What have I learnt?

I am on a 4-weeks integrated block, meaning that we spend Monday and Friday in the hospital (renal firm) and Tuesday to Thursday in the community (in a GP surgery or the community). I've found out that: Doctors walk fast, read fast and work long hours; and that men cannot multitask.

I've been really lucky to be allocated to this GP. Not only do we get free sandwiches every Thursday, he gets us as involve as possible in whatever he does. Home visits are really interesting. And the relationship between him and his patients is just amazing, he's such an excellent doctor, all his patients say that.

Dealt with death (or rather dying). Our GP when to a nursing home, said that an end-stage dementia patient might have just had a stroke - no point sending her to hospital as she will only die of horrible bed sores, and started her on the care for the dying pathway. A nurse who had cared for her and seen her suffered cried. He also then showed us the all the death certificates he signed for the past 10 years or so. We went to a one day placement on a hospice, observe a doctor managing symptom relief. Talking to patients there were alright actually, doesn't seem as if they were going to die very soon. I just felt that the atmosphere is deliberately made so beautiful and serene that it constantly reminds everyone present of what the patients are there for. On the ward some patients were not getting better despite dialysis and the doctors has decided to just stop treatment. Very harsh when I first thought about it. I mean, a patient has known renal failure, and you are just going to let his creatinine climb, and literally watch him get uraemic and die? But on second thought I figured if I were in that state, I wouldn't want to die while people are inserting and removing lines into and from my body all the time and forcing medications down my throats that is going to make me feel sick and unwell.

On the other hand, I've also learnt about intervention that offers hope. I sat in a renal post-transplant annual review clinic and saw same liver post-transplant patients in a liver clinic. Transplant is not as bad as I thought. I previously thought quality of life post-transplant would not be good because of various medication to take, but patients normally only take 2/3 immunosuppressants - that can't be too bad. And patients are no longer hooked on to dialysis, restricted diet and various existing medications. Things are even better for the liver patients since transplanted liver could potentially last for a life time. The transplant nurse told me that once the blood vessel of the donated kidney is joined to the patient, you can very obviously see the colour of life coming back on the patient's face. Such an amazing description, isn't it? It's not likely that I'll be seeing a transplant surgery but I think I'm going to ask tomorrow.