I was placed as a physician associate student on the respiratory ward in the middle of March, when I had been on AMU we talked about the possibility of COVID and how it would effect the hospital. Thinking a bit like a rare flu and couple of cases here and there.

Nothing could have prepared us.

A few weeks later I was on the resp ward getting fitted for FFP3 masks and helping clear as many side rooms as safely as possible. Anyone who could go home was getting discharged ready for the incoming patients.

We got pulled from placement that night my course put on hold, I decided I couldn’t sit at home and do nothing when I could be of use. I got a job as a healthcare assistant at the same hospital I had been placed at – as a student I was fast tracked through and started work a couple of weeks later.

The change in the hospital was crazy and something I never could have imagined – half of some floors wards where closed as they where completely empty. The corridors and atrium was bare it was like out of a horror film.

My supervisory shift was on a ward that was meant to be neurology but since it being booked it was at least half full of COVID patients, we lost two that day with them expecting to loose a few more in the next 24hrs. I knew this was a battle like I hadn’t ever seen.

My third shift I accidentally booked onto the same resp ward I had been on a month ago not realising it was now the HDU ITU step down unit. It felt terrifying having someone dress you in full PPE like you where going into battle unaware of what was beyond the green barriers. It is something I will never forget, hearing how sick the patients are on handover is one thing but seeing them with tracheostomy’s struggling for each breath, on a continuous monitor with sats I would usually start to panic over but everyone is calm. The usually oxygen target has been dropped to spare the hospitals oxygen supply, but everyone on this ward has just been through a battle looking exhausted and hagged.

2 hours that’s all we could stay in the PPE for, you forgot your in it when you are doing jobs. When you are so busy suctioning patients thick secretions enough to make them feel like that can catch a breath before having to suction it again.

We also help them washing and change into clean clothes, but it takes so much more energy and effort in full protective gear. You can feel the sweat dripping down your back whilst you try and do simple tasks.

Helping those who can eat for the first time in weeks have the first sip of tea without an NG tube. Being able to talk properly to their family over the tablet we have. Some choose video call some choose voice only not wanting to see there loved ones like this.

There needs to be continue care so we have to leave a written sheet for the hand over of the section unable to give them a verbal handover. We won’t see their faces again for the rest of the day.

There are only a couple of computers inside the hot zone, so we have to remember some of the details to document and to be sure email it over to ourselves to document when we are outside.

We have some people in PPE on the other side to help us undress from the respiratory hoods or full PPE and wipe it down to be cleaned later but enough to be removed. Then we wash our hands it feels strange to be out of PPE you forget when you are in it. But it feels equally good to wash my face and moisturise in my down time.

We work in waves, 2hr in and 2hr off – the off hours are documenting, peeing, drinking water and eating. We still work within this time such as updating the handover sheet for the night staff.

The clock clicks closer to the 2hr mark and you go around the one way system, mentally preparing myself for going back in.

It’s mentally draining and difficult but it’s the new normal. These are the lucky ones who are off the ventilator, still able to fight for there lives – they aren’t out of the woods as they still have trachys in which means they are in a worse state than those’s without.

But they are no longer on ITU. There are stories I could tell of FaceTiming family members so they could communicate with them and see there faces. That’s one of the most difficult things patients unable to see a reassuring smile. Unable to hear our comforting words properly through the masks.

The emotional toll is more that I thought it would be.

It still isn’t over.

Wards shifts start about 30 before A&E which means I have to get in even earlier but it’s a much smaller team so there are 1 or 2 HCAs per section usually with 1 nurse.

If you have patients that require specialist 1:1 care then there might be more than have been shuffled around as needed. In our section (and is the ward they just all where in my section) we had 3 patients that needed specialist care and one needs to be 2:1 (two staff to one patient), so we do have plenty of staff but they are whisked away to take handover from the night staff.

I am one of those, and as specialising patients for 12hr can be very boring and repetative so we tend to rotate with those ‘on the floor’ or specialising other patient. My patient is still asleep, me and the nurse make a clinical judgement not to wake them up until breakfast.

So I sit and drink my tea, whilst reading up on the patient history and the other patients in my section, but you can’t be on your phone and I don’t want to wake them up.

I do feel bad as my colleges have to do the breakfast for the whole ward but I understand that I can move from my post, and we have all been in this situation.

