Sunday, 30 March 2008

A Fitting End

Contrary to the title of this post, it isn't a story about rectal diazepam.

Tomorrow heralds the start of my final 4 week hospital placement: lower GI surgery. Rather fittingly, this is the same as my first ever clinical placement at the start of 3rd year (I wonder if the consultant will recognise me?). I wonder how much I've learnt and how far I've progressed in that time? Hopefully quite significantly! How much time I'm actually going to be able to devote to this placement I'm not entirely sure as I have an ever-growing list of other things to attend. I hope to spent most of the time with the F1 (fingers crossed that they'll be friendly and helpful, although its all change next week anyway as the F1s rotate).

The fact that this is my final placement means a couple of things: the first and most important thing is that finals are just 6 weeks away, secondly, in seven weeks it'll all be over one way or another, thirdly, that I have 4 PBL sessions left EVER and finally, that in 6 weeks I will hopefully never have to set foot in a certain city ever again!

To be perfectly honest, I wish finals were tomorrow. I just want to do them and get them out of the way. Sure 6 weeks is a long time and I've still got lots to learn, never mind revise but I'm awfully fed up of just waiting for these exams to come.

This weekend I attended the medicine version of the revision course I wrote about 2 weeks ago. It was a completely different style to the surgical one in that it concentrated on exam technique more than knowledge but it was useful nevertheless.

Friday, 28 March 2008

Vein Hunter

I'm a vein hunter. No, not an assassin of those with Narcissistic tendencies, but instead a pursuer of veins. My time in A+E has turned me into some sort of sadistic predator. My chosen weapon is a venepuncture needle. I stalk, like a cheetah on the savannah, just waiting for the chance to pounce. Every patient is a potential victim, but each with their own particular characteristics. A young man with magnificent engorged vessels entwining his arms - it would be almost too easy to swipe two bottles. Or you’d think so, until he begins to whimper in desperation, "I don't like needles", but it's too late I think, as the blood begins to flow and I reassure him; "almost done". A middle-aged man with similarly bulging veins, barely even flinches as my weapon penetrates his flesh with the greatest of ease. But these examples are like feeding meat to a crocodile, it is too easy, where is the fun, the challenge, the adventure?"

Go and bleed the lady in 9" my heart flickers, slightly nervous knowing that the 86 year old's veins are likely to be buried deep. This is more like it, I think to myself as I cleanse my hands in the ritualistic sacrifice of bacteria. I assemble my weapon and approach, pausing briefly to introduce myself, a mere interruption to what lies ahead. I strap on my tourniquet and begin to look for a potential victim. Like rabbits hidden in a burrow there is nothing, not even the scent of prey. I ask the patient to squeeze her hand while I gently feel my way around. Still nothing. Am I to fail at the first hurdle? I retrace my steps, carefully examining for the hint of blood streaming through a vein, hidden deep. YESSS! What's that, invisible to the eye and barely palpable, the mere hint of a vein? My fingers tell me its exact position and I load the needle. It is time.

Majestically, I recheck the vein, I panic as momentarily it's gone, but no, there it is. Oblivious to the world around me, I almost fail to hear the elderly lady announce "the district nurses always have trouble, they can never find any blood" - this just encourages me! I get into position, needle poised, "sharp scratch" I announce as I ease forward through the skin. With practice you can feel the needle puncture the vein, you think it's there. You ease back the syringe plunger and without delay a gush of red pours into the tube. You've hit the jackpot, first time too, perfect - but it’s not over yet. You've got to change the tubes, keep the needle perfectly positioned and finally, withdraw the needle. All in all a triumph, a perfect hit, another victim.

It's become a game, no longer challenged by the simplest of veins, only the difficult ones give the same satisfaction, the same feeling of achievement, the same buzz. I'm a vein hunter!

Wednesday, 26 March 2008

Reacting to Unexpected Situations

I've been in A&E for a couple of weeks now and you can never predict who or what is going to come through the door next. It could pretty much be anyone, from any background with anything wrong with them. You can't foresee every possible situation you might have to deal with.

