O&G - GP Week

This post is a little late, in fact an entire week late as I've become extremely sleep deprived and tired from my O&G firms...! But yes... my GP placement 2 weeks ago...

There is no set timetable from the medical school, just a simple set of learning objectives, and the GP can make what they want from it. So essentially.. GP sessions are as interesting/dull or long/short as the GP in charge wants to make it... and it's simply a matter of luck if you get what you want.

I'm not going to complain about my O&G GP placement this time though, as it's been pretty good!

Smear Clinic

It's perhaps a little immature and silly to find these things awkward and scary... but I admit... that was exactly how I felt the first time I had to insert a speculum. The awkward part came from being slightly startled by the very energetic, loud and possibly too friendly patient; and the scary part owing to the fear of inflicting any pain whilst carrying out the smear.

< Just look at the thing, you warn the patient it's going to be "uncomfortable", and I'm sure it probably would be just that.. if not worse!

The smear was pretty easy to perform, and particularly as I had the nurse with me to teach me step by step (Nurses tend to be awesome at teaching clinical skills).

We donned our gloves, lubed the sides of the speculum, making sure none got onto the tip, parted the labia, grabbed the speculum and pushed and rotated it, got the cervix in view, locked it open, inserted the brush thing, twisted it round in the same direction for possibly 10 times, and then just removing the whole thing, making sure the cervix doesn't get trapped! (Ouch). Quick few violent swirls of the brush in the solution, labels on and ta-da.. done!

It wasn't actually as bad as I thought it would be.

...... oh yes.. I forgot the mention the bit where the cervix starts bleeding whilst i was twirling the brush around.. the nurse warned me this happens quite often... but it didn't stop me from feeling a little bad. 

Vaccinating children and babys

Thankfully the children and babies were probably too young to remember me and hold a grudge against me for injecting their tiny thighs. We were taught to ask the mother's to hold their babies in a specific way, and then it was all stations go go go, trying to get the vaccinations over and done with as quickly as possible.

Innocently, all the babies would beam their little smiles at you, and as soon as the first needle went in, the crying would start, and it was a matter of trying to get the other vaccination into the other thigh as quickly as possible to get the ordeal over with.

Examining Baby Bumps

I'm the youngest in my family, and I was too young to remember any of my aunts being pregnant, and having not had any friends or relatives fall pregnant in my 2x years of life.. I felt my first baby bumps this week! We had a number of pregnant ladies come in to have their checks, and we were taught how to examine.

I was again a little nervous of hurting the mother, and it was made pretty obvious to me that I was pressing far too gently, when the pregnant lady herself looked up from her supine position, and told me not to worry, and that I could press harder on her! So yep... now i know they're pretty resilient, and I can put a bit of pressure on their baby bumps.

-----------------------

All in all, I can't really complain about my GP week, as I've been quite lucky with the placement with lots of hands on opportunities.. and no longer can i complain about far distances to travel, as a small group of students got sent to Southend for a week of daily GP placements.. despite being attached to a London hospital!

Now for a few weeks of hospital based O&G!

Starting Obs & Gynae firm

An intro week (which could have probably been compacted into 2 days), and a week of O&G lectures later... i'm now ready to start the firm!

It's a 5 week firm, the first week in the community (GP placement) and 4 weeks at the hospital.

This will be the first time in 3 years that I've had a complete week at the GP practice (from year 1 -3 we would attend on the same day, once every other week), and so instead of just experiencing what the GP would do every Tuesday, I now get a flavour of the entire week. It also means I don't get the disruptions from the hospital part.

Now no post about in-firms will be complete without my travel moans.

Living at home has its perks; it's cheaper, I have the company of my lovely parents, and.. the list goes on. However, as my hospital placement is an IN-FIRM, I've been placed rather far from home, and it means 4 weeks of leaving the house at 07:17am to get to the hospital by 09:00am...

I will be needing that morning cup of coffee (or 2)!

But for now, it's a week of GP from tomorrow! (and a far short travel distance)

Year 4: Day 1 of "The Hardest Year"

Introductory Week

So it was a pretty mix of excitement and fear today, probably more of the latter.

Excitement - well, it's the penultimate year! 3 years ago, around this time I had left my HCA job, received my Barts welcome pack, and was eagerly awaiting  the start of medical school.

And today? Well, i'm a tad over half way through, and approximately 1 Year and 8 Months from the finishing line (according to the informative lecture this morning, and with fingers crossed for all things going smoothly). I'm not quite sure how the last 3 years manage to pass so quickly, and now there's just the two left.

This sort of leads on to the Fear part. 

It's pretty scary for a few reasons. 

1. I've been told it's going to be the "HARDEST YEAR!" .. and looking at the timetable.. i believe that.
   There's a lot to cover this year, with less time to cover it all... and I will have to start from scratch, as a lot of these subjects i haven't touched since year 2.
2. It's the last year to work on the rankings (we're getting a talk on Friday for this), and if the weighting works how i currently think it does.. then this year's exams count for a meaty chunk, and more or less dictate how many points i will be getting for my Foundation Programme application.
3. It's my last year to get anything impressive down on my CV... and it was drummed in this morning, that leaving it till 5th year is simply too late.
   At this moment in time I honestly don't think I have anything for my CV, and don't really know where to start.

