Saturday, July 22, 2006

I'm back again (part 2)

Well it is the morning after the wedding, everyone who stayed in the hotel meets up in the restaurant for a champagne breakfast, we all chat and remember the occurrences of the previous day and one by one the group gets smaller as we all drift off home. It was such a nice day; Kal and I set of and stop on the way so that I can take pictures of the countryside for Nursie999 (she forgot her camera the night before). Kal and I arrive back in Edinburgh and he starts packing for college, I head home and get an early night for my next week in Theatres.

Monday morning arrives and I’m back in theatres, I meet up with J and we both head into our allocated anaesthetic room to set up, now by this stage she is expecting some help, so I ask how many patients and what procedures etc so that I can gather up the necessary equipment, we are ready by 0845 so it's coffee and bacon rolls. This is our routine for the remaining two weeks, set up coffee, patients, getting the consultants to sign me off on my various required procedures on the way!

Week 3 arrives and this is my final week to make sure I am happy with my new found practical skills (totally different on a real patient). I had been working at T in the Park over the weekend and chat to some of the staff about the event and the workload etc. The patients start rolling into the 9 main theatres, consultant surgeons and gas men (anaesthetists) all arrive and we begin again, now over my last two weeks I have received comments of praise from some of the staff etc but now it comes to the final day and I have to see the senior Operating Department Practitioner (Manager) and await my feedback, now this guy looks frightening, but he is very pleasant and gives me my certificate of competence and tells me that should I ever wish to come back into HIS department then I am more than welcome!!

Week 4 sees me moving departments and I am now working in the Coronary Care Unit (CCU) of the Edinburgh Royal Infirmary, which is a busy 10 bedded unit with a ward attached when patients are deemed as fit to be prepared for rehab prior to discharge. I arrive and meet up with the Ward Manager (Senior Sister in old terms) who I know fairly well. I am given my tour and follow the ward round, where the new team headed by Prof N reviews the patients.

I have various skills and procedures which I must have signed of as competent in their appliance and I start these straight away by going on the "Bloods round", this basically means taking the requested samples of blood from the patients as discussed in the ward round for analysis at the lab to see how well the patient is responding to treatment. I assist in making beds, toileting the patients and providing general care with the nursing staff.

Day 2 sees me in the theatres following various procedures including a pacemaker insertion and the cardiac catheter labs where patients are taking to have their coronary arteries either expanded with a balloon or strengthened with a wire mesh tube called a stent. Back on the ward after lunch and I am half way through some paperwork when the "Arrest" bleep blips into life, telling me and the other staff that somewhere in the hospital there is a patient in cardiac arrest and we have been summoned to assist in their resuscitation, now not knowing the hospital that well I drop 2 steps behind the Registrar and the staff nurse as we sprint along the corridors to get to the patient. We arrive along with the rest of the "Arrest Team" and start working on the patient, now bearing in mind normally you are lucky to have 3 people helping at an arrest when out on the road I am a bit shocked to see 14 staff (including myself in that number) all around one bed doing various tasks. We are successful in getting this patient breathing and their heart beating and it is decided that the patient does not need to go to CCU (as it turns out to have been a respiratory arrest) so we 3 all leave the rest of the team with the patient and return to the ward to cool down (27 degrees C outside and ward with arrest had not air conditioning!)

Day 3 begins with hand-over and ward round, then down to the catheter lab again for a more challenging procedure on an elderly male, unfortunately it is suspended due to his condition worsening suddenly. The consultant who is carrying out the procedure decides to reschedule for Thursday, as he will then be able to get a colleague to assist if the patient is stable enough. So back to the ward with the patient and watch as his condition bounces up and down like a rubber ball, eventually he stabilises after much hard work on the medical and nursing staff side. We receive a new patient onto the unit and they are clerked in, I assist with bloods and ECG etc and even teach a student nurse how to use the ECG machine!

