Something for you to think about...

To make up for my last short post - I'll give you guys something to think/reflect about.

So you meet a 55 year old male patient on the  neurology ward who was admitted with severe unilateral headaches in the front which radiates to the back of the head with no associated neck stiffness. As you talk to the patient you notice he's fairly relaxed and quite talkative. He tells you how he first presented to his GP 4 weeks ago who didn't explain much and sent him for a CT/MRI scan on his head, then proceeded to send him for Chest X-rays...eventually getting a pelvic MRI scan. The patient says: "I have no idea why I had to go through all these scans. Bit pointless in my opinion. It's just a headache...any ideas doc?" You know all these events had happened over the last 4 weeks and this patient has seen several doctors and you start to wonder why no one has told this man why all these investigations were done. Eventually you find out that the patient is aware that there is a "lump" in the back of his brain and that he's being scheduled to get a biopsy. After saying this, the patient still seems very relaxed and seemingly unaware of what is going on...actually he ends up telling you that he actually doesn't have a clue what's going on.

After the nice conversation you've had with the patient, you go look in his medical notes. You read the report from the scans which clearly says: "Query metastasis to the brain". You know that the GP/other doctors had sent this patient for several different investigations is to locate the primary cancer - which the patient is completely unaware of. Next imaging report: "Primary glioma". All brain tumours are technically malignant. Then you think: does this patient know he's possibly got brain cancer? No one knows how severe it is as a biopsy hasn't been done.

So here's something for you to think about. As a medic or soon to be medic: would you rather know about everything? Know exactly WHY the scans are being done and what are the results. Reasons behind all the investigations. All the plans from the doctors and suspicions/differentials. Then you look at it from another point. If this patient knew about all of the reasons and all the prior suspicions that the doctors had, would he still be as relaxed and calm about his "headache"? So is it actually better to not know that much?

Personally I think there's a fine line between knowing too much and knowing too little. As a patient, I would want as much info as I can as I'm a medic - I want to know things. If I didn't have any medical background, I think I wouldn't want to know anything. Live life in denial and in the unknown I guess? At least I won't be busy stressing myself out. These things can be emotionally difficult and cancer is such a sensitive topic. I would think the general population wouldn't want to know all the reasoning. It's tough. I think every person has a different view on this. Something for you to think about/reflect about.

Psychiatry - Final Week

This placement went by QUICK! I think it was the fact that the placement wasn't too bad and that I was quite busy doing my other work - time has just flown by. To be honest, I haven't seen too many exciting things as I had hoped to have seen. There's always a lot of misconceptions about each specialty and I think psychiatry is no different. Before I started the placement I was a bit unsure what to expect. I was a bit scared as on our first day we were each given a personal "alarm" which we would put on our belt loops. In addition to those alarms, when we entered the ward, we got another alarm which has tracking on it as well. You can't help but think that psychiatry might not be the safest specialty. We were also taught a lot about risk assessment when interviewing a patient. I remember we got a tutorial on where to sit and what to look out for in a room. We were told to always look out for objects that can be easily thrown and to sit near the door but not with our backs towards the door so if we need to escape we can just go out without turning around.

Okay yes, there are some "dangerous" patients who are known to be quite aggressive, but I never really felt "in danger" while on the wards or in clinic. I guess the only time I felt a bit "iffy" was today in clinic. The final patient I saw on my psychiatry attachment is known to have a very short temper and when he snaps - he snaps in a big way (throw objects, get violent, etc.). As the consultation went on, I could tell the patient was starting to get agitated and worst bit - I was sat furthest from the door and the patient was sat between the door and I (so much for remembering about risk assessment). To be honest - the clinic room wasn't appropriately arranged so there wasn't much one could do other than hope for the best. The consultation came to an end and for no reason the patient just "lost it". He lashed out but thankfully he didn't throw anything and instead stormed out the door and slammed it with a considerable amount of force. You could actually hear him leave the clinic as he was slamming every door along the way. I expected it to happen but it wasn't a nice situation to be caught in knowing there isn't really anywhere to go other than curling up into a ball.

Other than that incident - all the patients I have seen are all quite "alright". Despite some having a history of violence/aggression, these patients all seemed fairly cooperative. We are told of the ones who we shouldn't go speak to as they aren't cooperative but the "okay" ones are fairly normal. Of my 6 weeks in psychiatry, there hasn't been any major incidences. I'm sure more incidences/violence occur in A&E than in psychiatry. I think the one thing about psychiatry is the need for patience. Some of the patients are great historians...some are terrible and will not admit to anything/are not cooperative. With new patients - the clerking can take up to 1 hour and most of these inpatients don't have the patience to speak to you for an hour. I personally don't even have the patience to ask questions for an hour/listen to their history for an hour. I find it very time consuming. The number of times I have nearly fallen asleep during a consultation has been ridiculous. I drift off not because it is boring, but it's the fact that sitting and listening to a history for an hour is very difficult. Again with this attachment, there wasn't much I could do other than observe, but the good thing I had over GP was that when in the hospital - I can actually wander around and am not constrained to one building/area. Psychiatry is definitely different and I have definitely learned a lot since it is a new topic. I'm fairly certain it isn't something I can do, but it is quite interesting as you see a range of people and personalities.

