søndag den 26. maj 2013

Bye surgical ward - hello medical ward.

I've been here for almost two months, and I am now half way through this exchange - times flies, when you're having fun, even if you're not actually having it. If someone were to ask me, what I've learnt so far, I'd have trouble answering a question like that, because to be frank, I'm not sure what exactly I've learnt, but if you were to ask me this very same question in a few weeks, I'd probably be able to give you a decent and credible answer. But for now, let's just reminisce about the past six weeks...

I finished my internship at the surgical ward that I was at, and I can honestly say that I'm sad that I have to transfer to a different ward. One could argue that I was only being sad, because of the horrible things I've heard about the other ward, but that's not the case. I actually felt like part of the team on my ward, granted some days were longer (well, they weren't longer, but felt like it for sure!) than others, but all in all, I had a real good time at my ward. 
It almost feels like an act, because I got raving reviews of my performance at the ward by my mentor, who was the one stuck with me. Apparently I was humble, very caring, kind, attentive and embracing and open-minded towards the differences and didn't let them stop me into leaping (diving head in first!) into situations that were unfamiliar to me - I know, eh? Fooled her good! ;)

On Tuesday I start another six weeks at a medical ward, mainly dealing with cardiac patients. This could turn out to be a good experience, seeing that I actually did a ten week internship at a cardiology ward back home. So I should have an advantage, albeit that can also bite my in the arse and maybe make me even more narrow-minded than I already am, because I have a good grasp of patients with these types of problem. I guess only time will tell if it's one or the other, or maybe even a mixture of both? I know I'm excited and a bit scared to start there, because of the horro stories, but hey, I'll bring my flash light and pepper spray, that ought to hold the monsters at bay, right?

-xoxo-



lørdag den 18. maj 2013

Terms of endearment - overload.

One of the many things that I've now grown accoustum to is the frequent usage of these so-called terms of endearment. Now it hasn't been easy, let me tell you, and to be quite honest I'm not sure that I'm as okay with it as I come across.
People, very random people, call you things like, "sweetheart", "love", "darling", "dear" and the list goes on. Maybe it's a cultural thing, or I can most definitely say that it's a cultural thing, but can you really address a stranger like that? Well, the answer should be quite obvious, otherwise this post would be redundant...

It's one thing that the staff and the patients on the ward speak to you like that, because after these past five weeks, I feel like I've gotten to know them, probably not well enough to actually want to be called these names, but what can you do? They all mean well, and it makes it easier to digest, it'll probably give me an ulcer later on. But when the person behind the cash register in Sainsbury's calls you one of those things... I mean, there's only so much a person can take! I just want to take my cucumber and hit him on the head with it! It's really uncalled for! I think the reason that I keep objecting to all these terms of endearment (which are harmless, most of the time anyway!) is that I've been behind the cash register and never in my life have I called a customer anything remotely similar - that's crossing a line!
Also it would make sense when an elderly or a person older than yourself calls you something like that, but when a younger person adds terms of endearment into a conversation with an elderly person or someone older, then it comes of as disrespect to me. I mean, I can hardly imagine me saying "love" to a random elderly person, it just seems so wrong on so many levels. Again I'm inclined to blame this on my semi-Danish upbringing.

Alas there's nothing I can do, it's not like I can make a scene each time or maybe I could? If I did, then I'd probably need someone to bail me out eventually! And it's not like my name is easy to pronounce over here, and in retro spect, maybe "love", "dear" and "darling" are way better than "Zeeeniiia" and "Zena", at least my name doesn't get butchered, when people opt for the terms of endearment.

So instead of saying the famous line from Moby Dick, "Call me Ishmael", I will just have to settle with, "Call me love"...but when you do, I'd be on the look out for that cucumber!

-xoxo-

fredag den 17. maj 2013

A special place.

I went to Beacy Head, this is a really magical place, the cliffs are absolutely breath taking and stunning like nothing else. There's such a calm feeling that washes over you, when you stand near the cliff edge, it's almost overwhelming. That place is truely serene. But apparently not all people can cope with that serenity and the quiet, because a lot of suicides happen here. Imagine diving of the cliffs...