On a less serious note, we had a really funny talk today by a 5th year medic, who pretty much gave us the do's and don't for 4th year. I was also inspired by her to try and predict the modules i'll enjoy this year, and those i won't, and at the end of the year i'll see if i was correct... so here goes:

Obstetrics and Gynaecology - Like

Paediatrics - Like

Neurology - Like 

Psychiatry - Like

Opthalmology - Dislike
Orthopaedics - Dislike

Rheumatology - Dislike

Care of the Elderly - Like *

Dermatology - Dislike

GP - Dislike *

*When asked by doctors or others which speciality i'd like to pursue, I tend to either say care of the elderly, or GP... which is surprising, seeing as i don't think i will enjoy the GP component of 4th year.Only time will tell if these change by the end of the year ^^

However, for now.. it's a 9am lecture tomorrow, and time to sleep.

Year 3 Results: 3/5th of a doctor ^^

On Tuesday afternoon, we were sent an email titled: "MBBS Part 3 Results"

I clicked on the email, heart thumping and fingers a little sweaty, thinking the uni has upped it's game and has decided to release the results even earlier than the year before (!!)... instead I was greeted with this message:

"Your results for the MBBS Part 3 examinations will be      released on Blackboard Friday 13th July 2012 on                Blackboard at 2pm."

So from heart thumping, i went into a sigh of relief. 

.... that was until this morning, when the crazy refresh button bashing picked up again (just in case they decide to release things early!!).. and i see the number of students logged into blackboard gradually increase on the bottom right side bar. 11am.. nope still nothing...noon... nothing... and on the dot 2pm...  there they were! (uni didn't lie)

Paper A - 76%
Paper B - 75%
Paper C - 72%
Paper D - 71%
Paper E - 80%

Outcome: Pass with Distinction

YAYEEEEEEEEEEEEEEEEEEEEEEEeeeeeeeeeeeeeee i passed, 3/5th of the way there!!
Pleasantly surprised with the outcome too..  ^^


Having just passed 3rd year.. I would say... this was probably the hardest year yet.. it was more relaxing in that we didn't have as many lectures as before, or as many styles of exams to revise for. However, I still found this year the hardest to date, down to the shear amount of detail we had to go into. 

However, Summer holidays can finally begin now, and i can shout Yayeeeeeeeeeeeeeeeeeee.. hello 4th Year! I've heard some pretty scary things about you, but I can't wait to begin! 

First Rotation - September - Obs and Gynae 

...until then.. it's holiday time ^^ 

Paper 3C: Data interpretation

I was sort of dreading the data interpretation paper.. i didn't really know how to revise for it, but thankfully as the paper loaded on the computer screen, I was relieved the find that the majority of the questions were pretty much like the EMQ questions I've come across in question books. 

There were a few pathology questions, but having guessed that these may come up, my friend and I did a quick review of the pathology lectures in the morning, and lucky we did... the images came straight from the lectures ^^ 

So that's it... 3rd year exams are finally over! 

Now just to start enjoying my summer break and keeping these fingers crossed until next friday..... eeks!

Paper 3Dii: OSCEs (7 minute stations)

Station 1: Lethargic patient

Okay... so from yesterday, i came to the conclusion that I really struggle with communication skill based OSCE stations. When clerking patients on the wards, i tend to speak to them for quite a while, but when i was stuck with just 10 minutes yesterday, and just the 7 minutes today.. i realised it's not smart to waste too much time being nice to the patient, but more importantly to get all the questions in. I managed to make my way to finding out about the patient's social history, before the examiner had to interrupt me and ask me a few questions before the buzzer went. Managed to get a few nods from the examiner before the buzzer sounded and i moved on. 

Station 2: ABG and interpretation

This was a rather straight forward station, with a model arm attached to a bottle of red coloured fluid and to a machine to simulate a pulse in the arm. I managed to take a sample, cleared up my mess, and then went on to interpret the blood gas question which followed. 

Station 3: Rest

I needed this one, was super thirsty at this point!

Station 4: Cardiovascular examination

This station had nothing else to it; simply just do a cardiovascular examination and present! I went into full mode autopilot, almost forgetting to assess the carotid pulses (but managed to do it before i went onto auscultation of the chest). Presented the findings just in time before the buzzer sounded. 

Station 5: PE history

I basically had to take a history and present the findings at my next station. This station went quite well. The patient presented with shortness of breath, and after finding out he has recently returned to the UK on a long haul flight, i just focussed in on a PE history, and that was that. 

Station 6: CXR 

This station should have come at the end of the last station. I went into the station, and the examiner told me i had a lot of time.. and he was right. I presented my history, and then he took out a chest radiograph. He told me i didn't had to present it, and just had to point out the abnormality. The history pretty much gave the answer away, though the CXR had a pretty large wedge shaped infact which was hard to miss.. it looked a little like this.