Unfortunately I don't really get a break between this placement and the next other than a 3 day weekend. My next placement will be in Care of Old People - specifically Orthogeriatrics. Talk about luck. I'm actually really looking forward to it as I'll get to see and deal with something I'm interested in and maybe I can sneak off and see a few surgeries as well. I also know the team in the department - so I don't need to endure the whole awkward introduction/getting used to the ward/staff. It will be a short placement but I think it will be one that will pick my motivation back up and get me going again just in time for exams. Eek!

Psychiatry - Weeks 3 + 4.

So I'm finally past the halfway point for Psychiatry and to be fair, it isn't that bad. I mean nothing can get any worse than my GP attachment. Anyways...I finally went to the ward and spoke to a bunch of patients. I spent a week in the Substance Misuse Unit and it was really interesting. It was interesting to speak to the patients and to hear about how they have abused drugs/alcohol. It was shocking to hear that most of these patients have started using drugs since the age of 12! I had one patient who told me: "Any drug you can think of, I've tried it."

There was one particular male patient who stuck out for me. He is a 50 year old male (who looked 80 years old) and he was trying to detox off of methadone. He has tried almost every drug you can think of and at the age of 13 had already experimented with LSD. He was actually quite pleasant to talk to and it was interesting to hear about his forensic history. It was crazy to hear that he has been convicted many times and have served several prison sentences. What stuck out for me was his memory. Due to the many many many years of drug abuse, his memory is horrendous. His short-term memory was fairly poor and when doing the Mini Mental State Examination (MMSE), he scored 16 which is very low and abnormal. I'm not kidding - I spoke to him for almost an hour to get his history/why he is in hospital and then left for 20 minutes and came back to do the MMSE. When I came back to do the test, he had already forgotten who I am and thought I was a social worker! It was definitely a bit of a curve ball as I knew his memory wasn't great, but I didn't think he would already forget who I am after speaking to him for an hour and only had left for 20 minutes. Furthermore, because the patient had been injecting for so long, his legs are completely wasted. He has ulcers all over his leg which won't heal as he has poor blood supply to his legs and has suffered with DVTs. When you look at him, he looks unwell, tired, not with it, etc. Apparently on admission he looked like a ghost who was completely out of it. It makes you realize how bad drugs can affect a person. He looks so much older than what he really is and I actually double checked his date of birth with him to confirm that he was only 50! It was incredibly hard to believe.

Also during the 2 weeks I went to the regular ward and spoke to a few inpatients. It wasn't particularly interesting, but I realized that some of the patients don't know why they are in hospital and refuse to accept that they are in hospital for a mental illness. On top of that, I realized that in psychiatry, you have to build good rapport with the patient to get just a decent history as there are a lot of personal questions that you need to ask. In a psychiatric history, you have to ask about their childhood and about their personal life such as relationships and any possible attempts of suicide/self harm. Some of the things you need to ask are quite touchy and personal and I find that quite difficult. At the end of the day I think as a medical student you just need to find a way to word personal questions and be prepared to get an awkward answer or no answer at all.

So at the moment, the placement is starting to pick up, but as usual, once things start getting productive - it means it is coming to the end of my attachment. 2 more weeks left and then onwards to Care of the Elderly (which I'm actually quite excited about as by chance I am placed in Orthogeriatrics).

End of GP Placement.

Oh how much I looked forward to typing the title to this post. It could have easily been the least brain stimulating placement I have yet to have. Not only that, I couldn't go make myself useful elsewhere unlike being in the hospital. Looking back on the last 6 weeks, it was definitely a struggle and a challenge. It was mentally draining as it was just so much harder to get the motivation to work. After throwing my arms in the air when stepping out the door of the practice...I realized I have another GP placement next year. Joy. BUT, I know it'll be more useful as I'll have my own surgery and get to see my own patients. This placement literally has redefined work experience. It was 20 days, 10 hours/day of work experience.

Also in other news - crisis averted with all the deadlines as you would remember from my "Walls Closing In" post.

1 report - completed and submitted.
1 audit report - completed awaiting for submission.
1 audit poster - 90% complete.
1 audit abstract - completed and awaiting for submission.

Cannot feel any more satisfied and proud of myself managing to get everything done in time. I think it has been a long time since I was really sure I was not going to make the deadlines.  Miracles do happen. Actually it's more like: Efficient...and very late and long nights...

Oddly enough, in my final week of GP placement, I saw the most interesting case. It was a case of a man with an end-stage disease and the GP needed to start the palliative care pathway with him. This man is quite young (40 years old). Initially when I heard about his medical history, I did not know how old is he. In my mind I imagined him to be an elderly man. Surprisingly when I went to go meet the patient, he looked frail and skinny, but young. What really struck me was that he also has two very young children (ages 8 and 3). Unfortunately, the patient has not really told his children what is wrong with him. They are aware that their father is ill, but do not know the extent of his illness. With his condition, no one really knows how many more years he will live. His condition has been progressively getting worse and the GP told the patient and his wife that there would be one day where he does a nose dive and his health severely deteriorates. We discussed the various options for support and care. In my mind I knew the GP was trying to find the right moment to bring up the "Do Not Attempt to Resuscitate" (DNAR). Eventually we had to talk about it and only until you come onto the topic you then come to realize that the patient is still in denial. To be fair, he has a young family and he himself is quite young. Worst bit is that there is no cause for his condition - as what doctors like to call it: "Idiopathic". He was adamant that he wants to be resuscitated when it comes to the end of the line despite the GP fully informing him about the benefits and harm of resuscitation. As we were talking about his palliative care plan, his children were happily running outside - no clue what is going on in the room. It was definitely a very "grim" consultation. Before leaving, the GP advised the patient to find some support for his end-stage disease and to have someone help him to explain his condition to his children as they will have to know at some point. The GP was right that it is better for him to talk to his children while he is still well and still able to versus down the road he might not be well enough to explain - leaving his children a bit puzzled.

