiting to give birth and advised them as well as carrying out the necessary check-ups. Next we visited the patients from surgery the day before to check that they were recovering well and had not had any bad turns, Mr Hillard consulted with the nurses who had been observing and looking after the patients and this again reminded me of how important inter-professional communication is within the medical setting. Then I sat in on a menopause clinic for women with premature menopause. Mr Hillard explained their strange hormone levels and asked the patients to offer any other information which could help me learn about their conditions in more detail.
A colposcopy clinic was being held after lunch and one of Mr Hillard's colleagues kindly agreed to have me sit in. The ladies were examined for harmful matter which fell into one of three categories (mild, moderate and severe) all of which could potentially turn cancerous if not treated. These ladies had been invited to clinic because they had had unusual swabs when they visited the GP. I remember the procedure pretty accurately as I watched it so many times! 1) insert a duck billed specular 2) clean cervix with a saline swab 3) wipe cervix with dilute acetic acid 4) if it is clear, there is no problem, however if it turns white... 5) use pincers to take a biopsy of the cervix (feels like a small pinch) 6) cauterize the cervix using an instrument that looks a little like a pen 7) clean and finish. The doctor was very reassuring and listened to the ladies' reflections and made comments, I thought about how important listening to what the patient has to say is because they can give so much information rather than just a sheet of test results!
On Wednesday morning we were back in surgery again for a laparoscopy list. There were many cases; some ovarian cysts, some endometriosis, a fallopian tube joined to the stomach cavity by tissue. Again the medical student attached to Mr Hillard was present so I could ask him questions and learn from the teaching that the surgeons were giving him. I found the precision with which they carried out the procedures amazing, and also it was the first time I'd seen the insides of a real human, I was surprised by how vibrant the colours were: the yellow of the fatty deposits and the greeny blue of the veins. Some of the instruments they used were so strange! A corkscrew shaped tool was used for the TOT/TVT's to put the suspension tape under the urethra which was used by each hip bone and was inserted like a corkscrew into a bottle as far as I was aware! Endometriosis is where the lining of the womb grows on other areas of the body than the uterus and causes the woman pain. There is not too much detail that is known about it, but it looks like cigarette burns and the treatment is to cuarterize the area.
The afternoon was another antenatal clinic so I shadowed Mr Webster another consultant gynaecologist. It was ladies having last minute check-ups before delivery. Some ladies were breach, others were diabetic and others were allergic to aspirin or had other complications. They talked these through with Mr Webster and together formulated a birthing plan to cater for troublesome eventualities. I learnt about how it is important to include the patients in the decisions of their health treatment plans and make sure they are fully aware and satisfied with the conclusions and pathways chosen for them as advised by the doctor.
The cardiology department allowed me to see many of their procedures on Thursday morning. I watched a few stress echoes either with a treadmill or a drug that causes a heightened heart rate and blood pressure. Many find the drug very disconcerting and uncomfortable, but it is their only option if they are unable to get their BP and HR to the required level just by using the treadmill. Then the echo is taken and recordings are made of the heart at work and rest to check that it is contracting properly. The dark bits on the screen are the muscle under strain so it is good if the dark areas follow a constant pattern all the way around the contours of the heart. Then I shadowed in a few normal ECG's. the patients lay on their sides and had 3 electrodes attached to their chest with sticky pads. An ultrasound is taken (with care to avoid the lungs and ribs as these blur the image on the screen) and you can see the chambers, the septum, the valves and even the muscle fibres that hold the valves in place! The doctor conducting the ECG's told me about the collection of really good videos of ECG's he was making for his portfolio. This reminded me how training never ends for a doctor, and how self improvement and evaluation are such valuable skills to have and develop as I (hope to) have to use them for the rest of my career!
For Friday morning I shadowed Dr Battcock in geriatrics. He already had another work experience student who had been shadowing him all week (this made me think how lucky I was to have experienced such a variety of things, not just seen one department for the whole week!). We had ward rounds so visited the patients who were due to go home the next day, and assured them of their worries and advised them about how to cope at home to start with. The patients were all so grateful to Dr Battcock for his care, which showed how he must have spent time building a relationship with each of them as they had all been there for a significant period of time. Their gratitude showed how a compassionate nature even in a professional capacity really makes a difference in any form of caring environment to patient's experiences of being in hospital.
I want to again express a huge thank you to everyone who had me shadow them, explained things to me, helped me when I got lost in such a big hospital (!) and took the time to answer my questions. I really learnt so much while being at Poole, and the experience has once again concreted my choice that Medicine really is the right path for me!
