Purple Queens and Orange Llamas

Every so often I look around and I can’t believe that, against all odds, I actually made it into medicine. And that I made it this far. I know it’s been nearly four years now and the surprise should have worn off but it really hasn’t. 

Actually did stuff today

Went to clinic. Gave a leaflet to one patient but I don’t know if she’ll be able to do it because she’s having a pretty tough time of it at the moment. 

Then I got the shuttle bus back to the other hospital and the consultant that I’m working with on the Alzheimer’s project got on the bus as well and sat next to me. Which was useful as we had to discuss some things relating to the project, but then once we;d finished that it was all about the small talk, which isn’t something I’ve ever been particularly good at. Except that I discovered that she lives in Kent and gets the train here every morning. And not trying to be too cryptic, but Kent is AGES away. She must spend hours travelling every day. 

Back at the other hospital I went to do a balance test because I’m helping out with a colleagues project. It was pretty weird. It involved standing on a platform that could move. One of the setting was that the platform would move when you did, so if I leaned forwards the platform would tilt forwards. And then there was one where the surround moved. 

I was particularly bad at the one where I had my eyes closed at the platform could move and the one where both the platform and the surround moved. The last one was literally like being drunk, everything was slidy and moving and it was generally a bit weird. So yeah I failed those two. I’m not sure if this puts me in the balance disorder category or not! 

Oh and also, this is the grand sum of what I have eaten today: 

- Bowl of crunchy nut cornflakes
- Banana
- slice of toast
- A couple of tiny sausages and a random bit of leftover ham/turkey that we found in the freezer, carrots and a literal shitton of mashed potatoes
- A yoghurt

This is like, not enough food for a day. But eh. Felt a bit dizzy in the shower because it was hot water and not enough food. And I’m a bit peckish now but the kitchen is so far away. CBA. Also it’s 1am so need to sleep. 

Productivity!

Well, until I got home that is. 

In the morning, because we’ve got this awkward 2 registrars situation going on at the moment, they split the ward round in half so I went round with the new reg (who seems pretty nice, she had a stab at teaching me despite this being her first nephrology job so she doesn’t know all that much more than I do) and the FY1 I like better (he’s got neater handwriting and is really nice). Then we went case study crazy and tried to see how many we could do. I wasted some time because I wanted to talk to this one patient but she was on the phone for ages and then she disappeared for ages and then she went on peritoneal dialysis and a nurse was sitting with her so I didn’t get to talk to her yet.

So after the case studies we ate some lunch and someone had brought their Olympic torch in which was freaking awesome so we took pictures of each other holding it. And I gave a pound to the kidney association who were behind the whole thing which really limited my lunch choices because I only had £3 with me. Then after lunch we went to clinic and I sat in with the main consultant while T went with the slightly less senior consultant. I had lots of nice chats, chatted to some lovely patients and learnt a lot about outpatient management of CKD and when you start thinking about RRT. T got quizzed endlessly about kidney stuff and got told he doesn’t know enough so I felt a bit bad because I often seem to end up with the better clinic experience for some reason. The consultant I was with was so lovely, literally one of the nicest people I’ve come across in all my time in medicine (all 3 years…)

Of course since the clinic I’ve done bugger all, but never mind!

Brainy people, enlist!

So for my current block one of our tasks is to come up with a screening programme. Basically this takes place in a hypothetical future NHS that is privatised and so everything has to be paid for with insurance. They’ve come up with a new scheme where everyone who works for the NHS gets a screening test for free, and the various groups have to try and compete and come up with the best one. It has to meet the following criteria:

1. Not currently exist in the UK.
2. Be related to the GI system/metabolism/endocrinology/renal.

We don’t want to do H. pylori screening because two groups are already doing that apparently. We also considered microalbuminuria in diabetes but it already exists. Then we thought of familial hypercholesterolaemia but apparently that’s too cardiac. The SHO on our ward suggested things like cortisol in kids as a marker for future obesity, or looking at growth hormone and ageing, both of which sound interesting but I don’t know how much of an evidence base there is and anyway it’s a lot of work. There is also the option of congenital adrenal hyperplasia screening but it’s one of the more common ones and I think it would be fun to do something a little bit different. 

