Currently reading...

...this book:



I went to the book launch on Friday night, and I'm ploughing through it. Laughing lots at some of the things that Richard Dawkins thinks are valid arguements!

I'm having a good day, have eaten fairly well and done some boxing which was really tiring but I really enjoyed it. I'm dreading going back to the hospital tomorrow a bit...I'm on the acute admissions ward this week, although I'm helping out with the 2nd and 3rd year OSCEs for 2 mornings. I really need a patient to write up for my portfolio, and I need to get my act together with work stuff because the portfolio hand-in is drawing near...gulp! This is also the last week of the block, and thus the last time I'll be on the wards until I'm shadowing the person who's doing my job in July. So I'd better ask all the stupid questions I need to ask this week!

The problem is, I'm moving cities to start work in a different place so I suspect things will be done a bit differently in New City, but hopefully I'll get the hang of it. And hopefully I'll make friends! It's been a while since I've been in the don't-know-anyone situation so hopefully I'll meet some people to hang out with and settle in well.

Sometimes I get a bit overwhelmed by the impending change, and sometimes I can't wait to get started. I'm kind of dreading moving again, this time I have to get 6 years worth of stuff into a much smaller room, and it's very stressful and tiring moving anyway, so thank goodness my muscly brother is coming to help me, and bringing his band's van too, so between me in the car and him in the van we should be able to get it all home!

So it's a bit mixture of emotions being me at the moment, with occasional moments of rising panic about the coming portfolio hand-in!

Springtime brings new leaves

...in more ways than one!

I've had a good day today. I've been really lazy and eaten some rubbish, but not an inordinate amount, and I think that with the apple I will eat before I go to bed I have achieved my 5-a-day and I am feeling a lot better than I did yesterday.

I should explain that.

This week has been a bit weird and at times a bit stressful. Firstly, the change of ward has thrown everyone off and means that requests go to the wrong place, porters come to the wrong wards, and to top it off the pod system for the bloods hasn't been working that well so whenever porters are called to pick up bloods they come to the wrong place! Annoying. But because our previously 24-bed ward has now been reduced to 6 beds plus a few boarders, which makes for a lot of boredom.

This week the solution to the boredom seemed to be to gossip lots. Basically our (terrifying for several reasons) registrar came to hang out in the doctors' room and initiated a really graphic gossip session which removed any shred of naivety I had retained through uni, and I really didn't want to get involved. I have this thing where if I do or say something mean, it plagues me for days/weeks/months/sometimes even years afterwards, and the day before Crazy Gossip Session I had said something mean about one of the 4th years who has been skiving a lot - it was totally unnecessary and I didn't really mean it, but it meant that I didn't sleep too well for thinking about what a bitch I was. So I really just didn't want to get involved in this gossip, but couldn't really escape because Terrifying Registrar was present and there weren't any jobs I could go and do.

This particular gossip session served to inform me that in this hospital, in which I have worked/studied for the last six years, it turns out that everyone is shagging in every available cupboard/oncall room/sideroom and, apparently, I have been oblivious to it all. I learned (reluctantly) about the MDT Challenge (in which, in order to complete the challenge, one must sleep with a member of each discipline in the team), the Med School Challenge (in which one must sleep with a student from each year), and I learned about the nurse on one of the wards who has slept with nearly all of the doctors in Terrifying Registrar's year, and who believes that one of them will fall in love with her, cries in the cupboard when they treat her badly, and is totally ignorant of the fact that they are in fact asking each other, 'have you slept with that nurse yet? You really should...'

This totally APPALLED me. For a start, SURELY people don't really do these challenges. Oh no, I am assured, they do. And SURELY people don't take sex this lightly, and think it's ok to abuse this poor nurse who mistakenly believes that the doctors are after more than a quick shag in the oncall room. But yes, it would seem that this is the thing to do.

This gossip session went on for nearly an hour and a half, in which nobody was safe, and all secrets were revealed. Then, unbelievably, just as I was going to escape for lunch, Terrifying Registrar says, 'How about a quick game of Consequences before lunch?'

I couldn't believe it! How old are we?! There was no way I was going along with this, so I sneaked off to check some results, and was then stuck in the corner while the game finished.

I just found this whole thing so depressing - to find out that this 'caring' profession sometimes cares for patients (when not moaning about how annoying they are - we are all guilty of this, me included) but seems not to give a rat's ass about fellow colleagues. I just couldn't believe the total lack of respect that people seemed to show for each other.