What happens when its not something clinically relevant, but it surprises you nonetheless? For example what if a patient, during the middle of a consultation, says something unexpected? What if they go on a 5 minute racist rant about the state of 'our' country? How do you react to something like that? Particularly as a medical student, but even as a doctor or nurse. You can't possibly sit there and agree. At the same time you can't really challenge the person's views, that isn't what you're there for. So, do you just sit there politely and let them rant until they can rant no more? Do you look at your shoes, at the patient, at the wall? Do you make your excuses and leave? Is there a difference if your patient is a 30 years old or 90? Male? Female? What about afterwards when you have to present the case to a senior and the only seniors around are of a different race? Do you warn them of the patient's beliefs? Do you pretend you'd not heard anything? Do you go for an early lunch?

Being a doctor is much more than dealing with clinical situations.

Tuesday, 25 March 2008

What Next?

I'm not usually an ill person, sure I get the occasional bout of man flu once or twice a year but other than that I'm usually quite healthy. That was until this year, I've been ill almost constantly since before Christmas with one thing or another.

This weekend I was struck with a mysterious vomiting bug! It only lasted about 36 hours or so but I'm still feeling the effects now. Vomiting is not fun, especially when there is nothing left to bring up apart from tiny amounts of water that you've managed to drink to keep you hydrated.

I'm thoroughly fed up of being ill, it is quite literally, driving me insane!

What is wrong with me?

Sunday, 16 March 2008

A Vision of Revision

I've spent this weekend camped in a lecture theatre at a finals lecture course, not only that, I paid for the privilege. At £95 a weekend, its not cheap, especially when there is one for surgery and one for medicine. I guess whether or not they're worth it is a personal opinion, perhaps sitting at home reading a book would be just as effective and £95 cheaper for some people. A few thousand students each year attend one of the finals revision courses run by companies like the MDU so there must be something about them that makes them popular, perhaps its the misguided vision that attending such a course is a one-way ticket to finals success. I'm not as naive to think that and if anything this weekend has made me more scared than I was before.

You do get comprehensive notes but its a bloody expensive text-book! The lecturer, who was a most charismatic surgeon from Imperial, must do rather well financially out of the weekends although he does have to give up 5 or 6 weekends each year in order to lecture around the country. He didn't strike me as someone who was doing it for the money, he seemed passionate about teaching which is perhaps what made it so good, he also seemed like quiet the high flyer and had accomplished rather a lot for his modest age. He was adamant that it shouldn't be just a session about finals and paid more attention to things which will be useful if we actually get through finals to our foundation years. His lecturing style was very clear and concise with the occasional humorous anecdote to keep us all awake. He did well, lecturing by himself, to keep my attention for 2 whole days. It was odd being back in a lecture theatre having not had a proper lecture for almost 3 years (not that we had many lectures before that). There were a number of comments from the audience, made up of students from various Northern medical schools, about a percieved lack of knowledge. Without saying it explicitly, the lecturer was rather critical of some of the modern medical education methods, there was no shortage of students who agreed with him either. Many students, and not just from my medical school, are worried about serious deficiencies in their knowledge. I imagine medical students have always been worried about how much they know as they approach the end of the course and I suppose you might say its as much the students fault as the universities - but is it though? Not in my opinion, I recognise the importance of self-motivated learning, but there is a different between being self-motivated and having to teach yourself EVERYTHING! I could sit here and rant about things as I've done so in the past, but I won't, I'll leave it there but I really wished I'd been lectured to a little more in the last 5 years!

It is no wonder such intensive revision courses are so popular with a promise to prepare you for finals and personally I think it was worth every penny. I've learnt a lot and revised a lot over the last couple of days. Admittedly I missed my lie-in and doing physiology on a Sunday morning is not something that I particularly enjoy. One of the things I've realised is that there are more important things than finals, what about when we actually become doctors? It isn't going to matter who knows about Landau Kleffner syndrome, its going to matter who can actually deal with patients and who is competent.