Charlie x
Tuesday, 3 July 2012
Student Leadership positions!!
Today was very exciting, we found out what leadership roles we have been successful candidates for. The process started with letters of application, interviews and then finally allocation. I was given the position of head of the charity committee and student advisor on the town council! I was especially pleased to get both of these because charity is something very close to my heart and a position that I feel I can really make an impact on people in. While being a student advisor on the town council is a very rare opportunity, because as far as I am aware, Ringwood is the only school that does this, making it a rare privilege to become a part of a group of people with such power and such a voice. I really look forward to taking ideas from students within school to the meetings and discussing strategies to improve Ringwood as a place for young adults and teenagers. I also look forward to having the job of liaison between the council and the school so that I can make sure that students actually know what the current issues are/what is actually going on in their community!
Charlie x
This is a diagram of how student voice works within our school, it is my job to take into account views of students from each section and use them together to formulate plans, ideas and create new ways in which charities can become a more high profile and important part of of the school ethos.
Charlie x
Tuesday, 17 April 2012
Mocks time... :O
That time has come! Mocks are in the air! Today I had the result of my French oral mock back, one mark off an A, I'm pleased as it means that I'm close and with not too much extra work on top of the revision I'm doing anyway I should get that A. Also, my S1 (stats) mock was today, it seemed to go well and be pretty straight forward, so to all those in the same boat - don't fret, it was okay! For the whole of this year stats has been the subject I thought I'd need to dedicate the most time to in order to achieve the highest mark possible, but after gauging how much I found I knew and came easily in the mock, it's put me at ease a bit. Oh well, nose to the grind stone!
Good luck all to all of you who are revising, I hope its going well, and just remember what you're aiming for if ever you need a motivation boost!
Charlie x
Good luck all to all of you who are revising, I hope its going well, and just remember what you're aiming for if ever you need a motivation boost!
Charlie x
Wednesday, 11 April 2012
Work Experience at Salisbury hospital :D
Well, this might be a long one, but I've got so much to say! However, firstly and most importantly, THANKYOU so much to all of the doctors, nurses, departments and patients who made my few days so enriching, exciting and imspiring!
I spent last Monday, Tuesday and Wednesday at Salisbury District Hospital shadowing junior doctors, SpR's, consultants and nurses in various departments. It was brilliant to be able to get a grasp of all of these different positions within the healthcare system and see how important the interdepartmental teamwork really was. It was really valuable to see all of the different stages of treatment that a patient recieves in their time at hospital. Right from the first consultations after GP referral, then referral on to different specialty departments where further investigations were made, or treatment plans were formulated. Then surgery (if that was what was needed), then recovery, and finally discharge. It was really interesting to see how many healthcare professionals a single patient can potentially come into contact with during their stay in hospital.
I saw how important communication between different departments is when treating patients. If a doctor's writing in a patient's notes was too poor and a nurse administered an incorrect dosage of a specific drug, the result could be fatal. One of the SpR's I shadowed has created a system linked to Microsoft Outlook email which is like a task master. It means that anything that needs doing (for example any admin, audits, letterwriting, patients to see about somehting in particular) can be created as tasks on the system. This system is available just within the department or specific tasks can be made available on the hospital's intranet so all departments are aware of followups that are needed with certain patients if they are on different wards for example post-op tests and treatments. It means that important tasks are not forgotten and that there is an electronic document of when each task was carried out. This is useful when shift change overs in staff occur to make sure that nothing is forgotten or slips through the net when patient handovers are made.
This also helped efficiency within the department I was shadowing in too. The task manager system had a triaging option so important tasks could easily be identified by all users. This meant that nothing urgent was left too long and admin along with other lower priority jobs could be set as not urgent. Further more, the system had an "attachments" option for each taks as it is added to the system. This allowed xray images for example to be attached to the task and opened with it so that if for example the task was further inspection of an xray or MRI or CT image, the person who opened the task could do it straight away rather than having to find it in patients' files, this proved a big time saver.
On my first day, Monday I spent the day in the Emergency Department in the "minors" section. There was quite a variety of different cases that came in, broken arms, ankles, elbows, sprains and eye problems mainly. I was shadowing a consultant who talked me through each of the cases as he examined the patients and took a short history. I found it amazing how quickly he was able to come to a diagnosis or treatment plan. Within 15 minutes usually the patient was in, history taken, examined, referred on for more tests (e.g x-ray) or treated. In the ED they also had a triage system to show a) how urgent cases were b) how long the patient had been waiting and c) if they needed treating by a doctor, nurse or potentially a whole team. He explained to me that the hospital aims to have people in the ED for no longer than 4 hours in total to meet their target, and that the triaging system became such a useful tool when the department got busy or there was a local road traffic accident etc.
