Scrubs

Last Tuesday, I spent the day in Musgrove Park Hospital, mainly with the neurology team in Triscombe Ward. I started off with consultant ward round with Dr. Fathers and his team. I saw a variety of rare neurological conditions, varying from informing a patient that he had motor neurone disease to finally speaking to a woman who had been dumb for 2 months following a neurological problem. I also saw the value of MRI scans to review inflammation, among other problems, in patients, which can damage nerves and nerve transmission. Next in the plan for the day was viewing neurological tests. However, upon arrival, I was told that there were no tests that afternoon, but one of the testing team would be monitoring a patient’s neurological observations during a spinal operation. Was I interested in watching? Of course! So, for the first (and hopefully not the last!) time in my life, I got scrubbed up, complete with pyjama-like clothes, hideous shoes, a face mask and a very attractive hat. I also donned a lead apron (which was surprisingly heavy!) and then, fully dressed, I was allowed to go into the Operating Theatre (upon my promise that I didn’t faint at the sight of blood). I was in Theatre for 90 minutes, watching rods being inserted into the patient’s back as some of the vertebrae plates had fused. This had to be done with constant checks, both radiology checks to assess position, and nerve transmission checks to ensure that no lasting damage was being done. It was epic. After the operation (and lunch) I went to watch a lumbar puncture, where I saw the time taken to perform the procedure, due to the small size of the gaps and the precision needed to avoid nerve damage. Overall, I left feeling really excited and even more committed to my dream of being a doctor.

The Beacon Centre - Oncology

Yesterday, I spend the day at the Beacon Centre at Musgrove Park Hospital, which specialises in Oncology. As they recently won the International Quality Improvement Award in May 2012, I felt very privileged to be spending a day there. I started my day in a gynae-oncology MDT where I saw a variety of care teams discuss the latest changes to the patients’ conditions. This was supported by CT scans (which I really enjoyed looking at) showing progression of tumours and cysts etc. It was interesting to see the number of different specialties in the MDT, including a radiologist, a pathologist, a gynaecologist and both a medical and a clinical oncologist, which showed the importance of teamwork. I then spent the rest of the morning on the ward, shadowing 2 junior doctors. The patients, whilst it was an oncology ward, were mainly all suffering from other diseases as well as cancer, and many had palliative care programmes. This taught me the importance of reducing adverse symptoms to make patients more comfortable, rather than always trying to cure diseases. After this, I went to radiology where I saw the in depth planning systems required for radiotherapy, including CT scans and the colourful mapping of them. This, along with specifically angling the rays and being able to shape them using lead ‘fingers’ helped to reduce irradiating healthy tissue that could lead to unwanted side-effects. I also learnt how they use small tattoos on the patient to ensure that their numerous radiotherapy treatments (5 a week for 7.5 weeks in some cases) all go in the same place, and how increasing the number of rays used decreased side-effects by reducing dose except to where the rays met. I then went into the room where the radiotherapy occurs (luckily no-one was in there!) and saw the machine used to create the high-energy beams of photons or electrons used for the radiotherapy, and numerous safety devices to ensure that no-one but the patient receives doses of radiation that, if repeatedly received, could cause damage. In addition, I saw the bench for patients to lie on whilst they receive radiotherapy and it felt very uncomfortable but needed to be hard so that patients could always lie in exactly the same position.  Overall, I felt I learnt a lot and it was a worthwhile and interesting day.

Yeovil District Hospital

Last week, I spent 4 days in Yeovil District Hospital as part of a work experience programme. This gave me some insight into some departments in the hospital that I hadn’t seen before. This ranged from time with the porters and in the linen room to the Academy to the Day Hospital and the Cardiac Rehabilitation Unit. Whilst all were interesting and, as I learnt, important to the smooth running of the hospital, the areas I enjoyed the most were the Cardiac Rehab Unit and the Day Hospital. In Cardiac Rehab, I saw the importance of exercising after a heart operation for both physiological and psychological reasons – whilst rebuilding heart muscles is important, it is equally important that people doesn’t feel alone and realise that they can still do the things that they want to do. There was a great atmosphere, and the volunteers (who took me round pretending that I had had a heart operation) told me that the thing they strive for is for you to have fun. In the Day Hospital, I saw 3 blood transfusions being prepared and taking place. I was surprised how long the transfusion took and saw how the nurses constantly checked for adverse reactions to the blood.