The life changing hour.

So I've been slacking a bit with these posts, who would've thought that I'd manage to get some sort of a life, whilst being stuck in this God forsaken small town, but here am I...behind on my posts. I feel like I should continue this more serious roll, I have going on at the moment, so this post will also feature a story about a patient, just like the previous one...

It was a regular day and as always a tad slow in the morning, that was until my man, which is one of my many male patients got the news about him going down the OR (or as the lovely Brits say, theatre) in order to have a LBKA. I imagine your synapses are a bit crowded, as your neurons fire at an accelerated speed in order to solve this rather fancy abbreviation, let me put you out of your misery. LBKA is a left below knee amputation. This is an operation that I haven't seen before, so this was a once in a life time opportunity. My man, aka. P is such a lovely elderly man in his prime at the age of 73. He has a wonderful sense of humor and it's a pleasure to speak with him. He always smiles and sometimes waves at me, if he sees me coming down the hallway. However, due to his serious problem with his leg that causes him tremendous pain, he's often confused, because of the dosage of the pain relieving medication. The doctors made the decision about the amputation a couple of days ago, they even had to fly in specialists from London to see P. 

My man, I think it can be interpreted as wrong, if I keep refering to him as my man, but it just feels right and it's really a bad habbit that has followed me throughout the past three years, when I first enrolled to do this gig. 
So back on track...P is the only one, who makes my heart "flutter", when he shouts "love", "darling" and "dear" after me. He's one of those patients that stick with you...

The reason as to why he's having a LBKA, is him being on a drug called, Warfarin (this one you ought to look up, I won't give it all away!) Apparently this drug leaves some sort of crystals or it crystalizes in the arteries, which ever really, and when the crystals start to clot, then it becomes dangerous. This has caused that an area of P's leg has had limited blood flow with oxygen and the vital nutritions, this has caused ireversable tissue damage, so the leg is no longer viable. P has also got a history of Diabetes, and this doesn't exactly help his situation! So his leg is an ischemic one, that's almost neucrotic and the malleolus is exposed.

He's brought to the OR at around 4pm and an hour later it's all over. Imagine, an amputation sounds like major surgery, and to me it is, but in fact a bowel surgery takes longer. Shocker!
The surgeon begins with the laser, which enables him to cut through all the layers of the dermis. It smells, you can even spot a few "smoke bubbles", it's impossible to decribe what it smells like and even more so to compare it with something else. But it's manageable. The surgeon needn't worry about accidentally cutting something "important", seeing that there's no flow what-so-ever. He continues using the laser for about ½ an hour, even though it felt like longer. Some places he's forced to use the scalpel, which ensures that the laser has done its job. The skin is now loose and the tibia is completely exposed and "raw". It's time for the saw. I imagined it lookind differently than it did, I suppose I pictured it to be more "saw-y" (that's definitely not a word!) It was steel blade that moved in a "saw-y" way. You could see small saw dust particles, as if it had been a log, he'd cut into.
This was a humbling experience (not sure if that's the right word to use, to describe what I felt at that instance!), because it wasn't some random log, the surgeon was in the process of taking a man's ability to walk away from him. After a while the leg is no longer attached to the rest of the body, and the leg is removed by the sterile nurse and layed on a table next to P. Just one hour had passed since the first incision and the leg was now a seperate thing. The surgeon spends a lot of time to sow the skin laps together, and then attaches a drain and a vaccum-pump to relieve the pressure and excess the extra fluid. The stump is dressed with dressing pads and tegaderm. And then I leave him and don't see him until the next day...

