Not quite as exciting as the finals results that are out today, I thought I'd share something amazing that happened to me today.
I saw my first natural birth.
The medic in me wants to tell you all about the process, the fact she had a small amount of pethidine but mostly managed on gas and air, that Mum and Baby were both fine. It was her first baby and everything went to plan, apart from the fact they'd been told to expect a boy and a little girl popped out. She didn't need an episiotomy.
The girl in me just wants to grin, and say 'babybabybabybabybabybabybaby!!!!'
All of me wants to tell you what a wonderful experience it was, and how grateful I was to be allowed to observe something that personal and emotionally charged. The midwives on the ward are amazing and looked after Mum and me wonderfully. Mum, Dad and Grandma were all brilliant about me being there.
I don't think I'll ever forget today, Friday 13th, 1.56am, and I'm damn sure I can think of at least 3 more people that won't either :)
Friday 13 June 2008
Wigan woe
Originally drafted in a strop, in my new notebook (that irritatingly had neglected to tell me it was blank not ruled)...
Wigan has not made a good first impression on me.
I arrived on Sunday in a bad mood. This was partly due to the 15hr shift I'd just done, partly the fact I was feeling horribly ill and had lymph nodes sticking out my neck like golf balls, and partly down to crappy internet directions (and perhaps bad navigating by my friend) which had meant the journey had taken double the suggested time. It was almost midnight, which meant all obvious entrances to the hospital were locked. After what seemed like an age stood shivering outside (apparently it was warm, but I was awfully feverish) we decided to do the naughty thing and go in via A&E. Luckily a nice receptionist took pity on us and took us to switchboard to get our room keys. The man informed us our accommodation was on site, and that 'we couldn't miss it'.
We could. It took 3 circuits of the service road to locate it. It wasn't identifiably our block, but we tried our code and the door opened, so we breathed a sigh of relief and went in. My friend and I had been told we were in the same flat, me room X, her room Y. I opened the flat door and stumbled straight for my bed. My friend knocked on my door, whimpering, 'There is no room Y!'
I took some more paracetamol and tried not to cry. All I wanted to do was sleep. It took until the early hours to try her key in all the doors in the block and eventually find her a room in an entirely different flat. I passed out without unpacking and had an awful night's sleep.
I awoke early, still feeling ill. More paracetamol, then to the shower. Cold. Freezing cold. My bad mood escalated.
Our new consultant hadn't sent us the timetable he'd promised so we headed off to find someone that might know where he was. On locating him I was handed a page of pencil scrawl- my new timetable. A month of full-time, plus 2 on-calls a week. He suggested weekends, but as I'm still working long shifts at the agency to be able to eat/drink/drive (not all at the same time) I firmly declined. We have to get our timetable signed morning and afternoon to prove we've been in. I don't mind this (it stops me being lazy and makes sure I get the most) but towards the end of this attachment I have a 4000 word assignment to write, and I'd like to think I can be trusted to use the time wisely and decide when I'd be best off in my room at my laptop. Its not like there's internet access to distract me!
The rest of the morning was spent doing irritating admin tasks- ID badges, parking permits, computer logins. Then in the afternoon, still feeling ill, I headed off to another site to see some scans, and tried not to infect any pregnant mothers.
I got to leave a little early, so was back in my room (via a shop for more paracetamol, you apparently can't buy it in the hospital) by 5pm. I immediately fell asleep, and woke up a few hours later for long enough to be sick as I tried to take my next dose. I've not met my flatmates yet, but I'm pretty sure they'll have heard me retching into my sink. Joy.
Took Tuesday off. Now I'm missing two signatures on my timetable already, and have no way to contact my consultant and let him know why. I bet he thinks I'm a slacker. Really, I'm just scared of vomiting on small newborn babies.
I feel that's probably frowned upon.
Wigan has not made a good first impression on me.
I arrived on Sunday in a bad mood. This was partly due to the 15hr shift I'd just done, partly the fact I was feeling horribly ill and had lymph nodes sticking out my neck like golf balls, and partly down to crappy internet directions (and perhaps bad navigating by my friend) which had meant the journey had taken double the suggested time. It was almost midnight, which meant all obvious entrances to the hospital were locked. After what seemed like an age stood shivering outside (apparently it was warm, but I was awfully feverish) we decided to do the naughty thing and go in via A&E. Luckily a nice receptionist took pity on us and took us to switchboard to get our room keys. The man informed us our accommodation was on site, and that 'we couldn't miss it'.
We could. It took 3 circuits of the service road to locate it. It wasn't identifiably our block, but we tried our code and the door opened, so we breathed a sigh of relief and went in. My friend and I had been told we were in the same flat, me room X, her room Y. I opened the flat door and stumbled straight for my bed. My friend knocked on my door, whimpering, 'There is no room Y!'
I took some more paracetamol and tried not to cry. All I wanted to do was sleep. It took until the early hours to try her key in all the doors in the block and eventually find her a room in an entirely different flat. I passed out without unpacking and had an awful night's sleep.
I awoke early, still feeling ill. More paracetamol, then to the shower. Cold. Freezing cold. My bad mood escalated.
Our new consultant hadn't sent us the timetable he'd promised so we headed off to find someone that might know where he was. On locating him I was handed a page of pencil scrawl- my new timetable. A month of full-time, plus 2 on-calls a week. He suggested weekends, but as I'm still working long shifts at the agency to be able to eat/drink/drive (not all at the same time) I firmly declined. We have to get our timetable signed morning and afternoon to prove we've been in. I don't mind this (it stops me being lazy and makes sure I get the most) but towards the end of this attachment I have a 4000 word assignment to write, and I'd like to think I can be trusted to use the time wisely and decide when I'd be best off in my room at my laptop. Its not like there's internet access to distract me!
