Anaesthetics placement

ITU REG: Tofu, what's the difference between A&E and ITU?

TOFU: Well, it's a lot calmer in ITU, i mean, a lot of the patients are intubated and asleep...

ITU REG: Quite right! The difference between A&E and ITU, is that in A&E they do very non specialist things in a busy environment, and in ITU we do highly specialised things in a controlled environment

Whilst I find it a bit cringe worthy when someone in one speciality makes a comment about another, but I suppose he has a point about the environment. 

My 3 weeks in Anaesthetics went by quicker than I imagined, and I was surprised by how enjoyable it was! Probably a tad unfair, but I didn't expect much from my anaesthetics placement, and did expect it to be pretty sleep inducing ..ha!

The placement itself was probably the most well organised placement i've had to date, with a week tagging along to anything I want in the realm of anaesthetics (on call, O&G, pain clinics etc), a week of surgery (i went to a different one every day), and a week jumping between HDU & ITU.

I know this really shouldn't be a bonus point... but this placement got a lot of the bane of my life logbook ticked off too, so that has to count as a bonus! 

Oh, and that time i asked if i could do a chin lift, and the anaesthetist casually passes me the LMA mask and asks me to insert it into the patient whilst i'm there by the head was pretty decent too. I was pretty worried at first, seeing that i've never done it on a person before, but in his words "just shove it in, don't worry". 

So that was anaesthetics... it's 3 weeks of Vascular surgery when I'm back after the new year... !

The worst thing about having a part time job as a tutor...

... is having to revise GCSE Physics on a Saturday morning!

EURGH!!!

I'm not sure what's worse... revising physics so i can teach it later this afternoon; or spending another hour or two doing SJT practice questions.

6 days till SJT exam.. can't wait to have it out the way! I'm so fed up of doing questions and ranting about the stupid explanations given which seem to contradict every other question justification before it.

Getting busy

Final year is starting to really pick up, and I don't feel anywhere near ready yet... !

There's many a time this academic year to date, where i've actually felt completely stomped. You know where you feel like you should know the answer, but the words escape your mind... well yeah, that's happening a LOT at the moment!! 

It's good I realise how little of general medicine I remember, as "THE FEAR" is growing and that helps kick me into study mode...

Finals are in approximately 4 Months time!

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

So since my last post, I've been busy with my SSC in ophthalmology, followed by 3 weeks picking up skills on how to be a FY1 on the respiratory ward (part of my general medicine firm), and now i'm approaching the last week of my emergency medicine placement. 

Going to keep this short.. so in summary/highlights:

SSC:

Brilliant placement! I don't really want to say i know exactly what I want to do in the future just yet, but this is high on the list. Electives in ophthalmology? - definitely!

General medicine:  

I realised i don't know enough (!!), but on the plus side - I've done a lot of practical things, and i'm definitely growing more confident with doing ABGs, cannulas and bloods now. 

Got to know the nurses really well, and I had a few goes at setting up IV drugs, and giving nebulisers to patients (it sounds more complicated than it does, you just twist it open and pour it into the compartment in the mask, wack on the air, and hey presto!)

Emergency medicine: 

Got to put my first dislocated shoulder back in place! 

Reg: Tofu, have you ever done this before?

Me: no..  but I don't mind helping you out

Reg: Okay, in which case, Tofu you're going to do it

Me: erm... okay!

-- he gave me a quick tutorial outside the patient's cubicle, and we went in together and did it. I was surprised with how much strength i had to pull the arm with.. and how quickly it went back in place. 

Oh... and I managed to dodge the spit of a confused (or she really didn't like me) 80+ year old lady with a UTI in the emergency department. I was trying to do a CNS examination on her, and for a moment she held onto my hand. I thought this was simply her wanting my attention, but before i knew it, her lips formed together and they parted with spit coming in my direction. This sounds odd, but thankfully her mouth was rather dry and it didn't have much acceleration... I managed to wiggle my hand out from hers and escape before her 4th attempt at spitting at me. 

Trauma calls = be the scribe = i don't know where i'm meant to be filling in the information!

