Ward rounds

Memories of aged care

I wanted to write these things down months ago but never quite got around to it.

In aged care, I came across a consultant who was had this almost mean smirk on her face constantly, and spoke softly but harshly. She hardly said hello to patients, ever. One day she pinched an overweight lady's abdominal fat, wobbled it around, and then asked her - "what is this? You need to lose it." The patient said oh, with surprise, and I was equally surprised. Another lady had an unusual gait, and this consultant demanded to know "Ms X, why are you dancing like a ballerina?" What a strange sense of humour.

It was disheartening that the attitudes of the senior doctors were readily followed by the rest of the team. I remember an old man who the team rolled their eyes at and dreaded rounding because he always complained. As they whisked through his daily observations, talked about his condition and ignored his attempts to engage in conversation, he demanded with his gruff slurred voice - "aren't you going to talk to me?!" Having plenty of time as a student, I answered his questions about what was happening, and listened to his story about the apparently inattentive overnight nurse, and just a few minutes into the conversation, he (quite appropriately, and thoughtfully) said I should really go and catch up with the other doctors.

Somewhere during those weeks, I noted to myself to work hard to be a normal person, to say hi and bye, as you would in any other situation. And to do that even if the tension of scribbling madly, listening to multiple conversations and rushing off to see the next patient pulls you in the opposite direction.

My clearest memory of aged care was this man in his nineties who always greeted us with a hearty good morning, and winked at me, once or twice. I guess he (and others like him) remind me of my grandfather, who is so stubborn, but doting. Anyway, this man had been in hospital since the first day of my six week rotation and was there until something like my final week. Unlike many of our patients, his mind was sharp, and each day there was a pleasant albeit brief conversation. He had heart failure and I was supposed to complete an observed physical examination on him. Before the weekend he had been sitting up, and was getting ready to leave as soon as home supports were in place. Then he developed pneumonia, and was back in bed. I wasn't there to know the details but over the weekend his infection continued, he had acute renal failure, and ultimately died of a gastrointestinal bleed. So I had to find something else to do for my assessment. But that was okay. But every time I walked past his bed, or when I later saw his name on an old handover list, I would feel a bit sad, and wonder about where he was now (not his physical body of course).

The surgeon and his (her) minions

Groomed, with large leather bags or expensive handbags (I was curious and took a look inside, one was filled with multiple medical journals, another with an iPad and a very fat wallet). Hands on hips, arms crossed, walking deliberately, nodding, firing a question here and there. Talking amongst each other as if there is a massive gulf between themselves and the rest, joking darkly about people dying and having metastasis spread everywhere, complaining about the public hospital system, having lists cancelled, etc. Yes, this is your friendly consultant.

Then there are the in-betweens. Energetic but laid back, presenting with confidence but not yet arrogance and self importance, with distinct character but not yet obnoxious or growing an unsightly Hitler-styled moustache, probably having enough to indulge in delicious food but not entertaining a lifestyle of obesity yet. I guess, it's just a matter of time until these registrars become the men (women) in suits.

The team's secretaries - holding piles of papers, running to get files, scrambling to write down notes, looking intently at everyone who is talking, opening doors and stepping out of the way. Anonymous (the intern said so, not me). Behind them, the non medical staff, usually women, sometimes in alternative outfits, with large dangling earrings, talking indiscreetly about how doctors never actually talk to their patients.

Then there's us, with minds half there, half elsewhere, with our short attention spans. Standing at the patient's end of the bed (because there is no room on the foot end) wandering what he or she feels about the mass of doctors who swarm on them every morning. Wondering why this ward smells different to the next, watching the blood nurse sucking blood skillfully like a vampire - okay not really she is just doing her job. Seeing the multiple bouquets of beautiful flowers one patient has and wondering what makes a person have more flowers and cards than the person next to them. Reading educational posters and random signs and notes, looking out the window and looking at the city skyline in the distance. Admiring a colourful fish painting down the corridor and wondering whether a staff member painted and framed it there, or whether it was just a donated gift. Eyes lighting up to a multidisciplinary meeting - a platter of fruit, adjacent to an assortment of muffins, and delicious bacon and egg breakfast rolls. Mmm, that is what I came in for today!

I guess what goes on in hospital life, whilst familiar, still strikes me as strange. I'm surprised that what I paid attention to, the way I perceived my surroundings during those first ward rounds, are quite similar to what I have described here, on my last ward round as a student. Do I really have to switch roles? I don't really want to...


Ziph said...

That's interesting because in my experience, Age-care seems to be one of those areas where doctors spend that extra bit of time with patients. (Maybe because they can't prescribe anything or cut anything out to help the patient)

However, I guess its not just an issue of time its about how you see patients. Even on busy surg ward rounds, good consultants make an effort to see all the patients and say "hi," and check how they're going.

I've noticed dr's and maybe people in general love complaining, whether its about patients, health systems or the lack of anatomy teaching at med schools. Its seems to be a part of the small talk. But most seem to be very professional and caring in front of the patient. (good dr's are good actors)

Winnie said...

haha good explanation for why geriatricians do what they do (most of the time). they could just be generally caring and patient people.

yeah acting is not really my forte. even half of these exams is about acting, so maybe taking up some classes like WY is the way to go. maybe you can too, it will pave the way for your youtube career :D

S.ting said...

interesting observations

Winnie said...

thanks sting, glad you found them to be so :P


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