Wednesday, 24 February 2010


Alright well due to extreme busyness from both essay deadlines and intercalated personal statements this blog is seriously delayed - I even started writing some of it 2 weeks ago and never finished and posted :S. So sorry about that!

On friday (two weeks ago!) had the most awesome ward round ever! Literally! Reading the title of this blog you might think I'm a bit weird for saying that but I'll tell you now (spoiler alert..) that the patient was ok at the end so I think I can say legititmately say that it was awesome. So heres what happened...

I was on a ward round on CCU (cardiac care unit) with one other student and a lot of doctors (3/4 registrars, and 3 F1/F2's and we were going around seeing patients in turn who had recently had acute coronary events - such as angina, MI's or had just had arrthymias detected. After seeing several patients we reached one elderly gentleman whose heart was absolutely racing at over 200 beats per a minute and his monitors were bleeping away to alert the staff to this problem. In all honesty though the patient didn't seem that unwell considering his heart was pumping so fast and he was replying quite coherantly to the doctors. Then the nurse got him to sit forward because his blood pressure wire had gone underneath him so was not recording properly and the doctors needed to know seeing as his heart was going so abnormally fast. Then all of a sudden the patient collapsed and before I knew it the doctors and nurse were rushing around performing CPR, closing the curtain to all the other patients beds and grabbing the crash trolley. The patient had gone into ventricular fibrillation - one of the shockable types of cardiac arrest.

And it was just like ER/House/ Greys/ whatever medical drama you choose to watch. It really was, everyone scoffs and says it isn't really like how it is portrayed on tv but in this case from my position of hiding out of the way with my back pressed firmly against the curtain of the patient opposite it really was. The only difference really was that in England they don't use defib paddles but sticky pads that you stick on the patient (apparently it decreases the number of times staff accidently shock themselves). The nurse said at one point that she felt the patients ribs crack and the doctor in charge dramatically yelled out everyone stand clear before he adminstered the shock. And then in this case (just like in ER) our patient magically recovered and regained consiousness - I hear this is not often the case, but then again I suppose you are going to have a cardiac arrest you couldn't really pick a better time than when 7/8 doctors, 2 nurses (+ two useless observing med students!) are standing round your bed.

The patient then got rushed off to theatre to have a temporary pacing wire put in so that this way he could have medication to control his fast rhythms without causing more slow rhythms than he was already suffering from as the pace wire would stop these. Problem solved and life saved!

After this ward round I didn't really have much more on medicine than the odd bit of teaching and my CBD exam. My cbd exam went....well pretty awful to be honest. I got an ok mark but the experience in general was horrific as I got throughly grilled - normally consultants wait to the end of your case presentation and then ask just a few questions but the consultant doing mine prefered asking throughout and asked hundreds of question. Eeek! It really made me lose my flow and I know I was beetroot coloured by the end but at least he wasn't a harsh marker as it happened and I somehow still got an ok mark. I guess thats the main thing!

Had my halfway there ball (as we are halfway through our medical degree) last week, was awesome!! Now I actually am half a doctor allegedly :).I am now on surgery but will save that for next post so that I actually post something now rather than delaying further!!
So, will try and post sooner next time!

