Volunteering at QA Week 3 7th April 2012

Work Experience Week 3
Today I spent the first hour or so cleaning. I don’t mind cleaning because it allows you to be helpful, learn where everything is, listen to what’s happening and chat to people at the same time.

I had some more fun on the vital pac system which records patients’ observations. All sorts of things are noted down from the basic blood pressure and temperature to pain score and something called EWS. This means Early Warning Score and it highlights pateints who are at risk from rapid deterioration. It helps doctors to prioritize patients and get a heads up when something is about to go wrong. I have never seen any particularly high scores which is a good thing.

Next, I spoke to a junior doctor in his second year as a specialist registrar doing a placement in orthopaedics. His name was Ed and he studied at Leicester 9 years ago. It was great to be able to chat about what he did in the hospital and where he fitted in with the other staff and patients. He did a ward round and chatted to all the patients before doing a lot of filing and paperwork. I was surprised at how much responsibility he had already- he was a real doctor!

 

Although people are being treated to get better, many problems occur within the hospital. Infection control is a huge part of the day for nurses, health care workers and everyone inside the hospital. Lots of ill people+ lots of visitors in one place = infection. I bet most people can tell you about someone going in with one thing and coming out with something worse- my grandfather went into hospital after a fall and came out a long while later having had shingles and pneumonia.

Deep Vein Thrombosis (DVT) is a good example of problems caused by being in hospital. It’s what the fancy socks you wear in long haul flights are meant to prevent. Long periods of inactivity, like laying on a hospital bed can cause DVT. This week I learnt about the boots that create the same pressure by inflating as walking which lowers the chance of developing DVT from inactivity. They make a really cool noise as you walk past- a whoosh of air and a really annoying beeping noise when they don’t work.

There’s also loads of posters around about bed sores. Bodies don’t like being in the same position all day so the skin can respond by blistering and creating painful sores. Patients are therefore encouraged to move as much as they can, to reduce pressure on the sores and areas of contact between skin and bed.

As with lots of things I’m finding in the hospital, it comes down to a balance between doing good and bad. The bad part would be having a bed sore and good part allowing a new knee to heal. The best doctors I have seen so far know the good and bad in the decisions they make and quickly, but carefully determine the best path of action.

Work Experience Cardiology 10th April 2012

 

First things first- I saw so much cool stuff this week. I met some fantastic consultant cardiologists, interventialists, cardiologists, physiologists, students and registrars; every kind of person that has anything to do with the heart.

I am so  glad I did a bit of research first. I read up on the cardiac cycle, the anatomy of the heart and even how to read an ECG for beginners.

10th April AM

I was teamed up with a senior cardiologist who took me to do her round of inpatients echo cardiograms. It’s an ultrasound probe that poked around at a patient’s chest and produces an image of the heart. You can see all the valves and all the details in the heart. We were bale to measure the thickness of the ventricles , the speed of blood, volume etc. We were looking for back flow from the valves, weak flow and extra thickening of the left ventricle which are all signs of heart weakness.  The physiologist showed me what metal valves looked like and tissue valves which was cool. You can actually hear the metal ones ticking from quite a way away.

I think the echo cardiograms are a brilliant diagnostic tool because you can see what’s going on quickly and it’s completely non invasive! It’s much easier to do on men who are of a reasonable build than women or larger people for obvious access reasons, but in most cases a good physiologist is able to get a brilliant picture of the heart and spot any abnormalities and signs of heart trouble. We could see fatty lesions, flailing valves, blood going the wrong way, tumors and all sorts of interesting things. One of the most interesting things was being able to see a build up of fluid in the pericardial sack due to an infection. We were able to give a precise measurement between the heart and the membrane which means that when a doctor inserts a needle for a chest drain, they can know how far to go without stabbing the heart. Useful 🙂

I saw three patients. The first was being checked because a doctor wanted to confirm which kind of artificial valves had been put in, despite the patient insisting that both were metal. Turns out they were- we could even here them ticking.. It shows one vital thing- listen to the patient!

The second patient was a similar situation. She felt breathless and was having trouble breathing. The doctor wanted to know if there was any complications with the replaced valves, and wanted to know what kind they were. We saw that some blood was going the wrong way through the metal.