The rest of the morning was spent doing irritating admin tasks- ID badges, parking permits, computer logins. Then in the afternoon, still feeling ill, I headed off to another site to see some scans, and tried not to infect any pregnant mothers.
I got to leave a little early, so was back in my room (via a shop for more paracetamol, you apparently can't buy it in the hospital) by 5pm. I immediately fell asleep, and woke up a few hours later for long enough to be sick as I tried to take my next dose. I've not met my flatmates yet, but I'm pretty sure they'll have heard me retching into my sink. Joy.
Took Tuesday off. Now I'm missing two signatures on my timetable already, and have no way to contact my consultant and let him know why. I bet he thinks I'm a slacker. Really, I'm just scared of vomiting on small newborn babies.
I feel that's probably frowned upon.
Sunday 8 June 2008
OSCEs and post-alcohol-post-OSCE syndrome
I am poorly again.
I've been ill on and off for a couple of months, mostly due to the fact that I never get enough rest. I'm on placement all week, then work ridiculously long shifts at the weekend, and when I have the opportunity to go out I make it a big one. Entirely my own fault. Doesn't stop me feeling sorry for myself.
I had my OSCE on Thursday. I worried myself sick before it, and drank myself into the floor afterwards. It went surprisingly ok. Station breakdown as follows:
Setting up an IV infusion- not done it since week 1 in September. Regret that now. My particular favourite moment was me struggling to get the damn line to run through, and the examiner saying 'perhaps you might want to take the cap off'. Joy. I'd expected this to go badly though after hearing the people the day before had had it. Picked myself up and moved on.
Examine pt for hepatosplenomegaly- went really well. Looked confident, simulated patient looked happy (they're worse than the examiners for keeping a straight face). Finished early and the examiner didn't do that really annoying 'and what else?' thing that makes you know you've forgotten something really obvious.
Hx no 1- Heart failure- barn door diagnosis. Was polite and confident. Only error I can pick out is that I was too quick to decide that's what it was. Otherwise, happy.
Cannulation- was ok. Got the plaster stuck to my gloves and a bit tangled. Think it was alright.
Examine pt for thyrotoxicosis- have practised this examination loads so was quite confident. Examiner suggested one or two little extras afterwards, and pointed out I should use the equipment available (water for swallowing, instead of just asking to swallow). Happy.
Hx no 2- Bladder cancer- another barn door diagnosis. Didn't tell pt she had cancer, which is good. Calmed her anxieties about cystoscopy. Think it was quite good actually.
Explain new diagnosis of iron deficiency anaemia to a vegetarian- I am an anaemic vegetarian. I totally rocked this one.
Rest station- supposedly to calm down, took me out my swing and made me hyperventilate again. Ah well.
Examine pt for DVT- took the whole of 1 minute. Missed something obvious. Did however take the hint and use the tape measure. Came up with some good differentials, didn't however know what a Baker's cyst was. Hopefully haematoma, cellulitis and bursitis are enough to get the mark.
Consent pt for colonoscopy- had the external examiner in with me on this one. It was all he could do to not give me a double thumbs up afterwards, I could see him twitching. Was really happy. Heard from others afterwards that the simulated patient had sat there and said 'I'm not having it done. No, never, not having it' to them, so I must have done something right.
Examine for R sided pneumonia- didn't do tracheal deviation, decided it wasn't relevant, examiner made me go back to it- it was. Otherwise did a really competent respiratory exam, concluded well and knew exactly what I'd expect. Bolton did good things for my chest medicine knowledge.
Consent for ABG for 'education and training'- this one was interesting, mostly because I'd never actually ask someone if I could stick a needle in their wrist for practice when it's of no benefit to them. I misread the card at first (so did most) and went in thinking it was a test she needed. I don't know how well that went to be honest.
Urinalysis- another thing I've not done since September. I think I did ok, one of my questions I got wring but the examiner seemed pleased otherwise. They're well practised at not giving too much away.
Hx no 3- GORD/ulcer- Not so pleased with this one. Started well, but pt was deliberately talkative and pressing me to tell him whether something was up with his heart. Eventually I said I suspected it was more to do with his stomach and acid reflux. I'm not sure how well I did this, bearing in mind we're not actually able to tell patients their diagnosis. Everyone else seemed to go with the 'I'm a medical student, I don't know' option. We'll see when the marks come out, but I have a feeling I may fail on that one.
Overall, a mixed bag. I'm confident that I've passed, but I doubt it's a high mark. Nerves got the better of me in the end.
The post-exam celebrations however were much more successful. Made a fool of myself by drinking too much cider, as ever. After two days of drinking (and over 40 units) I spent most of yesterday in bed, and missed my housemate moving out for good. Felt really crap about that one.
Today I'm back at work. 7am-10pm. Two hours off in the afternoon. Then afterwards off to Wigan to start my SSC in Obs and Gynae in the morning.
I really just want to sleep.
I've been ill on and off for a couple of months, mostly due to the fact that I never get enough rest. I'm on placement all week, then work ridiculously long shifts at the weekend, and when I have the opportunity to go out I make it a big one. Entirely my own fault. Doesn't stop me feeling sorry for myself.