So, because there’s only a couple of weeks now until we have to present this stupid thing and we don’t even have a topic yet, I’m enlisting your help. If anyone has any ideas, please send them my way! We’ve had two meetings as a group that have lasted over an hour and have gotten nowhere (in fact I think we moved backwards at the last one) and are starting to get desperate! 

So, Today.

I was a model for a thing where they train GP’s how to do musculoskeletal examinations and histories better. Basically they pay medical students £50 to come along and get poked at for the day. It was quite fun. Mostly they commented on my flexibility (got Beighton scored at 9 and told I probably had some femoral anteversion) and how much easier it is to do stuff on a thin person. 

One of the GP’s in my room was obsessed with steroid injections into joints and asked basically all of the specialists where to do it and how to do it and what colour needle to use. I got pretend injected with quite a few pens. 

It was very educational though. As I haven’t done the musculoskeletal block yet a lot of it was new and I think it was quite good preparation. I might try and go again next year when that block isn’t a year and a half away…

Took blood today!

Admittedly I only got about a ml and the INR we were doing demands 4 mls so the FY1 had to go back int and get more. And the reason we were doing an INR was because her INR was 9.1 this morning and this was only about 4 hours later. So I don’t know if the giant bruise she got was because she has no coagulation still or because I suck at taking blood. 

After I’d stabbed her a bit and the FY1 was having his turn she was like “Have you done this many times before? You can tell me now!” and I was like “Yeah… not many…”

So yeah. Found a vein in a renal patient. Got a bit of blood. Tahdaa. 

Good things

• Sat in on an endocrinology clinic today with the mean consultant endocrinologist. He’s mean to patients too apparently, but I sort of warmed to him during the clinic. I think he honestly means well for his patients, and he seemed to like me enough which is good. I have a feeling he’s the sort of guy you don’t want to make an enemy of. There was a first year in the clinic as well trying to get a second patient for her dissertation. She wasn’t much help with answering questions (like how a GLP-1 analogue works, it’s not exactly first year stuff), but we got on well and it made a bit of a change from sitting lonely in clinic. Also the patient she nabbed for her dissertation seemed lovely so that should be good. 
   
• I LOVE the ward I’m attached to! Well, actually, the nurses are a bit mean, but the doctors are so so so so so so amazing, they like teaching and they’re friendly (even the consultant) and are happy to take time out to teach us things. We’re all a little bit in love with the SHO because he has so much time for us. He taught us about urinalysis today and signed our books off as being competent in urinalysis (because it’s not something that doctor’s do anyway so it seems a bit pointless).
  
  The FY1 is a busy chap so doesn’t offer his services up, but is happy to give us random little tasks to keep us busy (abbreviated mental test score on Mrs X? Sure!).
  
  The shadowing FY1 (the 5th year med student taking over the current FY1’s job in August) also likes teaching, and has got it into his head that he needs to teach us all the examinations, and we’re not complaining! We did thyroid last week, and respiratory today. Also he took me with him to do an ecg today (on my favourite patient), possibly partly for chaperone reasons, but it was a good learning exercise nonetheless.
  
  The registrars are actually a bit stroppy, but do take time out to quiz us and then tell us that we don’t know anything and need to go learn about lupus or myeloma or whatever it was they were quizzing us about. And they do a lot of the fun things like chest drains so we can watch (and then I get told off for mentioning the word cancer in front of a patient - apparently “mitotic lesion” is better).
  
  The consultant is so lovely. I want him to be my consultant. Even though I’m perfectly healthy. Even if he does laugh at me sometimes. He’s just so nice that I don’t even mind, and he’s really good at teaching us random stuff like how a haemodialysis machine works and cryoglobulinopathies. 
  