Now, I'm not so naive as to think that these stories haven't been well embellished by time and rumour, but there's no smoke without fire.

So was pretty shocked by all that.

The other solution to the boredom, for me, was to work lates on the Acute Admissions ward. This was fun for a bit, but after I worked 14 hours on thursday, saw the F1s get their paychecks and realised that not only was I not learning a lot on these long days but I was also not getting a penny, I decided that enough was enough.

I woke up on friday planning to do the late again and go in about 1pm to stay till 9pm, but actually my flatmate asked my why I looked so gloomy and I cried (which was embarassing) and poured out my tale of gossip-ridden, boring-days-and-busy-evenings, not-getting-my-portfolio-work-done tale, and she told me off and said I should stay home and do my portfolio stuff and not do any F1 jobs for which I am not getting paid because it's not my job. So, ever-so-slightly guilt-ridden, I stayed home, and tried to do some non-medical things, regain some sanity, and try to get rid of the disillusionment of working life in the hospital.

So, today, I feel good - I ate lots of fruit, baked some cookies (non-medical activity of the day - this is a good aim I think, to do something non-medical every day and stop getting into bad geek habits), read a good book and have done some blogging (both reading and writing, as you can see).

New Leaf for this week: Tip the work-life-balance a little towards the latter.

Apologies for the lengthy post, I hope you are still awake! I'm going to take my little self off to eat some raspberries. They are good for the soul. And you can stick them on your fingers a la Amelie and giggle at your own absurdity for a while, which is always theraputic.

SALT leads to hypertension

I'm in a weird mood today. It's a combination of indignance, anger, grumpiness, despair and exhaustion. Here's why:

Indignance because today I called the speech and language therapists to try and arrange a time when I could go with one of them to see a patient so I can get it signed off on my evil record of achievement, since they have turned me down every time to date. The conversation went a little like this...

[Please note: the line was engaged the first 3 times I called and there was no answer the next 2, so I am already a little exasperated]
Me: Hello, I'm a final year medical student working on the surgical floor, I was wondering if there would be a convenient time for me to come and see a SALT assessment as part of my record of achievement.
Very Helpful SALT Lady: I'm sorry, we are very busy, we don't have time for you.
Me: Right...um...I appreciate that you are busy, I worked on the Stroke unit during my medical placement and they've agreed that it's ok that I try and see one of their patients so could I watch a swallow assessment?
VHSALTL: I know you have to get this signed off but we just don't have time to fit in all the medical students just now.
Me: Ok, is there a more convenient time for me to call back?
VHSALTL: No, I don't think there will be.
Me: Right. Thanks for your, um, help.
[Hangs up phone and screams with annoyance!]

So yeah, no speech therapy for me. I was hopping mad by the end of this (WARNING: rant coming) THIS IS A TEACHING HOSPITAL where people are supposed to be TAUGHT and how many times have juniors been yelled at by SALT for inappropriate referrals but how are we supposed to know how to refer if they persistantly refuse to teach us anything?!?!?! There are approximately 150 medical students in each year, and given that a third of these will have the good fortune to get their box signed on an out-block, that leaves a mere 100 students. SURELY the SALT people see more than 100 patients in a year, especially since (despite massive hints to the contrary) I'm pretty sure there is more than one speech therapist in our 900-bed unit.

This pretty much ruined my morning - I knew they were going to be arsy, but this takes the cake.

So that was emotion number one, and two.

Grumpiness: Partly boredom-induced I think (our ward has been displaced to what's left of the acute surgical admissions ward in which the HDU is currently being done up, while acute admissions go to what was our ward, leaving only the side rooms for our patients) - 5 patients for for 3 JHOs and 2 final year med students does not a busy day make. Especially when one of the patients discharged against medical advice, leaving only 5.

Despair at my persistant inability to be a size 10 - all my good intentions seem to desert me when there is food to be eaten or an extra 40 minutes in bed instead of exercising.

And exhaustion because I've not been sleeping too well, and 8am starts don't suit everyone.

Man, this is a gripey post, I do apologise. I'm off to browse free-standing boxing kit on which I am planning to spend some of my *eventually* hard-earned cash come September.

Super-skinny me?

I just watched a programme on Channel 4 called 'Super-Skinny Me'. Basic plot was that two female journalists, both with plum-normal BMIs and both size 12, underwent a 5-week intensive diet and exercise regime in the hopes of dropping enough weight to become a US size 00 (UK size 2 I think).

