A Medical Student's Diary

Haematology - whats that all about?!

2006-10-24T00:09:00.000-07:00

I'm now 11 days into a 25 day rotation in Haematology and I am becoming steadily more bewildered by the subject on a day-to-day basis.

I started off by reading the first few chapters in a couple books I own which was a really solid grounding for getting to grips with cell lineage e.g. lymphoid and myeloid. Then I started reading up about the pathophysiology of different types of anaemia which I am hoping will prove useful in our multiple choice exams in a few weeks.

This was all going well until I decided to sdo some reading around our ward-based bread and butter - leukaemia, lymphoma and myeloma. Oh my god! Firstly, as a bit of a learning point, everything malignant in haematology can present as anaemia, thrombocytopenia or leucopenia. Therefore, based on a history you can't diagnose people! Crap! Standard issue clinical reasoning goes out the window!

When (or maybe more appropriately, if) I find out how to solve the blood based mysteries I will share my gift with all... unless you're on my course and in direct competition with me in the exams ;)

And winner for the longest anaesthetic...

2006-09-21T09:54:00.000-07:00

A very old woman is to undergo a laparotomy for investigation of small bowel obstruction.

She has no significant cardiovascular or respiratory problems excellent.

She has been admitted to ITU/HDU after a surgery last year due to difficulties ventilating – bollocks!

Time = 0hrs 0mins

The lady comes to anaesthetic room, very cheerful and smiling as all the “sick” old women are. The anaesthetist tries for 20 minutes to find a peripheral vein to cannulate. After around seven attempts he abandons this and moves onto an arterial line.

Time = 0hr 50mins

The arterial line is still not sited despite attempts in both radial arteries and brachial arteries (one under ultrasound guidance). It is decided to move on to a femoral arterial line. At this point a vein on the rear of the lady’s forearm stands to attention and lets us cannulate it.

Time = 1hr 10mins

A rapid sequence induction with cricoid pressure is carried out. This happens with relative ease. Despite popular belief across the pond cricoid pressure is required as (in this case) the patient risked aspirating 700mls of fluid from the stomach.

Time = 1hr 25mins

After a number of trips for ODAs and students to ICU a femoral line is finally sited under ultrasound guidance.

Time = 1hr 40mins

The epidural is finally sited despite this patient seeming to be made entirely of calcium.

Lessons learnt:

Little old ladies are made of clotted cream, atheroma and calcium...

Always use cricoid pressure in rapid sequence induction...

If at first you don’t succeed… use ultrasound guidance...

Even the best can sometimes struggle !

Hard decisions

2006-09-14T09:42:00.000-07:00

Over the past few weeks I have been learning about pre-operative assessment with regards to risks specific to surgery and anaesthetics. This has involved identifying key conditions (e.g. severe aortic stenosis) which may impact upon how anaesthesia is performed. I have then been putting this into practice and clerking patients before their surgery, making note of key conditions and considerations and specific assessment for anaesthesia – airway assessment, etc.

Until today this wasn’t too complicated as the most difficult issues I have dealt with were severe arthritis of the neck resulting in an inability to perform a standard intubation and allergies to some of the commonly used agents.

Today was somewhat more challenging however. I attended the preoperative assessment clinic where potentially complicated patients have already been identified through routine nurse-led clerking. One patient was particularly difficult (clinically) and quite upsetting as an observer.

The patient was an elderly woman who was to undergo major abdominal surgery. As well as this she had a significant history of respiratory and cardiac disease with coronary artery bypass surgery and pacing unable to control a longstanding history of unstable angina.

This lady was then told that she had to make a decision as to whether she had the surgery with a significant risk of peri-operative death or did nothing. A tough decision and certainly not one I would lightly make for myself or my patients…

48 weeks and counting…

2006-09-01T03:41:00.000-07:00

In a few days I return to university to start my fifth and final year of my medical degree. I have been looking forward to it as it means that I am only a few months away from finishing what seems to have taken me forever. Having said that, panic has also started to kick in as we are constantly sent emails on how long it will be until we have to apply for our first jobs, when we will be told where we will be working, and (most worryingly) how to appeal a decision!