When breakfast came around my patient told me where to stick it and fell back asleep. It did mean they didn’t bother me until we swapped over at 9am, and they started to kick off at 9:20 ish when the doctors came round. She was assessed to have capacity and self discharged about 11 so we got another staff member free.

Whilst this was happening I moved onto the floor which means working your away around the patients changing beds, of those who are mobile and self caring. Also assisting some in a wash which is a bed bath, changing pads etc. Some you have to work through quicker as they are off the surgery, meaning you are against the clock.

But the good news is the ODP or assistant comes to collect them and a nursing staff member is needed to escort them down and sign of the theatre checklist (plus they need 2 people to drive the beds). As I finish a time sensitive wash they appear to take my patient down.

Luckily the ODPs is someone I knew from doing my undergrad with so we get to have a little catch up on the way. It takes about 20mins to pop them down to theatre and get the checklist signed etc.

When I come back we are still behind on washes but we have to start rotating breaks for those specialising so we have to replace each other making sure the patient isn’t ever left alone. Usually we hope to get washed done before lunch but this rarely happens.

I take my break with my delicious packed lunch, and some old TV drama – but at least I have a cup of tea and some chocolate. It’s always good just to sit down and take stock of what’s happening.

My break is somehow well timed as when I finish I help serve lunch then 3/4 of the way around I swap out with a colleague who is specialising another patient so then can go on break and I assist them to eat the lunch I’m slightly jealous of even though I’ve just eaten. But who can resist the smell of school dinner style syrup sponge and custard.

After also assisting my other little old gents in the bay to eat and drink enough too. They pop around with a cup of tea making them all very happy, and also makes them more compliant and when I pop around with the blood pressure machine and obs.

I just do the bay as I can still keep an eye on my patient this way and take some weight of the rest of the staff. I complete the bays food diaries, fluid balance chart (after emptying their catheters), and document the obs.

The patient transport to take my patient back to their local hospital has arrives just before we swap over, so I give them a handover and all the paperwork (once the printer decides to work). It takes us about 10 mins to convince him it’s okay for us to slide him across to the ambulance trolley and explain what is happening, but he agrees and is compliant (he has advanced dementia – so we do have to remind him again before he goes).

Once we wave him off, I clean down his bed and the surfaces, remaking it and getting the screening swabs ready for the next patients.

I’m on the floor now for a little bit longer, responding to some buzzers to help a couple of patients to the bathroom or pass them a phone charger etc. I get to take another patient to theatre who is hilarious I feel for them as they only injured himself playing football (and they are a rugby player).

Returning to the ward and it’s a quick tea round before I take my second break. I took my break before swapping out with the 2 staff specialising for the rest of the shift.

I have left over pizza from yesterday, and a little bit of salad and an energy drink to keep me going through to the end of the shift.

Had a debate with my colleagues about the best energy drink I either go a monster white (zero) or a light or red bull zero. Which gives me enough energy to finish the shift.

There are 2 of us looking after this patient in psychosis – I feel for them as I know this isn’t how they normally are and it’s difficult to see and care for them at times, luckily there parents have come to visit (they are allowed due to supporting someone with learning difficulties) and it makes them much happier.

They also showed me how to make an origami butterfly which looks amazing – I was also shown how to make other origami animals but they did not look right no matter how many times I tried to fix it.

Outside agent staff take over from us at 7:15 so we have enough time to whizz round the other patients on the floor whilst the nightstaff take handover.

Dash through the door with 5 mins to get changed for my shift, and make it hand over with seconds to spare but with a coffee in hand and my uniform on the right way around.

I did manage to curse myself by getting on triage – by saying it’s not that bad.

4 patients when I arrive, 2 to go up to the ward, 1 LP who wanders off in a panic and phone call later he was self presenting to the pysch hospital. But turned up via ambulance about 2.5hrs later after attempting to OD, and one who needed bloods and the observation unit.

It was a steady morning where I spent an hour trying to sort out the fact I’m now currently locked out of my user account and all my IT access.

I also did a urine dip, a preganancy Test (positive but the patient knew – why they were in A&E), a very tricky and messy cannula but I got it in.

Anyone else find they have good/bad cannula days you either get them all inc the difficult ones or miss really easy ones?

Today was one of those days and it really frustrated me all day.

The strangest thing was I had to phone 999 from A&E in order to get a patient blue lighted across the road to the women’s hospital. Definitely not something I thought I would be doing.