The replacement valves do sound good, they usually work. The metal ones last longer than tissue ones( usually taken from pigs). However, they make it easier for clots to form around them so patients must take an anticoagulant- warfarin. You can tell if a patient takes warfarin because they’re usually covered in huge bruises. It’s probably not a good drug to take if you played rugby.

The role of physiologists has changed a lot in the last 10 years or so. Previously, the physiologists ween’t allowed to diagnose patients at all. They just ran the tests and all the data was sent to the doctors however now they are allowed to say what’s wrong and the doctor can confirm it or just go with what’s said. This gives them more responsibility but I think it makes sense, as physiologists see and know the rhythms every day, so they should be more practiced at recognising problems, but the data is still available to the doctors so they can check.

10th April PM

I spent the afternoon in the rhythm analysis room with an audio technician looking at 24hour ECGs. We were looking for particular rhythms and patterns in the ECG and comparing them with the patient’s diary. They were asked to record what they felt and did for 24 hours whilst their heart was being monitored via the ECG. More often than not, the device picked up abnormal rhythms and the patient didn’t feel them, or the patient recorded an abnormality when in fact the ECG was completely normal. In cases where abnormalities happen, and the patient’s health isn’t in danger, and they don’t feel unwell the nothing is done. “If it’s not broke, don’t fix it!” was the phrase of choice.

The technicians pick out the most interesting rhythms and print them off for the doctor’s report. The next step is usually a rhythm slowing drug or a pacemaker depending on the type of abnormality. This is decided in clinic with consultants.

I have to say, I didn’t enjoy looking at a computer screen for that amount of time. The ECG lines began to merge all together after a while but I think if I knew more about the rhythms and if I could interpret them I would be able to enjoy the more.

I also got to see some more indepth echo cardiograms, one with a gentleman who had an ICD. ICDs are pretty much pacemakers with defibrilators attatched so when you going into cardiac arrest, the machine shocks you and you go back to normal sinus rhythm. He let me touch it and it felt just like a match box under his skin. There are some gruesome stories of them rubbing their way out of the skin – skin erosion, and people letting them hang there for years after- eww. Anyway, here’s some amazing footage of it happening on a football pitch to a young guy with an ICD.

http://www.youtube.com/watch?v=DU_i0ZzIV5U

After that there was a primary case. The whole team got ready because a man on the Isle of Wight had a heart attck. The coast guard helicopter brought him in to Gosport because the helipad was too small to support the huge coastguard helicopter. Urgent cases like this are called primarys. The team have a two hour window to remove the clot. In goes the patient, scrub nurse, runner nurse, radiographer, physiologist, student nurses, student physiologists, registrars, senior consultants and the interventialist. Unfortunately for me,  my bus arrived so I didn’t get to look! I heard later that the guy was assessed, stabilised and sent to Southampton for more intricate bypass surgery.

Cool Stuff I learnt

  • I learnt about the role of a physiologist. Honestly, I had no idea what they were before that morning. They usually have a four year degree but some take 6 years, some are in schemes where you learn as you work but now that the government’s money has run out, these are very rare.
  • I have learnt about teamwork- at lunch time and during breaks it’s just like being back in school. They joke, they much around, they even play ACDC during major heart surgery. It’s fantastic!
  • I have learnt that they constantly ask each other questions. “Peer assessed learning” is what they call it at school, but in the hospital everyone from cleaners to the top of the consultants asks each other advice, recommends things. Information is always being exchanged, people are always learning and no one has  to make difficult decisions on their own. This was wonderful to know!
  • physiologists get plenty of patient time, plenty of time in the cath labs, time in front of a screen in rhythm analysis and time in pacing clinics. It’s a mixture job. I learnt that even within a job, people do lots of different things.

Volunteering at QA Week 6

This week I did the usual infection control stuff, it’s becoming a routine. I made a few beds, got chatting to the health care workers. I asked her why she did her job and she gave me a  pretty good answer..

” I like helping people but I don’t want the responsibility when it goes wrong”

I know the first part of her answer makes perfect sense. I doubt that many people wouldn’t want to help people. Despite many people not being religious it’s agreed that helping people is the best thing to do, so it makes sense that lots of people want a job where they get the satisfaction of helping people.

