Madness on the Wards

Well, it has been rather a long time since I wrote, and for this i do apologise. Having said that, it would have been irresponsible of me to concentrate more on this and less on not causing long-term damage to the people on the wards..

Anyway, I have been on my ward for almost 6 weeks now and I have to say, its a million times better than the last 3 years of flicking bits of corpse at each other and pretending to be listening to lectures. (That was obviously a joke...i never flicked anything..)
I am on a gastroenterology ward and everyone's reaction is 'errrrrrrrghh poooo!' but actually there isnt much poo around, or even that much wee... or sick. So thats a nice start. The doctors in who's way we are getting are really good- especially our consultant who says things like ' getting your arm fixed is now our most pressing concern' and 'now youre under our team, you'll be our greatest priority'..Seriously, Ive never seen anyone with a manner quite like his. I aspire to be as liked as him- he's pretty inspirational. Whats more, he actually seems to LIKE patients, which you may think is a pretty basic requirement, but you would be surprised!

We have been taught many things and the learning curve on which i have travelled has been exponential. I can now tell the difference between prostate cancer and benign prostate hyperplasia on a plastic bottom (key skill!), i can take blood samples and i have got over my initial awkwardness of asking people how much they drink and exactly what their diarrhoea looks like. I know youre now going 'ohhh thats gross' but you really would be quite surprised at both how important that question is and how much you can tell from colour, appearance and quantity ( eggcup, coffee mug, cereal bowl-ful?)

The thing about my ward is that we have quite a few alcoholics on there, we have discovered Boddingtons under beds and seen people as jaundiced as Homer Simpson. We had to present an interesting patient on the Student Grand Rounds, which is a hospital equivalent of 'Patient Show and Tell' and we picked a pretty classic case of decompensated liver disease (this is when people who are chronically alcohol dependent suddenly find themselves jaundiced, with massive bellies filled with fluid and rather vile bowel habits. Basically, where the body was compensating for the alcoholic trauma to the liver, it suddenly starts failing...anyway, the gentleman we interviewed was so nice- he was really quite traumatised by his hospitalisation and adamant he was going to give up drinking. I genuinely think he didnt know that his 3 cans of 9% beer a day were doing him damage. To be honest, I was surprised at how little that seems. however, when you work it out- were talking 80+ units a week.
Anyway, he recovered quite well over a period of time and was moved off the ward to another..(i think the hospital just moves patients to other wards nearer the main entrance, until miraculously, one day they get up and leave, instead of discharging them..) He was now under the community alcohol team and seemed well on his way to a new life.
Monday morning we turn up for rounds with the registrar. Bad news, He's back. Were all shocked, genuinely thinking he had made a great turnaround. Whats more- hes gone mad!
You need to bear in mind that he was such a gentle man, softly spoken and happy to help anyone who needed to practice taking a history...he had been rampaging around the wards trying to set off fire alarms and swiping at peoples ankles with his walking stick.
One of the problems with decompensation is that the liver cant help to get rid of all of the toxins you get from metabolising food, so they build up and can affect your brain.
He could have got some kind of spontaneous infection in the fluid in his tummy, which could have affected him...
These are both reversible, he will recover but it really shook us all up I think. We had gotten to know him so well and yet suddenly things took a sharp u-turn. Things could have been a lot worse but it shows how difficult it can be to get attached to patients...

Probably thats lesson 1 of hospital medicine.
Number 2 is to wear shin pads around bed 21 to avoid bruises.




P.S.

Listen to this, its amazing