About

Hello and welcome to Memorable Medic Moments.

This blog has been set up to share some reflective memoirs written by a group of 4th year medical students. As medical students we are privileged to experience powerful moments with patients and colleagues. These experiences can be positive or negative, trivial or paramount and all contribute to our education and development as future doctors. Writing about them helps us to reflect on what went well and what could have been done better. We hope to gain insight into the feelings and emotions of  both our patients and ourselves, ultimately aiming to improve as physicians and individuals.

All posts adhere to patient confidentiality. Any names or identifiable details have been changed or left out.

Please enjoy and leave a comment should you so wish.

First Day

I swipe my card through the reader. Nothing. Doors remain unmoved. Only a flash of red refusal from the LED panel.

I swipe again, Red.

Again, Red.

I furiously swipe once more, my face now a glowing reflection of the LED’s inevitable choice of colour. Still nothing. I frantically scan the door once more. The sign above still reading “Emergency Department”, although I’d half expected it to have changed. Ready to give in, I turn in place; a young lady in navy scrubs spotting my pleading expression.

“First day?” She asks, hand smoothly running her card through the reader. A mocking flash of green from the panel signals the doors to stutter to a start, seemingly still reluctant to let me enter. Thanking her, I stride through the doors, renewed with a little hope. “Oh” I hear from behind ” you see the next door over?” she giggles at the look of bewilderment on my face. “You don’t need a card for that one, probably best use it next time.”

 

I quickly shuffled over to join a handful of my colleagues stood at the end of a long central work desk. “Any ideas who we’re supposed to be meeting?” I ask, my eyes scanning the rows of navy scrubs-clad figures working along either side of the table, all seemingly oblivious to our arrival.

“ Not sure, but the doctor over there said if we just waited here, they’d likely find us” I followed the line of my colleague’s pointing finger to watch a navy-scrubs wearing lady dash into one of the many cubicles indented within the surrounding walls.

“Ah. right” I reply; wondering to myself how on earth someone we’d never actually met would have any chance of finding us. But I was quickly enlightened by a glance over at my colleagues. A gaggle of smartly dressed, young and incredibly, lost looking people standing uncomfortably in a hospital could only mean one thing. Medical Students. So with this in mind, we set to doing what medical students do best. We loitered.

 

“Ah, you must be the students.” Standing to attention we turn to face the tall man who’d just interrupted our loitering. Without a word, he begins pulling out his stethoscope, a number of different pens and couple of venepuncture vials, and finally pulls a square of folded paper from the pocket of his crumbled scrubs. “Going to need to write down your names. I’ll never remember them otherwise. You’ll probably have to get used to that unfortunately,” he says with a chuckle. After some quick introductions he stuffs the paper back into his pocket and quickly scans the department. “ Right lets go find you some patients!” he says. “Any Questions?”

I did have a question. On TV and on the news, the emergency department is always chaos. You see images of beds in the corridors, doctors crying in the cupboards and angry patients who’ve waited 8 hours to be seen. I knew that was all dramatised, but when I’d seen “emergency department” on my timetable, I hadn’t expected to see just a handful of peacefully waiting patients, beds in their rightful positions; some even empty, all with a distinct lack of tears. “ Is it always this q…” But before the Q even left my mouth a loud beeping erupted from his pocket. It wasn’t going to be quiet anymore.

We followed the tall man to the resuscitation room; an elderly lady was on her way in by ambulance, found unconscious by the staff of her care home, she would need his help. The resuscitation room had a different feel to it than the brightly lit department we’d just left. The only light sources were the dim ceiling lamps and the thin window slits sitting just beneath them; casting a long shadow over the entirety of the room. We found ourselves clinging to a long desk jutting out from the wall and spanning the full length of the room. Opposite us sat two empty beds, anxious to receive.

Within seconds the resuscitation room was filled with activity. My fingers gripped the desk harder, nails digging into the wood; if they slipped off, I felt I’d be dragged into the whirling chaos before me. Bags of fluid were now hung up; placed on stand by. The crash trolley, wheeled into position. A selection of needles, cannula and monitoring equipment laid on top of it. With the ECG set up, the final piece of preparation was in place. They were ready; all eyes turned to the double doors at the end of the room and silently, we waited.

