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...
Wednesday, 30 April 2008
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...)
Thursday, 6 December 2007
She died.
It wasn't the first crash call I'd been to. Whilst on placement at a DGH I went with the crash team to the gastro ward and watched them pump a very jaundiced man full of adrenaline and needles, and defibrillate his heart. However, he regained a pulse. Albeit briefly (he was expected to 'go off' again soon, but the decision was made not to attempt resus for a second time). The patient was old. He was very ill, with metastatic cancer. Somehow, it was ok.
This time was different. I was working in A & E, and the paramedics brought her in, one of them doing compressions as they moved the trolley. She was rushed into our cubicle in resus, and I took over compressions. I've taught CPR for a while now, but it's the first time I've ever done it in real life. It feels different, and there's no reassuring click when you're in the right place. But the major difference is that she was so high off the floor. I'm used to being down on my knees, using my weight over the dummy. I'm only small, I was struggling to get enough force into it and it was exhausting. Luckily this gave me something to think about so I didn't think too much about her. I stepped back, they checked her rhythm; asystole. Bad. My clinical partner took over. I stepped back and watched my consultant stick a central line in. I heard the paramedics talking to us, telling us how her son had found her at home. My partner and I swapped a few more times, she was still in asystole, and then as I was continuing compressions and starting to realise that we were going to stop soon, that it was hopeless, they let in the patient's son and mother. It was heartbreaking. He was wailing, screaming, holding her hand beside me as I was thinking that I was doing it wrong and not able to reach and his Mum (same age as mine) was dying beneath me and he was younger than me...
She was 47. No previous illness, no family history, no warning. He just came back from Uni and found her on the floor.
47.
Her husband arrived as we stopped.
Her daughter was upstairs on the maternity ward, 37 weeks pregnant with twins, admitted to reduce her stress levels.
She was just 47.
This time was different. I was working in A & E, and the paramedics brought her in, one of them doing compressions as they moved the trolley. She was rushed into our cubicle in resus, and I took over compressions. I've taught CPR for a while now, but it's the first time I've ever done it in real life. It feels different, and there's no reassuring click when you're in the right place. But the major difference is that she was so high off the floor. I'm used to being down on my knees, using my weight over the dummy. I'm only small, I was struggling to get enough force into it and it was exhausting. Luckily this gave me something to think about so I didn't think too much about her. I stepped back, they checked her rhythm; asystole. Bad. My clinical partner took over. I stepped back and watched my consultant stick a central line in. I heard the paramedics talking to us, telling us how her son had found her at home. My partner and I swapped a few more times, she was still in asystole, and then as I was continuing compressions and starting to realise that we were going to stop soon, that it was hopeless, they let in the patient's son and mother. It was heartbreaking. He was wailing, screaming, holding her hand beside me as I was thinking that I was doing it wrong and not able to reach and his Mum (same age as mine) was dying beneath me and he was younger than me...
She was 47. No previous illness, no family history, no warning. He just came back from Uni and found her on the floor.
47.
Her husband arrived as we stopped.
Her daughter was upstairs on the maternity ward, 37 weeks pregnant with twins, admitted to reduce her stress levels.
She was just 47.
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