Wednesday, 17 February 2010

Patient stealing and reaching the end of general medicine rotation

Been a bit overdue in posting this as have been a bit busy over the last week and a bit, for once this was mainly in a social way as its been my 21st this week - yay for legal USA drinking should I ever go there. Medicine has also been busy as this week is my last on general medicine so have been trying to complete my logbook (logbooks are the bane of a 3rd year medics life at my medical school, we have to get signatures to show we have attended particualar sessions, met various multiproffesionals and been observed practising various clincal skills).
The problem with our logbooks is that you have to get the signatures and as a result end up missing sessions that may be more useful educationally in order to get a signature. For example this morning I went to see the hospital Chaplain to find out about his role so that I could get my 10th and final "Multi Proffessional" experience signature. But as he couldn't do it any other time I had to see him rather than going to an additional teaching lecture, as that was optional and did not require a signature. It was admittedly interesting finding out what the chaplain does and how the chaplancy service at the hospital works (and I suppose will be useful to some medical students so that they know in the future they can refer patients there, but to be honest I already knew it existed so Im not sure I gained that much) but I'm sure my future patients would prefer I'd attended the lecture this morning by the famous visiting Clinician. That said I suppose logbooks do stop some people just skiving off.
Last tuesday I had my last "on take" to do and it proved to be a very annoying experience. I learnt the hard way that you can not always just trust other medical students with what you tell them as sometimes their competitive streak takes over their sense of fairness which is a real shame. During the morning on take I managed to find a patient that my consultant agreed could be a good CBD (case based discussion) patient - these are patients that we have to follow up throughout their time in hospital and then present (and be examined on) them at the end of the rotation. Anyway I spoke to this male patient and took his history just after he had been admitted and he was very easy to speak to and furthermore was unlikely to be in hospital too long which makes it easier as its a bit worrying when you don't know if your patient will be discharged in time for your CBD. He had chest pain which the doctors felt was ?PE and was exactly the kind of condition I was looking for - lots to talk about without being overly complex. However in the afternoon I made the mistake of telling another student on my firm (medical team) that I had found a cbd patient at last and the other student asked his name. Before I knew it this other student was running off to find the patients notes himself and also planning on using him for his CBD. :O! Now whilst we are not technically prevented from using the same CBD patient I think it is a bit frowned upon because really your CBD patients are meant to be people you clerked in when they came to A+E and then have seen ever since then. It is really meant to be an independent thing of finding a patient for yourself then following them through their admission. I didn't actually clerk this patient in but I did re take his history very shortly afterwards. What really annoys me is that this student didn't have the courtesy to ask if it was ok with me if he used the same patient but just did. Also Ive checked our examination timetable and I am doing my CBD after the other student in the same room - which means if the consultants don't change over in between then its going to look like I am the one who stole his patient and this could affect my grade unfairly. All in all very annoying.
I had more annoying times on this particular afternoon about patient stealing but not to the same extent. Not many patients were coming in for ages so I had to wait around in the MASU office for a while with nothing to do. On the plus side this meant that when patients did arrive, the registrar gave me one to go clerk in and my name was written up on the clerking sheet as seeing that patient (meaning in theory no one should go see the patient until after I have presented the clerking to them and then a junior doctor will review them with me). However when I found this patient in A+E her curtains were pulled and when I came in I discovered two other students on my firm already clerking her having seen her name on the A+E board as a new medical firm admission. This in itself was annoying when I had waited so long for a patient to clerk but then when I went back to the registrar and explained why I couldn't clerk them I gained a rant from him about how annoying it was when medical students didn't do things the proper way. He told me I had to tell my collegues the proper system but when I did so I'm not sure it came across the best way because it was hard not to show that I was a bit annoyed myself that they nicked my chance to do some clerking (and by this get some vital clincal skill logbook boxes signed off!). A tough day.
I had a better day yesterday managing to get a teaching ward round, gi history and mini cex (this is like a practise CBD but done from just one time seeing a patient) all before 1pm which was pretty awesome. I had previously had trouble finding both a GI history (as patients with GI problems always just seemed to be due to come in when I have been on take but have never emerged) and a mini cex so it was great to finally get these done (and both on the same patient as I used a GI problem for my cex!) The patient was lovely, she was happy to let me re take her history and examine her even though she knew it was just for my benefit and she was feeling very nauseous (she was actually sick whilst I was in there but then encouraged me to continue afterwards when I was a bit unsure whether I should continue putting her through it). Lovely lady and then I had the fortune to present her to a very nice registrar so got better marks for my cex than I feel I strictly earnt. Good times!
Thats all for now as I need to work on my CBD (and to be honest watch an episode of house I'm currently streaming!) Sorry its been a bit of a rant this week, its probably because it gets a bit stressful when your trying to get your last signatures (which are usually the hardest ones to get hence why you left them till last!) so its particulary annoying when things stop you from getting them! Still only three more signatures to go now (and they are all sessions I'm timetabled in for wooo!) and then logbook completed :D. Have a lovely week.
\p.s. Apolagies for the wierd paragraphing - it won't let me make gaps today without a \ for some reason!

