Green Lights and Sirens

2011-01-01T02:26:00.002Z

It's been a long year and I doubt anyone still reads my sporadic posts. It's the 1st of the 1st, 2011 which means my badge suddenly tells me I am graduating Next Year. Academically and Calendarily. I don't feel any older than I did when I started med school, yes, a little more lonely, but no more maturer. I'm back to the desert that is med school, instead on my first of January I am desperately trying to corral opinion on the few deaneries up North that I am considering.

2010-05-21T21:37:00.003+01:00

It has been a hell of a long time since I last posted. Apologies to everyone who is still checking in!

I'm currently on placement in a medium sized DGH out away from London. It is really nice to get out of London and see things like trees and skylines again (!) but it is a right mission to get back to London. We are talking 2 and a half hours on weekends and an hour and a half on weekdays. Suffice to say, I live in the shitty converted on call room that we have been provided. I sleep awfully there. A combination of thin blankets and dysfunctional blackout blinds (yeah right) mean I wake up through the night. As an example: Bed at 11, woke up 1. Woke up 3.30. Woke up 5. Woke up 6. Got up at 7. So consequently, felt like death. This has gone on for FOUR. WEEKS. I am a wreck when it comes to weekends.

There was a gift in my room on Thursday. No jokes, it made me grin like a kid. I got a DUVET. A soft, warm duvet. Cue immediately getting in bed and under the covers and having a nap. It felt Ah-ma-zing.

Settling into clinical medicine well. Almost at the end of my junior medical year! Exams in five weeks. I get put to use on my current urology firm, writing in the notes, doing the TTO paperwork, prescribing drugs and fluids. I even have the outfirm prerogative of being able to do the initial clerkings of sick medical patients presenting to A&E, making provisional diagnoses and initating management. Always a nice feeling.

Saw a gentleman who came in with his family. Laughing and quite jovial, although I suspect this was a front. Just his manner and the way he was asking a little *too* many questions that a relaxed person had. Through his tough guy Essex boy appearance, I occasionally saw glances of 'deer in the headlights' expressions. Poor guy was scared, and rightly so. He came in with a one day history of chest pain and nausea, that he neglected to seek medical advice for. Turns out he had a heart attack in September with his main coronary artery clogged with fatty plaques that reduced the diameter of the vessel by 70-95%. 95% stenosed artery!! It is a wonder his heart is getting any blood at all! Anyways the good news was that the blood result that measures heart damage by an enzyme that is leaked into the blood when the heart cells die came back negative, but his ECG showed a rather slow pulse and some changes that indicated some poor blood supply.

I did a brief examination that didn't show any new heart murmurs or signs of heart failure and consulting my trusty oxford handbook, deemed this patient fit to go home. Cue discussing with the consultant, who decides to send for his old notes to review what exactly his risk was. The changes (global T wave inversions) could be signs of a new heart attack or just artefacts from his previous ones, according to the consultant. So he was sent out to the chairs to wait for said notes and I went home.

I wonder how he got on.

2010-03-03T18:11:00.002Z

So I started my surgical rotation: 6 hours late! I was stuck in bed with a cold and decided to forgo the 6.30AM wakeup for the post take ward round (where my new consultant was responsible for 'taking' all the new surgical admissions over the weekend). I made it in for 1 to find that the ward round that was due to start at 7.30 actually started more like 11.45 for which I was truly thankful I didn't get out of bed at 6.30.

The service looks...a little sleepy compared to the intensity of my last 3 weeks on gastroenterology. There are only 6 patients and the house officer is usually done for the day around 12/1. We duly turned up to outpatients clinics and of course, the consultant was 45 minutes late. So, I sat around and twiddled my thumbs and argued why alcohol makes your blood sugar fall with the other students. None of us, including two biochemistry graduates and a Cambridge graduate could remember the rather simple answer: be scared, the future of the NHS beckons!

Consultant turned up and told us to leave since his clinic would be useless: :/
Great. Seeing as I just turned up, I wasn't going to admit defeat so easily and went with a colleague to theatres. After having a 'conversation' with a bitchy theatre nurse who suspiciously questioned our motives for being there (can anyone say SURGICAL students??) she refused my request to take a pair of scrubs to keep in my lockers with my clogs so I didn't have to a.) leave my stuff to be nicked in the general changing rooms and b.) stop me going back and forth between the theatres and my locker at the other end of the hospital.

