Week 2

Again the constant theme of challenge continues with the wealth of information and experiences never ending.

Week 2 Began with a day at the community, involving long walks through Nwelezane and Niwe and running away from sly dogs.Here we began with our first patient, a male estimated to being between the ages of 96-99 who had forgotten his name due to being reffered to as mkhulu or approximately half a century. This case again not only showed us how important relationships are within the community in terms of a way to keep track of people and collect case history data if the family is not present but also not to overly pathologise people. Upon arrival we were already forming hypotheses and collating symptoms to best provide assessment and treatment. However the symptoms we had observed such as signs of confusion, hearing difficulties  and not being orientated to self weren’t associated to the CVA that occured years earlier but due to the clients advancing age.

A contrast to this case being Mr X, A hospital inpatient that revealed to me how attention to detail and observation can make huge difference in the patients prognosis and the rehabilitation process. Mr X had 2 CVA’s with infarcts on each side of the brain resulting in paresis on both sides, which is more severe on left. Mr X had been making steady progress but rapidly deteriorated from Monday afternoon to Tuesday morning. The rapid change confused not only me but all medical staff as there wern’t any signs of a regression caused by a medical event. The answer we had been looking for was in the P/O intake chart-Mr X was recommended to be on a soft diet but had been given a full ward diet in the incorrect feeding position for 3 days, requiring a suction before any further reassessment or treatment. Mr X was then seen the next day and presented as well as he initially was before Monday.This taught me and the members of the MDT the importance of not only noting each others recommndations but trusting and following through with them. This further showed me the importance of being critical in investigating( weighing options and choosing the most realistic causes) but to also look at the details and stick to decisions based on my clinical judgement without being highly influenced by team members at the expense of my patients. This event proved to be the day that I realised that to be an effective and good clinician, I have to trust and fully stand by my decisions.