Back in action

Aunty visited late this month. I'm not usually glad to see her but today I am. This marks the end of my the low mood, low confidence, low motivation and generally low in everything for weeks.

Busying myself with clinical work has definitely made me happier. I'm on my second day in geriatric medicine. I am really enjoying it. My consultant is very enthusiastic to teach, my SHO has been very accommodating and the nurses are really friendly. Communication is difficult with old people as half the time I am talking to confused or deaf people, but they are manageable challenges.

Yesterday, I examined a lady who was quite ill. I think I have built a good rapport with her even with her advanced dementia. She has a lovely smile. Yesterday I was quite worried about her being unusually drowsy. But today she was much more alert. During ward round, I said hello and smiled at her. And she held her hand out towards me and looked at me like a child wanting sweets... But my body language in response was terrible! I hesitated and did not go ahead to receive her hand and she was left holding her hand out for about 10 seconds before the nurse took her hands, and then she said to the nurse 'don't leave me' repeatedly... Ohhh... I felt so bad. I just wasn't sure what to do for at that moment because I don't want to look rude interrupting the consultant's ward round. So to all medical student or anyone looking after patients in any way, never be like me.

In the afternoon, I went on another ward round by prof, another consultant geriatrician. This ward was duller, most patients were medically fit but remained in the ward with 'pending social issues'. Things went a little more interesting with a lady with advanced dementia who had unexplained depressed level of consciousness and refusing to eat or drink since two weeks ago and was 'dumped' to prof with the recommendation: 'for palliation only', which I wasn't entirely comfortable about, not least because it seemed no one had really looked into any reversible cause for her presentation. Possibilities like extradural haematoma, post-surgical bleed, depression are amenable to treatment and I felt we shouldn't give up just yet. Plus she wasn't drowsy all the time as the notes and nurses reported. I went to her bedside myself, offered her a glass of water and she took sips herself! I usually keep my opinion to myself but because I really don't want to go back home today burdened by another guilt, I asked prof if he would consider any reversible causes. He rambled (ie I didn't understand what he was saying), but in essence he wasn't comfortable with giving up on this lady as well just yet, so the plan was for the nursing staff to actively encourage food and drinking with charting for the next 3 days. I hate to think that the nurses would secretly be thinking that she's really on her way already, but I have a feeling they well may. I am not saying that they are lazy or unprofessional, but I just know from experience that preconception and prejudice can really influence how much effort you would put in with a patient. So I think I'm going to pop upstairs just to check on her for the rest of the week. In addition, at prof's request I am currently studying hypo- and hypernatraemia management using this lady as a case.

At the end of the round, we walked passed a side room and prof showed us the lady who had been on the care of the dying pathway. He commented on the irregular breathing, saying that she may well 'on her last minutes now'. We then literally watched her took three more breaths, and then she stopped. She has died. I have never seen a person die in front of me like this before. It was weird. I wasn't really upset because I didn't know her. But one minute she was alive, and the next she was gone. I left feeling weird, I still feel it now. The SHO and I then went in to confirmed her death. It was also the first time I have heard a doctor announcing the time of death of a person for real. I have now witnessed the process of a person both arriving and departing this world. Very, very humbling.

I like the person I am now. I am thinking and I am motivated to learn. I feel driven to read because otherwise I would not be of any help to my patients. Lets hope this will sustain.

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