 

It wasn’t long before the whining of hospital bed wheels outside the door interrupted our silence. The doors swung open and the room once again erupted into a flurry of organised chaos. As a medical student, even as an adult, I’d never seen someone grievously ill before and I didn’t expect to do so on my very first day. But hidden beneath the tangle of wires, probes and gloved hands, lay a small, elderly lady, completely motionless; her eyes loosely closed. People had always said to me that dying is like falling asleep, yet I saw no resemblance to sleep here.

A large group of doctors and nurses worked furiously around her, carrying out tests, examinations, trying to save her. But despite the needles, the drips and the wires, this lady’s motionless form gave little indication she noticed any of it. Only the irregular beeps from the monitors above indicated she was still with us, still fighting. However, it wasn’t her lack of movement or fading vitals that told me she was seriously unwell. It was her skin.

The rosy pink tinge of life was gone, sapped from her skin by the infection trying to overcome her. Leaving only white and grey. Grey lips superimposed on china white skin. The lines of emotion on her face, ever visible on even the most reserved individual, also gone. The flat, expressionless grooves now totally unreadable. Yet these signs told us more than any monitoring equipment ever could; she didn’t have long left.

The decision had been made; there was nothing more we could do. Heads sinking, we all left, leaving her precious last moments to her daughter. Despite the relentless efforts of the nurses and doctors that afternoon, despite the tests, the fluids and the drugs there was still nothing they could do. Every day on placements you take something away. A new disease, a new drug, new lessons. But this I hadn’t expected to learn on my first day.

Sometimes there is nothing you can do.

 

Rhythmic Destruction

“CT confirmed – dissection, type A”

“Bad news; tamponade.”

Faces turned grey. Dreams of simple cases, of lunch breaks or stops for coffee, simple schedules, life saving, heroism; all turned away.

A great vessel torn apart, the ferocity of pressure searing it open, and with it, natural order ripped, internal chaos commanded, for years of chronic pressure, body reprimanded.

Blood leaking back, bursting through tissue bursting through muscle through fibres and pooling.

Unnatrually stagnant. Muffling, constricting, blocking the heart. Drum sounds stifled as the body gasped for blood.

 

“Is there anything here that anyone can do?”

 

Emergency doctors looked at cardiac doctors looked at emergency nurses looked at cardiac nurses looked at SHOs looked at emergency doctors. The lowly lucky students, basking in our insignificance, were excluded from this circle of desperation,

agitation frustration,

hidden under layers of poker faces, professionalism and probity.

All that stared were aware that woefully,

Odds were slim.

Blood pressure dropping

Odds were slim

Sats were dropping

Odds were slim

No air ambulances, and odds

With a glimmer in it’s eye and a smirk, and  cackle

Became even slimmer

 

And now. Wait.

Wait for a flash of brilliance, instruction. Wait for a decision.

Wait for someone to decide on a 65 year old life.

A 65 year old life, who 24 hours ago was in the garden, family surrounding, laughing, enjoying, wife makes lemonade, children play, he sits and admires the idyllic display. Or perhaps;

A 65 year old life who 24 hours ago was crying for an out. Argument with the wife, divorce impending, considering the knife, considering an ending, or more likely

A 65 year old life who 24 hours ago, and 24 hours before, and 24 hours before; normal, ordinary, practically a bore. Uneventful days followed by uneventful nights followed by typical routines followed by timetabled lifestyle followed by average events followed by

 

Gasp. Splutter. Weakness. Pain.

Searing, tearing, indescribable pain.

Bright lights, monitors, needles.

Bright lights, masks, beeping.

Bright lights, chattering, fading.

Dim lights. Beeping. Slowing.

Dark lights, Gasping.

 

What’s happening?

 

Waiting.

The Consultation

“Is there anything else regarding your health that you’d like to mention? Anything at all.”

He hesitated before answering. It probably wasn’t really worth mentioning, after all, it was nothing like in the adverts or those public health announcements, and his GP, whom he highly regarded, didn’t mention it at all. Besides, was there really any point mentioning it to a student? Realistically they couldn’t do anything about it.

“Well, it’s nothing really,” he said, tone notably quieter than the rest of the conversation, “but, well, when you get to a certain age I suppose is it something that’s at the back of your mind, but I suppose it could be cancer.”