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

AFP interview in 11 days time! I stupidly left it late to select my interview date, and all the later dates have already been filled, so i'm going to have to prepare as much as i can in the short time i have! 

First Week of Final Year

That's 1 week done, and 43 more to go!

I didn't feel ready to walk into the Perrin lecture theatre on Monday. It's both quite scary, and exciting knowing that it's hopefully my last ever "first day back" to uni of my medical school life.

I woke up early (with the help of 3 alarm clocks - this doesn't seem to change), wasted time with my morning routine, and got myself to uni. Signed in, collected a huge pack of forms and a surprisingly small log book, and sat myself down for what was to be the typical boring week of introduction lectures.

I don't really have much to talk about, other than feeling pretty happy with all the "freebies" i managed to collect during the week (can't go wrong with a few pens, highlighters and books!).

Random fun of the week would probably be the "Class of 2014" photo - with the bleachers erected on Tuesday, (with no effort made by myself) we had the class photo taken, and ready to be collected for if when we get through the year.

Not exactly a negative, as i suppose it's pretty good that our medical school is preparing us for the national prescribing exam, but an exam at the end of the first week back?! Arghhhhhhh!

.............and that's it! Final year is finally up and running!

Just before i start final year...

So last September, at the very start of 4th year, i decided to have a guess at which modules I would enjoy and which I would probably hate.

This is how it looked...

Obstetrics and Gynaecology - Like (Really tiring, but a lot of fun!)

Paediatrics - Like (correct...ish)

Neurology - Like (wrong! I thought i would enjoy this..but.. nope!)

Psychiatry - Like (THIS WAS NOT FOR ME)

Opthalmology - Dislike (Loved it!)
Orthopaedics - Dislike (it was okay)

Rheumatology - Dislike (again, really enjoyed it!)

Care of the Elderly - Like (it was okay..) 

Dermatology - Dislike (this was actually quite interesting, but i wouldn't want anymore of it)

GP - Dislike (it was.. okay)

So i was pretty off with my guesses !!

First day of final year tomorrow... let's hope i fall asleep quickly!

Year 4 Results: 4/5th of a doctor ^^

This post is er... VERY late. I was half tempted to wait until mid September for all the results to be released before posting (Uni had a problem with one of the exams, meaning a few people unfortunately have to resit the paper due to techinical difficulties.. meaning we only get the percentages and such now, but no idea on merits etc until later), but ... with reality hitting hard.. and my first day of final year tomorrow, meh.. im getting this routine post out the way!!

I do find it a bit weird posting grades on here, but i've done it in my first year, and so in second year i followed suit.. and third year.. well i kept the format for the last two years.. and now forth year.. well ... well ... i guess it's for completion. So here goes:

Paper A - 76%
Paper B - 81%
Paper C - 64%
Paper D - 61%
Paper E - 80%

Eeks, not quite sure what happened with Paper D, i personally thought it went well.. but it goes to show.. i really need to start practising them communication skills before i hit my OSCE exams for final year!

Glad to finally be a finalist! ^^ 

Part 4D: OSCEs

Okay, so its 5:48am in the morning, and the fact that the results are out in 9 hours (!!) have nothing to do with why i'm still awake at this hour.

I blame the stupid painkillers i took before bed for my headache, the combination tablets where you get your dose of paracetamol with added caffeine. Having detoxed from the brown stuff for 4 weeks, this little dose has kept me awake through the evening.. and reluctantly i have given in to my insomnia, and now have resorted to writing down what i remember from my OSCEs.

This is going to be a pretty long post, seeing as i've left it a little late after my OSCEs to give a day by day recall, so i will just go all out and post about them both in one sitting. Prepare yourself for a very long and possibly quite boring read.




================================================

Monday - 4Di: 10 minute stations 

As i walked into the examination room, i gathered instantly that this was going to be a pretty intensive communication skills OSCE day, with 4 sets of actors and only one examination station behind a dividing screen (i could just about make out a bed behind the screen).