The point of this exercise is, apparently, to show how awful a life of extreme dieting is, how miserable it makes you, and how it affects you physically and mentally in an adverse way.

I've watched two of these things before, one a female journalist and a 5-6 week plan to drop weight and get to size zero, and one following Louise Redknapp with the same aim. Both were made with the intention of showing how rubbish it is to be a size zero.

I was jealous. Every time.

I would LOVE to be a size zero, or even just the size that these girls start off at - I would love for a size 10 to fit me, to have a personal trainer to kick my ass every morning, to go shopping and find that everything is too big rather than too small. I would love to have ribs that stick out, to have really prominent clavicles and for my hips to be the widest part of me rather than the fat over my hips.

I don't think this is the idea - we are supposed to feel sorry for these people, but instead I find myself planning exactly what I'm going to eat tomorrow and planning to get up early (I already get up at 6:30am so this will be a challenge) to work out for 30 minutes before I go to the hospital, then to go for a run when I get home.

[I'm told it gets addictive and you eventually get an endorphin rush from running, so I'm determined to get past the stage where my chest burns and my feet hurt and reach this wonderful goal of actually wanting to go running. I do enjoy the moment of mutual sheepish grinning that happens when you puff around the park and pass another runner - it's kind of a, 'yeah, we look stupid but at least we are trying' moment of unfit solidarity!]

So I think that for me, the programme did not fulfil it's intentions. I'm already trying to lose 1kg a week (I thought this was a reasonable goal) since for various reasons to do with illness and medication and sheer lack of willpower I have put on A LOT of weight during university, but this programme provided rather a lot of tips on how to increase that goal to 2kg or more...

Roll on the weight loss!

Lucky

Today some good things happened. Firstly I am very excited about something which seems trivial but made me very happy - last week I purchased a new MP3 player because my old one had started to randomly switch off which was very annoying. When I have a salary I intend to get an iPod, but right now I can't afford it and there's no way I can last six months without portable music, so I bought a Creative 1G to tide me over. It's small, pretty, and plays music, which is what I need, although the filing system is a little confusing and I haven't quite figured out where all my music is yet! Anyway, I noticed the other day that the battery cover was missing from the back - it's a tiny piece of white plastic, but I thought, it's okay, it'll be in my bag/pocket/room.

It wasn't.

It's very annoying to lose the back of a brand new player which has to last 6 months at least, and despite me retracing my footsteps and hunting high and low, there was no sign. I was just giving up and trying to work out a way of holding in the battery with micropore (magic stuff) which would look a bit crap but would mean nothing else fell off, when my flatmate came back from the shop down the road waving the precious piece of plastic at me! Hurrah! It had survived three days in the gutter with only a few scratches, so I was very happy.

So that was good thing number one.

The other good thing is that I got one of my boxes signed off this morning which was proving very difficult - as part of our course we have to get about a million boxes signed off, some for procedures we have to do/see, some for examinations, that kind of thing, and I'm now down to the last four boxes which are a bit of a chore. Anyway, I managed to go with a patient to mammography this morning, which was not only a great box-signing opportunity while avoiding the masses of students who have to queue up to see a mammogram at the clinic, but also a great chance to spend some time with a patient and chat - I really like talking to people as people and not just as 'lady with mastitis' or 'man with bowel obstruction', and this lady actually said as we got back to the ward that she appreciated having me come with her as she was able to ask question and it took her mind off things, so that made me feel like something I did today was worthwhile and actually made a difference to someone, which is a rare thing to feel as a medical student since we spend a lot of time filling in forms and taking blood. I'm aware that come August I won't have time to go with patients to investigations and get to know them a bit better, so it's also a priviledged position to be in as a student, and one which I hope I'll be able to be in more in my last few weeks.

On a more scary note, I'm still bricking it about starting work - I'm painfully aware of all the things I don't know and think I really should, so this weekend will be a lot of reading and learning I think, partly to alleviate my rising panic and partly to avoid the embarassment of having your FY2 saying 'you need to know this, you'll be a doctor in a few months' in front of the fourth years!

Win some lose some

I've been kind of ill over the weekend. I woke at 5am on sunday with searing pain in my back, bang over the loin, which didn't really go away all sunday and prevented both significant movement and sitting still - so basically i just lay in bed and fidgetted all day. Frustrating. Whole history sounded rather renal colicky when I put it all together but I'm in denial about that!

