Fourth Year - Rotation 3 - Neuro Initial Entry

After my musculoskeletal placement, I thought I had faced my scariest prac for this year. Fortunately, my last placement felt so comfortable working in the outpatient department that over this past week I have started to become slightly anxious about starting my neurosurg prac on Monday.

This anxiety is not so much about not knowing how to act in a hospital setting but it is stemmed by actually working with patients who are in such an acute stage of rehabilitation and that every action I take may be critical to their overall recovery. I expect the patients will have many co-morbidities which will need to be addressed or made aware of prior to treatment. They will possibly be unable to communicate or participate in treatment 100% secondary to their injury or post surgery anaesthetic which means the timing of treatments will be important and also finding other ways to communicate with the patient. This probably involves a lot of work within the multidisciplinary team, like the speech therapist, to determine the best way to communicate. The patients will most likely be surrounded by family members who are very concerned about the patients condition and may not like the treatment be are putting the patient through so communicating with the family and having a family orientated approach will be important. I am also expecting there to be many different protocols regarding the management of the patient I will need to know depending on the surgeon and type of surgery undergone.
Another aspect I am concerned about is the neurological examination. There is just so much to know and it can be quite complex! I think that working on perfecting my speed and technique of testing the cranial nerves, muscle strength, tone, motor control, vestibular function and analysing movements for patients with their various disabilities will be important and hopefully I come out of this prac feeling as though this aspect of my assessment has improved greatly!

I have been told that I will be seeing a wide variety of patients including patients with acute/traumatic brain injuries, cerebral haemorrhaging, cerebral tumours, spinal cord/nerve root compressions and hydrocephalus who have received shunts. I have not worked with this group of patients before and I’m worried if I will be confronted by how young the patients are and if this will affect my ability to treat them. I am also expected to make a 10 minute presentation during these 5 weeks so learning from last time I’d better get on top of that early!

I am no stranger to working within a tertiary hospital, but this one will be the largest hospital I will be attending so far. I think this will mean that I probably won’t get to know the staff as well as I have done in previous placements but hopefully they will be just as approachable and helpful as other hospital staff have been – especially in the first few weeks where I’ll more than likely get lost!

I will be receiving help from a tutor during this placement, which I think will be very helpful. I really enjoyed and appreciated the help I got from my last tutor last year at Joondalup hospital so I know that this one will be very beneficial for neuro.

This placement should be very interesting and it will give me the opportunity to experience life in a big tertiary hospital. Fingers crossed it all goes well!