Final Placement of the Year!

So today was Day 1 of my final placement of 2011. I'm only on this placement for 3 weeks so yay, but that also means...EXAMS are coming up. Been revising for the last 2 weeks and it's bringing good ol' memories of how much I hate revising. It's tedious, tiring, and stressful. Oh and I have to juggle it with placements as well. Luckily I've been placed in a fairly slack placement (Endocrinology) so hopefully I won't have to be too committed.

Met my consultant today and I always believe in first impressions. If you want to impress:

1. Dress well
2. Show up early
3. Be keen
4. Read up on the specialty

Today, I was 15 minutes late due to road closures and traffic, I ran to the ward so my shirt was all over the place, haven't read up on the specialty as I have been revising the respiratory system, and I was groggy from 3 hours of sleep. Nice one. The consultant wasn't very impressed as I bumped into him as he was leaving the ward to start his ward round. If I was perhaps a few minutes later I would've been able to follow the other consultant on the ward who is on another team as he was late himself, and I wouldn't have looked as bad. Lucky me. Anyways embarked on a ward round which spanned across the whole hospital (literally). My partners and I were out of breath by the time we reached our first port-of-call: Medical Assessment Unit (MAU), as it was quite a long walk and my consultant walks extremely fast.  From time to time we had to jog to catch up with him!

Saw quite a lot of patients - all seemed pretty ill. I also noticed a trend that most of the patients are quite confused. We had one patient who told us that her husband had passed away 30 minutes earlier, and seemed quite depressed. However, when asked what date it is she thought it was the 10th of October, 2009! She didn't know where she was either and didn't know what our consultant was (expected answer = doctor, she had no clue!). She is a new patient and the consultant wasn't sure whether the news of her husband's passing was whether she was confused or it really did happen. At this point my partner and I left the patient and stepped to one side as our consultant talked to a nurse about the patient's story. Unfortunately it was quite noisy and we couldn't hear what the nurse had told our consultant. I guess it is now just a mystery to us. Anyways our ward round lasted 2.5 hours (which isn't too bad as I've been on 4 hour ward rounds).  At the end we were told that today was our consultant's last day and another consultant will be taking over for the month. But because our consultant isn't actually leaving the hospital he now has more time to teach so he offered to teach us this week on anything we would like. It was great news as endocrinology is quite complex and it would be great revision for exams. However, that also means I will have to go in tomorrow morning to meet the new consultant as he will be the one to sign us off for the placement. I wasn't planning to go in so I could stay home to revise - guess that won't be happening. Who knows, this consultant might be really nice and good at teaching, so I guess there is something to look forward to! Cross my fingers that this new consultant won't be stern/serious/intimidating. Some of the doctors on the ward knows of this consultant and they say he is quite nice. Hopefully they were being honest. Bring on tomorrow!

End of Placement 3.

What a placement. It actually went by a lot faster than I thought it would as I hated my first week of placements. In the end, it wasn't too bad. Definitely found out colorectal surgery is not for me. I can never seem to orientate myself in theatre especially during laparoscopic procedures. Everything looks the same! Just bowels here and there. Clinics were alright - completely understand why consultants hate it though. It's usually the same old things - over and over again. Only been to 2.5 clinics - and to be fair - it was starting to get repetitive and boring. I must admit, I am a bit embarrassed by the fact that I only turned up to ward rounds ONCE in the entire 4 weeks of placement. Oops. 7:30am ward rounds are too early - Note to self: don't get admitted as a patient to a hospital with 7:30am ward rounds - no wonder most of the patients we saw on ward round were cranky. You're ill/in pain and you're tired - 7:30 am a team of 5+ doctors (have seen teams of 10) crowd around your bed - doctor takes a feel/ask a few questions and then disappear. As a patient, that would really tick me off, but then again I'm not the most cheerful person in the morning.

What else have I learned on this placement? As previously mentioned in an earlier post - common sense takes you a long way. Oh and some consultants are actually human and love to talk about other stuff other than medicine. And again especially at busy hospitals - medical students are probably the least important things in the hospital - be prepared to get ignored/no one caring about you. That's reality and you just have to be proactive and be responsible for your own learning.

Next placement will be in endocrinology. Don't know what to expect; however, I don't even think I will have time to go into placement as exams are around the corner (December). Need to really study and start focusing. Can't tell you how stressed I am - it's mental. Like most students - I hate revising. The only thing that keeps me going is the future. I keep telling myself that once these exams are over I can slack off again and it'll be a year before my next exam. Can't wait as we just had our year-end exams in May - so it's only been 6ish months. The thought of 2nd year exams/revision still scares me - it was tough/a nightmare. At least this year's December exam will be more clinical (what I like) and not as science based. Still a bit lost as to what to study. Just hoping the best and hoping that I'm studying the right material as this year - we've hardly had any guidance. Eep.