No, of course she wouldn't give it to me. Nurse on a power trip. Her face made me question to think if I had blurted out that I wanted to abduct her child or something: A PAIR OF SCRUBS WOMAN! GET A GRIP!

In the end, we saw through the bullshit and stuck around for a laparoscopic appendicectomy. We went down to pick up the patient from the acute ward and saw two sore thumbs on the ward. I suspiciously went over and checked who they were, slumped against a wall hands in their pockets. Two poor 14 year old schoolkids on work experience who had apparently stood in the same spot for 6 hours, and that they would probably stand there for the next two weeks. Disgraceful! What is the point of them turning up? No-one even made eye contact with these rather nervous, incredibly bored kids who ended up getting bollocked by a site manager for not putting their bags away-did anyone show them? Of course not! One HCA hopefully asked if they wanted to help her make some beds...is that really medical work experience? I felt sorry for them and showed a drug chart and an ECG to which they perked up a bit. Will try and find them tomorrow and get them to watch me clerk a patient for my SSM.

Anyways, back to the induction room and my favourite part of the operation. The drips all set up and the room is full. Two anaesthetists, one house officer,two medical students, two student nurses, one ODP and the patient, nervously looking around.

The trainee anaesthetist quietly explains what he is going to do and the room is pindrop silent as he injects the colourless liquid thiopentone into her vein. I watch, fascinated, as the liquid creeps up the pipe and whooshes into her system as he flushes. Small tears escape the corners of her eyes as she looks up anxiously through the oxygen mask, blinking back the irritating salt.

The blinking gets a little more fluttery, like a butterfly taking off...she speaks through the mask: "I feel it happennnuuuuuuuuungh". The anaesthetist replys "That's it, have a good sleep" and shes off, eyes closed. The next small syringe gets pushed through and within seconds her whole body is wracked by small twitches and shakes as every muscle in her body except her heart depolarises, all the while pressure being placed by the ODP on her neck to prevent her inhaling any food that she might bring up since it was an emergency operation.

A few seconds later, she is like a rag doll. Her floppy head is held into position as her mouth is opened and the blade of the laryngoscope enters her mouth, the light illuminating her vocal cords as the vallecula is parted and the tube passed down.

The anaesthetic machine is hooked up and the pressure increased, the bag being squeezed that drives a mixture of oxygen and volatile gases into her lungs. The chest wall moves synchronously with each squeeze, showing a good tube position.

Finally, her eyes are taped down to prevent scratches from airborne dust and sheets damaging her corneas and the tube is secured with a tie around the face.

All this time, the surgeon next door is scrubbing up, methodically washing his hands and putting his gown and gloves on. He walks in as the patient is being placed on the table and with a "ready to go?" is off with the knife.

Half an hour later and without one vermiform appendix the patient is wheeled off, with only a few millimetres of stitches in her stomach thanks to the wonders of laparascopic surgery.

2010-02-17T00:37:00.002Z

Soooooooo it is a shitty day in London today. I mean really miserable. It has rained the whole day, non stop! My alarm went off at 7.30 today after a night full of strange nightmares and full bladders and I found it very hard to get out of my nice warm, freshly washed duveted bed. My pillows were extra soft and the rain gently pattered against my window...but no, I had GP.

Yes, that enjoyable shower with itchy eyes from tiredness, the dry face feeling and a hurried breakfast. Luckily I had ironed last night, a nice blue and white checked shirt that is one of my favourites so I put that on and opted for my nice 4 pound chavvy but extra cosy and warm jacket from Dubai over my rather nice black smart overcoat that more suits my Yves Saint Laurent shirt and tie, but what the hell. I didn't give a shit what London thought today and it was far better than being soaked in the rain.

My 2 pound tactical umbrella buy from Asda (I love that place) got put into use as I left at 8.20, making good time I thought! Of course, that is such a schoolboy error, never get up early to try and be on time as you get screwed over doubly bad. Little did I know London Overground trains run every 20-25 minutes and I rocked up onto the platform just as one left. Cue next train at 8.50, as I wait for a 15 minute journey and a 10 minute walk, supposedly having to be in at 9. Uh-oh.

