Something Strange

I don’t even know where this week has gone! I can believe there’s now only one week left until exams (ahhhh), and that in two weeks I will be in Australia =O There’s still so much left to do for both - eeep!

I need to try and revise the whole of medicine and surgery in the next 7 days (despite not having finished being taught it all yet!), then panic about the ominous OSLER, then, having done my last exam at 9:30 Friday week, I’ve then got to make sure I’m packed and ready to board my flight less than 12 hours later!

What is the OSLER? It’s the bigger, scarier, crueler older brother of the OSCE from first and second year. Okay, I’m being a bit melodramatic but it’s certainly daunting, in part because we haven’t done one before! The OSLER involves braking a history from, and examining a patient (including their heart, lungs, and abdomen), before having 5 mins to present your findings to the examiner. They then have 5 minutes to ask you questions about the patient and whatever conditions they may have. Lastly, there are two OSCE stations - but instead of being 6 minutes, there’s now only 5, and 1 of those minutes is supposed to be spent presenting your findings. So it’s a 55 minute behemoth in my opinion!

Fortunately I had the opportunity to do a mock exam on Monday and it didn’t go horribly. There were quite a few things I forgot (for instance I always forget to check people hands for ‘flapping’) and there’s plenty to improve on, but overall it wasn’t awful. There’s hope for me yet.

As for the massive knowledge exam, I need to keep telling myself that I only have to pass. Sure, I want to do better than that, but I only need to pass. That’s all any of us medics need to do. We’ll still graduate, we’ll still be doctors, and we’ll still be great doctors in the end. Naturally I’m still gonna try to do better but I’m trying to also keep things in perspective a bit (trying to) in order to panic/freak out less. I’ll let you know of it works.

The other major thing I need to do this week is pack! I’m going to utilise revision breaks to try and cram 6 months-worth of stuff into a suitcase! Hopefully it’ll stop me panicking about exams and start getting excited about Oz! I’m mostly sorted I terms of important document but there still seems to be a long list of things to sort out!! But I’m not complaining :P

Have great week guys, I’ll try to despite revision!

Firstly, I’m sorry about missing last weeks blog post. My excuse is that I was on a train back from home (having spent the day celebrating my Grandma’s 90th birthday!), got in about 11pm, and realised I had left my charger at home so had no battery. Oops.

So this is a ‘double post’ covering 2 weeks! I’ve got to write it all quickly though - I’m having a BBQ with my housemates/hall friends and I’m already late!! (Double oops)

Right, highlights of the 'missing’ week: meal with my firm (the 5 other people in my clinical placement group with whom I have teaching etc) which involved delicious food (expertly cooked by one of the boys) and a hilarious game in which I got way too competitive. It also involved one person thinking that masquerade had a 'c’ in it….before the second a, and I forgot what a teapot was (for the record, it’s not a genie lamp, tea cup, or mini tea kettle). Friday night I celebrated my brother finishing his exams by finally watching Pulp Fiction and eating an impressive amount of pizza and ice cream. Then it was off home for the weekend to celebrate my Grandma’s milestone - involving the funniest communion (part of a church service) I’ve ever been too!

Then this week I got to see anaesthetics in action: I saw a patient being given and epidural (a injection of general anaesthetic into the spine), general anaesthetic (which puts them to sleep), and being intubated. I also got the chance to talk to the anaesthetist about the specialty and what the training involves, so that was useful and another consideration for my future.

I also took another trip home to have my health check - a require for my Australian visa - and I can now say I have a clean bill of health! Or I’m at least healthy enough to be allowed into the country =] Another step in the right direction! Now all that’s left it money, housing, packing, and so on…. Oh, and there’s the tiny hurdle of exams to jump over too…. eeep. While a lot of people have finished exams (some have even finished Uni!!!), I haven’t even started yet. There’s 2 weeks until crunch-time and it’s safe to say I’m already getting freaked! Hopefully I can up my game these next couple of weeks to nail them and head of to Australia feeling good. Worst case, at least going to Australia will cheer me up =D

Today’s been pretty busy though - this morning I did the Race For Life with the football girls (and ran my fastest ever 5k), then this evening I’ve got this BBQ =]

