{"id":452,"date":"2019-02-01T12:21:41","date_gmt":"2019-02-01T12:21:41","guid":{"rendered":"http:\/\/blogs.cardiff.ac.uk\/carer\/?p=452"},"modified":"2019-02-01T12:21:43","modified_gmt":"2019-02-01T12:21:43","slug":"an-average-day-in-january","status":"publish","type":"post","link":"https:\/\/blogs.cardiff.ac.uk\/carer\/an-average-day-in-january\/","title":{"rendered":"An average day in January"},"content":{"rendered":"\n

There would be many questions in my <\/em>head if I were beginning something like the CARER year 3 \u2013\nquestions I might ask someone that was already doing it, for instance.\nQuestions like \u201cDo you feel like you\u2019re missing out?\u201d (no), \u201cWhat\u2019s it like so\nfar away from Cardiff?\u201d (ask the North Wales students that!), \u201cWhy did you\ndecide to do it in the first place?\u201d (one-to-one teaching; independence), and\nso on.<\/p>\n\n\n\n

Perhaps one question that slowly bubbles up once some of\nthese have already risen is \u201cwhat\u2019s an average day like for CARER students?\u201d.\nBesides the fact that there is<\/em> no\naverage day, making the question impossible, I also cannot generalise to CARER\nstudents, plural. We\u2019re all different: the surgeries, the patients, our\nG.P. mentors, the landscapes all through Cardiganshire and Powys and Gwynedd.\nIt can be snowing over the bogs in Tregaron while the sun shines in Borth and the\nrain flies sideways in Machynlleth. I can be helping in a minor operation while\nother students are doing baby clinic or seeing patients on home visits.<\/p>\n\n\n\n

But rather than continue with tasks and things I cannot\ndo, I thought it better to describe at least one CARER student\u2019s day. It is not\nrepresentative; I don\u2019t think there has been any day so far which was typical<\/em>.<\/p>\n\n\n\n

The sun rises at 8:04 AM, but by this time I\u2019m de-icing the windscreen of the car. The mornings in late January have become beautiful, crawling a little further into daylight every day so that by now as I set off from Aberystwyth and head North the sky is clear. Orange and pink light scatters from hilltops to the East over rivers almost overflowing their banks and sheep that stare with dull inattention. The road goes winding between neighbour hills which either shelter close bushes and a few sparse trees or host wind turbines which lazily whir in perfect synchrony.<\/p>\n\n\n\n

By the time I arrive at the Cemmaes Road surgery the\ninside of the car has heated up and the sky is full of light. There are a few\npatients sitting quietly in the waiting room as I arrive with a few minutes to\nspare before my first patient. I set myself up in one of the consulting rooms. I\npop my head round the door of Dr Louise Hyde, my G.P. mentor, to let her know I\u2019ve\narrived and that I\u2019ll call in my first patient when he arrives.<\/p>\n\n\n\n

\u201cOh yes, good \u2013 you\u2019ve just got two of your own this morning,\nand then you\u2019re helping me out with a minor op.\u201d<\/p>\n\n\n\n

\u201cWhat is it?\u201d<\/p>\n\n\n\n

\u201cWe\u2019ve someone coming in for some skin lesions under his\nchin, he keeps cutting them while shaving and they bleed everywhere, so Dr Ali\nbooked him in to have them removed.\u201d<\/p>\n\n\n\n

\u201cO.K. great \u2013 I\u2019ll let you know when I\u2019m done with my first\npatient and then I\u2019ll call you in.\u201d<\/p>\n\n\n\n

With this I log in to the computer and get out a pad of paper\nand my stethoscope, before reading the patient\u2019s recent notes. I have about\nfive minutes to learn some of his background before I see from a red mark on\nthe monitor that he\u2019s arrived and is in the waiting room. In theory he\u2019s had\nsome dreadful fractures from last year and has recently had lots of hip pain.\nTo my surprise I am greeted with a seventy-something chap jumping up from his\nchair \u2013 admittedly holding crutches \u2013 and springing forward to meet me with\nmore energy than men half his age.<\/p>\n\n\n\n

