Work Experience 101: What I have learned from two years volunteering in a residential home

This is an account of my experiences volunteering every Sunday for two hours (10am till 12pm) from February 2013 to March 2015 at my local residential home, *all surnames have been changed.
I will always remember my first day as a volunteer at my local care home; standing mentally trembling as a timid fourteen year old in the foyer. I had no experience of speaking to anyone older than the age of 60, other than my own grandparents and even that was a challenging task for me. This barrier was soon broken when a sweet petite old lady called ‘Nancy’ approached me, telling me how lovely I was and proceeded to kiss my hand. I think that my initial problem was finding something to talk to the residents, but I quickly overcame this and I ended up gaining an extensive knowledge on local history, childhood, school and parenting in the early 20th century, the music greats of past era’s and memories of World War II. Some of my best times during the years that I was there were around Halloween, Christmas and Easter when the whole home was decorated; I loved to entertain the residents by singing and dancing around the dinner tables- I also played to them a few times on the piano. I began to learn that the only true things that separated us were the dates that we were born and unfortunately, their illnesses.

There were occasions in which I had to comfort patients in times of sadness. I would sometimes watch them break down in front of me over the deaths of family or friends. They would also sometimes feel worthless or depressed and express their wishes to die. Staying professional, I took on a more personal caring role. I became the listener whilst care staff were busy with their duties. I would try my very best to lighten their mood, reminding them of all the things to be happy about, reminding them that their loved one would not wish to see them unhappy and by making them laugh. I dealt with them as I would comfort, or want to be comforted, by my own friends.

In the home, tensions sometimes were high between residents. Some were due to their medical conditions, or the drugs that they were taking, and some were not. For example, I once witnessed one resident bullying another. My first instinct was to alert the carer. I then helped to politely ask them to move apart from each other whilst the carer told ‘the bully’ that this behaviour was not acceptable. Another example, in which dementia played a part, was a woman who refused to eat her cornflakes despite asking for them. The woman was very aggressive towards the carer, shouting and swearing. As another carer was present, I chose to not be involved but I watched how the carer, knowing her condition, continued to act professionally and make the woman a different bowl of cereal. The woman soon relaxed and I can imagine that an incident report was filed. In the future, I know that I would deal with any similar situations in the same manner. It also alerted me further to the difficulties faced when caring for patients with dementia.

Volunteering at the home created my first experiences of dealing with people with forms of dementia and observing people living with long term health conditions. I learnt that patience is a virtue when Mrs Hilda Smith* is telling you how her mother always used to tell her “treat people as you want to be treated”; despite this being a very  useful phrase, it begins to loose meaning after the 10th time she has told you that story that day. I also learnt to never be alarmed as no action is too peculiar when dealing with dementia patients. One of the residents called 'Ken' repeated to use other residents cabinets as a toilet, despite having no recollection of it and never stopping even when the carers had told him several times. Through times of observing memory loss, mood swings and hallucinations- I began to realise the harsh realities of dementia and the effects on not just the individuals, but the family members and the carers. It was then when I began to take an interest in the disease, signing up for the Alzheimer’s Awareness magazine and raising money for the cause.

Dementia was not the only long term condition I witnessed whilst at the home. I also spent a long time with a resident called ‘Kath’ who had chosen to live apart from the other residents- she had recovered from bowel cancer, however; she was still living with some of the effects. She suffered from extreme pain almost every day, she struggled to go to the toilet and it was terribly painful for her to walk. I like to believe that I helped her a lot by visiting her room every week, making her bed, listening to her experiences, making her drinks and making sure that she got her dinner on time.

Whilst at the home, I also had to become more mature in order to deal with the deaths of the residents (something I had not previously experienced). The time that I was told that a resident had died, it upset me a lot. I can still remember shedding tears for them at home, but whilst volunteering I learnt to act professionally by not crying and being respectful and comforting to the residents affected by the death. Because I spent such a long time there, I began to get used to getting to know a resident and then seeing them deteriorate over a long period of time until one week I would arrive to be told that they are no longer with us. Despite these sad times, I feel these sad experiences have helped prepare me for life as a future medical student.

