How I felt,
First Impressions
My first placement with UCL was at the ITU in the Whittington Hospital. I was very excited for this placement as I find the busy, more fast paced side of medicine really interesting.
This was also only my second time on the wards however, and I was nervous. There is no way for the patients to tell who is a clinical year medical student, junior doctor, or pre-clinical student. We were representing the hospital, the medical school, and making an impression on consultants we may meet again further on in our career. This is a terrifying prospect!
Working in ITU, all the staff were expected to wear scrubs, and the novelty of scrubbing up hasn't worn off yet! Hopefully during this week you guys will have the chance too!
Ward Round
At ITU, the ward rounds are always with a consultant, due to the nature of the patients and the severity of their illness. Luckily, the consultant my partner and I had was very welcoming, and really tried to involve us in the discussions. She even printed off blood gasses for us to interpret with the help from the junior doctors.
We were also with 3 FY1 (junior doctors), who explained more complex terms with us that we had not yet covered.
It was nerve wracking, and sometimes the discussions regarding the patient seemed very separate to the individual (which is understandable when the patient is unconscious), but also felt a little abrupt at times. This attitude is necessary though, as there are many patients to see, with complex, multi-morbidities (different chronic conditions at once), as well as acute occurrence which exacerbate the underlying conditions. One such patient was suffering from an acute case of pneumonia, yet was already diagnosed with COPD, this made his treatment more complex, and hence why he was placed into ITU.
What it’s like meeting patients;
depends on how ill they are
Meeting and interacting with patients is a treat, especially after what feels like ages of revision and book learning during the preclinical years. How much you are able to get back from the patient however, depends on their condition. Due to the nature of ITU, a lot of the patients were unable to respond or where confused. On gentleman had been moved from another hospital and was unconscious since his arrival. He began to come around during the ward round, and was very confused. He was an alcoholic, and had passed out at a bus stop. He had severe liver damage and appeared very jaundiced (yellow skin, and a yellowing of the whites of his eye). It was very interesting to hear the registrar explain to the man where he was, why he had been brought to ITU, and how his current state had been caused by his alcohol abuse.
One thing I won’t forget is the man had a tattoo of a man’s name and date on his arm, presumable a son. The man had been found alone, and since he had been at the Whittington (3 days by this point), he had not received any visitors. Meeting patients brings home the humanity of medicine, these are real people with lives, not just biochemical malfunctions.
How to deal with witnessing difficult circumstances.
you may see some upsetting things on the wards, but it is important to remember that everything is being done to help them, and to not take it upon yourself, otherwise you can be overwhelmed. This is something that I still find difficult, but it does improve with more experience in these settings. I used to cry every time we lost a resident at the care home I volunteered at, but over time I have built up some form of resilience.
man with unexplained fitting, wife with him, was hospital worker
One gentleman was being admitted as my partner and I arrived for our placement. He was a porter at the hospital, and had become increasingly unwell over the last few days. He was suffering from idiopathic seizures (of an unknown cause) and was drifting in and out of consciousness. This was difficult enough to observe, but while we were being briefed by the reg in the staff room, we could hear the patient’s wife, distraught in the corridor, as the consultant tried to explain why the woman’s husband was being brought to ITU, and that they didn’t know what was wrong with him at this point in time.
My partner and I were a bit shaken by this, and understood the woman’s distress and confusion, as she said her husband had been fine 3 days ago. The lady was calmed slightly, but her husband continued to fit. Watching a seizure can also be quite difficult, but nothing can be done except to let them, and prevent them from doing any harm to themselves.
- you might see someone who had died, and whose family is very upset by the news, or worse, with no family there. Remember there are people you can talk to; others in your group, the consultant you are shadowing, or us mentors when we meet up again. Just don’t bottle it up.
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