Tuesday, 19 April 2011

Almost there

I have an hour to write before my last badminton evening in GNT - both the Monday and Tuesday clubs stop after Easter. It's been pretty busy, both during the day and in the evenings and weekends, seeing patients, doing homework and catching up with Mr A, who continues to be a hero even though I'm much less fragile now.

The work on the wards is going well. The manager of the department asked me directly last week, "Are you enjoying yourself?" It was a tricky moment, and I just said "I'm having quite a good week." It's not enjoyable, I'm too wary of making mistakes. There's a well-known theory of learning, which is all about moving from 'unconscious incompetence' through 'conscious incompetence' and 'conscious competence' to 'unconscious competence'. I've reached the conscious competence stage, which is very much like becoming able to walk along a tightrope: lose concentration for a second and the effect can be serious.

The supervising dietitians in this final phase are much more encouraging and have a way of imparting advice and information that makes it very easy to take on board, unlike many other members of the department that I had to work with earlier in the placement. This isn't deliberate; the other two students worked with these same people in previous weeks, I was just unlucky. I'm fairly certain that my meltdown plus the feedback I've given will mean that the same mistakes won't occur for future students.

I've been exposed to all sorts of different conditions over the past couple of weeks. Alcoholic liver disease, pancreatic cancer, chronic obstructive pulmonary disease, an oesophageal operation to treat achalasia, and a number of old people who have been admitted for all sorts of conditions but can't be discharged until some arrangement is made to support them at home. In the hospital, the main aspects of dietetic treatment involved enriching food (with extra calories and protein), offering extra snacks, and then prescribing supplements of various different kinds. Occasionally there's someone who needs to be fed through a tube, and the other two students have both been involved in intravenous (parenteral) feeding.

I've also been seeing outpatients, and tomorrow's clinic is unlike the GP clinics I've seen over recent weeks. The referrals from GPs have almost (but not quite) exclusively been about dietary advice for people who have type 2 diabetes, are overweight, or both. The clinic tomorrow has an array of possibilities, including low folate and vitamin B, polycystic ovarian syndrome, someone who claims to be consuming more than 2500 calories a day but has managed to lose weight, and someone who is finding it difficult to manage an ileostomy. It's a bit daunting, actually. I'm fairly confident that I can manage now, though.

Meanwhile, I have completed my case study and will be doing a presentation to the department about it on Thursday. It isn't actually a very interesting case, but that hardly matters at this stage. We students have done our joint audit and our joint audit report; writing a report between four people one of whom is 50 miles away is difficult, and it has dragged on and been emailed to and fro so many times that we're all heartily sick of it.

Outside work, this week is difficult because of my hectic social life. Lovely Landlady Lola is going away on holiday next week, so tomorrow is our last night together and we will no doubt share strong drink and sing mournful songs. She has managed to resist my dietetic influences throughout our 12 weeks together and maintains her shocking diet; today's lunch as reported: a crisp sandwich (white bread, butter and a packet of cheese and onion). Meanwhile I have three types of salad in the fridge that I pack into my lovely Japanese lunchbox and take to work. This healthy lifestyle including the two lots of badminton per week has allowed me to lose 5 kg and counting. Progress on the weight loss has stalled, but I'm still determined to try and keep the weight off when I go home. There will have to be changes.

Last night was the last Monday night badminton, so I went to the pub afterwards and didn't get home until much later than usual. Tonight is the last Tuesday night badminton, and I'm very much afraid the same thing may happen. Combined with tomorrow night being the last night with Landlady Lola I'm not entirely sure how I will get through Thursday - at least that will be the end of the week, thanks to Easter. And then it's only three more days, and I can go home!

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