Thursday, April 16, 2015

Ward rounds

I'm not going to be able to get any work done with the events of this morning's ward rounds still bouncing around my cranial cavity, so I might as well just kill two birds with one stone by blogging and getting it off my chest.

I've just started the Medicine rotation, which means actually getting to go into the hospital. It's a stark difference from the lecture and placement-based Primary Care rotation, and it seems a fair bit more interesting so far (then again, it's only been two days).

Today was my first ward round, which I was a bit nervous about. Finding the place to meet the registrar was a problem for directionally-challenged people like myself, but luckily Sandeep had given me instructions on how to get there the night before. There was also the problem of not actually being able to recognise said registrar since I'd had a BST to attend during the time he'd arranged to meet with our Med team, and Will hadn't been able to meet him either. However, this didn't turn out to be a problem as he found us instead of the other way round (I'm positive he'd never laid eyes on us before, but the lost, nervous looks on our faces must have been a dead giveaway). Also, every single meme out there about med students on ward rounds is painfully accurate -- I felt like I was in everyone's way all the time, and just followed our superiors around like a duckling with extreme separation anxiety. I think it was post-take day as well, so things were particularly busy and we were particularly in everyone's way.

But all that wasn't really what I came to blog about, I'm just kind of beating around the bush.

I obviously can't say too much, but the gist of it was that I was present when a patient and their family were being given some pretty bad news. A ridiculous number of people were present, actually: the consultant, the registrar, the resident, the intern, the nurse, a nursing intern (I think), her superior, a fifth year med student, and two awkward third year med students. That's ten people. Anyway, the patient and their family took it pretty well at first -- lots of nodding and "Yes"s and "We figured"s. But then the consultant gently brought up the topic of DNRs ('do not resuscitate' orders), and I think that was when the gravity of the situation hit them. Hard.

The spouse started to cry. Their adult child started to cry. The patient pretended to roll their eyes but was really just trying not to cry. The spouse started to get a bit panicky and fidgety, wringing the patient's hands, hugging their crying child, shaking the consultant's hand and thanking him for his honesty. All the while, they kept glancing over their shoulder at us, all too aware of the fact that they and their newly grieving family had an audience. I felt awful and very sorry that they couldn't have been given this news in private.

Their adult child freaked out a little bit about the concept of the DNR and started to get unreasonably angry, demanding to know who would "make the call" when push came to shove. The consultant and spouse managed to talk to them and calm them down. I think the child was in denial, taking their negative feelings stemming from grief and latching them onto something else. It was interesting to observe.

But boy, was observing painful. Feeling like I was intruding on an exceptionally intimate situation, trying to arrange my facial features into an expression that was stoic but not unfeeling, telling myself over and over again "Don't cry don't cry don't cry"... The diagnosis was one that's close to my heart, so that made it extra difficult. There were other things and aspects as well, but I really shouldn't be discussing those. Anyway, that was a fairly detailed but completely deidentified gist of what happened this morning. What a start to the day for everyone involved.

As we left the room, the lady who I think is the resident muttered to me "Pretty intense first ward round, huh?"

It was, Dr. Resident lady. It really was.


  1. wait till you go on the ridiculously large orthopaedic grand round, a mega ward round that happens once a week, where the whole bloody team from all the consultants to the med students goes on this huge ego parade around the ward, sucking precious oxygen from recuperating patients, and just being an inefficient bloody waste of time.