It is the middle of the week, and things are in full swing on the ward. I am currently working as an SHO doctor on a general medicine ward in a hospital in Surrey. We see a variety of patients from psychiatry and neurology, to cardiology and gastroenterology. Now we are also seeing COVID positive patients. I have been here for four months and absolutely love it! I get along really well with my colleagues, including doctors, nurses, healthcare assistants, pharmacists and the therapists. We are literally like a big family on our ward, but unfortunately my time here is coming to an end in a few days, as permanent doctors will be starting on the ward.
Today we had a new admission. A 62-year-old lady was admitted feeling increasingly lethargic with some unintentional weight loss in the past few weeks. Her blood tests revealed a high calcium (this is usually suspicious for malignancy) and raised CRP. She was booked for an urgent CT chest, abdomen and pelvis. The CT confirmed the presence of a uterine mass with metastatic changes in her lungs and adrenal glands. I informed the patient that the scan was suggestive of cancer - most likely endometrial. Unfortunately, due to visiting restrictions on the ward, she was alone whilst receiving this information, but I updated her husband and daughter via telephone. It was difficult to give them this news over the phone knowing that they could not see her. She was referred to the gynaecology team and they added her to the Gynae MDT list for discussion.
This week my patients have remained the same. There are a lot of medically fit patients awaiting placement in a nursing or care home, or their package of care. I am also looking after a 27-year-old lady in her who was unfortunately recently diagnosed with metastatic melanoma of her right thigh. She came in with a headache and persistent vomiting four days after completing her fourth cycle of immunotherapy. She was prescribed antiemetics and rehydrated with IV fluids. However, despite this she continued to feel nauseous and her electrolytes became increasingly deranged. I discussed her with her oncology team at another hospital and they suggested requesting an MRI brain.
The MRI revealed an immunotherapy induced hypophysitis. This is a disorder of the pituitary gland where the immune cells infiltrate the pituitary gland, in her case it is caused by her immunotherapy treatment. This produces a mass effect, which can lead to hormonal dysfunction, impingement of the optic chiasm leading to visual problems. The inflammatory process devastates the pituitary gland leading to adrenal insufficiency, hypothyroidism, hypogonadism, and diabetes insipidus. This explained a lot of her symptoms. She was discussed with Endocrinology. She was started on a high dose of steroids, quickly improved and was well enough to be discharged to be followed up with endocrinology and her oncology team.
Today is bittersweet. I am so happy to have the weekend off, but on the other hand it is my last day here. My colleagues arranged for pizza to be ordered in and I brought in some cakes and snacks, so we had a mini leaving party in the staff room. I said my goodbyes, but of course it would not be a Friday without something to throw a spanner in the works at 4:30pm. Apart from the last-minute discharges to prepare for the weekend, this Friday was pretty smooth sailing, and I was able to leave on time by 5pm. Thank God it’s Friday!
Thanks to COVID my plans for the weekend include sleep, catching up on some episodes of Sister Sister on Netflix and live streaming church s