Day 4 I arrive onto the unit to begin and there are new patients, some of the others were transferred to the attached ward as they were more stable than the new admissions. The unit is now full and there are numerous tests and examinations requiring to be carried out so I ask the Charge Nurse if I can help and I am allocated the bloods and ECG's for all the necessary patients in the unit along with assisting the staff nurse and student I'm working with for that day. Just as lunch arrives "blip blip blip ... Cardiac Arrest on ward..." yes you have it, the arrest bleep so off we go like a well oiled team sprinting into action and sprinting along the vast corridors to the correct ward, we arrive, with the other team members and begin to swing into our allocated roles, orders are barked out and equipment is brought... unfortunately this time we could not save the patient and it is agreed after a considerably long time that we have tried everything and we should now stop. So back to the unit, feeling low, but knowing we did everything we could do for the patient. As we arrive back on the unit the staff nurse and myself go for some water to cool us down as the Dr had remaining on the ward to complete the necessary paperwork certifying death has occurred. Blip blip blip "Cardiac Arrest.... ward...." I look at the staff nurse and she and I are off again, sprinting along catching up with our Dr (who was closer because of the previous callout) and the full team swing into action again, orders are given, equipment brought, more orders, more equipment and with each new item another team member arrives until the room is filled with medical, nursing and associated staff making 19 of us in total, once again I think back to my last arrest on the road when there were two of us!

We are successful this time, the patient is stabilised and transferred to the Intensive Care Unit (ICU) for further treatment. Back to the unit again, lunch for us and time to relax. The afternoon finds me catching up on my outstanding procedures and getting them signed off by the Charge Nurse. I finish earlier that evening, as it is Kal's end of course drink, which I head down to.

Kal is now 7 weeks into his 9-week technician course; having completed his Ambulance Aid (the care side of things) he now only has his 2-week driving to go... The whole group are found in the bar of the college, I bump into some old friends who are there for various reasons, chat, drink my diet cola, chat some more and then head off as I have an early start the next day. I give Kal a small gift and card to congratulate him and leave him to his party.

Day 5 sees me back on the unit, after having called Kal to make sure he was up, even although unknown to me he had been woke at 6am with the fire alarms, I wished him well and let him get back to his "Long lie"

I now only have one week to go, I walk onto the unit thinking that I will miss the staff, as they have been very friendly and helpful. I am not more than 5 minutes on the unit when the ward manager calls on me and tells me that we have a shout in A&E for a fast track chest pain patient who needed to come up to the unit, so we take the equipment and go down with the Dr. We arrive and the patient is post cardiac arrest, now with classic signs of an MI. The patient is prepared for transfer to the unit and off we go. Back on the unit I am in time for the start of my final ward round and Prof N once again carries this out (as he has for the last 4 days), meeting the patients and putting them at ease with his manner and tone, I am then invited by him to come back to A&E to review a patient with him and the other Specialist Registrar (SpR). We wander down and assess the patient and it is decided that he does not need to come to the unit and can go to the ward for further care.

It is now lunchtime, I have completed all my necessary procedures and had my training record signed off and I bid my farewells to the staff and leave then with the thank you card and a box of chocolates.

Well one more week to go and I will be finished...

Sunday, July 16, 2006

I'm back again! (part 1)

Sorry that I have not updated for a while, but with my paramedic in hospital clinical placements, looking for a new house and making sure Kal is still relaxed (not sure if I'm managing that one) about his course things get a bit hectic.

Anyway, here I am so I will try and fill the gaps...

After completing my college based training for my paramedic qualification I had 5 weeks back on the road as a technician (with paramedic knowledge) I worked mostly nights and this was good because the shifts were such that I was rostered with another Qualified and Experienced Paramedic (State Registered in HPC Terms). My first night back started with a cardiac arrest; which had been an urgent GP call for a male with difficulty in breathing, then a couple of genuinely unwell patients and a male in his 50's having a full blow MI, which eventually caused him to go into cardiac arrest following Thrombolysis in the back of the ambulance (in fact he arrested as we entered the lifts to go to CCU!).

For the other 2 nights we were back and forward to Edinburgh Royal Infirmary, dealing with lots of genuine patients and having a good time.

The other 4 weeks seemed to bring out all the genuine patients for me to deal with and my colleagues seemed to be left to pick up the drunks, this was good because it gave me a chance to work with some highly skilled Paramedics and learn from them along with using my new found knowledge to allow me to care for the patients in a more in-depth manner than before.

