Plumbers and Electricians

Thanks for all the emails that keep arriving, it's brilliant to see that someone reads this. Do leave me a comment if you visit - makes my day every time!

The main thing I keep getting asked is :

1. What made me want to change from nursing to medicine
2. Has my nursing background helped since moving to medicine

I will answer the first question soon, but have to say that as far as the second question goes, my nursing background has not helped me in the slightest.

In my humble opinion, nursing and medicine have little in common. I never thought this to start with - I presumed that I would be half way to being a doctor with my nursing degree and twelve years experience but this just is not the case.

I was a 1992 "Project 2000" nursing student, a course which was criticised for being too academic and not clinical enough. For the first 18 months we were classroom based, studying sociology, psychology and physiology.

For the first 18 months in medical school, we studied biochemistry, genetics, histology, epidemiology, cell biology, pharmacology (None of this was covered in any fashion as a student nurse) and clinical modules such as MSK, CVS, nephrology, GI etc. We spent 12 weeks on each module, starting with the biochemistry of each clinical subject and working up to pathological processes.

After three years I have realised that thinking that nursing was going to give me a leg up the medical ladder was very, very wrong.

Nurses and Doctors are like plumbers and electricians. They both work in the same environment and are specialised in what they do. They cannot do each others jobs, simply because the jobs are different. By them doing their different jobs and sticking to what they know best, the house gets built.

If the plumber is off sick, the electrician can't cover their job. I don't think doctors could cover the nurses job any better than a nurse could cover a doctor's.

To wander off the trail a little, I think one problem is that although the jobs are completely different, there are tasks within each role that cross over (Bloods, interpreting spirometry, cannulation etc) Over my twelve years in nursing, I saw the boundaries between nursing and medicine blur, as the managers realised that nurses were not only cheaper, but could so some of the doctors tasks (I have trundled on about this here)

In my old job in occupational health, this quickly lead to a reduction in the docs hours as managers assessed which parts of their roles could be sliced off and handed to the nurses. Then, lo and behold, the same managers realised that "Technicians" were cheaper than nurses. Hey great - lets shave the nurses role (Presumably so that she could do some of the docs job) and pay the technicians half of what the nurse earns. Don't think I am exaggerating here, over a period of five years, the doctor's hours reduced from 5 a week to 4 a month and when one of the OH nurses left, she was replaced with a fork lift truck driver who had taken a OH technicians course at Carmarthen college)

To get back to the original subject, I will be interested to see if my view changes in my last 18 months as a medical student, but so far nursing just hasn't helped me as a medical student.

Has anything changed since 1954?

With big exams looming, I am procrastinating like a good'un. I managed to watch "Doctor in the House" again today. Some of the acting is a bit duff (The "Welsh" chap sounds like he is from Glasgow) but lots of things seem exactly the same.




This is my favourite clip - still happens in most hospitals up and down the country, every day!

Star Trek

I went to theatre a few days ago to see an Atrial Fibrillation ablation. Hells bells - it was amazing, like something off tomorrow's world.

Ablations are done when drugs and cardioversion have failed to convert the heart back to sinus rhythm. It's a long procedure, done under local (This continues to shock me - imagine lying fully awake for five hours whilst someone burns your heart) and the patient tolerated it really well. They start by pushing tubes up through each femoral vein and then they push a round ended tip into the right atrium. Things get a bit scary (For me anyway - everyone else seemed quite blase!) at this point because they have to then push the tip of the catheter through the wall of the atria, through what would have been the foramen ovale when the patient was in the womb. Creating a hole in the heart seemed worrying to me, but apparently it heals and is fine.

It got really exciting then - they push another catheter into the heart and start to build a 3D image of the patients heart. It's hard to explain, but every time the catheter tip touches the atria, the software recognises it and maps like a geometrical image. It was unbelievable - it takes about an hour and then they have a model that looks a bit like the one at the top of this page, only much clearer. Once this is done, they start the ablation which basically means making lots of small burns on the atria with the aim of interfering with the electrical signals and hopefully prompt the heart to flip into sinus rhythm.

I went to speak to the patient the next day to see what he had thought of it all - he was bright as a button and only remembered small bits of what had happened (A little bit of midalozam seemed to have helped)

Then, today I got a bit upset in clinic. I think of myself as quite a tough nut as far as people go - I am useless with animals but I tend to be fine with people and not much upsets me.

An old chap came in with his daughter. His heart had been going a bit slowly and so it was recommended that he had a pacemaker. Unfortunately he was deaf and did not speak much English. He had also lost his wife a few months ago and was understandably very down. As he left the room, after not speaking all through the consultation, he came up to me and and said that it is important to love one person for all of your life and that when you have loved someone all your life and then they die, you want to die and go with them. Sounds a bit naff when I am writing it, but it made me fill up. Crying in front of the consultant is not a good look!

I'm not having anything done under local anaesthetic!

Hello.!

I have finished my month in respiratory medicine and now am stuck in cardio for three weeks. I think it's a bit crap that this three weeks is all I have in cardiology for the whole of my clinical training. Seems like too little experience for such common illness. This is made worse by one of my consultants wanting me to attend a pacing clinic three times a week. I went this week and watched a patient have an implantable defib fitted under local (more about that later) than I watched another patient having an implantable defib fitted. Then I watched another patient having an implantable device....OK you get the picture.

I'm a bit annoyed at having to stand in theatre three times this week watching patient after patient having the same thing done. I learn very little from this - watching one so that I am aware of what happens is great, but having to watch it again and again isn't. I feel like my time would be so much better spend on the wards, trying to work out how to look after barn door heart failure, arrhythmias etc. It's hard though because if I dig my heels in and go to the wards rather than theatre, I might well end up in a situation where the consultant refuses to sign my end of module forms (Details of attendance, performance etc)

What has also scared me is that having one of these devices fitted is a bit nasty. They take around 2 hours and the patient has it all done under a local anaesthetic. They lie there and seem to be in agony when the local is being given. Things get better then apart from one patient who seemed to feel the whole thing and was squirming throughout. I was starting to feel a bit light headed to be honest - it's not nice watching someone in pain during an operation.

It seems that the risks of G.A make it much safer to do this under local. Also, they are not often able to give the patient midazolam (Sedative) because it makes the blood pressure drop which they tell me isn't good in the middle of heart procedures.

I hope I never have to have anything done under a local - on my last block an old chap was having his carpel tunnel done under an axillary block and told the surgeon he could feel her cutting his hand. Hells bells.