I had my OSCE on Thursday. I worried myself sick before it, and drank myself into the floor afterwards. It went surprisingly ok. Station breakdown as follows:
Setting up an IV infusion- not done it since week 1 in September. Regret that now. My particular favourite moment was me struggling to get the damn line to run through, and the examiner saying 'perhaps you might want to take the cap off'. Joy. I'd expected this to go badly though after hearing the people the day before had had it. Picked myself up and moved on.
Examine pt for hepatosplenomegaly- went really well. Looked confident, simulated patient looked happy (they're worse than the examiners for keeping a straight face). Finished early and the examiner didn't do that really annoying 'and what else?' thing that makes you know you've forgotten something really obvious.
Hx no 1- Heart failure- barn door diagnosis. Was polite and confident. Only error I can pick out is that I was too quick to decide that's what it was. Otherwise, happy.
Cannulation- was ok. Got the plaster stuck to my gloves and a bit tangled. Think it was alright.
Examine pt for thyrotoxicosis- have practised this examination loads so was quite confident. Examiner suggested one or two little extras afterwards, and pointed out I should use the equipment available (water for swallowing, instead of just asking to swallow). Happy.
Hx no 2- Bladder cancer- another barn door diagnosis. Didn't tell pt she had cancer, which is good. Calmed her anxieties about cystoscopy. Think it was quite good actually.
Explain new diagnosis of iron deficiency anaemia to a vegetarian- I am an anaemic vegetarian. I totally rocked this one.
Rest station- supposedly to calm down, took me out my swing and made me hyperventilate again. Ah well.
Examine pt for DVT- took the whole of 1 minute. Missed something obvious. Did however take the hint and use the tape measure. Came up with some good differentials, didn't however know what a Baker's cyst was. Hopefully haematoma, cellulitis and bursitis are enough to get the mark.
Consent pt for colonoscopy- had the external examiner in with me on this one. It was all he could do to not give me a double thumbs up afterwards, I could see him twitching. Was really happy. Heard from others afterwards that the simulated patient had sat there and said 'I'm not having it done. No, never, not having it' to them, so I must have done something right.
Examine for R sided pneumonia- didn't do tracheal deviation, decided it wasn't relevant, examiner made me go back to it- it was. Otherwise did a really competent respiratory exam, concluded well and knew exactly what I'd expect. Bolton did good things for my chest medicine knowledge.
Consent for ABG for 'education and training'- this one was interesting, mostly because I'd never actually ask someone if I could stick a needle in their wrist for practice when it's of no benefit to them. I misread the card at first (so did most) and went in thinking it was a test she needed. I don't know how well that went to be honest.
Urinalysis- another thing I've not done since September. I think I did ok, one of my questions I got wring but the examiner seemed pleased otherwise. They're well practised at not giving too much away.
Hx no 3- GORD/ulcer- Not so pleased with this one. Started well, but pt was deliberately talkative and pressing me to tell him whether something was up with his heart. Eventually I said I suspected it was more to do with his stomach and acid reflux. I'm not sure how well I did this, bearing in mind we're not actually able to tell patients their diagnosis. Everyone else seemed to go with the 'I'm a medical student, I don't know' option. We'll see when the marks come out, but I have a feeling I may fail on that one.
Overall, a mixed bag. I'm confident that I've passed, but I doubt it's a high mark. Nerves got the better of me in the end.
The post-exam celebrations however were much more successful. Made a fool of myself by drinking too much cider, as ever. After two days of drinking (and over 40 units) I spent most of yesterday in bed, and missed my housemate moving out for good. Felt really crap about that one.
Today I'm back at work. 7am-10pm. Two hours off in the afternoon. Then afterwards off to Wigan to start my SSC in Obs and Gynae in the morning.
I really just want to sleep.
Sunday 25 May 2008
Feedback
At the end of every attachment we do we're supposed to have a feedback meeting with our tutor, and they tick and sign our sheets. There's room for comments. Most of the time they bother to write a few words, and ask us how we feel we're doing. That's about it.
This time my tutor did it properly. Individual meetings, discussion of our strengths and weaknesses. I'm really glad he did. Its rare on our course to be told how well you're doing compared to everyone else, and getting one-on-one time is almost unheard of.
He was very complimentary. I don't think I've ever had anyone be so nice. He told me that he thinks I'd be a great GP before I even told him that's what I'm leaning towards. He said that if I were to become a GP he'd want me to be his, as my smile and positive professional persona would make him feel better just by being in the same room. He filled in my feedback form with the words 'outstanding student' at the top.
I didn't really know how to take it to be honest. I assumed he was just a gushy kind of guy, but having seen the face of a very intelligent colleague who came out just before me I don't think he was as nice to everyone. I don't really know how I managed to deserve it.
I did have a moment of over-analysing, and got upset by the fact that I never get told my knowledge is strong, only my caring side. I often think I feel more comfortable as a home carer than a medical student, although I couldn't live comfortably on the income! I'm too lazy to do the reading, I seem to think I'll absorb what I need to know by turning up to seminars and sticking needles in people occasionally. So far it's working, but I doubt I'll get away with it for much longer. I don't really want to if I'm honest. Yet I've not had that kick up the arse moment yet. I'd half hoped he'd tell me I'm a slacker and to pull my finger out. Now I just know I can slack off for longer. Sigh.
Then I thought maybe he'd analysed me and realised I'm insecure, and that's why he was so nice to me. I need reassurance more than most.
Then I thought that I should just stop thinking about it and take the compliment. On my Mum's advice. She was very proud!
