An average week of a fourth year medical student: Friday

An average week of a fourth year medical student: Friday

Firstly I finally just got down and did a reasonable amount of essay, woo! Secondly yes this does mean I am in at home on a Friday night doing essay rather than out :/ still on the plus side at least I don't have finals in a few weeks like my fifth year friends!

I'm so sorry...I just couldn't resist!

So its friday today, which means it is GP day, I don't have GP visits every Friday, just 8 in the year but today does happen to be one of those 8.
Here is my rough day:

8.15 Leave for GP surgery
8.50 Get stuck in a horrible traffic jam and only move 1mile in 30 mins. Perfect.
9.30 Arrive at GP surgery 30 mins late, and very stressed and panicked.  GP is ok about this though and very understanding - phew!
9.40-11.00 See patients at the GP surgery, a good mix of cases but mostly older patients due to the demographic of the town this GP surgery is in.  Quite a few "heart sink" patients though like an elderly lady who has recently gone blind, has epilepsy as well and now is also very depressed.  She is a "heart sink" patient because its quite difficult for the GP to treat her depression through medication at any rate as anti depressants can increase the amount of seizures in those with epilepsy and also certain antidepressants may interact with epilepsy drugs so this makes it harder for the doctor to choose a treatment for her which will not complicate  things further.
11.00-12.00 The GP goes on house calls at this point.  This GP surgery seems to do a lot more house calls than other surgeries I have been attached to although maybe this is partially because of the older population here.

The house calls bring a whole new level to the heart sink factor as the five the GP I am shadowing takes are all at a care home for people with very advanced dementia.  It does really shock me how absent some of the residents in this care home are, some are able to answer the GPs equations about their symptoms but others are simply staring vacantly at the walls/ ceiling.  Now when I say phrases like "vacant" I don't mean any disrespect to the patients or their families, that's just simply how it is, some of these patients had such advanced dementia that they had absolutely no idea what was going on around them and didn't ever realise the doctor was there.  These cases are heart breaking as there is so little that can be done for the patient (beyond treating whatever acute bout of illness has caused the doctor to be summoned).  I think in many ways its probably harder for the relatives than the patients once an individual reaches this degree of illness because beyond the occasional lucid moment that they may have, for the most part the patient will not be aware that things had been different / that they are ill.

Afternoon:  I picked up those desk chairs I bought off ebay, definitely a bargain at £5.98! And fortunately it turns out you can fit 4 desk chairs in a ford ka, if you try really really hard! Anyway means I can now sit at my desk and write my essay on a comfy seat rather than a wooden fold out seat stolen from elsewhere in my house!

Met up with my research supervisor and get some of the stuff I need though not all of it, he is a very nice guy and we randomly talk about other career progression things for most of the meeting.  He always enthuses me research wise when I meet up with him, its just when I'm not meeting up with him it can be quite tricky to hear back from him and get help with the bits I need help with :/.

In the evening, I cook/eat dinner, do a decent amount of essay, write this and now its bedtime and the weekend!

My weekend will not be exciting so here is its summary: Tomorrow I will be working till 5.30 at WHSmiths earning money for food and other such luxuries (or for another four desk chairs, who knows!), Sunday I am determined to virtually finish that essay.

So there you go, the average (rather than exciting stories) week of a fourth year medical student :)

Halfadoc x

An average week of a fourth year medical student: Thursday

An average week of a fourth year medical student: Thursday


Bit of an annoying day today, just kind of one of those days where nothing goes quite right/ as you planned it.

So to start with today is my designated research day, now my research hasn't been going very well this year at all through no fault of my own (but probably one of those things thats better not to moan too much about on this blog in case my identity is not as anonymous as I would like to think it is).  Well for the unmentioned-moan-reasons a lot of my Thursdays have effectively just been days off this year as I haven't been able to do anything with them, but today I hoped I was actually going to be able to get some of the data I need to get.  I spoke to my supervisor on Friday in person and it looked like I was going to be able to come in today and get some of my data but he needed to talk to some of his colleagues and check this and then let me know what time.  He ask me to email him and remind him, so I did this first thing on Monday....

.....Wednesday morning: Still no reply... *Emailed him again with a polite nagging email*....
.....Wednesday Evening pre sleep: Still no reply :/ great, set my alarm for 9am so I can see if he replies first thing

9am: No reply... Reset alarm for 10am....
10am: No reply, decide he clearly can't do today and turn alarm off going for a lie in.
10.30: He replies saying to come in for 12.30 (yep thats 2 hours notice when the drive to get there is around an hour...) I'm asleep now so don't see this!
11.30: I wake up, see email. Too late! By the time I'm changed and ready thats just toooooo late.

Quite frustrating tbh!

I realise he is a busy clinician and probably get tons of emails, still it is frustrating because he gets funding from the medical school for each student he supervises and if he doesn't have time to offer each of us the help we need (which really isn't that much) then he probably shouldn't take on as many students :/

So the first part of my day (admittedly not morning due to the excessive lie in...) was spent trying to rearrange this, it is now hopefully happening tomorrow.

So then I decide to make today a day of serious essay work, I set up my desk just so, (with a very geeky dualscreen system set up so that I can read journals and have my essay up at the same time, very geeky but also very useful) and start essay.