In Memory of...

Sorry everyone, but this is going to be a solemn post so if you're not into reading something depressing please read another post - will be making another post either tonight or later in the week which will be a bit more cheerful.

Anyways...I've been a medical student for almost three years now - been around the hospitals a fair bit. Have seen happy things, have seen sad things. Have seen births, have seen deaths. Can one environment contain any more contrasting emotions? One family is in tears of joy; another family is in tears of sorrow as they have lost someone close. I myself have witnessed these events as a medical student. I smile with those who celebrate/are in joy; and I try to comfort those who are in a tough time. To be fair, deaths in the hospital has yet to make me lose any sleep or never really bothered me as I know everyone on the healthcare team has tried their best to save a person's life or at least have tried to make it as comfortable as possible.

When I first came to university - we were told in our first week that we will experience many personal obstacles. We are at the age where drastic things happen in our lives - some good, some bad. One of these "bad" things is death. Me being the typical fresher who didn't really pay attention in the lecture just brushed it off. Most of us tend to think: "Meh this won't happen to us."

October 24, 2011, I received the news that a friend of mine had passed away. I have never met this friend face to face, but we had shared many life stories and experiences. He was a guy I could talk to and have a nice laugh with, but because he lived in another country - I never had the chance to meet him. In terms of how I met this person? Well 4 years ago I purchased a custom item from him that required a lot of communication as we were in different countries - so I couldn't just walk into his factory and tell him what I want done. Anyways we would have periods where we would talk every single day - like loads, and then go through weeks where we wouldn't talk at all as this man was very busy with his business. Few weeks later - he would contact me again and we would talk about random things/he would check up on the product he made for me and whether I'm still happy with it. When I heard the tragic news - I was shocked. To be honest - I didn't know what to feel. It was mixed. Shocked, sad, empty...essentially confused. It was weird because I never met this man face to face, but yet cared about him. He was a very kind man. I still remember just last year he sent me a surprise Christmas present and I was planning to surprise him this year with a Christmas present. I had not been in contact with him for the whole summer as I did not want to bother him as he said he was very busy. Thinking back, I wish I had checked up on him.

Unfortunately this made me realize that death can occur in anyone's life. Like it or not, it's a fact. You can brush it off as much as you want, but it is something we will all have to face in our life. Take care of your friends, keep in touch with love ones, and if you know you don't talk to a friend that much - make sure you make every sentence count. You don't want to regret not telling someone something as anything can happen in this world. I wish I had told my friend how great of a friend he was to me and how much I enjoy his product. Hopefully he could decipher that from our conversations but I just wish I had told him plain and simple and thank him for his advice and lovely chats. If I could have done anything differently, I wish I had just contacted my friend despite knowing he was busy - just to make sure everything is alright.

But to those who are still reading - seriously, cherish your friends and loved ones. Death is a topic we all want to avoid and never want to think about, but it can happen to anyone. Because once you're in university and especially when we are all travelling away from home/friends, make an effort to keep in touch. Check up on your friends once in awhile. Be there for them. Support them. Don't hide things away and make sure they know you're there for them.

RIP buddy, you know who you are. Thank you for the great memories and the fantastic product. I will miss you. 

Common Sense.

On tuesday at clinic my consultant looked me in the eyes and told me: "No matter how smart you are, in order to be a successful doctor, you must have common sense." Since then, I can't stop thinking about what he said.

So I've started revision for my December exams and as I'm studying up on management and treatments of conditions, "common sense" suddenly pops up. I realized I can know nothing about the disease, but if I know the symptoms from a history and use common sense - I can figure out how to manage a patient and treat. What my consultant told me on tuesday was really starting to click.

Clinical years of medicine is all about logic and common sense. A person can study all they want and flip through every textbook and know everything, but without common sense: they won't know how to apply their knowledge. It's all about going back to basics. Picking out key bits in a patient history and focusing on it. Unfortunately, in pre-clinical years of medical school - students tend to forget what is common sense. 2 years of pre-clinical almost trains your brain to just retain information and splurge at exams. Because questions in exams are structured in such a detailed manner such as where cells of something is asked - common sense can't really be used. It's either you know the answer or you don't. It's that straight forward. Now in clinical years, you can work your way through a history and physical examination. It's really difficult to describe but in high pressure situations, you got to stop, relax, and think. Think basic and work through all the clues and start piecing the puzzle. Lots of people have the tendency to just jump to the most ridiculous diagnosis as they panic and don't think how one symptom can lead to a sign.