  
• This isn’t really a good or a bad thing, but I burnt some toast earlier. As in I burnt it to an absolute blackened crisp. The toaster was on setting 1 and hadn’t even popped up yet. It is demon toaster. Anyway, I say this because the house still smells like burnt toast. I’d be concerned that there was something burning but I already got concerned about that and have checked the hob and oven. 
  
  
• I made scones. Again. And ate the rest of the M&M’s that I only bought yesterday. 

An unusually awesome day in Psych

7.50 - sort of stumble out of bed after five hours sleep due to being up until 2am sorting out presentation for the day. Take two pro plus tablets. 

8.15 - get breakfast/get dressed/etc.

8.50 - leave house (I have no idea what I spent an hour doing this morning either)

9.10 - arrive at psychotherapy place

9.30 - sit in on CBT session with partially sighted man who is a skin picker (dermatillomania - there you go, word of the day!). He was given some habit reversal tasks - when he feels like he wants to pick at his skin (something that involves tensing a fair few muscles) he has to clench his fists and put his hands by his sides and hold them clenched for one minute. The psychotherapist made me join in on a practice run and it’s actually quite painful to hold it for that long - which is good, associating something negative with the sensation. 

10.00 - sit in on group therapy session that uses behavioural activation therapy to treat a group of people with depression. It was really interesting, and even though I was only there for an hour and a half I liked seeing this motley group of people, with their wildly different personalities and how they responded as a group. Also I finally understood what mindfulness is! 

11.45 - inhale lunch

12.00 - sit in on CBT session with a patient whom I was fortunate enough to see last week as well so it was really good to get to follow her up a little and see what she got up to over the week. 

1.15 - finish that session. The next one I was going to sit in on was a DNA (did not attend) so someone suggested I go home. 

1.30 - go home. I’d just made a cup of tea so wanted to drink that first. 

1.40 - arrive back at home. Do productive things like panic fill in my workbook in case they take it in today. 

3.00 - leave house again. Just as I’m about to leave a policeman knocks on the door wanting to talk to my housemate in relation to our cars getting broken into the other week. Seeing as I apparently got forgotten about at some point he wasn’t able to say anything to me - it had to be to her. He says that he will come back later. 

3.35 - arrive at portfolio session really hot and bothered and stressed. 

3.40 - session starts, we do our presentation (the one I was up until 2am the night before preparing). I talk about interpersonal therapy and systemic therapies. 

5.15 - the consultant taking the session grades our presentations and me and T both get excellents for our parts (didn’t see whta the other two got). Not bad for a night before job! Especially as the entire time I was presenting I had no idea what I was talking about. Saying things like “interpersonal changes” while the inner me is going what the hell are interpersonal changes?! Apparently I came off relatively knowledgeable so that’s okay. 

5.30 - me and T complain to the consultant (who is one of the leads for the psych block) about our lack of support from our consultant during the block and he says that he will look into it. He also offered us a session next Wednesday morning but it clashes with a course that T has already signed up to and that I really should sign up to. 

6.00 - finally leave hospital

6.30 - arrive home. It’s my cooking day so I make food. Meanwhile housemate is making cupcakes. They go a bit wrong and she declared them “the worst cupcakes I have ever made!” Still taste good.

7.00 - dinner ready. Find out from housemate that cupcake baking housemate is upset that we went to co-op without her yesterday, even though the reason she wasn’t invited was because it’s her birthday this weekend and we have to make her a cake at some point. And I’m slightly annoyed that she’s annoyed because after a year and a half of living together this shit always goes down in the week before someone’s birthday, but at least all will be resolved on Sunday.

7.05 - Back in kitchen to ‘eat’ dinner. I don’t really eat anything. I think I went past hunger so long ago that I just felt sick by this point, and I had some really bad hunger pains. 

7.30 - after dinner I dry up while housemate who was baking washes up. (Rookie error, baking on the day you wash up). I finally extract bowl from saucepan. 

8.00 - policeman from earlier is supposed to be coming around this time.