Islip Medical Practice

Last Monday, I went to Oxford to spend a day with Dr. Lisa Ibbs in the Islip Medical Practice. I started off by visiting the local nursing home, The Manor, which cared for elderly patients, mostly with severe dementia. The Islip Medical Practice provides regular medical support to The Manor and its residents. Having regularly visited Rowden House, a residential home, I could very easily notice the difference in the severity of the condition of the residents, most of whom were bedridden. Next, I sat in with the Practice Nurse, where I learnt the general role of the Practice Nurse and a lot about childhood immunisations. This showed me how much doctors rely on the nurses for a wide range of tasks, such as tests, vaccinations and chronic condition check-ups, e.g. diabetes. After lunch, I went to the dispensary where I helped find drugs for peoples’ prescriptions. After being repeatedly instructed to check the type of drug (e.g. capsules vs tablets) as well as the dosage, I further appreciated the importance of getting the medication right. I was also told that morphine was kept in a locked opaque cabinet, and had to be signed out by doctors due to its controlled drug status and addictive properties. I spent the rest of the day with Dr. Ibbs, mainly in her surgery. Firstly I watched Dr. Ibbs change a catheter which demonstrated a common complaint with an ageing population. Next, I saw the other end of the age spectrum – a baby’s 6-week check-up, where Dr. Ibbs checked the baby’s measurements, hips, skull and breathing. It was adorable! I then saw a large range of patients with conditions from conjunctivitis to ankle injuries to stomach pain. This taught me the large variety of illnesses that GPs have to know about, and that GPs have a very different relationship with the patient than most hospital doctors. Dr. Ibbs also told me that, whilst you do get a lot of people coming to their GPs for common ailments like coughs and colds, you also get a lot coming for chronic disease check-ups. Finally, I accompanied Dr. Ibbs (as duty doctor) on a home visit to an elderly patient with a suspected infection. Whilst I only had a day, it did give me a real snapshot of life as a GP. 

Pathway to Medicine

Back from another 2 days at Musgrove Park Hospital where I have spent the time on the Pathway to Medicine programme. This involved a general introduction to the NHS and a talk on infection control, which taught me what I needed to do to minimise the risk of spreading infections. Then came the fun bit! I met up with an F1 doctor who was working in the respiratory ward and who I would be shadowing for the next day and a half. It was really exciting to get closer to patients and the different types of treatment. Some of the things I enjoyed seeing were chest X-Rays, blood tests and a diagnostic lung tap, to see if any fluid in the lung was infected. I was also lucky enough to accompany a long consultant ward round and it was interesting to see how the consultant talked to both the patients and the other doctors who were in training. It also showed me that being a junior doctor involved moments that may not have been exciting (i.e. paperwork) but that they were still really important to patient care. These two days have made me even keener (if that's possible) on becoming a doctor.

The endocrinology clinic

So today was the day I learnt more about diabetes! I was invited to accompany Dr. Close (Medical Director) at Musgrove Park Hospital during his outpatient's endocrinology clinic. A number of these patients have had diabetes for many years and were suffering the side-effects such as kidney failure, circulation problems and eye problems. This taught me that for some conditions, treating the side-effects can be as difficult and as important as treating the main condition. What I found really interesting was how Dr. Close's communication style changed with each patient so that he and the patient got the most out of every consultation. It also further proved to me that not all patients can follow instructions and take their medication, even when they know there are significant risks.

Shadowing a matron

Monday 2^nd April started early for me! Leaving home before 6:30 to get to Musgrove Park Hospital in Taunton by 8 am proved ... a bit of a challenge, but by the end of the day, it was well worth while! I was lucky enough to be shadowing a matron (Sally Maltravers) who looks after Endocrinology amongst other wards. First of all, I toured the Endocrinology ward with the other nurses who were discussing changes that would be made to allow for two single sex recovery rooms. I was then given the opportunity to accompany a consultant ward round in the Neurology Unit which focused on rehabilitation. This was great, as this is an area that really interests me, and taught me that whilst doctors generally know what’s best for the patient, the patient isn’t always co-operative, so listening skills, having patience and staying calm are all very important. After that, I went to SAU, where I learnt the role of the ward sister and the need to balance time spent with patients and time managing staff. Towards the end of the day, I headed to a meeting to discuss the changes to the Endocrinology ward, which involved people from different functions in the hospital to talk about practicalities of the changes and to suggest alternative options. This showed to me the planning side of medicine and the number of things that nurses and doctors get involved in.