Throughout my volunteering I learnt a lot about what it would be like to work as a Health Care assistant (HCA). They have the responsibility of watching over a ‘unit’ of 6-8 residents, sometimes when no carers are present. Whilst I was there I was often left to fill in a small amount of paperwork,  such as the dinner menu, which involves recording what each resident would like to eat. I had to be aware of various dietary needs, for example; diabetes and food allergies. This was nowhere near the amount of paperwork that the HCA’s had to fill in, detailing every patient’s state every half an hour and I now appreciate the paperwork load that health care professionals face every day. Some of my other duties included feeding some of the patients and assisting them when moving around the room, both of which required an incredible amount of patience and self-awareness, but I enjoyed the feeling of responsibility.

Dignity. The word plastered across posters around the home stating: ‘How have you maintained my dignity?’ This may be a simple question for some, but for me this was the first time when I began to realise the true meaning of the word and from there, I began to put a real emphasis on maintaining it. If a woman’s underwear was on show whilst she was being hoisted, I made sure that it was pulled down. I made sure that residents had the opportunity to wear clothes protectors whilst eating. Making sure, when I was mistakenly left with a resident on the toilet (I was asked to do so by a carer), that I kept the door closed and checked on their progress only discreetly with the door only slightly ajar. Checking dignity became one of my most important rituals for residents left in my care.

All the experiences that I gained, good and bad, developed my skills as not only a person, but it furthered my certainty that I want to be a doctor. I carry the skills that I have learnt with me and I have applied them to further placements...but that’s another story!

The Science of getting drunk

Alcohol is classified as a suppressant drug however that does not fully explains its effects. People think that alcohol helps them cope with difficult situations and emotions, and that it reduces stress or relieves anxiety. But what does it really do to our body?

As alcohols enter  your body and makes their way to your brain, they starts to interact with brain cells and affect the neurotransmitters (brain chemicals that communicate information throughout the brain and body). There are two types of neurotransmitter- either excitatory (increase brain electrical activity), or inhibitory, (decrease brain electrical activity.)

1.       Alcohols can enhance the effects of the inhibitory neurotransmitter GABA in your brain which means your brain cell activities are slowed down and become less excited. And that’s what causes slow reaction, slurred speech and poor coordination and judgement. You will think very little but with great clarity.

2.       The feeling of pleasure when you are taking a drink is created by the increasing amount of the chemical dopamine in the brain's reward centre.

3.       Alcohols can also affect the brain’s memory storage area which known as hippocampus. People tend to forget what they did when they were drinking because in fact the memory at this point was never formed properly.

Hippocampus also controls your emotions. As a result you will find that you feel exaggerated emotions for example really happy:D or very depressed :(.

4.       It causes dehydration in your body as your kidney tries to eliminate them via urination. And this is why you need the toilet more.

5.       At intoxicating levels, alcohol causes blood vessels to relax and widen. At even higher levels, it can shrink the vessels and increase blood pressure, causes condition like migraine headaches.

6.      Your body will shut down when it gets overloaded with too much alcohol to metabolise, so your body is constantly digesting, but not getting any energy from the digestion of the alcohol. This results in passing out.

How is alcohol metabolised?

Once alcohol is in your system, your body makes metabolising it a priority because unlike carbohydrate and fat, there is nowhere for alcohol to be stored. Alcohol does not need to be digested like food therefore it can pass quickly and easily into the bloodstream. In general, 20% of the alcohol is absorbed in the stomach and the rest 80% is absorbed in the small intestine. You are more likely to get drunk with an empty stomach as there is nothing between the stomach wall and the alcohol- this increases the rate of alcohol absorption in your body. After the absorption, it dissolves in water and blood which then being carried throughout the rest of your body via blood circulation.

Factors that affects your alcohol tolerance
Gender- Muscle tissue contains more water than fat tissue. As alcohol get diluted in water, a female will reach a higher blood alcohol concentration than a male of the same weight after same amount of alcohol being ingested.

Genetic- Most individuals use a form of acetaldehyde dehydrogenase called ALD2 to metabolize the acetaldehyde which results from alcohol metabolism.
However some individual would produce another form of acetaldehyde dehydrogenase due to their genetic code. This is far less efficient at breaking down acetaldehyde than ALD2. The accumulation of acetaldehyde causes rosy cheeks, rapid heartbeat, headaches and vomiting.