The student nodded, eyebrows furrowing a bit; now he was just concerned that he was making a great fuss about it. “Is this something in particular you’re concerned about?” This must have been the third time she’d mentioned the word “concern”

“Well,” he could have talked about how that was a conversation he didn’t want to have with his family, how he wasn’t sure that his son, who aged 40 still lived with his parents, was properly equipped to deal with loss or to look after his mother, but it seemed unnecessary. The closed curtains did very little to conceal the noise from the outside, and he didn’t want the rest of his ward mates to look at him with pity. “I wouldn’t say I’m concerned about it per say. I mean, I’d certainly be more worried if I had symptoms like blood, or weight loss, but I’ve no doubt that it’s a fear unfounded.”

“Sure,” said the student, refusing to drop eye contact as she ferociously scribbled down notes in her notebook. “Well, thank you for talking with me,” she said whilst reaching for the hand wash that laid at the foot of the bed. Immediately, the already sterile stench of the ward doubled, as alcohol dissipated throughout the room. It wasn’t a bad smell, but there was something overtly clean about it. He’d been in hospital a mere three days, and he was already longing for human smells, real smells – of weather and the sea from his back garden, of sawdust and woodworking oils from his garage, of rosemary and tarragon from his wife’s wonderful cooking, from real food, not like the gruel they served here at the regimented timetable.

“Yes of course,” he said smiling. Some of his ward mates seemed annoyed by students, but he really didn’t mind. It was someone to talk to at the very least. It reminded him of decades gone when he was surrounded by students. Years after retiring, he still loved seeing students flourish, seeing knowledge imparted, seeing people living up to their potential, even if it was just for twenty minutes at a time. He started to sit up to properly say goodbye, but his stomach was still in pain following the examination. At least she was thorough. “And best of luck to you in the future! I really do think it’s wonderful what you’re doing!”

“Thank you!” she said, a slight blush creeping to her cheeks. “Do you want the curtains open or closed?”

“Open I think,” he said, aware that he was mid conversation with his neighbour before she’d come in. It was merely small talk, but at least it was something.

Butlins

I let go of my nan’s hand, as she instantly finds half a dozen people to greet, and stand at the door to the lounge. The short distance between here and my grandfather’s chair is one he and I struggle with for different reasons.

“And a happy new …”

Loud gasp for breath. I turn to see one elderly resident conducting with both hands while being backed cautiously out of her bedroom in a wheelchair.

“Year!”

Anatomy

When they are not being held up and turned about and pointed out, the skull rests heavy on the letters my friends have written me. A striking paperweight with their empty orbits, gaping sinuses and perfectly aligned teeth biting down into lines of affection. Their face has sallowed with time, deep arches tired from being misnamed. All the crevices where vessels would have pumped and nerves fired, lie empty.

Deadline

How much time had passed since I’d heard the door creak closed? How long have I been the lone inhabitant? How much longer will I have to be here? Only distant sirens and the repetitive tip and tap of keys broke the silence, no comforting quiet chatter. Just like myself, the room longed for sleep, for peaceful darkness. Instead, the endless rows of book-filled shelves cast a grid of shadows, my screen’s harsh blue light the room’s lone and aggravating light source.

I pull off my glasses and rub my eyes, nervously glancing at the time. “01:45. The last time I leave it this late”. Every student’s favourite lie. I’m just writing nonsense now, the ever-elusive word count and fast approaching deadline encouraging a “quantity over quality” philosophy. I’d stopped even reading what I’d written, my usual perfectionist trait buried deep under layers of stress and caffeinated fatigue, the gravestone of enthusiasm lingering overhead. RIP.

Performance Art

“He’ll need re-cannulating” said the aneasthetist off-handedly to no one in particular. Certainly not to me, watching and listening, and ready to pounce; like an incompetent vulture.

“Erm, do you mind if I had a go?” I squeaked, regretting the sentence merely halfway through. I was met by blank stares from the qualified team. “It’s just that, I’ve never really done one before.” For some reason I couldn’t stop talking; word vomit was just tumbling out, my brain apparently had no control over my mouth.

“What, never?” said the shocked voice of an SHO. 4th year medical student and never even done a cannula. I was truly shameful.

“Well, not technically,” I mumbled, “tried a few times but like, it didn’t work. There was blood everywhere,” stop talking Sarah. “It was a grey, you know” stop talking Sarah. “I think the pressure was off. Burst right through the vein. The second time there was just a lot of skin… But, thought it might be good now…he’s asleep you know…” I had started to trail off, I was essentially talking nonsense to myself, trying to swallow my own words out of sheer embarrassment, while simultaneously convincing myself that I was the person for the job. “I’ve done it on models before!” I offered, more optimistically. I was only met with pitied giggles from my placement partners.

