What haven’t I done this week? First, I was partnered up with another medical student for the 2nd week of my ophthalmology placement based in the Royal. Where was the clinic on the first day? Daisy Hill…in Newry. Our consultant just happened to have a clinic on every Monday there, which was just great. Of course we were about an hour early, and the consultant was stuck in traffic, so he was an hour later than the advertised time, so the morning was an extended tea break. When we did get into clinic, all was well, and three patients later, the morning clinic was over. Thankfully the afternoon clinic proved rather more enjoyable, and we had a chance to see a lot of cataracts and rubeotic glaucoma and other fun stuff. The journey home was the real event, and we got slightly off track; by an hour or so. All part of the experience I suppose.
Tuesday started early, but for no real reason, as the time slot was free for us to go and find a patient to write up. So we rushed in early, and could have realistically turned up whenever we wanted, which was great. It was an uninspiring morning and nothing much was going on in the eye ward, so we split. It felt like more work could be done at home, so we went our own ways, and pretty much wrote off the day. It didn’t stop there for me though, as I finally got round to visiting the NI Blood Transfusion Service to give that most vital of commodities, blood. It was my first donation, but will not be my last hopefully. My view on blood – I have plenty of it, and I don’t need all of it, but someone else sure as hell could benefit from it someday, so why not? It takes about a day to replace the plasma lost, and a few weeks for the red cells, so it isn’t an issue. I would thoroughly urge anyone considering it, and meeting the criteria, to give blood. The people down at NIBTS are all really friendly, and the whole process takes about 45 minutes but is faster for current (5-7 minutes for the actual blood donation). Sessions are also run at various hospitals and other locations, so there should be somewhere to give blood wherever in the country you are. Blood of all groups will always be in demand, and you could be saving a life.
I met my tutor for this year on Tuesday evening. I can’t say I was looking forward to it, because my experience of portfolio meetings up to this point hasn’t been terribly positive. They felt like a necessary evil; a tick-box exercise fulfilling another arbitrary criteria. This one was different. It was actually, perish the thought, useful! My tutor is a consultant nephrologist in Belfast City Hospital, and was just really easy to talk to and helpful. He had spent three years in Canada training and doing research, and recommended going away and working somewhere else to gain a better perspective on things, and experience another healthcare system. This was exactly what I wanted to hear, because I have been thinking about heading off to the states for a few years to see what life out there, and medicine, is like. I imagine it is quite different without the strict budgetary limitations we experience here with the National Health Service; both better and worse, depending on your point of view.
What would you do if you came across someone who collapsed out in the street? It’s a tough one, and I managed to run into this exact situation on the way back from the Royal during the week, in Stranmillis. You never really know how you will react until it happens to you, but there was already people on the scene in this case. A few bystanders and an A&E nurse, which is handy in an emergency situation like that. I tried ascertaining what happened from the witnesses, but everyone was a bit vague, and didn’t really know what happened. He appeared to have hit his head, and one guy had blood on his hand. Possible head injury? The differential diagnosis was beginning to build. Some said he was walking along and just fell. Others said he went stiff, fell to the ground, and convulsed. Alarm bells were ringing, and wrongly confirmed my initial thoughts – that this was a seizure of some variety. The nurse had placed him into the recovery position and was sitting with him, but giving him space to rest. The thought barely crossed my mind at that moment to check his belongings. How can you deal with a situation like this if you have no idea WHAT you are dealing with? If you find yourself in this sort of situation, first things first, if the person cannot tell you what is wrong, then find out. Go through their bag, or other belongings and look for clues. It may seem invasive, but is it not better to help someone and compromise their privacy, or compromise their life?
The ambulance was called anyway, and after some time, the paramedics arrived. They first tried to rouse him, but he was being difficult, and appeared confused and slightly aggressive, refusing to move. He still had not spoken, or responded adequately, so we searched the bag. First clue: a glucometer! Things were getting clearer now. He was an insulin dependent diabetic, most likely having a hypoglycaemic attack. Hypoglycaemia is when the blood sugar level drops significantly, and the symptoms experienced result mainly from decreased glucose supply to the brain, including confusion, headaches, loss of consciousness, seizure, and coma. The pieces of the puzzle were fitting together now, even if it was a rather simplistic puzzle that I should have solved from the outset. Next, who was he? Another thing we had failed to determine at the scene which would have been helpful from the start. There is a danger of social compliance, as I fell into, assuming because the nurse looked authoritative and was on the scene first that she had it under control. Don’t take things like this for granted, and always make sure that person knows absolutely what they are doing. Don’t be afraid to question people when the stakes are high. So now the paramedics were managing a hypoglycaemic person, and the first thing to do is to give a fast carb: something sugary like Lucozade or glucose tablets, followed by a slow carb once the sugar level has increased. He had chocolate in his bag, which he reluctantly ate, but no sugary drink. I could finally make myself useful and requisition some Lucozade from the Centra in Stranmillis, stating rather urgently, “A diabetic collapsed up the street and the paramedics need this!”. They were very obliging and I back to the scene in no time. The paramedics brought him to the ambulance for a more thorough assessment, and my role in the whole business was over. It was scary, and quite exciting, and I’ve learned a lot from it. The main thing is the importance of first aid training, and common sense! I really need to update both. Everyone should be first aid trained – it would make incidents like this a lot easier to manage, and I’m sure it would be cost effective in reducing the number of preventable deaths.
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