In all fairness - my experience in GP has not been the best, but the GPs who I have worked with are all really nice people and some are great at teaching. Guess it just wasn't my "cup of tea". Had a good feedback session with my supervisor though and I suggested giving students a bit more responsibilities and letting us see our own patients. Hopefully they'll take my feedback on board as I really think it'll improve the student's experience. All in all though, 7 weeks...that was painful.

Psychiatry up next...don't really know what to expect...actually I have no clue what to expect. At least it is hospital based (in a more familiar environment). I'm sure it'll be interesting seeing these sort of patients. Hopefully it'll be better than my GP placement and get back to the happy-go-lucky medical student.

Old Age.

Had quite a weird week...weird as in a week which really made me change my perspective on things.

I got to go visit a nursing home for people with dementia. I had previously volunteered in a nursing home before medical school but I didn't work with patients with dementia. I went to visit a 75 year old man who has vascular dementia and had just moved to this new home. The nursing staff were worried about him as he had spent the entire night pacing up and down the hallways continuously for 15 hours non-stop. I went into his room and sat down in front of him. His room was fairly small. One single bed. One small wardrobe in the corner. 1 night stand. 1 cabinet. This man just sat in his chair, hunched over. He wore a baseball cap so I couldn't see his face. As he sat there I saw him dribbling on to the floor. It was almost like he wasn't even there and was staring at his shadow. I looked over to his night stand and saw 2 pictures of him and his family. In the pictures, he was middle-aged and appeared to be a very proud man. He stood in the pictures full of confidence. He looked very happy. Then I looked back at the patient, still dribbling and staring at the ground. He looked quite frail. I eventually said hello to him and he didn't reply. I moved his hat a bit so I could see his face. He still stared at the ground. I asked him what is his name and he replied me without looking up. I tried to carry out a very basic conversation with him, which proved difficult as midway through he started mumbling. I couldn't quite understand him and he quickly stood up. He walked to his wardrobe and was very unsteady on his feet. He had a very unbalanced waddling gait. I asked him where is he going and he replied: "Home". I kindly told him this is his home and to sit down again. As he came back to his seat I looked into his eyes and he didn't look happy. He didn't really even look like the man in the picture by his bed. As he sat down, he went back to staring at the ground and stopped talking to me. I just sat there looking at him. I thought to myself: Is this how residents here pass their day? I found it pretty sad as they just sit in a fairly tiny room. This particular man, if he isn't pacing up and down the hallway, he is sat in his chair almost lifeless. Really made me think that people need to live their life to the fullest. Appreciate the things and people around them. I felt bad for this man. His life seemed pointless. He was confused. Ageing is a scary thing. Just comparing this man to the man in the pictures - it is almost like night and day.

Then when I went back to the GP practice, I met another lady who desperately needed a total hip replacement. Her x-rays showed severe osteoarthritis (OA) as in it was bone on bone. The patient had a shortened right leg as well due to the OA. On palpation of the greater trochanter...it felt like you were running your hand over a bag of marbles. You could feel the osteophytes! Range of movement was severely decreased and the patient had pain on extension and flexion. Actually any movement made the patient jump. It was fairly remarkable that she doesn't need to use any aids to walk, but you can tell she is struggling. Unfortunately, the surgeons do not want to operate on her due to her health and as well she does not have anyone at home to look after her. She told me that she has outlived her entire family and there was no one left. She explained to me that she tries her best to get through the day, but usually just stays at home to avoid any hassle and because her hip hurts too much. She has tried all sorts of analgesics and even tried topical treatments (which doesn't work, which is no surprise as her hip was bone on bone). I asked her what does she do every day if she doesn't really go out. She told me she just sits there and read and told me that her life has become very boring and that there isn't much meaning to it any more. She talked about how active she was when she was young and gradually as her hip got worse, she couldn't go out for walks in the park or even do her gardening.

If you think about it, when I start reaching the peak of my career, the majority of my patients will be the elderly. In general the population would be quite old as the current generation of "baby boomers" are starting to reach retirement age. I think it is key for medical students to learn how to deal with the elderly. It is frustrating to hear students go: "I don't like old people. I hate talking to them." I sometimes can't help but say back to them: "Well start liking it as the population ain't getting any younger." I'm sure I have said this before,  but I quite enjoy talking to the elderly. They always have a great story to tell or have some pretty wise things to say to you. They are all so strong as they have been through so much. They seriously need a heck load more respect from people of my generation and the younger generations. Ageing is the fact of life and there isn't any way to avoid it (well unless something really tragic happens to you at a young age...). Sometimes it is just hard to see what the future lies for you when you see so many elderly patients.