This time my tutor did it properly. Individual meetings, discussion of our strengths and weaknesses. I'm really glad he did. Its rare on our course to be told how well you're doing compared to everyone else, and getting one-on-one time is almost unheard of.
He was very complimentary. I don't think I've ever had anyone be so nice. He told me that he thinks I'd be a great GP before I even told him that's what I'm leaning towards. He said that if I were to become a GP he'd want me to be his, as my smile and positive professional persona would make him feel better just by being in the same room. He filled in my feedback form with the words 'outstanding student' at the top.
I didn't really know how to take it to be honest. I assumed he was just a gushy kind of guy, but having seen the face of a very intelligent colleague who came out just before me I don't think he was as nice to everyone. I don't really know how I managed to deserve it.
I did have a moment of over-analysing, and got upset by the fact that I never get told my knowledge is strong, only my caring side. I often think I feel more comfortable as a home carer than a medical student, although I couldn't live comfortably on the income! I'm too lazy to do the reading, I seem to think I'll absorb what I need to know by turning up to seminars and sticking needles in people occasionally. So far it's working, but I doubt I'll get away with it for much longer. I don't really want to if I'm honest. Yet I've not had that kick up the arse moment yet. I'd half hoped he'd tell me I'm a slacker and to pull my finger out. Now I just know I can slack off for longer. Sigh.
Then I thought maybe he'd analysed me and realised I'm insecure, and that's why he was so nice to me. I need reassurance more than most.
Then I thought that I should just stop thinking about it and take the compliment. On my Mum's advice. She was very proud!
Monday 19 May 2008
All work and no play...
Why does everything pile up at once?
Not only do I have my OSCEs in 2 weeks time, all my added extras seem to have deadlines at the minute. I have so much on, and so little time. I had a fairly productive day today, in that I did a shift at work so I can afford to eat for another week, took back all my library books that have been gathering dust in the corner (this time before they cost me the earth in fines) and went into three banks in an attempt to sort out my finances. See, what with summer holidays so far away and no summer schools jobs this year I'm more than a little strapped for cash. I've maxed both my overdrafts (yes, that would be 3000 pounds) and haven't paid for my house deposit or my car repairs yet. My quote was 600 pounds. Joy of joys.
So I'm back to 15hr shifts and added extras here and there. Exactly what I need when everything else is mounting up.
I just don't see how I'm gonna fix this mess I've made.
Not only do I have my OSCEs in 2 weeks time, all my added extras seem to have deadlines at the minute. I have so much on, and so little time. I had a fairly productive day today, in that I did a shift at work so I can afford to eat for another week, took back all my library books that have been gathering dust in the corner (this time before they cost me the earth in fines) and went into three banks in an attempt to sort out my finances. See, what with summer holidays so far away and no summer schools jobs this year I'm more than a little strapped for cash. I've maxed both my overdrafts (yes, that would be 3000 pounds) and haven't paid for my house deposit or my car repairs yet. My quote was 600 pounds. Joy of joys.
So I'm back to 15hr shifts and added extras here and there. Exactly what I need when everything else is mounting up.
I just don't see how I'm gonna fix this mess I've made.
Monday 12 May 2008
Exam stress?
I have my end of year written exam this afternoon.
Since I didn't do so well in my A Levels, and consequently had a horrifically awful results day involving rejection, clearing, and eventually Manchester changing their mind a few days later, you'd expect me to be quite bothered by exams. I'm not. I'm far too laid back. I usually get mildly panicky for the few days before, but never enough to actually do too much revision. When we had semester tests in the pre-clinical years my friend and I did 3 15hr days revision before every test and passed comfortably. I'm lucky, I seem to manage it somehow.
My professor the other day made the huge error of telling us that the progress test (the exam I have in less than 4hrs time) is designed to be cram-proof. If I don't know it already, I won't know it. This relaxed me even more than normal, and made me feel much less guilty about the fact I had a holiday booked the weekend before a Monday exam.
I've been away the past 3 days with 6 other girls to a cottage in the middle of nowhere. With the beautiful weather, we spent most of the weekend in the garden, in and out the hot tub, with a glass of something sparkly in our hands. Any fluids I lost through sunbathing were quickly replaced by champagne, gin and cider. Lots of fun was had. The books came out for an hour on Saturday afternoon.
Yesterday we intended to get back in time to do some practise questions, learn some of the common topics. Unfortunately after a weekend of problems, my car finally gave in as we tried to leave, and whilst awaiting AA men and tow trucks we ended up back in the sunshine in a beer garden, accompanied by a few more beverages of the alcoholic variety. I finally got back to Manchester at bedtime, and couldn't make myself do any work.
This morning, revision has started. 5hrs before my exam. And an hour later, I'm writing this.
I only hope my confidence pays off, that the work I've done throughout the year will be enough. I enjoy medicine, I pick it up fairly quickly when I try. I just don't seem to do that often enough.
Since I didn't do so well in my A Levels, and consequently had a horrifically awful results day involving rejection, clearing, and eventually Manchester changing their mind a few days later, you'd expect me to be quite bothered by exams. I'm not. I'm far too laid back. I usually get mildly panicky for the few days before, but never enough to actually do too much revision. When we had semester tests in the pre-clinical years my friend and I did 3 15hr days revision before every test and passed comfortably. I'm lucky, I seem to manage it somehow.
My professor the other day made the huge error of telling us that the progress test (the exam I have in less than 4hrs time) is designed to be cram-proof. If I don't know it already, I won't know it. This relaxed me even more than normal, and made me feel much less guilty about the fact I had a holiday booked the weekend before a Monday exam.
