I remember when I first started the course, the new decade seemed like a lifetime away. I spent a lot of time wishing that it could just be 2021 and I could finally begin living the life that I wanted. As it stands, 2020 has come around in the blink of an eye and now that the end is in sight, I think I'm finally starting to appreciate what a privilege being a medical student is. I'm currently splitting my time between Shrewsbury and Telford hospitals. This is my year to experience life in district generals, which are substantially smaller and less well resourced than the Royal Stoke. I'm starting to get the hang of the hospital routine now - the morning ward round starts at 8:30am on most wards and after this jobs are divvied out, which the juniors spend much of the afternoon getting on with. I'm finally at the stage now where I feel confident enough to help do some of these jobs. I back myself to take blood from, or cannulate, most patients; even those with 'difficult' veins and my history taking skills have come on in leaps and bounds. There are some skills that I still need to work on, as there is less opportunity to practice them. Things such as inserting a nano-gastric tube - this is a tube that goes up the nose and down the food pipe to sit in the stomach. Once in place we can use it to feed patients who are having trouble swallowing, or we can syringe off fluid from the stomach via the tube, thus relieving pressure for people with bowel obstructions. There is a common phrase in the NHS: 'watch one, do one, teach one' and as much as this is slightly facetious, I don't think I appreciated before starting the course that every doctor/nurse has to try things for the first time and this can be highly unusual when the thing you are trying involves putting pipes up peoples noses, potentially causing them a lot of discomfort. But anyway, I had my first opportunity to attempt an NG tube a couple of weeks ago. The nurse asked me if I knew what I was doing and I said I had done all the training. She said "great, the things are in clean utility, let me know if you have any problems." I could see that the ward was very busy and the chances of getting supervision were slim, so I decided to take one of my good friends on the course to assist me. We went and introduced ourselves to the patient requiring the tube and gathered all the equipment. I was nervous, but confident that I knew how to perform the technique, so I went for it. The tube passed up the nose and down into the oesophagus fine, but then the patient asked us to pause. Listening to him was a huge error. After 4 years of having the importance of listening to patients drilled into us, I fell for it and did what I was told. I stopped inserting the tube, which by this point was half way down the patient's food pipe. It turns out that getting things stuck in this area causes you to vomit... Violently. 3 bowls of green bile came out of the patient's mouth in a projectile manner. My pal was wearing a white shirt which has since been thrown away (sorry Soph!). The nurse that tasked me with the job will forever think I'm an absolute moron and the patient may well make a formal complaint (kidding, he was semi okay with it, but he did quite fairly say he wouldn't let us touch him again).
I left the ward feeling a bit dejected and inadequate that day, but one of the best pieces of advice I have ever been given by a tutor is to get back on the horse as quickly as possible. I spent the next week seeking out patients who needed an NG tube until eventually I found one. This gentleman had required several tubes before, so he knew exactly what to expect. He even gave me some tips on the best position to lie patients in etc. Normally we ask patients to swallow the tube down with water as we insert it, but he preferred to use Lucosade. This time I quickly advanced the tube, being careful not to pause and the whole process went very smoothly. I knew the tube was in the stomach and not his lungs, because when I aspirated it, i got a syringe full of Lucosade. That day, I went home feeling epic. Like I said at the start of this post. I'm finally starting to appreciate what a privilege it is to do what I do. As a student I learn new things every day, I get to try things for the first time without the pressure of expectation that doctors have to do things perfectly, and finally, I get to meet interesting people, who put their trust in me, even if that is sometimes misplaced.
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AuthorMy name is Stephan. I'm a 23 year old medical student. I like to travel, play the odd game of rugby and I'm very vocal on formula 1 fan forums (yes I am a bit of a sports nerd). Archives
April 2021
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