Station 1: Psychotic patient 

So this was a rather tough station. The fact that the patient seemed to have only one symptom and pretty much denied having anything else, made it really difficult to lead one question onto the other. Perhaps i didn't ask the correct questions to get the history out of him, but as the buzzer sounded for 1 minute remaining the examiner turns to me and asks me what sort of delusion i thought the actor had. Well, it wasn't a difficult decision for me to make, seeing as I could only identify the one thing!! - i went for persecutory delusions. 

Station 2: Explaining Citalopram

It was heavily hinted out to us that SSRI prescribing is a hot topic to revise for during the revision sessions, and having actually done a lot of reading and practice, i was pretty relieved when it came up! The actress playing the patient was also very easy to please! She had no questions and literally wanted me to tell her EVERYTHING, and so i just blabbed on about how to take it, when to take it, how long she will have to take it for, all the very obvious things, and checking now and then she understood everything and didn't have any questions. Again the 1 minute buzzer sounded, and out of nowhere she suddenly has a question for me. A common theme was emerging, Buzzer = question time! 

Station 3: Rest station

Headphones on, sipped 3 glasses of water, and sat on the chair waiting for time to pass. 

Station 4: Collateral Paeds History 

This was pretty much taking a general paeds history from a mother, and then homing in on the few symptoms that the kid had. The actress had to play a concerned mother, but she seemed rather uninterested, and would smile at me randomly throughout the interview. Again there were only a few symptoms, and the history was a very clear type 1 diabetes picture. As the buzzer went.. well you guessed it.. question time! The examiner then asked me for my diagnosis, and then asked for the compliance issues for children with type 1 diabetes, i listed those i could think of, he smiled and nodded.

Station 5: Suicide History

This was another biggy hinted out at the psych. revision lectures, and well it didn't really have to be hinted out, as it's an OSCE favourite. Knowing this, I should have really nailed this one, but the 10 minutes went by quicker than I expected, and i made this biggest of all fails... i didn't have time to ask the golden question.... "Are you going to commit suicide again". Nope i completely forgot to ask that, and yep, pretty sure i flopped this station.

Station 6: Smear and Bimanual examination 

This was a surprising station, as having spoken to upper years, this has always been a 5 minute station, so when i walked behind the dividers and was faced with a rather odd set up.. i was a little surprised. A woman was lying in bed fully clothed, and a pelvic model was placed approximately 1 metre on from her, and i had to speak to her whilst examining the pelvic model. What perhaps threw me off a little bit more, was the fact that the examiner was my obs and gynae rotation consultant (!!), and i remember how demanding she was. 

Having practised this station as a 5 minute station, and purposely slowing down to fit it into the 10 minute station, i still managed to finish rather early. This time, the examiner asked me a few questions on cervical screening, and that was it. 

Day 1 of osces over! 

================================================

Wednesday - 4Dii: 5 minute stations 

So thankfully i had the whole of Tuesday to revise for these exams - last exam of the year... i couldn't wait to finish!

Station 1: Explaining spacer technique

This was a simple station, explaining how to use a spacer to the examiner, and demonstrating it on a plastic paeds model, followed by questions on acute asthma management. 

Station 2: Knee examination

Another pretty straight forward examination, where I was told not to do a few tests and instead had to describe them, and give specific names to the tests i was allowed to do. The station ended pretty quickly, as all the cruciate ligament tests were no to be performed, and I couldn't quite remember the name for one test i did perform. I finished the station with what sort of investigations i would do, and stood there in silence waiting for the buzzer signalling us to move on to the next station. Luckily however, at the end with time remaining, the name of the test popped into my head, and i asked the examiner if i could still tell her, she nodded, i named it, and i saw her give me the tick on the mark sheet. Another good station. 

Station 3: CNS examination

Again, another straight forward station, where i had to perform a CNS exam. I haven't read back on my pass years OSCE exams, but i'm pretty sure ive had this at least twice before! It's an OSCE exam favourite! I finished in time, only for me to move on to the next station and realise i had forgotten to check for accommodation reflex. meh. 