Speaking of, I’m going to finish this post and go - I’m starving! Have a great week guys and well done to everyone who has finished!! Congratulations and enjoy your summer =D

This week I spent a day on SAU - the Surgical Admissions Unit which meant starting the day at 8am with the morning handover and ward round, and staying until the evening handover at 8pm. The aim of these ‘surgical on call’ days is to get an idea of what happens when patients are first admitted and assessed, and how the unit is run - similar to the 'AMU week’ I had when I was on my medicine rotation (which you can read about here). I also went to a hepatobiliary (HPB) clinic (this area of medicine is mostly about the liver, gallbladder, and pancreas) and a very rapid urology theatre list. Oh, and I passed my last two MACCS (mandatory assessments of core clinical skills)!

One of the major things I learnt this week was that communication is integral to practising medicine. First example: the first patient at the HPB clinic had learning difficulties, which meant they didn’t have capacity. In medicine, every time we want to do something regarding the patient, we need their consent - including simple things like taking a history or drawing some blood for tests (depending on what we want to do, it can be written or verbal). In order to get consent we have to be sure that the patients are able to understand what we’ve told them and are able to make a decision based on that information - they need to have capacity. I won’t go into all the ethical details (it could end up being a looooong post) but in short, this patient didn’t have capacity because she wasn’t able to take in the information given to her and wasn’t able to make decisions about her health. So what happens when a patient doesn’t have capacity? Usually someone else (e.g. a relative or a carer) takes the reigns and makes decisions for them. But it’s not that simple. In order to protect the patient, there are rules/guidelines that need to be stuck to: for example everything needs to be in the patient’s best interests, and needs to be minimally invasive/harmful. Coming back to the patient in the clinic, they were accompanied by their carer, and the hospital provided a disability liaison who was there to make sure that their needs were met and that everything was ethical.

You’ll be pleased to know that it was all done by the book and all parties were satisfied. I also noticed that the consultant, though they mainly talked to the carer to make sure that they, as the decision-maker, knew what was going on, they also tried to talk directly to the patient as well to include them which I though was nice. Although this particular patient didn’t really seem to understand anything that was going on, it was reassuring to think that the doctor was still trying to involve the patient, especially since there will be other patients who lack capacity but may still be aware of what is going on and will greatly appreciate being spoken to directly. The same thing applies to children.

Example #2: I spent a lot of time on my SAU day taking histories from patients. This is were listening to the patient is very important in order to pick up all the little clues pointing towards what’s wrong. It’s said that the diagnosis comes from the history and examination of the patient, and that tests are just to confirm the diagnosis, or to chose between 2 or 3 options. Now that I’ve actually learnt about some medical conditions and have got more comfortable with taking histories, I’ve found that my guesses at what the patient has are getting more and more accurate. Communication is also important when presenting the history to a senior - the aim is to quickly and concisely tell them what you’ve found and what you think in order to allow them to get up to speed and efficiently help the patient. On ward rounds, the junior doctors give the consultant or registrar a summary about the patient’s history and their care so far so that when they go see the patient they don’t have to ask all the same questions and get straight to point: working out what’s going on and how to help them.

The morning and evening handover is another similar example of how critical communication is. During these sessions, the team that has been caring for the patients on the ward all sit down together with the team that are going to be taking over from them for the next shift. They tell the newcomers about the patients, their diagnoses, and the plan for their treatment including tests they need or wards they need to be transferred to. They also include any information about incoming patients (e.g. from A&E), and tell them things they need to monitor e.g. some patients may need repeated blood tests, or some patients may be particular poorly and need a close eye on them. All this means that, despite only turning up on the ward 30 minutes ago, the new team know who they’re working with for that shift, and what patients they have - pretty important information if you ask me.

