“No not Dr Mick…DR NICK…NO Betty!…I said DR NICK!”

Evening all,

Well talk about a change of pace!

This week I bid farewell to my job in intensive care medicine and said hello to my new job on the care of the elderly ward…average age 93 years…with a list of medical problems equally as long.

Now if intensive care was the Ferrari of medicine – exciting, sexy, shiney….Care of the elderly is a bit like that really comfy arm-chair you have – enjoyable, bit of an funny smell, pleasing for a while but you worry you might become part of it.

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It was, I must say a shock and I have a feeling that this may take a while to get used to. However, I have to say that after only three days on the care of the elderly ward, where I have the pleasure (and I do really mean that!) of looking after 17 lovely old ladies who have suffered a stroke…or two…well in one case…7 (She IS a fighter!)!

So as I sit back with a whisky (no, I have not suddenly metamorphasised into a 80 year old man…I am a genuine lover of the drink, as my regular readership of 3 – my mum included, will testify) and think about this week’s ‘changing of the guard’ if you like, I have come to see some very clear differences, that may in some cases, take a while to get accustomed to:

1. I have to shout a lot louder at my patients…or, at times, just put in their hearing aids
2. I have to talk about Frank Sinatra if I want to win their trust (I even let out a verse of ‘My Way’ today..)
3. Sleep is a patient’s favourite hobby.
4. Eating is their second favourite hobby
5. A clinical assessment requires deviations into stories about the war (which are fascinating, and humbling all at once)
6. A hot topic seems to be if I a) have a girlfriend b) am married and in one rather odd scenario c) “am one of those new age boys that likes other boys”…I clarified I was not the latter and that I was indeed unattached because, of course, I was “dedicated to looking after my patients” [reality: can’t seem to trap the right girl!].
7. The number of medical problems has jumped from 1 on ITU i.e. massive heart attack or over-dose, to 20 on care of the elderly i.e. ischaemic heart disease, hyptension, previous cancer, arthritis, depression and pulmonary fibrosis…on top of the stroke.
8. You have to repeat yourself A LOT…

Now in case you are reading this and thinking what a disrespectful young man! etc etc…let me re-assure you that this is all said tongue in cheek as I infact am absolutely have a ball with these old girls! They are such fun and so unbelievably sweet in the face of such challenges. Afterall what lays ahead for them and their families are the realities of getting to grips with the irreversible changes that the stroke has brought to their lives so suddenly – in a literal blink of an eye. It is a pleasure to be looking after and helping them.

Look at me, going all soft.

Ok, so we should probably digress to a little bit of science and medicine ever so quickly and talk about what a stroke actually is. A stroke in laymans terms (I by the way, operate in laymans terms) is the equivalent of a heart attack in the brain – ‘brain attack’ if you like. Its medical definition is an irreversible deficit in central nervous system brain function beyond 24 hours as a result of a vascular event. This vascular event may be in the form of a blockage of a brain blood vessel i.e. a thrombus (from a ruptured cholesterol plaque in a brain blood vessel for example) or a embolus (a blood clot from another source such as the heart in patients with atrial fibrillation which encourages blood clots to form, and which is ‘thrown off’ circulating around the body to end up blocking an brain blood vessel). A vascular event may also be, in 10-15% of cases, the cause – this is in the form of a brain bleed (a ‘haemorrhage’) such as in trauma or a aneurysm. Whether it is a thrombo-embolic event or a haemorrhagic event both lead to a lack of blood flow to parts of the brain causing a paucity of oxygen (i.e. ischaemia) as the brain is starved of oxygen and eventually causing an infarction – brain tissue death.

Where this happens in the brain will dictate what functional deficit will occur for my 17 lovely ladies. If the stroke for example happens in the LEFT side of the brain’s blood supply then the ability to move the RIGHT side of the body may be affected – and visa versa. This is because the brain controls the opposite side of the body that it is on. Weird set up I agree.

Stroke is a huge subject and I would like to come back to tell you more about it over the next few months – I am sure I will. For now, let’s not worry too much about the details and focus on what a fun few months I have ahead.

Right, it’s friday night…maybe I’ll put on some Frank Sinatra as I sit here drinking my whisky over the London skyline.

Have a great weekend.

Dr Nick

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