I've been away the past 3 days with 6 other girls to a cottage in the middle of nowhere. With the beautiful weather, we spent most of the weekend in the garden, in and out the hot tub, with a glass of something sparkly in our hands. Any fluids I lost through sunbathing were quickly replaced by champagne, gin and cider. Lots of fun was had. The books came out for an hour on Saturday afternoon.
Yesterday we intended to get back in time to do some practise questions, learn some of the common topics. Unfortunately after a weekend of problems, my car finally gave in as we tried to leave, and whilst awaiting AA men and tow trucks we ended up back in the sunshine in a beer garden, accompanied by a few more beverages of the alcoholic variety. I finally got back to Manchester at bedtime, and couldn't make myself do any work.
This morning, revision has started. 5hrs before my exam. And an hour later, I'm writing this.
I only hope my confidence pays off, that the work I've done throughout the year will be enough. I enjoy medicine, I pick it up fairly quickly when I try. I just don't seem to do that often enough.
Wednesday 30 April 2008
Livers and lookers
Well, I finally learnt the liver. Had a really good PBL session yesterday where we blitzed the whole thing, and with me having made the decision to stay in the night before and do some work for a change, I understood it. It's a big relief!
Have moved back onto a diabetic/endocrinology ward, which is alright. I was taking a history from a patient who was my age yesterday. It was really odd, I'm used to patients being significantly older than me. Getting the balance right between professional and human is more difficult with younger patients I think.
Our junior doctors are really great. Both have offered us teaching every day, and are sympathetic to our upcoming exam pressures. A few months ago I was embarrassed to have a guess or ask silly questions when I didn't know the answers, now I am comfortable enough to throw out random words and say when I'm not sure, and nice teachers really help that and mean I get much more out of it. It helps as well that one of them is quite hot. Lol.
All in all, I've had a really good few days. I only hope this good mood sticks with me during the next fortnight before my written exam...
Have moved back onto a diabetic/endocrinology ward, which is alright. I was taking a history from a patient who was my age yesterday. It was really odd, I'm used to patients being significantly older than me. Getting the balance right between professional and human is more difficult with younger patients I think.
Our junior doctors are really great. Both have offered us teaching every day, and are sympathetic to our upcoming exam pressures. A few months ago I was embarrassed to have a guess or ask silly questions when I didn't know the answers, now I am comfortable enough to throw out random words and say when I'm not sure, and nice teachers really help that and mean I get much more out of it. It helps as well that one of them is quite hot. Lol.
All in all, I've had a really good few days. I only hope this good mood sticks with me during the next fortnight before my written exam...
Thursday 24 April 2008
Surgery, General Practice, Emergency Medicine, Obstetrics... how do you choose?
I have no idea what I want to do with my life.
I came into medicine wanting to be a GP. I love general practice. But I'm easily distracted, and have found over the past year that several other specialities have grabbed my eye. I loved A & E, and I've always had an interest in Obs & Gynae, and actually I didn't hate chest medicine as much as I expected. In fact, the only thing that I've always been certain on was that I didn't want to do surgery. (Well, apart from pathology, which for me wasn't even worth contemplating).
I did a day at the Bolton Breast Unit this week. It was part of my community placements that we've had to do, including pharmacy and podiatry and all sorts of fun things. My favourite so far had been the Bury Cancer Support Centre who were so pleased to have me there that they gave me a massage before I went home. Awesome. But, back to breasts. I had thought I'd be spending the day in new patient clinics, referrals from GP-land who had a newly-discovered lump that wanted triple investigation (clinical exam, imaging, biopsy). The clinic's good in that the radiologist reports on the image there and then so they usually get a result the same day. I spent the afternoon examining lumps and learnt very quickly how to decide what one is. I also got to see a nipple abcess, a condition directly linked to smoking. If the lung cancer won't put you off, that sure will!
But the morning I spent in theatre. Having decided very early on in my medical degree that I wouldn't enjoy surgery, I'd so far managed to avoid having to see any. I hated dissection and am terrified of cutting things. But I didn't really have much choice in the matter, they told me I was going into theatre and I couldn't really tell them the idea terrified me, so I went. The reg took me under his wing and taught me how to scrub up and don my gown and mask, and then I was handed retractors.
I spent 4hrs there. Mostly I was just holding skin flaps out the way and cutting stitches, but it was great. I saw mastectomies and a hernia repair (breast surgeons are specialised general surgeons, they can't promise just breasts). I loved it.
So now, after a day of being a breast surgeon, I've had to add surgery to my possible career list. I'll need to do a lot more work than I tend to do now, and perhaps deal with the fact that babies may have to come later than planned (a sentence I usually hate to hear from women), but it's possible. My consultant was impressed by me (not entirely sure how) and has suggested I work there in my F1 year and I'm really keen on the idea. I had planned to apply to Bolton anyway.
Generally, my head is a big mess of confusion at the moment. I hate not having a life plan. I've just put forward my SSC choices and they're a totally different set from those I chose 6 months ago. I really hope I decide soon what I want to be. And whether I want to intercalate. But that's another confused moan for another day.
I came into medicine wanting to be a GP. I love general practice. But I'm easily distracted, and have found over the past year that several other specialities have grabbed my eye. I loved A & E, and I've always had an interest in Obs & Gynae, and actually I didn't hate chest medicine as much as I expected. In fact, the only thing that I've always been certain on was that I didn't want to do surgery. (Well, apart from pathology, which for me wasn't even worth contemplating).