A final example of beneficial communication again stems from my experience on SAU. A young patient was admitted and needed a cannula and some bloods drawn. This involves sticking a needle into their arm in order to slide a little hollow plastic tube into a vein. This allows drugs e.g. pain medication to be quickly administered. So it’s undoubtedly beneficial to the patient. Unfortunately it can also pretty uncomfortable and can be a bit painful too. The patient was already pretty anxious and in pain so they obviously weren’t feeling to great at the prospect of having the cannula stuck in. I initially went in with the doctor with the hope of getting to try putting the cannula in myself, but once in the room we both agreed it’d be best for the doctor to do it themselves. So instead I was going to watch and see how they used a special connector to draw some blood at the same time. But that plan changed when I saw that the patient was getting a bit distressed about the whole thing. “How old are you?” I asked quickly, trying to distract them. Fortunately for me, there were school-age which meant I could ask lots of questions about school and their favourite subject, and what they wanted to do in life, and it meant I could ramble. It didn’t stop them noticing when the needle actually went in but it did seem to help them relax a little throughout the whole thing. It may seem a little lame to some, but to me I felt like I had actually done something to help. I may not have stuck in a cannula or made an important diagnosis, but I felt I had made a slight difference in their care. It also made me once again realise the importance of remembering that a patient is a person not an illness, and that sometimes talking to them can also help.

So that’s what I learnt this week! I hope you all have a great week, and good luck to all the people who are blasting their way through exams!
           

Or is it? This Monday I got to see neurosurgery! We don’t have any neurosurgery timetabled, but I remember being told that we can see the stuff like spinal, emergency and neurosurgery that isn’t officially timetabled for us if we ask nicely and persuade the surgeons to let us in.

So I turned up on Monday morning and asked if there any neurosurgery was scheduled, and I was told that the man in scrubs stood a few feet behind me was one of the surgeons! I was in luck =D so I politely asked him if I could come watch and he said it was fine and told me to get in scrubs and meet him in there. Score. So I was going to get to see a tumour excision. But wait, it gets better. One of the consultants arrived and, while we were waiting for the patient to be given anaesthetic etc. (there’s a lot a to do to prepare the patient for brain surgery, I’m sure none of you are surprised), he showed and explained the scans of the tumour to me which was really cool. He also told me about subdural haematomas (bleeds that occur between the brain and the skull). But it gets better. He then got me scrub in! I was now really glad I woke up early! So I was getting to scrub in for the first time, which also meant I could stand really close to the surgeons as they operated. And still it gets better! Since there were using a microscope to visualise the brain better (it’s precise stuff, as you might hope since it’s the brain), I got to look down the other viewing piece so I got a super-close up view of the whole operation. And that’s not all! When they removed the tumour (which in itself was a magical moment), the consultant then asked if I wanted to feel it (of course I did), then asked me to cut it open to see what it looked like inside! I felt pretty great getting to use the surgical instruments while gowned up like a proper surgeon =D

That’s not the early surgery I saw this week either, on Wednesday I got to see some vascular surgery. This time I stepped into the operating theatre and asked the consultant if I could watch, to which he replied, “of course. Do you know how to scrub in?” So not only was I seeing another cool surgery, I was scrubbing in again and getting stand right where the action was! To make things even better, I got to help! I held a retractor (used to hold things out the way to give the surgeons better access), and I got to use the suction tube to suck out some of the fluid (to make it easier for the surgeons to see).

Being in surgery was amazing. It really hit home that these are real people that the surgeons are working on and it’s incredible how they’re able to navigate their way around the body and skillfully fix whatever ailments the patient may have. It was also really different seeing the anatomy up close and personally, in a real live person - it was totally different to dissection last year. Being in theatre this week has been a fantastic experience full of wonder, hopefully this week will bring more of the same!

Another enjoyable thing I did this week was help teach some of the first years about heart failure to help the revise for their exams which start this week. It once again showed me how much I love teaching, I really miss doing the weekly anatomy sessions with SCRUBS (despite the mammoth amount of work it involved). In fact, I would definitely consider becoming a teaching fellow when I’m qualified to teach the pre-clinical and clinical students. Still haven’t got a clue what specialty I want to do though!

I’ve also made progress in terms of preparing for Australia, I have now received and accepted my offer to study there, and I’ve also now sorted both travel and health insurance =] Next up is applying for my visa, getting the necessary (and very expensive) health check, and filling in some forms that are required for me to be able to study clinical medicine. So, uhm still quite a lot to do!

