mean that they’d already arrived, but the other two didn’t. Emma thought she’d better make a start.
Emma went to the trolley to find the notes for the first patient, a Mr Edwards, in bed 6. Glancing through the outpatient letters, he seemed straightforward: gallstones for about a year and he’d come in for a cholecystectomy. She went over to his bed.
“Good afternoon, Mr Edwards.” she said without really looking at him. “I’m Dr Jones, the house officer, and I need to ask you some questions and examine you before your operation tomorrow.”
“Are you really a doctor, miss?” he said. “You don’t look any older than my daughter and she’s still at school.”
Emma felt herself bristling but didn’t rise to the bait. “Well, to be honest with you, Mr Edwards, I’m as new to this hospital as you are, as I’ve just started today,” she said with a smile.
“Out of the frying pan into the fire, is it then?” he said.
“Well, it’s a bit like that until we find our feet. I see in your notes that some tummy pain was the first thing you noticed. Can you tell me about that?”
“Well, it was just after having an Indian meal for my birthday last year. I probably ate too much and also had too much beer, but I got a digging pain here – he pointed to just under his ribs on the right – and it wouldn’t go away. I thought it must be indigestion. Anyhow, it went a bit but then kept on coming back. I like my fry-ups and they really made it bad. So I thought I should see my GP – that was about two months after it started - and she got me seen by the professor. And that’s the whole story really, doctor.”
“And I see that Professor Cuthbertson then arranged for you to have an ultrasound scan, which showed that you’ve got stones in your gall bladder,” she said, glancing through the investigations section of his notes. “What’s been happening since then? Has the pain been getting worse? Have you had any other symptoms?”
“Well, if the truth be told, I’ve been drinking more to cope with the pain. I know I shouldn’t, but you know what it’s like. It’s only beer, mind you. I never touch spirits.”
“When did you last drink any alcohol?” asked Emma.
Mr Edwards seemed embarrassed and he looked down at his feet. “Well, to be honest, doctor, I had a few pints first thing just to get going, you know.”
Emma leant closer to her patient. The smell of alcohol on his breath was very obvious. “Mr Edwards, I’ll need to examine you, but I’ll also need to take some blood for tests and we’ll need to check your liver.” She pulled the curtain around his bed.
She reached for the sphygmomanometer attached to the wall above his bed. “Let’s check your blood pressure first.” She inflated the cuff and applied the diaphragm of the stethoscope over the brachial artery. She listened as the cuff deflated and heard the sound of the systolic which then faded away when she reached the diastolic. His blood pressure was elevated at 160 over 110.
“Now could you lean forwards and take some deep breaths.” She listened intently and heard a few wheezes but put that down to him being a smoker.
“Very good, let’s examine your tummy.” Mr Edwards was very obese. He winced a bit when she palpated below his ribs and she thought she could feel the liver edge. Not a good sign, she thought. She finished the rest of the examination, thanked him and went off to get a tray to take his bloods.
Emma mulled over what she’d found so far. He was a classic case of gallstones but his high blood pressure was a concern and the alcohol even more so. He certainly needed liver function tests and might need to be on an alcohol detox. He might even have memory problems. So hardly that straightforward and she wondered what the Professor would say.
She returned to Mr Edwards’s bedside with the bloods tray. “Is it alright if I go out for a cigarette, doctor?” he asked.
“After I’ve taken some
Emma went to the trolley to find the notes for the first patient, a Mr Edwards, in bed 6. Glancing through the outpatient letters, he seemed straightforward: gallstones for about a year and he’d come in for a cholecystectomy. She went over to his bed.
“Good afternoon, Mr Edwards.” she said without really looking at him. “I’m Dr Jones, the house officer, and I need to ask you some questions and examine you before your operation tomorrow.”
“Are you really a doctor, miss?” he said. “You don’t look any older than my daughter and she’s still at school.”
Emma felt herself bristling but didn’t rise to the bait. “Well, to be honest with you, Mr Edwards, I’m as new to this hospital as you are, as I’ve just started today,” she said with a smile.
“Out of the frying pan into the fire, is it then?” he said.
“Well, it’s a bit like that until we find our feet. I see in your notes that some tummy pain was the first thing you noticed. Can you tell me about that?”
“Well, it was just after having an Indian meal for my birthday last year. I probably ate too much and also had too much beer, but I got a digging pain here – he pointed to just under his ribs on the right – and it wouldn’t go away. I thought it must be indigestion. Anyhow, it went a bit but then kept on coming back. I like my fry-ups and they really made it bad. So I thought I should see my GP – that was about two months after it started - and she got me seen by the professor. And that’s the whole story really, doctor.”
“And I see that Professor Cuthbertson then arranged for you to have an ultrasound scan, which showed that you’ve got stones in your gall bladder,” she said, glancing through the investigations section of his notes. “What’s been happening since then? Has the pain been getting worse? Have you had any other symptoms?”
“Well, if the truth be told, I’ve been drinking more to cope with the pain. I know I shouldn’t, but you know what it’s like. It’s only beer, mind you. I never touch spirits.”
“When did you last drink any alcohol?” asked Emma.
Mr Edwards seemed embarrassed and he looked down at his feet. “Well, to be honest, doctor, I had a few pints first thing just to get going, you know.”
Emma leant closer to her patient. The smell of alcohol on his breath was very obvious. “Mr Edwards, I’ll need to examine you, but I’ll also need to take some blood for tests and we’ll need to check your liver.” She pulled the curtain around his bed.
She reached for the sphygmomanometer attached to the wall above his bed. “Let’s check your blood pressure first.” She inflated the cuff and applied the diaphragm of the stethoscope over the brachial artery. She listened as the cuff deflated and heard the sound of the systolic which then faded away when she reached the diastolic. His blood pressure was elevated at 160 over 110.
“Now could you lean forwards and take some deep breaths.” She listened intently and heard a few wheezes but put that down to him being a smoker.
“Very good, let’s examine your tummy.” Mr Edwards was very obese. He winced a bit when she palpated below his ribs and she thought she could feel the liver edge. Not a good sign, she thought. She finished the rest of the examination, thanked him and went off to get a tray to take his bloods.
Emma mulled over what she’d found so far. He was a classic case of gallstones but his high blood pressure was a concern and the alcohol even more so. He certainly needed liver function tests and might need to be on an alcohol detox. He might even have memory problems. So hardly that straightforward and she wondered what the Professor would say.
She returned to Mr Edwards’s bedside with the bloods tray. “Is it alright if I go out for a cigarette, doctor?” he asked.
“After I’ve taken some
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