In his own words he tells me what\u2019s been happening\nrecently and I try to keep my mouth closed. One of the locum G.P.\u2019s at the\npractice is a firm advocate for a minute \u2013 the \u2018Golden minute\u2019 \u2013 where after inviting\nthe patient to give their story you keep your lips sealed. And, true to form,\nthe entire story from this gentleman\u2019s perspective unfolds. The questions that enter\nmy head are telepathically received and before I can open my lips he has\nanswered every single one. After shattering both of his heels falling off a\nladder last year he has had surgical fixation of both of them – he shows me the\nX-rays, where his feet are rammed full of what look like metal pistons holding\nall the pieces together. He recovered in record time, surprising the\northopaedic team by hopping onto the bed in his outpatient follow-up when they\nhad thought him wheelchair bound, but now he has new pain in his hips. When I\nexamine his legs they are strong and springy, and he casually explains his\nphysiotherapy regimen that he has followed religiously every day, as well as at\nleast an hour\u2019s walk every day with his crutches.<\/p>\n\n\n\n

I can\u2019t find anything markedly wrong with his hips \u2013 they\u2019re\nnot tender, or red, and the range of movement is better than mine this early in\nthe day \u2013 so after thinking about his posture walking with the crutches it is\ntime for me to give up and call in Dr Hyde. I present all the features of the\ncase as I see them, and after the cogs turning for no more than a few seconds\nboth myself and the patient are relieved when she says \u201cI think I know what you\nhave, and the history you\u2019ve given is quite typical for it.\u201d<\/p>\n\n\n\n

\u201cI think this is a case of trochanteric pain syndrome \u2013\nwhat we used to call trochanteric bursitis.\u201d I see my patient\u2019s face change as\nhe faces Dr Hyde.<\/p>\n\n\n\n

\u201cDo I need anything for it?\u201d<\/p>\n\n\n\n

Her face changes in response, matching his expression.<\/p>\n\n\n\n

\u201cWell\u2026 it can actually resolve on its own. But if you\nwant anti-inflammatories for the pain in the meantime, I\u2019ll be happy to\nprescribe some for you. I think you should re-refer to the physio in Mach, and\nthey\u2019ll give you a few different stretches for the outside of your hips that\nmight help you.\u201d<\/p>\n\n\n\n

Now it is his turn to change.<\/p>\n\n\n\n

\u201cAh! I was<\/em>\ngiven some different stretches a while ago, but I stopped doing them. Look,\u201d he\nsays, turning on his side in the chair and raising his leg straight from the\nhip. \u201cBut it got too painful a few weeks ago,\u201d he explains.<\/p>\n\n\n\n

With a few more deliberations things are brought to a\nclose. Satisfied, he exits, thanking us both very graciously.<\/p>\n\n\n\n

The next patient is already here. Time is quite slippery\nwith patients, focus on their story spinning the hands of the clock faster than\nexpected. She is a charming lady with black hair carefully framing her head and\na large brooch glittering on her cardigan. She moves more slowly than my first\npatient, owing to some heart trouble. She is also in her 70\u2019s, and was seen\nbefore the weekend by the advanced nurse practitioner. She had an electrocardiogram\n\u2013 or ECG for short \u2013 before being booked in again for a review of it with the\ndoctors.<\/p>\n\n\n\n

She scares me quite badly at one point in the consultation. It happens like this. She has a type of heart trouble \u2013 angina, a pain in the chest when stressed or working hard \u2013 and recently it\u2019s been happening more than it used to. She\u2019s had for some time a spray to use under her tongue to widen coronary blood vessels and supply the heart with more blood. Recently she\u2019s had to use it a lot more than in the past. In fact, she mentions casually, she had a bit of an attack on Friday, the day after her last appointment. I begin to question her. Yes, it was a heavy pain on her chest \u2013 and do you know, she says, it went all the way down my left arm, like this, and it went up into my jaw, while I was on the phone to my friend. I double check what she said. Yes, my left arm and my jaw. I see, I say, now just a little <\/em>more worried. And did the pain start quickly, or did it creep up on you? Oh, she says, it happened slowly. And what did you do next? Well, I took my morning ibuprofen, for my arthritis, and I used that spray, and I took some aspirin as well. Did it help?, I ask, not urgently but keenly focussed on her answer. Yes \u2013 yes, it went away in about thirty minutes or so.<\/p>\n\n\n\n

