Radiology: Dark Room - Perfect for Snoozing.

So I had my attachment in Radiology. I was a bit hesitant about it, as I'm not great at sitting still, though I was excited to actually be taught how to read X-rays, CT/MRI scans and maybe see a bit of intervention radiology done. As expected first day I was sat in a dark room in front of a computer screen with a radiologist. Had great teaching on how to read chest x-rays, but eventually it got a bit boring and repetitive. Eventually I found myself zoning out, but luckily the radiologist had to go to a meeting so allowed me to go home. Thought to myself: "Jeez how am I going to survive a full day tomorrow in a dark room?"

Next day, same thing in a dark room, but smaller room...which was fairly stuffy and warm. Perfect environment for a snooze. This time we were going through MRI scans of the head. Complicated, but interesting. Had a bit of a late night the day before trying to do job applications, so I found it hard to wake up. Eventually again, found myself drifting off. I was sat behind the radiologist and because he had quite a long list of things to do, he would go back into his own world and dictate a report. While he does that, I felt my eyes getting heavier...and let's say at one point I nearly fell off my chair. Then off to ultrasound in the afternoon. I followed the sonographer, and again they work in a dark room. It was fairly straight forward, except at least there's a little bit of patient contact. Despite this, found myself falling off the high chairs while trying to focus on the screen.  I think it didn't help that I didn't get any hands-on as this attachment was more just to get a feel for the specialty.

So this dark room saga and me dozing off continued for a few days. I guess I didn't learn as much as I had hoped. I think with radiology, it is one specialty where you just need to sit down with a book of examples and go through them at your own pace. It is nice to have someone there pointing stuff out, but I found that the radiologists does them really quickly as they're well-experienced, but for an untrained eye like mine...I really need to sit there and admire the abnormality and compare it with "normal".

Really not that exciting of a week. Starting another specialty next week...by the looks of it, it isn't that exciting. I do have Orthopaedics coming up in a few weeks so definitely looking forward to that. It's been awhile since I've been in theatres (since electives) and it'll be nice to be back in there!

A&E Night Shifts.

Many apologies for the lack of updates...A&E is proving to be a lot busier than first thought. My first week was a bit shaky as I started off with a week of night shifts. I really did not know what to expect. I made sure I sorted out my sleeping schedule and got plenty of sleep right before my shift. No matter how many placements I go on, the first day will always be slightly awkward. Literally stood around for a good hour by the doctor's desk waiting for a friendly doctor to say hi and welcome my group and I. Nope. Eventually we stopped a doctor and was quickly told: "Get stuck in! There is the box of the patient notes. Take a history and stalk the box and see which doctor picks up the patient you saw." Was quite perplexed and shrugged and just "got stuck in". Eventually attached myself to a doctor and found myself with a list of jobs, which included putting cannulas in and taking bloods. Just coming off from Anaesthetics proved useful, as I was still confident in putting in cannulas and was popping them in with ease. Though not having another pair of hands to help like we do in the anaesthetics room in theatre was proving to be quite tricky (and messy). Eventually it got to about 4am, and you notice yourself starting to lapse in concentration. I was definitely starting to miss veins and needed to "fish around" before getting into a vein when inserting a cannula. What's really annoying is that no matter how late I eat my dinner, I will get hungry at 4am. Luckily the doctors were really chilled and are always prepared. The registrar brings food for the team on night shifts so when A&E was calming down, we all sat around and snacked. Thankfully my first night wasn't too busy and the doctors told us to leave at around 5:30am. It was eerily quiet when leaving the hospital. And the roads were even quieter.

Anyways the next few days of nights progressively got quieter and quieter which was quite "abnormal". Just my luck. Didn't manage to see as many patients and didn't get to feel that useful/productive. At least the nights treated me well! Then I had to start my weekend night shifts. Saturday night...should be interesting! Swear the first 5 patients I saw had "intoxicated +++" written at the top of their notes. It was actually very frustrating to try and get histories out from them or their friends. What was a bit shocking was that there were students coming in from other cities to experience the night life here and end up getting completely plastered (and ending up in A&E). I personally would never go to a foreign city and get absolutely plastered. I guess I would be a bit more "aware" in a foreign city as the last place I want to end up in is in A&E. But of course, everyone has their own version of "fun" and I'm just a boring...old...medical student. Other than the non-stop flow of "intoxicated +++" people, it was a fairly uneventful night. Didn't really get to do very much either.

All in all, night shifts weren't actually that bad! But I do think I got off quite lightly as my friends who were on night shifts said they saw a few cardiac arrests and a few trauma cases. Oh well.

I'll try and make a few more posts this weekend. Need to catch up! Apologies again!

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!

What to do during summer holiday...