I just spend my morning doing job after job, as you clear one patient 2 more appear needing ECGs, but the rooms are being used by the doctors so you have to dash in before you loose it.

I managed to have my lunch at around 11:30 – with the joy of this morning in the staff room (someone had also donated a box of Cadbury chocolate that was much appreciated).

Head back and there where 101 jobs in the board but mainly trying to locate 2 patients notes to get them scanned and take them up to the ward before they breeched at the magical 4hr mark (managing to do it in 3hr 58mins).

The difficulty is in the last 30mins when we get a plan or are awaiting a bed and we need to get them up before they breech. But if they are in a bed then we need a porter and staff member to take them up. Especially are unable to transfer them it’s finding two staff memebers on the ward, a pat slide and a slide sheet to move them – and can mean you are away for 20 mins.

We seem to also get the little old ladies who we want to keep an eye on and psych patients through to my section, some of which aren’t the nicest. But regardless of how rude or inappropriate they are we still give them the best care.

About 2/3 ish is when it starts to pick up, with more and more patients coming threw the doors. I had someone come in with a positive cardiac history and chest pain, with ST elevation. You can’t react just school your face (helped by the mask) and say the doctor will review it. My tip leave the stickers on if you think they need a repeat makes it a lot easier. Also they will ask for a trop to be sent (should be sent with most chest pains as an FYI).

20 mins later it was a static change and non-dynamic so after being seen they could go to the observation unit and await the second trop. I was relieved as they was such a nice man, I dislike things like this when you where await results or can see changes but need checking before you can tell them. We have a duty of candor but it’s the doctor’s responsibility or mine as a PA to tell them.

After that I then had to go help a little old lady with dementia and a UTI to the bathroom for the 4th time in an hour as she forgot that she had just been, and won’t go (as she hasn’t actually the last 2 times). But you never know.

I also have to chaperone a male catheter change and about 2 PR exams, in between documenting, chasing up beds and blood results (basically sat on hold with the lab).

Anyone who is being admitted also need a COVID swab which if you haven’t done/had isn’t painful but not the most pleasant. You have to swab the back of someone’s throat and the very back of the nasal passages. It makes you gag and also makes your eyes water – most people aren’t happy to have it done but understand. You do have the ones who are arseholes who refuse or kick off which is there right but makes the job of doing a swab so much more difficult.

It got to around to 6pm somehow and I realised I hadn’t had my second break. Despite having a mountain of jobs sometimes you have to just take it, although it can be chaos and the break goes out the window (sorry the reality of healthcare).

I am trying to be healthier but the call of the M&S iced and spiced buns, reduced of course. They do comes in packs of 2 and yes I ate both and have no shame. Sometimes I eat at work but I was trying to resist the call of the canteen.

I don’t know what I returned to but it was beyond crazy, it was like trying to do doggy paddle and keep your head above water. Juggling ECGs for patients which chest pain, trying to update patients on there management plans and when they will see a doctor.

Yes it is busy and there is a wait to see a doctor, unfortunately it’s a busy department and patients are seen by priority and clinical need opposed to time order. This does mean the person with a laceration and query broken arm may not be seen before the gentleman having chest pain and I have no control over it – no matter how much you yell at me.

Not to mention I know that you are in pain or feeling nausea but I do need to get the cannula in before we can get you the pain relief.

There has also been another couple of psych patients appear who need to be specialised one to one care therefore I have to spend the rest of the shift watching them like a hawk, making small talk and offering the cups of tea/sandwiches whilst we await for the LP team to come see them. It makes me sad that someone as a young adult and younger than me is going through something so tough.

I hand over to my night staff colleague but unfortunately there is only one NA/HCA for the whole of major cubicles which means that there will be a bit of a delay on jobs and transfers. It also means the doctors may need to do there own jobs (such as bloods, cannula and ECGs). I do feel for my night staff colleagues but I’ve been there but now I get to head home and my housemates have the kettle on.

I also realise I haven’t drunk enough water today or had a chance to pop to the toilet. It’s part of the job – even if it sucks.

I love the adrenaline that A&E gives me as things can change at a click of the fingers and you never know what is coming through the door.

You meet the best and worse people you can imagine but the team are amazing. We are a bit sinical at times but it comes with the job and I wouldn’t change it for the world.