Anyways, make it their on time to find we have dreaded video roleplays to do. This is where we get some fake history to play as we are split up into pairs, one being the doctor taking the history and the other being a patient.

Suffice to say, my useless slacker of a partner didn't turn up so I was left chilling out on my own in an empty room, again finding myself listen to the rain on a window. What an excellent use of my time.

Come 11 o clock, we rotate around and the two girls who were in surgery this morning came up to do their own roleplay. I went down and out of the 6 doctors running sessions, I chose the women's health clinic doctor. Nice move. It is the bane of a male medical students' life, the women's health rotation. Everyone women looks at you suspiciously, those who don't outright refuse consent to have you even in the consulting room either act like a curse has been evoked on them or flat out ignore you for the entire time. All this time I sit like a schoolboy in the corner, nodding pensively and trying desperately to make my time useful by reading over the GP's shoulder. Why won't patients understand that I'm not a pervert, I'm a medical student trying to learn so that someday in the not too distant future, you may be one of my patients! Surely you would want me to be competent and observe, rather than be incompetent and dangerous to you!

Frustratingly, I "watched" a coil get removed from behind a curtain, had two come back for prescriptions for the pill and saw an emergency case of a lovely, friendly, rather chatty (although unintelligible) one year old with no thyroid with some hand, foot and mouth disease. The poor father looked exhausted with great big bags under his eyes as he told us he had a brand new, 2 day old baby at home...he looked worked off his feet!

Anyways, day came around and I rushed back home, again through rain and high winds, grabbed a bite of food to eat and flogged to the other side of London for a medical for the Army, which I unfortunately failed on some medical condition. Well, you can't blame them, but it unfortunately means that I won't be pursuing any sort of career in the Army now which was dissapointing. So tired now, I really am...personal day off tomorrow methinks.

2010-02-10T20:29:00.002Z

I'm tired.

I promised myself I would be in bed by 3 today. I had a plan! Went in for 9 and ran straight into the ward round, where I fulfilled 6 years of over achievement in academics to draw curtains and hold open folders for others to read.

We were sat down by the F1 yesterday and told in no uncertain terms that the last groups' skiving had meant that the registrars and consultants were very keen for us to turn up to everything. The ward round was tomorrow at 9 and all four of our subgroup were meant to attend. One of the girls on our team put her hand up and calmly said that any afternoon ward rounds wouldn't be attended by her as she had a job-why she said this I have no idea. Surely you would just slope off as jobs are supposed to not get in the way of the thousands of pounds of SIFT payments to NHS trusts in compensation for having students on the wards? How many turned up to the ward round? 1. Me.

Anyway, said ward round goes on. Cue much curtain drawing, standing in uncomfortable positions pressed up against walls and hot radiators as the bedside is crowded by everyone present. Got to feel a nice 3cm liver edge though on a patient with alcoholic cirrhosis which was rather interesting.

Anyways the day sped by with more teaching from the registrar on abdominal examination followed by some surgical teaching on the examination of a lump and ulcers. The surgeon is so funny, he told one girl "you are talking out of your ass" and retorted with "absolute bullshit" when some guy tried to blag his way through an answer. Nice straight talking fella, that's what I like!

Anyways, wolfed down some lunch and headed back to the ward. Did an insta clerk of a patient with acute pancreatitis for tomorrow's ward round as I will have to present to the consultant (eek!) and then did a cannula. Managed to get home by five which was a pretty good effort with me today!

I'm sorry if this is a bit of a shit post, but I'm dead tired...probably going to have an early night today and get myself some rest.

In other news, I'm considering doing an intercalated BSc in Pharmacology next year! Watch this space!

2010-02-04T19:49:00.002Z

Well yesterday was a pretty disappointing day, me and my flatmate were going to hit the union but he instead went out to one of the central london bars, so I ended up having a quiet night in!

Was really excited to have a lie in as well, I reckon my sleep debt rivals that of the UK treasury! Sod's law however that the day I decide to be lazy is the day I a.) get woken up by said flatmate going home b.) get really hot and thirsty c.) get woken up almost hourly by random texts. Woke up at 12 feeling pretty tired!

