Work Experience – Day 2 – Neonatal and General Outpatients

Right, after yet another eventful journey to the hospital (got up at 5.30 and then got stuck in a traffic jam…oh, and also, the bus was freezing…), I completed another day at hospital. Eleanor and I started out in the Maternity and Neonatal unit.

So when we arrived, everything was slightly manic, as the doctor who we were meant to be shadowing was at a meeting, and the ward was short staffed. Anyway, after a while, we managed to see a handover on the maternity ward. This was really interesting, as not only did they hand over all the expected things (baby weight, age (in hours), when they last fed and of course, how the mothers were doing), but also the method of feeding, how much and how often. We then shadowed the doctor on the ward in the ICU and SCBU (Special Care Baby Unit), to do full checks (for jaundice, if they were feeding, how they were breathing…). Babies with jaundice were kept under blue light, and had blood taken for a bili test (checking bilirubin levels in the blood (which should be being removed by the liver)). We also examined a chest x-ray of one of the babies, which had an elevated breathing rate. It showed a slight chest infection, so they gave it a prescription of antibiotics.

From what I saw, the ICU homed preterm babies, those with jaundice and breathing problems. Many babies were in incubators or had cannulas. It was sad to see such young lives having such problems. I can only try to imagine what it must be like for the parents. I saw one mother sitting by her baby, looking absolutely exhausted with worry and lack of sleep, but she did not want to leave her child. Apart from the care of the child, another important job for the staff is to reassure the parents and to try and settle them and also to teach them how to look after the baby (when he/she’s brought home).

The SCBU concentrated on the feeding and growth of the preterm and heathy babies. We learned that the babies who can’t feed normally are fed through a stomach tube (gastric tube). This is fed through the nose, down the oesophagus and into the stomach. Before feeding, they test that the tube is in the stomach by syringing out fluid and test that it’s acidic on pH paper (to test that its stomach acid). If the test is positive, then milk is put in the syringe and is allowed to go down the tube by gravity (not pressure/syringing). The amount of food/milk needed is calculated from the baby’s age and weight.

General Outpatients

In the afternoon, we journeyed on to outpatients. First of all, we spent some time learning how the reception worked, and how they worked as a team- from receptionist, to nurse then to doctor. The reception has to get all the patient notes ready before the consultation, book appointments and sign in the patients.

I then observed five consultations, two Gastric Bypass cases, two Gallstone cases and one Gastric Band patient.

There are two methods of removing Gallstones (small, hard crystalline mass formed abnormally in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts)

  1. Endoscopy- a thin, flexible camera is put down the oesophagus into the gall bladder used to see and remove gall stones. This method is the least invasive and easier way of removal, but due to complications, you sometimes need…

  2. Keyhole surgery- to remove the gall bladder (therefore removing the gallstones). This is a longer and more invasive process and has a much longer recovery time.

I also learnt that gallstones can cause the worst pain ever (according to the doctor and a patient, who said that it’s worse than child birth…).

So, with my four “gastric cases” as I’m calling them, I discovered the determination which these patients have to have before they even have the weight loss surgery. I was told that it is a last resort- after trying weight loss schemes for a long period of time (and them not working), in one case, it was two years!

These procedures are life changers- not only do they affect the weight and lifespan of the individual, but the determination and the changed, healthy lifestyle is passed on to their children and the rest of their family.

I’m sorry that today’s post is quite badly written and doesn’t include much about clinic…but I’m rather tired and I can’t talk much about the cases due to confidentiality. So as a little conclusionary thingy…today I learnt so much about how the various roles of outpatients and the neonatal unit work (even if they were having to fill in for each other), the effect that having an unwell new-born has on the parents and families as well as the baby and how one procedure can affect many people’s lives.

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