Firstly I am going to do yet another shout out to everyone on the frontline and working hard to keep this country going (I am going stir crazy and hate being ill/stuck inside – although I am not the best when ill just ask my BF).

There is a lot of advice available on things to do in this crazy time, so I decided to compile my 10 top tips that I have learnt over the last week or two and found on internet deep dives in the middle of the night.

1. Shower & Get Dressed

I know the temptation of just staying in PJs and struggling to remember when you last washed your hair. But this makes me feel so much better and more human, even if I just get changed from PJs to joggers and a hoodie for the day to back into PJs.

This also including brushing your teeth, washing your face, moisturising and the usually hygiene stuff (esp deoderant for those in shared houses…)

2. Exercise

This is only if you can, I am struggling with SoB at the moment so even walking up a some stairs a workout so for the time being I am out. There are some amazing free workouts online (live streamed, recorded or just workout plans) or some plans like beachbody (insanity etc) that you pay for but it’s good to keep moving. I use a local PT online with home workouts and then top it off with a little bit of HIIT or an online yoga stretch video.

We have the amazing PE with Joe, PureGym Online, Youtube, and Insta (aliceliving) but there are plenty out there is you want to find one to suit you it’s worth a nose around.

If a full hour is too much, then break it down into exercise chunks like 10/15 mins per day. If you are in the lucky category that are still allowed once a day – then go for a walk, cycle or jog, this counts and means you can get the fresh air which some of us are craving especially with the rare blue sky that has appeared.

Its also good for your mental health too!

3. Try to stick to a routine

Get up at the same time and go to sleep at the same time! This is when sleep schedules will go awry with the temptation to stay in bed all day. Have meals at around the same time you would usually and keep your body on track.

Obviously things to vary and I am not suggesting a military timetable type thing, but soemthing to keep your day in order and help you stay on top of things. I like to add something in to look forward too like a good film and time to sit with some tea.

4. Plan your day

This is for those of you that the days are just stretching on or lacking the motivation to do any work (trust me I feel you).

Plan out what your day or next few days will look like. You don’t have to have everything written down minute by minutes, but an approximate time to have lunch, go for the daily walk/run/necessary trip, phone friends (so they don’t catch you mid-bite of a sandwich), and any online lectures can help makes things feel a bit more structured.

It helps me feel like I am in control of what is happening, any old bit of paper can do, or you can use a table or free template online – I found a free printable version of the passion planner to give it a try over the next few weeks.

You can also use an online calendar but I prefer the pencil and paper method – the designing it and making it pretty (yes one of those – also called procrastinating) plus the feel of ticking something off.

Make sure to also add in some unwind time, any good movies on TV and those odd jobs that you have been meaning to do.

5. Avoid Snacking and Meal Plans

Okay! I am so guilty of this one – my snacks are going down drastically and if I am feeling hungry then I will just snack rather than have a full meal. So I am limiting/rationing my snacks for the next week or so (mainly so they last), an I can keep an eye on my progress.

I use my lovely meal planning board to sort out my meals (£2 from card factory) so I don’t need to worry or stress about what I am going to eat. I also can see what is in the freezer/fridge on my little list on the side and spend about 10 mins each week writing a list and planning what I a going to have and takes the stress completely out of it.

This way I am eating health-ish meals on a regular basis and avoiding the constant snacking.

6. Calling Friends and Family

I am majorly struggling with this one! Make sure to call your friends and family, I have discovered group apps like zoom and houseparty are so useful as multiple friends groups can join in together (and play some cheeky quizzes).

I make sure to call a friend, family, my gran or BF someone once a day to check in with someone face to face (or as close as we can get to) which has helped. Me and my gran both watch a lunchtime quiz show and keep a tally of who gets the most right, then discuss the answers.

Messaging is useful but I don’t feel it has as stronger emotional connection and video calling as you can see peoples faces (and pets such as dogs!)

7. Try something new

I love crafts and doing little bits, and now is the perfect time to do it! I have ordered a few bits to keep me busy – a paint by numbers, diamond painting (I don’t know how its different but we will see) and some wool to attempt to knit a blanket (I have knitted before but nothing like this just squares or a scalf).

They are currently undergoing snail mail so will arrive when possible but I am excited for these projects to give me something to do! There is also doodling, colouring and other bits to keep you busy, I prefer the switch off time this gives me when I can relax with the cup of tea.