This has been a great summer for preparing me for my fifth year as I have been writing formative assessment questions for students in lower year groups. I have been able to write questions based around the areas in which I am lacking medical knowledge and I am sure that this will prove to be of value in our assessments and certainly on the ward. I have also been working with two doctors who are undertaking posts in medical education, interestingly one as a senior house officer and the other an F2 doctor – essentially the same role but each training under a different career structure. It has been interesting to listen to their experiences and how best to cope with work on the wards and I will take their advice forward into this coming academic year and beyond.

This year I have five training blocks and my medical elective to carry out, alongside all the assessments which run throughout our medical degree.

My five training blocks are anaesthetics, haematology, respiratory medicine, colorectal surgery and general practice. I consider myself very lucky as I had put all these in my shortlist for placements I would like to undertake. Anaesthetics and respiratory medicine are careers I have given a great deal of consideration to, whilst haematology and colorectal surgery were placements I thoroughly enjoyed during my third and four year placements.

My medical elective is starting to take shape and this summer I have spent a great deal of time getting ‘jabbed’ and searching the internet for cheap flights and insurance, all of which are now sorted. It doesn’t seem at all long until I’ll be off to South Africa and I really can’t wait now.

I will be making more of an effort to keep this blog updated now as I have found out that a considerable number of people from all over the world seem to be logging in to see what I have been up to!

End of another year!

2006-06-17T23:30:00.000-07:00

Our fourth year clinical finals happened on wednesday and friday of last week and (with the exception of a few formalities) concludes yet another year at medical school. In true medical student style we finished off the year with "pub golf" - which I won!!!

The next few weeks will be an interesting time as I should be getting things together for my elective in January but I am reluctant to do this as if (heaven forbid) I had to resit this year I stand to lose considerable sums of money. I'm going to have to sit on my hands as best I can...

With the academics done with for a few weeks I can also get back on track with my weights training which has had to tke a back seat to exam revision. It is my intention to lose about half a stone in fat and put back on a couple pounds of muscle before September and the new rugby season. To help with this I am also starting pre-season training next week as well as continuing with my boxing training. Roll on summer!

If its not one thing...

2006-04-11T03:13:00.000-07:00

So for a few very brief moments my life was pretty much calm and collected. No financial worries (for a few years), exam results were good, weather was great, and then... somewhere rea... drives into the back of me in a queue of traffic (I would have said "someone rear-ended me" but i'm sure mike would have turned that into a homo-erotic statement; the boy can't help it... its just the way he's programmed). So now I have the joy of (1) trying to get my car fixed, and (2) trying to get a courtesy car so that I can actually continue to live over the next few weeks (minimum).

Oh well, life goes on.

I've really enjoyed my weight training over the past few weeks and with the Rocky films being shown on television over the past few weeks I couldn't resist buying a punch bag to go in the gym/garage. Lots of fun, although I have to admit I didn't realise that there are "techniques" to hitting bags so you don't hurt yourself. Luckily I've a few friends who kickbox and used to box who have put me on the straight and narrow before I end up with broken fingers.

For once it seems that the start of our easter break and the good weather have coincided so for the last few days i've been going to the beach to do my revision which has been awesome. The only problem is that I now want an office with this view (see below) - fingers crossed.

Roll on weights training!

2006-03-15T14:54:00.000-08:00

Over the past few weeks i've lost a reasonable amount of weight and have been quite happy with this, but now its time to start building up the muscle for beach season. In the last two weeks I've had two great deals: one nice york weight bench for £25, and york bench/weights/bars also for £25.

So I now have well over 100 kilos in cast iron weights to play around with and a friend of mine has taken some weights and a bench off my hands (he's not quite as big as me so doesn't need so much just yet... pm02rs for those who this means something too).

I've been given the challenge of benching 230lbs (105 kilos) by one of the guys my dad works with and so from tomorrow the race will be on... although it may be a very slow and arduous race. As well as this, with my new bars I can finally get back into my squats which I haven't been able to do properly for a few years.