I did a day at the Bolton Breast Unit this week. It was part of my community placements that we've had to do, including pharmacy and podiatry and all sorts of fun things. My favourite so far had been the Bury Cancer Support Centre who were so pleased to have me there that they gave me a massage before I went home. Awesome. But, back to breasts. I had thought I'd be spending the day in new patient clinics, referrals from GP-land who had a newly-discovered lump that wanted triple investigation (clinical exam, imaging, biopsy). The clinic's good in that the radiologist reports on the image there and then so they usually get a result the same day. I spent the afternoon examining lumps and learnt very quickly how to decide what one is. I also got to see a nipple abcess, a condition directly linked to smoking. If the lung cancer won't put you off, that sure will!
But the morning I spent in theatre. Having decided very early on in my medical degree that I wouldn't enjoy surgery, I'd so far managed to avoid having to see any. I hated dissection and am terrified of cutting things. But I didn't really have much choice in the matter, they told me I was going into theatre and I couldn't really tell them the idea terrified me, so I went. The reg took me under his wing and taught me how to scrub up and don my gown and mask, and then I was handed retractors.
I spent 4hrs there. Mostly I was just holding skin flaps out the way and cutting stitches, but it was great. I saw mastectomies and a hernia repair (breast surgeons are specialised general surgeons, they can't promise just breasts). I loved it.
So now, after a day of being a breast surgeon, I've had to add surgery to my possible career list. I'll need to do a lot more work than I tend to do now, and perhaps deal with the fact that babies may have to come later than planned (a sentence I usually hate to hear from women), but it's possible. My consultant was impressed by me (not entirely sure how) and has suggested I work there in my F1 year and I'm really keen on the idea. I had planned to apply to Bolton anyway.
Generally, my head is a big mess of confusion at the moment. I hate not having a life plan. I've just put forward my SSC choices and they're a totally different set from those I chose 6 months ago. I really hope I decide soon what I want to be. And whether I want to intercalate. But that's another confused moan for another day.
Friday 18 April 2008
Tea and wine
Most medical students will attempt a ward round hungover.
Most medical students will be able to list the amount of times they've attempted this on one hand.
I have already said how much I hate ward rounds. I don't need to go into that again. But hungover, they take on a whole new level of awfulness. There are the long words you don't understand, combined with the consultant who thinks you must, and then there is the amount of brainpower needed to stay upright. This is not a good combination.
I've only ever done one ward round hungover. I, as a student, drink more than my fair share according to the DoH. But I always make sure this is before a morning off, or communication skills. Never when seeing patients.
Tonight I had an emotional crisis. I am 21, I'm allowed these from time to time. And as many British citizens would, I reached for the merlot.
Four large glasses and a pint later I am regretting this. Not least because my ward round starts in not-very-many hours, which means leaving my house in even fewer and being up in a number not worth considering. My blood alcohol level is not good. Luckily for me I have a clinical partner who will pick me up and not question the drunkeness, just laugh.
On the plus side, the toast I just made fell to the floor butter side up. I don't know what this means but I assume it's a good omen. Despite the floor resembling your average alleyway, I have continued to eat it. I assume this is less of a good omen for my physical state in the morning.
I do hope there's tea tomorrow. Tea may make it all better. Strong tea.
And a biscuit.
Most medical students will be able to list the amount of times they've attempted this on one hand.
I have already said how much I hate ward rounds. I don't need to go into that again. But hungover, they take on a whole new level of awfulness. There are the long words you don't understand, combined with the consultant who thinks you must, and then there is the amount of brainpower needed to stay upright. This is not a good combination.
I've only ever done one ward round hungover. I, as a student, drink more than my fair share according to the DoH. But I always make sure this is before a morning off, or communication skills. Never when seeing patients.
Tonight I had an emotional crisis. I am 21, I'm allowed these from time to time. And as many British citizens would, I reached for the merlot.
Four large glasses and a pint later I am regretting this. Not least because my ward round starts in not-very-many hours, which means leaving my house in even fewer and being up in a number not worth considering. My blood alcohol level is not good. Luckily for me I have a clinical partner who will pick me up and not question the drunkeness, just laugh.
On the plus side, the toast I just made fell to the floor butter side up. I don't know what this means but I assume it's a good omen. Despite the floor resembling your average alleyway, I have continued to eat it. I assume this is less of a good omen for my physical state in the morning.
I do hope there's tea tomorrow. Tea may make it all better. Strong tea.
And a biscuit.
Monday 14 April 2008
I like PBL
I feel it's about time I had my say about PBL. There has recently been a survey showing that graduates from a PBL medical course are more likely to fail their membership exams (specifically RCGP). Although I can't argue the stats, I can't help but feel that PBL is what you make of it, and for me, I wouldn't have done medicine any other way.
For anyone unfamiliar with the concept of PBL, or problem-based learning, the idea is this- as a group you are presented with a 'case', which is a story detailing the symptoms, investigations and treatments of a patient passing through the healthcare service. These cases are based on the 200 most common clinical conditions, and include hints towards various important medical and non-medical 'cues' to guide us to cover the syllabus. As a group, we would dissect the case and form a list of learning objectives for the week, in order to better understand the problem in hand. For example, a case involving a man presenting with severe indigestion who had an endoscopy and was treated with antibiotics and omeprazole and was a heavy drinker may translate to learning about the anatomy of the stomach, physiology of gastric secretions, ulcer formation, investigation and treatment of ulcers, and alcoholism. Over the course of the following week there will be some lectures/seminars related to these points, there will be time for us to research on our own, and ward time to take histories from patients suffering with similar conditions. We may go to the endoscopy suite and see examples. Perhaps there would be chance to go into theatre and see emergency ulcer repairs. Using this method over the 5 years means we cover all major clinical conditions, their presenting features and how to treat them. We are expected to read around the topic each week and discover the less common presentations or variations. At the end of the week we come together as a group and discuss our findings, ensuring every member of the group understands the main concepts by teaching each other, and sharing ward experience relevant to the case.