The following day P is in pain. A lot of pain! And it's not only because I like him as much as I do, but it hurts me to see him like that. And because of the very heavy dosage of pain relieving medication, he's so confused that he's refusing to take any stronger tablets. 
Of course because I'm fond of him, it affects me a bit more than had it been a who-ever. I put my hand on his shoulder and tried to take his mind of his pain, easier said than done! He's hurting in a place that's no longer there. 
"I know it hurts right now, but it won't hurt forever! I promise it will get better and I know that it doesn't seem like that, but it will!" those were the only comforting words I could muster, I was absolutely no help whatsoever! I just sat with him and tried to keep the tears at bay, almost easier said than done...

-xoxo-

torsdag den 9. maj 2013

Trauma - like no other.

So this is a post that's unlike the others, this follows my experince of a patient, who suffered cardiac arrest while I was on-call. I've had people dying on me, but I've never seen anything like this before...so bare with me, this post will include plenty of medical jargon.

I was in for a quite day with one of the out reach nurses, J, who's basically a nurse skilled within the critical and ICU (or as it's called in the UK, ITU) field. We started our day with hand-over reports with the anesthesiologists, when suddenly the pages wen't off and a voice practically shouted "cardiac arrest MAU" and then all hell broke loose. Just to keep you with me, the MAU is the Medical Assessment Unit. Then one of the anesthesiologist doctors took of and J signaled for me to join. At first I was a bit confused, I mean, she couldn't have meant for me to actually join in with the cardiac arrest...oh but she did. So there we were, running like crazy for MAU. 

Once we got there, the patient hadn't actually arrested...but that scenario wasn't that far out in the future, so the defibrillation pads were put on the patient just in case. And while that was going on, the patient now arrested and the biotelemetry showed asystole, which rendered the pads useless, so they started pushing Epinephrine and Atropine. However, the patient's major problem was that she was in the process of bleeding out. I kid you not, if I say that the minute I got there, the scene looked like it was taken out of Grey's Anatomy or ER. There was blood everywhere, it looked like there was an Ebola outbreak - the patient bleed from her nose, throat and ears... The anesthesiologist intubated and started ventilating, while simultaneously sucking blood from the intubation tube, while she was concentrating on this, the leader of the Resus team started CPR. The regular staff, including J started hanging units of blood up - the only problem with this was, as fast as they were pouring it into her venflons (and I say this in plural, she had about 4 of them!), just as fast it left her body again. They simply couldn't keep up. However, nobody had called the MHP (Major Hemorrhage Protocol) even though in my oh-so skilled opinion, if this wasn't one of those, I don't know what else would qualify. Just to give you a clear picture of how much she was actually bleeding, the patient had -pre-arrest- gotten three units of blood and her Hgb was still merely 3, we ended up giving a total of 9 units of blood and two units of FFP's to boot. They even considered drilling a hole into the tibia in order to boost the effect of the blood. Her pillow was completely soaked, blood even dripped onto the floor from it - like I said, there was so much blood. There were also much melena, I had never in my life seen that much. The CPR was performed in 6 stages consisting of 2 minute rounds of chest compressions and ventilation. 
The regular staff tried to contact next of kin, they were successful, but I didn't see any relatives until she was transferred into ITU - as you probably can deduce by now, she actually made it. Even though that the doctors decided to end CPR, afterwhich she had no pulse, but then after a few seconds, the pulse came back and they continued trying to save her. 

It was chaos, plain and simple - there were 9 people surrounding the patient, all trying to help to the best of their ability. I mean, some of the doctors started filling out the DNR form in the middle of the process, one of the male nurses forgot to check the blood, before he started pouring it into the patient (a serious lawsuit waiting to happen!). It was like time just stood still.

After what felt like forever, but was more like two hours - the patient was semi-stable and could be moved. However, the doctors had difficulties sorting out their next step, because could she survive an emergency surgery? It was either that or giving the radiologists a chance to see, if they could do some damage control. They upped for the latter and she was transferred to the X-ray ward. I had to suit up for this one, wearing a led skirt and shirt, in order to protect myself from the radiation now blasting through the room. The radiologists went in through the femoral artery and started the embolisation. Safe to say that they were successful and the patient was now transferred into the ITU.