“Yeah sure,” said the SHO, “you can give it a shot.”

“Great!” I muttered, unconvincingly, while trembling hands reached for gloves. As the stodgy blue rubber trapped my hands, I was trapped in performance; my audience were watching, participating like a Greek chorus, nerves and notable anticipation building. The placement partners to my left offering glances of encouragement as they edged back slightly. The anaesthetic nurse, offering quips and witticisms: “When he wakes up with a haemorrage, we can just blame the medical student!” The Greek Chorus erupted with laughter, while I chuckled out of desperation, as the spotlight shone brighter. The SHO’s on either side of me, preparing the vein, preparing the saline, preparing my stage and gently nudging me closer to the centre when suddenly the genre turned farcical.

“You’ll want to go in that vein there.”

“That one right there?”

“Yep, that one there.”

“Right there?”

This must have only gone on for a moment, but it felt like an age. I could feel the SHO internally laughing at my incompetence.

I picked up the cannula, my main prop for the performance – my foil. Stumbling at the very first hurdle, I fumbled with the wrapping, and then, there it was; part plastic, part metal, with unlimited potential; this could be the vector wherin lives are saved – drugs administered, fluid given, life saved. Or, this could be the vector of destruction; burst vessels, blood pooling until the pressure builds and builds until an outpouring of hot sticky red liquid comes seeping out. One of the SHO’s laid down a pad under his wrist.

“Just in case. I always get blood everywhere,” she said unconvincingly.

With one final look to my partners, I knelt down to the patients’s wrist, my stage. The back of his hand was a sickly colour – slightly yellow under the cold light of the aneasthetic room, with green veins leaping forward, all with a reflective, unhealthy, artificial sheen of recent alcoholic washing. The vein looked at me, shiny, pearlescent, dimensional, almost daring me to miss.

“So right there?”

“Yep. Right there.”

“Go in at a slightly lower angle,” suggested the SHO.

“Don’t forget to pull the skin,” offered a colleage. I was being heckled. The greek chorus was now participating, as the room bounced with offers and suggestions from more experienced practitioners.

“Hold it from the wings.”

“Go in smoothly.”

“Not too quickly!”

As the tip reached the the vein, suddenly silence; my only soundtrack was the constant beeping of the heart monitors, and my own breaths, becoming ever shallower.

 

Friends, Doctors, Patients, lend me your wrist

I come to cannulate your vein, not to burst it.

 

As the tip edged ever slowly to the vein, the rest of my body became paralysed; stage fright had taken over me as I couldn’t blink, couldn’t breath, couldn’t do anything but edge the cannula ever closer. I met resistance as the skin was acting as a barrier – the antagonist to my cannula’s noble journey. With a further push forwards, the skin gave way beneath me, as I felt an offload of pressure. As I focused on the vein, eyes boring into it, out of the corner of my eye, I noticed a flash of red; I was in.

The journey wasn’t quite over yet though. “Just advance it a tiny bit.” The cannula carried forward as I gently nudged the plastic tubing, dark red blood spilling back into the tube until the journey was over, the cannula could go forward no more; I was definitely in. I breathed – anxiety and anticipation came pouring out with my breath, and I breathed in relief with a hint of pride – I daren’t look up at the audience yet. The relief and loss of adrenaline made my arms go weak; I pushed onto his wrist as I took the needle out, but still blood dripped out – as it touched the pad, the deep burgundy drops slowly seeped out, diffused at the edges, making a gradual gradient of colour; there was something oddly soothing about the stains. When compared to my first attempt at cannulation, where blood mercilessly was bursting out of the vein at the patient cried in pain, this was in some ways the same sign, but it was the sign of a job well done; the cannula was firmly in place, the patient was still asleep, and I could feel my ears heat up as I looked at my handiwork.

I finally looked up at my audience; no longer were they the cruel judgemental Greek Chorus, but an ensemble cast with words of congratulations and encouragement. I pulled off the gloves, and with that, the scene ended and the curtains dropped.

Bedroom Diagnosis

The room was small. To small to fit myself, the paramedics, Betty and her daughter. Also too small for the sense of anxiety from her daughter, the wavering denial from Betty, and the feelings of intrusion from myself. With every word, the room was getting smaller.
“We’re worried about this pain.” The ceiling fell by a foot
“I don’t want to have to go to hospital.” The walls crept in.
“This isn’t normal for you. We might have to take you in.” The door shrunk in half. The feelings of anxiety, dread, fear, were stifling the room, giving a sense of claustrophobia.