Post #100 - A Look Back.

Post #100 for this blog. I obviously want to make a special post and let's take a trip back to the beginning of this blog.

August 6, 2009 - my first blog post. It was a big day for me as it was the day I received an unconditional offer from my university to study Medicine in the UK. Looking back, coming to study in the UK was a huge decision and definitely a path of a lot of unknowns. A new country. A new culture. A new chapter. Little did I know what a roller coaster ride it would be for the next 2.5 years. I faced many challenges (and still facing challenges) and have grown up a lot in the last 2.5 years. University was a new chapter to my life. Saw and learned so many new things. It has so far been the best few years of my life. I can easily say that Freshers week will always be a highlight as it was quite an experience getting to know so many new people in such a short amount of time. I've been in the same school for half my life so making new friends is something "new" and I was extremely nervous. Kind of laughing at myself now for being so nervous/scared as there was nothing to be scared about. Every one is on the same boat in terms of friends and people are just so friendly. A tip for those who will be starting this coming September: be EXCITED. There is nothing to be afraid of and don't let anything hold you back. Enjoy your time as a Fresher as it will blow by in a blink of an eye. 

When I first started this blog I was really unsure whether I will even be able to keep up with it. Slowly I've noticed that people are reading it and it really motivated me to keep posting. Whilst scrolling through my archives...I have noticed quite a change in frequency of posts. I think it's a fairly good representation of excitement through my years in medical school. Obviously if there is something exciting, I would post about it. Here's reality: the first 2 years of medical school is a bit of a shock. I think a lot of us come into medical school thinking like we would be like the TV show ER...or House and we would be immersed in doing clinical procedures and running around. WRONG. Well in my case I was stuck in a lecture theatre for 2 years learning about the basic sciences, which isn't the most exciting thing. It is obvious there were a lot of up and downs in the last 2 years. I lost sight of the final prize (becoming a doctor) several times throughout the last 2 years. You get to a certain point where you're like "get me on the wards!" and then there will be times where you ask yourself: "Why in the world am I studying Medicine?" Medical school is full of obstacles and it is emotionally, mentally, and physically tough. There are so many times where you're on the floor and you really need to dig deep to pick yourself back up. I realized this is a degree that you have to be committed to because there are times where you truly do question your desires of being a doctor. Then at last - I reached clinical years. 2 grueling years of being cooped up in a lecture theatre and finally I am able to do some practical things and talk to patients. But hold up...with my school we are quite lucky to have a bit of clinical experience in the first 2 years.

March 15, 2010 - first hospital attachment. It was a short clinical attachment and really just a taste test of what I'll be doing in the future. Only a few months ago I saw first year medical students starting with their first clinical attachment like I did back in 2010. Seeing these freshers really put things into perspective of how far you have come along. (And for once it was nice not being at the bottom of the ladder at the hospital). It really gave me a flashback to what it was like when I started my first clinical attachment. Patient histories were a struggle...I was not good at them at all. Hardly knew any medical sciences so I didn't really understand anything and tried my best to keep up. Couldn't do any clinical skills. Essentially just shadowed the doctors and tried to not get in the way. Went to observe a few surgeries and standing on a pedestal trying to peer over the consultant's shoulder. However, I do remember how much I enjoyed watching surgeries. It just clicked. Fast forward to 2012. Patient histories - easy. Interacting with patients - easy. Medical knowledge - growing every day. Clinical skills - taking bloods, inserting cannulas, inserting catheters...just the other day I put in an endotracheal tube on my own (supervised by the anaesthetist). Surgery - observe? Heck I'm scrubbing in now and even helping close up at the end! Medical school is a long and painful process...but when you take the time to stop and think back to when you started...you see how far you have come.

February 8, 2011 - immigration laws changing. I believe this is the first proper post where I've discussed in detail about being an international student and things we have to think about. From then on, I have dedicated 2 other posts (Tidbit for International Students and Life of an International Student) to give a bit more insight about the life of an INTERNATIONAL medical student. To be honest, being an international student isn't that much more different than a local British student. We go through the same course. We get treated the same. We learn the same things. We see the same things. The only difference is our accents, and our passports...and the fact we have to worry about Visas and immigration laws. But other than that, being an international student hasn't been that hard of a transition that I had initially thought. Before I started medical school, my biggest fear was the fact I was an international student and it might be a bit harder for me to make friends or get used to the culture. Again during Freshers week...everyone was just so friendly...I didn't feel different. I didn't feel that much of an outsider. There were a few times in the last 2.5 years where it was frustrating to be an international student due to the lack of support from the medical school, but you learn to manage. As an international student, you make a lot of sacrifice. You leave your family behind. You leave home behind (which can be thousands of miles away). You pay higher fees. But hey hopefully it will be worth it. Hopefully this is something I will not regret. At the end of the day...hopefully this will be all worth it. Homesickness is a huge thing for international students and a lot of my friends do struggle with this...including me. Every time this happens I just have to take a break and tell myself it will be worth it and think about all the obstacles I have already been through and how far I have come. What makes me wake up every morning is the end prospect from studying medicine. I am grateful to be in such a great field and the experiences I have had so far have been amazing. The future with immigration and working in the UK - not a straight path and one with many bumps, but the fact I have made so many sacrifices just gives me so much more motivation and determination to make it work. Work hard and hopefully have a bit of luck on my side when it comes to jobs.