Saturday, 15 March 2008

Flipping Shoes

This is a picture of our living room floor, you might thing its staged, but I can assure you it isn't! This is just the normal state of our house. There are no less than 7 pairs of shoes here, all of which belong to missbliss. This colossal mountain has accumulated over a matter of days! How many pairs of shoes does one person need to wear in a few days?! Never mind have immediately available on demand in a pile on the living room floor. I don't think I've worn this many different shoes in the last......well..... ever!
Hopefully I'll make it out of the house today avoiding the huge obstacle that is this pile of shoes.

Thursday, 13 March 2008

"There is a 3:38 in Bay 5"

Having spent a few days in A+E, it is already immediately obvious what the most important thing is. Wouldn't you think that in 2008 the central focus of care in the A+E department would be the patient? It isn't the nurses' fault, nor the doctors', both of whom work very hard to ensure patients receive the best care possible, but there is something more important on their minds. What can be more important than the patients I hear you cry with horror? I'm sure most of you have guessed by now: the 4 hour target.

The 4 hour target effectively means that all patients presenting to A&E, regardless of what is wrong with them, must be seen, assessed, treated and shipped out (either sent home or forwarded on to another department) within 4 hours. This might seem like a good plan, and well, it is wonderful that nobody has to wait for more than 4 hours before they see a doctor, but unfortunately every patient is different. You can't shoehorn all patients with their vast range of problems into the same 4 hour bracket. Things just don't work like that in real life.

Sometimes it is easy to see, assess and treat patients within 4 hours. But in a fair number of cases, and particularly on a Friday or Saturday night, this is simply not possible. Or rather, it isn't possible to assess patients properly and provide the best possible care. It really shouldn't matter how long it takes, it should matter that it’s done right!

Patients are no longer known by their names, or even by their conditions any more. At best they might be known by their location – “bed 5” - but more often than not patients are referred to by a very special number. This number tells you how long they've been in the department. Displayed prominently on an electronic whiteboard is a list of all the patients currently in A&E and waiting to be seen, and the second a patient ticks past a 3 hour wait, their name lights up like a Christmas tree in bright red. If their stay approaches 3 hours 30, then the managers start to appear from their hidden lair (where I imagine they must watch intently the time spent in A&E by each individual patient). Of course they don't actually care in the slightest about Mr Jones who is having a heart attack right there in the department. The fact is, they are there to remind you that he has got to go. Wherever it may be. As long as its not A&E, and as long as it's not their problem any more. If you even mutter the word 'breach' (the description of those who miss the 4 hour target) in the vicinity of the A&E department you'll either be shot, or smothered in managers eager to find out what you know and what they can do to stop it.

In my few days in A+E I've already seen patient care put at risk due to this target. To me this is ridiculous, in fact, it's beyond ridiculous, it's dangerous. I imagine this target was thought up by someone in an office somewhere who'd not been near an A&E department since getting a little too drunk one night during their Philosophy degree. That is the problem with these things, they're dreamt up by people who haven't the faintest idea about how they will work in real life. Targets, targets, targets is all anyone seems to care about these days, forget the patients in hospital, they don't matter. I'm sure it makes wonderful headlines and prodigious soundbites for the government. Which voter wouldn't want to see "A&E Waiting Times Down!" plastered across the media? And there we have it, as much as the government, it's the fault of masses who demand reassuring statistics and some of the media, who leave only a few huddled words below a headline that hits the reader between the eyes. We need our journalists, and the voters, to look beyond headlines and ask, “waiting times might be down, but at what cost?”

Monday, 10 March 2008

A & E

So today, I finally made it for my first day in A&E, admittedly I was a week late thanks to being ill but I was glad to have made it eventually. Only then did I realise that my supervising consultant was in fact on leave all last week and is on leave all this week too so he doesn't yet know I even exist let alone that I was off all last week. His secretary had received all my messages and was pleased to see that I seemed to have recovered satisfactorily. I've been in the department before as a student so I had the briefest of tours of the department before being seconded to on of the FY2s. It is safe to say that as a student in A&E I stand out like a sore thumb, or perhaps more like a large grey blob in my beautifully coloured grey scrubs. I'm not sure whether or not they got a really good deal on awfully coloured scrubs or if it is intentional that we stand out quite blatantly so as not to look anything like we know what we're doing and we can be avoided at all costs.