Drinking history- Tolerance takes time to build. As a person’s drinking increases, the liver’s capacity of metabolising alcohol would also increase which means this person would be able to handle more drinks than you do.

Technology Update: The New "Cool" Life-saving Car

The latest addition to the London City Ambulance service fleet is a Skoda Octavia fitted with the latest in fast response equipment to help those suffering from a cardiac arrest.

Following a cardiac arrest, blood flow to the brain can be compromised and this can result in permanent brain damage - it is predicted that any more than 3 minutes of no blood flow to the brain can result in permanent damage. Statistics show that only 9% of the 60,000 cardiac arrest patients visited by ambulance services each year in the UK survive to be discharged from hospital; due to this alarming statistic, the London air ambulance have decided to kit out their own response car which responds only to collapsed patients who are suspected to be having a cardiac arrest. Unlike other response cars, this vehicle carries an advanced piece of equipment which is a large cooling system. This piece of equipment is currently used in intensive care units of hospitals however it has only just been fitted to a vehicle - the system is used to cool the patient down following a cardiac arrest; the body is cooled to a temperature between 32C-36C, causing therapeutic hypothermia. Inducing this condition has the intention to reduce brain damage - the science between this system is not extensively documented however it is believed that cooling the brain to this temperature causes the brain to have a lower metabolism and therefore it requires less oxygen.

So far, the patients treated by this 'cool car' who have undergone this treatment, followed by medical attention at a specialist heart hospital, have had a 48% survival rate. This statistic is significantly better than the 9% shown from previous years and other ambulance services; so should this be rolled out across the UK?

This question is debatable due to the statistics not being entirely representative as to whether the scheme has had a great effect. It could be argued that as this system is enabling fast response paramedics to deliver a higher level of care at the scene of a cardiac arrest, the outcome of an arrest is likely to be more successful however this has not entirely been proven. The statistics shown above may not show this as the 48% survival rate is only representing one response vehicle's outcome when the patient is taken to a specialist heart hospital - it could be found that it is the specialist heart hospital causing most of the survival rate increase and therefore if this scheme were to be rolled across the UK, the survival rates may not be as high as those shown from this study.

Despite this and the high cost associated with the scheme, any increase in survival rates is surely better for any patients and therefore a worthwhile investment. I believe that this scheme should continue to operate within London and once any 'teething' issues have been highlighted and resolved, the scheme should be rolled out across the UK - provided that there are no major issues with introducing the scheme, I believe that this technology could eventually be rolled out to more services than just the ambulance service. Just looking at how fast the defibrillator has spread across the UK leads me to believe that equipment like this cooling system could soon become technology found alongside a defibrillator in community buildings across the UK for use by any member of the public, not just a trained paramedics.

For more information, see:
Image source = Google Images

Cell transplantation: The Cure to Everything?

After a horrific attack where he was stabbed repeatedly in the back with a knife in 2010, Darek Fidyka was paralysed from the chest downwards. However, after a two year struggle he has since regained the ability to walk with a frame due to a brand new treatment involving cell transplantation.

The most widely used forms of cell transplantation are the use of bone marrow and blood to treat conditions such as leukaemia. Cell transplantations are also used in the treatment of many cancers after intense chemotherapy. However, in the last decade many more uses of stem cells have arisen, and Mr Fidyka is now the first man to undergo a cell transplant for his spine.

There are two different types of transplant - allogenic and autologous. An allogenic cell transplant is where the stem cells used for a transplant come from a donor, usually taken from the blood or bone marrow. The major setback of this is that a close match needs to be found in order for the transplant to effectively work. The patient undergoing the transplant would also have to take immunosuppressant drugs to prevent the immune system from destroying the cells. Allogenic transplants are where the stem cells used are taken from the patient themselves. These can be taken from anywhere in the body that produce the cells required for the transplant, provided that the body is healthy. This was the case with Mr Fidyka.

The cells used in the transplant, called olfactory ensheathing cells (OECs), form part of the sense of smell. These are essential in the olfactory system as they enable nerve fibres to renew themselves. The OECs used in the transplant were taken directly from the nasal cavity and injected into the damaged spinal chord. This enabled the fibres above and below the injured sites to reconnect and eventually reform the spine.