Station 7: Fundoscopy

This was awful! I did a quick visual examination on the patient, then picked up the opthalmoscope and had to look into the eye of the plastic head, reading off words they've stuck on bits of paper attached to each quadrant of the eye and the macula. I was really struggling to look into the eye, and this was made worse, when i was a little too rough with the plastic model head, and ended up pushing it onto the floor. I had to pick the head up mid-exam, place it back onto the stand and continue looking into the head!

Station 8: Cannulation

 This station was pretty straight forward. It was another plastic arm hooked up to a bag of red coloured fluid.  I inserted the cannula, finished the station, and was then instructed to remove it before the next student arrived. 

Station 9: Thyroid Examination

Another straight forward examination, with a question at the end. Almost forgot to assess for lid lag and opthalmoplegia, but managed to slip them in before i went on to the legs. 

Station 10: Breast Examination

So during the last CCS week, we were taught how to perform a breast examination on real volunteers, and this was basically the exact same thing.

....................... and that's it! OSCES are over for 2012 (i hope!)

Just one more paper to go on Friday, but luckily i have the day off tomorrow to cram for it...not exactly sure how i'm going to cram for a data interpretation exam >.<

Paper 3Di: OSCEs 1 (10 minute stations)

OSCE Day 1: 10 minute stations

I don't exactly look forward to OSCEs, but i always end up enjoying them each year; I suppose they're a pretty fun exam to sit ^^... even though at times, I wish the floor would open up and take me away from a cringey moment.

Station 1: Lower limb motor and sensory exam
I've practised this examination quite a bit, so i was pretty chuffed when the buzzer sounded and i turned around and saw the station instructions. I went behind the curtains and went into auto-pilot, finishing the exam with 3 minutes to spare to present my examination, and answer the examiner's questions on diabetic neuropathy.

Station 2: Non-compliant patient
This was my first ever communication skills station, and I was terrible. I asked the patient at the start to score how confident he was feeling about making a change, and he goes 8/10.... I was a bit taken back, as he already seemed quite determined to make a change, and there didn't seem to be much scope for me to "motivate" him with. ...... not sure if i passed this station.. (thankfully i think we're aloud to fail a few stations).

Station 3: Resus/ IV drip / 02 therapy
I turned behind the curtain and was faced with a plastic dummy. I was sort of confused on what I had to do for this station, but the really nice examiner sort of guided me through. So it was basically ABCDE.. with the examiner firing questions as i went along. Airway was patent, Resp rate was raised, Sats low... i had to administer oxygen... this was when i had to decide on the oxygen mask to use and the litres of oxygen to set it to. The patient was hypotensive, so I set up a drip for a fluid challenge. It's pretty hard to do a GCS or AVPU on a dummy, so we just spoke about that, and wrapped up the station discussing SBAR.

Station 4: Rest!

Station 5: Respiratory Exam and peak flow 
This was another station i've practised quite a few times, so i went into my routine, finishing off the exam with approximately 2 minutes left to quickly teach the patient how to use the peak flow machine, take 3 readings and assess on the chart whether his peak flow was normal or not. This was probably the best station of the day, as the examiner and patient were both very smiley and encouraging, and actually seemed happy to be there.

Station 6: Fainting patient
Arghhhhhhhhhhh this was another communication skills station i messed up!! I honestly struggle at making differential diagnoses on the spot under pressure; and i really had no idea what the underlying cause was >.<

Station 7: Abdominal examination/ RIF pain / Management
So.. I struggled with what to do with the patient in pain. I've always been taught to not cause the patient any pain, and the actor (very convincingly) had a right inguinal fossa pain and i just didn't know if i was meant to do deep palpation in the area or not...and when it came to management.. all surgery just went out of my head. I muttered what I could make up, and had to move onto my next station.

Station 8: Discharging a patient
This was the only communication skill station that went relatively well. The patient was to be discharged with 4 new medications, and i had to explain the drugs, their side effects, and how to take them to the patient. The  actress was really nice, and as the one minute left buzzer went, the actress guided me into telling her about lifestyle changes she could make, and before the final buzzer went, i slid the Ideas, Concerns and Expectations (ICE) in .

Day 1 of OSCES over... day 2 tomorrow!

Paper 3B: 150 SBAs (and dairy milk chocolate)

"The Barts Touch"

I entered the exam hall and snaked my way from the front of the dark wooden panelled room to the back, and again to the front of the hall as i frantically looked for the desk with my candidate number on. Having the majority of the year seated by this point, my seat stuck out, and i stumbled to it, being greeted with a fun sized chocolate bar on my desk. I thought this must have been left from the student before me (in hindsight, this was stupid, as it's the first day of exams, and the only exam of the day). I then noticed the desk ahead of me had one too, as did the one next to me.... this was the Barts' touch.

It was shortly announced during the normal exam instructions, that we have all been given a chocolate bar to help us through the 3 hour long paper. This was a pretty neat touch! - I love BL.  

