They Think Its All Over....

Well it very nearly almost is. I finished my last clinical placement on Friday. This signifies a couple of things, firstly that I'm supposed to know everything that I could possibly need to function as a doctor and secondly that finals are in 2 weeks.

2 weeks tomorrow, my first exam, then 2 more, spread out over the rest of the week and that is it. I'm free...at least for a month until results.

As a result of this, I'm not going to be writing, or reading blogs much over the next 3 weeks. Well that is the plan anyway. I know I've already mentioned my upcoming exams plenty of times and thanks to all those of you who've wished me luck.

Best of luck to all those readers who are also sitting exams as we come towards the end of another year.

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.

Wherefore Art Thou Portfolio

Tomorrow I meet with the dean at my hospital to review my portfolio. Along with most of my colleagues, my portfolio is something which tends to get neglected until shortly before its due to be reviewed. We've had the idea of a portfolio hammered into us since we started medical school but particularly in the clinical years. I was going to describe exactly what a portfolio is, or is supposed to be, but I can't. I don't really know. I mean sure, I get that its supposes to be a record of your progression, your achievements, your reflection and all that but I'm still not entirely sure what this is made up of. I quite enjoy reflective writing (never thought I'd hear myself say that), that is one of the reasons I enjoy blogging - not that I often do much deep reflection here but you get the idea.

So I'm wondering what else should I put in my portfolio. Perhaps I should just print out my blog although I don't think that would go down too well. Some of my posts might be useful though. Fortunately today is my 'study day' so I've got plenty of time to get my portfolio in order, although saying that its already 11:00 and I've got a million and one other jobs to do today. I will do a SWOT analysis, for those of you who don't know, that is a breakdown of my Strenghts, Weaknesses, Opportunities and Threats. That should be interesting, perhaps I'll share it over at the real little medic.

My portfolio meeting could go one of two ways, it could be an easy half hour chat where I don't approach anything controversial, or it could be a half our discussion about what I really think, I've yet to decide which way to take it. A few people seem to think the dean is a bit scared of me (well not scared, so much as, apprehensive), mainly because back in 3rd year my portfolio meeting (usually strictly half an hour) took an hour as I had a list of things to talk about so long that he never even looked at my portfolio.

I actually think these portfolio meetings are rather important for a couple of reasons. Firstly there is the portfolio, nobody likes to admit it but its a fairly important aspect of being a medic, nurse or anyone else really. Its particularly relevant to medical students and doctors as reflective writing is key to the 'white box' application forms used throughout nowadays. And IF you ever finally get to be interviewed, its always useful to have a good, up-to-date, polished portfolio. More importantly as a medical student, these meetings give us individual time with the dean to express our concerns, feelings, thoughts and worries. I think this is a very important aspect of life as a medical student - but hey, maybe its just me.

I really like the dean at my hospital. Unlike every member of staff I've ever come across affiliated with the university (no offence PHD Scientist - I've never come across you so you don't count) he is actually willing to listen and empathise. He might not be able to offer a solution to things but he'll certainly let you rant away at him (at least he lets me). Sure he has his own peculiarities but don't we all? I know some people don't like him because of this, but I think he's a genuinely nice guy.

Any suggestions for portfolio material are welcome...

What Not to Wear

From Jan 1st 2008, our hospital trust has implemented a 'bare below the elbow' policy following advice from the Dept of Health. A detailed email was sent to all the medical staff (whom this encompasses i'm not sure, it may just be the doctors or it may-be all of the people who come into contact with patients). Medical staff are no longer allowed to wear: long sleeved shirts (or at least they must be rolled up), ties (unless tucked in), jackets (this is going to piss the consultants off), watches, or anything else below the elbow, a solitary ring (gold band) may be worn.

A recent BBC article covered this story, in particular with regards to doctors not being allowed to wear watches. Research showed that doctors were unable to estimate accurately pulse and breathing rate. Personally I think the restriction on watches is going a bit too far, I hate not wearing a watch, especially as the BBC article says, there are very few clocks around the hospital. I can't see many of the consultants being willing to follow the watch part of this policy but I guess we'll have to wait and see. Particularly as many don't even bother to alcohol gel their hands between patients.

What's next? A latex skin tight uniform which can be wiped down between each patient?

This topic brings up another argument as to whether doctors, having disposed of the stereotypical white coat should have a uniform. Personally I think we should all be able to wear scrubs all of the time, but apparently that doesn't match with the professional ethos that doctors are supposed to emit.

I suppose it gives students something else to worry about in OSCEs, i'll be sure to make a point that "I'm observing the bare below the elbow policy".