Station 4: GALS and Hip examination

I was a little worried about this station. Each year a GALS + joint exam comes up, and well, whilst practising for this OSCE i was struggling to complete the GALS exam in 5 minutes let alone fit in the examination of any joint. However, as soon as i read the candidate instructions, I was very relieved to find out that we didn't actually have to comment at all on what we saw on the exam, so rather than commenting on all the normal muscle bulks, spine curvatures etc, i just made it really obvious i was looking.. and moved on very quickly. 

Station 5: Fundoscopy 

During the preparation for my data interpretation exam, i had looked over all the fundoscopy images at the clinical skills lab, and well, that put me in a pretty good position for this exam. As i peered into the eye, i've seen that image enough times at the labs, and so it was simply a matter of describing it. 

Station 6: SBAR - ruptured ectopic pregnancy

This was a very very very odd station! I was sat in a booth, with 3 bits of paper and a telephone. One piece of paper had the instructions, the other had the patient's history, and the last bit of paper was an ultrasound report. I was given 5 minutes to basically process all the information, call the consultant (she was actually hidden behind a divider), update her on the situation and get her to come down to see the patient. It was more a test of how quickly i could read!! 

Station 7: Large Breech Baby

This was purely a communication station, with a mother who wanted a natural delivery at home, and having to basically tell her about the risks etc. 

Station 8: Down's Syndrome 

This was another communication skills station where i had to explain down's syndrome to a worried mother, who believes her child has been born with down's syndrome. I listed out a few things, gave some supportive advise and gave her an imaginary leaflet on down's syndrome to take away with her, 

Station 9: Upper limb PNS examination 

This was a PNS exam with a slight twist. The patient for this exam had to pretend to have a right sided wrist drop, and the question that followed was - "where is the lesion likely to be?". I went for a mid humeral shaft fracture, and the exam finished with plenty of time to spare.

Station 10: Collateral History - Dementia

I didn't really know what to expect from this station. I asked a few questions, and was rather clueless to where i was meant to be heading with this history. With only 5 minutes to ask questions, i got a very brief history, had the chance to offer the patient a leaflet, and that was it. 

......... and that was the end of Year 4! 

Part 4C: Data Interpretation exam (my last)

Okay, so it wasn't until a few days ago i realised that this was going to be my last ever data interpretation exam (final year exams is purely EMQ/SBA and OSCEs)! It's pretty evident that i'm damn clueless about these exam things... but alas there it goes, my last ever data interpretation exam. 

So after yesterday's exam, my body didn't really know what it wanted to do.

I got home from the EMQ paper feeling utterly exhausted and wanted a good two hour mini-sleep/nap before i soldiered on with revision for the data interp. paper, but i simply just couldn't fall asleep! (i hate when that happens). So instead, half sleepy I started on some revision.. what a bad idea!

With eyelids weighing down, it ended up taking me around 4 hours to do what was very little work! But again by 11 i was too tired, and decided to hit the bed.. and yep... same thing happens! It wasn't because i was nervous or anything, I was too tired to care, and simply wanted to sleep... but every time i opened my eyes to check the time, it was getting later and later, and I wasn't getting any sleep or work done.

Guessing i fell asleep around 1, my body clock wakes me up before my alarm clock at 5am, and feeling refreshed (relatively) i cracked on with some revision, and sat my paper at 11.45am this morning.

The paper was again, fair. Anything in year 4 is game, and judging by the sort of questions that came up... care of the elderly is a perfect excuse for them to chuck in everything (ECGs, CXRs)! - that said this is meant to be the last, and the hardest data interpretation exam of my medical school years.

So with this done, just the OSCEs left to go next week! (Monday and Wednesday)

Going to thoroughly relax tonight (before having to crack on with it again tomorrow), and hope I get a little more sleep!

Part 4B: 170 EMQs/SBAs - 3 Hours

So today was the first day of exams, and what marks just 9 days left of 4th year!

The exam paper was fair.

There was a mix of the usual straight forward questions, a few sketchy ones to mess you up, and then there are the few I mess up myself by putting pen to paper before my brain has actually thought it through.