Pretty glad they had that chocolate bar ready for us, I was tired as it was, and 50 questions in I was pretty much wanting to sleep there and then. This paper was bad... not the worse I've sat, but not a good paper. I made so many silly errors, and simply had no ideas how to answer some of the questions. I'm not sure i could have revised for and correctly answered the questions i had no clue about, so .. 

Meh. What's done is done, time to revise for the next two days of OSCES!!

Revision: 7 days left!

Revision updated..

Cardio

Resp

GI

Surgery

Renal 

Endocrine 

CSP 1,2,3 

PH 

OSCE stuff 

I'm a little optimistic striking through the list of things that need to be revised, as technically i still have 2 lectures before i finish off endocrine; but as it's crazy o'clock and i should go to bed soon, i'll just pretend it's done for today ^^

Revision appears to be going rather briskly, but sadly it's going in as quick as it's going out. I can hardly recall any GI medicine, let alone cardio and resp. This worries me a tad.. OKAY truthfully, it worries me a lot.

As soon as i learn one set of guidelines, i will remember it for a week and recite exact figures and doses, but give it a few more days and I can hardly recall it at all. I have exactly a week now, to some how re-cram everything back in, practice OSCEs on my friends, and hope whatever i learn from CSP and PH manages to stick.

On a side note, 4th Year firm allocations are out! - Just a single out firm next year for care of the elderly, otherwise i'm pretty much based in London. I foresee many posts complaining about my journey to and from firms, but before that, i need to pass these exams and make it into 4th year!

Back i go to finishing the 2 breast lectures.. or i could go sleep.. hmmmm....

Revision: 15 Days to go

So revision looks a little bit like this at the moment..

Revision:

Cardio

Resp

GI

Surgery

Renal 

Endocrine 

CSP 1,2,3 

PH 

OSCE stuff 

Still have Met3b topics to cover, and a big chunk of CSP and Public health lectures to go.. i'm really not looking forward to revising the latter 2..

Something to look forward to though, is if the timetable is correct, i should be finding out my 4th year allocations tomorrow :) I know I shouldn't get ahead of myself and start getting too excited about 4th year, especially when i still have to sit and pass the 3rd year exams first.. but i can't help but feel a little excited about things.

1 Week left on my out firm
15 Days till Exam week

Revision: 21 days left

That's it. I received my last ICA result of the year today, and now given the all clear to sit the final exams... it's all revision, sleep, revision and cram till its all over and it's summer again.

I don't know how or when it got to this point, but there's only 21 days left until i sit my first end of Y3 exam!

I sort of knew they were coming, but with my last SSC essay and ICA to worry about, it didn't really dawn on me so much.

Revision:

Cardio [X]

Resp [  ]

GI [  ]

Surgery [  ]

Renal [  ]

Endocrine [  ]

CSP 1,2,3 [  ]

PH [  ]

OSCE stuff [  ]

............. okay .. so i've only just done cardio... and a bit of resp.. i need to start this cram!!! 

CCS week 2 + MET3a ICA

I struck a deal with D, if he allows me to insert a nasogastric tube into him, i would let him do the same after. We shook on it. 

So under the supervision of the teaching staff, i had a quick practice on the dummy with the self/water- lubricating NG tube, and as expected with a plastic dummy, it went straight in without any resistance whatsoever (Hoping for the same luck, if this comes up as an OSCE station!). 

However, i'm pretty sure both D and I knew it wasn't going to be quite the same when it came to our nostrils being penetrated. 

So firstly, i had to drape the tube from his nose to his ear, and then down to his xiphisternum, okay, so approximately 55cm; that's how far the tube has to travel in. I gave him a glass of water to hold, dipped the end of the NG tube with ky jelly for lubrication, and asked him which nostril he preferred, and off we went! I probably got around 5cm in before i hit my first bit of resistance, i was instructed to turn the tube 180 degrees and keep pushing... it was just stuck, and i started to feel bad as D's eyes started to well up (it's pretty normal, around the room i don't think i saw a single student with a NG tube in, without tears rolling down the same side of the face!.. but still.. i felt bad!!). It sort of eventually gave way, and i asked D to keep sipping water, and once it got past the second bit of resistance, it was just like the dummy, slipping straight down until i hit the 55cm mark. Yep, almost there. 

Last bit, was just to take the syringe and aspirate some stomach contents and test the pH on a bit of litmus paper just to make sure it was in the stomach and not the lungs. 

Now my turn. Okay, so it was pretty much the same thing, just i was a little more self concious as i just had a tuna salad for lunch, and was a bit worried he'd syringe out a bit of that onto the tray (!!) It really wasn't too bad, definitely not pleasant though as it stings a LOT when it goes through the nasal cavity, (and the tears... you really have no control over it!!) but once it's into the back of the throat, it no longer stings, perhaps a little more uncomfortable than anything. 

.... and no tuna salad was aspirated. 

So that was probably the highlight of CCS week 2, and at the end of which i had a weekend of cramming, followed by Met3a ICA on monday!