Mr Fidyka's road to recovery has been a long and rigorous one, having undergone 25 hours of physiotherapy a week for two years. However, after the success of this treatment a further ten patients with similar spinal injuries are due to be treated in the next decade. Meanwhile the potential of cell transplantation continues to increase.

Research is currently being conducted into the use of cell transplantation to help strengthen the immune system of those suffering from HIV and AIDS. Corneal cells have successfully been transplanted into damaged eyes to cure blindness, and cochlea hair cells have been grown from embryonic stem cells as part of research to cure deafness. 

While the possibilities appear to be endless, many of these are merely hypotheses and have yet to be trialed. This is partially to do with the controversy surrounding the use of embryonic stem cells, as these would play a crucial role in the development of many of these potential cures. However, the success of Mr Fidyka's cell transplantation may lead to further research into the use of healthy specialised cells instead of stem cells, and these potential cures may eventually become reality.

For more information about Darek Fidyka's story, here is the link to the BBC News article.

Book Review: BMA Concise Guide to Medicines & Drugs

Following recent purchases, Lydia and I have decided to conduct a short book review on the British Medical Association's Concise Guide to Medicines & Drugs. We are both intending to follow different career paths and we therefore thought having both of our opinions in one article would allow for a more rounded review of the book.

Jonathan's Review:

The copy which
Jonathan uses.
With the intention of studying Medicine and pursuing a career as a Doctor, I decided to purchase this book to increase my awareness and knowledge about prescription and over-the-counter drugs; with a purchase price of £2.99 I found the opportunity hard to turn down!

The book features over 2,500 drugs with detailed information for each one including: general information, dosage instructions, adverse effects and conflicts with other medication. Not only this, but the book includes a simple to use indexing system which makes searching through the drugs fast to complete.

For the first 110 pages, the book explains the different major drug types there are, with information on how the drugs work within the body and what intentions the drug taking is meant to have. I found this section of the book highly useful as I believe that knowing why a drug is used is essential for professionals to confidently prescribe medication. One particular feature of this section which appeals to me is the use of tables to list common drugs for certain drug types - an example of this being the table on page 61 which lists antibiotics and the areas of the body which they can be used to treat (e.g. Co-trimoxazole being used for infections in the respiratory tract as well as the kidney and urinary tract).

Due to the sheer amount of information which is held within the book, as well as the simple to use index means that I enjoy using this book and means that I would happily recommend it to anybody interested in learning more about the drug types there are.

Lydia's Review:

The copy which
Lydia uses.
My aspiration is to study Pharmacy and therefore this book is well suited to my interests in learning about medicines and their action within the body. Intrigued by the the mechanism of action of drugs, I decided that this book would be ideal for me as it not only focuses on the chemical interactions of drugs, but it also explains the application of them. 

Through reading the detailed descriptions of each drug, I have learnt some new terminology and some of the nomenclature of drugs - an example of this being that antibiotics often end in 'cillin' (e.g. Amoxicillin). Adding to this, my edition of the book includes a small section of First Aid; despite this not being directly related to medicines and drugs, I find this section useful as a brief knowledge of general First Aid can link in with some drugs whilst also giving me the knowledge to help others in the case of an emergency.

The book also includes brand names for each generic drug - I found that by including this, the commonly mixed up names were clearly categorised into generic names and brand names. In addition to this, the book lists profiles for vitamins and minerals which explains the importance of each substance whilst also describing the symptoms of deficiencies; this is an area which I initially did not expect inside the book, however I have found it very interesting to read as these are lifestyle health issues which can often be reversed by changing a diet rather than through the use of medication.

Overall, I find this book extremely interesting to read and considering that the knowledge learnt from this book could benefit my future studies makes it a worthwhile purchase. The only improvement I can think of is for more diagrams and images to be included however this is not essential - I would definitely recommend this book!

ISBN - 10: 1405393939
Paperback - 480 pages

Technology Update: Transplant of a "Dead Heart"

The Heart-in-a-box machine.
Following a transplant procedure two months ago, surgeons in Sydney have confirmed that the operation was successful and could be the beginning of a new standard procedure.

