Serum Rhubarb.

I’ve started my final term in general medicine (a.k.a the revolving seasonal-chest-infection-suffering-geriatric and de-boozing-boozer lounge). 

Self preservation is kicking in, and I’ve been in at all sorts of ridiculous hours all week.

Whilst general medicine holds no especial charm for me, I do hold a burning desire not to look too daft next year when I start working as a Real Doctor. Hence the new-found virtuous attendance, although being paid to feel stupid will remove the sting somewhat. Currently I do it for free. 

I’m turning up to ward rounds like they’re going out of fashion, multitasking away with blood slips and radiology forms and doing my best to keep neat little lists of patients and tasks.

You know, actual practise.

It had to happen eventually, even if I prefer hiding in the hospital library like most other medical students, emerging only to scuttle across the hospital for tutorials, and avoiding the wards at all costs. I mean you might see a honest-to-goodness patient that way and then where would the great tradition of medical education be?

I will briefly share a few things that I have learned about the average general medical ward patient:

• They’re all at least 85, completely doolally (severely demented), deaf, doubly incontinent and non-verbal. 
• They come from nursing homes that appear to specialise in thrush infections and pressure areas. AND don’t supply transfer paperwork, so if there’s no old hospital files to refer to, it’s a crap-shoot guess as to what problems they have. The relatives almost never know.
• Every single one of them has diabetes, hypertension and heart failure. Those that don’t will have them diagnosed before they leave.
• Because they all smoked for most of the last century, every patient has a hacking cough that sounds like oysters of sputum may be launched fresh and forcefully into the shirt of the unwary staff member at any moment. If they don’t when they arrive, they do by the time they leave, thanks to hospital acquired infections.
• Despite the fact that they never actually visit their geriatric matriarch (and don’t have a clue about their medical history) the relatives will inevitably insist on full resuscitation and ICU management. For someone who, if everyone involved had more sense, would have been allowed to die with dignity when they had their first massive stroke that left them bed-bound and dribbling. Ten years ago.

Enough of that. Back to the ward round. I can’t speak highly enough of the five hours a day I spend running around a veritable comet trail of doctors learning the important things about medicine like where the pathology chute lives and the fax number for radiology. Clinical medicine? You must be kidding.

I just do the paperwork.

There is an old adage in medicine that one cannot always order a ‘Serum Rhubarb’ to magically divine the cause of a mystery ailment. There are blood tests for many, many things, but not everything.

I’m familiar with most of the common tests and it makes me feel more like a Real Doctor to authoritatively fill out request slips as we view the patient, so I do it.

For every patient we see, I hover, listening to the works of wisdom imparted by the registrar and infer which tests needed.

Some are dead easy and I can do them before I’ve even entered the room. I mean, it doesn’t take a medical degree to work out that a woman who’s been puking blood for three days probably needs her haemoglobin level checked.

Let’s not discuss the relatives that refuse to let anyone tell their matriarch that she has a zonking dirty fungating adenocarcinoma in her stomach causing said blood puke in case she (quite reasonably) refused further transfusion and actually died at the ripe old age of 95. Rather than at 95.6, in agonising pain from metastatic disease, and unable to eat due to the stomach obstruction caused by the tumor.

I just write the request slips and leave advanced thinking like that for my seniors.

But, not infrequently, I’m stumped and find myself whispering to the nearest Real Doctor…’A serum ya-what-a-what? How do I write that?’.

Given that I’ve also noticed that nobody seems to actually check the result of all those blood tests a significant portion of time, I have a plan. The next time it happens, I will simply knod knowledgably,  smile beatifically and write serum rhubarb on the slip. It will make me feel better.

I fully expect that it will pass completely unnoticed.