9.00 - now. He still hasn’t arrived. I might have misremembered the time he said he’d come back and maybe it was at 9. It’s not really a problem, it’s just that our house is quite big but our doorbell sucks so people always knock on the door and we don’t hear it. Two of my housemates are revising in the living room so that they’ll hear it when he comes. I’m also watching from the window. There’s currently a GIANT parking space right outside our house and I’m sort of tempted to move my car but I already moved it once closer and I can see it from my window where it is so it seems a bit excessive. 

So yeah, day in the life of a med student. 

A week in the life

Monday: wake up to find car has been broken into and only have 8p of credit on spare mobile phone. Ring police from hospital. Sit through one lecture. Call insurance. Go home. Drive out to get window fixed. SHIT day.

Tuesday: sit in on psych ward round. Say nothing. It takes fucking ages. At end of ward round introduce self to consultant. Me: “Hi, I’m one of your medical students!” Him: “Oh. I didn’t know I had any medical students.” Spend afternoon doing “ward work” but get offered lift home at 3pm so take it. 

Wednesday: Am supposed to meet consultant at 9.30am. Arrive on ward at 9.35am but he’s not here yet. Wait for two and a half hours while he permanently ‘will be here soon’ before getting kicked out of the nurses station for being in the way. At 12.00 go and get magic card so can access psych departments from main hospital rather than going all the way round the outside. Get lunch. Talk to a couple of patients. Go home at about 3pm again. Meet housemates on bus. 

Thursday: Drive housemates to hospital and park in recently discovered free parking. Observe ECT. It’s weird. Think I pass all the questions offered to me by the consultant. Finish at 10.45. Drive home without getting lost. Go get parcel containing usual mobile phone from station. 

Friday: Teaching session in morning which was really good and possibly the best thing all week, which is saying something. It finishes late. Have no time for lunch before session at Uni about why we should all do academic foundation years. Was hungry and irritable, and I already know I want to do an academic foundation year so felt a bit pointless. Came home. 

Saturday: Woke up at sensible time and ate good breakfast. Watched Homeland. Felt crap so fell asleep again for 2 hours. Now feel crap for achieving nothing with day. Yay. I fucking hate weekends. 

Additional note: every night except last night has been punctuated by fears of my car getting stolen/broken into again (even though there’s only a gaping hole where the radio should be so it’s not like anyone’s going to bother). Last night I instead dreamt that my two housemates had a massive falling out and it was really awkward. I think we might have been on a cruise ship. 

Day in the life of a med student (on surgical rotation)

7.00am - wake up. Decide it’s too early to get up and fall asleep again.
7.20am - get up. Eat, get dressed, etc.
8.05am - meet clinical partner outside flats and head over to main hospital.
8.10am - arrive at admissions ward. Be informed that patient is an inpatient and can be found on fifth floor.
8.15am - arrive on fifth floor. Chat to very nice 80 year old male scheduled for a carotid endarterectomy. 
8.30am - porters arrive to take him to theatre. Head for ICU/HDU to try and find yesterday’s patient.
8.32am - realise we don’t know where HDU/ICU is.
8.40am - spontaneously end up outside ICU with no knowledge of how we got there.
8.41am - go and chat to yesterday’s patient.
8.50am - her consultant shows up to see how she’s doing. He then teaches us a bit about HDU obs charts and how to analyse an ABG (which we already knew how to do but hey ho).
9.05am - head up to theatres and put scrubs on.
9.15am - get quizzed on carotid endarterectomies and the anatomy of the blood vessels to the brain. Two other med students from our rival med school show up and want to help out too.
9.30am - it’s T’s turn to scrub in. After scrubbing he realises he hasn’t put a mask on (rookie error) so I have to try and do it for him. It’s very hard to put a mask on someone else, I think I almost made his nose fall off. 
9.40am - T finally finishes scrubbing and we get to go watch the surgery. I spend most of it stood on a stool to try and see what’s going on. It’s really cool! I have to adjust T’s mask about four times, and scratch his nose once. Baad. Other med students keep nicking my stool. 
12.20pm (ish) - surgery is pretty much finished. T gets to help suture, which I’m uber jealous of.
12.30pm -  head back to accommodation to get fooooood. Watch Modern Family because all I have to do with my time is watch TV.
1.45pm - head off to clinic. Realise we don’t know where clinic is.
1.55pm - arrive at possible location for clinic. Nurse directs us to correct location.
2.25pm - consultant finally shows up. There’s only room for one student at the clinic so T goes off to try and find case studies. 
2.30pm - See the following patients:

• Man with teeny tiny inguinal hernia
• Young lad (probably about 23) who had his appendix out last year. On biopsy it was discovered that he had a tumour (neoplastic) in the appendix, and as it perforated during the appendicitis they’re a bit concerned about spread so he’s getting heaps of follow up. Really bad luck.
• Man presenting with PR bleeding, changes in stools, tiredness and massive weight loss. He got a 2 week wait sticker on his referrals (meaning suspected cancer). 
• Paraplegic lady with changes in stools. She needed a PR so there was lots of confusion with hoists and whatnot. 
• A lumbar hernia! Ever heard of one of them? They’re really rare, she’s possibly the only lumbar hernia I’m ever going to see. 
• Lady with suspected cholecystitis, but with pain completely out of proportion to normal presentations. She was offered an inpatient bed to try and control her pain, but there was a 9 hour wait in A&E and she really wanted to go home. I felt so bad for her, there really wasn’t anything we could do - she was already on the strongest thing we could prescribe. 
• Man with recent onset iron deficiency anaemia. He was a bit of a dude, really obese with a greasy ponytail and leather jacket, funky hat and carved walking stick. 

5.30pm - after final patient me and the other med student (the reason T couldn’t stay at the clinic, and who didn’t show up until 4) walked back to the accommodation. 
5.35pm - arrive back. Procrastinate.
6.00pm - decide to go and make some dinner. It’s good, had a satay sauce stir fry (with fake meat, mushrooms and leek) with rice. 3xnurses in flat are trying to cook their unhealthy food at the same time, so it’s a bit of a squeeze in the kitchen. 
6.20pm - finish cooking. Eat. Procrastinate. Watch more Modern Family. Lament lack of TV.
7.30pm - shower
8.00pm - head to flat next door to play cards.  Do very badly at all games. 
9.30pm - return to my flat. Procrastinate some more. Try to find somewhere to stream season 3 of spooks. Fail. I suck at streaming. 
10.00pm - decide to write this as a way to put off learning about the gall bladder. 

Makin’ notes on carotid endarterectomy

And cravin’ toast. 

Surgery is like dissection room (DR). There’s something about tissues and fat globules that makes me so hungry. Even just looking at pictures of disgusting, stenosed carotid arteries is making me want some toast dripping with butter. Or even better, pizza covered in melted cheese the exact colour of the fat.

I remember in first year I couldn’t eat the halls pizza on DR days because it looked too gross (well, actually, I couldn’t eat the pizza any time because it was disgusting but that’s beside the point). Now it doesn’t bother me at all. Vulval carcinomas make good dinner time reading. 

Oh how innocent I was back then. If you’d said the words ‘carotid endarterectomy’ to me I’d probably have started crying at the sheer wall of knowledge I didn’t realise was coming at me. 

On an entirely different note, it pisses me off that my room has a very faint smell of cigarette smoke because the girl next door is smoking in her room (I assume that’s where it’s coming from anyway). Antisocial much? 

Maybe I should just shower now (at 20 to midnight) to piss her off. Except that I forgot my hairdryer so can’t, unless I want to stay awake until 3am while it dries #curlyhairproblems

Psychiatrists can read your mind

I was 15 minutes late to the lecture today because I was busy trying to pick up my workbooks/dissertation/portfolio. Quite sad I missed the beginning because according to my friend it was akin to learning to give a raisin oral sex. Look at the raisin, appreciate the raisin. Put the raisin in your mouth. Suck on the raisin. Chew the raisin- (sharp ending to metaphor). 