Anyways, that’s enough from me! To all the people starting exams this week, good luck! Have a great week guys =D

Firstly, sorry for not writing this last night. My is that I was super tired (I spent the day playing rugby - oops) and needed to get up early in the morning to try and see some cool surgeries. Anyways, here is a summary of my week:
It was my first week on my surgical attachment and I actually got to see some surgery (reason one for the pun in the title)! I got stuck right in on Tuesday morning and saw two hepatobiliary surgeries (hepatobiliary surgery basically covers the liver, pancreas, gallbladder and bile ducts). I can’t go into too much detail, but one of the surgeries was laparoscopic (‘keyhole surgery’), which was really cool because the whole thing was done through tiny little holes in the stomach using a camera to see inside!

During the week also involved a few teaching sessions - we had our first session with our assigned vascular consultant who was awesome! He was straight to the point: he was gonna ask us lots of questions and expect us to read up for his sessions…but he’s not going to tell us what they are about (I think he was joking about that…but I’m not sure!). I went into the session basically knowing nothing about vascular surgery but I came out feeling like I know everything. Just kidding, I still know nearly nothing, but at least I now know more that I did before!

Talking of knowing more than I did before, I went onto the hepatobiliary ward later in the week to try taking a history from a patient, and I was able to work out what was wrong and what surgery they had done - progress! Maybe I am learning some stuff by osmosis after all =D

So, as a reward for surviving my first week on surgery, I spent Sunday at a rugby sevens tournament which rocked. Sevens is basically rugby but with only 7 players on each team, while still playing on a full-sized pitch. This means a lot more running! I really enjoyed getting to run around lots (well, until I got worn out of course) and getting to 'cut’ and 'step’ round players (reason number 2 for the punny title) to avoid their tackles. It was a laid-back affair with the teams in our part of the competition all there to just have some fun and not take themselves too seriously, so it was a great laugh. One of the teams was only able to muster up 4 players so, being the stellar citizens we are, the uni team volunteered to loan some players (we also pilfered some players from the amply-supplied West Bridgford team) in order for them to compete. Good for me because it meant I could play twice as many games!

Right, I need to get to bed because tomorrow morning I’m going to a renal clinic! Have a good week guys =D

I am shattered. I can barely move right now, even trying to look down at
my feet causes pain. Why? Because I have a major ‘rugby hangover!’
Yesterday was the biggest game of the season - the varsity game against
Nottingham Trent University - and we smashed it =D We won 24-12 after
dominating the game.
It was the best game of my 3 years at uni, I was getting in rucks,
making big tackles and I even stole a scrum! My favourite part was our
line-outs. Line-outs are the rugby equivalent of football throw-ins but
instead the two teams set up a line of players next to each other with a
gap between them while one player (usually me) gets lifted into the air
to try and catch the rugby ball as it’s thrown down the middle between
the teams. We decided before the game to do a catch-and-drive each time
to set up a rolling maul - this is when the person in the air catches
the ball and holds onto it until they’re back on the ground. Then, the
rest of the forwards (7 other team members) join up, sort of in a big
hug, and the ball taken to the back by one of them. The point of this is
that there are now 8 players joined together who can push against the
other team to make ground towards the try-line, while the ball carrier
is protected at the back so they can’t be tackled and can keep moving
forwards. Our mauls were unstoppable, Trent just couldn’t slow us down!
One of the times we were actually running against them instead of
slowing pushing our way forwards. It was awesome, especially since my
parents and brother were all there to see it!

So that was fantastic, but I’m now very glad there is bank holiday
tomorrow because I’m ridiculously stiff and bruised after yesterday.
After the bank holiday, I’m starting my clinical placement in surgery!
This means I’ll have the opportunity to watch real live surgeries! Don’t
worry, I won’t be let loose on real patients while in there. I will
still be able to go on wards and to clinics during the next 7 weeks so I
can still practise taking histories and presenting them as well.