Now I take the patient\u2019s blood pressure, press fingertips onto her ankles and her back, take my stethoscope and listen to her heart and lungs, check her pulse, etc. I come back to questions \u2013 is she too breathless to go shopping? Can she get up the stairs? Is she sleeping normally? and so on \u2013 then I begin typing up the notes and send Dr Hyde a message to come through when she\u2019s ready. I bring up the patient\u2019s ECG and current medication while presenting the case so far, looking straight into the doctor\u2019s eyes as I explain. In particular, the gradual onset, central and heavy chest pain, that radiated into the left arm and jaw and seemed to be relieved. I hope my eyes convey a question: \u201cIs she alright?\u201d Dr Hyde reassures both myself and the patient, explains that for the moment her current medications for angina and blood pressure need to be modified and that we should book her to have an appointment in Bronglais hospital with the cardiology team. The good news is that this lady is well at the moment: her pulse was a reasonable rate, it was regular, she has no signs of congestive heart failure and her previous ECG was normal. An appointment with cardiology will make sure she gets more detailed care.<\/p>\n\n\n\n

Normally I would see four or six patients in this way,\nbut today two slots are booked off for a minor operation. The consent forms are\nprinted off and I get the gentleman in question comfortable in what is referred\nto as \u2018the treatment room\u2019. If someone had ripped their leg open or if a child\nhad banged their head in a fall, they would sit on this same bed. He is propped\nup, and a curtain of paper is tucked into the collar of his rugby shirt. I get\nhim to relax his head back onto the bed\u2019s back, and he is cracking a joke or\ntwo. Next moment Dr Hyde has prepared an anaesthetic, which I then inject into\nthe oval of space around where Dr Hyde will cut. We have both scrubbed our\nhands before donning sterile surgical gloves and she tests the patient with the\ntip of the scalpel:<\/p>\n\n\n\n

\u201cSharp, or blunt?\u201d she moves the point to the opposite\nend of the oval.<\/p>\n\n\n\n

\u201cAnd again, sharp, or blunt?\u201d We wait a minute or two \u2013\nhe can still feel the point.<\/p>\n\n\n\n

It is time \u2013 the local anaesthetic has worked – and the\ndoctor makes a neat first incision. Once or twice the patient goes to talk\nwhile the scalpel is hovering above his skin, and my brain instantly fills with\nthe image of him accidentally impaling himself as he tries to crack another\njoke. But he stays still. The face and neck are well supplied with blood vessels,\nand as well as a scalpel Dr Hyde is using an electric cautery machine to zap\nthe ends of a few vessels closed. The bed is low down and I am bending forward over\nthe patient, which is perhaps why I suddenly feel light headed. I explain to Dr\nHyde that I\u2019m going to sit down for a moment, and within a few seconds my vision\nclears up. Soon I am back at the side of the action, feeling silly but glad I didn\u2019t\nhave to leave or worse, actually pass out. The small ellipse of skin is just\nnow finally being gently taken off and it then drops into a pot to be sent off\nfor analysis \u2013 not because Dr Hyde thinks it\u2019s suspicious or worrying, but as a\nroutine matter.<\/p>\n\n\n\n

With lunchtime still a few minutes away I drive the short hop into Mach to the community hospital, where I go to meet a patient. She has had problems with pain relief during her stay so far and I am hoping to get her consent to be followed up by me in more detail for some coursework. I explain the project I have to do, what it will mean for her \u2013 she will have to endure my interrogations twice a week on how her care is progressing and whether things have gone well or poorly, as well as running through with me her medical background and her social history. It will hopefully mean I become an expert in her case, and know exactly what is happening with her. I leave the consent form with her so that she can decide to sign it in the next few days, ask for her previous notes to be kept a few days longer so I can read them before they are sent off, then jump back in the car to Cemmaes Road for lunch and my afternoon clinic. The sun which has been absent for the past three months or so now shines bright in the sky, surprisingly strong. For a long time it’s been gloomy brooding clouds overhead in the daytime, and a long night, only finishing as I arrive in the morning and beginning again before I drive home.<\/p>\n\n\n\n