My nice tidy desk and organised dualscreen system! (and yes that is a coffee cup on the desk...standard)

Do about an hour of good work when I get a text from the president of a committee I'm on asking me to meet someone this afternoon about a talk we are doing later this year.  Well I could hardly say I was busy when I was just sat at home but it was unfortunate timing when I was actually genuinely being productive for once.  The meeting ends up taking two and half hours which with time for getting there and getting ready (out of my essay writing very non professional slob clothes of trackies and a hoody and bedlook hair) was really 3 and a half hours gone from my day.  Not to mention that my concentration was completely shot after the meeting (it was a necessary and productive meeting, just bad timing for me productivity wise!) and I certainly wasn't feeling as productive.

Still finally 6pm: Start doing some work for about another hour, but then I have to go on a pre decided supermarket shop and cook dinner....eat dinner... and before you know its late and I haven't done anywhere near as much essay as I planned :( Fail of a day really, and very boring too, no interesting clinical stuff for you the reader to hear about today I'm afraid! Maybe tomorrow :) (and maybe I will do a decent amount of essay tomorrow too!)

Halfadoc

The average week of a fourth year medical student: Wednesday

The average week of a fourth year medical student: Wednesday


7.30- 8.25: The usual excessive pressing of snooze!
8.30-8.45: The equally usual rush to get ready and quickly downed coffee
8.50: *Once again running late!!*

^ I really do wish these things had never been invented!

9.05-12.30:  A morning in the eye hospitals A+E department
Eye hospital A+E is in someways much like a regular A+E in that patients can just self refer and turn up on the day with eye problems and wait to be seen, equally GP's (and because its the eyes: opticians) can suggest to patients that they attend the A+E and refer them.

In some other ways though its very different to a normal A+E, for starters I saw a number of patients today (and during subsquent mornings I have sat in on this department) who had appointments booked for them for a weeksa time to come back and check things are progressing/improving as they should.  This makes it almost more like a clinic or GP appointment system - in regular A+E if a doctor told a patient to bring themselves back into the A+E department to be rechecked they would probably receive some very harsh words from colleagues and hospital doctors!  But I suppose the eye is such a specialised area that there no point telling the patient to get their GP to recheck them in a week because without the special equipment the eye hospital has and years of specific expertise in that area, a GP wouldn't stand a chance of picking up any reasonably subtle but important eye changes.

Saw quite a few interesting patients today but also had a lot of waiting about in between patients due to the nature of A+E and amount of refering to other departments the poor overworked registrar had to do.  Here are the top three most interesting patients:

1. A patient who had herpes zoster (aka shingles) and had been unfortunate enough to get eye involvement with her shingles and was first seen by the eye team last week and now was being followed up..  She had whats called "Herpes Zoster Opthalmicus" which simply refers to the  region that her shingles had appeared (it is in the opthalmic division of the trigeminal nerve) - over the right hand side of her forehead going down to below her eye.  The worrying possible complication of when shingles affects this area is that it can cause eye problems such as uveitis, conjunctivitis, keratitis and ocular nerve palsys although these are reasonably rare.  This patient when she first presented to her GP the previous week was recorded as having something called "hutchinson's sign" which is where there are shingle vesicles on the tip of their nose.  This is significant as the nerve which supplies this area (the nasociliary branch) also innervates the globe of the eye, so patients with this sign are twice as likely to develop eye involvement with their shingles (where as having herpes zoster opthalmicus with vesicle on the eyelids does not increase risk from herpes zoster opthalmicus where the vesicles are just on the foreheard).

Herpes Zoster Opthalmicus

 Unfortunately for todays patient she had got eye involvement and had developed anterior uveitis a week ago.  Uveitis is inflammation anywhere in the uveal tract and the anterior part just means it was affecting the front of the eye.  However after a weeks treatment the patient was actually doing a lot better, but has to slowly come off the eye drops over the next 8 weeks to try and prevent worsening/ recurrence.

2.  A patient with a coldsore (herpes simplex causing a dendritic shaped corneal ulcer) in his eye!! Another unlucky chap as this is reasonably rare as well.

3. An eleven year old who came in with the most swollen eye I have ever seen outside of medical pictures.  Poor poor boy it looked so painful.  Apparently it is an infection probably from within his body although he feels systemically well at the moment.  He was referred straight across the road to the childrens hospital to have IV antibiotics because the doctor wasn't sure if he had slight orbital cellulitis which is serious as it can be both sight and life threatening as it can enter the meningeal cavity (in other words there is a small risk of developing meningitis from it).

The boys eye looked pretty similar to this but without the red scabs this childs eye has

Wednesday afternoons are usually off for "sport", I am probably one of the rarer medical students who does actually use them for this but as I said yesterday BUCs matchs are finished now so this time is now available :) 


12.45- 4.30:  Had a nice lunch out in the sunshine with my rabbit hopping about, met the new next door neighbours because they were peering over the wall watching their cat who was out in this area for the first time.  Made friends with the next door neighbours quickly when they spotted Chunks and exclaimed that they had rabbits too and held theirs over the wall to meet me!

Wrote some of this blog out there and did a little ophthalmology reading but then actually got too hot (remarkably for march!) so I've headed back inside and am ready to do a serious amount of essay work! (I did do some yesterday, but lots more to do).

Till tomorrow!

Halfadoc