It was my second day in Addiction Medicine and I started settling in after getting to know some of the patients. The typical 'medical student' day in this department is from 0900 to about 1400, but I make a point to stay back as long as I can, to do what I can to help. Thankfully, most of us are doing the same thing.
My wristwatch read 1700 and I thought it was about time to go home and head over to the gym. I have been neglecting my physical health for a couple of months due to exam preparation and a whole lot of procrastination. The phone buzzed and walked over to pick it up. It was Dr. KF, my mentor and now my supervisor in this sub-specialty rotation.
I was hoping you could accompany the intern tonight on his evening shift in the hospital? He only just found out he's working and hasn't had much to eat. It would be great if you could give him a hand if you're not busy.
I'll be there in 5 minutes.
Thanks so much.
Dr. KF bought the intern and I some dinner before the shift started. As expected, the pager started piercing the air, prompting us to head over to the wards. We ate quickly and off we went.
Which wards are we looking after tonight?
Surgical wards and also the medical assessment unit.
The Medical Assessment Unit (MAU) is the place where the majority of the geriatric patients go for assessment prior to admission to hospital. So the patients tend to have a very complex medical presentation with multiple problems as well as Not For Resuscitation (NFR) orders. The families tend to be involved in decision making, if they don't make the decisions on behalf of the patients altogether.
The first consultation was out of the ordinary - the paediatric ward for some analgesia prescriptions. That didn't take long and we soon made ourselves known to the nurses in MAU and the surgical wards. It wasn't as chaotic as we anticipated and so we took our time taking bloods, inserting cannulas. There was the odd scare - a few hypotensive patients in the surgical ward gave us a fright but after some observation, they were fine.
So far, so good.
At about 2100 things started to get hectic. The intensity of calls for cannulations, bloods and medication reviews spiked and at this point the intern and I were on separate wards. I can't say I was comfortable with the frequent misunderstanding that I was a doctor and not a medical student. I'm sure the nurses did get rather annoyed with being corrected constantly and in their eyes, if we were wearing shirts, ties and holding a stethoscope, we were no different. Appearances can definitely be deceiving.
It was almost 2200 and we were about to make our way over to the common meeting room where the hand-overs were done. I had the intern's pager and he was at the other end of the surgical ward. I was just talking to a patient about inserting a cannula and the pager went off.
E2 medical student. Somebody paged?
Yes, I'm calling from MAU. Bed 1 has stopped breathing.
And that's all I heard. I put the phone down and power walked toward the intern.
We have a MET Call.
Fuck. Let's move!
MET referred to the Medical Emergency Team and they are composed of an anaesthesiologist, intensivie care physician, nurses and other team members. We both ran down the surgical ward, waking most if not all patients with our not-for-sprinting shoes and the nurses on the wards weren't phased much; they understood the significance of our haste.
When we arrived outside Bed 1, all the curtains were drawn and the lights were off. MET was obviously not called and I hadn't let the nurse explain that the patient was NFR.
The intern looked at me. What are the components of the clinical assessment to declare a patient dead?
I drew a blank, but quickly composed myself. Dilated and unresponsive pupils. No heart sounds. No breath sounds. No response of any kind to painful stimuli.
Good. We have to elicit them.
After spending a few minutes looking for a pen-light, we went to examine the patient.
He was pale and stiff; his face and neck turned to the right with his mouth open and eyes partially closed. We called his name and there was no response. We shook his shoulder and he did not startle. The intern looked at me as I handed him my stethoscope. He confirmed the absence of heart and breath sounds. Then he pinched the patient's chest, then his eye-brow... there was no response. The pen-light partially lit the room and we looked at both his pupils, completely dilated and they were not responsive to light in any way.
He's gone.
It was the second shell of a patient I had seen. Quiet, calm and absent. I had trouble putting my thoughts together and thought it would be best to just stay silent and only speak when spoken to.
