Ward Rounds for Dummies

I’ve changed posts at the hospital, and the powers that be decide to level up my experience by throwing in a few ward rounds during my induction week.

“I’m going for my first ward round tomorrow,” I tell a couple of the nurses.  “Any advice?”

“Are you now, love?”  One of them grins.  “Bare below the elbows.  You can wear your wedding ring but nothing else.  And closed toed shoes.”

Next morning, 9:00am, I’m ‘bare below the elbows’ and anxious.  The ward is a foreign country.  Everything comes at you from all sides.  Metal carts with sharp things, medicine things.  Patients in beds or chairs, talking, wheezing, groaning, wandering down the hall.  No matter where you stand, you’re having to move aside for a wheely bed or chair, or busy person opening a drawer.  All of my senses have trouble adjusting – sharp and antiseptic mingles with human scents.  The room is alive with beeps and hums, voices, and rustling of fabric curtains.

The junior doctors and nurses are huddled around the palliative care consultant, who is reading from a patient’s file.  I introduce myself, stand awkwardly and strain to hear above discordant blend of sounds.  At some point the consultant looks up briskly, “Right, let’s go see her.”

They go to the bed first, get permission for me to observe – it’s clear I’m the outsider.  I’m the only one without a crisply pressed uniform or white lab coat.  I’m carrying a notebook, like a prop.  I crowd inside the rippling wall of blue fabric and mimic what the others do.  If they kneel by the bed, I kneel.  They write notes, I write notes.  Mostly I try not to reflect the patient’s pain back to them on my face.  The patients don’t look at me much, anyway.  They tell their stories, hurts, and fears to the doctor or nurse.

The Ward Round is not round at all – we zigzag around the ward, then duck into another ward, then back to the first.  The blue curtain is pulled around us, a new patient, diagnosis, story, symptoms, medicine adjustments.  Over and over, for several hours.

Over the week you get the hang of the process, but then every consultant has a different style.  The palliative care consultant kneels at the bed, holds the patient’s hand, asks probing questions in a gentle voice.  Another consultant flies by the beds, talking non-stop to a hive of junior doctors and nurses.  He puts a firm hand on the patient’s shoulder, talks clearly but succinctly, gets the facts.  Medical decisions are made, discussed, retracted, rehashed, and reset in minutes.

At night the faces, symptoms, diseases go through my head.  Sickle cell anaemia, wide frightened eyes, dementia, confusion, yellow jaundiced skin, exhaustion, breast cancer, hypoxic brain injury, skin pocked with needle scars.   Relatives crying, standing at the bed stiffly, making jokes, holding their loved one’s head up for water.

I don’t know how they do it, these medical folks – on their feet for hours, facing all of this pain and chaos, making some sense and order out of it.  Wake up and do it all over again.

The Ward Round is not for sissies.  You gotta be ready.

And wear comfortable shoes.

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