On my second day, Tuesday I was shadowing junior doctors and an SpR in the ENT department. This started with doing the rounds of their parients that had been in over night or for longer after operations or with more complicated ailments. Check-ups that they had been well monitored during the night, checking of there had been any change in their conditions, seeing if any treatments they were undergoing had had an effect etc. Rounds lasted about 45 minutes, then we had a day surgery slot. This was for procedures such as tonsillectomies, gromits and broken noses. First of all we went and saw the patients that were due to be operated on, some of them had concerns, mainly it was just calming nerves and making sure that they were aware of what the procedure was going to entail. Then we went and got changed into scrubs (first time I'd worn scrubs = exciting!) and went into theatre.
To start with I obeved from about 5 ft away, but as they saw that I wasn't feeling dizzy or sick they allowed me to scrub up, taught me how to put on a gown/gloves/mask and come right in close. I was talked through the procudures, it was really interesting to see the techniques they used to prevent too much bleeding, burning the ends of the cut off blood vessels, I didn't know that they used that technique. The broken nose was interesting, they literally just squashed it and pushed it with quite alot of force until they heard a click, and then it was perfectl straight! I thought it would have been more technical but it seemed as simple as that. All of the patients were under GA, therefore an anaesthetist as well as other doctors and nurses were present. The teamwork that they all used was very important, from tasks just as simple as rolling the patient onto the operating bed to judging the amount of pain relief and anaesthetic needed between the main surgeon and the anaesthetist. The scrub nurse had a very important job of making sure all that the surgeon was going to need for the procedure was present and kept sterile. I was told that "a decent scrub nurse who has a good relationship with the surgeons makes all the difference."
On my last day, Wednesday, I was shadowing a variety of anaesthetists in different surgeries. It suprised me that they have the same amount of pre surgery patient contact as the doctors do, though I don't know why I didn't consider this before, because obviously they are in charge of the patients overall welfare whilst they are in surgery. Firstly we went and saw all of the patients and explained how the operation and anaesthesia was going to work, then went to the anaesthesia room (there was one next to each theatre) and waited for the forst patient to come. They walked in, lay down on the bed and were asked questions as to their identity and did they give informed consent to the operation going ahead. Then a canula was inserted, then a variety of anaesthesia products, within 10 seconds the patient was unconcious! It amazed me how fast the drugs took effect! During the surgeries I asked about the machinery that was used to monitor the patient and was taught about how it worked and other signs that patients give other than those picked up by machines that anaesthetists have to worry about. I found learning about the procedures and drugs used by the anaesthetists and why they choose certain ones really interesting, and I think that if I could, I would love work in theatre! The atmosphere and variety of different procedures I saw just in that one day really inspired me as to what we can actually achieve, mend and solve nowadays within the human body, its amazing! There was one case where a thumb was made out of some bone from the same person's pelvis, the operation had been over 8 hours long by the time I got there and they thought that it was atleast another 4 hours to go.
Its so amazing what is possible today, how we can change somebody's life, how we can just make them a new body part, replace worn out hips and knees, give them back their health which is at he end of the day the most valuable thing a person can have. It was such a privelege to see that in action and I really hope that one day I'll be there, contributing and involved in that process too!
Charlie x
I spent last Monday, Tuesday and Wednesday at Salisbury District Hospital shadowing junior doctors, SpR's, consultants and nurses in various departments. It was brilliant to be able to get a grasp of all of these different positions within the healthcare system and see how important the interdepartmental teamwork really was. It was really valuable to see all of the different stages of treatment that a patient recieves in their time at hospital. Right from the first consultations after GP referral, then referral on to different specialty departments where further investigations were made, or treatment plans were formulated. Then surgery (if that was what was needed), then recovery, and finally discharge. It was really interesting to see how many healthcare professionals a single patient can potentially come into contact with during their stay in hospital.
I saw how important communication between different departments is when treating patients. If a doctor's writing in a patient's notes was too poor and a nurse administered an incorrect dosage of a specific drug, the result could be fatal. One of the SpR's I shadowed has created a system linked to Microsoft Outlook email which is like a task master. It means that anything that needs doing (for example any admin, audits, letterwriting, patients to see about somehting in particular) can be created as tasks on the system. This system is available just within the department or specific tasks can be made available on the hospital's intranet so all departments are aware of followups that are needed with certain patients if they are on different wards for example post-op tests and treatments. It means that important tasks are not forgotten and that there is an electronic document of when each task was carried out. This is useful when shift change overs in staff occur to make sure that nothing is forgotten or slips through the net when patient handovers are made.