I received a phone call from the Training Department Queen (Administration officer, she is the woman who sorts your career basically) telling me that she has managed to get a space for me to start my in-hospital clinical placements to finalise my training requirements and that the placement starts on the 26th of June...."Oh I see" is my reaction, I explain that I am on annual leave that week as it's my Birthday and I have a friends wedding (which I am an usher and Kal is the Best Man)... Right she says, well the next placement is probably going to be the end of AUGUST, "I see" I think quickly and offer to cancel my leave for three days if that would be of any help, she says that should be ok and I have to clear it with my station manager. I call into the station that day, speak with my boss, who tells me that's fine and to claim Overtime for the three days I am in hospital on my placement and wishes me luck! Score, I get my annual leave payment and now time and a half and travelling for going into hospital! ££££

My first week of the two on annual leave it taken up mostly with the Royal Highland Show (Big agricultural and food fair etc) over 5 days including a day setting up, I work in the Communications centre, out on patrol and then on the Saturday I work with Kal, now we have only worked together once before and even then it was slightly different, we walk around on patrol and get a patient who is unconscious (through alcohol) and as we arrive I tell Kal that "Your attending" meaning that he is looking after the patient and I will do all the radio work, gathering equipment etc. I do this to see two things (1) how he has developed whilst at the college and (2) if he can cope with sudden change in situations... he performs well, and even when I am taking the piss out of him for his airway management he remains calm. (If all the future Technician's are all as confident and competent as him then Scotland will be a safe place to live).

Having arrived at the hospital for my first day I am shown around the Theatre suites (which is where I will be based for the first 3 out of 5 weeks), I'm introduced as the "Trainee Para-headache" to the staff and then pointed towards the changing room to get into my theatre greens. I meet up with my ODP mentor and stand sheepishly in the background as the patients start arriving. My ODP (J) is brilliant, now she is not full time staff, she is employed by an agency but has worked in the theatre for the last year, she is bubbly, chatty, full of information and so willing to teach, by the end of the first day my head it thumping, but I am already 1/4 of the way through some of the necessary procedures that I must achieve whilst on placement.

I inform J that I am off for two days annual leave later in the week and she notes this on my theatre schedule and gets her senior to amend the master sheet, I have my two days off and enjoy them (down at Ambex which may sound dull but is an international ambulance conference and exhibition) meeting lots of friends and colleagues and on the day of my birthday I am drinking vodka with breakfast!!!

I arrive home and start preparing for the wedding on the Saturday, I go with Kal to the pre wedding friends and family get together in Pathhead (which not two hours previously I had driven through on the way home from Ambex) I am fed lots of food, offered alcohol (which I decline as I am driving) collect the necessary items that still require dropping off at the hotel for the reception and with Kal we take the Groom to be to his hotel for the evening, depositing him at Midnight Kal and I roll back to his and collapse into bed, exhausted and set the alarm for an early start the next day.

The day of the wedding, we wake at 7:30am, roam around the flat getting ready and not really talking as we are still half asleep and the coffee machine has not finished spitting out the black nectar of life yet!

We both have things to do; I drop Kal off in town, head home and get into my kilt, drive back to Kal's and collect him.... WOW how hot does he look in his Purple kilt mmmmmmm, drive to the hotel and collect the Groom, who is looking pale and slightly nervous. Driving around to the church we confirm that rings are with Kal? Check, G you had food? Nope, stop off at shop and buy supplies, Water, Bananas and ready salted crisps etc (all non staining foods since we are all in white shifts and kilts) Onward to the church again, we arrive G and Kal are getting things sorted in the back and myself and the other Usher are discussing tactics, who sits where etc.

Everyone is now in the church and the Bride arrives (Groom is BRC and Bride is St. Andrew's so plenty first aiders in the guests in case of accidents) She looks stunning, slightly nervous as well, but totally stunning. Her father and also her Maid of Honour and bride’s maid’s who are all in lovely purple dresses escort her in. The wedding goes well, the pictures are taken (G is project manager and R the bride is a teacher so everything is set out in time tables and schedules for us to follow). Time for the reception, lovely drive in convoy to the hotel in the Scottish Borders, beautiful weather, lots of alcohol, gorgeous food, more alcohol, Chocolate fountain, great music and ceilidh band. The evening goes on, the buffet comes out.... Bacon rolls Mmmmmm. More music and dancing and drinking. I dance with Kal to a song that summed up how I was feeling (Yeah you know the one boy) and the guests all drift off home. Only a small number of us were booked into the hotel, we all meet in the bar, tired, slightly tipsy (some more than others) and start to unwind with another drink. The Midnight munchies (hunger) arrive around 0130hrs for most of us and we get some pringles from somewhere, just as we open them the manager walks in with a tray of hot bacon rolls.... the pringles are left and the rolls vanish in seconds with moans and groans from the group now demolishing the hot food to soak up all the alcohol.