Two months ago, surgeons in Sydney performed a heart transplant  using a heart which had stopped beating for up to 20 minutes; this is unusual as most heart transplants use hearts from donors with a heart which is still beating. The complication with using a 'dead heart' is that without the heart pumping, a lack of oxygen is supplied to the heart muscle cells and therefore the cells can die resulting in a heart which cannot function.

To avoid this, the new method includes a machine named "heart-in-a-box" which restores the beating of the heart whilst also supplying the heart with warmth and nourishing fluids; all of these factors should enable the heart cells to survive and this will allow for the heart to be used in a transplant. It is believed that using these methods could save many more lives by increasing the amount of available organs (organs which previously had been damaged my a lack of blood circulation can now be considered for use if the procedure is carried out).

If this procedure continues to prove successful through testing with different organs, the breakthrough could have significant effects across the globe. Having this could increase the number of organs which can be used for transplants - as organ donations are already in short supply, this increase in organs saved is highly important. Alternatives to organ transplants are not always suitable so without these precious organs, patients may not survive. The decision whether this procedure could become standard procedure depends upon many factors including: the further testing results, the financial implications and the availability of resources to continue this.

To join the Organ Donor Register, click on the image below:

For further reading, see:

The Independent Report:

TransMedics' Website:

First Aid Fridays - Toothache

Welcome to a series called “First Aid Fridays”. This is a series inspired by my voluntary work as an Event First Aider with the British Red Cross and all articles published are written in accordance with the ‘DK First Aid Manual Revised 9th Edition’ (which is authorised by the UK’s largest first aid providers). In this series I have decided to write a short article on Fridays explaining the authorised procedures to follow in order to administer first aid to various injuries – the sole purpose of this series is to educate the readers with knowledge to apply in order to care for a casualty and possibly even save lives.

The written articles of this series only contain a summary of each condition and First Aid procedure; therefore it is advised that training or reading of the full manual is completed to understand the full procedure. Reading these articles alone does not classify as First Aid training.

Toothache develops when pulp inside a tooth becomes inflamed due to dental decay. If the condition is left untreated, the pulp may become infected which leads to a throbbing pain; the infection inside the pulp may also spread to the mouth and jaw if left untreated.

Recognition Signs:

- A throbbing feeling which causes pain in the mouth.

  1. To reduce the feeling of pain, painkillers may be given. If the casualty is an adult, they may take the recommended dose of paracetamol (or their usual painkillers); if the casualty is a child, they may take the recommended dose of paracetamol in either tablet or syrup form.
  2. Give the casualty warm compress which they can apply to the affected side of the face - ensure that the compress is not too hot otherwise burns may occur. Ideal compresses include hot water bottles wrapped in towels.
  3. If available, a plug of cotton wool can be soaked in oil of cloves and this can then be held against the affected tooth. The oil of cloves acts as a local anaesthetic.
  4. If the pain persists or worsens, advise the casualty to seek medical assistance from their dentist.

Apply a warm compress to the affected side.

For more information, see page 225 of the DK First Aid manual.

Could intestinal bacteria help catch criminals?

Earlier this year I was given the opportunity to observe at an embalmers. Whilst there I was surprised to find that many of the bodies had green abdomens and chests. This is as a result of the 'friendly' bacteria in our intestines.

There are more than 100 trillion bacterial cells within our intestines. They have a constant supply of food, but also aid in the breakdown of food as it passes through our digestive systems, and help to keep pathogens at bay by outcompeting them.

When we die, however, the muscles within the intestines relax and the bacteria is released. It colonises tissues, starting with the large and small intestines, and feed off of carbohydrates, amino acids and lipids secreted from dying cells. This can take anywhere between 24 hours and a week, but eventually gives the cadavers their gorey green colour.

The structure of a bacterial cell
However, a recent article in New Scientist divulged the results of an investigation into intestinal bacteria, or thanatomicrobiome, and how they behave after death. It was discovered that, since there is a lot of variation in thanatomicrobiome between individuals, this could be used in forensic sciences as a new form of identification.