I tend to see a lot of prospective medical students and current medical students wondering what they should be doing during holidays. For most people they see it as a bit of a dilemma...I personally don't...but some people feel the need to be doing something during the summer.

The most common question I see from prospective medical students is what should you read during summer holiday to prepare for medical school. To be completely honest: you don't need to do any pre-reading unless the medical school specifically told you so (which is unlikely).  If you are a gap year student and haven't studied in a long time - then just quickly look over your biology notes. I don't think looking over your notes will really get you ready for medical school. I don't think it is that big of a jump from school to medical school. I guess it varies from university to university, but for me - there was a gradual introduction to medicine. What did I do the summer before I started medical school? I traveled with parents as I know once I get to university, I won't see them as much - so I spent quality time with them. I did a lot of sleeping. Played social basketball and hockey. Chilled with friends before we all split up across the world for university.  Essentially I did a lot of relaxing..I don't think I did anything related to medicine or prepared for medical school. The most preparing I did was probably reading the intro/welcome guide that the university sent.

Another common question from prospective medical students: What books will I need to buy for medical school? I personally won't buy any books until a few months into medical school. Most medical schools will give you a recommended reading list. Go to the library and take a look at all the textbooks and see which one suits you. Textbooks are expensive so choose wisely. I made the mistake of buying books too early and ended up only using a few of them. Some of my textbooks are still sitting on my shelf looking brand new untouched. If I had to recommend ONE textbook - it would probably be Vander's Human Physiology. It is probably the only textbook I have that is quite beat up and well-used. I found it to be the perfect textbook for the first two years. Again, go to the library and check it out before buying! Kumar and Clarke Clinical Medicine is also another great textbook, but I never really used mine. Medical students from other universities say that it's really useful. I've only used it for certain topics that weren't covered well in lectures. The few chapters that I looked at - I really liked the layout and how things were explained. The only problem I had was that I found that there was a lot of assumed knowledge and some descriptions of certain conditions were too brief.  My friends say that it is either a hit or miss. Some students swear by it. Others like me, don't really care for it. Another textbook you should check out in the library before buying.

So you're a medical student and you're sitting around at home feeling that you should be doing something productive and medically related. If you're in 1st or 2nd year and you've still got a long summer holiday - go enjoy your holiday. As the years progress - your summer holiday will get shorter and shorter. This year, my summer holiday is only 3 weeks. Stupidly short. In first year my summer holiday was 3.5 months! Most of the doctors that I have talked to all told me to not work during my summer holiday as I'm currently doing an audit project. I was quite stressed about it before holiday started trying to get it done so I don't have to worry about it, and I'm glad I did get it done before holiday. Now, I can relax and just sleep as much as I want. Actually might be taking the whole sleeping in to a whole other level. Thinking about it, it's nice to sleep in. Before holiday, I was getting about 4-5 hours of sleep per night. Now I'm well rested as I'm getting about 10-12 hours of sleep...doing some major catch-up. Knowing that my holiday is only 3 weeks, I'm glad I didn't bring any work with me as I'm spending as much time as I can relaxing and doing the things I love to do. Hanging out with friends. Eating good food. Sitting around. Just doing absolutely nothing. Need to get the brain rested as exam season is coming up. So my biggest tip to current medics: RELAX when you can! Enjoy your holidays while they last! Take a break as you'll just end up burning out. Medicine is mentally and physically demanding - give yourself the needed break!

Okay so you're not convinced and you HAVE to do something during summer holiday. Try to avoid doing something medically related. Go volunteer for summer camps. Go volunteer for an activity that you enjoy doing. Do the things that you love to do. For medics: I really advise against shadowing a consultant during your holiday at your local hospital. You'll get to spend all the time you want in the hospital in the near future. For some, your next 30+ years will be working in the hospital. You can follow/observe as many consultants you want when you get back to medical school.

Anyways that kind of gives you an idea what I'm usually up to during holidays and what I think is the best way to enjoy your holiday.

1 down, 6 More Weeks to Go.

What a shock to the brain. I've tried my best to prepare myself for my next attachment in General Practice....and actually had very little expectations. My main fear prior to starting my attachment was the prospect of just sitting in the corner of a clinic from 9-5pm and not really do anything practical/talk to any patients. I have never had a rotation in GP before so I am obviously out of my element. I have always been in a hospital and there are a lot of advantages of being in a hospital such as if you don't find your attachment particularly interesting/useful - you can always go to another ward/department and there will surely be someone who will be willing to teach. The problem with GP is that you are stuck in the same building and there is no where to run. I am a type of medical student who likes to venture off to find more interesting things if I find myself getting very bored. There is a sense of "freedom" in a hospital as you aren't bound to a single area for the whole day. It is seen to be acceptable for us to roam to other wards to learn about different things while we are in the hospital so no one would really notice you not being on your assigned ward (unless there is scheduled teaching). In terms of GP, it is VERY obvious if I do not turn up as I am the only student in the practice and the GPs who I am attached to can see on their own schedules that they should have me, the student, in clinic with them. Very difficult to escape.