I am awful at languages (I can apologise and order a drink in a few but that is it) but a few of my friends have started to try and learn Spanish, Italian, Russian on sites such as Duolingo. There are free online courses that are available if you want to learn something, a friend is on furlough from her job so is taking the time to do an online PT course and a nutrition course. Others I know for a small fee (£20-ish) are doing a TEFL, photographer, calligraphy and writing a book! Such a wide range of things to keep busy!

There are also apps that you can do painting on, jigsaw, sudokus, crosswords, wordsearches you name it! This is especially good if you don’t have any money as they are free and are there for mindless entertainment (and add extra challenges in by randomly changing things around).

8. Me Time

Make some time for yourself to unwind and relax, switching off from the crazy news. Have a bubble bath, read that book you have been putting off or make a DIY face mask anything like that to focus on yourself and self care.

Meditation, yoga, going for a walk all these also fit in here, but I am more partial to a good book in the bath with a glass of wine and some chocolate.

You can also join in on me and grans daily quiz (Hardball on BBC 1pm daily – no plug or sponser just good general knowledge fun and competitiveness) there also pub quizzes online or group games like cards against humanity too if that is how you like to spend your time.

9. Volunteer

If you can volunteer part of your day! There are local community support groups all over Facebook and the internet for those in need – help someone who is stuck in quarantine with collecting medications or getting some shopping for them.

Some people need dogs walking or are lonely and just need a phone call! The NHS also have a volunteer scheme that is available – so even if you can’t leave the house you can still help. I saw some care homes have asked people to write letters to residents a little personal touch you can also do to bring someone joy.

Plus they often have amazing stories to cheer you up.

10. Don’t be a COVID-OT

The last one is the most important, don’t be a COVID-19 idiot or the new term covidiot. Please follow government advise and stay hope, use protection measures like washing your hands and social distancing. There are storied of health people catching it an passing it on, don’t put others at risk due to your own stupidity as it could end up biting you in the backside but passing it to an elderly or at risk family member – it is not worth it.

Also please don’t stockpile loo roll, paracetamol, basic essentials that we all need. Especially those of us who can do it – some of us don’t have the luxury of that so please be considerate for those people.

Thank You!

I hope these tips will help you keep you sane and occupied! We will get through this together I promise – if you have any good tips for me the share please let me know.

So this one has been a difficult one to post, I’ve attended a few arrests and found myself at them but right/wrong place and timing.

Thankful every time that bleep goes off for a crash call it isn’t actually a crash – but that doesn’t mean you speed walk any slower.

The first one I attended they were pre-arrest the nurse had taken the obs and imminently presses the emergency buzzer.

Others have been someone found on the floor after suffering a ruptured oesophageal varices and having a massive haemorrhage, which is still a medical emergency but not a crash.

We also have been to several faints (vasovagal) which thankful resolved quickly and need a quick trip to the ED just to check everything was okay.

I am talking about Cardiac Arrests but you can also have a respiratory arrest.

You also have the ones that are actually arrest and they aren’t as pretty as you see on TV dramas. When the say in a slightly louder and more dramatic fashion, they are in arrest and gentle press on there chest whilst giving each other glances.

They inject something and maybe jolt them with a shock and they their pass away fully covered in a dignified dramatic fashion, it switches to a break/ending or they come back round and thank the hunky doctor with a swoon worth kiss.

Definitely not like that. I am a first aider so have done all the training before. I was also a lifeguard over the summer and we ran lifelike arrest drills every few weeks (CPR is difficult enough – try on a moving boat at 30mph, even though it was a dummy) or driving that boat. Then doing the full oxygen mask d-fib and calling an ‘ambulance/first aid team’ then doing the ambulance handover and backboard them off the dock.

But in a hospital it’s a different environment you aren’t waiting for the ambulance to arrive or someone else to take charge. It’s you, and time to step it up as your patient needs you.

In reality the chances of recovering after an arrest are low, if it’s out of hospital this image shows how many are attempted, come back to be ROSC (return of spontaneous circulation) at hospital hand over and then those who were able to be discharged.

In hospital it’s a different ballgame as it can be only seconds until CPR is started and the crash team called, it can be a few minutes but generally it’s a fast and rapid response.

A study over 150 UK hospitals examined how many people survived for at least 20 minutes after the initial attempt at resuscitation and how many people survived to leave hospital.

