“I woke up at seven this morning, got dressed and had a quick breakfast before driving into work. My day starts at 08:00 with the ward round, where we see each of the patients on our ward, and a few that other specialties have asked us to help with. I pop my back down in the office and open up the ward list on the computer. Three new patients have come in overnight so I add them to our list and read their notes to see why they have been admitted.
Once the consultant arrives, at about 08:30, the ward round begins. The team sees each patient in turn to see how they’re getting on, if they need any changes to their treatment, and to start planning on getting them home.
Mr Jones in bed one has come in with shortness of breath. He was having high temperatures and coughing up nasty phlegm so we organised a chest xray and took some bloods. The xray showed a patch of increased density on the left lung, and the bloods suggested there was a significant immune response. All together the picture was of a chest infection, and we started treating him with strong intravenous antibiotics. He was also very dehydrated from the fever making him sweat and so we prescribed some intravenous fluids. Today he is feeling much better, and so we have changed the antibiotics from intravenous to tablet form, so that he can be discharged and finish his course of antibiotics at home. That means we need to write a discharge summary to tell his GP what has been going on, and to make sure he has all the correct medications to go home with.
Eighty-three year old Mrs Betty in bed two came into hospital because she has been falling over at home. She lives alone and is usually completely independent but now is starting to struggle and has lost confidence in her balance and mobility. Usually she walks with a stick but recently has noticed that her heart failure is making it difficult to walk because she gets very out of breath. The physiotherapy team have been working hard with Mrs Betty to get her moving on her feet, and trying different tools such as crutches and frames, and it seems today she is more confident with a zimmer frame. It’s nice to see her smiling again! Unfortunately she doesn’t have any family nearby to help out with shopping and cleaning, so we need to work together with the occupational therapy team and the social workers to figure out whether she would need carers to visit once or twice a day to help her keep her independence, rather than having to move into a care home. A lot of the time the care we provide for patients doesn’t involve medications, but requires huge amounts of teamwork between different departments to help keep them safe and independent as much as possible.
We see every patient in the same way, checking their latest bloods, medications and observations (heart rate, blood pressure, oxygen levels) to see if they’re improving or if we need to add to their treatment plan. As you can imagine, seeing thirty or so patients takes all morning, and often part of the afternoon! Once the ward round finishes the consultant usually heads off to clinic to see patients that have appointments for their ongoing conditions, and the juniors then start working through the jobs from the ward round. This would include taking bloods, requesting xrays and scans, reading ECGs and talking to families about what the plan is with their relative’s care.
Once all the jobs are done, and hopefully somewhere near to five o’clock (sometimes you have to stay on later to get everything done!) we check through all the patient’s blood results from the day to make sure nobody is likely to become unwell overnight, and we hand over any remaining jobs to the on-call doctor. This is one of the juniors who is assigned to cover all the medical wards overnight, dealing with emergencies or prescribing medications, and making sure everyone is safe until the morning.
I’m always tired at the end of the day because it’s often very busy, but I usually have enough time in the evening to go to the gym or go for dinner with some friends. Today was especially good because Mr Jones was very sick and almost died, but now is walking home with a smile on his face, and we finally made progress with Mrs Betty’s mobility. She was really grateful for all the work that the physiotherapy and occupational therapy teams had put in to help get her back on her feet. It’s a nice reminder of why we do the job!”