Sunday, 24 January 2010

My life in a nutshell




So I am half a doctor. Actually I am not; I would not be able to diagnose, examine or treat half of all patients, I cannot yet even insert a catheter - one of the most basic junior doctor tasks (in fact I still have problems taking blood), but as a third year medical student, in feb I will have reached the 'halfway there' mark in my studies and so supposedly am halfway there to graduating as a british doctor. Cool. But also bloody scary as by now consultants, friends, family and even lower year medical students expect me to know something, anything about medicine. The scariest fact is, I'm not sure I do. I've passed the exams so far, celebrated the results and regretably promptly forgotten everything I ever learnt. Family members and friends ask me for informal medical advice, they describe their symptoms and look expectantly for my advice and all I can do is blag it, suggest they see their GP or mutter something about not having learnt it yet. So that is my life in a nutshell, and that sets the scene for this blog - a student who is now on the wards and seeing patients full time and desperately trying to learn what I should already know before a consultant inevitably grills me on it.

So at the moment I am three weeks into my general medicine rotation. This is known for being the hardest rotation quite simply because you will be seeing patients who could have basically any medical condition so the amount of differential diagnoses and then possible treatments seems infinite and yet we are expecting to be learning about them all, or at least realistically all of the common conditions causing patients to present to hospital. This still seems infinite. Still, one thing its not is boring. I am actually really enjoying it despite being scared on a daily basis about how much I need to learn. This week has been particulary exciting.

The highlight of my week was easily getting the chance to see an emergency angioplasty during a morning spent in the cardiac catheter lab. The cardiac catheter lab is where patient who have been experiencing chest pains/ are known to have angina come to have the tiny blood vessels (coronary arteries) that supply the hearts muscle looked at and if appropriate recieve treatment to relieve their symptoms then and there. The first part of this procedure is called an angiogram and it involves a catheter being inserted into the patients femoral artery and goes back up the artery and then down the main artery going from the heart (the aorta) and into the main coronary artery where contrast (something that will show up on x rays) is then released and x rays are taken of the heart. The contrast goes down all of the coronary arteries and shows up on the x rays allowing you to visualise the blood vessels and see if they are narrowed in any places. The narrowing is often quite obvious - even I could pick out some narrowed sections before the doctor showed me them. Narrowing to a blood vessel may mean your heart muscle doesn't get enough oxygen, particulary when you are stressed or exercising. This causes the chest pain known as angina. In the cardiac catheter lab if the doctor carrying out the procedure finds a narrowing then if the patient is an inpatient they can fix it then and there using angioplasty and stenting (the patient has to stay in hospital over night after having a stent so if they had the angiogram as an outpatient they have to come back for the actual treatment). Angioplasty is basically inflating a ballon on the catheter to crush the fatty build up on the arteries and so increase the amount of blood flow that can get through; stents looks similar to the springs you get in the end of cheap pens (but the metal is interwoven in a different way) and hold this newly widen artery open.

I found this bit very interesting to watch because my father developed angina last year and ended up with a stent so it was good to learn what he had been through (patients stay awake for this procedure). I think had I seen this last year I would not have been so scared for him because it really is much more of a routine and mostly risk free procedure than statistics make it appear.

The most exciting bit of the catheter lab though, was easily the emergency angioplasty which came right at the end of the morning. Emergency angioplastys are essentially the same except the patient is in the middle of a heart attack so you have got to get to the blockage and remove it as quickly as possible to minimise heart muscle damage. It was amazing to observe the difference in the atmosphere as this patient came in. Previously the atmosphere had been laid back and jokey with members of the team mocking each other in a pleasant way, now they were working rapidly together to get to the important part of this procedure as quickly as possible and save the patients life. As a medical student watching this I found it hard to know where to stand and what to do - I didn't want to get in their way or slow them down for even a second. I ended up being involved in the team work simply because there was a limited of people in the room who were not scrubbed in and so could be utlised to open bottles/packets and pour solutions. This is how aseptic techniques work - someone who is not sterilised opens a packet without touching the inside and then the scrubbed in nurse/doctor takes the item (in this case catheters) from inside without touching the outside thus keep the item sterile. I felt a bit useless as I was not even great at doing this, having not opened the packets before I fumbled to find the openings and felt I was slowly the team down and frustating them. Still, at least I didn't drop anything onto the floor or touch the sterile trolley!

When the procedure was going on I talked to a bit to the patient who was in considerable amounts of pain. I felt sorry for him as it must be very scary having the medical team rushing about around you and not really knowing what was going on so I tried to explain what was going on to him at least to the small degree I could and reassure him without giving him false hope. I think he appreciated it but then he started asking me questions I could not answer and so I had to just keep advising him to ask the doctor afterwards fortuanately I was called away to open another packet before I could flounder too much...

The procedure was succesful, the clot blocking his artery was found and literally vacummed up and then he recieved a stent to remove the narrowing in the artery that had caused the clot to block it up. A success story and a literal case of a life probably being saved, this is the reason I came to medical school, I just hope that one day I will be as proficient as the doctors on the team I saw today.