Anyway I was promptly given my first majors patient and sent off to see them. The FY2 who was a bit cranky having done 8 days straight including a couple of 12 hour weekend shifts was very friendly indeed and not once made me feel in the way which is always a bonus. And so the morning continued and before I knew it lunch time had hit, although I didn't take all that long for lunch and was soon back on a now hectic shop floor. Things soon calmed and organised chaos was restored.

I didn't see any particularly interesting patients, in fact, it seems like the local GPs couldn't really be bothered this morning and had sent everyone to A&E. I was pleasantly surprised to hit some veins first time, although one 21year old almost collapsed after I'd finished with him. I enjoyed my first day, it wasn't too taxing, I learnt things and got in some good practice. I'm looking forward to the next 3 weeks...

Saturday, 8 March 2008

In 30 Years Time...

Technology fascinates me, maybe its because I've grown up with it but I've always felt affectionately towards it. In some ways it fascinates me more than life itself, what is a few billion years of evolution compared with with the technological advances of the last 30-50-100 years? Sure evolution is pretty dam clever but the technological revolution which allows me to type this and instantly have potentially millions (or, more realistically, about 30 - I can dream...) of readers is simply staggering.

Can you possibly imagine what the next 30-40-50 years hold in terms of technology...what about beyond that? Where are the limits? I'm sure some of my older readers can remember a time when there were no computers, no Internet, no CD players, no mobile phones. Of course now my mobile phone does all of that and a whole lot more. With my mobile phone which is smaller than a pack of cards I can calculate my exact position on the Earth using GPS, find out where my nearest book shop is and navigate my way there. When I get there and I've forgotten the name of the book I'm looking for I can use the Internet on my mobile phone to check, then, if they don't have it in store, I can order it over the Internet there and then and have it delivered to my door. I can do all that whilst listening to my entire CD collection and taking pictures of myself at the same time! Why I would want to do any of that when I could have ordered the same book online at home without any of that hassle is beside the point - I do it because I can! Oh and I suppose I could mention I can use my mobile phone to make phone calls too! I remember when my dad got his first mobile, he was quite an early adopter for business reasons, you can buy cars smaller than the phone he had back then and all it could do was make calls, sometimes. Nevertheless I was fascinated and of course I instantly knew everything about it before well before he did. Now, almost every person over the age of about 10 (although many younger people have them too) has a mobile phone which makes everyone almost instantly contactable. The pros and cons of this are another post in itself but as technological feats go its gigantic (the instant contact breaks down a bit when people have their phones tucked in the glove compartment for emergencies only *cough* older generation *cough*). It is almost impossible to imagine going back to a time pre-mobile phone, young people today cannot possibly imagine a life without it how would they possible communicate 150,000,000 sms messages worth of information per day! That is just in the UK, an average of nearly 3 messages per person every single day! Extraordinary.

The mobile phone is just one example of the technological revolution but what is the most important? In my opinion it is the Internet, not only the Internet itself but much advancement has been brought about because of the Internet. I know, that right now, I can find out almost anything I want or would ever need in about 10 seconds using Google. I can buy almost anything, I can download and listen to almost any song ever made, I can chat to people on the other side of the world.

I'd never imagined a life without technology before our Summer trip to the Solomon Islands but even there, in one of the most remote places on Earth technology is slowly creeping in. Its a long way behind and the people of Lata are a long way off plasma screen TVs and mobile phones which access the Internet, in fact, these things may never make it there - perhaps they don't need to. I couldn't live like that knowing what I do now about the world so if I ever do emigrate to the jungle I'll be taking the biggest possible satellite dish a mountain of toys. Technology is what I missed most about the developed world.

I can spend hours reading about technology, studying my favourite magazine T3 is one of my favourite things and the first blog I usually check is Engadget. If I could muster the same enthusiasm for studying, I'd never have any motivational issues. The kick of adrenaline I get when researching a new gadget purchase is only super seeded by that of opening the box and reading the instructions. Many would call it sad, I'm sure, but to me its a hobby, apart from missbliss, technology is what I live for. I love it.

