Outpatients

As a student, I had been to outpatient clinics a lot. “I’ve got outpatients today” or “Sorry, got stuck with a long list at outpatients” were common messages sent between myself and my peers. Outpatient clinics, or OPC, were a great chance for us medical students to see the long term care and follow up side of medicine. Sometimes we even had the opportunity to take some responsibility and take a history and examination of half of the list for the consultant, then present the patient to them to both save time (or take up time, depending on how good/bad you were) and have a taste of what being qualified would be like. I was pretty excited when the letter came through for my first outpatients appointment, as this hopefully meant that some further plans for my treatment would be made and I could feel like I had a goal again instead of aimlessly floating through recovery. My OPC was on the 1st of July. A week previously, I had come in for a 2 week post-op MRI scan to see how Ralph was behaving after being given a good dose of superglue. As I knew from experience on the other side, outpatient appointments often had a specific goal from the medical side (i.e. discussing results, following up on treatment, seeing how the patient is coping etc.) and some non-specific goals from the patient side (i.e. what’s going on, what’s going to happen, why does this happen, or even just… I’m feeling great). In the run up to my OPC I found myself theorizing the points of discussion that my consultant would have:

  • How are you feeling
  • Here are the results from the scan
  • Next plan of action

I, on the other hand, had a lot more points to discuss:

  • How I was feeling
  • What were the results from the scan?
  • What’s the next plan of action
  • Can I write a case report on myself
  • What should I do about my degree(s)
  • When can I start doing exercise/studying/working
  • Could I get a hospital note to give to uni

Since March I had been faced with a dilemma. During the academic year of 2013/14 I was doing an intercalated BSc in (ironically) neuroscience, which meant I had taken a year off from my medical degree to do another degree. Ralph ruptured the day after my final day of timetabled sessions (22nd March), which meant all I had left to do of my degree was finish my dissertation (due for mid-April) and write my exams (in May). Obviously, as one would expect, having a brain haemorrhage left me a bit worse for wear in terms of academia so my exams and dissertation were postponed until the August period. I was now completely torn. Should I take my exams in August (which would mean I would have to start revising as soon as I got back from the clinic), therefore finishing my BSc in August so I could go back to medicine in September? Going back in September would mean starting the penultimate year of my medical degree, which was notorious for being one of the most intense years mentally and physically. Should I drop the BSc altogether and just go back to medicine in September? Or should I postpone my exams again until May 2015, thus deferring a year and going back to medicine in September 2015? This was a great source of upset and mental anguish for me. I desperately wanted to go back to med in September, to be reunited with my peers and go back to what I felt I was stronger at. My brain was so exhausted from even just simple daily activities that even the thought of going through the process of revision, exam prep and writing the exams put me on the verge of tears. Dropping my BSc was very, very tempting. But then again at the same time it felt like a waste to have gone through all the hours of lectures and lab work, the thousands of words that was put into coursework, presentations, journal clubs and posters and for nothing to come out of it other than an unusually detailed knowledge of vesicles. Fellow iBSc Neuro people that did Cells & Systems, you’ll understand that last sentence far too well.

Due to my extreme lack of short term memory, and just because I wanted the company, I asked my boyfriend to accompany me – it would also be useful to have somebody else’s perspective (i.e. a non-medic) of how the clinic went. The day came and we eagerly got to the clinic early, then ended up having to wait about 45 minutes anyway. Not that this was unexpected to me; going through the OPC process on the medical side showed me that patients and doctors almost always overran their time slot. When I was eventually called, we were both surprised to see it was not my consultant that had called me but instead his registrar. We very quickly ticked off the first three points – I was feeling better, almost feeling “pre-morbidly” normal (“pre-morbid” is the term used to refer to the patient’s state before the health incident happened). The results from the scan were “very good” and there was a “definite change” despite the post-op MRI scan being only 2 weeks post-op. And the next plan for me was to have a follow up MRI/angiogram in September, then a possible further embolisation based on what the follow up imaging showed.

So overall, the answers to the main points seems pretty positive. Unfortunately I had less positive feedback on the other points. It was decided that there was no point in me writing a case report on myself as there would be no “learning point” in my case as, even though my condition is unusual, it apparently wasn’t rare enough to be worth writing about. I was also advised not to work or study until at least after the results from my follow up scans in September. Which, unfortunately, meant that all of my mental anguish about to BSc or not to BSc was dealt with in one fell swoop. Under doctor’s orders, I had to fill out all the relevant paperwork and admin to request to take a year out, and take my BSc exams in May 2015. I will admit: I did cry quite a bit over having to do this. Even though logically I knew it would be the best thing for my health to take a year out, this did mean that I wouldn’t be able to graduate with my cohort that I had started university with and I would have to get to know a completely new year group. I suppose in the grand scheme of things this isn’t too important, but I now had 2 months ahead of me whilst I was waiting for my MRI where I wasn’t supposed to study, work, exercise or generally do much to keep my thoughts distracted from how much I was going to miss being with my cohort. It sucked. It still does.

As I am writing these blog posts on a delay of a few months, I have been given the wisdom of hindsight. And in hindsight, whilst I am still very sad at not being able to rejoin my year group, and I have had other repercussions involved with taking a year out, it was definitely the best decision. Only now at the beginning of October, 6 and a half months on from my stroke, am I beginning to truly feel like I’m starting to return to my pre-morbid state. Every time I think I am going back to “normal”, another month passes and I realise I wasn’t. I’m sure that this time next month I’ll look back at how energy-less I was now. Take home message from this blog post: Sometimes your doctors will make decisions for you that you won’t be happy with at first. It might take a few weeks, or even months in my case, for you to accept that decision or understand why it was made, but often it really is for the best, even if you just can’t see it yet.

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