August 7, 2009 - first tip post. Not exactly one of my best tip post, but hey we all got to start somewhere. Obviously this blog was to keep a track of my crazy life of being a medical student, but also to give some tips to future medical applicants. I try my best and over the last 2 years I have posted quite a few tip posts here and there. Applying to medical school is no easy process and I wished I got some tips. My school back in Canada was not very good with helping out students with applying abroad as they are not very familiar with the process. It was a difficult process as I had to do a lot of stuff myself and call up universities in the middle of the night (my time due to the time difference) to get some more information. Hopefully with my tip posts I am able to help future applicants with the process. Obviously I applied 3ish years ago so UKCAT info and tips are a bit off, but I'm sure the interview process is still the same. Now I'm trying to focus on giving tips on surviving medical school. Little tricks I have learned here and there. I remember my very first medical school lecture, one of my professors told all of us: "Life is not fair." And it is so true and particularly true with medical school. So here is a tip to all of you: Life is not fair. You cannot have your way with everything...unfortunately, BUT what you can do is make the best of every experience no matter how undesirable it is. There is always something to learn. Stay humble and treat those around you with the same respect you would expect in return. You will meet a lot of people throughout medical school and treat everyone well as you never know, you might see he or she again in the future. Consultants on placements - treat them with as much respect as you can as who knows, he or she may just be your future employer in a few years. Don't do anything you will regret, even outside of school hours as things can come back and bite you on the ass. Unfortunately as a medical student - we got to grow up very fast. We start medical school at around 18 or 19 years old...you will see patients of all ages and they expect professional behaviour despite your age. Also grow some thick skin - consultants can be very unforgiving. Do your best to not take it personal. At the end of the day their criticisms are for your own good.

June 2, 2012 - post #100. It has been quite a journey and I expect more ups and downs in the next 2 years. Being a doctor is starting to get real. Now going through my specialty placements, I'm starting to do more and more on placements. This post has made me look back and realize how much I have grown emotionally and mentally. Thank you to all you readers out there and keeping me going on this blog. I really appreciate it. Happy reading!

Expectations.

Everyone has his or her own expectations for certain things. In my case: I had my own expectations for this placement (Obs & Gynae). Before I even started this new year and embarked on my specialty placements, I had already made up my mind about some of the specialties. And I have once again been proven wrong and again shouldn't be making judgments before even starting a specialty. You would think I would learn by now not to judge so early. Before I started O&G I constantly told myself that it is going to be my worst placement ever and I will truly hate it. I was not looking forward to it. I even marked it on my calendar as: "Ugh." To make things short, I had extremely low expectations for O&G. And you know what, sometimes I like being proven wrong. Don't get me wrong I have respect for the specialty, it just never clicked with me. You get this whole: "Awkwardddd women's health...it's going to be weeeirdddd!". I think in general anything that deals with bits downstairs is a whole taboo subject.

So I went back to my archives and read up on my blog post that I typed up before starting the specialty:

"My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!"

I really can't blame myself for being scared as it is a sensitive subject, but in terms of changing my behaviour from playful to professional was something I was a bit unsure about as I'm naturally a "happy-go-lucky" so I was a bit nervous for that change. Thinking back through the last few weeks, I haven't had so much fun on placement. Even more fun than my paediatric placement. Yes I have to be professional and build a good rapport with patients to talk about more sensitive things, but I realized that if I'm having a good time, the rapport comes naturally and you as a person become a bit more easier to approach and get along with. In paeds I was told that it was "written all over me" that I was not enjoying my placement. For this placement, yes I went in knowing I'll hate it, but I really wanted to make sure that I didn't make it obvious that I'm not enjoying the attachment. Because I went in with such low expectations I was open for anything and had little expectations. This actually helped me be a bit more welcome to anything and I think a lot of the staff and my supervisor could see that. I was even told by the nurses that some of the patients thought I was a "breath of fresh air" as I was always smiling on the wards and just enjoying my time. A patient told me that most of the staff look bored, but I look interested and just trying to have fun. Because in my last placement in paeds I looked super bored, it was probably the main reason it took me a bit longer to get to know the staff and interact with the patients.

And I can't really call it luck anymore with getting a nice/easy going/chill supervisor. I've said it before, but at the end of the day, a consultant/supervisor is a person as well. Yes they too have expectations for me and I try to meet their expectations, but because they are also people, you can certainly have some good banter with them. I got to know my supervisor and probably saw my supervisor the most out of the rest of my group so I guess he got to know me better than the others. Definitely made the attachment more enjoyable as I could feel that my supervisor genuinely cared about my learning and it's also nice to get to know your supervisor as it'll keep my blood pressure and heart rate from shooting through the roof whenever I see him. In some placements I would purposely avoid my supervisor just to avoid getting told off/being quizzed. For this placement, I didn't mind bumping into my supervisor on the ward or even in the corridors. I think we also had a "mutual understanding". He knew what my personality is like and what sort of student I am so he didn't form unrealistic expectations for me so that put me at ease and allowed me to feel comfortable in the hospital.  Again it is a two-way process. I know when my supervisor didn't want to see me and I guess I'm fairly good at telling when I can be cracking jokes. I guess it is a skill I definitely cherish as like I said I'm a "happy-go-lucky" and a bit of a prankster/joker who is quite cheeky as well...so I definitely need to know where to draw my line with each person.