Really looking forward to it. Before and after photos ETA July 2006...?

A quick update...

2006-03-06T15:15:00.000-08:00

The last month or so has been very busy at university with a number of deadlines in the next couple weeks. This won't be anything particularly deep or interesting; just a brief update for the people that know me...

Ok, so another pathway is over and our special study units are upon us - what fun?! With the deadlines for about four 2000 word essays and a number of other articles aoon for sumission I don't think its unreasonable to say I (like most of my year) am very, very tired. I won't dwell on this too much though as I've really enjoyed the last few weeks...

I stopped drinking after New Year and to this date I have only slipped once (at a house party where a drink 3/4 pints of cider). This cessation of booze and change in diet (general not fad) has led to me losing 17lbs since new year and I am rather happy about this as according to the wonderfully accurate fatty caculator - the Body Mass Index (BMI) - I am now "overweight" and no longer "obese". Anyone who knows me will know what a pile of crap I think this particular measure is as I don't think many people would see me in the street and think "there goes a fatty".

Enough of a rant on that... I bought a weights bench today! This may confuse people who I have been telling that I've been doing weights for the past two months. Previously i've been only using dumbbells and a swiss ball and decided that to do bench press and and squats properly I needed a bech with a rack so i don't damage my back lifting from the floor.

Anyways, there's the update. Hopefully will write gain soon. Please prompt me if you're waiting for an update!!!

Man Flu

2006-02-02T00:29:00.000-08:00

I have man flu and it sucks nuts!

If I was still in school it would have been great - few days off watching crappy day time television. But no, I had to get it when i'm at university and more importantly on a medical attachment with a speciality I am really interested in; I am therefore attempting to make a good impression by battling through the headache, blocked nose, aching ears and sore throat and attending all my placements.

Standing in theatres wearing two sets of scrubs and still shivering is probably not a great idea and i'm guessing it will all catch up with me this weekend.

But hey, what can you do?

Bigwig - The House Rabbit

2006-01-18T14:51:00.000-08:00

Xmas Cheer?

2005-12-30T11:34:00.000-08:00

After reading my friend mike's blog this afternoon I felt that I should make it clear that he is a bitter and twisted medical student of the mature variety and does not necessarily reflect the views and opinions of all medical students at christmas.

Sorry Mike. But just for you... Weebl!

Hope everyone has a great new year and, if i'm still able to do so (alcohol permitting), I will post again in the new year!

KONG!!!

2005-12-18T02:48:00.000-08:00

As a reward for finishing/considering starting our recent assessment a few of us decided to see King Kong last night, and it was stunning!

In typical Peter Jackson style it was a three hour saga, but what have we come to expect from the big man? Unlike the LOTR films though, you don't get two hours into this film and start looking at your watch to see how much more of f**king Samwise Gamgee you have to endure.

A little slow to start, but once the ball got rolling it was never going to stop... destroying trees, buildings and people. Some very amusing moments where the cast and the CGI teams should be commended, and also a few tearful moments.

A great film, which I could watch over and over..

http://www.kingkongmovie.com/

An update...

2005-12-01T05:35:00.000-08:00

So, as it has been a little while, I will give a brief run down on all the wonderful things I have seen.

Child Development
I spent time with the child development team assessing children for all manner of conditions and syndromes. I spent a couple hours pretending to be a monkey to see if autistic children could appreciate my "imaginative play". I don't know whether they could put I got a pat on the head for my ability to interact with paediatric patients.

Neurology
Another week was spent at a stroke rehabilitation centre where I was asked by the consultant to see two of his patients - the first with physical impairment and the second with aphasia. The second of these proved a real test of both the patient and my own ability to communicate and (more importantly) our patience. This was a real eye opener for me and something I will give consideration to over the coming weeks.

