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I got to ward rounds about one minute late, but nobody seemed to notice me anyway. Until Dr R was like, "how are you?" and I turned around thinking he was addressing someone behind me, and there was nobody there :P

Instead of tailing the resident around though, I followed one of the consultants up to the gen med ward. Oxford is different to Sydney in that many people with simple heart conditions are managed entirely by the general medicine team, don't have much contact with actual cardiologists, and never get moved to the cardiology ward. So I saw 4 patients with heart failure with Dr D, who quizzed me throughout the morning. Luckily I was able to answer his questions about Barret's, Multiple Myeloma and Thyroid diseases because they show up in 5th year case protocols!

I then made a mug of instant ramen. Shortly after coming out of the staffroom though, the emergency alarm went off. It turned out one of the patients (a 50-year-old lady with dilated cardiomyopathy who'd just had an ICD inserted) on the cardiology ward collapsed, having gone into VT. A minute later I heard her talking though, so I assumed she recovered. But then she went into VT for a second time, and lost consciousness.

In years 4 and 5, whenever there was an emergency, all the students would be told to get the hell out of the way. I was about to do the same here, before one of the junior doctors asked if I knew how to give CPR. When I replied in the affirmative, he told me to get a pair of gloves on and get into the room ready to take over from someone doing chest compressions. I did a couple of times, though I fear I wasn't terribly useful because I'm a bit of a weakling and I tire quickly. Actually, once more fit young male doctors came along, my job was to hold the arms of the patient because in her semi-conscious state she kept flinging them around, dislodging her cannulas. The patient's pulse came and went, she flipped between sinus/VT/VF, they had to put a magnet over her ICD because it kept randomly going off, many shocks were given, PE/rupture/etc were all ruled out eg by echo, a heck of a lot of adrenaline got infused, they had to suction the intubation tube because it filled up with sinister red fluid, and the team even tried some amiodarone. The resuscitation efforts continued for about one and a half hours but unfortunately, with the patient becoming less responsive and the pH dropping severely and the lactate rising, and since the patient had requested to not end up in the ICU, they decided to stop. 

My paternal grandfather passed away when I was 11, my great-grandfather when I was 12, my maternal grandfather when I was 16, and my great-grandmother when I was 21, so this wasn't the first time I'd seen someone who'd recently passed away. But I don't think any of that fully prepared me for how sad and scary it is when someone slips away rapidly before your eyes. Like as I saw the patient's extremities turning blue, watched as successive blood gas readings came back more and more acidotic, felt her grip weaken in response to "squeeze my hands if you can hear me", and then got asked to help clean up some of the blood before the patient's husband came in, I still didn't quite believe what was happening. I just kept imagining she was going to get her pulse back properly, and then slowly but surely wake up. And also, when we were leaving the room, I couldn't help but think how horrible her final moments must have been...she was evidently aware that she had a tube down her throat and a needle in her neck and two more in her arms, plus we were squashing her sternum, and taking arterial blood samples from the femoral artery (that's basically in the groin, folks). One of her cannulas failed so a new one had to be put in, and she tried to fend off the needle. And even when we weren't checking her response, I noticed she sometimes just held my hand anyway. 

But yeah. Just nothing completely prepares you. I sort of sleep-walked out of the ward and to the registrars' room to message someone online, because I remember just desperately wanting a hug but being too scared to ask any of the doctors. So I got a virtual hug from Mr Ravenclaw. Then I decided to call it a day and calm my nerves with some piano and fudge. It was kind of good timing, as I realised I could properly bid farewell to the Steinway that has served me so well during my term at Oxford. Whenever I've felt like a wreck, I've usually gone to the piano and just played all the bad feelings away. I did a post office run to send off some goodies to Northern Ireland (only 2.70 pounds including packaging for a small parcel going across a body of water!? And the lady felt apologetic that I couldn't quite fit it into a "large letter" and had to pay more. I'm pretty sure I've paid more than $5 to send a hat from one Sydney suburb to another). 

The weather was dismal. Seriously, not only was it bucketing down, the wind was howling away so that even if you had both an umbrella and a raincoat, you still got wet. And since nobody was keen on joining me for an Atomic Burger (apparently there's a burger place that's decorated to look like a cartoon), so I just went back to my flat, did a quick ab workout, showered, and then ate up the last of my udon. I just need to figure out what on earth I'm going to do with my rice, because I have a large packet and nothing to cook it with. I think I may just end up eating it plain one morning. 

I was going to write an entry the other day about how the snow had all melted, and just like the winter wonderland, and my English adventures (along with all my petty woes), nothing can last forever. But I can't think of a clearer example than today of how fragile life is. And it is so humbling when you think that even though it was my first time, for everyone else in that room it was just part of their daily job. They have the courage to deal with such trials as these many times a month. I have been reminded once again that even though I'm near the end of my med school journey, I'm barely at the beginning of becoming a doctor. 
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