Wednesday, 22 April 2009

I Shouldn't Be Here!

Happily walked into a respiratory outpatient's clinic the other day.  The consultant I was with was a bit crazy but they all seem to be in some way.  The Vascular Surgeon I'm going to be with in 4 weeks time will not pay me any attention, in fact he might send me home, if I don't wear a tie!

Back to the clinic.  There were several patients seeing the Consultant for various diseases, Tuberculosis, Chronic Lung Disease, etc.  There were a couple of patients there to receive a confirmation of a diagnosis of lung cancer.  Lung cancer is one of the really bad cancers, they are all bad of course, but many offer good prognoses with current treatment and many people can survive it nowadays.  Lung cancer, however, remains stubbornly resilient to treatment and more importantly early diagnosis.  Early diagnosis is the key to curative treatment in most if not all disease.  Because of this the 5 year survival for lung cancer is around 5% and has been that way for a while.  So most patients will understand that being told they have lung cancer has a major impact on their lives.

So, a patient came in who was wheeled in on her wheelchair by one of her daughters followed swiftly by another daughter wheeling in the patient's husband.  Now the husband had already been diagnosed and treated for terminal prostate cancer.  By some weird trick of fate I ended up sat in the middle of the family, from left to right it went - patient, daughter 1, me, daughter 2, patient's husband.  As the consultation went on the consultant gave the diagnosis and I suddenly felt very aware that I was sat in the middle of all of them!  I have never wanted to run so much in my life!  Partly for me because I was weirded out and felt like a gooseberry but mostly because I felt I shouldn't be allowed to just sit and watch a moment like this, it's too personal!

Truth is though, that I have to be there.  Doctors of every speciality have to be able to break bad news well and sensitively.  It is a learning process and requires a lot of observation of senior colleagues who have done it many times before.  Get it right and you can help people through a very difficult time, get it wrong and you have an already sad patient who is angry and shocked to boot.

Hello again!

Back to abortion later...I'm back on the wards! Hurrah!  It's a brand spanking new hospital and I'm doing Respiratory medicine first then vascular surgery.  I've missed the hospital, lectures are boring and you learn so much interacting with patients.

I was reminded a couple of weeks ago about how weird being a medical student can be.  You don't really know anything and you've not done many procedures but you are referred to as a 'Colleague' by senior consultants and patients seem to trust you implicitly!  Anyway, I had been asked to put a cannula into a patient, should look something like this:

It was all going well, I'd got the flashback of blood which told me that was in the vein (hurrah!) and happily turned my back to get the cap to seal it up when I heard a faint "Blood!" from the patient behind me.  I turned around to find a scene out of The Predator.  The cannula being in vein correctly meant that the blood was free to leave it...and because muggins over here had forgotten to undo the tourniquet the blood was under pressure.  Needless to say I had to spend some time cleaning his arm and wiping some blood off of the floor. Delightful.