Thats all for now, I must stop procrastinating and do some work, fill you in soon.

7 comments:

  1. hey u shuldn't feel dat u dun knw anithing....i want 2 do medicine n i didnt knw any of wat u were saying n i learned a bit frm u so dun b down u knw a lot n r stilll in uni so u can learn more....jus stay motivated n thing of actually achieving wat u wanted! i want 2 b a doctor 2 but dun like seious work such dat can cause death so i might stay in a safe profession....am still thinking abt dat...i'll keep reading ur blog n hopefully will learn more abt uniexperiance!
    can u jus tell me which uni u go 2 n hw hard it was 2 get entered, wat u gt 4 A levls, hw da UKCAT went and hw u did da interview....a lot 2 ask but it would b alot of help
    thankz

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  2. Hi there, thanks for your comment, its great to get some feedback :).

    In terms of your questions I will answer what I can - Im afraid I can't tell you what medical school I am at because I would rather keep that unknown to help ensure patient confidentiality - if I say the hospitals area then people might think I am writing about them even if Im actually not.

    UKCAT wise I got a very average score but luckily for me it was the first year ukcat was used - quite a few medical school now have cut off points so if you do decide to apply for medicine then check these out, my score probably wouldn't have been high enough for the cut off points some uni have since implemented so I would have had to avoid some.

    A level wise I got 4 A's but I do know people who simply met the grade requirement and they do just as well academically at medical school.
    For me I had two interwiews, one of which I got an offer from and one of which rejected me. Both interviews were friendly and very personal statement based but it really varies depending on the uni. Other unis ask much more academic questions.

    Hope that helps a bit, if you haven't done any work experience yet then maybe that will help you make up your mind :).

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  3. First, thank you so much for the blogroll. I am extremely honoured. I miss the med blogosphere SO much (as I keep repeating on my blog.)

    Thus, you are a GREAT find! Well, not just for that, but I love you already! Ace sense of humour. This was killing me. So, blogroll reciprocity back from Dr. PA!

    Speaking of, in reading about your difficulties, try not to be too scared. Dr. PA still hasn't gotten the hang of a blood pressure cuff! Oh, you rotten screw on the bulb. Slippery, tricky devil! You are EVIL!

    I can do an auscultation, though! I just don't know what I'm necessarily listening to and/or why I should be listening to it. You know. What it might mean, right?

    I think I could probably figure out what I should listen for if someone came to me hacking up all sorts of sputum, green or yellow or both. Hey! Even different colours!

    Dr. PA to Patient: Your chest is all bubbly and gurgly. You may need antibiotics for a bacterial infection, or have something called a pneumothorax. If it's the latter, I have to cut you and put a tube somewhere near your lung.

    I'm not sure though, so let me check with Half a doc. She'll probably know. Oh, crap! Her mobile's busy. Well, you just lie down and relax. You'll be fine, I promise. Meanwhile, they're still serving breakfast, so let me get you a tray.

    So what do you think? We can tag team? Help each other out? Two halves make a hole! Oops, I meant "whole."

    Take care,
    Dr. PA

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  4. You are more than welcome for the blogroll, I can't remember how I found your blog (one of those random procrastinating sessions of just following link after link I guess!) but I really enjoyed it :). Thanks for the blogroll-ing return :D

    Haha yeah tag teaming sounds like a great plan - you cannualate , I'll decide what to put in through the cannula ;). A problem halved and all that! (its quite amusing reading back through this post of mine and realising that in the two years since I wrote it I've only actually successfully done one cannuala :/ oh well final year next year apparently then you get the opportunity to do hundreds, fingers crossed, if not I'll be getting on my mobile to you ;D)

    Thanks for commenting!
    Halfadoc

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  5. (also you have a quote from Hawkeye Pierce on your blog - that alone made me want to follow you ;D)

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  6. Hey!

    Well, I wore a cannula once (okay, twice but I was unconscious.) However, the problem was I didn't have eyes in the back of my head. Therefore, I couldn't see just how the paramedics stuck it into the oxygen tank. Some accoutrement needed?

    Next time I see someone wearing one, I'll take a close look. Even stop them to examine it.

    Because...the tube is small. With a mask...okay, I'd better stop here. I'll continue with an email.

    I can do sutures! That's on my blog. However, not for the stomach of the weak! That sounds like I've just made a column in a Gastro Magazine or something. I love playing with words. Suture business also in the email.

    Yes, I was watching M*A*S*H one night and thought it was perfect. That's going on my blog!

    Talk soon,
    PA

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  7. Hey, I missed this somehow, apolagies!
    Ahh by cannula I meant the tube that is inserted into your veins for fluids/medications to be given through, but yeah oxygen can also be given through something called a cannula, bit different tho ( I can do that one!)

    I'll make you do the suturing then :P

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