Alive and kicking

I’d like to share with you, if I may, an episode from my life as medical student. No, stop, don’t run away! It’s not that bad, I swear. There may even be a moral at the end of it.

You begin Medicine learning dry facts and theories but the emphasis on these largely evaporates by the time you reach the wards in the clinical years.

Instead, you are encouraged – even forced by some consultants – to talk to patients. The official word is “clerking” and the desiccated dryness of these terms almost put me off applying to Imperial. In practice, you spend the better part of an hour listening to a person regale you with a chapter of their life. These chapters may span sagas or may only be a few scribbled lines but they are invariably fascinating. And at the end, you may get to prod them with your stethoscope, if you’re lucky.

Last year, I did my first hospital placement in Endocrinology. After a few weeks on the wards, the initial excitement of seeing every new case of diabetes began to ebb and I had settled into a comfortable routine – ward rounds, clinic, and lectures. I still enjoyed the medicine but it had ceased to surprise me. Or so I thought.

We were on a particularly long ward round on a hot, uncomfortable Monday afternoon when we came to one patient in particular. She was a little old lady, engulfed by the hospital bedding around her. My consultant gently roused her and asked if she could have a look at her ulcer. [WARNING – EDUCATION: Because they can’t feel their toes and because their blood vessels are shot through, diabetic patients have the worst feet. I’ve seen patients go for amputation for what started as a blister. Imagine what Day of the Dead or 28 Days Later would look like from the ankle down.] Yet another foot, I sighed inwardly. The patient stared back mutely, the result of a recent stroke. The consultant gingerly began to undress the wound.

That was when the patient let out the most pitiful and heart-wrenching cry I have ever heard. She was in a pain beyond words. I once ripped a plaster off my arm really fast for a dare, taking a good rectangle of hair with it. That hurt but I can’t even begin to comprehend the pain this lady was in. As distressing as it was for the patient and for us, the consultant continued her work until the sore in question was exposed.

It was horrific. It probed right down to the bone of the big toe, with pus, gangrene and necrotic tissue all the way down. With a high temperature and a low BP, she had gone into septic shock from this wound. This was despite being treated with metronidazole, vancomycin and teicoplanin, three of the strongest drugs in our arsenal for foot ulcers.

I was shocked. In my mind, people died of strokes or heart attacks or road traffic accidents, not of something so simple as a “bad blister”

Afterwards, when we discussed the ward round, it was agreed that this lady was not going to live long and since our antibiotics were neither prolonging her life or treating her disease (clearly), we would switch to supportive management. I was shocked. In my mind, people died of strokes or heart attacks or road traffic accidents, not of something so simple as a “bad blister”.

And so it was. We withdrew antibiotics and prescribed morphine as required, warning the nurse that this patient would not be able to ask for pain relief. We tried to make her as comfortable as possible. After that, we sat back and waited for the inevitable. Even our consultant, who is notoriously optimistic and determined when it comes to foot ulcers, admitted that she probably wouldn’t last the night.

With that said, I was more than a little surprised when I came in on Tuesday morning and the patient was still in her bed. She was still ill but also still alive. And Wednesday, and Thursday, and Friday, and she was still there by the next Monday. What’s more, she even began to look a little better. Later that week, I caught her sitting up in bed, smiling.

I was amazed. If this were a textbook case scenario, she would have passed away on that first night, but she didn’t! I’m only in my third year and I still have a lot to learn but one thing that this lady taught me was that medicine – and people – will always find ways to surprise you.

I love this course.