The Start of a New Year

Today was my first day back after the Christmas break, which I should add, seemed to go ridiculously fast. You might have remembered that I'm now doing an 8 week GP placement and I've not exactly been looking forward to it. In fact I've been dreading it, I don't know why because sometimes when I get into it I quite enjoy my GP placements. Nevertheless, I wasn't feeling very enthused when I awoke this morning.

I arrived at the GPs early and was met by friendly reception staff. The surgery is split over 2 sites, one of which was briefly my own practice. I met my supervisor who seemed really nice, I have a feeling she is going to work me hard and expect quite a lot but that is no bad thing I suppose. I spent the morning with her, although it didn't exactly go to plan to start with. 3 of the first 4 patients refused to have me in. Fair enough I suppose. The rest of the morning was surprisingly quiet, there was only a trickle of patients and about the most interesting thing was an ear with raging otitis media.

All in all it wasn't the most interesting of mornings but I'm pleasantly surprised and slightly more optimistic about the next 8 weeks. I'm also fairly pleased with my timetable, it potentially looks like Tuesdays might be all-day study days which would be fabulous, 4 day weeks are just what I need. Perhaps I will enjoy it (at least a bit) after all. It will get a lot more interesting next week when I get to have my own surgery with half hour appointments of my own! I hope the patients know what is about to hit them.

The rest of the day was taken up by my favourite thing in the whole entire world, yes that's right - PBL. The groups have changed, although 4 people out of 8 didn't make it today, apparently they are still on holiday - how bloody nice for them!!! The process itself was just as boring as ever. I even spent half an hour trying to write a poem about PBL but I was so dispirited that my creative juices were flowing like treacle up a hill.

Back to the real world, here we go with 2008 - Happy New Year!

New Years Resolution Update: Today I went to the post office and they have these amazing wine gum things that I usually eat by the crate full. I had such an urge to have 'just one packet' but I didn't I managed to resist. I almost cracked by the chocolate machine too but will-power prevailed and so far so good, i've not had any sweets, chocolate, crisps or biscuits. COME ON!

The second first day

5
5th December 2007
20 Days to go till Christmas


tlm fact: It is my lifetime ambition to own a brand spanking new red Ferrari bought from the showroom, in cash. Hopefully before I'm 45. I daresay missbliss might have something to say about this.

A confusing title indeed, today is the day that all the F1s (junior doctors) in my hospital (and probably most other hospitals) rotated to their new 4 month posts. I suppose it must be better now they've got 4 months experience but it must still be quite stressful, especially going from surgery to medicine for example. I missed that day in August when you should never under any circumstances go near a hospital because the wards are full of junior doctors on their first day but personally i'd give hospital a miss today too if you possibly could as it was somewhat chaotic and it rather scared the shit out of me thinking that i'll be in this position in 8 months!

What scares me the most is the ridiculously little amount of support the F1s on my ward received from their seniors today. My new F1, who is a pleasant chap who has just come from 4 months A+E, I helped him out quite a lot today by doing jobs, hopefully I'll be able to help him settle in a bit as I've been on the ward for a couple of weeks and know how things work. The SHO, who was supposed to be there at 9 ended up walking in at about 9 45 and neither the consultant or registrar were anywhere to be seen. Now I know its unrealistic to think the whole team would be there to greet you on your first day, but it'd be nice if someone was there to explain what the fuck you're supposed to do.

The other F1 who started on my ward today had even less success, nobody from his team turned up so he just took off and did the ward round on his own without having the foggiest idea what the hell was going on.

This situation can't be good for patient care, I know for a fact that things were missed today because of it and patients treatment has been put back by at least a few days until everyone is back up to speed.

Note to self - must make sure when I'm an F1 that I've got a reasonable idea of what I'm supposed to be doing whenever I change jobs. I'm hoping that I'll at least have some support wherever I end up, but I suppose I shouldn't expect there to be much in the way of help.

The Adrenaline Rush

4
4th December 2007
21 Days to go till Christmas

tlm fact: All through primary school, I was obsessed with becoming a policeman. So much so that I used to wear my little uniform whenever possible and whenever I wrote my name on my school work, I always wrote: PC Little Medic so I could pretend to be a policeman. Fortunately I did grow out of this and spent many years after that wanting to be a vet. I changed my mind only a year or so before applying to medical school. I've not yet taken to writing Dr Little Medic on my work so I can pretend to be a doctor.

