The doctor will see you now…

Welcome back! 

This week I wanted to talk about the work we do in the clinic. I think it would be safe to say that when I started working in the clinic it didn’t turn out quite how I expected. What I mean by that, is the patient’s reason for coming to the clinic is, usually quite sad.Often the patients that come to us will come in once every couple of weeks or once a month so we get to actually build a really good rapport with them which is something completely different to working on theward. From this it often means that patient’s will stick in your head for a little bit longer and you find yourself wondering how they are months later. This week we had a patient coming in who we have seen regularly for quite some time. She needed to be drained, but it was quite clear that she had lost further weight and was just generally not feeling as great as she had been the last time we saw her. This patient has been coming regularly for a couple of years I think, before I even started in the clinic, she would be drained every three weeks and leave the clinic feeling so much better and can carry on with life. She had asked the doctor if she could be seen and it only been 10 days, which is unusual for her, when we performed the ultrasound we found that actually she already needed a drain again. Since the last visit, she also had noticed a lump had formed under the site of the last drain. Naturally, the patient was quite concerned by this lump and wanted it checked out before her next appointment in a couple of weeks. When our consultant reviewed her and looked at the lump she felt that actually her mesothelioma had grown into the Pleural space, this is something I’ve never seen before. According to the doctor, this used to happen quite frequently where people would have regular drainage in the same spot on the same side and then the tumour would just grow into the space that we had left essentially. The decrease in this, she felt, was due to the drains we use now being much smaller in size. The treatment for this is actually targeted radiotherapy at the site of where the cancer has grown into that space. The patient was naturally very upset and felt that this changed things, however although this would add a treatment to her plan it didn’t actually change the progression or staging of the diagnosis. I think what was quite clear was that the patient was definitely reassured by the fact that she knew the team and could trust the team. She had known the doctor for quite some years and had pretty much always seen her for  treatment of her pleural effusion. I think hearing from her that this was definitely treatable was the reassurance she needed. 

One of my favourite parts of the clinic is being able to offer that comfort and a kind smile when everything else feels pretty bleak. I hope the patient’s feel the same way. From the feedback we have had from the lung cancer specialist nurses we’ve made quite a big impact on their patients specifically because they have somewhere to turn to about the Pleural effusion and it has prevented delays in being seen as we control the appointment list alongside the doctors. 

Day to day in the clinic can vary from just reviewing a patient to performing several procedures back to back. This means that sometimes the clinic is quite quiet. We have an hour per patient and actually sometimes we really only need 10 minutes and sometimes we go way over that hour. For example this week we had a patient who appointment was at 10 o’clock and she didn’t leave till 1 o’clock. From what I’ve heard from other clinics in the hospital we are probably one of the more flexible with timings because everyone reacts completely differently to having a drain put in. Some people barely feel it and some are in agony afterwards, it really varies. From what I’ve seen in the last six months, as surprising as this may be, the older population tend to be the ones that can’t really feel it happening and just sit there as if they’re asleep, the younger population tend to be the ones that faint. 

When I first started nursing, I don’t think I ever could’ve guessed that less than three years later I’d be splitting my time between working in an outpatient clinic and working on the ward. The idea of a clinic when I first qualified didn’t interest me at all. For some reason I assumed that working in the clinic or in outpatient’s would be very much just taking observations and bloods. What I guess I didn’t anticipate was the potential of what could come from that. This week we’ve been told we can go on an ultrasound course, safe to say I’m very excited about this. The Pleural service has only increased in the last five years and even in the short time that I’ve been working there, our workload has increased dramatically. Having the three pleural  nurses being able to ultrasound will enable the referrals for impatient to potentially be seen quicker and of course, we get to develop our knowledge even further. 

See you next week and don’t forget to breathe...