Sunday, 3 November 2013

Raised Blood Pressure

The theme for this week was renal and in studying for this week it was actually the first time the kidneys made proper sense to me.  We had some very good teaches during the week and things just started to click.  It was quite exciting.  The week started with an hour and half wait for the first placement, and I really wish I was exaggerating.  I remember reading something on twitter or a blog about how medical school was actually just training you to be good at waiting, and how particularly in your clinical years you mostly wait around for things to happen.  I thought at the time, how can that be?  Our days a timetabled and choreographed to the smallest detail and wards are full of things happening.  Maybe our medical school will be different.  Nope.  I turned up at 9.15 as my timetable said to be chastised by a nurse for being 45 minutes late as all the Doctors were in a meeting.  Our introduction was only supposed to last 15 minutes before we were expected somewhere else so I was a bit antsy about waiting.  Two others from my class turned up, but they weren't my partners, they were from another week also based on the renal ward.  When my partners turned up, I had now been waiting 30 minutes, and was 15 minutes late for the next slot.  The Doctors still had not emerged form their morning meeting.  My partners and I traipsed around the hospital looking for the renal transplant team the timetable said to find, but not where to find.  Eventually we gave up and returned to the Renal ward, just as the Doctors were finishing up.  One approached us and seemed to be expecting us, saying "wait over there, I'll be back in a minute".  30 minutes later, he was.  He told us to go home, and we would see him in the afternoon.  Successful morning.

Day two was spent in a diabetes clinic, which was interesting,but the theme seemed to be patient has poor blood sugar control and feels awful, patient goes to Doctor to make them feel better, Doctor recommends tablets and insulin and lifestyle changes, patient accepts, patient is non-compliant, patient has poor control and feels awful.  Repeat.  I'm awfully cynical, aren't I?  It reminded me of a lecture we had on breaking bad news, about how patients sometimes go through the grieving process when they are diagnosed with a chronic disease, as they mourn the loss of the life they dreamed for themselves that did not feature this disease, and this disease means they cannot have any more.  Not without medication and lifestyle changes, anyway.  I guess what they really wanted, was the magic wand to wave and take their diabetes away.  Variations on the theme included patients bringing any ache, pain or niggle to the Doctor, diabetes related or not.  And mostly not.  Things that GP's should really deal with, but they were relishing the chance to sit in front of a consultant with their issues, even though it wasn't his area.

The thing I mostly learnt from the week, was a greater appreciation of how fragile the kidneys were.  My feedback patient had been hospitalised because after having diarrhoea and vomiting for three days, their kidneys had started to shut down.  They were usually fit and well, and although no spring chicken, they were pretty ok for their age.  I was really surprised and shocked at how ill they were and how quickly it got so bad.

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