Anyway, today I stayed in bed in the morning and took a lot of painkillers (co-dydramol, mmmm) till I was able to get up and move about, then I went to the hospital for the afternoon. Ended up staying till about 7pm with two of the F1s as it all started to get busy at about 4pm - how annoying when that happens! The good thing was I got to do lots - lots of bloods, anyway, and an ECG.

Most of the bloods were successful, but there's this one lady on the ward whose veins are becoming my nemesis! The thing is, every time her exceptionally needle-phobic daughter is visiting, I seem to be approaching with a tray full of needles with which to stick her, and the daughter goes a bit green and has to leave...today it happened 3 times. First off I stuck her for venous bloods and couldn't get a drop, despite using several different kinds of needle - it's not that she doesn't have veins, it's just that none of them bled or stayed still enough for me to get anything significant out of them. This irritated me no end, because I don't usually miss bloods, and at this stage I get the panicky oh-no-in-a-couple-of-months-I-won't-have-backup feeling, and I'm starting to feel like the more I miss the more likely I am to miss and so I lose confidence. So stupid.

Anyway, no sooner had I stuck her and missed, and gone back to the F1s with my tail between my legs, than she needed flippin' ABGs. D'oh! By this time in the evening I'd already got ABGs of a guy in one of the siderooms perfectly successfully and was feeling pretty confident, and sure enough, once I had placated the needle-phobic daughter and apologised for disrupting visiting time once again, I got blood pretty easily.

Went to analyse the sample and it was VENOUS. Grrrrrrrrrrr.

Tail between legs again...better get the ECG machine and do that instead while someone else does the ABG, even I can't screw up an ECG.

I know everyone has good days and bad days, and the fact that I wasn't feeling 100% today anyway probably didn't help, but it doesn't stop me beating myself up about being crap at simple things. Tomorrow, I WILL do better.

Thank goodness my rather smug fellow shadowing student had scampered off home by then - I'm sure he would have had a good gloat. He announced in a meeting that he thinks women are less intelligent than men, which is not the best thing to say when two of our registrars are (very scary and intimidating and) female! I'm trying not to rise to his big-headed comments and just get on with it all. Grrrrrr again.

Enough of my down-on-myself rambling, I'm going to bed or I won't be able to think straight tomorrow let alone cannulate straight!

Boredom and drama in unequal measure

Sorry for the lack of posting of late people, surgical shadowing is actually busier than I thought!

We start at 8am, do a surgical ward round [read: wave at the patient from the end of the bed and say 'ok today? good, see you later'], do the jobs from the ward round - which is mainly taking the bloods the phlebotomists won't do, which on a breast surgery ward is most of them because most of the patients have had mastectomies and so have oedematous arms and they leave all the bloods for us - then do the admissions for the day.

Because the patients are mostly coming for elective surgery, they are usually pretty well, so they end up looking at me blankly while I ask about lots of symptoms they don't have, then sometime interject 'but am I supposed to have these things, doctor?' I reassure them that no, they are not supposed to have them, and that saying no to all these symptoms is a good thing, then I examine them, find nothing, take some bloods, which are normal, fill in an ECG form (or in fact take the ECG myself) for an ECG which is usually normal, then fill in the Kardex and get someone else to sign it all. Not the most intellectually stimulating job, but it keeps me out of trouble.

There have been two moments of drama though - firstly, an elderly lady who started making funny breathing noises while we were doing the ward round in her bay (good timing!) - she was pretty unresponsive and in her chair, so while we were all rallying round trying to figure out what to do and how to get her onto the bed, when one of the auxillaries runs over and just scoops her off and dumps her on the bed - it was impressive! So no output, we are all getting a bit stressed, the arrest call goes out, we start poking about in the groin looking for a femoral pulse, grab the arrest trolley. We put the pads on her chest, start thinking about chest compressions, and just as we do, she opens her eyes and goes 'oh, hello, I felt a bit funny!'

Phew!

The clever doctors arrive at this point looking flustered, see the two regs, two JHOs, two 5th year med students and about six nurses, not to mention the now-talking patient, and we look sheepishly at them - sorry guys, false alarm. I end up staying with her sticking pins in all sorts of vessels, sometimes successfully and sometimes not - my JHO ended up getting blood out of the brachial artery, it was impressive.

Today on the ward round, she was sitting up eating her breakfast. As our colleagues Across The Pond would say: Go figure.

