Week three

I want to write, I really do. I want to sit down quietly at the end of a long and fascinating day, and spend some time thinking, reflecting, pondering on the events of the day. What that patient was thinking, there in that bed, with all their relatives sitting around. How they had reached this point in their life, in a hospital, needing so much help. What the ward staff are doing, whizzing about without a minute to sit with someone and reassure them. How many people rush about the whole time, looking after a ward full of sick people. How much noise and bustle there is, so much efficiency, and yet often so ineffective, care full of holes.

But at the end of a day I drive home, Mr A and I muster something to eat, and I'm tired. Writing is a solitary activity, and I like to talk to him, spend time with him rather than in my room at the computer. Even if we're just watching a DVD together, it's together rather than individually. Although being asked to help with integrating equations involving sines and cosines at 7 a.m. took being together a little too far last week, even for me. Mr A is finding the maths modules considerably more challenging than the computing ones.

There's really a lot going on at 'work'. Most days I shadow one or other of the dietitians in their daily clinics, either in the Dietetic department (in a separate building on the hospital site) or on the wards. Last week, in addition to paediatrics, I spent time on an orthopaedic ward, a renal ward, the ITU (Intensive Therapy Unit) and a general outpatient clinic.

In the general clinic I can just about imagine running a consultation, but the wards are still too much for me, especially ITU. Each ward is organised differently, the notes are kept in three different places, and even though there's usually a white board listing the patients' names, they are sometimes organised by location on the ward, sometimes by surname, and sometimes by the supervising consultant. Often there is information missing: fluid or food intake, bowel movements, whether food or drink given was actually eaten or drunk. There is often no accurate weight, which is the main criterion we can use (alongside dietary components in blood measurements) to determine whether a dietary therapy is working or not.

J and I also spent a morning being shown around the Pharmacy department - there are more than 100 members of staff working there, one third qualified Pharmacists, one third Technicians (not quite so qualified) and the rest unqualified or administrative staff. As well as managing purchasing and distribution of drugs around the hospital, they also make up the preparations used in cancer treatment in aseptic rooms, and would also make up bags for intravenous (parenteral) nutrition if this wasn't contracted out at the moment. There's a Medicines Information section whom you call if you have any queries about pharmaceuticals - for example, if someone were being fed exclusively through a tube, how a tablet designed for swallowing might be administered.

J and I have also been collaborating on our healthy lunchbox task. We've decided what the display might include, and spent a happy half-day printing pictures and text, cutting them out and mounting on card and then sticking them onto a large sheet of paper to see how they looked. Our supervisor made some useful comments, and this week we are constructing the final version.