Oncology
I have only spent three days with oncology so far and this has been the best learning experience I have had since starting my clinical placements two years ago. I have improved my knowledge of cancer and its managment many times over and by the end of this three week block I intend to have a wroking knowledge of the oncological emergencies - spinal cord compression, etc.

I had previously never given consideration to a career in oncology and although I am still keen on my anaesthetics and respiratory medicine it is dfinitely an area of medicine I will keep in my "options bank".

Ooops...

2005-11-30T05:46:00.000-08:00

Last night I realised just how long it has been since I last posted something on my blog.

I thought I had better put this up to let people know that I am still alive and well but i've just been snowed under with work (more details to follow).

I have also been sidetracked by another blog project for my medical school team. Its another blogger site called "peninsula pride" and the link to this site can be found on the right hand side of this page.

Will update people on my life in a little more depth over the coming few days.

New Stereo!

2005-10-03T15:12:00.000-07:00

I'm not in the habit of buying myself expensive new things as i'm penniless at the moment (like most students in their fourth year). But, to hell with it! I deserve something new; and if i'm going to spend money on something for me I may as well spend a reasonable amount!!!

So here it is, me new stereo!

For anyone who is interested, it is a PURE Legato and its (in my mind) HiFi porn.

http://www.pure-digital.com/Products/product.asp?Product=VL-60692

Kidneys...

2005-10-01T06:53:00.000-07:00

This was a really interesting week which blew my understanding of hypertension (high blood pressure) out of the water.

It had previously been a relatively straight forward concept and I knew how a physician should treat the condition. This past week with the renal, diabetic and cardiology teams has given me a huge insight into the pathophysiology which underlies the condition and how renal disease and diabetes impacts upon the standard managment plan.

It was great to get back onto the wards of a busy hospital after a long summer* and a lecture at the end of the week from a professor of endocrinology has made the propsect of spending time with them next week a little (not a lot, but a little) less daunting.

*I was back in placement last week but this was not at the main teaching hospital with its sweltering wards and MRSA (aaah, its good to be home)

Eyes...

2005-09-22T15:51:00.000-07:00

Ophthalmology: 1. the branch of medicine concerned with the eye and its diseases, 2. a branch of medicine I thought I would have absolutely no interest in.

Turns out that I was wrong. I am absolutely fascinated by eyes after just four days. I've been involved in casualty clinics, diabetic and glaucoma clinics and testing of visual acuity, fields etc. and it has been amazing.

I got absolutely drawn into the subject matter and have come out with so much insight into an area of medicine I had totally written off as a career choice many years ago. Although I still feel that anaesthetics is still my preferred speciality I won't rule this out just yet.

This has been a great start to the year and I can only hope that this trend continues in my next attachments with the renal and diabetic units. As an added bonus my clinical partner (who I will be spending the next few months with) is brilliant - really chilled out, but also really bright and driven (something which can only be positive at this important time in our training).

The start of a year...

2005-09-06T13:30:00.000-07:00

This posting marks the start of a new academic year for me.

I started back on Monday with a wonderful day of admin, fire safety, security, IT registration.... the list goes on. Not the most energising start to a new year.

Today, in contrast, was great. I've started a study module with a consultant paediatrician and I am to produce a report over the year based around the history of children in hospital i.e. the attitudes towards children, the development of Paediatrics as a speciality in its own right - a more recent development than I had previously been lead to believe. All I need to do now is develop a research question and then I''m away (please feel free to provide a question for me as a comment as I don't have a clue at this point in time - seems very interesting though).

I have also been told my placements which follow on from this unit and I will be making a concerted effort to find out anything I can about eyes as I currently can put my knowledge of eye disease on the head of a pin! (Again, if anyone knows as any good resources then let me know).

Training Update:
I don't feel any fitter but I have lost 10 lbs in the last two months which I am very pleased with! I'm sure my rugby team will be less than impressed but who cares, i'm still bigger than most of them ;)

Wheels in motion

2005-08-09T18:05:00.000-07:00

I have started training again for the half marathon and its not going to be as easy as I expected. I'm basically back to square one feeling really unfit. On a positive, I have found someone who is as "fit" as I am and we're going to run together a couple times a week.