Went to the consultant ward round today. Not a bad turnout really, 9 students and the team. Saw a woman who was literally the colour of mustard from liver failure, drifting in and out of conciousness. Was quite disturbing really. The doctors reckoned it was alcoholic liver cirrhosis with encephalopathy, with completely deranged liver biochemical (bilirubin in the high 500s), synthetic function off (low albumin, TP, INR 2). Family were quite upset really. My lady I clerked with an infective exacerbation of COPD was getting better which was good to hear, although she was still very wheezy.

Ward round finished at 4.50, so I stayed till 5.20. By the time I got my stuff from my locker and got to the bus stop, I tactically missed all the rush hour traffic! It was a pretty good tradeoff I think-at least the ward is warm compared to a freezing, windy bus stop.

Been watching Planet Earth by David Attenborough :) I love it! So amazing what really is out there on Earth, the hunting dogs of Africa and migrating elephants were what I saw today. Baby elephants swimming and playing in the water-v. cute!

2010-02-04T00:13:00.002Z

Well almost 8 months later, I decide to post. A lot has changed since my last update, mostly for the better. I'm feeling a lot happier this year, moved into a nice new house with some great flatmates and keeping myself busy, which is a blessing and a curse.

Finished my first firm at Chelmsford which was brilliant. I was the only medical student on the entire cardiorespiratory service, which meant I learnt quickly and got to do lots of things, i.e. 3 cannulas before lunch, clerking in new admissions, rewriting charts, doing ward rounds etc. My SHO even thought I was capable to look after our four albeit stable patients for one day which was great! Learnt about the curse of the bleep, the one day I decide to have an afternoon nap I get bleeped asking why I wasn't in clinic. Or getting bleeped to come to clinic starting at 1.30 when I was stuck in an elevator (bleep received at 1330). However, it proved amazing to get out of the awful MDT meetings, a quick bleep from a mate and "I have to go to the ward" was perfect.

Also managed to wangle myself a shift on an ambulance. Turning up predawn was an experience to say the least and the 10 hours I did with the crew made me develop a lot of respect for them. It was such a thrill to be driving on blue lights, but I seriously thought I was going to die when we switched into the oncoming traffic lane at 70 miles an hour with the oncoming traffic refusing to stop! Saw 2xCVA, 2xRTA (no injuries) and a few falls. However, I was glad to return to A&E...as much as I respect the ambulance crews, I think I would prefer the diagnostic challenge of a doctor more.

Mentally, it was also great to get out of London, into the fresh air and countryside...we even had rabbits! I miss that place, being stuck in my current firm.

Which is an inner London hospital, where I am technically supposed to be doing surgery and anaesthetics (my current career choice) for 9 weeks. Instead, lumped on 3 weeks of general medicine/rheumatology, 3 weeks of gastro and only 3 weeks of upper GI surgery. That means I will qualify with only 7 weeks of surgical experience and be expected to take up a surgical house officer position. I feel sorry for my future patients!

It's really busy as well, 10 students per firm which means a lot of competition. The staff are rushed off their feet and can't really teach. Responsibility is non existent, a far cry from my last firm...not helped by the fact that most of my firm is an absolute disgrace in terms of medical knowledge. Some have never even done a single cannula before!

Mentally, it's tiring me out. I feel like I have no social life anymore, as when I am free I am dog tired. I'm basically working a 9-6 every day and just don't have the energy to go out on the town after a night. My stomach is playing up as well, on domperidone as I feel sick as a dog after everything I eat or drink, especially alcohol. It isn't really fun at all. I kinda feel I'm being cheated out of my youth, after all I'm only 20! Tempted to take a year out and intercalate at a Northern uni, just spend a year enjoying myself and life in general. Think it would do me good, but could I really be bothered? Part of me just wants to hurry up and qualify.

Dr. Digitalis MBBS(London)....hopefully it will be worth it in the end.

2009-06-20T21:27:00.000+01:00

It's that lovely time of the year again: one day left before second year finals begin. I'm majorly stressed, not helped by the litre of kick I thought would be a good idea to down at about 5PM. I'm still jittery and nervous, with my little checklist on notepaper growing larger and larger as I realise topics that I have either forgotten/never knew existed in the first place!

I was slightly relieved that I managed to do the practice EMQs OK, I probably got about 60% in them. Must review my kidney physiology and pharmacology before Tuesday though!

