Renal Firm over.. and now Public Health

Just as i've become really settled in on the ward, and struck a nice rapport with the doctors and the nurses, who saved chocolates and lemon sherbets for me.. and promised to find a urinary catheter for me to put in (though this never happened) i'm done with renal and have to move on! :(

.. and what could be worse.. i'm moving back to london for a week of.. PUBLIC HEALTH lectures! (zzZ) BUT i'm glad to be home ^^ - can't beat laying down on my own bed, and drinking tea from my favourite mug at home.... but annoyingly i've left my keys and oyster card in Essex, so i will have to be the annoying bum who needs people to open and lock the front door for me everytime i leave the house >.<

I really REALLY enjoyed renal medicine, and i know i will probably say this for EVERY firm i do... but.. i might even consider nephrology as a future career!! - in fact, i like it so much i arranged an SSC on renal transplant.. i may regret this.. but for now.. i love kidneys!

(i know i should be more open, and i'm sure i only love this so much, because it's my first ever taste of clinical medicine... but meh.. right now.. i'm loving the kidneys!)

Next Week: Public health lectures

Next Firm: Endocrine

Clinical Examination: Feeling & Hearing "abnormal" for the first time

For my year 1 and 2 OSCE exams i more or less learnt a "script" of what needs to be done, without really knowing what i was suppose to be feeling for, hearing out for or eliciting when i do a certain clinical examination.

(Well, i knew the exam, in that i know i can hear murmurs for different valves at certain points, feel an enlarged kidney if i balloted and can percuss the chest to look for areas of dullness etc..But i didn't really "KNOW" the sounds, or the feeling... since we only ever practised on healthy individuals)

BUT, slowly slowly now, i've had the opportunity to feel and listen out for different signs, and have started to collect a small collection of ideas as to what "abnormal" feels or sounds like... and hopefully i will pick up more of these "sounds" and "feelings" throughout the year. It sounds so odd, but i when i do a routine examination as i would in an OSCE exam and feel something for the first time, it really surprises me, and in a way in which i think i will never be able to forget "the first time"

Examples:

"the man in the side room with aortic stenosis"

- i approached the chest with my stethoscope, and first placed it at the 2nd intercostal space on the right of the patient's sternum and listened to the aortic valve (i've been taught to go A-P-T-M) and heard a wooshing sound... i wasn't sure if it was abnormal, and continued to place my stethoscope at the P position and so on, and then all of a sudden i realised.. A was definately abnormal! I timed this with the pulse, and the abnormal sound occured with systole, this was aortic stenosis!

"the lady with malaria, and hepatomegaly"

- i was on a ward round with the team, and when we got to this lady, my FY1 told me they had found something on an abdominal examination, but i had to go find out what it was myself. I started feeling all 9 quadrants, and they all felt pretty much the same to me, soft and non-tender. Then i continued to find the borders of the liver, and this was when i first suspected the liver may have been enlarged, and to confirm i continued to feel for hepatomegaly and there it was, an approximate 3cm enlargement. The first time i've ever come across hepatomegaly.

I've had many of these "firsts" so far, and hope to continue adding more experiences to my collection.

Taking bloods and wearing scrubs

Although we're in hospitals now, we can't really escape the GP placements, and neither do i want to escape from them either.. i actually really enjoyed them last year.. and i think i love this gp practice even more!

Dr D. sat on the corner, and gave me his seat behind his desk, and for that morning, i took the history for every patient that sat in, including a deaf patient which was definitely an experience to remember. I gave a handful of flu vaccinations, did a few examinations, and felt lymph nodes the size of £2 coins (this was a patient with CLL, Chronic Lymphocytic Leukemia). I also had to take blood from an 83 year old gentleman, who despite his age, had lovely veins which i managed to take blood from on the very first hit... Success!

This was however, very different to my first attempt at taking blood at the hospital...

Whilst heading to the doctor's office to grab my bag and head off home, a random FY1 stops me, and asks "are you a 3rd year? wanna take some bloods?".. this was so random.. as i had never met him before, but as i've never done it before so..hell yea! This enthusiasm was however shortlived, as he took me to a very ill patient who was sat up in bed and very short of breath. The patient was more than happy for me to take his bloods, but his veins were very hard to bleed, and after 2 attempts, the FY1 had to take over :( This was a bit of a downer, and i felt awful for having tried to take blood from him and failing twice, when he is so ill.

I'm not going to lie, but on a few occasions, particulary in the first week i did feel really lost and even a tad down. I simply just did not know what i was meant to be doing there as a medical student. However, what they say is really true.. if you don't ask, you don't get. With that in mind, i randomly asked a dialysis nurse if i could go watch a fistula being done.. and it was as simple as that.

Friday morning, 8am i was in some rather comfortable navy scrubs and some comfy crocs, standing in on a minor surgery, but surgery none the less =) I do have a surgical firm at the end of the year, but this was good enough for now, seeing that otherwise i was going to spend friday morning on the ward which i do everyday anyway... this was a nice change!!

Artichokes

I absolutely love love LOVE clinical years so far!

(Fair enough it has only been 2 days in.. but so far, it has been excellent!)

I'm currently on placement on an out firm, and it's been more than i could have hoped for. I'm not even sure where all the rumours about how bad the accommodation for this firm is comes from.. (then again this is my first firm so i have no parameters to compare it too... but so far... i'm really enjoying it!)

First off... the rooms are all ensuite, there is a common room with freeview tvs, on site parking (free), accommodation is on site to the hospital, the entire block is for medical students,.. and albeit a bit of a problem with the internet.. everything is pretty good! Hmmm okay i guess some would be unhappy with how far it is from anywhere... it took us around 20 minutes to drive to the local big tesco for our groceries >.<

When it comes to ward placements.. all the students are allocated to their own FY1 mentor and a consultant each.. and there's only 2 of us to a ward, so no overcrowding!

It's getting a tad late, but i really want to write about the sort of things i've got up to this week, (i will make another post this weekend!!), but just to end this abruptly.. this is a funny random conversation i had today whilst i sat in on my consultant's clinic, where he sprung a question on me:

Consultant (C) Tofu (T)

C: What tests are useful in assessing renal function

T: GFR?

C: How would you do that?

T: Gold standard would be using innulin, a carbohydrate derived from jerusalem artichokes, it is neither secreted or reabsorbed, and is freely filtered and not metabolised...

...a few sentences later....

C: What's the difference between a jerusalem artichoke and the other ones? How do you eat jerusalem artichokes?

T: er... well i like to boil mine and dip the ends in butter..

C: I have only ever had the preserved ones