First Day at Hospital
Woke up for my first day at work and soon found out there was virtually no hot water to be had in the shower. I got some lukewarm water at first, as I attempted to warm it up whilst brushing my teeth, but sadly it never got any warmer and only took a turn for the worse. So I washed up a little but no proper shower…gross!! I suppose I might have to take my showers in the evenings now. At least the heat is on in the flat at that time!!!
Arrived to the hospital a bit on the late side as I am still figuring it all out…went into the ICU and it wasn’t hard to figure out who I should follow around. There was a large group of people in scrubs huddled around a patient’s bed so I joined the crowd.
I listened as they made their rounds to each of the 19 ICU beds. The patients don’t get a whole lot of privacy there. There is only a blue paper curtain separating each bed in the wards and most of the time that curtain is left open. Their charts are a bit different too…they are more like books than ring-bound binders. There is a desk at the end of each bed and on top of it is a huge paper, like the size of one of those desk calendars and there is where they chart labs, medication dosages and changes. Quite different…
There seem to be some interesting patients on the service right now. There is a young woman who had been having seizures (status epilepticus) due to her TB in her brain (cerebral tuberculoma). She actually had TB meningitis in the past too. For those at home, TB is not something commonly seen in the US these days unless you are in a major city with lots of recent immigrants like NYC, Los Angeles, etc. I found it a bit odd that they didn’t have her in a pressurized room to prevent her from spreading TB to others. I mean it is not as if we all walked around in the special masks. I wondered if it was because most everyone in Europe receives the BCG vaccine (TB vaccine)…but I thought the reason we didn’t get it in the US was because it was not that effective. Seriously hope I don’t get TB…
Some of the other patients include a woman who just gave birth, then suffered a hemorrhage and now has a degree of heart failure. They are thinking perhaps peripartum cardiomyopathy. Another patient is an older woman who had a parotid mass removed (this is like a salivary gland on the face). She kinda looks like half of her face is missing and actually one of her eyes is gone from before, all that is left is scar tissue over the socket. There is another man who has neurofibromatosis which is a disease of skin and the neurological system. He has these wart type bumps all over his body. Never seen it before! Then there are the run of the mill things like the alcoholics with gastrointestinal bleeds, the renal failure patient, and so on…
After we rounded, this one guy, called, Ed, introduced himself to me. He had sort of been running the rounds. He referred to himself as the registrar, which I later learned means that he is like a resident. Anyway, he gave me the low down for the rotation. Every morning walking rounds at 8am. Then the patients are divided up amongst the residents/interns (although that is not British terminology) and everyone works on writing their notes and looking up lab reports, etc. Then at 10:30 everyone meets in the conference room for talk rounds where each patient is discussed at length with the consultant (aka. Attending physician) who gives his input on the plans and does some teaching. All the while, everyone sips on tea or coffee and eats biscuits (aka. cookies). There is actually a sign up saying that the tea and biscuits are to be prepared by the “interns” each morning and they must also do the washing up later as the nurses and domestics are not expected to clean up after us! Anyway, I quite like this institution and I am not sure why we don’t round with tea and biscuits at home…I think it would really serve to lift everyone’s spirits!!
So the rounds went on for about 2 hours. Overall they were much the same as their US counterparts…they mentioned a few drugs I had never heard of and that were not in my Palm Pilot program. When they presented a patient they might say, “This is a 39 year old chap who had an upper GI bleed…” When it was finally done, we went back for another short walking round in the wards. This ended about 1pm and at that time people took lunch breaks or worked on anything that needed to be done. I got a chance to chat more with Ed about the system there. He explained more to me about how medical training works in the UK. Right out of high school, a student can enter into a medical school program. This lasts for 5-6 years. Then they work for about 12-18 months in something called Foundation Year which is like internship but they get some degree of control over what sorts of fields they spend time in. Then they work as a House Officer…which is still a training time. Eventually they apply to be a registrar which is the more specialized training time. He is doing Respiratory Medicine (aka. Pulmonary) but instead of splitting it into residency and then fellowship they do it all at once…I still don’t know if I have it right... He is in his final year of training and when he is done, it will have been 11 years since he graduated from med school!! That is a long time. Their work hours are much less. He said when he first started he had some weeks he put in 100 hours but now it is like 50-some hours/week and soon will be dropped to 46 hrs/week! That is a hard concept for any American resident to understand!!!
I ate lunch with a woman named something like, “Janpaoula” who is an ICU consultant (attending) from Milan, Italy. She is hoping to spend 6 months here working and observing the British ICU as a kind of research to bring back home. She was very friendly and also a bit lost like me as she just started last week. She got a flat in downtown London and I felt a little jealous however she is paying twice as much as me!! We shared a table with a woman who lived in Birmingham (she was probably Indian) and works as a general practitioner. She had driven her son down here for his medical school interview at St. Georges. It is apparently very competitive. Her daughter is doing her training now in the UK and she was given a scholarship for a program with Harvard in Infectious Disease this summer.
When we finished eating, we returned to the ICU. I told Ed that I would head out and sort some things out since I had just arrived. He said that he thought that sounded “quite sensible.” He said in general the schedule will be what I make of it. Officially, they finish at 5pm each day but he said I am welcome to work nights if I want (no, thanks!). Also said I can try to do as much as I want-as far as procedures go, there are no limitations to me as a student.
After I left, I went to the Sainsbury’s down the street, this is one of their main grocery stores in England. I had a jolly good time perusing through their goods!! I got some interesting yogurt flavors like rhubarb with jersey cow milk and Madagascar vanilla. They had a lovely selection of English cheeses with names like Cheshire and Wilshire. I picked up some dark chocolate biscuits to go with my Fair Trade tea. They had a big selection of crumpets and scones!! They also have “English muffins” but of course they don’t call them that. They had the most varied selection of honeys too with one from Australia costing almost $20!! Many of the European brands of jams we get at home are much much cheaper here! It was hard not to buy a ton of food but I tried to limit it because I knew for one, that I had to carry it on the bus home! They really try to promote the use of re-useable shopping bags here so for 9p (9 pence=14 cents) I bought a re-useable Sainsbury bag! When I got home, I had to try a crumpet!!
Since the weather had improved a bit (no more rain, touch of sun), I decided to take a stroll around the neighborhood. Not much to see really. There is a park at one end of my street called Tooting Bec Common. It was quite drab really. I guess it is known for having one of the biggest public swimming pools in all of Europe…too bad it’s winter now. I walked a bit more through Streatham and saw some nicer homes and charming row houses. Most everything is brick or stone. I walked down one of the main streets in town which has some random stores: general stores, kebab houses, hair dressers, mobile phone stores, etc. Tried to find the nearby train station but I guess I missed a turn. It is really close to my place though. That is it for my day…tomorrow, a real work day for me!
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