Intestinal bacteria can be analysed and matched to bacteria found on the clothing of missing persons, for example. Furthermore, analysis could prove vital for murder trials; if bacteria surrounding a victim does not match their thanatomicrobiome it could be indicative that the body was moved.

While the investigation into thanatomicrobiome is ongoing, it has already made new breakthroughs. 'The microbiome of a cadaver is an unknown data set in biology' according to scientist Sibyl Bucheli and, even if no medical or forensic uses are proven, the investigation will allow for thousands of new species of bacteria to be catalogued and studied. I think that this is going to become an important new forensic technique and could yield many more new scientific discoveries in the future.

First Aid Fridays - Insect and Arachnid Bites

Welcome to a series called “First Aid Fridays”. This is a series inspired by my voluntary work as an Event First Aider with the British Red Cross and all articles published are written in accordance with the ‘DK First Aid Manual Revised 9th Edition’ (which is authorised by the UK’s largest first aid providers). In this series I have decided to write a short article on Fridays explaining the authorised procedures to follow in order to administer first aid to various injuries – the sole purpose of this series is to educate the readers with knowledge to apply in order to care for a casualty and possibly even save lives.

The written articles of this series only contain a summary of each condition and First Aid procedure; therefore it is advised that training or reading of the full manual is completed to understand the full procedure. Reading these articles alone does not classify as First Aid training.

Following recent news stories about multiple spider bites which have been life threatening, I decided to publish today's article about insect and arachnid bites as they can be treated in a similar manner. Bites from some animals such as spiders and mosquitoes can cause serious illness and may even lead to death if not treated promptly and correctly. If the bite takes place in the mouth or throat, be aware that the swelling from the bite may obstruct the airways of the casualty.

Recognition Signs:

These signs can vary dependent upon the species of the biter.
- Pain, redness and swelling around the site of the injury.
- Nausea and vomiting.
- Headaches.
- Allergic reaction/anaphylactic shock.

  1. Reassure the casualty and encourage them to either sit or lie down.
  2. Elevate the affected area and place a cold compress onto the injury. Apply this for at least 10 minutes to minimise the risk of swelling.
  3. Monitor the vital signs of the casualty for at least 15 minutes - if the casualty develops breathing difficulties or appears to have an allergic reaction, contact further medical assistance.
  4. Call for emergency medical assistance (by calling 999) if the casualty shows signs of anaphylactic shock or has been bitten by a red back spider or a funnel web spider.
Redness and swelling due to a
spider bite.

For more information, see page 213 of the DK First Aid Manual.

The Brain: Neurons and Glial Cells

The Brain is composed primarily of two different types of cell: The Neuron, which acts as a cable through which electrical impulses travel through the brain and the entire body, and Glial Cells, which perform many functions to support the neurons. 
Above is a diagram of a basic neuron and it's components. A neuron has many basic cell components such as mitochondria, endoplasmic reticulum and others that you may know about if you study AS Biology. Besides from these, neurons also have many unique organelles which I will now describe:

Dendrites - dendrites carry nerve impulses to the cell body.

Axon - an axon is the long fibre that makes up most of the length of a neuron. Electrical impulses travel away from the cell body and down the Axon to the terminal endings.

Myelin Sheath - this is, in essence, an extremely extended plasma membrane that is wrapped around the Axon. The Myelin Sheath electrically insulates the axon.

Nodes of Ranvier - The nodes of ranvier are gaps in the myelin sheath. Gaps are usually between two and three micrometers and occur ever one to three millimeters.

Terminal Endings - Terminal Endings (or Axon terminals) are where the electrical impulse leaves a neuron in a chemical form, which travels across a synapse and then to another neuron.

There are three main types of neuron:
- Sensory, transmits nerve signals from a receptor to a motor neurone.
- Motor, transmits signals from a sensory neurone to an effector such as a muscle.
-Immediate, transmit impulses between neurones.

Glial Cells
For a long time, glial cells were believed to be of not much use, but it is now believed that they perform quite a few important functions. The glial cells generally work to keep the brain in a good shape, which they do in a number of ways:
- Removing dead neurons
- Removing dead pathogens
- Supply neurons with vitals such as nutrients and oxygen
-Supporting the structure of the brains by keeping neurons in the correct place.