Yesterday, I went to see some endoscopies, expecting a nice relaxing morning. Fortunately for the patients, everyone was normal. That was until there was an addition onto the list, an elderly (70+) lady who'd recently had a GI bleed. She had already been scoped but they couldn't find where the bleeding had been coming from. Her haemoglobin was already ridiculously low (i'd never heard of a Hb so low). They scoped her again and found where the bleeding must have come from and made an attempt to stop any future bleeding. Unfortunately, right there in front of our eyes (well, on camera), an artery started spurting blood inside her stomach. From this point, my heart started pounding in what must have been an adrenaline rush. By now the endoscopist couldn't see a thing because there was blood everywhere so he couldn't do anything about it. He called down the best endoscopist in the hospital to see if he could do anything and he also called the surgeon on call to take the patient to theatre if nothing could be done. Before I knew it, the room was crammed with people. Endoscopists trying to stop the bleeding, the surgeon on call and an anaesthetist assessing him for theatre. Various other doctors were running around like crazy putting cannulas in and taking blood for cross matching. Blood and fluids were being put up by the bucket load. Meanwhile I was in the middle trying to hold the patient down as she fought to remove the endoscope despite being sedated.

They couldn't do anything endoscopically, so they took her down to theatre to open her up and try to stop the bleeding. Unfortunately thats where I had to leave, so I don't know what happened. I guess I'll find out today. I hope she is ok.

I feel bad that I was sort-of excited by the emergency response to her rapid deterioration. I suppose it must have been the rush of adrenaline as people were running around me trying to do their best for the patient. The whole team were fantastically calm despite what I thought was quite a serious situation. I think it was dealt with really well and maybe the adrenaline rush that each member of the team must get helps them to do what they need to do efficiently.

Are We a Hotel or a Hospital

One of the patients on my ward has been medically fit for well over a week, unfortunately he just won't go home. In fact, he probably never needed to be admitted in the first place. He does have a number of issues, and does require some level of support but not medically. At the moment he has his own room with private bathroom and he gets fed three times a day. We're not doing anything for him, he's just using the hospital as a free hotel!

He was admitted with complex symptoms which needed to be investigated but he could have gone home a few days after being admitted. Coincidentally, when he was admitted, his partner (who provides the care he needs) was to be admitted for an elective procedure the next day (so wouldn't be there to provide support for him). The cynical among the staff, suspect that this isn't the coincidence it was made out to be.

And so it is, we're stuck with him, don't get me wrong, I think he probably did need some help at home when his partner was going into hospital but hospital isn't the place. He's medically fit so is just tying up a bed at the moment and who knows when he'll go home. I suspect in the old days he'd have just been kicked out, but now, there are complex issues when it comes to discharges, especially in complicated cases. As a result, its almost impossible to get rid of someone who just won't go.

We're not a hotel, we're a hospital. A hospital that is currently in the midst of a serious bed crisis, so much so that we might be closed next week - not a surprise really with patients like this.

n.b. Patient details changed and omitted for confidentiality.

I Actually Like Medicine!

Yes ladies, gentlemen and others, I actually want to be a Doctor and I'm really looking forward to it. Just about every medical student, goes through periods when then think 'is this really for me?' and i've had my fair share of feeling like that but:....

I've not been this excited about medicine for....well, ever really. Sure when I first started clinicals the first week on the wards were exciting and interesting but following that I fell into sort of a hole whereby I just went along with the flow. I found the work mildly interesting but I wasn't really inspired by it. If I'm totally honest I drifted through most of 3rd and 4th year. I learnt things along the way and really enjoyed parts of it but I never really felt truly involved. I wasn't the first, and I won't be the last person who doesn't really put themselves forward for things. I mean yeah, I was always ready to try and answer questions when others would just stand silently staring off into space but when it comes to being keen or having to actively ask to do or be shown something I just tended to drift into the background. I know this isn't the way to do things, or a good way of learning things and I've always advised others to put themselves forward.

I think perhaps things started to change during my elective, for the first time ever I felt almost useful, like I could really help and make a difference. I liked the atmosphere, I enjoyed learning and I was interested in medicine. On my return I went back into somewhat of a lull, back to my old ways of coasting if you like. Perhaps this is because I was on somewhat of a come-down following the amazing experience of my elective.

I've never enjoyed a week of medicine as much as I've enjoyed this week, I've not done anything particularly special, or seen anything wildly exciting but for the first time in a long time I'm excited, I'm enthused, I'm eager to learn. Very rarely have I come away at the end of the day with the intention of reading up on something I've seen or learnt about, even less so have I followed through on that intention but now I feel like I want to, I'm inspired to. I think I'm behind some of my peers with regards to being involved, some of them have probably been at it since 3rd year. But I don't care, for me, its important that I've finally seen what medicine is really like and that I can see myself doing it, and doing it well. Perhaps its because its 5th year and that things are starting to come together and make sense (still very slowly but still, its progress!), I know what tests patient x needs and why, I no longer feel useless or in the way (although I still probably am) I enjoy helping the house officer out with jobs. I can pin-point one reason which might be contributing to my new found love of medicine - the one-on-one style of 5th year. I have a whole team to myself, there is nobody else to get in the way/compete with/hide behind. Not only do I learn a lot from one-on-one teaching, I find the whole experience much more beneficial, I'm more confident and much more willing to do things. Today, when I had my own patients in clinic I felt like a doctor, I was making taking complete histories, doing full examinations, making diagnoses, coming up with management plans all the things doctors do and I loved it. Ok, so they were not the most taxing of problems but for me, it made me realise that I really do like this medicine malarkey, I really do want to be a doctor, and I really can't wait...

