Reflection: Neurosurgery: Thoughts from a student
This placement was an extremely demanding one. it covered a wide variety of patients ranging from head injury patient, spinal cord to basic post operative backs. What surprised me is the range of presentations within each division, particularly head injury patients. For example one patient may only have mild dysarrthria however another may have complet neglect on one side of the body and have poor prognosis of mobilising independently. Although predicting a patients potential level of achievement is very difficult because the patient can change i feel I have developed my knowledge of this baseline. I now need to focus on progressing these treatments to challenge the patient and achieve their full potential. This placement will allow you to see patients from the initial stages of rehabilitation through until discharge (not always within a period of your placement). There is an opportunity to see back surgery and I found this beneficial to gain some understanding of the surgery so that explaination to the patient is accurate and clear.
The complexity of the patients helped to develop my understanding of the ‘bigger picture.’ When considering neuro patients the vision is never black or white and often there will be a number of cognitive issues along with muscle weakness, neglect, balance problems and many more. This is difficult to comprehend at first but this placement will help you develop skills to ‘think outside the box.’
I had the opportunity to lead ITU and HDU ward rounds which, although initially is very scary, is very useful in developing your communications skills with the MDT. Although I was initially nervous the confidence this gives you liasing with the MDT away from ward round is vital for the benefit of patient care. Its fundamental purpose allows you to report on the patient who you may know better (in terms of mobility) than the doctor. Often patients look different on paper than in reality! Someone who should often be up and moving with no pain might not be!
You will gain experience of both neuro and respiratory specialities. Tracheostomies are common due to the nature of the patients so you will learn how to care for these and the weaning process if you are lucky to see one start to finish. You will have the opportunity to treat both ward and ITU based patients with appropriate supervision. Managing your own caseload, prioriting and writing notes are all very important which can be difficult if your patients are not always straight forward, have reduced mobility, and involve rehab tht takes longer than someone who walks themselves to the gym (TIP: you can take the bed to th gym- if not on o2 etc)
Overall you are in for a treat! This was my favourite placement however also my hardest. There is a huge amount of information to take in and the complexity of the patients means that there is a lot to consider. You will be seeing a lot of patients and families where life changing events have occurred and this can be difficult for them. This is something that can be sad and you can always discuss with your educator. Finally the team is very friendly and approachable so don’t be afraid to ask.