Okay sorry if I disappeared for a while but I have had A LOT going on (mostly bad unfortunately) and I will update you in another post. Anyways I applied for a work experience placement in like October and it started today so I will fill you in about what happened etc. Hope you all have been well <3
Okay so first things first, we had a mini induction where we were given a leaflet and we got our ID badges and met some of the other students who were also at that hospital for work experience. When I went up to my department, the doctor I was meant to shadow/follow was not there which sucked. I kept asking and staying around the doctor room with another student and eventually someone gave us someone to follow around which was great. He was an F2 doctor I think and he was only in that department as a cover which means we will probably not see him for the rest of the week which sucks because he was REALLY good at explaining and showing us things.
The first thing we did was take a blood test from a patient who had had their pituitary gland removed. The pituitary gland is a major endocrine gland which helps produce essential hormones by sending out hormones which act as messengers to different organs and glands which in turn produce essential hormones needed in the body. He explained it to us in a simple way. Say there is a senior manager, a manager and then the workers (or doctors in this case). The pituitary gland acts as the senior manager sending out instructions (messenger hormones e.g. thyroid stimulating hormone) to the manager, the manager (organs or gland) then receives the message and in turn sends out the jobs/instructions to be completed by the doctor (produce a certain hormone e.g. thyroid hormone).
Anyway, the patient we were seeing had had a tumour growing on/next to their pituitary gland which had caused his sexual hormones to stop being produced and this was visible since he lost all his body hair and had a loss of erection. The tumour had been growing for 15 years and was only discovered a year ago when he felt very faint on a tube and had to go to hospital. The tumour was 2.6 cm which was massive seeing as the gland was about a pea size. The reason he had to have the pituitary gland removed despite it producing the rest of the hormones fine was because the tumour was putting pressure on his optical nerve which was starting to lead to a vision problem and could have eventually lead to blindness. Once the pituitary gland was removed, the patient had to undergo hormone therapy and the doctor we were shadowing was taking his blood test to make sure his hormone levels were okay.
There was one complication that was mentioned. The patient had previously had a pacemaker implanted because he had a blocked vessel and was at risk of a heart attack so even though he had not had a heart attack, he underwent open heart surgery to prevent one. This pacemaker was metal so it meant that he could not have a MRI scan and only had a CT scan. I was not sure what that meant but thought to mention it anyway.
Next we had a patient who had Pancytopenia which meant that she had a deficiency in red and white blood cells and platelets. The decrease in platelets meant that the body found it harder to clot and so there was random bleeding around the body and loss of blood as the blood would flow out. This meant she had to undergo blood infusion to make up for all the blood that was lost. The decrease in white blood cells meant her immune system was weakened and therefore she was more at risk of catching an infection, for this reason the doctors put her in isolation to prevent her catching anything from the other patients.
We then had 2 patients who were both having lumbar decompression surgery (discectomy operation) because of the cartilage wearing away (due to old age) which then for the first patient caused friction between the L4 and L5 vertebrate which was causing the leg pain. The second patient was caused by the L4 vertebra collapsing over the L5 vertebra and putting pressure on a nerve cord which was causing him intense pain in his left leg. Both patients were old and male and the doctor was taking their history and seeing if everything was okay before they underwent the operation in a couple weeks.
During both assessments, we learnt how to do a history. He did the history of the first patient and then showed us and explained how he wrote everything. First he asked the patient about the presenting complaint which in this case was his leg pain, then he asked the patient about his medical history if he had any medical conditions or surgeries prior and the patient had severe depression. Next the doctor asked and noted down the medication and drug history of the patient which were a few anti depressants. The doctor also asked about allergies which he stressed was very important (patient had none). Then the doctor asked about the patients social history which was basically asking his living in conditions, travel history, if he smoked/drank alcohol etc. Then the doctor listened to his chest to check his lungs and checked his abdomen to see if his stomach was okay.
The doctor then asked us to take a history for the second patient whilst he talked to him. Here is what I did:
Presenting complaint: Left leg in pain downwards, a sharp pain (9) and very intense which prevented him from being able to stand or walk.
Medical history: He had previously had hernia but had a keyhole surgery to fix that.
Medication: He had a couple medications but the patient gave the doctor a prescription list so we didn’t need to write it down.
Social history: The patient lived with his kids and wife, he did not drink or smoke, he was retired. He used to be very active but this leg pain prevents him from going about his normal daily activities.
Italics means the doctor added it when I read my history. The doctor then explained to us that it is very important to ask about allergies. He told us a story about a German doctor who did not know English was told by his patient that he was allergic to Penicillin but either the doctor didn’t understand or forgot/dismissed. The patient was giving penicillin as a medication and ended up dying.
NKDA – No known allergies (no known drug allergies)
Patients are also assessed on NEWS score which stands for National Early Warning Score and is assessed on Repository rate, Oxygen rate, Temperature, Blood pressure and Heart rate. The lower the score the better and anything at 5 poses a high risk and 7 requires emergency help.
We even used a bleeper. Each doctor had a bleep number and you could use any telephone in the hospital to call that specific doctor as long as you knew their bleep number. We wrote down the doctor we were shawdowing’s bleep number before we went off to lunch and once we finished we “bleeped” him so we could meet him again to follow him around on which ever ward he was on. I swear that bleeper went off every few minutes for some of the doctors and you could see the annoyance on their face sometimes. I remember reading on a medical students blog how annoying it was and the mini struggles and I finally understood haha xD
Lastly we saw a patient who had a blockage in her upper leg but she had had it fixed and was nearly mobile and ready to go home.
We did spend a lot of time sitting down and waiting for something to happen whilst the doctor filled in paper work or ran around doing small things. Today showed me a great insight of what it is like in a day in the ward and I learnt A LOT of things. Apart from the stuff I mentioned, we also saw the doctors phoning up GPs and medical registrars and sorting out which patients were gonna be discharged and problems/complications or medication etc etc One patient who had been discharged from the hospital was given an overdose of paracetamol because the pain was intense and his wife had given the husband more than she was meant to and this could have caused liver damage so the doctor had to follow up on that and make sure he went to see his GP or even if he may have to go A&E.
Overall it was a very tiring and productive day where I learnt loads and did enjoy myself. It kind of made me excited again about medicine. Tomorrow I am going to try and attend a morning meeting where all the consultants and doctors kind of have a debrief which should interesting to watch and it may even mean I get to find my original doctor (the one that didnt turn up or was too busy) or find another person to shadow. The doctor we were with today said if we asked someone in that meeting if we could go the theatre and observe a surgery, we may get to scrub up and do watch which is exciting. But it also means I have to wake up at like 6am and since its 2:30am, I am gonna have to pump myself with caffeine o.o
I described a lot of what happened in this blog post and may edit it later on to add what experiences or things that I learnt and skills etc One thing I did learn today which I thought was useful was how to write a history. I also learnt what it is like in a ward, checking on patients, giving medications and making sure everything is running smoothly. I could also see how stressful it was when I was in the doctors room, one of the doctors was talking to colleague saying how she had so many patients to follow up she might not even have time to have lunch!
Anyway I needed to write all that so I wouldn’t forget since I have 4 more days to experience! I will write another post tomorrow about the second day of my work experience placement in the neurosurgery department :)