All in all, I think this attachment has worked out really well and essentially exceeded my expectations. I have definitely gained a heck lot more respect for the specialty and it has definitely changed my view on the specialty. It really ain't that bad at the end of the day. The doctors are also pretty cool people as well so it was good. The hospital was great as well and was really good at making sure medical students are learning and interacting. Following a doctor around is one thing, but being able to assist and do things is a whole other ball game that makes your attachment so much better. This could be the very last time I'll be doing O&G for the rest of my career, but hey if I do get a rotation in it in the future, I won't mind doing it again. Hate to say this, but this is easily the best placement I have ever had so far. Who would've thought I would be saying this 7 weeks later. I wish all my placements can be this good. Now I'm scared about my future attachments as this placement has set the bar so high. How can I go back to just following a doctor around? How can I go back to standing in theatre not scrubbed in and peering over the surgeon's shoulder? Will I get along with my next supervisor how I got along with my supervisor now? What are my expectations for my next placements now?

Thank you for proving me wrong and giving me the best 7 weeks of my medical degree. What a placement. Damn. Can't believe it is over. The one time I am dreading for the end of a placement. I guess one good thing about this is that I finally get a much needed 3 week holiday.

Side note: Will be on holiday for the next 3 weeks and I, most likely, will not be posting as I really need a break. Sorry! 

O&G Ward Week.

You can hardly call this my "Ward Week" as I probably spent more time in clinics than on the ward. This week also marks my last timetabled week of my placement and I have been seriously trying my best to enjoy every day of it as there is a bit more flexibility with my week.

Spent Monday morning in Gynae clinic. I managed to see a lot of prolapses such as cystoceles (proplapse of the bladder). Luckily the consultant has gotten to know me as I've been in a few of his clinics with him so I got to do a vaginal examination on almost every patient. It was interesting to feel a prolapse as it is definitely very different and then feel the difference when a shelf/pessary is inserted as a temporary treatment for the prolapse. Patients with cystoceles tend to classically present with a "dragging" feeling down below which becomes quite uncomfortable as the day progresses. There is also a "heavy" feeling, which again gets worse as the day progresses especially when stood up for a long time. Some of these patients also present with urinary symptoms such as urinary frequency and hesitancy. I think by coincidence these patients also present with some form of urinary incontinence as well. Usually elderly women would not be offered a surgical repair where stitches will be placed to reinforce the anterior wall of the vagina (where the bladder prolapses through) as these patients are usually unsuitable to go under anaesthesia.  By the looks of it, most of the women are fine with the pessary and it seems to sort out their problems quite well.

Then I wandered onto the wards with one main goal in my mind: Take as many gynae patient histories as possible. Why so keen? This is because my assessment is taking place the following day. Essentially we are required to take a full patient history with an assessor sitting alongside. This assessment either makes or breaks me. If I fail, I would obviously have to resit the assessment which would go down on my records that I had 1 failed attempt. If I fail the second time, then I will have to repeat the entire 7 week placement all over again. I mean I'm having a good time on this placement, but if you asked me to do another 7 weeks, it might be a bit of an overkill. Anyways I took about 4 patient histories in the afternoon and had a good time talking to patients. It's nice to see patients enjoying talking to me as I guess for them it is better than sitting in silence and day dreaming as the hospital is pretty boring in general.

So I had my assessment...and oddly enough...I wasn't too nervous for it. Actually I was so calm it was worrying. I was struggling to take the assessment seriously as before I went in to take the patient history I was chatting away with my colleagues (well I did the talking...they just listened as they all looked very nervous). I kept telling myself to take this assessment seriously but I struggled. I was fairly annoyed with myself, but at the same time - if I'm in a good mood I tend to take better patient histories and form much better rapport with the patients, which is key for the assessment. Luckily, my patient wasn't too complicated (vaginal hysterectomy and anterior wall repair). I finished my history quite quickly and  I thought I did quite well. Didn't have any difficulties whatsoever. Huge contrast from my last placement (paediatrics) assessment. In my last placement I was properly pooping myself prior to my assessment and I was dead scared. I was much more confident for this gynae assessment - night and day in terms of confidence between my last placement assessment and this one. My assessor had no difficulties in passing me and even gave me an "above average" mark which I was quite chuffed about. I was quite proud of myself as I was only expecting a "meets expectation" as my supervisor is known to be quite strict with marking.

Since my next assessment isn't until next week, I knew I can relax for a bit and return to enjoying my placement. Oddly enough I thought I was going to be quite bored on the wards as there isn't much a medical student can do on the wards, but I was actually quite productive on the wards. The doctors were all really welcoming and actually allowed me to write in the medical notes and sign off on them (of course the doctors reviewed and counter-signed my notes). I also got to clerk in a few patients, which is always interesting. It's weird seeing how seriously some of the patients treat me. I mean at the end of the day I'm just a medical student, but these patients really take everything I say seriously and show a lot of respect. It's quite nice to not be treated as a joke and it definitely makes me feel much more responsible.

