29 December 2016

Acute care 'sharp end' of medicine

My rotation just passed involved all the areas of acute care - anaesthetics, ED, ICU etc. It was fab as a medical student, especially on ED. Getting your own patients to clerk, do bloods and investigations on, take round to CT, refer and discuss with seniors, actually made me feel like a doctor. I felt useful and part of the team, helping to bring the waiting time down and doing jobs for everyone.
I was at a major trauma centre so my time on resus was great, very '24 hours in A&E', and also fascinating medicine. The acute assessment and diagnostic side of things is so interesting, especially with all the ultrasound technology etc. they have. Trauma pathophysiology really grabbed me, and also lead me to pick up a physiology book for the first time in about three years.
I can really understand how the faster paced, 'sharp end' of medicine grabs people, but I think for me I would miss the follow-up too much. Even now there's still patients who float into my head and I wonder what happened to them after they were wheeled away.
There were also some incredibly upsetting cases, a neonatal death, multi-mortality RTC etc. I can imagine it is a very emotionally draining speciality.
For example, an elderly lady was brought in with type 1 respiratory failure, severe confusion and drowsiness, and x-ray showed a florid chest infection. She was already elderly with multiple co-morbidities, and BiPAP on resus was failing to bring her O2 sats up. A quick decision needed to be made about escalation of care and DNACPR status, all the while still waiting for her family to arrive. Emotionally difficult for all involved, as DNACPR was decided and the lady eventually went into cardiac arrest and passed. Dealing with death in such a fast-paced way was not something I was used to. Previously, my main experiences with death had been in a Palliative setting, where it is profoundly prepared for, still upsetting, but much more time and consideration has gone into 'planning the death' for want of a better phrase. Although, the consultant told me it was unusual for someone like this lady (in a care home etc.) to not already have a DNACPR decision in place.

Anaesthetics was okay, I got to intubate, do lots of cannulas and LMA's, but I just didn't really enjoy it, not sure why. Maybe it was because of the acute NHS bed crisis, something that underlined all of my time in acute medicine actually. At least one list a day (normally many more) was cancelled due to there being no beds, meaning there was lots of running from theatre to theatre trying to catch them in time to be useful. Then of course there was competition with ODP students, paramedic students, and other medical students! I just always felt like I was awkwardly stood in corridors knocking on scrub windows and bothering people, maybe I just need more confidence.
I enjoyed ICU, but I didn't feel like I could do very much. And my feet! The agony! Those 12 hour shifts with little to do left me dreaming of bringing my own chair to sit on.

Overall, whilst really enjoying my time on the various acute specialities, I don't think they're for me. I can really appreciate why a F2 job in ED would be invaluable though, I feel like I learnt so much there.

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