The sheer amount of stuff you have to learn is amazing. It just never seems to end! God only knows what Finals must be like! Everything has started to blend into one. Howell-Jolly body. Reed-steinberg cell. Bence-Jones protein. Just a question of pure memorisation to match with its' disease. The thing is, so many diseases have similar symptoms, you have to really rack your brains to conjure up ways in which to differentiate them.

Take 'B' symptoms for example: Night sweats, weight loss and fever. Multiple myeloma or TB? Malignancy? Chronic alcoholism? They all produce the damn same symptoms!

And what's worse is that on top of all the diseases, you are expected to know the disease process related to the physiology in second year. For example, diabetic nephropathy. On top of being asked how does diabetes affect the kidneys, you could also be asked to describe how the renal tubules reabsorb sodium, or how and where do diuretics act on the renal tubules?

I'm so glad it's the last week of second year and I'm praying I pass. God knows I want this year to end! Roll on third year, get rid of shitty poorly run lectures and anatomy classes and on to REAL MEDICINE, taught by real doctors!

2009-06-17T23:53:00.003+01:00

It's almost the end of preclinical medicine for me.
I haven't posted in the last few months because...not really much has happened to be honest. I went into 3 hours of lectures in a month of teaching and came up out with 57%. All good. Orthopaedics and derm was quite interesting, I enjoyed the X ray interpretation. Apart from that, nothing much to report.

Finals are on Tuesday and I'm pretty damn worried. I can't remember how to examine cranial nerves, I just found out the trigeminal nerve innevated masseter, med. and lat. pterigoids and temporalis and I couldn't tell you the dermatomes of the leg.

I escaped to the countryside of Derbyshire this weekend to provide medical cover at Download festival. Great fun, lots of responsibility and paid 300 quid to clerk patients for 3 days! Itchy eyes? Irrigate with saline. Got hayfever? Here's some chlorphenamine. Sunburn? Here's some aftersun. Sorted.

My only excitement was a mid 20s male who didn't speak good English, presented with a history of vomiting over the last 24 hours. No blood or bile, just lots of fluid. He seemed slightly confused with dry buccal mucosa and skin. Couldn't keep anything down, inc. fluids. Vomited twice in twenty minutes whilst in Majors. No tonsilar enlargement, no ear pathology, just some generalised abdo tenderness consistent with the vomiting. Decided to dip his urine to assess the specific gravity and check for ketones with the plan to rehydrate with IV fluids.

Came back with:
+ leucocytes
+++ nitrites
+ protein
+++ ketones

UTI! So I got to jab him with some cyclizine IM, watched him rehydrate orally and got a 'script for trimethoprim signed off. Happy punter.

2009-03-31T15:44:00.002+01:00

Sorry about the lack of blogging. Night has turned to day and day has blended into dreams. I have been working hard as hell the last week, putting everything I have into it and I have reaped the rewards. I quickly decided on my plastic surgery SSM that surgery was a.) boring and b.) repetitive not to mention egotistic and argumentitive. I therefore do the bare minimum (putting in two stiches and debriding a wound under local anaesthetic) and escape to A&E, the real coal face of medicine.

This was a great move, I now know most of the A&E staff and they all genuinly thank me for the work I have done. I have learnt how to cannulate, perform venepuncture, suture, set up a giving set for IV fluids, order the correct bloods and investigations and accept ambulance crew handovers. Essential skills for my summer job (hopefully!). I have clerked and formulated management plans for more patients than I can remember, participated on trauma calls, done chest compressions on said trauma calls, seen two people die...all at the age of 19. How I feel I have grown up the last two years. The last death really bothered me, a young guy, died all alone behind a brick wall. A still chest is not a nice thing to hear. Emotionally, I'm shattered. Will provide a more in depth account when I recover on Easter hols.

On another note, wiping mildew and fungus off bathroom ceilings is intensely satisfying.

2009-03-24T00:26:00.002Z

First day of SSM on plastics.

I was bored shitless.

I quickly realised that following the SHO and waiting a respectful two paces behind as he bitched for half an hour (no jokes) about his firm was not the best way to spend my time, so I sneakily went off to buy some hobnobs.

OK, I thought, its only 10.30 AM, things can only get better.

Wrong.

