Monday, 31 May 2010

A catch up..

Well its been some time since I've posted so will try to feel in the gaps a bit...
Since I last posted I have finished vascular, had a week of urology experience and started + now finished paediatrics.

Vascular wasn't really my cup of tea - it was very gory with lots of leg ulcers and ischaemic legs with gangrenous toes. There is (fortunately) no smell quite like an infected leg ulcer. If you are a smoker perhaps paying a visit to a vascular ward might help you to quit - during my time there it was fair to say most of the patients were smokers/ex heavy smokers and/or diabetic. I only saw one surgery during vascular and that was a leg amputation due to ischaemia which had caused irreversible tissue damage.

This was quite a strange and brutal operation to watch, and literally involves the bones being sawn through. I found it quite surreal watching someones leg being taken off - I suppose this was because in medicine obviously normally you are doing everything you can to avoid long term damage to the patient but this was a situation where irreversible damage has occurred and now the surgeons job is really "damage limitation". There is sadly no point leaving a patient with a leg full of dead tissue that they cannot use and that will get infected causing damage to the remainder of the leg - it is much better to save as much of the leg as you can as this will improve the patients ability to late on walk with a prosthetic leg. I did feel very sorry for the patient though and I think even if (as in this case) you are aware you are going into an operation where your leg will be amputated it still must be a horrible shock when you wake up with only one leg. Of course it must be even more of a shock if you are in an accident and end up having your leg amputated as an emergency.

My week on urology also wasn't really my cup of tea - whilst its fair to say I'm unlikely to ever want to go into surgery, I found this a particularly dull area of surgery. Urology surgeries often involve camera going up into the bladder which (compared to the kind of views you get from cameras in GI surgeries) really isn't a very exciting organ to look at. I'm not saying surgeons who specialise in urology don't do great work because obviously they do but personally I can't see the appeal...
It was also a kind of rubbish week in general we were meant to have several teaching sessions on urology but all of them ended up being cancelled... Therefore I know very little about urology - hope not too much comes up in the end of year exams!

Paeds on the other hand has very much been my cup of tea! I had been looking forward to this rotation all year because Ive always thought it might be an area I would want to specialise in. My first week was in outpatients and this week was particularly interesting. One of the clinics I watched was a very specialised endocrinology clinic which was being overseen by one of the top endocrinologists in the country, as a result all of the patients in this clinic were individuals with really interesting conditions that needed to be seen once a year by a more specialised doctor as opposed to the local general paediatrician who normally sees them. There was no diabetes to be seen here! I saw patients with turners syndrome (where girls are missing one of their x chromosome), patients with growth problems due to various complicated causes such as pituitary tumours and patients with problems with their sex organs eg cliteromegaly. It was a really interesting clinic!! And too top it all of we got a free drug company marks and Spencer lunch afterwards :D.

My second week was in inpatients which was also interesting although certainly much quieter in general than the adult inpatients. Apparently during the winter it is a lot busier though because then lots of kids get respiratory problems. My on take in paediatrics was ridiculously quiet as only one kid came in during the whole evening so whilst we got to take his history and exam him we didn't really get much hands on experience unfortunately. During the week we did have a teaching session where we got to try examining kids - the doctor overseeing us got us to try and check a toddlers reflexes...this is very difficult! Firstly you have to try and distract the child in order to get them to relax their leg (or arm if it those reflexes you are testing) and then even once you have managed that, the space you need to tap in order to get the reflex is ridiculously small in a child!

Now I am just about to starts OBs and Gynae and I had my first session on the delivery suite yesterday and got to see my first birth :D. The birth wasn't natural but a caesarrean as the baby was showing sign of distress. Nonetheless it was so amazing seeing the baby being pulled out and then start crying and watching the dad walk over and see his little girl for the first time, and then once the baby was cleaned down he got to carry her over to the head end of the operating table so that the mum (who was awake during this c-section with a spinal anaesthetic as this is the preferred way for most caesarreans to be done now) could see and kiss her baby. It was magical! Certainly one of the plus sides to being a medical student is getting to watch moments like this :).