This also helped efficiency within the department I was shadowing in too. The task manager system had a triaging option so important tasks could easily be identified by all users. This meant that nothing urgent was left too long and admin along with other lower priority jobs could be set as not urgent. Further more, the system had an "attachments" option for each taks as it is added to the system. This allowed xray images for example to be attached to the task and opened with it so that if for example the task was further inspection of an xray or MRI or CT image, the person who opened the task could do it straight away rather than having to find it in patients' files, this proved a big time saver.
On my first day, Monday I spent the day in the Emergency Department in the "minors" section. There was quite a variety of different cases that came in, broken arms, ankles, elbows, sprains and eye problems mainly. I was shadowing a consultant who talked me through each of the cases as he examined the patients and took a short history. I found it amazing how quickly he was able to come to a diagnosis or treatment plan. Within 15 minutes usually the patient was in, history taken, examined, referred on for more tests (e.g x-ray) or treated. In the ED they also had a triage system to show a) how urgent cases were b) how long the patient had been waiting and c) if they needed treating by a doctor, nurse or potentially a whole team. He explained to me that the hospital aims to have people in the ED for no longer than 4 hours in total to meet their target, and that the triaging system became such a useful tool when the department got busy or there was a local road traffic accident etc.
On my second day, Tuesday I was shadowing junior doctors and an SpR in the ENT department. This started with doing the rounds of their parients that had been in over night or for longer after operations or with more complicated ailments. Check-ups that they had been well monitored during the night, checking of there had been any change in their conditions, seeing if any treatments they were undergoing had had an effect etc. Rounds lasted about 45 minutes, then we had a day surgery slot. This was for procedures such as tonsillectomies, gromits and broken noses. First of all we went and saw the patients that were due to be operated on, some of them had concerns, mainly it was just calming nerves and making sure that they were aware of what the procedure was going to entail. Then we went and got changed into scrubs (first time I'd worn scrubs = exciting!) and went into theatre.
To start with I obeved from about 5 ft away, but as they saw that I wasn't feeling dizzy or sick they allowed me to scrub up, taught me how to put on a gown/gloves/mask and come right in close. I was talked through the procudures, it was really interesting to see the techniques they used to prevent too much bleeding, burning the ends of the cut off blood vessels, I didn't know that they used that technique. The broken nose was interesting, they literally just squashed it and pushed it with quite alot of force until they heard a click, and then it was perfectl straight! I thought it would have been more technical but it seemed as simple as that. All of the patients were under GA, therefore an anaesthetist as well as other doctors and nurses were present. The teamwork that they all used was very important, from tasks just as simple as rolling the patient onto the operating bed to judging the amount of pain relief and anaesthetic needed between the main surgeon and the anaesthetist. The scrub nurse had a very important job of making sure all that the surgeon was going to need for the procedure was present and kept sterile. I was told that "a decent scrub nurse who has a good relationship with the surgeons makes all the difference."
On my last day, Wednesday, I was shadowing a variety of anaesthetists in different surgeries. It suprised me that they have the same amount of pre surgery patient contact as the doctors do, though I don't know why I didn't consider this before, because obviously they are in charge of the patients overall welfare whilst they are in surgery. Firstly we went and saw all of the patients and explained how the operation and anaesthesia was going to work, then went to the anaesthesia room (there was one next to each theatre) and waited for the forst patient to come. They walked in, lay down on the bed and were asked questions as to their identity and did they give informed consent to the operation going ahead. Then a canula was inserted, then a variety of anaesthesia products, within 10 seconds the patient was unconcious! It amazed me how fast the drugs took effect! During the surgeries I asked about the machinery that was used to monitor the patient and was taught about how it worked and other signs that patients give other than those picked up by machines that anaesthetists have to worry about. I found learning about the procedures and drugs used by the anaesthetists and why they choose certain ones really interesting, and I think that if I could, I would love work in theatre! The atmosphere and variety of different procedures I saw just in that one day really inspired me as to what we can actually achieve, mend and solve nowadays within the human body, its amazing! There was one case where a thumb was made out of some bone from the same person's pelvis, the operation had been over 8 hours long by the time I got there and they thought that it was atleast another 4 hours to go.
Its so amazing what is possible today, how we can change somebody's life, how we can just make them a new body part, replace worn out hips and knees, give them back their health which is at he end of the day the most valuable thing a person can have. It was such a privelege to see that in action and I really hope that one day I'll be there, contributing and involved in that process too!
Charlie x
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