By the time I got there he was onto depression (and specifically depression as it applies to med students/doctors), which I found slightly uncomfortable. The stats surrounding depression are stark. 50% of people develop depression at some point in their lives, with 10% having it at any one point. Rates are 3 times higher in medical students. As far as I can tell pretty much every graduating class will have one person who later commits suicide.

Doctors and medical students are inherently bad at seeking help. I know this because for all of last year, when I felt like crap, that the whole world was against me and that I was never going to amount to anything, I never once went to my GP. I got as far as filling in the form on the uni counselling service page to request an appointment but was too chicken to press submit. 

Everything he said to us in the lecture today was like a lightbulb. Like he had jumped inside my head and was telling me exactly how I felt. He said that whenever someone who has suffered a bout of depression has a minor setback, their thoughts instantly return to the pattern they took when they were depressed. Which is true. I can’t be feeling a bit miserable any more. Either I’m happy, or I’m stuck in that pit of feeling worthless and scared and like the world is black and I have to fight the desire to self harm even though all I want to do is make myself feel worse. 

It doesn’t last very long. But every time it happens I’m scared that it means it’s coming back. A relapse. And I never want to feel that way again.

50% of people with one bout of depression get another one. There’s a coin toss deciding my future.

If it happens again, I will do something about it. I know that’s easy to say now when I’m excited about starting rotations and it’s nice to see all my friends again and I got my dissertation feedback today and it was lovely. I am a bit stressed because I’ve been ignoring extracurricular things lately and they’re starting to catch up with me but I’m able to put that to one side.

For the time being, my world is bright. And so I leave you with the following:

Guess what?

I passed!

Ohhhh yeahh.

Not only did I pass the exam I was fairly sure I failed, I also got the highest mark I’ve ever gotten in an exam, and got a distinction on my dissertation. And only 12 people in a year of nearly 200 got distinctions. It does go some way to explaining why my Viva was so fucking weird. 

But you know what this means?

I am a medical student on rotations. On the clinical phase of her course. I’m going to get to take blood and see patients every day rather than once a week and going to a lecture will be an exception rather than the norm. This is the beginning of the rest of my life, and I’m so happy that it started on a high.

And now me and my two housemates (all of us passed btw) are going to go shopping to look at holidays and buy clothes for going on the wards full time and it’s going to be AWESOME and I literally haven’t been this excited about the future since I got my A level results and my medical school offer turned from conditional to unconditional. 

It’s nice to be able to use a happy gif for once :D

It’s the 12th January

10 hours-ish until my exam.

This day has held a sort of revered silence ever since they announced it months and months ago (after we all got over the fact that they scheduled paper two on Friday 13th). And even before it had a date, it still held something for us. This exam is the gatekeeper into clinical years. It marks the end of a world that has seemed so safe for so long, of lectures and group work and one morning a week of patient contact. By passing this exam we are showing them that we can do it, that we know enough to be let loose on the wards and not look like fools in front of the consultants.

Because at the end of the day, we’re representing the med school in the wider world. They can’t contain us any more. This is our chance to maybe actually make a difference. Perhaps not in the way of diagnosis or treatment, but we can get to know our patients, and this is the last time we are going to be able to dedicate so much time to them. We can talk to them, try and make them feel better even if all we can do is hold their hand. Medical school is a precious time, before there is any great responsibility, when it’s still okay to admit that you don’t know something. 

Except today I have to know everything I’ve ever been taught. I’ll have to recall meticulous details of the adverse effects of ezetimibe when any non-cardiologist doctor would just look it up in the BNF. I’ll need to know the embryology behind the formation of an ear, even though unless I become an otologist or a paediatrician, it’s probably not going to need to be something I know off the top of my head. 

Medical school is a weird time. It’s conflicting, always wondering if you have done enough, wondering how much you really need to know. I read once that third year medical students have the broadest knowledge of the entire medical profession. From the first years to consultants, it is us that knows the most about the most. We have to know a little of everything and a lot of nothing.

It’s comforting to think that it’s all downhill from here.