It sounds easy, but as a medical student it is difficult to remember to just use common sense. 2 years of pre-clinical medical sciences in our brains - we can't help but panic and just dig/try to remember information/answers that we crammed for exams. There were times where I would get put on the spot with a question and I would panic. My consultant had told me off a few times for blanking out as all I need to do is just stop trying to dig for an answer but instead work it out. I guess the closest thing I can relate it to is that in maths we learned 2 + 2 = 4. By now we've all memorized it - don't put any thought into it whatsoever. It's kinda like that in medicine. We see 2 + 2 = 4 (symptom + symptom = disease x) - easy. Sometimes we don't know the answer so when we get 1238 + 236, we will panic. Our brains will go "I haven't memorized this!". Instead break it down and try and link them together to come to your answer.

Anyways I hope that made sense. But only now, after 2.5 years - it has clicked. Medicine is all about common sense. We can't memorize everything. At the end of the day we'll need to use our brain to solve/work out things. It won't all be 2 + 2. But as we encounter more problems, we learn more. The beauty of medicine - never ending knowledge.

The Key is to be Proactive

Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.

You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.

Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!

Placement 3 - Week 2

Pretty straight forward week...well except for Wednesday. I had to wake up early to attend a whole day of theatre. Saw a TEMS procedure to remove an early cancer in the rectum. Also got to do my first PR on a patient...which I was trying to avoid like no tomorrow. It isn't exactly the most pleasant thing to do. I mean I got to feel the cancer which was quite small. But yeah...really didn't enjoy doing the PR. At least the patient was asleep though (as it was right before the start of the operation). Finished the TEMS procedure quite quickly and then we found out that the next patient will be late coming down to theatre. So I had a bit of a dilemma because I had a meeting to go to at 12pm to meet another consultant. Essentially when it was time to do the next operation, I had to leave for my meeting. Grreatt...I was kinda excited for it as it was an APER procedure to remove a late rectal cancer.

If I remember correctly, this involves the removal of the sigmoid colon and the entire rectum.  The surgery is done in two parts - first part is to do key hole surgery in the abdomen to separate the sigmoid colon from the rest of the colon.  The second part is to turn the patient over into a prone position to remove the sigmoid colon and rectum. Sounds pretty interesting right...so I was pretty bummed out that I had to miss a bit of it.

Anyways rushed to meet another consultant only to find out he was late. I sat outside his office and ended up falling asleep in the chair. Next thing I know, the consultant comes out to meet me and I was snoozing with my phone in one hand. Awkward. He said my name and the first thing that went through my mind was the synonym of crap. Opened my eyes and saw a really confused consultant. Mind you I have never met this consultant before..so great first impression. Had a really great chat though and it was really relaxed. I was pooping myself (before I fell asleep) as I wasn't sure if this consultant was going to be mean or super serious. By the end of the meeting I didn't even know why I was so nervous. It turned out fine and I managed to sort some things out for next year (that's for another blog entry later in the year). I was really happy with how the meeting went and quickly went back to theatre to watch the APER.

Apparently I didn't miss too much of the APER but I did miss the chance to scrub-in. I also realized my consultant has some pretty dodgy camera skills as the abdomen bit of the procedure was laparoscopic. There were times where he would shake the camera so much, everyone would start feeling a bit sick. Oh well. After the first part, we took a 5ish minute break and then went on to the second bit. I must say...this bit was a lot more gruesome than I imagined it to be. Incisions were made around the anus and you would keep cutting in to access the rectum.  Because the colon has been separated, all the surgeons had to do was remove the sigmoid colon and rectum and close up the anus. One of the incisions went too deep and there was quite a lot of blood. At one point blood spurted out and luckily I dodged just in time as I was right in its path. My consultant was really on the ball though and quickly stopped the bleed and we continued on with the procedure. Removed the sigmoid colon and rectum (which was quite a large specimen). Unfortunately, I had to leave early from the surgery so I missed the part where they closed everything up. Either way it was a really interesting operation to watch and I enjoyed it quite a bit.

Thursday - day-case surgery. Not going ever again. It was pretty boring as we just did a bunch of procedures to fix anal fissures/fistulas/etc. I didn't really enjoy it and my consultant did pretty much no teaching either. I was pretty excited to just go home and get ready for the epic Medics Fancy Dress Pub Crawl. Obviously that meant I couldn't go into placement on Friday. The registrar told me to go to clinic on Friday morning and I told her "I don't think I'll make it." She gave me a really confused face and I just smiled and laughed nervously. My consultant picked up on my nervous laugh and he was really cool about it and was like "Yeah....clinic will be boring so just sleep in and I'll see you next week *wink*" The registrar was pretty clueless. Pretty sure everyone else got the gist of what I was saying, except for her. I guess she would find out if she ventured out to city centre that night. Haha.