I've had a few people say that i'm looking a lot fitter in the past few weeks which is a real confidence boost. I've lost about a pound a week since being home and training properly and I expect the fat to drop off quicker now i'm running. I'm intending to drop another stone in fat and put on half a stone in muscle (if that makes sense), with the end result being a more toned, athletic me.

Depending on how that goes I may post pictures of myself - before and after (will wait and see...)

Something to get off my chest:

Women, if a few blokes are out in a club and look like big guys they are not always marines! I had one hell of a battle trying to convince a girl I was a doctor (ok, i extrapolated on the truth) and she came back with "you can't be, you're all really big - you must be marines"!!! No, we all play rugby and do weight training. Why does big = marine?

(sorry, needed to be said...)

A change for the better

2005-07-24T06:25:00.000-07:00

Since coming back from uni at the end of June I have been making a concerted effort to try and get fit again for the coming rugby season. The last time I felt 'match fit' was probably in April when we played against the local prison and I had two of my ribs broken. This stopped my rugby for a couple weeks and finished off my efforts of training for a half marathon. I was about five weeks into my training and had been feeling great (with the exception of my calves every morning after a run). Unfortunately, breaking my ribs meant that I couldn't run for a couple weeks because of the pain and I never got back into it.

I am hoping this will all now change. I went for a run today for the first time since April and although it wasn't that far I feel I can now get back into it and go for the half marathon next year. A girl I work with at the moment(another medical student) is also keen to go running with someone and I hope that this will be another driving factor. This, together with my rugby training, weights training, etc., should be the start of a big change for me.I have also had quite a significant change in another part of my life.

Recently I have felt the need to be with someone, and after three years of being single this really has struck me as strange. I get the feeling that this has something to do with all my schoolamtes finishing their degrees and moving on with another stage of their lives. Maybe I need to do the same. Who knows....?

New Job

2005-07-15T11:30:00.000-07:00

This week I began a job with the medical school writing formative examination questions for the first and second year students. This has already proved to be really useful as I have been able to identify gaps in my knowledge (most likely due to alcohol) and address these.

My hope is that this will be a great revision tool for the summer before the fourth year, but failing that its just a shed load better than the job I did last year. I won't give any specifics but it was working in a freight depot, doing split shifts, for crap pay with people I couldn't bear to be around.

Nothing else to report... so I won't.

A Great Week

2005-07-02T10:15:00.000-07:00

This week has been wonderful. A week off from university, work and pretty much any other form of responsibility. The only problem is a lack of money, so to pass the time I've been redecorating at home, helping my friends move house and repainting their new home.

A week which some might consider dull, but for me it was great. A chance to see my friends again after three months and also to do something a bit physical which isn't part of my new rugby training schedule.

To top the whole week off I was dropped home today to find a replica of the car featured in Starsky & Hutch. Despite being too young to remember the original series, the release of the new film means I can truly appreciate the majesty of this vehicle.

For your viewing pleasure...

The end of a year...

2005-06-27T09:00:00.000-07:00

I have just finished my third year at medical school and looking back on it the past twelve months has provided me with a number of firsts:

First time living away from home
First clinical year
First time playing with a university rugby team*
First time I have ended the year literally penniless

The past year has been exhausting - physically, mentally and emotionally - but, I wouldn't change a second of it. I built some great friendships, some less successful relationships and now feel like I am on the road to becoming a doctor.

The disparity between the pre-clinical and clinical years is difficult to put into words without losing its impact, so I won't - you'll just have to trust me. I can now draw on a wealth of first hand clinical knowledge and the prospect of having to treat sick people seems a little less daunting.

As the third year drew to an end I was filled with a lust for knowledge which I have not experienced before. In future posting I will write about my preparation for the coming year and my experiences both within and outside the hospital.

*those who know me would say this is untrue but in fairness the teams which I played with previously drafted me in as and when they needed me and I never really felt like part of the team (this isn't the start of a sob story - that ends here).