When I went in to the hospice this morning the doctor had just taken a blood sample from a patient who he was suspecting as having a weakened liver function due to a cancer which has grown blocking some of the tubes to his liver. He told me about this patient and how they need to find out the extent of his liver function before giving him a dye and sending him for scan so they can assess the extent of the tumour. It was important to check the liver function to ensure that the patient would be able to naturally work the chemicals contained within the dye out of the body, particularly because he had already expressed that he did not want to go on dialysis. I went down to the pathology lab at the local hospital where the doctor went to request the samples to urgently be tested.
Upon returning to the hospice the plan was to check all the patients, but one of the nurses informed him that a particular patient was really unsettled and struggling to breathe. I did not go into this consultation as it wasn’t considerate of me towards the patient to enter if he was in an uncomfortable state. The doctor went into the room for a while and then allowed me to listen to his breathing from the corridor which was noisy, heavy and very fast. He later informed me that the patient was struggling to breathe due to a tumour in his neck which had started to close his windpipe. The doctor said that this was something which had been foreseen and they had suggested that the patient went for a tracheostomy which would involve cutting a hole in his trachea enabling him to breathe through this hole.
During today’s shadowing I could see the unpredictability that a career in Medicine holds and also the importance of possessing the ability to prioritise. The doctor had planned to focus on the patient whose liver function was concerning him, but a turn of events now meant that he had another patient whom he had to urgently give his attention to. The ambulance had to be called at the patient had to be taken to hospital. One of the things that surprised me was how long the ambulance took to arrive. I had thought that they would arrive within a few minutes, but they took almost a quarter of an hour. This made me wonder how the situation would have been if the patient was in an even more critical state and he wasn’t in a healthcare environment, like the hospice, where he condo be monitored and any urgent interventions could be made. I spoke to the doctor about this who mentioned that when the ambulance is called the emergencies either be placed in a 20 minute window or a 40 minute window which perhaps explained the delay.
One of the things that I spoke to the doctor about regarding this patient was his capacity. The doctor had to ask him whether he would be happy to be taken to hospital for a tracheostomy as he had previously refused it. In order to do this it was the doctors responsibility to make sure the patient understood the risks and benefits of having or not having such a procedure. When the doctor first went to see him, the lack of oxygen reaching his brain due to the breathing difficulties he was experiencing meant that he did not have full capacity. The doctor provided him with oxygen so he became more alert and this gave him back his capacity so he could make decisions with the doctor. This was a true reflection on how capacity was only temporary and can easily be altered.
At the end of today’s experience I also went with the doctor to see a patient who was requesting to be sent home as she wanted to spend her final days at home. This lady had been confused for the past few days so the doctor had to assess her mental capacity and ensure that she understood the risks and precautions that may need to be taken in order to allow her to stay at home. The nurses had noticed a sense of paranoia developing with her which they reported to the doctor so when he first went to see her he ensured that she knew where she was. He then asked her how she feels and why she thinks people here were trying to harm her. It was clear that the patient did have capacity now and it was also clear that she linger wanted to stay in the hospice. I recognised how important it was to first ensure that the patient was in the right state of mind to come to such decisions as well as making sure that she understood the extent of these decisions.