So now having sat all 3 ICAs of the year, personally i think i would rank it as: 

CR --> Met3a --> Met3b in order of difficulty. Not...that is matters, as I still have to revise all 3 for finals >.<

Now onto my Vascular surgical firm, revision for finals, and looking forward to my summer vacation!

Oncology Week, back in London + ICA cram

This week was basically a whirlwind tour of Oncology, ending with a visit to the local hospice.

I'm not too sure how or where oncology really fits into the 3rd year curriculum, and the oncology FY1 thought it may have been better placed in 5th year "when you've seen a bit more of everything". I think i have to agree with him here. A lot of the patients were quite ill, with multiple problems over multiple systems, which i had very little knowledge of, that and i don't think i was quite prepared for the palliative care side of things.

I found it quite difficult to understand why certain drugs were stopped, or why certain consultants believed a certain way of dying for the patient would have been a "better death". I know there must be a reason behind it, but i wish i had some insight into it too, i guess these things come with experience.

Oncology week aside, i'm finally back in London for a 2nd week of CCS (clinical and communication skills), and i've heard some pretty good things for this week, including putting NG tubes into each other.

Only 10 days left till my last ICA of the year, time to start the cram!
... well.. actually.. thinking about it....there's only 44 days until the end of year FINALS!

.. YEP I REALLY NEED TO START THE CRAM!

Patient: "A Normal Poo"

I have to admit, i use to find talking to patients about their bowel movements quite difficult, as i guess, i was embarrassed, or i felt it was slightly too personal and worried the patients would feel uncomfortable to discuss it  with me (I have yet to overcome this difficulty when asking patients about sex). However, it turns out, that i didn't really have to worry at all.

All the patients i've clerked so far, have been more than happy to tell me all about their bowel movements, from colour, smell and consistency, to if there are bits in it. Though, one memorable moment, is from a very fit elderly lady, who upon us entering her side room on an early ward round, jumped out of her bed, held my FY1 by her shoulders, and exclaimed that this morning she did a "NORMAL poo". She was so excited and happy, it actually made me smile and be really happy for her.

I didn't quite know what was going on, but i knew after the ward round i had to go back and clerk her. She seemed so happy, i guess i just wanted to find out what had happened to her before.

She very kindly let me interview and examine her, and i found out that she unfortunately has been having constant diarrhoea for 6 months now, sometimes going to the bathroom up to 16 times a day, and have awoken many times in the morning in soiled sheets. I can only imagine how difficult this must be. However, since admission she has had a colonoscopy with a biopsy taken and steroids started, and after a week of starting her on steroids she passed what she described as her first NORMAL solid movement in months.

Her joy was infectious.

Gastroenterology Firm

So i got things a little mixed up.

It turns out i wasn't going to start Met3a with colorectal and vascular surgery, but instead i was going to experience 4 weeks of Gastroenterology, 1 Week of Oncology and finally 4 Weeks of Surgery (just before the end of year exams) to finish the year.

Having been on an out-firm before, this wasn't too bad, i SERIOUSLY over-packed the first time i had to move out (who seriously thinks they need to bring 3 extra loo rolls for the first week ¬.¬ ... it was me). I settled in pretty quickly, and before i knew it, i sat through the introduction talks, met my FY1, was on daily ward rounds, went to clinics, watched endoscopy and colonoscopy on Wednesdays, and ERCP on Fridays.

All in all, Gastro. has been quite an action packed firm, and it's already been 3 weeks of it! Not quite sure where the time has all gone!

Surgical Firm Next.. feeling queasy

The idea of observing and learning is great, i love seeing medicine in action, and i've enjoyed watching open cardiothoracic and vascular surgery in the past... but there is something about GI surgery which makes me feel rather uncomfortable.

I'm not sure what it is exactly... but i sort of cringed a little every now and then when the lecturer showed clips of his procedures, but more so specifically a procedure using SILS! It's where a single port of entry to the abdomen was achieved by inserting a bit of equipment in.. via the "belly button". It's amazing how much can be done through the belly button, and you're left without a new scar, but i can't help but feel a little queasy when seeing it performed.

Now, just one more week of Easter break left before I'm out on my last out firm to see this being done in person...but before that i...

Watched a similar clip on youtube.. and yep.. still makes me feel a little queasy!

Photos from the new hospital

On a more cheerful note from the last post, where i sort of just moaned about being tired.. here are a few photos taken from the new hospital. I couldn't resist being in Whitechapel and not venturing up to admire the view from the hospital.

2 Weeks of teaching to follow... can't wait to be lazy!!

Post CR ICA Burn Out

As soon as i manage to find myself a seat on the train i will fall asleep, i struggled with my eyelids driving 10 minutes to my boyfriend's, and now the only thing i look forward to when i get home in the evening is a cup of tea and sitting in front of the telly. Couple this with having a headache for the 4th day in a row now.. Thank god my in firm and the ICA are over!!