This system doesn't work for everyone. Some people want to be spoon fed. Some people can only learn by spending hours with their head in a book and copying out notes. I'm lucky. I learn by discussion, by teaching others and by practical methods. If you stick me in a lecture theatre my mind wanders within a few minutes and I take in the first 1o and last 5 minutes. I accept that the syllabus is often unclear with our PBL course, but I don't expect to be told what's going to be on the exam- as a doctor I will need to have a grounding in everything and an appreciation of the fact that common things occur commonly- I think my course gives me the opportunity to do well in the real world.
My science background is less solid than that of the St Andrews students. My anatomy is not up to scratch. However I understand concepts, I see how drugs work and I am still learning and willing to work on it. Anatomy was not badly taught at Manchester, the demonstrators were fantastic teachers, but it was rarely examined and come exam time psychology took preference to tactically boost your grade. I have fantastic notes on it to go back to whenever I need. And besides, I have no intention of doing surgery.
Manchester doesn't aim to produce research scientists. It aims to produce doctors that are competent, aware of their limits, capable of finding the information they need quickly, and caring. I don't see what's wrong with that.
For anyone unfamiliar with the concept of PBL, or problem-based learning, the idea is this- as a group you are presented with a 'case', which is a story detailing the symptoms, investigations and treatments of a patient passing through the healthcare service. These cases are based on the 200 most common clinical conditions, and include hints towards various important medical and non-medical 'cues' to guide us to cover the syllabus. As a group, we would dissect the case and form a list of learning objectives for the week, in order to better understand the problem in hand. For example, a case involving a man presenting with severe indigestion who had an endoscopy and was treated with antibiotics and omeprazole and was a heavy drinker may translate to learning about the anatomy of the stomach, physiology of gastric secretions, ulcer formation, investigation and treatment of ulcers, and alcoholism. Over the course of the following week there will be some lectures/seminars related to these points, there will be time for us to research on our own, and ward time to take histories from patients suffering with similar conditions. We may go to the endoscopy suite and see examples. Perhaps there would be chance to go into theatre and see emergency ulcer repairs. Using this method over the 5 years means we cover all major clinical conditions, their presenting features and how to treat them. We are expected to read around the topic each week and discover the less common presentations or variations. At the end of the week we come together as a group and discuss our findings, ensuring every member of the group understands the main concepts by teaching each other, and sharing ward experience relevant to the case.
This system doesn't work for everyone. Some people want to be spoon fed. Some people can only learn by spending hours with their head in a book and copying out notes. I'm lucky. I learn by discussion, by teaching others and by practical methods. If you stick me in a lecture theatre my mind wanders within a few minutes and I take in the first 1o and last 5 minutes. I accept that the syllabus is often unclear with our PBL course, but I don't expect to be told what's going to be on the exam- as a doctor I will need to have a grounding in everything and an appreciation of the fact that common things occur commonly- I think my course gives me the opportunity to do well in the real world.
My science background is less solid than that of the St Andrews students. My anatomy is not up to scratch. However I understand concepts, I see how drugs work and I am still learning and willing to work on it. Anatomy was not badly taught at Manchester, the demonstrators were fantastic teachers, but it was rarely examined and come exam time psychology took preference to tactically boost your grade. I have fantastic notes on it to go back to whenever I need. And besides, I have no intention of doing surgery.
Manchester doesn't aim to produce research scientists. It aims to produce doctors that are competent, aware of their limits, capable of finding the information they need quickly, and caring. I don't see what's wrong with that.
Saturday 1 March 2008
Ward rounds
I've just started semester two (Nutrition, Metabolism, Excretion) of proper medicine.
On day one we met our new consultant. His opening speech included the words 'I believe in learning by humiliation' and 'you, make a dunce's cap for next week's session'. He terrified me. I came into medicine believing this kind of consultant had died out. There have been endless studies proving that it's not of benefit to us to be ridiculed infront of the team on answering a question wrongly. It was horrifying to see this system in practice.
After spending the day with the man, I came home and cried. It's only a four week placement but I could not see me being able to stand it.
On Tuesday and Thursday I went to the GP surgery. I can't express how much of a nicer environment for learning it was. I love GP placements, the way the doctor knows everything about their patient, medically and socially. I love being able to ask any question I like and not be thought of as stupid.
Wednesday was spent in a hospice finding out about the day to day activities there. I loved that too. I considered giving up medicine in favour of nursing again. The job just seems much nicer.
Then Friday came, and it was back to the hospital for case discussions and a ward round. Urgh. I hate ward rounds. I can't help but notice how uncomfortable it must be for the patients to see a group of doctors and student doctors stood at the bottom of your bed talking in abbreviations and quizzing the younger members on the mechanisms of certain conditions. Then they turn and say 'Hi Mrs Jones, no news on the scan today but we'll see you again tomorrow'. If I'm ever an inpatient the doctors will have a nightmare, I'll be listening to every word and questioning every test. It constantly amazes me how when I ask someone what medication they're on they say 'Oh I dunno love, I just swallow whatever the nurses give me'. People have so much trust in the system.