Second dramatic moment was this morning - we were one doc down so the only one with prescribing abilities was getting autograph-fatigue. He went off to shout at CT about a patient who was having to hang around in hospital for five days waiting for a scan, and while he was away, one of the patients got sick. Let me tell you a tiny, non-confidentiality-breaching something about this guy: he's come in for surgery, but he's really not very well, and we think he might die before he gets to theatre. Not the most cheerful of cases. Anyway, while OnlyDoc was away debating intensely with CT, this man desaturates to 69% on room air. Now, for non-medics among you, this is Not Good. If I were Dr Shroom, I would day that this is not something you want your sats to be.

Unfortunately for this chap, I am the nearest thing to a doctor on the ward at this time. One of the student nurses comes and asks to borrow me for a minute, and I take a look at the patient, and my most insightful first-uttered phrase is, yes, you've guessed it........'Hmmmm'.

I kid you not. Smooth, Joey.

Thankfully, the second thing was 'bleep OnlyDoc', so all was well. Once more, much sticking of pins ensued, again with occasional success. When I left today, he was still alive, so that's good I guess. Think there might be a resus status discussion tomorrow.

So there's a little insight into my life on this block. Ah, crap, I've just remembered I have to create some kind of learning plan to show my supervisor tomorrow, and I'm midway through a great episode of House. Grrrr. Let the creative writing begin.

Rantage

Sorry folks, has to be done:

Number one: why is it that whenever you have worn your jeans till they are the comfiest thing in the world do they need washing and come out all small and stiff so they are not comfy at all any more?!

Number two: more seriously, I am having Skype issues. I hate the thing, I really do. I use it to talk to my family abroad because it's free, but to be honest I think the makers should pay me to put up with it! It's just decided to cut out completely so I can hear my dad but he can't hear me, and when they can hear me it echos so loudly with whatever I'm saying but with a 2 second delay that I can barely string a sentence together, it's so offputting.

If my parents were oil tycoons as people assume when I say they work in the ME then maybe we could afford to use the good old telephone, but as it is we have to use Evil Skype.

And in case you hadn't guessed it, I HATE THE STUPID THING!!!!!!!!

Right, I'm going to restart this thing and see if it will work then.

Grrrrrrrrrr.

Home again home again quickety quick

...And boy, did it go quickly! Holidays always do, it must be a relativity thing. I'm missing the family lots now, but my brother lives (mostly) one city away, and I'm going back out to see the parents in June once the exams are dusted.

So now, back to the grindstone for the final hurdles of med school. I have one more block left, which unfortunately is surgical shadowing - I'm not a huge fan of surgery and consequently haven't done much this year, so I have forgotten lots of things that might come in handy in this block...better hit the books tomorrow.

I'm quite looking forward to getting back to a more practical clinical block - the last one (paeds) was clinical, but because it was with kids I didn't get to do anything, so I'm looking forward to getting to do some stuff in this block. Not least brush up my clinical skills - I've not examined a fully-grown patient since before Christmas so need to be better at that also given the speed at which August is approaching!

There are lots of niggling little things that I am worried about starting work - you'd think I'd be more worried about big things like cardiac arrests and stuff, but recently I've been dwelling on the little things. An example: what happens to discharge scripts after I write them?! Weird, I know, but I get asked to write them by the F1, so I do, and put them in the front of the notes, and somehow they get to the pharmacist/GP/filed in the notes, but how?! I'm just worried in case this is going to become my job and I haven't realised it...I keep imagining myself drowning in discharge scripts because I haven't worked out that it's my job to deal with them!

Yes, I realise I'm crazy, but I'm sure it's relatively normal to be stressed about starting a new job of any kind, let alone one where you can screw up really badly and people might die!

There are still some hoops to jump through before the real fun begins, which I'm not going to think about just now to preserve some modicum of sanity.

For now, it's Easter, which is a pretty big deal, so I'm going to try and spend some time over the next few days thinking about that. The pastor at the church my parents go to in Cyprus seems to think that in order to be holy you must be in church, so, this being holy week, he has held a service every day, including a watch-night last night and a three-hour service today, so my parents are feeling rather over-churched - think next year they will try to have a less-holy week!

So have a happy Easter, I hope it means as much to you as it does to me.

Forgot the locust...

The locust comment on the last post was not totally random, we actually have a 'pet' locust who inhabits the plantpots in my parents' back yard. He's about 12cm long and has stripy legs.

I have named him Ioannis Baptiste - a Greek version of the name of his greatest predator.

It took my dad two days to get it. Ministers, eh?!