Emergency medicine, Queanbeyan, NSW | Pallative care, Clare Holland House, ACT

For my elective placement, I chose to stay closer to home, and undertook two 2 week placements within the Canberra region and surrounds.

First, at the Queanbeyan Emergency Department, and second, at Clare Holland House, both of which provided enriching yet disparate clinical experiences.

Queanbeyan ED

At the Queanbeyan ED I was mentored by a team of approximately 10 doctors, from registrar to consultant level, as well as by the nursing staff. I was provided with opportunities to see patients independently, taking histories and doing examinations, and then discussing my findings with my supervising doctor and formulating a management plan together.

I also had the opportunity to practice clinical skills such as fluid charting, suturing, venepuncture, cannulation, and catheterisation, and to observe some more complicated cases and procedures.

One interesting moment was when I was asked to pull a pencil out of a young boy’s foot (while he was under sedation)! He had been running to the school bus, when he stepped on a pencil that was sticking out of the ground, and went through his school shoes.

I felt that I was able to engage in patient care in a meaningful way, in light of the clinical experiences and learning I had gained throughout the third year medical program, and further honing these skills. It was wonderful to feel part of the team, with each staff member more than willing to give guidance, advice and teaching.

Clare Holland House

I was unsure as to what to expect from my placement at Clare Holland House, having had limited clinical exposure and limited previous knowledge of palliative care. The placement was very interesting, and all staff were approachable and willing to include me in different aspects of their work.

Daily I would accompany the registrar and resident on rounds, seeing each person within the inpatient facility, observing as they discussed symptom management, medication changes, and any other emotional or spiritual needs of the patient or their families.

Opportunity also arose for me to attend multi-disciplinary meetings, where each patient’s case was discussed with medical, social work, pastoral care, nursing, and physio input. Following this was a bereavement meeting, where staff discussed any ongoing support family members may require following the passing of their loved one.

Additional clinical experiences included sitting in on outpatient clinics, including the motor neurone disease clinic held at the new rehabilitation hospital monthly, family meetings, and accompanying consultants on home visits for both clinical and research purposes.

Key learning that I hope to incorporate into my future practice include a deeper understanding of a palliative approach to care. I recognise that it is not only relevant for those with cancer diagnoses, but all terminal diagnoses (including dementia, renal failure, liver failure, MND).

This approach incorporates both comfort care and active care, to varying degrees based on the diagnosis and care goals of the patient, with importance placed on symptom management, and emotional, spiritual and psychological support for both patients and their families.

Overall my placements provided me with fantastic learning experience. I felt welcomed, supported and challenged.

It was a great opportunity to further my medical education, and to see the application of both emergency medicine and palliative care. I appreciate having been exposed to difficult conversations regarding death and dying, and goals and ceiling of care.

The generosity of patients, and their families, who allowed me to share in a part of their health journey continues to humble me.