I'm not very confident with how well i'll do this year. I have really slacked, owing to a few problems going on at home, and generally a lame excuse of not having my boyfriend around, constantly breathing down my back telling me to revise the entire year.

Feeling extremely tired at the moment, and in a way, i'm really glad it will all be over soon.

Don't get me wrong, i love medical school and all, but maybe being at university for 7 years now has really taken its toll.

Data interpretation exam tomorrow - it's a quick nap and straight to revision!

 - oh and rather miffed i wasted a day revising ENT when none of it even came up! Argh!

Not so prepared for 4th year exams

I've never really been to an exam thinking "okay, i am well prepared, and ready to kill the paper!", and this exam is no exception.

There is simply too many possible random things that can pop up (public health.. omg!), and simply put...

the more i learn the more i forget.

I thought my revision was going quite well, ticking off a lot of the topics as i went along; but my brain has failed to store the information, and at this moment in time, I feel as clueless as i was a few weeks ago.

It's nice to think, that after these exams, we'll pass the year and become the finalists (i don't want to jinx things, but this day can't come any sooner!), but before i can even start day dreaming about it... there are these huge exams next week which are pretty darn scary! 

Back to cramming. 

Last ICA at Barts

So yesterday i sat my last ICA of medical school! 

I was a little behind the ball, and didn't quite realise it was going to be the last in course assessment (part of Paper A) of my medical school years... until my friend texted me at 1am in the morning to wish me good luck. I couldn't quite believe it.

That's it; no more in course assessments, and what simply stands between me and my medical school final exams, are these 4th year exams in 2 weeks time.

Quite scary, how quickly time has flown by!

On a positive note, the ICA yesterday turned out pretty well (i hope, it still needs to be marked). I normally blog about how i'm revising for it etc, but this time round I simply didn't have the time as I was so busy reading the material again and again, and making sure I did a lot of emq questions.

So... with only 2 weeks to go, the medical school has organised a few optional revision lectures for us (love the medical school), with a few hours dedicated to each module. I'm not sure i'll be attending all of them, but a few i think are pretty much essential (O&G!!).

So here's hows revision looking so far:

Care of the Elderly
CSP
ENT

Dermatology

Neurology 

Neurosurgery

Obstetrics and Gynaecology

Ophthalmology
Orthopaedics 

Paediatrics

Psychiatry
Rheumatology

Sexual Health and HIV
OSCEs

Whilst i've got a chunk of it striked off, there's a problem of actually remembering it all... !!

Here's 2 weeks of a lot of reading, emq questions practising, and general junk food consuming - hello chubby tofu!

Derma-holiday + revision update

"Derma-holiday" - it's in the name!

The dermatology placement so far has been as described, pretty much holiday-esque. There's just 3 clinics to attend in 2 weeks, and the rest of the time.. well that's all private study or teaching sessions.

That said, dermatology is far from simple. In principle (from the books) it seems pretty straight forward, but when it comes to seeing these skin conditions, unless it's screamingly obvious (Psoriasis - silvery plaques on the extensor surfaces).. then sadly for me, everything pretty much looks the same.

Triple diagnosis

So last week, i was paired up with my friend (T) for the dermatology placement, and amidst a slow paediatrics dermatology clinic, i showed T my nails. I've got these weird dark vertical lines running through a few of them. T whips out his hands and goes "oh, me too, they're just normal i think". We sort of just left it at that.

Today in clinic, on a 2 week referral (i.e. something suspected to be pretty sinister), comes a young lady. After sitting herself in the chair opposite the consultant, she puts her hands on her laps, and indicates to these lines in her nails. The consultant asked us to come closer and have a look, and asked us what we thought of them.

It was exactly what T and I both had! - and before I could even process if it would be a good or bad idea, I stuck my hands out, and said: "oh, i have these too, and always wondered if it was a fungal infection or something".

So in clinic, there's the patient, myself and T all examining and comparing our nails with each other, and the consultant googling images to reassure the 3 of us, that it's simply a normal occurrence.

... being the medical student with a bad case of medical student syndrome, this was a pretty good day - getting a clinic done and a diagnosis all in one morning.