From this firm, i've really learnt that "in firms" are really difficult for me! The long daily (hour plus journeys each way) travels into the East end of London is INCREDIBLY draining; and after 9 weeks of early starts and late finishes, and with the CardioResp ICA chucked in, i am absolutely drained!!

Roll on the 2 weeks of lectures... CSP and Met3a (Gastro. and Vascular Surgery teaching)! For once, i actually look forward to just sitting down in a lecture theatre for 2 weeks, Easter, and finally back out of London for my out firm to finish the year!

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CR ICA Exam:

So yesterday i sat my CR ICA, which wasn't as bad as i thought it could have been. I started the paper pretty badly, being thrown off with the first two questions which seemed so simple, but had me confused for quite a while. Things got better as i progressed through the paper, with a few obvious ECGs thrown in and a blood gas analysis at the end of the paper.

I've had a pretty tough time getting my head around ECGs, i think i've made a little progress, but have to admit, unless the pathology is pretty clear, i would probably miss it! Luckily the ECGs in the ICA had a clear 3rd degree heart block, and my favourite.. irregularly irregular rate... it's Atrial Fibrillation!

"Am i there yet?" // "The man with the ticking chest"

I was chatting to my friend the other day about how quickly the current firm has gone, in fact there's only 2 weeks until my next ICA (!!), it was then we had a think about August 2014.

Aug 2014, that's the projected month and year i'll start as a FY1, that is .. if everything goes to plan. Then taking Sept 2009 as my starting date at BL, we're 2.5 Years in, just about half way there! WOW time really had just gone by so quickly!!

Now...that's enough day dreaming..and now back to reality...

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The man with the ticking chest

So today was my last trip to the GP practice for my medsoc placement. The GP had organised for us to take a history and examine a cardio patient.

At first glance, it was pretty hard to miss his mid sternotomy scar, it looked a bit red and i'm not sure if he was trying to hint it out to us, but he was itching it quite a bit! So starting at the end of the bed, i rolled into the normal routine, looking for paraphenalia, seeing if the patient was well or unwell, and when i rolled his trousers up from the bottom, i tested for pitting oedema (it was present), and i was off on the hunt for where they've taken out the vein for a bypass graft.... and i couldn't find it.

I admitted to not being able to find it, and then moved on to the rest of the chest examination.. which seemed pretty normal to me......

This was when the GP told me to have a listen. I didn't really know what for exactly, she clearly didn't mean with a stethoscope. She turned the mumbling heater off, and got us to be quiet.. and there it was! A clicking sound, almost like the sound from the clock in a quiet room! I had completely missed it! His midsternotomy scar wasn't for a bypass graft, but for a mechanical aortic valve replacement!!

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Cardio-Respiratory ICA in 2 weeks time!

Cram was meant to start today...

but... i went over to D's for dinner tonight, and after a lot of curry.. i fell into a food coma... !!

.... CRAM STARTS TOMORROW!

Consultant: "yep, i agree with everything she said"

Had that awesome feeling, when the consultant agrees with you!

Earlier this week, i attended an Asthma clinic, where i was instructed to clerk patients before the consultant got to see them, and then present the patients to him at the clinic.

The consultant took me to a spare consultation room, and gave me a patient at a time. I managed to clerk 3 patients that afternoon, with full abdomen, respiratory and cardiovascular examinations, and a rare chance to actually take their blood pressures manually (on the wards... i'm a tad lazy, and i just take it off their observation charts, but in the clinic they didn't even have the electrical one so it had to be manual..that and the consultant made it pretty clear he wanted me to take all the blood pressures manually) - this was really good practice!

I'm a bit insecure when it comes to clinical signs, i guess it comes down to not having very much experience and confidence. It sounds silly, but i can sound so confident when i present a patient, but secretly be so insecure and unsure of what i'm saying or doing.

".........Mrs X has bi-basel coarse end inspiratory crackles ...........everything else was unremarkable"

Consultant gives me a look of "oh really?" - "I better have a listen too", and gets the patient to sit up on the examination bed. After the consultant wizzes through the examinations (how do they do it so quickly?!) he take his stethoscope off, gestures towards me and says : "yep, i agree with everything she said"

i can't explain the feeling itself, but it's pretty awesome when you do a clinical examination and someone agrees with your findings!!

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WARNING: Moaning about resp. firm coming up
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Respiratory medicine has been pretty relaxed.

We don't have much teaching, there's 15 of us here (!!) and there's simply too many of us to have many group activities. I think it's called a MEGA firm, - that's what i've been told.. im not sure if that's an official name for such a big firm, or if it's what the students call it...but meh!

So respiratory is a crazy game of following the timetable, and you only get to experience everything once, i.e TB clinic once (mine got cancelled), CF clinic once (mine also got cancelled), and making sure you turn up to tutor teaching and X-ray teaching (yep both of mine also got cancelled).

Week one.. was pretty bad. I commuted to hospital, and my morning session was cancelled, stayed till 1.30pm, then find out my afternoon clinic was cancelled too. So i just clerked away on the wards and went to watch bronchoscopy... and that's sort of how i managed to get through week 1. Week 2 thankfully has been a bit better!