Because my next assessment is on obstetrics and I haven't had much exposure to it on the wards, I decided to spend my day on the obstetrics ward and practice my obstetrics examination skills. And jeez....I suck at obstetrics examination. I swear I cannot feel a thing. In our assessment I'm supposed to be able to tell the position of the baby, the engagement of the head, the lie, etc. I feel like my hands are dead stubborn as I swear the bum of the baby feels the same as the head! Yes I know one side is flat and the other is round like a ball, but at the same time I'm too scared to palpate deeply in fear of hurting the mother. I definitely need to get more confident in doing this examination or else I will fail my final assessment. Not looking good. I thought I could get away with just a full day of practice, but I definitely need to go back to the obstetrics ward next week to examine more pregnant women. I think I did leave a good impression with the midwives as they seemed keen to have me around and that I am welcomed to come back next week to practice some more.

1 more week until holiday...well not even. Technically only 2.5 more days of placement left as I have a half day next Thursday (and Monday is a bank holiday and I get Friday off).  Can't believe it's already been 7 weeks. I can still remember my very first lecture for O&G like it was just yesterday. This placement seriously went by way too fast...and I'm having such a good time. Argh.

Exam Preparation.

To be honest...I haven't really done anything in placement, hence, the lack of updates. As you probably noticed from previous posts, my exams are coming up which involves 2 written papers and 1 OSCE. It's my first year of taking OSCE and doing more clinical based papers, so I'm quite nervous as I don't know what to expect. Yesterday, I finally got an idea what the OSCE will be like though as the school held a mock OSCE session for the students.

Essentially, our OSCE will be 6 stations of patient histories, and 6 stations of physical examinations. Each station will be7-8 minutes long. Before going into the mock, I had an impression that it will be really difficult. To my delight, the mock turned out a lot easier than I thought. Obviously could have done better as I didn't study for it (haven't had time to) or really practice for it. All in all, it wasn't too bad. I do have to work on making my examinations more slick and quicker as I take too long examining the peripheries. For example in Cardiovascular examination, I spend too much time looking at the hands and face. I think I need to just quickly glance over the hands and really just scan it instead of really looking at every single detail. Obviously the most important part of the exam is to examine the chest and I felt that I spent less time on the chest than the peripheries. Again, I think this is down to practising more.

It was really nice getting feedback from people on how I did in the mock OSCE and I now know what to focus on. Prior to the mock, I wasn't too sure what I needed to work on so I will be making a trip to the hospital tomorrow with one goal in mind: get slick at examinations. It should be good and I'm quite determined to get this down as the OSCE is worth 70% of our mark. In terms of history taking, it has always been my "strong point" as I do enjoy talking and I feel that I have a really good logical system of asking questions. In a patient history you would ask Presenting Complaint, History of Presenting Complaint, Drug History, Family History, Social History. Once I get that in my head, I find that asking questions and getting info from the patients quite easy. During mock, I was also helping out and was a patient for a station. Some people don't have a system at all and you can tell as their questions are all over the place. It's nice to see the level of history taking other students are at as it gives me a good idea of how much I need to work on my history taking skills.

Other than that.....3.5 weeks until exams. Eep.

Late Again!

I left my flat really early today to make sure I would show up on time to meet my new consultant. Obviously turning up on time is going to be my new enemy for this placement. Despite leaving my flat much earlier, I still ended up being 5 minutes late and the new consultant started his ward round right at 9am. I can't wait until the roads are reopened so I don't have to deal with the nightmare traffic I had to endure for these 2 days. However, I was quite lucky as this new consultant is really nice. He assumed I was late because I had some teaching earlier and was running a bit late. He greeted me and introduced himself and made sure I felt part of the team. It was definitely a nice thing for him to do and I do admit I felt bad for being late.

Anyways saw a new patient today who was moved from another ward. Found myself sympathizing with this patient as he had a metastatic tumour in his brain. He had undergone chemotherapy and radiotherapy, but is now placed for palliative care as it is an advanced tumour. Met the family today and you see the family trying to be strong and keep their chin up, but in the end the wife broke down. Felt quite useless as a student as no matter what you say - it isn't going to change the situation.

What confuses me the most about this placement is that I am placed in Endocrinology but majority of the patients don't have an endocrine related illness. Most of the patients I've seen have chest infections/pneumonia. It's quite weird. I only saw 1 patient today who had an endocrine related illness (Cushing's). I guess endocrinology is quite flexible? Will definitely have to ask one of the SHOs or FY1/2 doctors about this.

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.

End of Week 2.

Wow this week went by really quickly. One more week and then summer holiday!

So last week wasn't the most productive, so this week I wanted to make sure I get lots of patient histories and examinations done, as well as find a patient for my SSC project. This week I have managed to do about five patient histories and managed to do at least two physical examinations on 3 of the 5 patients. Again today (Friday), was my most productive day. Started bright and early and went to go see a patient my partner and I had taken a history from yesterday. The patient was going to be discharged today so we quickly did all the physical examinations we needed to do for our SSC project. Our SSC project requires us to find a patient where we do a full case history and all physical examinations (Cardio, Respiratory, GI, GALS, and CNS). This patient was extremely nice. I mean he was not feeling well and was quite frail. My partner and I expected him to say "no" when we asked for permission to take a history and examine him, but to our surprise he quickly said "yes" with a big smile on his face!