Initial resuscitation attempts were successful in 52%, and 26% survived to leave hospital, this is obvious an average but varies with age, illnesses etc. So in an arrest we might get them back but there is on a 1/4 chance that if we do they are going to be discharged.

So now we have covered that let me tell you about the actually arrests. My heart sinks when I hear the arrest on the doctors bleep and hold my breath for a second as we get ready to move the moment we hear the ward and bed.

‘Cardiac Arrest. Cardiac Arrest Crash Call to Ward 123 Bed A’ then it’s mentally figuring out the quickest way there, and that is all you get. You may know the patient for example we were in CCU and there was a crash on the cardiology ward and they knew who it was. It may just be a nip across the corridor or up a few flights of stairs or the other side of the hospital.

One bit of advise was don’t run, speed walk and if you aren’t exactly sure of the bed/ward or in one case the toilets. Then follow the small crowd of people also speed walking in that direction.

When we have got there in most cases it’s been about 4/5 people on the arrest already, and other staff directing us. The patient is undressed from the waist up with the d fib attached already (this is usually when we arrive one or two cycles in), some pumping down on the chest whilst people are running all over (it is organised chaos), and shouting instructions to the person running it.

I’ve always followed the doctor who I am with direction and put on gloves then wait until I can be of assistance, with getting a sharps bin, opening the drugs, getting a flush or the actually scary one rotating in for compressions.

Compressions are usually done in a 30:2 ratio so for every 30 compressions you do 2 ‘breaths’ using a BVM or airway device.

Most devices have a beat to follow so you are doing the right amount at the right pace, but some have a sensor that tell you to press harder or go faster (it does depend on where the sensor is in relation to your hand – in simulation we took the time to line it up but in reality you don’t have time to line up).

In reality you don’t have time to think and worry about the stress of the situation but it’s time to step up to the plate. CPR is exhausting and you can be doing it for a while so you switch between people every couple of cycles.

You are pumping for heart so it takes a lot of energy, and especially if the patient Is overweight and then less if its a little old lady. It’s mentally tiring too especially when you get them back and then go again.

There are people all over frantically trying to get them back. But sometimes you do have to call it and admit that you have done all you can.

Then you take a deep breath, and get on with your day. Hoping the bleep doesn’t go off again.

Not everyone can handle it, it can be something that can build up in your head but essential it was something I’m glad I got out of the way on placement. Therefore I know when it comes to it I can handle it and step up to run it.

So this is a typical day on AMU I have altered a few little details for patient privacy.

8:00 – Get to the ward/unit for handover from the day to night team, any issues that came up or bloods etc that need following up.

Also a good chance to grab a cup of tea.

8:30 – Ward Rounds! The areas/sections area and broken down into about 12 patients each, but these may be nightingale style, 4 bed bays, isolation or pysch rooms (or any combination of them).

These patients aren’t technically ‘admitted’ which means any outside services aren’t stopped which makes things easier especially for the elderly patients.

10:00 – There is a list of jobs that need doing so we divide them between the two juniors and me. I do the whole section of bloods, attempt a cannula (I wasn’t successful but neither was the doctor), do a urine dip and take a collateral history.

Whilst the doctors do the prescribing, discharge letters and other jobs that I am unable to do.

It makes me feel better knowing I can be of use to the doctors in my role as a student but also as a qualified PA.

11:00 – Teaching time we have an hour session on each of CXR interpretation and hepatology, which was a good refresher.

13:00 – Lunch time

13:30 – After I have stuffed my face, I grab a coffee and join the clarking team for the afternoon.

First patient was a with chest pain/discomfort, which turned out to have a trop rise and t wave changes (prizes for those who guessed).

14:30 – A patient with PR bleeding/blood in stool, due to a haemorrhoid (didn’t know she had one) Just needed advise and GP referral.

14:45 – Next patient is an alcohol withdrawal, who needed admitting for fluid and observation after a fall.

15:50 – Saw a patient with a viral illness who needed to be sent home for rest (it wasn’t coronovirus)

16:00 – This patient was an infective exacerbation of COPD, with antibiotics in the community not being able to clear it.

Just needed some stronger antibiotics for a few days (IV), pain relief and nebulisers.

17:30 – Finished for the day, now I just have to continue with this essay.

8:00 – Get to the hospital and do my usual routine of water, sign in and check any new patients.