Went to clinic, saw two patients. That took till 12, where I answered the SHOs bleep. At this point, I hastily made my exit to the beloved sink that all medical students can hide in, A&E. I value my clinical time, I learn far more medicine than crappily organised lectures can ever teach. The best way to learn medicine, I have quickly learnt, is to do things. Be involved. A&E was a blast, they actually valued my presence there! I spent my time in between Majors and Streaming Plus where I overheard one of the doctors say to another, "you'll be fine, you have yourself, the nurse and that medical student running the unit". Part of a team! A registrar pulled me aside and genuinly thanked me, even offering to sign me off for whatever SSM I was doing!

I spent my time assessing new patients, doing their obs, venous access and bloods, then presenting to the doctor on duty. I passed enough venflons to now do it without really trying, which is a nice feeling. Saves you embarresment in front of little old ladies, who instead comment on what a lovely doctor you will be.

I did have the opportunity to take part in three trauma calls, the real sharp end of A&E medicine. How different it was from TV, no dramatic music and shouting but a quiet and orderly environment with about 12 people working inside a the space of a double bed. Apart from two paediatric RTAs brought in by the paramedics, the saddest case was a youngish lady who collapsed and had a sub-arachnoid bleed. For those who do not know, this is usually due to a burst blood vessel that bleeds inside the brain, putting pressure on it and stopping blood reaching the brain. She collapsed suddenly and never regained conciousness. The family were devastated, watching helplessly as she got transferred to ITU.

I worked till 11.30PM and felt great for it, although almost being 17 hours. However, I got back to the surgical changing room to get out of my scrubs to find...my tie and shoes. No shirt, no trousers, but the tie tossed loosly over where I had folded it. Yes, some sneaky, snivelling bastard stole my Aquascutum shirt, one of my favourites. Long, cold trip home in dirty scrubs for me. Gutted.

2009-03-20T15:26:00.002Z

Exams are over! Time to brain dump the perineum and pelvis for another two years! I'm feeling great, it's sunny outside and I'm off to the pub soon.

Got a great song to share is my mood at the moment, from my all time favourite artist.

http://www.youtube.com/watch?v=Dz3rz1bnvBs&feature=PlayList&p=07DB74330624ABDC&playnext=1&playnext_from=PL&index=11

Gabriel and Dresden. Classic euphoric progressive trance, the stuff that got me into DJing in the first place. It's almost a year since G&D broke up, sad times. Even Andain, Josh Gabriel's offshoot has collapsed.

Hope it makes you smile! :)

2009-03-19T15:55:00.003Z

It's exam time! Therefore I continue to procrastinate wildly, sitting in my dressing gown trying to look interested in a fat book of anatomy that is sitting in front of me. It's staring me down, willing to get lost in its multiple folds like a morbidly obese person and a bowl full of jelly. It's about bottles of Orangina and Haribos, organising pens and pencils then thinking of any excuse not to learn what the borders of the pelvic inlet are but its just not working! I have three more PBLs to cover and then the WHOLE of microanatomy for tomorrow...I think it's going to be a late one!

On a cheery note, it's SSM time next week! Whilst most people like it for the dossy two weeks it is, I like it because it reminds me of why I'm doing medicine and not a science degree. It's about treating the sick, not learning latin. It lets me play doctor for two weeks at a time, gives me a chance to debunk the myths of medicine that have built up over the years and lets me learn something new and practical. I've learnt a good mantra for clinical medicine as a student, "If you don't bother, sure as hell no-one else will". Doctors are busy.

Ward staff are busy. You are an encumberance. You could turn up for ward round twice a week and leave by 10.30 and you would still get a pass. But is it that good a use of your time? For me at least, it's what keeps me going through the dreary lectures and naff practicals that we have to do. I learnt how to cannulate, draw bloods and write a good clerking last SSM, thanks to my lovely house officer (can't bear myself to call them F1s, what are we, in Star Wars?!) and I learnt some more tricks on difficult cannulations, how to read a CTG (baby heart rate/contraction monitor) and scrub on my last night in the Labour Ward. But I had to force people to teach me!