But, as she put it, we don’t want to be responsible for people suffering. Even in the elective ward where people are being fixed there is suffering, though substantially less than say, an oncology ward.  I didn’t like seeing people cry because they couldn’t walk with their new knees and hips. Within a couple of days they could, but all the same I was moved by their frustration at not being able to walk. There are lots of things I have seen and not liked in the hospital and I am sure there will be even sadder things I will see, but my work experience at The Rowans Hospice has taught me not to run away from them, but to go over and see what I could do to help them, even if it’s something as simple as helping someone put on their slippers!

I suppose I would like to be in a place where I am able to take on responsibility. Not everyone wants to, not everyone is able to.  At the moment I can help people by being a volunteer. Patients frequently say that they appreciate what volunteers do. However, if I did have a degree in medicine, or a pharmaceutical business, I would be in a better position to help more people, and in more ways. In this sense, I have to potential to help a lot more people and I could spend the rest of my life doing what I enjoy, helping people, being of use.

The health care worker assured me she was happy with her job. She enjoyed helping people and found the job really satisfying. All day she spoke to people and did what she could to help them, which is exactly what the doctors I followed for work shadowing did.

That’s exactly what I would like from a job- enjoying it, and being satisfied by it. It could be that I find that being a doctor fits that criteria; certainly all the doctors I have met seem to really love their job and are prepared to work extremely hard to keep it. It could be that I find a different job that allows me to fulfill the same criteria.

I suppose that’s the brilliant part about being 17- so much potential to do very good things.

 

Volunteering at QA Week 1 24th March 2012

Week 1 at Ward D5 in Queen Alexandra Hospital.

I won’t lie to you, I was terrified of the ward. I got lost, I didn’t know who anyone was and I had no idea what was going on!

D5 is an elective orthopedics ward which means people choose to go there. It’s mostly hip and knee replacements. There is very little trauma and it’s really chilled out most of the time. It means I have time to ask questions and learn things; which drugs are used, what they do etc.

A lovely nurse took care of me, showed me around, gave me an introduction booklet and introduced me to the staff. The most enjoyable part was chatting to the patients, getting them ice packs and simple things that they appreciate.

I checked all the oxygen taps, suction and hand gels, did little jobs like that. They wern’t difficult but took me ages because I didn’t know where anything was.  I suppose it was quite helpful because I know my way around more. I helped do the observations of the patients which means recording blood pressure, oxygen levels and generally seeing how they are. I was shown how to measure blood pressure without hurting people which I’m sure will come in handy.

At the moment I’m not entirely sure who everyone is on the ward but I am struck by how well they work together. I am looking forward to next week!

 

 

Volunteering at QA Week 5 – 21,4,12

Hello 🙂

I am settling really well with volunteering on the ward and getting lots faster at making beds!  The nurses are lovely, the physios all know me etc. It is amazing being part of their team and actually helping people instead of following them around. This week there were some interesting cases as well as the usual knee and hip replacements, including some patients having vertebrae removed.

I talked to lots of people as usual and spoke to some surgeons who were preparing a patient to go to theatre. They spoke really quickly and were very business like despite the patient looking more than a little nervous. It was a shame they didn’t have time to sit down and chat properly. I am thinking that I would prefer a role where talking is more important and the doctor can build a firmer relationship with the patient. The same goes for nurses, people are far happier in a ward where the nurses chat to them.

This week I spent some time reading through patients notes. I am becoming more familiar with with names of the drugs and what they do. as well as procedure details. I find that I learn lots of new words, eg supine position = laying down on your back. The nurses are always happy to answer questions, and the health care workers and I make sure I make the best of their knowledge. I was pleased to see that all of the staff were still learning, studying, taking exams, right from the caterers to the consultants. I think that’s the brilliant thing about working in a hospital/ health profession; there is always room for improving your knowledge and new things to learn.

I am fascinated by all the gadgets in the hospital too. There in a smartphone system allowing information form observations, pathology reports and other diagnostics to be viewed on a single portable screen that the doctor can take round on their ward. I had a fiddle with it and tried to guess which patient matched each set of observations without looking at the names.

 

As always, I am looking forward to next week and I am happy to announce that I am doing some more work experience on the last weekend of April in the Emergency Department with a senior cardiologist. It should be good!