8:30 – Board round to discuss the patients and outliers, along with any issues that may occur.

9:00 – I join the renal acutes/referrals today, heading around the hospital to see those who are acutely unwell.

10:30 – Join the consultant in Transplant Clinic. Which I really enjoyed as my mum was a transplant patient and some people had kidneys that were older that me and still going strong!

12:30 – Grab some lunch before the grand round.

13:00 – Grand Round presentations, these are useful as we have to do a grand round in a few months.

14:30 – Head back up to the ward to do a few jobs. Some bloods and infusions.

15:00 – Teaching on Anaemia, Transfusions, ABGs and CXR.

17:30 – Home time I could really murder a cup of tea.

18:30 – Home with a decent cuppa and put my food in the oven, spending the time it’s cooking to unwind.

19:30 – Eaten, Washed Up and put everything away. Time to do some work I have an essay due soon so it’s at the top of my to do list so I get some planning done.

21:00 – Time to grab a shower and have an early night.

Cardiology/CCU/Cath Lab

So I am based across all three departments/units and depending on the day I try to split myself by were I am needed/interesting things are on. CCU is the coronary care unit – the high dependence cardiology ward.

Note during the course of this rotation I have been able to assist in crashes and I deliberately chose a day to write up when there weren’t any as it’s depending on who you are with and I want to be respectful to those patients.

I will however being doing a reflection on the crashes as a whole I have attended so you can understand what it’s like and mentally prepare yourself.

Again I have written out my morning routine multiple times it changes depending on how much I hit snooze.

8:00 – Get into the hospital, put my stuff in the locker and sign in.

8:15 – Get onto CCU and wave to my 2 favourites (they are two STEMI patients who came in as emergencies this week and have been here since – every time I see them they say thank you or love to chat plus say good morning every morning and good night every evening ).

I check on the system to catch up on anything that has happened overnight (mainly so I don’t look like an idiot on WR)

8:30 – Ward rounds starts, in only a small unit with around 10 beds not all of which are filled.

9:15 – We run through the referrals and outliers there are only a few so we a grab a coffee before head all over the hospital.

10:00 – Finished referrals really early so I head up to the wards for jobs I manage to work through 2 cannulas, 3 urgent bloods, 2 ECGs, 3 IV Bolus and 4 infusions! I missed one cannula but did everything else and got it signed off 🎉!

12:30 – Time to sit down with a cuppa and grab some lunch before teaching at 13:00 the canteen does amazing salads for £1.80 this is dangerous…

13:00 – Teaching with a qualified PA on Upper and Lower Limb Neurology Exams! Learning the tips and tricks for them and remembering some sort of order. Practising on each other and the PA before heading up to the ward and running it through with a patient with pathology timed!

14:30 – Head back onto the ward to take a history and do and examination for one of my cases.

15:00 – Head down to the cath labs to see and PFO closure under general with a trans-thoracic echo guidance (30mins) and a complex PCI (which took a lot longer than expected)

18:00 – Finally on my way home! It’s been a long one and I can’t wait to curl up in bed with a tea and some food.

Next Week: Renal

Remember I’m not reposting my morning routine but I’ll start from when I arrive at the hospital! Unfortunately my choice in days was limited to I’m sorry if it isn’t the most exciting but that’s what life is I’m afraid.

8:00 – I’m getting in early as we didn’t get to spend any time on the ward yesterday as we had teaching all day. So I used the computer to look over some of the cases on the ward so I was aware before we had ward rounds.

8:30 – Grab and coffee and head up to the ward and introduce ourselves to the staff so we know who we are with this week.

8:45 – Crash Call on the ward, so it was a case of stand out the way as the doctors, PAs and nurses were on it within seconds.

Meaning ward round were delayed for obvious reasons.

I just wanna give a shout out to anyone who’s ever responded to crash call – they handled it like a well oiled machine and reacted immediately jumping into action and step aside when needed.

9:30 – Ward Rounds, I’m with the liver PA today we are going around transplant patients who are on the list, as well as other ascites patients etc.

11:30 – Ward rounds finish and we are given the details of 2 interesting cases to take the history from (we weren’t given any details as we hadn’t seen them on ward rounds they were a different liver/GI team).

12:30 – Head down to the mess to microwave my stereotypical student pasta for lunch!

13:00 – Teaching with one of the PAs running through the Respiratory Exam OSCE, along with a new PA student from the cohort above us – they were able to give us handy tips.

