I spent two days of my work experience in nephrology at X, which I found fascinating because I was able to compare the department to the one at Y. Although X is a large teaching hospital, there is not an adult dialysis unit so very ill patients who need dialysis are sent to the intensive care unit for blood filtration, or transported to Y.
Both mornings I spent at X started off with long ward rounds and many of the patients we saw were the same, so it was interesting to see the continuity of patient care.
One of the patients we saw was in a side room, because they’d had an infection, which had affected their kidneys. Although the patient’s kidneys had recovered they had picked up a hospital-acquired infection and it had made them very confused causing them to attack one of the doctors. I saw the patient a couple of days later and they were much better and they apologised to the doctor. This made me realise some of the difficulties of a career in medicine and highlighted the importance of keeping everything clean to prevent hospital-acquired infections.
One of the patients we saw needed to have a catheter put in to their kidneys for the doctor to measure how much water they passed, however they had refused. The doctor couldn’t go against the patient’s wishes because everyone has a right to autonomy so the doctor had to do their best for the patient with the information they had, even though it wasn’t entirely accurate. It was interesting to watch how the doctor interacted with the patient, explaining to them why having a catheter would be beneficial and asking them again if they would consider having one put in, after explaining that they couldn’t work out exactly what to do with recordings that weren’t accurate. The doctor explained later that the patient would probably be in hospital for a while because they wouldn’t get out of bed and move around, which was essential for their recovery, so they would need rehab.
Another patient was memorable, because they were quite elderly and had kidney problems as well as bladder cancer, which couldn’t be treated. The doctor had to have a difficult conversation with them about the likelihood of their heart stopping in hospital and whether they would want resuscitation. It’s a sensitive topic and the doctor was really empathetic. The patient hadn’t ever thought about what they would want so they were going to think about it and talk to their family. The doctor explained that if they were resuscitated they could survive, or they could end up on a ventilator with a poor quality of life. This made me think about ethical issues and what to do when a patient is dying. If the patient hadn’t expressed clear wishes then the doctors would act in their best interests and follow the correct path.
There was one patient who had become blind almost overnight after a kidney infection and dehydration. Many of the doctors were surprised because the patient had completely lost their vision and they hadn’t seen a case like it before. Although the patient had recovered from their infection, they would have to remain in hospital for a while longer until they had the right support and rehabilitation to adjust and return home. They were being cared for not only by the doctors and nurses but also occupational therapists, who had to assess their flat and make sure it was safe. This made me realise that while many patients in hospital have recovered from their illness, many require rehabilitation and after-care before they are able to leave.
Another patient we saw on the ward round had just come into hospital and when the doctor tried to ask them questions they seemed confused and didn’t reply. When a medical student spent some more time talking to them she found that the patient was more responsive if she talked loudly and they thought the patient could be a bit deaf. The doctors found it hard to get a history from the patient who still didn’t move or talk much at all so they tried to contact a relative who’d brought in the patient. The relative was able to give a history to one of the junior doctors, describing how the patient was an alcoholic and visited the pub everyday.
I really enjoyed going on the ward rounds and seeing lots of patients who were so different and who each had individual needs.