I have lunch and chase up a few loose ends before my\nbloods clinic starts. Normally blood samples are taken by the nurses, but I\nasked for lots of practice and as a result I now get allocated half days where\nI have about 12 patients come through for all sorts of tests – with all kinds\nof veins in their arms. At the start of the year I was quite apprehensive,\nhaving only had two practice goes on other medical students before what seemed\nto me like being thrown in the deep end. Now I settle into a routine, bringing\nup each patient\u2019s notes, filling out the test requests on the yellow laboratory\nslips and then calling the patient in. Today the tests are for all sorts of\nthings: a medication review, ulcerative colitis, intermenstrual bleeding,\npossible malaria (for this I have to ring Bronglais microbiology department to\nask which colour blood bottle the sample should be in) and one or two general\nchecks, to give some background to problems like recent falls and dizziness or tiredness\nand fatigue. To my relief and pride I get blood first time on every patient,\nand even receive a few compliments. \u201cOh, I hardly felt it!\u201d \u201cThat didn\u2019t hurt\nat all,\u201d and \u201cis that it?\u201d My last patient booked in slowly inches into the\nroom guided by her daughter, and to my surprise has excellent veins despite nudging\nninety years old. She tells me that she didn\u2019t feel a thing. She goes next door\nstraight away into an appointment with Dr Hyde \u2013 she hasn\u2019t been to a doctor in\nyears and years, and is only now having some problems. About two or three\nminutes later there\u2019s a knock on my door.<\/p>\n\n\n\n

\u201cHave you had your ECG signed off? have you done one on a\npatient?\u201d<\/p>\n\n\n\n

\u201cNo, but I\u2019d like to.\u201d<\/p>\n\n\n\n

\u201cWell, come through and help me set one up. It\u2019s for the\nlady you\u2019ve just seen \u2013 I think she has an irregular heart rhythm.\u201d<\/p>\n\n\n\n

Being as gentle as I can be, I place the sticky gel pads on the limbs and across the chest of the lady who I have just taken blood from. She stares up at me calmly as I untangle the mass of ten electrodes and clip them in place, before Dr Hyde tells the patient to stay still while her heart trace is recorded. Then the printer grumbles and whirs, and lots of black squiggled lines jag up and down graph paper. The patient gets up slowly, the electrodes and the pads come off. She gets her jumper over her head and the halo of fine white hair that surrounds it, and again her daughter helps her down the corridor to Dr Hyde\u2019s room.<\/p>\n\n\n\n

I round up a few last bits and pieces, check I haven\u2019t\nforgotten anything, log off the computer and say goodbye for the day. I am just\na few minutes too late for the daylight, but there is the faintest purple shadow\nover the Dyfi valley and the green hills. Racing back to Aberystwyth, I make it\njust in time for the warm up with the university athletics society. A warm up\nis definitely needed at this point \u2013 the temperature is dropping quickly and\nthere was a terrific gale blowing about the town all of the day before, doing\nits best to rip the roof of the house during the night and shrieking round us\nduring the day. At the end of the week there is a cross-country event coming\nup, so when we have our breath back the talk is of what to do in town to\ncelebrate afterward.<\/p>\n\n\n\n

After an hour on the track I am back home, where my\nhousemates are cooking and there\u2019s hot water for a shower. It\u2019s easy to get to\nsleep at night \u2013 even if the wind was howling, I\u2019ve been on the go all day. I\ncould probably sleep if the neighbours built a drum kit from frying pans and\nfire alarms and tested it out for the first time at midnight.<\/p>\n\n\n\n

I hope this exhaustive, extensive, descriptive, verbose day in January 2019 answers the question you perhaps never even asked: \u201cwhat\u2019s an average day like for CARER students?\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"There would be many questions in my head if I were beginning something like the CARER year 3 \u2013 questions I might ask someone that was already doing it, for […]","protected":false},"author":1592,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-452","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"meta_box":[],"_links":{"self":[{"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/posts\/452","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/users\/1592"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/comments?post=452"}],"version-history":[{"count":6,"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/posts\/452\/revisions"}],"predecessor-version":[{"id":458,"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/posts\/452\/revisions\/458"}],"wp:attachment":[{"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/media?parent=452"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/categories?post=452"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.cardiff.ac.uk\/carer\/wp-json\/wp\/v2\/tags?post=452"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}