Revision left to cram 

So there's now only 34 days till end of year exams, and just 17 till the ICA!
Here's what's left to be done:

Care of the Elderly
ENT

Dermatology

Neurology 

Neurosurgery

Obstetrics and Gynaecology

Ophthalmology
Orthopaedics 

Paediatrics

Psychiatry
Rheumatology

Sexual Health and HIV

... best make full use of my dermaholiday! REVISION TIMES!

Revision - [27 Days + 44 Days] left

That's 27 days to the last ICA of the year (Rheumatology, Orthopaedics, Dermatology and GP), and just 44 extremely scary days left till the first end of year exams!

Monday 15/07 - Section B (EMQ/SBA)
Tuesday 16/07 - Section C (Data Interpretation)
--------------------------------------------------------
Monday 22/07 to Friday 26/07 - Section D (OSCEs)

--------------------------------------------------------
Thursday 01/08 - Examination Board Meeting
Friday 02/08  - Results Day

Year 4 is meant to be the hardest year, and well, there definitely is a LOT for me to go through before the end of year exams.. here comes the list!

Care of the Elderly
ENT

Dermatology

Neurology 

Neurosurgery

O&G

Ophthalmology
Orthopaedics 

Paediatrics

Psychiatry
Rheumatology

Sexual Health & HIV

................................. and somewhere along the line i swear i had some public health and ethics that i've completely forgotten about...

So yes.. i best get cracking on with my revision! 

Awkward Examination - Orthopaedics Chapter

So I'm currently back in London, on a pretty good Orthopaedics and Rheumatology firm - there's a lot of variety to the clinics available, and the teaching has been pretty good (probably the best i've had on firms)!

In fact each week we get rheumatology teaching, and on Thursdays we get an orthopaedics OSCE themed tutorial, and on Friday we come back to practice on each other.

Our consultant splits the group into boys and girls, and we go off to our side rooms/examination rooms to  practice, and the consultant whizzes in and out between the two groups to watch/teach....

...and as it happens, the consultant comes back into the girl's room as i was examining the spine.

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

Tofu: "ah, okay i think i've finished my exam now"

Consultant: "So tofu, let's say your patient has sciatica, how would you test for it?"

Tofu: "ah! yes i forgot to test for it! well i will get the patient to lay flat, and i will elevate her leg, and i suppose i could press on her perineal region and see if that elicits pain"

Consultant: "her perineal region?"

Tofu: "yes, her perineal region"

Friend playing the patient: *laughs* "umm.. i don't really want you pressing my perineal region"

Consultant: "Tofu, where is the perineal region?"

Tofu: "it's the area behind the knee"

Consultant: "are you sure?"

Tofu: "yes..." 

*AND then it hit me.. nooooooooooooooooooo!*

Tofu: "NOOooooooooooooooooooooooooooooooooooooooo! i mean her popliteal region! the Popliteal region!"

For reference the top image demonstrates the popliteal region, and bottom image shows the perineal region - definitely not part of the spine exam!

Falls Clinic - Why do old people fall?

So the Falls Clinic is meant to be the bread and butter of the module, and as it was put to us by the man in charge, on the very first day.. 

"you can't possibly do a care of the elderly firm without going to a falls clinic!" 

... and so i went

.. as did two other medical students, a physiotherapist, a nurse, the registrar, the consultant, a patient and their relative... 

that's 9 of us all cramped into a tiny clinic room - Cosy! 

I didn't really know what to expect in the clinic, but luckily I did some ECG interpretation revision the night before, and that came in handy! I'm not sure why i didn't really expect it earlier, but every patient that came through the door had their ECGs taken, and the consultant would shove the ECG to us, and ask us what was wrong with it. (i remember dreading ECGs in year 3, but i've noticed that they're not so frightening anymore.. or perhaps i'm not so afraid to be told im wrong)

I soon gathered that there are too many reasons as to why the elderly are likely to fall, and it's a matter of really going through all the possibilities like a detective -- from visual impairment, to parkinsons, arrythmias, or even just their mix of medications. In most cases, it was the latter...

