Monday, 29 March 2010

Easter holiday envy: Welcome to your career

A real mixed week of excellent GI teaching, being yelled at by admin staff, meeting a fantastic recovering anorexic, starting vascular, and having my last official surgery "on take". Where to start!

Well lets start with where this week falls in all students at my universities timetables. Well like students at universities across the country they are now enjoying the comfort and relaxation of home cooked food, lie ins and the chance to catch up with friends from home. And me? Well nothings changed really, my friends from home are contacting me asking when I am around for a catch up and the answer regretably is...well sorry I'm just not really. So this is the life of a 3rd year: holidays we have are shorter, days are longer and some holidays disappear altogether. At better moments I even forget last year I would have been on a month holiday around now and at other times the remainder of the lazy uni student in me (I feel this is a side that is disappearing bit by bit with every 8am I successfully make) feels that something is dreadfully wrong because shouldn't I be watching telly and eating edible food about now?! My batteries are used to a recharging every 10 or so weeks and so as its now week 12 I do feel a bit overdue for a holiday

I'm not bitter really (well ok not bitter mostly!) because really this is the life we chose and to be honest we still have it easier than actual doctors - we get a four day weekend over the bank holiday (but as a doctor its not like the hospital cannot be staffed just because its a bank holiday or even christmas. People still get ill) and we have a random week holiday in 3 weeks and 4 days time (but whose counting?!!)

So time to update what I've actually done with this week I suppose.. The highlight of the week for me came at my SSM (special study module - this is an aspect we pick and have a few hours on each week alongside our main rotation). My SSM this rotation has been based around eating disorders. I've been finding it incredibily interesting - whilst I had done a psych rotation just before I started this blog, this is an area of pychiatry I never really got to experience and its quite different from many other areas of mental health. This week I met a lovely girl who came in just to talk to us about her experiences of anorexia nervosa (AN). What struck me most about this experience was how wonderfully honest the girl was. For example she told us about the kind of things she used to do when she had AN before her GP weighed her (she used to water load - this is where the patient drinks lots of water just before their appointment causing the full extent of their weight loss not to be so obvious; she also used to wear multiple layers of clothes to increase her weight). She told us that whilst she knew she was underweight even at the time she feels it is only now when she watches home videos that she can see just how underweight she was. When she was in the grips of the disease she only weighed around 4 and a half stone and would eat very very little but exercise frequently.

It was quite a thought provoking and sad experience as well though meeting this girl because even now when she has been a normal weight and BMI for about a quite a long period of time she doesn't feel happy with the way she looks and feels she could do with losing about a stone despite being a perfect BMI. Anorexia unfortuanately is a lot like alcoholism - once you've been in its grips it is thought you are never fully free from it as its always something you are at risk of developing again.

Last week of gastro has been and gone now. Our registrar very kindly went through some assessment areas we have to do and be signed off for in our logbooks and from this I learnt a lot more about how to examine the abdo system which was really useful. Unfortuanately the downside of this was that this teaching session started a lot later than we orginally had arranged with him because he got held up with a patient. This meant it encroached on a "multi proffessional session" I had to do afterwards - I did tell the reg I had to get away at that specific time so he let me be assessed first but unfortuanately it still over run and I was late to the session really through no fault of my own. When I arrived at the session about 10 minutes late I got completely yelled at by an admin worker connected to the department despite trying to explain to her there was nothing I could do about it (I couldn't just leave halfway through examining a patient!) and she refused to let me go in saying I had missed it all now and there was no point. Most annoyingly I know this wasn't even true - the patient that was being seen in the session was waiting nearby and hadn't even been bought in yet.

I found out from others scheduled to attend that session that a few of them had been 5 mins late and she had been cross with them but let them in despite them having just come from home for the session. Quite frustrating when I was genuinally having teaching and assessment elsewhere! Furthermore I still have to slot this session in somehow and its going to be very difficult to do so as I have other multi proffessional sessions to attend during that time on other weeks. Somethimes it feels like that as medical students we are the bottom of the food chain as it were and so a lot of other staffs anger at perhaps the way they have been treated at times gets taken out on us as we are not allowed to stand up for ourselves and voice our own opinions. Argh. Anyway rant over :).

Yesterday was my last surgery on take and rather than the usual ?appendicitis patients I got to see a really good mix this time. I saw one patient who had come in following complications after an operation to change her gender and create a neo vagina - this is technically a GI case as it is bowel that is used to create the new vagina not however your standard GI case so interesting to see! I also got to see my first new vascular patient - a patient with a cold, pulseless foot. This is one of the more common vascular emergencies. And lastly I finally did something right in an examination - when examining a patients abdomen I thought I felt an area of hardness and was wondering if it was a mass or just muscle guarding. I felt it was more likely to be a mass however as I could feel a clear edge to it. When the junior doctor came and saw him she felt it was just the muscle wall however she then told me later that when the patient was xrayed there did seem to be mass of faeces in that area and when she examined him again later she felt what I meant..... SUCCESS! Maybe I will make a full doctor yet :).