So I had a short week...had 2 days of lecture and 2 days on placement + 1 day off. Despite only being in the GP practice for only 2 days...it still has managed to knock my motivation completely over. My last attachment in orthopaedics probably was the highlight of my degree and my motivation to work was at an all-time high. I could wake up for early morning meetings. I rarely found it boring. Just everything clicked. I was truly happy. I was hoping all the happiness and motivation I managed to build up in my orthopaedics attachment will get me through GP. Wrong. In 1 week....my motivation level is at an all-time low. I am not interested in doing anything. Can't wake up in the morning. Don't feel like doing any work. Do not feel like participating. According to my friends, I am in a horrible mood. I am actually really low at the moment. On my first day I walked in with a very open mind and told myself it will be a good change as I'll get to see various different type of conditions and get to relax a bit more.

I will certainly not dispute that GPs see a lot of different things, and actually props to them for being such patient people. Some of the patients who come through the doors really....erm....there are no words to describe it. GPs are given 10 minutes per patient...but some patients come through the door expecting to get 30 minutes and talk about everything and anything. I can obviously tell in between patients that GPs get frustrated and they have to put on a mask whenever another patient comes through the door. As a student (who is sitting in a corner), it's just painful. If the GP finds it frustrating and boring to constantly have to reassure and listen to life stories...think about the poor student sitting in the corner who can't do anything but sit and watch. There is only so much I can learn by sitting and listening. I learned from my last placement that you won't learn anything until someone pushes you into the deep end of the pool. I was very hesitant in my first week of orthopaedics to go see new patients on my own as I had never done that before...but very quickly I found it very useful and eventually became quite good with taking patient histories. I don't think you can learn communication skills by just observing. It is something you have to learn by experience and I think that by making your student sit in the corner and listen is not very productive/a good way for he/she to learn.

I personally think that medical students can actually be very useful if used correctly. At the moment I feel like an old piece of furniture which isn't being used. I literally just sit there and watch. I don't even get to interact with the patient. I just try my best to not fall asleep and smile. I don't want to look not interested in what GPs do so I have to put on a face. I was so bored in my morning clinic today that I was desperate enough to offer to get things for the GP or make him a cup of coffee/tea, but nope...was told everything is fine and to just sit there. I haven't been so frustrated with a placement in a long time. I mean paediatrics wasn't my most favourite placement....but at least I was in a hospital where I was given the freedom to walk around and go to other wards...go see other things. I feel trapped at the moment. How am I going to survive next week. I don't get how I'll stay sane by the end of this attachment. All I want to do now is just sleep the day away. Props to people who want to be a GP...don't think I have the patience/tolerance to be one. Need to desperately find a way this weekend to pick myself back up or else I won't be able to bring myself in to the practice on Monday.

Lack of Sleep.

5 weeks in! 2 more weeks to go. This has got to me the toughest week in terms of waking up. Every morning I am waking up at 6:30am to get ready, but it doesn't help that there isn't much to motivate me to get up.  I think the only thing that is making me wake up on time is the fact that I have to drive other people to the hospital so they kinda rely on me. I also think that being 5 weeks in, there isn't much else to see. Most of the patients we see have acute illnesses as most of the special illnesses get referred to a bigger hospital. 

I was on-call on Wednesday and the best bit is that the doctors on the ward can tell when I am on-call as I'm never on the ward when I am on-call. I try to go to clinics to try and make the time go by faster. As usual...Wednesday - I escaped the ward. I went to the Children's Orthopaedic Clinic for the entire morning. It was a lot more interesting than I expected it to be. I saw a lot of different cases. I was even able to sympathize with some of the patients. Met a girl who is hypermobile, which was affecting her participation in sports.  The consultant was doing a physical examination on the range of movement of her joints and on doing internal rotation of the hip, the consultant asked me if it was normal. I knew my leg could turn that far so I said: "normal". I have never seen such a confused face. "That is NOT normal. LOOK how far it goes!" Feeling a bit dumb/embarrassed I covered my back side by saying: "Oh sorry didn't notice how far it went *blushes*"

Once the patient left, the consultant questioned why I thought the range of movement was normal as it was apparently fairly abnormal. Then I proceeded to tell him that I am hypermobile as well. Then I found out he isn't very good with hypermobility.  The consultant looked quite uncomfortable and didn't want to see me showing my "flexibility". I was quite surprised about his reaction, but thinking about it....it is fairly gross. Fingers shouldn't bend so far back and such.  Haha. Hypermobility is a great party trick by the way. Just thought I would throw that out there.

