A week in my ... geriatric ward: ‘I know every aspect of the patients’

Challenging but rewarding

I initially worked as a dentist and, when I went back to UCC to study medicine, I supplemented my fees by doing dental work at weekends. Dentistry is quite isolated and, because you’re generally in private practice, it’s really a business. I prefer hospital-based work, so I became drawn to medicine. My uncle was a GP, and I have cousins in medicine. I used to help out in my uncle’s surgery in the summer, so that’s probably where the seed was sown.

I specialise in geriatrics at Cork University Hospital. That could have to do with the fact that in my family when I was younger, my elderly grandparents lived with us [in Camp, Co Kerry].

There’s a lot of acute medicine in geriatrics. As a population, geriatric patients get sick a lot, so it’s challenging but very rewarding. There is a daily ward round, which I do every morning with a medical consultant. The team consultant, registrar, senior house officer and intern see all the patients under our care.

We check their progress, check blood tests, order scans or X-rays, start or stop medications as appropriate, and engage with other specialities such as physiotherapy, occupational therapy and speech and language therapy, if required. In the care of the elderly, we often have to look at issues such as rehabilitation services for stroke patients, convalescence homes or long-term facilities if patients can no longer return home once medically well.

Given the nature of geriatrics, some people are in for quite a long time, so it’s not hard to remember their names. I could be dealing with up to 30 patients. Part of my responsibility is knowing every aspect of them. I also talk to their families. If the patients are going home, you could be looking at home help for them. Crisis talks with families happen more in geriatrics than in a lot of other specialities, purely because of the demographics. There are a lot of people doing great jobs at home, looking after an elderly parent or spouse. But sometimes it can get too much for the carer. That’s a crisis situation.

I carry two bleeps that I can be contacted on. One is a general inquiry bleep that any hospital staff member can contact me on, regarding queries. The second bleep is a stroke bleep, whereby any patient aged over 65 who comes into hospital during the day with a suspected stroke activates a “code stroke” call when initially assessed.

I go and review the patient straight away, examine and assess the degree of stroke, order a Cat scan of their brain and decided what treatment is appropriate.

Being on call is challenging

I am on weekday on-call duty once every seven to 10 days, and weekend call happens once every three to four weeks. Being on call on a weekday starts at 5pm after you’ve done your nine-to-five day. It goes on until 9am the next day, so you do 24 hours. Thankfully, things have improved from the days when you’d work nine to five, then be on call overnight and work through the following day. That was still happening a couple of years ago. But in the past year, I’ve been going home at 9am after being on call and I go straight to bed.

Being on call is challenging. It depends on the night. Illness focuses the mind. While you’re working, you’re functioning at quite a high level. Certainly, there are times when you’re tired. When you’re on call at weekends, you work from 10am on Saturday to 10am on Sunday. There is no defined time to sit down and eat, but we try to eat early in the evening. If things are quiet while I’m on call, I do things like finishing writing notes. But, even if a patient isn’t unwell, you have to go and check on them a couple of times during the night.

Stroke medicine has got better

Given the nature of working with older patients, there can be some deaths, but not every week. Stroke medicine is a big part of what I do. Unfortunately, some people have large strokes and they tend to be the subset of people who probably die most often. A large stroke is devastating, as it’s a brain injury.

Thankfully, stroke medicine has got a lot better and there are now much better survival rates.

My favourite day is Friday. We have an X-ray conference in the morning. We go over all our stroke patients and meet the neurologists.

We go through every stroke case that happened in the preceding week. We look at how each case was handled and what happened to the patient and see what their likely outcome will be. It’s a great learning tool because you’re learning from consultants who have a lot of expertise.

We have a departmental meeting in the afternoon for the geriatric group. Junior doctors get to present topics of interest to them. That’s the time you get to hear about articles in journals that are relevant. It’s great to be able to do that. When you’re busy all the time during the week, it’s nice to have learning time on Friday.

I was at the annual conference of the Irish Gerontology Society recently; this supports doctors who work in geriatrics. This year, it was in Galway on a Friday and a Saturday. It’s a chance for geriatricians to present research, which is always [ongoing in areas such as] stroke, dementia, heart problems and social issues. There are keynote addresses from consultants in different areas of geriatrics.

For me, it’s a chance to meet consultants and geriatric doctors. You talk to them about their research and about what their hospitals are like because, potentially, you might work with them in the future. You’re expected to keep up with research. Stroke is what I’m looking at, seeing if patients in short stays at acute medical units fare better than being in a general ward.

I am happy with my training

For me, the ultimate achievement is to be a consultant in Ireland, I hope. I know there are people leaving. Some aren’t happy. I am happy with my training. There were about 120 in my year who graduated in 2008. Just under half were North American, Asian and from the Middle East. They all tend to go home after graduation.

Of the Irish group who emigrated, the majority went to Australia or the US after our first intern training year.

Many went for one or two years’ travelling and to get experience. There are between 20 and 30 who have remained abroad and are now on training schemes abroad.

They can have a nicer work-life balance in the countries they’re in.

Out of hours

I try to get to the cinema once a week. I usually go to see blockbusters. The last film I saw was Lucy, starring Scarlett Johansson. I try to go to the gym as well but I don't do it as often as I should.

Sometimes, around October, we have team dinners. Rotations come to an end and some doctors move on. We like to get together in a restaurant just to say thanks for working with us. But not everyone can come because they might be on call.