..and this proved another opportunity for the consultant to quiz us. As he took the patient next door to be examined, he would divide the boxes of medication between us and get us each to talk about each medication and their side effects when he got back. Finally he'd ask us what we thought the cause of the fall was for each patient.

These are the sort of clinics i enjoy! Where the consultant get's the students involved and constantly has something for us to work on... and before i knew it, it was over. 

I'm pretty sure i only enjoyed the clinic so much because the consultant was so engaging, but either way, the man was right, experiencing a Falls clinic on a care of the elderly firm is a must! 

Care of the elderly

On the ward round this morning...

Reg: Tofu, what do you notice about his mouth?

Me: Well, i'm pretty sure that's just a blob of dried toothpaste on the corner

Reg: No not that..... *turns to look at the nurse* So how long has he had the facial droop for?

Okay, so turns out, the Reg didn't really care about the blob of white toothpaste, and luckily it wasn't actually a droop, it had always been there. 

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

Ah, it's been a while since i've last blogged! 

Since my last post, I've had 5 weeks of Psychiatry and an ICA in between, and now i'm out in the countryside in the North  ( thanks for pointing that out to me Grumpy) South East of England, with the care of the elderly team. 

In summary, this is pretty much ALL OF YEAR 3 squished into one module, or indeed into a single individual. It's definitely general medicine at its finest.  

Being the "specialities" year, every module this year has been pretty much a different speciality with the same thing week in week out; but COTE makes a really nice change. It's chucking me back into general medicine, and making me realise how much of it I've forgotten. 

I wish i posted a bit more now, i've had a few encounters with really nice patient's and it would have been a nice memory to have kept, and to read back on in the future. I will try! However, until then, there's 9 mini cases I need to get through.... work times! 

6 Years old

I wasn't actually sure my mental arithmetic was correct, and childishly had to whip out my fingers and count to be 100% certain. This blog is 6 today ^^

Back in 2007 i was scribbling my journey through Biochem. at KCL, and now 6 years on, I'm a 4th year at BL, scribbling my way through medical school.

Hopefully next year i'll be scribbling my way to finals! - but for that to happen...let's get on with some revision!

PS - i don't actually drink as much soya milk as i did 6 years ago.....!

Sounding stupid - Ophthalmology Chapter

Consultant: "Tofu, look at these glasses and tell me about the prism, and the direction of his double vision"
*consultant takes the glasses from the patient and passes them over to me*

Me: "okay"
*okay...he probably just wants me to tell him if the patient is short of long sighted*
*takes a look at the pair of glasses*

Me: "i think he is long sighted"

Consultant: "Yes, he is, but tell me about the prism"

Me: "okay"
*okay, damn....that's not what he wanted!
hmmmm he definitely said prism...and as far as i know, a prism is long and triangular shaped with a light shone in one end, and a spectrum of colours beaming out the other.... and these... well... these are definitely just a pair of glasses....*

Tofu's Prism

Me: "well, er.... these are glasses. I'm not sure if they're a prism or not *mumble mumble* ummm, i mean, a prism is triangular and long........ er..er....  Dr... i'm actually not sure what you're asking me"

Consultant: "okay, never mind"
*continues with his consultation*

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

Yep, unfortunately when i had both the patient and the consultant sitting and staring at me, expecting an answer... i did the foolish thing of just saying anything i had in my mind to fill the silence.

Luckily i admitted i didn't have a clue about what he was asking me, and i didn't embarrass myself further by going on about the spectrum of light and all....

As it turns out, almost every other patient turning up to the clinic this afternoon had these prism lenses, which corrected for their double vision, and unfortunately with every question that came firing in my direction, the impression i left with the consultant sort of just went from "she needs to revise" to "how the hell did she get into medical school?".

At one point he blurted out something Latin sounding, and was asking me what it meant. Lucky i didn't start guessing the patient's condition, as it turns out, he was asking me about medical ethics (!!!!!!!!!)!

So yep.. it was a very long afternoon clinic.

I best go and do a bit of reading before i turn up to the remaining clinics.

