Clinical placements

A hectic medical emergency taught me not to forget my patient’s needs

I was on a clinical placement on a ward when a patient’s relative came to me to tell me he was worried about his grandfather.

I was on a clinical placement on a ward when a patient’s relative came to me to tell me he was worried about his grandfather.

About an hour earlier I had performed a set of observations on this patient, who I will call Fred, and had no concerns. He was talking, moving around, eating and drinking well.

When I entered Fred’s room this time, I was shocked at his deterioration. His breathing was laboured and he was slumped in a chair. A member of staff was passing and I asked him to get a nurse urgently and tell them that Fred’s respirations were 36 breaths per minute.

I was trying to remain calm while recording a full set of observations and talking to Fred and his grandson. Fred had deteriorated so much that his MEWS, or modified early warning score, was eight. When the nurse arrived and I reported this, she immediately called the medical emergency team.

The team arrived, running. We had administered oxygen to Fred and I was holding his hand, checking his pulse and responding when people asked me for readings from the machines. But Fred was agitated. He shouted: ‘What’s going on? What do all the numbers mean?’ I realised that in the midst of all the treatment I had stopped communicating with my patient. I was horrified. I tried to slow down and explain everything to Fred and his family.

Later, as the doctors spoke to the family to explain Fred’s prognosis, I sat holding his hand and reading the newspaper to him. This was probably the most useful I had felt all morning, knowing that Fred needed to rest and I was soothing him.

There were many positives in this experience. Fred’s symptoms were recognised and the medical emergency team came quickly, he was treated appropriately, and I was able to see an emergency team at work and understand their tests and terminology. Fred recovered and went home with his family a few days later.

But there was a negative element too. My patient was left frightened and vulnerable by the experience. In all the hustle and bustle, I had not thought about how he would feel.

Reflecting on this episode, the fact that I felt awful afterwards helped me to learn. I do not want to make the same mistake again. Perhaps most importantly I realised that I always have a duty of care and must think of my patient no matter what is going on.

I am glad I did stop and explain what was happening to Fred and his family. They were grateful and pleased to see me the next day, and also happy with the care given and that Fred was making progress. I learned that communication is key and to focus on my patient – and what that means holistically.

I will always remember Fred and if I am ever in a similar situation I will recall the fear in his eyes and the vulnerability of a patient in need.

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