Here is the lovely attitude that I got throughout my first SSM:-

Day 1: Walking onto the ward, go to the notes trolley just as the two Registrars and House Officer are starting ward round. Cheerfully introduce myself....silence. Try again a few minutes later...silence. More coffee drinking. I take off my tie and slouch.
Day 2: After introducing myself yesterday, Registrar takes a look at my name badge mid conversation with patient and misreads my last name, as only my initials are spelt.
Day 3: Get a dirty look from sitting in a chair after standing for five hours.
Day 4: Chased a clinic up that we were told to attend with no further instructions, when where, who?
Day 5: Repeat with transplant surgery.
Sometime along the line, get dirty looks from doctors when patient has addressed me as doctor.
General skivvy work, get a pair of gloves, get a sick bowl etc.
By FAR the worst job...standing with a nurse retracting three folds of fat in one hand for half an hour bent over a low hospital bed in a morbidly obese, bed ridden, MRSA-ed woman whilst the surgeon inserted a vascath into her femoral artery. I was close to fainting, really close.
After ward round...I would stand literally for hours, or wander from bed to bed chatting to patients with no-one telling me what to do. When asked if there was anything I could do, I was lucky if someone looked up from their computer as they checked their emails. Of course, there were never was anything to do. Only the house officer made an effort (presumably because she remembered how shit it was to stand and do nothing!)
Noone looked up when I said bye after two weeks-Why should they I guess? I was only there watching and not really contributing!

Labour ward was great on the other hand! Lovely, maternal attitude, everyone cooing over me, making me cups of tea and toast etc, people calling me to be taught, spontaneous random bedside teaching without being beasted, people finding opportunties for me to learn and trying to involve me...I fell in love with O&G right there!

Roll on reconstructive surgery!

2009-03-18T12:18:00.002Z

Nothing much to report the last few days, it's been making friends with my library booth again...yes, it's that time again. I procrastinated nicely by binding all my lecture notes and have just about reviewed all the lectures so far. Plan for today? Finish off the last four lectures and start on PBLs.

2009-03-14T15:50:00.002Z

Working my way through the first two lectures of the module, on subfertility and complications of pregnancy. Sigh. I hate revision!

Makes me think though, it's a wonder how the human race survives with all the things that can go wrong with reproduction!

2009-03-10T16:21:00.003Z

GP day today! Cringy start to the day when our "confidential" feedback reports were quietly printed off infront of us by the GP (who we had slated, saying she was a disgrace, patronising etc etc) and read. She then started to question us on our answers and I thought "the hell I'm going to stand here and feel like a naughty kid with a crap report!" and reminded her that we weren't obliged to explain our feelings. So she then started to backtrack and say how was she supposed to learn from her mistakes etc! Not fun having to deal with that at 9AM!

Started off with a quick presentation that we had prepared on renal function and then started off the day's list. Saw some rather interesting things, a woman with polycystic ovary syndrome who was quite textbook, rather overweight, hirsutism (excess hair), irregular periods and an inability to conceive after a year. Sent off for ovulation induction.

Secondly, we saw a woman with a mysterious lump behind her ear that had disappeared by the time she had got to surgery but complained of a general malaise. Blagged our way through a brief general exam, had a peer in her ears and after driving forward...nothing. What the hell? Pulled it out and it was blocked with thick brown wax...looovely! I have a strange fascination with looking in people's ears, I bought a bargain opthalmoscope/otoscope set by Keeler off eBay for 50 quid last term, great condition...but that is beside the point! I think it's pretty cool to look into someone's ear, considering that you don't get to see the tiny tympanic membrane that conducts everything we hear inwards.

Finally, we saw the girl who was ?schizophrenia. She told us she had been hearing voices since the age of 8, currently aged 13. She had a very difficult childhood admittedly, anger problems with a family history of schizophrenia but she didn't look like she was acutely unwell. She just sat there, answered our questions in monotone whilst her mother told us how she had wanted to kill the mother, sister and herself. Psych came back with a diagnosis of "loud inner voices but not auditory hallucinations", start in antipsychotics. Correct diagnosis? The GP said she had played it safe by referring on to psych as she would have lost her registration the next day if the girl had killed herself. Caring, anyone?

2009-03-09T18:27:00.005Z

We had a lecture on child abuse today by a very sharp paediatrician, obviously knowing a lot about her very complicated field. It was horrific to see some of the things people intentionally do to their own kids, (dipping them feet first into boiling water?-I thought that went out with witch hunts!) surely they must have some sort of complex to do that! It was a sobering thought to see how a lot of offenders who abuse children have been abused themselves as children, so breaking what can be a vicious cycle is pretty damn difficult.