On a semi-finale note, the reason to her almost dying was that, she had had two DU's in the past and this was probably what had caused her to almost bleed out... 

On a final note...I still cannot believe that she made it! I really can't believe it! It really looked grim, when they were doing the chest compressions and you could hear the ribs cracking from all the weight. It was a surreal experience, but one I wouldn't want to be without!
The most shocking part of this was actually that no one seemed to know the name of the patient! It was embarassing to say the least and really undignified to the patient! She wasn't a Jane Doe - she was J.J.

-xoxo-


torsdag den 2. maj 2013

Cultural shock - understatement of the year.

I've been meaning to write this for quite a while now, so I figured it was time for me to sit my arse down and get down to it and I find it a wee-bit ironic that as I'm sitting here and trying to write this, Bruno Mars' "The Lazy Song" is cheering me on...

As you probably can deduce with those awesome Sherlock Holmes skills of yours, it was quite a cultural shocker coming to the UK. 
I can honestly say that I haven't met nicer and more friendly people than the Brits. It doesn't matter who you approach to ask for directions or whatever, you will be helped. People actually go out of their way to try and help you and that's definitely not something I'm used to. It makes for a nice change, it's just too bad that I've been damaged by my semi-Danish upbringing. I'm way too picky as to whom I'll ask for directions and I'm always suspicious of the people I ask, it's almost like I've decided that they have less honorable intentions as to why they're helping me. I know, paranoid much?! I need to lay of the horror films and stop re-playing the theme from Jaws in my head!

...time for another story from real life...

It was a cold, windy and very rainy afternoon, two girls set out to find the nearest computer and gadget store...*enter dramatic music*
Nah, just kidding. We went looking for one, because Sarah's computer practically went up in flames, so being two girls with little or no flair for computers, we decided to seek the help of computer wizards in a land far far away. Once we entered Curry's PC-World, an employee of the store spotted us and went straight for us. We had literally just entered the store and there he was, all ready to help us. Albeit we did look completely soaked and probably lost, I hadn't imagined that within two seconds a person would drop everything in his hands in order to help us. It turned out that the computer couldn't be salvaged, the guy then spent almost half an hour with us to try and find out, if a Danish computer could be shipped to their store or if we could purchase a Danish keyboard online. That guy went out of his way to try and fix our problem, I'm not that gullible that I don't know that he was also trying to make a sale, but it was still very nice for him to go to some lengths in order to help us. So if the short Asian bloke is reading this - a very big thank you!

So an interesting fact, Brits don't greet by handshake, this gesture is seen as being very business-y, so whenever I greet somebody, I have to keep that in mind. I'm not the biggest people person out there, and I can honestly say, I really dislike touching random people, but I don't feel like I've greeted the person, unless a handshake has been exchanged. This has been difficult for me and I have to admit that I've forgotten this and sometimes this has resulted in many strange looks. I mean, c'mon - you don't know that you won't be doing business with me in the future, and then what? Should I shake you hand after all those years, let's just get that big boy out of the way right now!
What's more interesting and very peculiar, if you were to try to understand the two things in extention to one another, is that Brits stand very close to one another. A distance of 2 feet (oh no! I've been in this country too long, I've forgotten my beloved Metric system!), as I was saying a distance of 0.5 metres is kept between one another, and that's extremly close! I mean, if you were standing any closer, you'd be in my lap! I was told that personal space is very important and it's probably true for most people, but how much personal space can you have within 0.5 metres? So it's all very odd. People don't want to shake your hand, but they want you to stand in their grills - yeah, that totally makes sense!
What's more hilarious is that I can't get it right, I want (well, not want, but you get it) to shake hands, but as soon as someone enters my space, I immediately back up, and I catch myself doing it, I instinctively arch my back away from the person. It's quite the conundrum!

So to all of you, who prefers handshakes and maybe 1 metre of distance (or maybe even 0.75 metres) - it's all good! Unless you're in Britain, then tug away that devilish hand of yours and remember, it's 2.5 feet and not 0.75 metres! ;)

-xoxo-