Consultant's Prism

Neurosurgery Placement

NEUROSURGERY

I LOVED this placement.
- i have never considered surgery as a career, but if i had to do any surgery, this would probably be it.

From my experience so far, as a medical student you don't normally get to feel as part of the surgical team as much as you would if you were doing a medical rotation. This all changed with Neurosurgery.

On my very first day, my reg was on call and we went straight to theatre to put in a VP shunt. This was already quite exciting, as I had literally just done that lecture the night before so it all seemed pretty relevant, but perhaps this was the first time the entire theatre team were so keen to have a student scrub in.

Reg: "Tofu, have you ever scrubbed in before?"
Me: "Well I did in 3rd year.... *mumble mumble*"
Reg: "Okay, get one of the nurses to watch you scrub in and come stand next to the head"
Me: "OKAY!" *tears of joy*

*okay i didn't actually have any tears of joy.. but I was pretty happy with having such an enthusiastic reg.

The head was fixed in place, overlying hair was shaved off, the scalp cut into, and using power tool like instruments, a hole was bored into the skull.

For the very first time i saw the human brain in a living person, it quivers ever so little, almost like a pulsating movement. A long metal shaft was shunted through the neck, over the clavicle and into the abdomen, where one end of the catheter was inserted. Whilst the valved end of the catheter was shoved into the brain and into the ventricles, and you can instantly see the valved area fill up with CSF.

That was my first taste of neurosurgery. I had to come back!

I went back to theatres for my consultant's surgery list, and it was awesome! As soon as i walked in, the nurses remembered me, and already asked if I wanted to scrub in today, i nodded with a big smile.

The list was rather short, but I was lucky to get to see a good mixture of procedures, from spinal surgery and brain tumour biopsy to sub-dural haematoma extraction. Managing to scrub in for every procedure, as the day progressed I got to go from standing by the head, to given the suction, helping with the sutures and stapling up the scalp at the end.

The only down sides from this placement, is that it was only a week long... and that from now onwards, i will never be able to have any grass jelly drink or dessert, without it reminding me of a sub-dural haematoma!

Found this picture online, not sure if it makes me want to eat it anymore.

A difficult few months

It's been a while since i've updated my blog, and it's been a pretty emotional and difficult few months since then.

Back in 2009 my mum had a traumatic fall and fractured her spine, that was fixed with a few screws and plates, and i thought that was the end of that. However, sadly i've learnt over the last few months that it's not quite the end of it. After a year or so of neurological symptoms which has gradually worsened with time, my mum finally had a MRI followed up very quickly by an urgent MRI.

The good news being the mass in her spinal cord doesn't seem to be a malignant mass, and the main differential at this point, is a post-traumatic syrinx. Referred to the neurosurgeons, we're now just waiting to see what's going to be done; but i was told at my mum's appointment, it's almost certain she will need some form of surgery pretty soon.

Seeing my mum's eyes red and close to tears as she sat at her appointment worried that she had cancer really was very difficult, thankfully it's not that. I know it could be a lot worse, and there is always a better way of seeing what could be seen as a bad situation, but it was difficult trying not to worry wondering what it could have been, and what it may mean in the future.

I've found it pretty hard to sleep at night, and that sort of led to not being able to concentrate and i sort of just slept or day dreamed my way through my paediatrics firm, my last ICA and the week of neurology, opthalmology and psychiatry lectures; and i'm worried with how im going to cope with my upcoming firm.

Starting with neurosurgery and neurology in a weeks time is a little difficult for me. I am generally emotionally quite weak. I know i'm probably worrying myself more and predisposing myself to being upset, but I know i will find it hard to see patients in a similar situation to my mum.

At the same time, i think it's making me want to work a lot harder now; and naive as it may sound, i just want to work really hard and be the best i could be, and one day be able to help others, knowing that every patient is important to someone else out there.

With a week to go before uni and my firm starts, i'm going to start with revising year 1 and 2 B&B lectures, and then move on swiftly to cover as many of the 4th year neurology lectures as i can before i start my short 1 week of Neurosurgery, and 2 weeks of Neurology.