I got home and shed some tears - I wasn't expecting this, but then again, that's my mistake. We are in a hospital. We deal with death everyday. The intern seemed to have no problems with it. It wasn't long before he was talking about the weekend, some facebook competition, karaoke the night before and which girls he was attracted to. Thankfully he was talking to another intern and so, I could tune out from their conversation.
This wasn't the way I was expecting to start Psychiatry, but one way or another, I end up getting pulled into some task, somewhere. And I definitely do appreciate it. Everything is a learning experience and no two patients are the same.
The next day I was tempted to go and see some of the patients we saw over the evening, but decided against it.
I am grateful for this week to be over. We have a lecture or two in the late afternoon and then I am free to relax throughout the night. Some time to myself and distractions with books and lectures is what I probably need.
Seeing some of my friends also made me happy. I look forward to keeping in touch with more of them now that I've returned to the student accommodation.
So far, so good.
At about 2100 things started to get hectic. The intensity of calls for cannulations, bloods and medication reviews spiked and at this point the intern and I were on separate wards. I can't say I was comfortable with the frequent misunderstanding that I was a doctor and not a medical student. I'm sure the nurses did get rather annoyed with being corrected constantly and in their eyes, if we were wearing shirts, ties and holding a stethoscope, we were no different. Appearances can definitely be deceiving.
It was almost 2200 and we were about to make our way over to the common meeting room where the hand-overs were done. I had the intern's pager and he was at the other end of the surgical ward. I was just talking to a patient about inserting a cannula and the pager went off.
E2 medical student. Somebody paged?
Yes, I'm calling from MAU. Bed 1 has stopped breathing.
And that's all I heard. I put the phone down and power walked toward the intern.
We have a MET Call.
Fuck. Let's move!
MET referred to the Medical Emergency Team and they are composed of an anaesthesiologist, intensivie care physician, nurses and other team members. We both ran down the surgical ward, waking most if not all patients with our not-for-sprinting shoes and the nurses on the wards weren't phased much; they understood the significance of our haste.
When we arrived outside Bed 1, all the curtains were drawn and the lights were off. MET was obviously not called and I hadn't let the nurse explain that the patient was NFR.
The intern looked at me. What are the components of the clinical assessment to declare a patient dead?
I drew a blank, but quickly composed myself. Dilated and unresponsive pupils. No heart sounds. No breath sounds. No response of any kind to painful stimuli.
Good. We have to elicit them.
After spending a few minutes looking for a pen-light, we went to examine the patient.
He was pale and stiff; his face and neck turned to the right with his mouth open and eyes partially closed. We called his name and there was no response. We shook his shoulder and he did not startle. The intern looked at me as I handed him my stethoscope. He confirmed the absence of heart and breath sounds. Then he pinched the patient's chest, then his eye-brow... there was no response. The pen-light partially lit the room and we looked at both his pupils, completely dilated and they were not responsive to light in any way.
It was the second shell of a patient I had seen. Quiet, calm and absent. I had trouble putting my thoughts together and thought it would be best to just stay silent and only speak when spoken to.
I got home and shed some tears - I wasn't expecting this, but then again, that's my mistake. We are in a hospital. We deal with death everyday. The intern seemed to have no problems with it. It wasn't long before he was talking about the weekend, some facebook competition, karaoke the night before and which girls he was attracted to. Thankfully he was talking to another intern and so, I could tune out from their conversation.
This wasn't the way I was expecting to start Psychiatry, but one way or another, I end up getting pulled into some task, somewhere. And I definitely do appreciate it. Everything is a learning experience and no two patients are the same.
The next day I was tempted to go and see some of the patients we saw over the evening, but decided against it.
I am grateful for this week to be over. We have a lecture or two in the late afternoon and then I am free to relax throughout the night. Some time to myself and distractions with books and lectures is what I probably need.
Seeing some of my friends also made me happy. I look forward to keeping in touch with more of them now that I've returned to the student accommodation.
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