But there was a plus point. Monday's consultant came to tell us he'd come to the wrong room before- our consultant is someone much much nicer. He has found himself another group to torment.
Is it really any wonder that I want to be a GP? Medics seem to see general practice as a step down from 'real medicine'. I guess I started off with no hospital experience, so to me a GP has always been how I've visualised a doctor.
I just can't see myself doing ward rounds forever.
On day one we met our new consultant. His opening speech included the words 'I believe in learning by humiliation' and 'you, make a dunce's cap for next week's session'. He terrified me. I came into medicine believing this kind of consultant had died out. There have been endless studies proving that it's not of benefit to us to be ridiculed infront of the team on answering a question wrongly. It was horrifying to see this system in practice.
After spending the day with the man, I came home and cried. It's only a four week placement but I could not see me being able to stand it.
On Tuesday and Thursday I went to the GP surgery. I can't express how much of a nicer environment for learning it was. I love GP placements, the way the doctor knows everything about their patient, medically and socially. I love being able to ask any question I like and not be thought of as stupid.
Wednesday was spent in a hospice finding out about the day to day activities there. I loved that too. I considered giving up medicine in favour of nursing again. The job just seems much nicer.
Then Friday came, and it was back to the hospital for case discussions and a ward round. Urgh. I hate ward rounds. I can't help but notice how uncomfortable it must be for the patients to see a group of doctors and student doctors stood at the bottom of your bed talking in abbreviations and quizzing the younger members on the mechanisms of certain conditions. Then they turn and say 'Hi Mrs Jones, no news on the scan today but we'll see you again tomorrow'. If I'm ever an inpatient the doctors will have a nightmare, I'll be listening to every word and questioning every test. It constantly amazes me how when I ask someone what medication they're on they say 'Oh I dunno love, I just swallow whatever the nurses give me'. People have so much trust in the system.
But there was a plus point. Monday's consultant came to tell us he'd come to the wrong room before- our consultant is someone much much nicer. He has found himself another group to torment.
Is it really any wonder that I want to be a GP? Medics seem to see general practice as a step down from 'real medicine'. I guess I started off with no hospital experience, so to me a GP has always been how I've visualised a doctor.
I just can't see myself doing ward rounds forever.
Monday 7 January 2008
Yes, so it's a little late...
I appreciate that resolutions are meant to be made on January 1st, but I was hungover then. So when I sat down to attempt to start revision with some equally dedicated colleagues, we skipped the work part and made lists of how to be better. Here goes...
New Year’s Resolutions
Be elegantly inebriated – no accidental sexual hiccoughs, bad text messages or conversation that will be regrettable the following morning.
Replace some 5th/Tarts nights out with classy Northern Quarter visits with aim of meeting new people and securing at least one date (however bad) a month.
Aim to reduce caloric intake from alcohol and avoid particular drinks that may cause “lairy” behaviour or any other undesired effect.
Do minimum of two exercise sessions a week (dancing in clubs does not count, even if thighs hurt the next day from acrobatic, over-ambitious porn-star-esque moves).
No skiving due to hangovers, regardless of epic boy trauma, notification of clinical partners whilst under the influence (of alcohol and/or each other), or fabulously concocted excuses.
Be aloof, poised, fabulous and sophisticated with not a hint of bitterness (at least when not in the privacy of our own homes).
Live within our means. There is no justification for £18 bottles of Jack Daniels, eight pairs of new shoes in two weeks even if they are in the sale, or ridiculous items from the kitchenware aisle of Tesco.
Aim to eat three proper and healthy meals a day. Cut out late night fast food and overpriced deli sandwiches (just because you can’t be arsed to make a packed lunch) and eat at least four portions of fruit and veg a day. Plus, drink loads and loads of water and green tea, cos it’s good for you.
To summarise… drink less and be better.
Also, do not allow oneself to be led astray by less dedicated members of the trio.
(The 8 pairs of shoes were mine. But they were really pretty...)
New Year’s Resolutions
Be elegantly inebriated – no accidental sexual hiccoughs, bad text messages or conversation that will be regrettable the following morning.
Replace some 5th/Tarts nights out with classy Northern Quarter visits with aim of meeting new people and securing at least one date (however bad) a month.
Aim to reduce caloric intake from alcohol and avoid particular drinks that may cause “lairy” behaviour or any other undesired effect.
Do minimum of two exercise sessions a week (dancing in clubs does not count, even if thighs hurt the next day from acrobatic, over-ambitious porn-star-esque moves).
No skiving due to hangovers, regardless of epic boy trauma, notification of clinical partners whilst under the influence (of alcohol and/or each other), or fabulously concocted excuses.
Be aloof, poised, fabulous and sophisticated with not a hint of bitterness (at least when not in the privacy of our own homes).
Live within our means. There is no justification for £18 bottles of Jack Daniels, eight pairs of new shoes in two weeks even if they are in the sale, or ridiculous items from the kitchenware aisle of Tesco.
Aim to eat three proper and healthy meals a day. Cut out late night fast food and overpriced deli sandwiches (just because you can’t be arsed to make a packed lunch) and eat at least four portions of fruit and veg a day. Plus, drink loads and loads of water and green tea, cos it’s good for you.
To summarise… drink less and be better.
Also, do not allow oneself to be led astray by less dedicated members of the trio.
(The 8 pairs of shoes were mine. But they were really pretty...)
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