Anyways clinic took quite long, but we had a lot of patients. What I enjoyed the most about the clinic is that we did not see two of the same case. Every single patient had a different problem and it really kept me awake and interested. For the first time at a clinic, I did not find myself bored. I was constantly engaged and I found each case interesting.  Probably could be one of the best clinics that I have ever been to. Long, but interesting.

At some point the clinic had to end and I had to return to the ward. On the way back, I stopped for a lunch break.  When I returned to the ward I was told there was another clinic happening in 30 minutes. Obviously I pounced on that opportunity and I disappeared from the ward for another 4 hours. By the time I got back to the ward, I only had 4 more hours left of my on-call to do. Luckily when I got back, the ward started to get busy and I got to clerk in a few patients. Most of them were diarrhoea and vomiting problems, so it wasn't too exciting. It was better than sitting around doing nothing.  But because the ward started to get busy, I didn't get to leave til 9:30pm. I had quite a bit of work to do when I got home and didn't get to sleep early. Worst part, I had to get up at 6:30am the next morning again. Thursday was brutal. For the entire day I was falling asleep whenever I sat down.  We also had lunchtime teaching from the registrar and I accidentally fell asleep. I felt really bad as I didn't mean to fall asleep as it wasn't boring. I was just so tired I couldn't keep my eyes open. Now I think the registrar hates me. She wouldn't talk to me afterwards and it was kinda awkward on the ward. Hopefully she'll forget about it after the weekend. And hopefully I can catch up on my sleep.

Practice Makes Perfect.

I was signed off from placement on Monday so I haven't been doing anything particularly interesting other than revising for exams. Met up with a friend on Thursday to do some physical examination practice on patients at the hospital. As you may recall in my first attachment back in the summer (doesn't seem that long ago...time flies) I was drilling Cardio an Respiratory Examinations. Well exams are in 2.5 weeks so I got to get drilling on the rest of the examinations.

So we went and practised Abdominal, Shoulder, and Knee exams. Got that down pretty quickly. Never really had trouble with those examinations to be honest. Then we practised Cranial Nerves, peripheral neuro, and hand examinations. We did these with each other as these exams have quite a lot of steps. Before practising, I was hopeless at Cranial Nerve exams. I was not slick at all and obviously needed some serious practice. After a few attempts, I have finally gotten it down and was starting to get slicker at it. Did the same with the other examinations and I could definitely see an improvement. I was starting to feel much more confident with my examination skills and a bit more confident for my OSCE exam. Have arranged another physical examination practice session for Monday so hopefully I'll continue to improve and get better at these things.

Today I finally reached the last system to revise (Gastrointestinal). It surely doesn't feel like the last unit as my binder is still full of notes and it just doesn't seem real that exams are so soon. It's really weird. Most of my friends and I agree that exams don't seem near and the panic still hasn't set in. Generally been feeling quite unmotivated so I constantly have to remind myself how close exams are which results in mini panic attacks/a kick up the ass. I guess it kind of works as I've been revising furiously for these last few days and really pushing to get ahead of my revision schedule to give myself an extra half week of revision for anything I'm unsure of. At the moment I have scheduled in 1 extra week prior to exams for random revision/going over sample questions. Hopefully if I work hard enough I can make it 1.5 weeks of extra revision time to actually properly learn Microbiology. I swear Microbiology is my new nemesis. It used to be histology, but because we don't do that as much anymore...Microbiology has quickly taken Histology's crown of being my nemesis. There are so many things to remember! And all the stains for the different bacteria. Mental.

Pharmacology comes close behind. Drug treatments for Cardiovascular disease and respiratory are fairly straight forward. The minute you get to Dermatology...oh wow. You start feeling like a walking BNF (British National Formulary - it is a book of drugs)...but more like a BNF written with fading ink. Put some new drugs into my brain...the old drugs fall out. Dermatology...endless amount of drugs. So many names as well! Half of them I can't really spell! I can picture myself writing drug names in my exam and writing the first few-ish letters and then squiggling the rest and making sure it looks like the drug I'm thinking of. Thank goodness spelling doesn't count in our exams! As long as the word is recognizable they will take it.

My Oxford Handbook of Clinical Medicine is also finally getting beat up. It had been in mint condition for 2 years and FINALLY it is getting used...and I am seriously using it to death. Also random note - think I might be getting tennis elbow as my desk isn't great to write on as it is fairly deep. That means my elbow is constantly resting on the hard surface and sometimes I can feel my hand go tingly and numb. Also my elbow is sore from resting on the hard surface. The things you sacrifice for exams. Sacrifice sleep, good food (yay for quick microwave food), social life, going out, sanity, blah blah blah, and now sacrificing joints! Prospective future for my body. YES!

I hate revision. I miss lounging around and being lazy.