14:30 – Typed up the cases I wrote down earlier for our portfolio and reflect on them alongside floating around for any jobs.

15:00 – A patient got ‘the call’ for a potential transplant so I got to see the excitement and work up in preparation incase it goes ahead.

16:30 – Finish typing up my cases for earlier and some helpful hints I wrote on the respiratory exam.

17:00 – Home time, listening to an awesome podcast on the way even though it’s raining.

18:00 – Get in and sit down with a brew and relax before putting my homemade shepherds pie in the oven.

Whilst it cooks I start my formative essay (always the hardest part).

19:00 – Put a cheesy film (Herbie: Fully Loaded) on and pour myself a lemonade which I unwind.

This is where I started to feel unwell so I’m gonna end it here for your sake but essentially I walked upstairs and fell straight asleep after taking a paracetamol.

Sorry it wasn’t the most exciting day but I did enjoy it! Sorry again for the delay!

I’m only on this ward for a week so I had to hit the ground running and in the morning for ward rounds there are usually a lot of med students around as well – there were 20 on our ward along with us for rounds and they disappeared as soon as it finished!

This does however mean that the patients with the best signs and indications are often student-ed out, but don’t give up maybe come back once they have slept or in the morning to see if they would like to be examined.

I’m not listening my getting ready etc but it’s the same as my previous post y’all can read the start of that.

8:50 – I have a physiotherapist appointment at 9 at the hospital so I am going to this instead (YAY) but the other student I am with goes to the joint neurology and radiology meeting where they look over the scans for the whole ward and discuss what they mean etc.

In the mean time I got the library and type up some cases and pick one out for my upcoming essay.

10:30 – The doctors are back from the meeting so we have ward rounds. When I started in neurology I was thinking the cases would be stroke and haemorrhages and more ITU but this was not the case as each of these have a separate ward and neurology isn’t a speciality seen in may places it’s often lumped in with others. Mainly it is epilepsy, seizures, brain tumours, nerve disorders, functional disorders, encephalitis, meningitis and ataxia therefore covering a lot more than I initially expected.

Side Note

I feel like we are treated slightly differently to medical students as when I get things wrong they go you need to learn this – however when a medical student gets something wrong it’s often explained slightly differently to how to explain to us (sometimes I seems condescending to me – but that might be my interpretation). Maybe this is just my impression and came across differently to how it was meant to. I do we are held to a higher level than medical students and expected to know more despite being more junior than others (3 months in over 3 years).

12:30 – Ward round have finished, so time to grab lunch before teaching at 1.

13:00 – The reg on our ward is running teaching on the different types of seizures and their management for the juniors on our wards so we tag along – it was really useful to understand the difference and when to escalate the treatment.

14:00 – I get to observe some lumbar punctures but they aren’t in our clinical skills but it’s something worth observing. It sounds an easy skill but when observing they are difficult.

15:30 – As I go to do bloods on the ward another patient gets a NEWs of 10 and starts to go downhill, so I make a cup of tea and go reassure/comfort the wife and son (when I left in the evening he was stable after ‘giving us all a scare’ – his wife’s words not mine) whilst the clinical team look after him.

16:00 – Asked to assist with another lumbar puncture this patient is struggling to maintain the correct position therefore I have to reassure and comfort them and well as help them stay in the correct position (helping them hold their knees up to their chest and roll onto her side). This was a difficult one due to the curvature of the patients spine however after a few attempts we finally got the sample.

17:30 – Finally done for the day time to head home and get some work done.

18:30 – Make brew and get my homemade lasagna in the oven as soon as I get in.

19:00 – Food decided to fall out the oven (or I dropped it) and it splattered everywhere so I give up and order McDonalds and clean up the mess.

19:30 – Start planning the essay and break down my topic into areas I can research and investigate further.

20:00 – Thank you UberEats! I settle in in front of Netflix to catch up with The Good Place and my newly acquired McDonalds.

20:30 – Do my physiotherapy that I was given today (see I am a good patient), write this up and do my online HITT workout I was meant to do this morning but decided to press snooze instead.

21:00 – Grab a shower and put my washing away from yesterday and tidy my room – it’s slowly starting to look like a bomb site.

21:20 – Get ready for bed and settle in with my trashy kindle book and some herbal tea.

21:45 – Night All!!!