Saturday, 6 February 2010

Sometimes you can't win

I had some interesting patient experiences this week, so I'm going to talk about them but to preserve confidentiality obviously I won't use any actual names and I'm not going to give all details to further ensure the patient is not recognisable (this is also why I never mention what medical school I am at as I do not want people to be able to work out what hospital I have met particular patients at).

On monday in a clinic for a particular progressive chronic disease (again I will not mention what) I met a lovely elderly (ish) couple. The husband was the sufferer of the chronic disease but his prognosis at the moment for that was very good and he had years left before it would become a problem. At the moment he was just attending clinic so that it could be monitored and he could be educated about what choices he had further down the line. This was one of his early clinic appointments so the consultant was suggesting his wife and him attend a group patient education session on his future possible treatments. The great thing about session like this is that they allow the patient to meet other people who are in exactly the same position and so not feel so isolated in their misfortune of getting a chronic conditon. The couple were very positive about the suggestion and so were going to attend the next session. I had really enjoyed meeting this couple and it was nice to see how chronic conditions can be managed positively and effectively. Unfortuanately though when the consultant looked through some recent scans the patient had had (purely to teach me for my education, not because he was expecting to see anything) things did not turn out to be so positive. The scans showed what was very likely to be lung cancer which the consultant pointed out was most likely to be metastatic (spread from somewhere else) as he did not have it just a few months before when he was scanned and now it was pretty big. Metastatic lung cancer is terminal. I felt really bad knowing this before the patient knew and I expect it will be a while before he finds out for sure as they will want to do proper diagnostic tests firsts. I think the consultant also felt bad that he hadn't seen this before the appointment as then he would not have told them they needed to consider the future and sent them for further education. He was trying to do the best for this patient and to help them plan for the future but in doing so he had made the assumption the patient had long enough left for his chronic condition to progress that far. As my title suggests sometimes you cannot win.

The next memorable patient I met was a much happier experience. She was in her mid 90's and body appearance wise was frail but in all other ways was one of the fiestiest most chirpy patients I had met. She turned up with her nails painted and hair dyed a vivid colour and virtually bounced around the clinic room with her energy and happyness - she very much reminded me of the poem that says "when I'm old I shall wear purple" because she had such a mischeivous/rebellious attitude. She was simply awesome. Frankly if I can be as cool as she is (and so sharp and witty still) when I am in my 90's then I will also be very happy! I wish I could share some more specific anecdotes about this patient as she was so awesome but I think if I did so I would make her too recognisable to either her or her neighbour who came to the appointment with her and I don't want to risk that on the ridiculously slim off chance they ever saw this.

On tuesday I had a cardiology clinic. Last time I went to this specific cardiology clinic three weeks ago I completely crashed and burned when I was getting grilled by the consultant. Furthermore it when everything was snowed up so the consultant had loads of time to grill me as many patients were unable to make the clinic. My partner had got the wrong location for the clinic and so I had to face the torrent of cardiac grilling by myself with no one to hide behind... The grilling progressed to the point that I was even mucking up the bits I did know really well and thus making myself look thoroughly stupid. The clinic then ended with the consultant saying (albeit in a very nice way) that I was rusty on my knowledge and I should go away and learn lots and it would be nice if he saw me later on the rotation so he could see if I had progressed...Eeek! So go and try to learn lots I did. I bought and ECG "made easy" book and I'm slowly learning all about the confusion that is 12 lead ECG's and I've been teaching myself about heart murmurs and heart failure. So what did he grill me on today? Well he asked me (and my partner this time) if I knew what Gin was made from, whether we speak italian and what fiction book we were currently reading. On learning that we weren't currently reading any fiction books he was dismayed that it was all work at the moment and told us we should read fiction books because they were the breath of life... DAMMIT! I couldn't agree more that reading is a great hobby and escapism but part of the reason I have not had not had time is because I was trying to know more about heart to avoid getting another embarrassing grilling. As I said, sometimes you can't win!