Anyways pretty slack and uneventful week. Wednesday was definitely the highlight of my week though.

Placement 3 - Week 1

Can't believe it's already my third placement. Time flies. Actually I lied...this week was pretty slow.  So I'm back in the local teaching hospital so I don't have to drive like 40-50 minutes to the peripheral hospital anymore. But day 1 of my placement was probably the worst experience I have had on placement...ever. First I found out I was placed in General Surgery....AGAIN.  Found out I was in colorectal surgery...joy. I mean general surgery is interesting, but I'm a bit tired of it as I want to see other specialties. First year I had 2 surgical placements both in General Surgery. First placement of this year was General Surgery. Now...general surgery...again. I feel like I know loads about the GI system...and nothing about other systems.

Met my consultant in the afternoon...and only to be told I couldn't join him in endoscopy as I was in a group of 3 and only 2 people can stay in the room. My two other partners are quite keen...and jumped on the opportunity before I even started moving my slow Canadian mouth. I was a bit bummed out as it is our first time meeting the consultant and I kinda missed out on the first meeting. But then again I got to go home early as there wasn't anything else for me to do in the hospital. Also got to suck in the last of the amazing heatwave/get some colour back into me. Got home and hoped that the next day will be MUCH better as I felt like I accomplished nothing. Also felt that the nurses and doctors weren't as nice as the ones in the peripheral hospitals. Everyone seemed busy and us medical students just blended into the background/environment. It was a weird feeling. It was a bit unsettling. Kind of like: this is reality. I must've had too high of expectations as I did have a great time in the peripheral hospital as I got loads of teaching and everyone was so friendly (and the hospital wasn't as busy). It finally struck - us medical students are no one. We are of no importance as there are more important things for doctors and nurses to care about. It is a big hospital and it is very very busy. Depressing start to be honest.

Tuesday - I was determined to make my placement better as I will be on this placement for 4 weeks. I have a strong interest in Orthopaedics so I decided to go to theatre with my friend who is placed in Orthopaedics. Went in really early and I was quite content. I definitely felt less anxious and tense about the placement. I started to relax and was enjoying being in theatre. We were quizzed on the ankle and I knew how to answer the question as I know my MSK anatomy quite well. I got a sudden boost of confidence and my day was looking to be a good day. In the afternoon I went to meet my consultant to go to a really busy clinic...I think we had about 20+ patients. It was also my first time properly meeting my consultant. Managed to see a lot of PRs and unfortunately a lot of patients who have/had colorectal cancer. It seems like the surgery for colorectal cancer is quite effective especially if the cancer is a T1 cancer (early cancer).  Also learned about the different surgical procedures for colorectal cancer such as the TAEMS procedure which is apparently quite new and the major surgery which is an anterior resection.  After 4 hours...and getting the impression that our consultant doesn't particularly find his job that interesting...my partner and I finally got dismissed from clinic as our consultant noticed that we were quite bored and it was also getting late. I mean my consultant seems like a really great guy. Very chill and relaxed and doesn't really care about us. Not caring about us is sometimes good...sometimes bad. He does teach a bit, but he wouldn't breathe down your neck about going to placement from 7:30am to 5pm (I do have friends who are forced to go in every day 7:30am to 5pm).

Took a day-off on Wednesday as my other 2 partner wanted to go to theatre. Thursday...can't really remember what I did....hmmm. What did I do on Thursday?! I know I went in...so I assume I was on the wards talking to patients...I guess Thursday is my new mystery. Old age...can't even remember what I did 2 days ago. Friday....first time I went in for ward round, which was at 7:30am. I think a little bit of me died when I woke up at 6:00am to get ready. It was pitch black outside. Got to the ward to meet up with the team and was trying to stay awake. My consultant came in...did probably the fastest ward round I have experienced. It took less than an hour. Met the new registrar and he did some teaching with us and watched us do patient histories and abdominal examinations. Examined a patient with an incisional hernia. It was really interesting and I really enjoyed the teaching. It was a nice change. So I guess I ended the week on a high note. Oh and I think my consultant has came to a conclusion I'm a lazy bugger. Apparently he was on ward rounds which I didn't go to on Wednesday morning. Maybe that's why I got a surprised look from him on Friday morning. Anyways bring on a really busy next week.