This post is FAR too positive for me, so it should also be noted that I still hate the course and PBL. Perhaps I wouldn't have been so slow in finding my path if I had gone elsewhere, but not to worry, better late than never eh?

The Little Doctor, coming to a ward near you, and excited about it! (if I pass finals EEEK!)

so much to do, so little time

I knew things were going to be busy when we returned from our trip but busy is probably an understatement!

I have finally finished my elective report, it is pretty good now even if I do say so myself. My blog actually proved useful as rereading some of my posts whilst away helped with the content of my report. It was supposed to be 3500 words but that simply isn't enough so it ended up at 3700 which is still a ridiculously small amount considering everything that happened. I don't think I've done it justice but I've done the best I possibly could have. Much credit must go to missbliss for her help. Now I just have to hand the dam thing in which is going to be a pain in the arse as it has to be handed into the medical school not my hospital. I'll look forward to me 100 mile, each way, commute on Monday.

I thought about putting a copy of my report up on the net but since the university seem to have stepped up their assault on plagiarism it'll have to wait for a while. I wouldn't want to be accused of stealing someone else's report and making up 2 months of my life now would I? If you're desperate to read it then drop me an email.

That's one thing I can cross off on my ever expanding list of things to do. I can also cross off finding a flat as we've found one! Although finding somewhere to live adds about 60 different things to my to-do list. Particularly as its unfurnished so we're going to be sleeping on the floor. IKEA here we come!

My first week back in hospital was both eventful and uneventful, you can read about it here at the real little medic (email me for an invite if you want).

Next week promises to be busier than ever! We're moving into our flat next Saturday, I'm going on a surgical skills course in Edinburgh next Friday and there is the small matter of the foundation application form which I've yet to really study in detail! Expect to here more about that next week (if I get time to blog that is!)

I'm also planning a post about some of the crazy things people have googled only to end up at my blog. At the moment its mostly about the foundation programme application form as I've written about the questions but there have been some gems just recently and I'm sure it would be worth sharing them.

Finally, this is my 100th post, so I'd just like to say a quick thanks to all the readers and commenters out there who make blogging a bit more interesting!

Car Park Dodgems, a New Toy and Another Moan

Parking at hospitals is notoriously stupid! The one I'm at is no exception, it is awful! Cars everywhere, car parks full to the brim. Crazy drivers spending ages looking for a space, the older generation struggling to fit into a space which you couldn't fit a cat in never mind swing it. Having been in Hospitals for about 2 years now, my car looks like its been through a safari park of raging elephants followed by a parade of chavs with baseball bats and keys.There are dents and scratches everywhere! And I'm really fucked off. I didn't do any of them (well maybe one) yet nobody has ever stopped and left their details. Seriously my car must have been hit or scratched about 7 times in the past 2 years. It'd cost me thousands to have it all repaired. Stupid useless drivers! Seriously people should learn how to park, it's not that hard is it?No wonder the consultants all have their own spaces which are about twice the size of everyone elses!

A new toy? It is phone upgrade time, I've been with the network 02 for almost 4years but I've decided to swap to T-Mobile. Mainly for their great data tariffs.Anyway, I've been getting more and more excited recently about the prospect of a new phone (Yes I know I'm lame but I just like new gadgets and toys), I went to the T-Mobile shop yesterday and I knew exactly what I wanted. I toyed with the idea of getting a PDA phone to integrate my phone and PDA but eventually decided to go with the Nokia N95. I've always been a Sony Erricson man before,and this Nokia is going to take some getting used to! I spent last night playing with it (I LOVE getting new things and reading the instructions and setting them up and...and...well everything really) So I now have a sexy new phone with built in GPS which rocks! I've downloaded free maps for the places we're going in summer (Australia, Thailand and California. Sadly there are no maps for the Solomon Islands, I think because there are no roads!) It has great built-in Internet browser so I can surf the net anywhere and a really good camera so I don't need to carry yet another piece of stuff. I expect you're all bored now of me talking about my new gadget so I'll shut up and runaway and play with it some more ...*childlike excited giggle*...

And the moan? Well that is a secret :)