To help prepare us for our stint on surgery, we had an introductory
session Friday afternoon in which we were shown how to scrub in (in case
we get the opportunity to get close to the patient during the surgery,
instead of standing at the edges of the room). It involves meticulously
hand-washing with copious amounts of  browny-yellow iodine scrub,
carefully putting on a sterile gown without touching the outside of it,
and then putting on sterile surgical gloves while your hands are still
inside the sleeves of the gown - a task which is going to require some
practice! While we don’t have to scrub in every time if we’re just
observing the surgery, we do always get to wear scrubs which I think is
really cool =]

So I’ve got a lot to look forward to….I’ve also got a lot of work to
do! The past 7 weeks on my medical placement have been insane and I’ve
had a lot of information thrown at me so now I need to use some of spare
time during the next few weeks to actually make sure I’ve learnt it all
- it’s not going to easy =/ But hey, I didn’t pick a medical degree for
an easy ride, I knew I was signing up for a lot of hard work.

Anyways, I need to rest my aching bones. Have a great week guys =D

Sorry for the lateness of this post - I was having internet issues meaning I wasn’t able to post this last night!

Anyways, so this week I was on my ‘AMU week’ - which stands for Acute Medicine Unit. This meant I spent the majority of my time (when I wasn’t attending teaching sessions) on one of two acute admission wards. These wards are where patients are first sent after it’s decided that they need to be in hospital, so there are patients who were bought in by ambulance, admitted from A&E, or referred by their GPs. Patients are then 'clerked’ - basically they’re seen by a doctor who takes a history to find out why they’ve been sent in and try to start figuring out what’s wrong with them, performs an examination of their heart, lungs, abdomen, and any other key areas (e.g. legs/skin or neurology). They’ll then write down their 'impression’ - the fancy word for 'what I think the problem is’ - and come up with a treatment plan which usually comprises some more tests to confirm the diagnosis and determine the best treatment. This is all written down in a little booklet which is then put into the patient’s file. In the booklet there’s also a section for the 'senior review’ which is when someone higher up e.g. a consultant does a ward round and decides what needs to be done next for the patient.

So guess what I got to do - I got to see lots of patients and 'clerk’ them! The first couple of times I saw patients, they’d already been clerked and I saw them with another student. We wrote our findings, diagnosis, and plan down on a different piece of paper before comparing it to the notes but it was really good because we were, for the most part, right! So maybe some of the information that’s been thrown at me in vast quantities these past few weeks has somehow sunk in! Later on in the week we were allowed to write in the official booklets themselves, and after they had been checked over by someone who’s actually qualified, they were filed and officially used in the patient’s notes! It may not seem much but to me it’s pretty cool - something I did was useful! This week I also took lots of ECGs (the thing were you get some stickers with leads stuck on you chest so that the electrical activity of your heart can be measured). Again, I felt really useful doing it and I’ve gotten pretty good at getting the machine set up and the leads in the right places as well as actually interpreting the results (as long as it’s nothing too complicated and is one of the few heart conditions I actually know =P).

Another good thing which happened this week is that I made the team for varsity!!!! I don’t know if I a sub or a starter yet - we’ll find that out tonight after training - but I’m glad I’ve made the team again =D It’s going to be another busy week and it’s my last week on medicine before switching to surgery but it’s really the weekend I’m looking forward to! I’m ready to beat Trent on Saturday!

Have a great week guys =]

This week I think I’ve made some progress! I’ve passed another couple of
my maccs (mandatory assessed core clinical skills) - this time
examinations of the central and peripheral nervous system, and Ive taken
some more histories from patients, I feel I’m really starting to get
the hang of it in terms of remembering what conditions have which
symptoms, then matching that to potential questions to ask. I still need
a lot of practice - it’s hard to thinks about so many things at the
same time! You’ve got to remember the different ‘sections’ you need to
cover, like family history and past medical history, you’ve got to
remember what questions you’ve asked and still need to ask, you’ve
obviously got to pay attention to the patient and remember their answers
while also trying to put it all together in your head so you can figure
out what the most likely problem is, then work out which questions you
need to ask to confirm it is that, as well as important questions to
make sure it isn’t something else (especially if that something else
could kill them super quick!). So it’s a lot to think about all at once!

This week I also had a really good meeting with my 'reflective tutor’.
She’s a foundation doctor (meaning she’s just qualified) and her role is
to give me advice etc. One of the things I have to fill out in my
logbook is a couple of 'reflections’ on my experiences as a CP1 student
to basically make sure I’m turning up to things, and thinking about what
I’m learning. Anyways, this meeting was really helpful because we had a
discussion about my reflection, then I got to present one of the
histories I’d taken earlier in the week and my tutor gave me tonnes of
really good advice about the condition the patient had, how to treat it,
and how to take a better history and present it better. Super useful.

