Emergency Medicine
Life as a 'senior' medical student is somewhat removed from life as an ordinary uni student. For starters, you're not on campus (to make use of campus amenities, but that's another story), you have few if any lectures, and you hardly see your classmates. The way 'we' as med students learn, is by being placed into various specialties in the community, be that in the hospital or elsewhere, and we learn by observing and doing. Kind of like an apprenticeship.
For the last four weeks, I have been doing ED at RPH - and I have to say, it has been one of the more enjoyable terms. There have been some real eye-opening moments, and a lot of good teaching provided by the kind staff there.
Allow me to go through some of the more interesting points about the term.
Working shifts
There were 8 of us at RPH ED, and each of us was rostered onto a different ED team. A team consists of four or five junior doctors (that's me next year!), and each of them work the same shift together. It was kind of cool hanging out with people only one year more advanced than me their careers - the still remember what it was like to be in my position!
Importantly, being attached to the team meant that we worked the same hours as they did! Thanks to the rota, I started the term with 9 days solid in a row working. That's 8am-4pm for the first five days, and then 12noon-10.30pm for the other four. It was not the easiest of experiences and really made me realise the physical drain that junior docs have to endure. I was pretty tired by the end of that.
Facing emergencies and death
We had all completed a day's worth of Immediate Life Support training, but we practiced on dummies, not the real thing! On one of my first shifts in ED, we got a call from the ambulance saying that they were bringing in a patient with a GCS of 3. Meaning he was as conscious and as responsive as a brick. I was charged with putting the intravenous line into him, whilst the other staff (docs and nurses) busied themselves with all the other things (ECG, undressing him, checking blood pressure etc). When I felt for his veins, I was shocked to feel a freezing cold, sweaty arm with no veins to feel at all. The patient's peripheral circulation was completely shut down. The consultant ended up putting the IV line into the patient's external jugular vein - but we couldn't do much for him. With a GCS of 3, his outcome wasn't good. We eventually stopped the resus and the patient died.
Dealing with death was one of the difficult aspects of being in ED. On the wards, you're not so intimately involved with patients' care to the point that you see people die. I saw someone die for the first time during my time in ED. It was a surreal experience to see someone deteriorate from being alive and aware at one instant to being dead within five minutes. Unfortunately for him, he had a ruptured aortic dissection. Definitely something I'll never forget.
Bed shortages
There is a worldwide phenomenon of decreasing numbers of beds in hospitals and more people wanting to get in. ED is no difference, in fact it is probably one of the places where that reality is most obvious. You rarely have a day in RPH ED where you don't see at least ten beds lined up in the corridor simply because there is no place else in the hospital to put them. It becomes a never-ending game of musical beds, wheeling patients in and out of cubicles, in an attempt to gain some provacy for when the doctor comes to see them.
Helping so many people
I saw more sub-acute stuff on my own than I ever did in GP. And as opposed to GP, most of these patients actually had medical problems! It was a good test of my training to be able to see a patient, and assess quickly whether they needed serious medical intervention, or if we could give them some medications, or suture their wound, or plaster cast their arm - and then send them on their way. And even if they needed serious intervention, they would always be turfed off to one of the other departments. The rapid turnover of patients and the fact that they did not need on going care from us was very appealing to me.
All in all, a useful term - and one that gave me a lot of confidence for next year, when I actually become a doctor. For the first time, I think I can do this!
Tags: Medical
For the last four weeks, I have been doing ED at RPH - and I have to say, it has been one of the more enjoyable terms. There have been some real eye-opening moments, and a lot of good teaching provided by the kind staff there.
Allow me to go through some of the more interesting points about the term.
Working shifts
There were 8 of us at RPH ED, and each of us was rostered onto a different ED team. A team consists of four or five junior doctors (that's me next year!), and each of them work the same shift together. It was kind of cool hanging out with people only one year more advanced than me their careers - the still remember what it was like to be in my position!
Importantly, being attached to the team meant that we worked the same hours as they did! Thanks to the rota, I started the term with 9 days solid in a row working. That's 8am-4pm for the first five days, and then 12noon-10.30pm for the other four. It was not the easiest of experiences and really made me realise the physical drain that junior docs have to endure. I was pretty tired by the end of that.
Facing emergencies and death
We had all completed a day's worth of Immediate Life Support training, but we practiced on dummies, not the real thing! On one of my first shifts in ED, we got a call from the ambulance saying that they were bringing in a patient with a GCS of 3. Meaning he was as conscious and as responsive as a brick. I was charged with putting the intravenous line into him, whilst the other staff (docs and nurses) busied themselves with all the other things (ECG, undressing him, checking blood pressure etc). When I felt for his veins, I was shocked to feel a freezing cold, sweaty arm with no veins to feel at all. The patient's peripheral circulation was completely shut down. The consultant ended up putting the IV line into the patient's external jugular vein - but we couldn't do much for him. With a GCS of 3, his outcome wasn't good. We eventually stopped the resus and the patient died.
Dealing with death was one of the difficult aspects of being in ED. On the wards, you're not so intimately involved with patients' care to the point that you see people die. I saw someone die for the first time during my time in ED. It was a surreal experience to see someone deteriorate from being alive and aware at one instant to being dead within five minutes. Unfortunately for him, he had a ruptured aortic dissection. Definitely something I'll never forget.
Bed shortages
There is a worldwide phenomenon of decreasing numbers of beds in hospitals and more people wanting to get in. ED is no difference, in fact it is probably one of the places where that reality is most obvious. You rarely have a day in RPH ED where you don't see at least ten beds lined up in the corridor simply because there is no place else in the hospital to put them. It becomes a never-ending game of musical beds, wheeling patients in and out of cubicles, in an attempt to gain some provacy for when the doctor comes to see them.
Helping so many people
I saw more sub-acute stuff on my own than I ever did in GP. And as opposed to GP, most of these patients actually had medical problems! It was a good test of my training to be able to see a patient, and assess quickly whether they needed serious medical intervention, or if we could give them some medications, or suture their wound, or plaster cast their arm - and then send them on their way. And even if they needed serious intervention, they would always be turfed off to one of the other departments. The rapid turnover of patients and the fact that they did not need on going care from us was very appealing to me.
All in all, a useful term - and one that gave me a lot of confidence for next year, when I actually become a doctor. For the first time, I think I can do this!
Tags: Medical
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