Bronchoscopy again today! (looking forward to it)

EDIT: DAMN it.... after posting this.. i went in to hospital... and lo and behold bronchoscopy was cancelled today! >.<

Bronchoscopy Part One: 2 patients presenting with haemoptysis

RESP FIRM
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Yesterday morning I stumbled into the hospital with my ward partner, located the bronchoscopy room, and then proceeded to resist the urge to fall asleep whilst waiting outside for the doctor to arrive.

The GP (for my gp placement), and the 5th years at the hospital have been warning me with their experiences of watching bronchoscopy, but being the ever so slightly odd medical student... i was really looking forward to finding out what the fuss was all about! To be honest.. it really wasn't that bad, mucus doesn't really phase me, if anything, i found the scared and distressed patient more uncomfortable to watch than anything else.

Patient 1:

The first patient was terrified, and had been referred for the procedure, having recently been coughing up blood.

This was her 4th Bronchoscopy procedure attempt, having failed to complete the bronchoscopy 3 times previously. The last time, she struggled and yanked the broncoscope out herself, mid procedure. However, she was willing to give it one more go, "i've had enough", starting to get slightly tearful as she propped herself onto the bed.

We popped apron, mask and gloves on, and in a flash the Dr had popped the cannula into the patient's hand, and administered the sedatives. However, although sedated, the patient was still quite distressed, she wanted to carry on, but was struggling to stay calm as the bronchoscope meandered its way through the conducting airways. I felt terrible, as the Dr asked the other student and myself to hold the patient's hands, and keep her calm and still, when she was clearly quite distressed. However, the patient's bravery got her through the procedure, and finally on her 4th attempt, they managed to have a good look, and take samples for testing. The patient was simply relieved to finally having it done, and not needing to go in again.

Patient 2

A very similar presenting story as patient 1, but this lady was very different! She was calm, almost a complete 180 of the previous patient; smiling, relaxed and just wanted to get the investigation over and done with.

This was a slightly more complicated procedure, as the Dr had to take biopsies from the lung, and whilst this sounds incredibly stupid, i honestly had no clue how they managed to do that, until i finally saw it being performed! A very very thin wire with a "clamp" at the end is inserted in a separate tunnel attached to the bronchoscope, and comes out the other end adjacent to the camera. The assisting nurse then opens the clamp as the Dr positions it, and closes the clamp upon the Dr's instruction, grabbing onto a bit of the bronchiole, before a sharp yank is applied to remove the specimen. This was almost always followed with some bleeding, but that's a common side effect of bronchoscopy.

Goodbye Cardiology Firm

So that was my cardiology firm over, and my respiratory firm starts on Tuesday!

(no no.. i don't have Monday off, it's just GP placement day... NOTE TO SELF: bring a sandwich)

I think being in London, the ward was always hectic, and i managed to see a lot of different pathologies, and had the opportunity to take several pain histories from patients presenting with myocardial infarctions, or an acute coronary syndrome of sort.

This was great for learning how to take a pain history!! However, in the past 4 weeks, i've not taken a single blood or done a single cannula, and not had an observed cardiology exam done, simply because the doctors are too busy, and there's simply too many of us on the ward... there's:

6 x 3rd years

2 x 5th years

2 x work experience students

... and by the time the 5th week had come round, only 4 students got observed doing a cardiovascular exam on one of the bedside teaching sessions.

I wouldn't say i'm dissapointed at all, because being in London, i knew the doctor's had a busy job to do, and in terms of learning pathology and history taking wise..this has been great!!

Simply put... you get out as much as you put in, and to be honest with myself, i've turned incredibly lazy since coming back to London.. hopefully respiratory firm will be more hands on ^^

To end the firm we had a mini quiz (good bit of emq practice) and that was it... good bye Cardiology....

Hello Respiratory medicine!

Microwave

This post isn't very interesting.. its basically about how i managed to get my chilli con carne microwaved!!

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Medsoc this term has been quite uneventful.

On my last GP placement, i would interview all the patients coming in to the Dr's clinic, and do quite a few random jobs and examinations... but at the current GP placement i've only seen 2 patients in the 2 visits, examined them both, and didn't get to take a history from either patient...Instead i've been instructed to prepare a 30minute odd presentation on a different topic each time....

GP placements can be so hit and miss!

That aside, this post is titled microwave, simply because my gp placement lacks one. Last week, the snow was still pretty thick, and being a bunch of 4 rather goofy medical students, we all thought it would be a good idea to go out to the town centre and buy microwave meals so we can have a warm lunch that day. It was a mission to make it back out to town (technically my gp placement falls under Essex, and it's pretty green .. and empty out where i;ve been placed!) but alas, we managed to brave it out and back without slipping and breaking any bones..to find that the practice has a dishwasher, and an instant hot water boiler thingy-mabob attached to the wall, but no microwave!