Betty’s lightbulb would need changing soon. Everything the light touched had a faint orange glow, and everything it didn’t was cast out in elongated shadows creeping up the wall.

[hospital lights are neon. open, pale neon]

I couldn’t stop staring at the decor. Cartoon paintings of fish were just above the headboard – open eyes staring at the scene. They were the silent observers, judging every false move with their relentless, souless eyes. I imagined in an other setting they would be welcoming. Grandchildren spotting them with glee, naming them, giving them character, backstories and joyous fun lives as Betty watched happily, a smile creeping on her face as she knitted them jumpers for the upcoming winter, a matching rainbow fish pattern. Their character, backstory and lives were now reduced to judgement; all seeing, all knowing, all judging.

[there’s no such judgement on the hospital walls]

Surviving Surgery

You’ve just got to throw yourself into it! I told myself. Everyone has to start somewhere! Even HE started somewhere! I could feel my heart beating hard now. If it weren’t for the coarse surgical gown and my poorly gloved hands resting on my chest, I have no doubts the whole theatre could have seen it. In reality it’d been racing for what felt like hours now. Jump started by the grilling I’d received in the staffroom. He’d treated the nurses, doctors and other surgeons to quite the show whilst they wolfed down their lunch.

I don’t even want to be a surgeon. How do you know? You even haven’t tried it. I argued with myself, but there was no going back. I tentatively shuffled over to the operating table. The young boy whose hand I’d shaken hours ago, now a 40cm by 10cm abdomen laid in front of me. He, the consultant who I’d been shadowing all morning, beckoned me to come closure, pointing for me to stand at the end of the table where the boys’ legs were. I stood, knees shaking like I’d just run a marathon and sweating like it too, now ready to begin the first ever surgical experience of my career.

I did very little but stand for the first hour, however it felt like just ten minutes. I watched the scalpel trace thin red lines over the boy’s abdomen, only to be replaced by small pools of a thick red liquid. Blood, human blood, the boy’s blood. But before I could dwell, they we’re swiftly wiped away, and the surgery began. Scopes, levers and cutting instruments invading those small incisions, carrying out their delicate and intricate work. However it was impossible for me to appreciate it. My mind was consumed by the echo of one thought: don’t mess up, don’t be THAT guy; the guy who passes out. And with each reverberated echo my legs sagged heavier and my heart beat faster and faster and faster.

“Can you hold this for me a second?” my arm unconsciously sprang away from my chest, opening my hand ready to receive. Ready to receive what? I didn’t care; all I could notice was the sweat beading underneath the two layers of gloves that I’d fumbled on an hour before. That’s when the registrar placed the end of a long, brownish tube into my hand, collapsing as I closed my hand around it.

 

Human bowel.

 

He’d placed human bowel into my naive open palm. This is it I thought I’m a goner. I’d almost braced myself for impact, when I was overcome by a feeling of sudden amazement. I was holding onto a human bowel!

As I began to inspect the rough brown exterior of the tube, noting the ridges and areas of black decay as I scoured it’s length, my legs began to steady and my heart slowed. The nerves I’d felt 15 seconds before replaced by fascination for the organ’s I’d spent the last two years of my life studying. It quickly dawned on me that the human body, it’s components; even those components being cut into, had never been the root of my anxieties.

The fear of failure was the reason my heart had almost escaped my chest, why my body was now drenched in sweat, and why I’d spent the first hour of my first-ever surgical experience, only thinking about not passing out. The fear of failure had been planted back in that staffroom, and watered by every derogatory comment he’d made. But I had learnt something from today. I was right, I didn’t want to be a surgeon.

Ceiling of Care

I unravelled the thin plastic filmed aprons, separating their static and tearing them at a marked edge, just as you would for black bin bags, except these were aprons. Disposable aprons which I handed to both my colleague and the consultant we were shadowing. Disposable just as everything in this world eventually is.

The thin red plastic was unflattering and of poor quality. I took care not to overstretch and break it. Picking out two appropriately sized gloves to fit my hands, I wiggled my fingers in against the elasticated resistance, and pulled the gloves edge down to reach my wrist. Nothing like cinema or television where the glove snaps back with a ‘thwack’. I have never seen that happen in medicine.