Childhood is where you develop as a person, those sort of experiences mould you into adults as you are exposed to what you grow up perceiving to be normal behaviour. It brought me back to thinking about my own childhood experiences, playing under duvets or with diggers in the sand, chasing bees or getting dragged around village fayres and contrasted them with some of the nasty lives children have, cowering from a whip made of electrical wire in a dirty hovel, not having their nappies changed for days.

However, the lecturer did show us the implications of accusing somebody of abuse. As I try to explain to many people, medicine is an inexact science going on probability of a diagnosis being correct, that is why we make differential diagnosis lists up. A picture of spattered oil burns on a childs leg...or is it bullous impetigo? Fingertip bruising or skin rash? Consequences are serious if you make the wrong call, broken families, shamed parents, kids in foster homes...it's a lot on your shoulders.

2009-03-06T20:36:00.004Z

Well, reviving the blog I started pre medical school. Cut out all the keen, idealistic stuff and decided to pare it back to shit that bothers me, freaks me out or just plain old interests me about the wonderful (!) world of medicine.

Second year has been hellishly boring. Boring, irrelevant, wishy washy lectures on random unrelated preclinical medicine interspersed with HOURS of spare time. I have so much of it, I just don't know what to do with it! I watch movies, I go to the local market, I go watch aircraft at the local airport (people who know me know I love flying!) but I STILL have loads of free time!

I came across a great PDF that I recommend everyone should read, it's called Heart Failure by Dr. Michael Greger MD. http://www.upalumni.org/medschool/
When I read this, I realised just what an easy ride UK medical school is compared to the Yanks. They work you to the bone, but by God you learn a lot. Compare that to third year medical students in the UK attending ward round, not doing much and leaving for the day at 12. I always thought that the US students were just extra keen, but reading that really opened my eyes up to their training. Highly recommended read.

I spent a voluntary night on the labour ward on Wednesday. 7.45PM to 8.30 AM. I've always been interested in O&G (always suspect when you say that at school) and this just reinforced my interest. It was absolutely great! But by far the best part of it was actually feeling like I was doing something. Pulling a babies head out, running down corridors to see crash caesareans, bloodied scrubs, patients saying thanks...(imagine that!) it was absolutely brilliant. I ended up seeing 4 or 5 babies being delivered that night, two of which were Caesarian sections. Can't remember the exact number!

The Senior Reg who organised it was wonderful and her team I could speak for hours on their virtues. Apart from being eager to teach (1AM teaching sessions on CTG analysis and 4AM cannulation teaching?!) they were just nice people in general. Without being sexist, I think the atmosphere was so nice because it was female driven and quite motherly. Midwives were making me tea, registrars fussing over me making me toast and telling me to sleep, it was great.
This was real medicine, fun medicine, exciting medicine. Even getting a call to cannulate someone at 3AM made me feel worthwhile, easing the SHOs workload just a little bit. Sure as hell made me dread going to PBL the next morning, back to shitty lectures and being treated like a schoolboy.

However, I posted that link to Dr. Greger because I read it the next day and realised how I was slowly being moulded into the medical mould. I kept thinking how cool is this? How exciting! I get to wake up a women and wonder why she is getting upset about blood on her sheet. How trivial! How unimportant I sniffed as I tucked her sheet away, telling her it would be seen to in the morning, more concerned with going back to report triumphantly to the SHO that I managed to cannulate her. It's only a bit of blood right? Evidently not, she was almost in tears.

Later on, why won't this bloody woman let me see her baby being born? I don't care she is lying in stirrups with all to see as she screams and bleeds everywhere, damn it...she is so inconsiderate! I want to learn!

Again, why won't this woman hurry up and dilate! I want to see her baby born before the night ends!

My worst feeling, the one I felt most guilty about the next day was running for the crash call, so charged and excited, positively relishing the fact that this woman was close to dying. So ER-like, so thrilling. Lord forbid I would ever think she was alive, shit scared, with a semi-dying foetus in her as the surgeons started cutting. My only thought? Can I scrub in and retract before that foetus comes out. How disgusting.