1 student gave up and settled for cafeteria food, but the 3 of us still hungry, and not willing to settle for sandwiches... we walked to hospital next to the practice, and asked the receptionist if there was anyway we could possibly borrow a microwave!

We were directed to the sister's office in outpatients. I knocked on the door politely, and asked the sister if there was anyway, we could please please please use the microwave in the staff room so we could eat our lunches... and she said yes.. on one condition.. "it better not be really strong smelling food like curries and stuff.. what do you guys have?"

1 x prawn biriyani

1 x chicken korma and rice

1 x chilli con carne

............................... she let us use it anyway.... and we were fed!

...............and that's probably the best bit of my new gp placement so far.

Cardiac Surgery: Triple bypass

Last Friday i had one of those moments where i honestly felt truly privileged to be a medical student, as i was given the opportunity to stoop over the operating table and watch a triple bypass being performed.

I've clerked so many patients with CABGs (Coronary artery bypass grafts) and valve replacements before, but i never really thought about the process of having it done, and seeing the sternum cut down the middle with a saw, the ribs retracted backwards, and the heart pumping in the surgeons hands... I'm definitely going to appreciate what goes into a CABG!!

Whilst Mr S. (the consultant) and his registrars were dealing with isolating the LIMA and the heart itself, others were at the legs isolating the veins. This was one of those "team work moments", and what was 5 hours standing at the head of the patient, felt more like 2 hours. I was just so fascinated by how resilient the body was.

I'm not sure when i started thinking this, but i always thought the heart and the lungs were quite delicate, but this was obviously not so true, as the doctor brushed things aside, and rotated the heart in his hands, sticking bits of "towels" (i have no clue what the technical name would be) around the heart to get it into the right position and to clear up whatever blood spilled over.

The surgery had no complications and as fresh i was coming into the theatre in the morning, i left that afternoon with a new appreciation for CABGs. The next time i come across a patient with a CABG, i will definitely think about the pain the patient must have gone through post-surgery.

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Only 1.5 weeks left on my Cardiology firm! - and i feel like i havn't learnt enough cardiology yet!!

Viva, SBAs and some pharmacology end of firm exam next thursday...

and i have no idea how to revise for it.. i don't even think i can... meh.

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Random fact.. but i've heard on the rumour mill, that dissection is now going to be made a core component of the medical course at Barts! I'm JEALOUS! Why are they only implementing this the year after i finish my pre-clinical medicine :(

ECGs and the Cath lab.

ECGs remain hard and still manages without fail to send me into a sinus tachycardia when i get them passed onto me on the ward rounds (!!)

When a doctor picks up the patient's folder, and start clicking the binder open... i know the ECG is on its way !!..and is shortly followed with a: "So... medical students.. what do you think this is?"

I planned to have an ECG cram day today and have myself read ECG made easy.. but alas.. that didn't happen...tomorrow it is!!! - eeks.. i know i really shouldn't leave it too late.. as i only have 4 weeks of cardiology left.... and a viva exam at the end of the firm > . < (i have a feeling..they will slip an ecg in there!)

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Cath lab - Yesterday i had the opportunity to sit in the Cath lab and observe a few angiograms and angioplasty being performed..which were pretty cool. The last time i sat in a Cath lab was when i was 17 for a spot of work experience... that was ages ago!

I sort of wish i started bugging the registrar a bit earlier.. as the other 2 medical students and myself just stood there looking at the screen and trying to work out which coronary artery was which, and if there was any narrowing among ourselves. We didn't really get much teaching until i started asking him questions.. it's really important to be pro-active on these firms... as if you don't ask... you sometimes just don't really learn anything from just being there.

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4 more weeks of Cardio left.....

CCS & CardioRespiratory 3

After a short 2 week winter break, which basically involved me gaining 2kg of Christmas and New Years weight... we started the year bright and early (3rd Jan!!) with Cardiorespiratory (CR) teaching!

- this was extremely intense! perhaps the toughest week i've had in terms of the amount of lectures we had to sit through since starting medical school. It was spread out over 5 days, with 33 lectures to be covered... 4 of which was done over that week.. and the last one .. i have tomorrow.

The amount of lectures wasn't the hard bit, but more to do with the content.....

...this is where i admit.. i HATE ECGs! I find them so difficult, and i get a tad depressed when people around me are shouting out "It's a right bundle branch block", "Supraventricular blah blah" .... when im still looking at the rhythm strip bit to work out the rate > .< ...*sigh*...this will take a lot of practice! The picture below depicts it will:

Sadly...time is limited.. as i'm let loose on my Cardio firm this Tuesday!

Last week we also had CCS and i fail to remember what it stands for.. but i think its clinical and communication skills - possibly? This had a good mix of communication skills practice with interpreters and difficult racist patients, but also a bit of clinical skills (my favourite part)!

We worked on these simulation manikin sort of things.. i can't really describe it.. i wish i took a photo, but they were essentially manikins, wired up to a computer.. you can take vital signs like it's pulse and breathing rate, a blood pressure, sats and even do an ABG, and then administer o2 etc and access the patient's response. It was pretty cool actually!!