Fortune Telling...

Today I had the loveliest patients arrive in via A&E. They were elderly patients who were confused and unwell and I was able to spend some time holding hands and giving a bit of comfort as well as finding out what had brought them in. You know that was one of the loveliest days as a result. Even now, when I still have a lot to learn I get a chance to be kind to people and do simple things to make them feel better and it gives me a lot of happiness. Much better than yelling at another lawyer down the phone! I'm only worried that when I'm actually a doctor there will be more time pressure and I won't be able to do this as well as I can now.

As one of the students with the on-call team I got to go clerk our new patients and do all the examinations for the admitting registrar. Basically this means getting to find out the history and carrying out lots of examinations and checking basic obs (heart rate, respiration rate, blood pressure, oxygen saturations etc). Naturally as the student its a given that everyone is going to do this all again to check you did things properly but its good to get a chance to see someone without a clear diagnosis so you can have a go working out what is wrong with them and seeing if you are on the right lines. There's always plenty to learn if you get it wrong and if you are correct it makes you feel a bit excited that something from all the reading has finally sunk in...

 

"Hmmm...UTI you have"

I remember the first diagnosis I ever made was in a setting like this and I had seen a patient with shortness of breath, peripheral oedema and chest crackles at the bases. I was suddenly there thinking "heart failure" and was just so relieved that all the things I had seen fit a pattern and meant something! I still had no idea whether it was right or left sided but at least I had made a start on the right path! My greatest fear in the first two years was writing all the symptoms and history down neatly and still having no idea what was going on...

One particular patient was quite interesting because they had a set of symptoms somewhere between pneumonia, heart failure and asthma exacerbation. Definitely one of those times when you get grateful for imaging and blood tests.

I don't know how everyone managed in the days before all these investigations. It would be like trying to drive to Scotland with signs pointing in different directions whilst you are running out of petrol...