Metaphorically, technology runs through in my blood, it probably won't be long before that metaphor becomes literal as nanobots sweep through my veins zapping cancer cells as they form. I know it sounds like science fiction now, but what about all that we've got now? That was the science fiction of 50 years ago. I can't wait to see what happens during my lifetime I don't think any of us can imagine some of the changes to come in the next 30 years never mind the next 100 or 200.

N.B. I recently bought myself a TomTom 520 GPS Sat Nav system for adventures ahead in new places. Whether this was the inspiration for my declaration of love to technology I don't know.

Thursday, 6 March 2008

I'm Improving - just a little

You'll* be pleased and relieved to know that I'm improving.
*I know some of you won't, but still.

Its slow though, I'm taking my Pen V religiously and I think its probably that which is helping. Having caught sight of my tonsils I've decided I probably have tonsillitis with a bit of sinusitis thrown in for good measure. I'm thoroughly fed up of being ill but I want to get right, which I'm still significantly far from, before I venture back into hospital. As a result I think this week has been a complete washout, rain-stopped-play!

I did the washing up this morning, something which is usually a something and nothing job, there wasn't even a lot of it but it almost killed me. Half way through I was fighting exhaustion, pain and hotness and clinging on by the skin of my teeth. I purposefully sprayed the cold tap at my face on several occasions to prevent me collapsing. After the mountainous load of a few cups and plates I couldn't face the the pan and promptly went to bed, collapsed and fell asleep for about an hour, I was absolutely shattered, it was like I'd run 7 marathons in 7 days.

I've also started to eat a little bit, which ought to improve my energy as for about a week I've had a bit of scrambled egg and a bit of toast. I'm wasting away. I even refused fish and chips last night and that is NOT like me!

I'm looking forward to hopefully (crossing fingers, touching wood and praying) feeling better next week when hopefully I'll have something more interesting to blog about than my temperature and mucus.

Wednesday, 5 March 2008


I'm so very poorly and its driving me fucking insane! This year so far, I've had more illnesses than I've had in my entire life.


For the past 3 months I've had sort of a chronic sore throat, except its not actually my throat its more my nasopharynx (the bit above my throat) It was more of an irritation than anything most of the time with a feeling of sticky mucus I needed to clear. Sounds a bit like PND (post-nasal-drip) right? well yeah, that's what the doctor thought that I saw about a month ago. Unfortunately that night I awoke with a raging fever and was ill for a good few days, my throat became acutely worse, was painful to swallow, I felt generally like shit, had a headache, was clearing some greeny mucus from my nasopharynx and had a few days off. I couldn't get a doctors appointment and I improved but was left with the same chronic PND like symptoms, I checked myself out for malaria and glandular fever, both were -ve but I did have some raised white cells.

Last week I awoke with the same fever- even with the same accompanying dream. By this time it was starting to drive me slightly crazy. The symptoms got worse and worse over the weekend and I finally got to see a doctor (I basically had to crawl there feeling atrocious) He didn't have much of a clue but agreed that it might be time for some antibiotics so gave me some penicillin.

So what were my symptoms? Fever, vomiting, Very painful swallowing (but I don't think in your typical tonsillitis type way) Lots and lots of mucus I had to clear which was green and brown (clearing this did offer mild relief), foul taste in my mouth, being barely able to talk due to throat, sinus headache and feeling generally like shit.

Things do seem to have improved in the last day or so with the antibiotics in that my fever and generally shitty feeling have gone now but my throat/nasopharynx is still ridiculously painful and is producing lots of mucus which since the antibiotics has become black and reddish. Drinking cold water relieves my throat temporarily, I must have drunk litres and litres of it this last week.

I've been taking loads of paracetamol and decongestants as well as my penicillin which is helping too, at least to make the mucus a bit less sticky. missbliss has been looking after me but all I've managed to eat is a bit of scrambled egg.

I've missed the start of my A&E placement which I'm really pissed about as it only 4 weeks and i'm probably going to miss about a week of it. I was really looking forward to it too. I'm thoroughly, thoroughly pissed off with life at the moment.

What the fuck is it and how do I get rid of it for good?

Something else?

sorry for not blogging recently