We first asked why he was admitted into hospital and listening to his history made me feel quite sad. This patient lives on his own and is almost at the grand age of 90 and he had collapsed on his floor at night. Because no one lived with him, no one knew he had collapsed and unfortunately he could not get up off the floor. He spent the entire night on the cold floor and because he had not answered his phone, his son had gotten worried about him and went to see if he was alright. The way the patient described his ordeal made it sound painful and you just feel really bad for the patient. He looked very upset and distressed about collapsing and told us that the pain he had from falling was immense. Whilst talking to the patient, we realized he was quite short of breath and had a constant and productive cough; therefore, we thought we should give the patient a break and would come back and examine him the next day (Friday).

So today we went to see the patient and the nurses told us not to bother the patient because they had just finished ward rounds and had prodded him quite a bit. He also looked quite tired as well and did not look very comfortable. We were then told he was going to be discharged later in the afternoon, so after popping to another ward to join a ward round we went back to the patient and asked if it was alright to do a quick full examination on him. Again, we were expecting to hear a "no" and a "leave me alone!" as he did look quite annoyed; however, he looked at us and promptly smiled and told us that he'll be more than happy to let us examine him. Because the patient looked quite tired, we tried to do our examination as quick as possible to minimize the amount of "prodding" we had to do. At the end we thanked our patient again and he gave us a firm handshake and wished us good luck with our career. He said it with so much sincerity and kindness it definitely brightened up my day. If I was in the patient's position I definitely would not let two medical students poke around and bother me if I was not feeling well. What a kind man and I got to say, my partner and I had learned a lot from this patient as he had an extensive history and was an immense pleasure to talk to.

Also now being my 2nd week of venturing the hospital, I realized that the staff in the ward I am placed in are starting to recognize me and it was nice to see them saying "Hi" to me. Makes me feel like I am not invisible and that the staff do remember there's a medical student wandering around. I even had a lovely chat with one of the nurses as well and finally felt welcomed. Worst part is that next week is my last week and I feel like I am starting to get the hang of being in my ward and getting to know people. The turnover is so quick as each placement only lasts 3 weeks for us (total of 4 placements). Can't believe that next week is my last week! I feel like I've still got lots of stuff to do. I still have to be assessed on doing a patient history and a physical examination by a doctor. As well, I need to find another patient for my second SSC project with some sort of ethics and law background to it, such as discussing patient confidentiality, DNR forms, etc. Not only do we have to do that, but also we need to find our consultant. We haven't seen him since Monday in theatre as he is away for the rest of this week. He said he'll be back next Monday and my partner and I will have to chain him down (as he can vanish into thin air in a blink of an eye) and hopefully arrange a meeting with him on Wednesday morning as he will be free. I will definitely make the most of my final week and I still haven't been in clinic so I'm going to try really hard to go to one next week. It should be good. And then...I'll be HOME! Haven't been back since winter holiday and I'm starting to get really homesick.

Anyways sorry for the long post. Will update next week if I have time!

Agitated Patient.

As some of you know - I am currently on my 6 week SSC Research Attachment. Today I was lucky enough to go to clinic with my supervisor to get some clinical experience. It was quite a straight forward day. 6 patients - all mainly with osteoporosis. However, one patient does stick out. She is fairly young to be having osteoporosis and the minute she walked in there was a sense of tension. I quickly noticed that she seemed fairly annoyed/agitated. It seemed like she was forced to come and was absolutely not interested about going to clinic.

I have followed/gone to clinics several times and have seen some patients and I luckily have not come across an "agitated" patient before. All the ones I have met are quite nice and did not fuss much about going to clinic.

First question asked to the patient: "Do you know why you're here today?"

Patient: "NO."

Immediately there was a bit of an awkward silence and in your head you're already saying: "This is going to be an interesting one..." Throughout the consultation it almost seemed like the patient was not listening at all and just did not care. At one point I thought she was going to get aggressive and thump my supervisor with her bag! It was such an uncomfortable environment. Throughout the consultation there were no bad news and everything was good - my supervisor and I were smiling and thinking that the patient would be glad to hear the good news and would smile...well she still looked "pissed". My supervisor tried to inform the patient about her treatment options and that everything will be fine and that it is essentially up to her if she wants to follow with the treatment. At no point was he rude or confronting. He was actually REALLY nice and patient. He took his time to explain to her about things and the treatment.

Anyways after a bit, the consultation was done and the patient left - obviously still agitated and annoyed. She was apparently moaning to the nurses about the treatment and all that and was being a bit uncooperative. No joke I had a sigh of relief when she left as it was really uncomfortable. It didn't help that the office was TINY.

Definitely a neat experience and I will definitely encounter some patients who do not want to be in the hospital or at the clinic and will be a bit uncooperative. It was a good learning experience and it is something I will keep in mind. I felt that my supervisor handled it very well and calmly. Thought I'd mention this as I thought it was something different and made clinic a bit more interesting.