My reflection was on another experience I’ve had this week: I went to an
endoscopy list and saw a colonoscopy and an 'OGD’ - which is where they
stick a camera down your throat to look at your throat, stomach, and
the start of your small intestine. One thing that stuck with me was how
unpleasant it was for the patients, at best it was unpleasant but for
some it can be painful! This made me think about other times we have to
cause some harm to patients in order to help them. For example, even
just taking blood for a blood test can be painful, and inserting
cannulas so that they can be given important medications can take
numerous painful attempts. Suddenly, the lectures on medical ethics from
the last two years seem a lot more relevant - the four principles of
justice, autonomy, non-maleficence and beneficence aren’t just for
special occasions, they able to everyday practice. Sometimes it’s
obviously the right thing to do, the blood test might reveal what’s
wrong with the patient, or the cannula might let them receive
life-saving treatment, but it’s not always like that.

So that’s just a couple of things that happened last week. This week is
my 'AMU’ week where I spend the week on the Acute Medical Admission
wards to get a taste of how patients are managed when they first arrive
in hospital. It also involves doing to late shifts until 10pm during the
week, and one 9-5 day at the weekend. Hopefully this week I’ll be able
to take some more histories, get some more stuff signed off in my
logbook, and maybe even help admit people to hospital by filling in the
forms about their history and exam etc.

I want to talk about one last thing that happened this week: I got taken
on a mystery day out by some of my friends as a belated birthday
celebration and it was awesome! I had no idea what was planned (which
was completely strange to me as I tend to plan everything!), all I was
told was to be ready to go out at 11am.  First I was taken for a picnic
and a couple of hours exploring the gardens at Newstead Abbey in the
beautiful sunshine. Now, when we got in the car to come back to
Nottingham, I thought that was it and was happy with my lunch in the
sun, so I was really surprised when I was then taken to play crazy golf!
This involved a lot of laughter and some very questionable attempts at
putting. And that’s not all! The next stop was an all-you-can-eat buffet
with food from around the world, including Chinese, Indian, incredible
British roast beef, and numerous varied desserts - a favourite of mine
being the vast bowl of melted chocolate. By this point I didn’t know how
to react anymore, it was so much more than I was expecting! We then
waddled our way back to watch the last two harry potter films…after
they gave me a present too! I know have an 'Australia survival kit’ with
bug spray, sun cream, a guidebook, travel shampoo and conditioner and
so on. I felt very spoilt to say the least!

Anyways, I’ve got some ironing to do so I have something smart to wear for my first day on AMU. Have a great week guys!

I am now over halfway through my medicine placement, and I still feel
like I know nothing! The good news is my CFU coursework is now out the
way, so hopefully Ill have more time (at least at the weekends maybe?)
to study… Or do fun things! This weekend I went to a friend’s birthday
party Friday night which was really fun (especially since there was
toffee popcorn and tonnes of strawberry cables and white mice sweets!),
then today I went bouldering for the first time in agesssss. This does
mean that once again I feel as though I haven’t done enough work…but
at least I feel relaxed and ready for the week ahead =]

Thursday night was also really fun - I went to see ‘the curious incident
of the dog in the night-time’ at the theatre and it was soooooo good!!!
I loved the book so I already knew I’d enjoy the plot but the acting
was superb and the production was fantastic! The set design was really
interesting, and the way the scenes were told and choreographed was
brilliant. Seriously good stuff!

This week in medicine I’ve successfully taken some more histories from
patients and I think I’m starting to get the hang of making lists of
potential diagnoses and linking them to tests that could be used to
confirm them. I’ve also heard some heart murmurs - and I even worked out
what some of them were (i.e. Which valves were affected and how). So
progress has been made!

It was only a four-day week, but we had 6 days of teaching crammed into
them to make up for the Monday and Friday we missed for Easter, so it
was a lot of information to take in! It meant I learnt a lot but didn’t
really get out on the wards much this week. Tomorrow has zero teaching,
so I’ll be back on the wards and getting in the way =P

So that’s it for this post. Have a great week guys =D