Now I'm on vascular, had a clinic today which was really good and interesting but I'm not sure the consultant was too impressed with our vascular surgical knowledge (or lack there of!) but still that is why we have a vascular rotation: to learn this!

Monday, 22 March 2010

A failed vampire

So now I am on surgery... Stop reading now if you are eating or about to have dinner ;)

For the last three weeks and remainder of this week I have been on GI surgery, I have quickly learnt that this is a strange area of medicine where patients go if they have abdominal pain and/or poo problems. Whilst asking patients how their bowels are working is a common question in all areas of medicine, GI surgeons really like to concentrate on it, if you forget to ask exactly when a patient had their last bowel movement and its errr consistency (I did tell you to stop eating!) then you haven't taken a history fully. I've become quite blase remarkably quickly about asking patients about such an intimate area of their lives, to start with though I can't deny I found it a bit embarrassing to ask someone that and even caught myself once refering to stools as "Number two's".... Opps!

Despite the strange basis of this speciality and the fact I am really not interested in becoming a surgeon (which with my perfected combo of clumsiness and cackhandedness is definately a good thing as far as patient care is concerned!) I am actually really enjoying being a student in this area. My team on my current firm is great - the junior doctors are all really lovely and happy to teach us during their breaks (the F1's happily tell us you get quite a lot of breaks as a surgery F1 which means you can eat all the mess food before the medic F1's get there!) so I'm learning quite a lot. Furthermore as its surgery we get to do some of the cool practical stuff that you always look forward to doing in your pre clinical years. Last tuesday by a case of being in the right place at the right time and having randomly mentioned to an F2 who was on call that I really wanted to have a chance to scrub up for an operation (we've been taught how to but I hadn't put it into practice yet) I got the awesome opportunity of assisting with an open appendictomy. How cool is that!! The F2 got bleeped and asked to come help assist because the assistant surgeon had to leave but because she was on call and too busy clerking in all the new patients she suggested to the registrar who bleeped her that I could assist instead :D. A kind anaesthetist helped me remember how to scrub in and before I knew it I was there retracting bits of bowel and holding someones appendix. The operation took quite a long time as it wasn't a typical appendictomy as the appendix was quite hidden (which is why it ended up being an open operation - it was attempted using keyhole first of all but it wasn't going to work) and I was starting to feel quite faint near the end due to the heat in the theatre and the constant standing up, as it was only the theatre nurse, the surgeon and me scrubbed in I was starting to worry what would happen if I reached a point where I was going to faint or have to sit down as I wasn't sure who would retract whilst someone else was scrubbing in to replace me (it takes over 5mins to scrub in). Fortunately it didn't come to that so my first attempt at assisting in surgery did not become a complete disaster!

Whilst this is the only operation I've assisted in I've been able to see quite a few others - a hernia repair, a gallbladder removal and three appendictomys. Ive also seen a colonoscopy (a camera up your back passage as the surgeons describe it) and an endoscopy (same but down your throat for the upper end). Today in clinc I see (and look down) a sigmoidoscopy (similar to colonoscopy but doesn't go so far and the surgeon looks down rather than looks on the screen at the images transmitted from the camera) and see haemorroids (aka piles) being banded. So theres been lots to see which has been cool and I've also had lots of on takes (including one 8am-10pm one - eek) so have also got to and clerk in lots of patients by myself which is always great practise.

Another skill I have been able to practice whilst on GI is taking blood. This is something we are meant to try an practise as much as possible but unfortunately despite regulary voluntering to take blood I have so far only got the chance to try on one patient right back on my very first rotation (an attempt that was only successful with a little help from the reg who was with me). Due to this and my aforementioned cackhandedness I am rubbish at this... During this rotation I have had the chance to try on three patients so far...and have succeded to get 1 measley tube out of all of them combined :S. My first attempt was on a patient who was about my age and absolutely lovely to be despite the fact I stabbed her with a needle on an area that was already covered in bruises from blood tests and failed to get any blood whatsoever. In my defence in this case she did have tiny veins and the bruising made it impossible to see them so even the F1 struggled a bit. But she told me I really didn't hurt her and was generally lovely. I later found out that she was considering medicine as a career so perhaps that is why she was so understanding. My second patient was on someone who have enormous veins so there was no excuse for missing in him, I did get the vein and successfully got one tube of blood but unfortuanately in trying to switch for the second tube (the tubes are vaccum sealed so have to be pushed on with quite a bit of force to break the seal) the needle must of moved within and no blood filled this one; I tried to adjust the needle position slightly as sometimes this helps but I pulled the needle out to far and heard the hiss of air caused by the tubes vaccum being ruined as the needle leaves the skin and so air enters. Then not thinking I pulled the needle out fully whilst the tourniqet was still on the patients arm.... This means the blood is still under a lot of pressure and so causes blood to come out rapidly which never looks to great from a patients perspective.... My third patient I was never going to have much luck with - a very elderly patient who had been in hospital a long time which means lots of his veins had become unusable, leaving no easy vein options. Predictably I completely failed on this one.

So yes, glad I am not a vampire! Ah well practise practise I will keep trying, sooner or later surely I will hit that red gold!