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!


  1. Our vascular consultant picked on some of us to draw the anatomy of various arteries up on the board!

  2. Hoping to get another post soon halfadoc!