A day in the life of a specialist registrar doctor
This diary was written in June 2021.
8:20 Leave home, albeit slightly later than planned, after getting myself and my two children ready for the day. I cycle to work on my new electric bike.
8:40 Arrive at the John Radcliffe Hospital (JR) and head straight to the office shared by the hospital palliative care team. I quickly change into scrubs and find that my colleague, Damian, has freshly brewed the coffee. We are properly fuelled to start our day!
8:50 We have a virtual clinical check-in for all staff working across Sobell House Hospice and Katharine House Hospice, including the three main hospital sites and the community teams. This meeting is chaired by one of the consultants and allows us to check that all sites and services are adequately covered. We then move on to discuss the patients listed for admission to the two hospices.
9:15 As that meeting finishes, we move on to review our list of patients to be seen at the JR. Today, we are busy with more than 20 patients to be discussed and seen, including several new referrals. We prioritise and divide up who we need to see, with a specialist nurse each joining myself and my medical colleague Julia. Our consultant pharmacist, Mel, joins Julia to see a patient requiring complex medication manipulation.
9:45 Jenny – my specialist nurse colleague – and I make a start by liaising with the acute oncology team for an update about our first patient, who we see in the emergency assessment unit. On review, this elderly gentleman is extremely unwell. We contact his medical team to advise on medication changes and ensure that they will update his family. He is too unwell to transfer to the Sobell House ward (as we had hoped) so we update the oncology nurses.
10:30 We next head up the many flights of stairs to the new respiratory unit, to review a gentleman I saw last week. After seeing him, we meet with the ward doctors to advise on changes to his medications to improve symptom control. This patient is now at the end of his life and we check that the team have communicated this with his family.
11:00 We move on to our next patient but are met by one of the ward nurses who recognises Jenny; she tells us that the patient has just died. She has no concerns as he was settled and pain-free.
11:05 We head up more stairs to Level 7, where we see an elderly patient who has recently been diagnosed with leukaemia alongside other medical problems. We spend some time with him; he understands that his condition cannot be treated, and he recognises that he is approaching the end of his life. We advise on medications to improve symptoms, but he is understandably concerned about how his needs would be met at home. We offer him a bed on the Sobell House ward – we describe to him the environment and teams and how it would meet his needs. He agrees to the transfer and understands that he would be moving to Sobell House to die. The ward medical team are in full agreement and will discuss this with his family when they visit. For this patient, who is nearing the end of his life, the hospital ward managers are permitting one or two members of his family to visit every day. I then speak with the admissions doctor for Sobell House, and we add him to the waiting list. We expect a bed to become available in the next 1-2 days.
12:00 Jenny and I start our descent by visiting a lady on the infectious disease ward. She has serious infection but today we are met by the consultant with the news that she has started to respond to treatment, and on review she is much better. At least for now, this patient does not need our input but the team know they can re-refer if she deteriorates.
12:15 We head back to our office and carefully write up our assessments and recommendations on the electronic patient notes system. This is followed by lunch which is curry leftovers from last night’s dinner… perhaps not the best choice on a hot day! We try to stop doing clinical work for 15-20 minutes.
13:30 After lunch, the team regroups to plan a timeline for reviews and assess the referrals that have been made to the team during the morning. We liaise with the medical and surgical teams who have referred patients so we can prioritise who to see this afternoon.
14:00 We head off for another busy clinical afternoon session. It’s a mix of seeing patients who are known to the team and new referrals. It’s nice to meet a patient who I gave telephone advice to on the weekend. He has improved symptom control with an infusion of medications and I’m pleased to hear that he is now feeling much better. His medical team are now able to start planning his discharge home.
16:00 I end the day writing notes and catching up on emails. Just as I turn off my computer, one of the oncology nurses pops in to tell me about a patient on the intensive care unit who may need our input. I ring the intensive care unit’s consultant and we talk through the process of managing medications for transfer to a ward for end of life care. I ask her to phone the consultant on-call for palliative medicine overnight if more help is later needed. I then update the patient’s records and the on-call doctors to this effect.
18:00 It’s back to my bike for the downhill ride home. I get home to two happy girls who have cooled off in the paddling pool, just in time for my husband to leave for a university dinner. I wish I had counted my steps today!
I love working in palliative medicine and our hospital palliative care team is made up of a mix of brilliant nurses, doctors, pharmacists, and our occupational therapist, Bronwyn. The team is well regarded in the hospitals and we can make a real difference to the outcome for patients. We make it possible for patients to feel better, to get home or transfer to our hospices. We also support the teams so that patients may die comfortably in hospital. My children often ask me “have you made your patients better today?” and I say “yes, I have made them feel better”.
The last 18 months have been more difficult and challenging than we could have ever predicted. All the colleagues I have worked with in this time at Sobell House, Katharine House, in our community teams and the hospitals, have continued to show strength, flexibility, professionalism and resilience. I am proud of them and feel grateful to be part of this. I look forward to continuing my medical role as a consultant when I start in September.