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!!

End of term, and a surprise result (yay!!)

Yayeeeeee!!! Finally the long awaited 2 week holiday is about to begin!!

I'm looking forward to hibernating under my duvets, eating lots of festive food, seeing some old friends... and generally just having some time off ^^

CSP week 2 was challenging.. not so much because of the content, but more the freezing cold lecture theatre, and the inability to switch the heating on.. or switch the air conditioning off!!!! Everyone is sat here with coats, scarves, and hats still on.. and I've even had to put my gloves on too! It's so cold in here!!!

But yay! That's the 1st term done and almost dusted, ICA results to follow in January, and to end it all on a high note.. I got some fantastic news this week!!

We had an email sent out to us randomly about an exam board meeting with instructions to check blackboard for rankings, deciles and distinctions..... And I checked my results and was lucky to get a distinction for preclinical medicine ^^ - yay!!!!!!!!!!

(One of the best random emails ever!!)

Now ... Xmas and general relaxation till CR in January!!

Zzzzzzzzzzzzzzz

MET3B End of Firm + ICA exams

Last week was incredibly slow at the hospital.

All the other medical students had already moved back to London, and it was just the 4 of us doing Met3b... and to be honest, at this point i was pretty burnt out from all the late night revision for the exam looming around the corner.

I tried to keep myself busy during the day, and made lots of visits to the EAU. I did the usual thing, and introduced myself to the sister, and asked if i could help them take some bloods and put in a few cannulas... the sister was VERY enthusiastic... but her enthusiasm was more towards telling me to sit in the staff room and eat cake (literally - carrot cake).

From experience, bugging the HCAs are the best way forward...they know all these nifty tricks!! I stayed a few hours every day, took bloods, clerked a few patients and managed to bug a respiratory registrar to let me do my first ABG.

Doing my first ABG - i was instructed to find the pulse with the tips of my index and middle finger, to then lift the index finger and insert the needle in its place. It sounds simple..but the tricky bit here.. was not being able to feel or see the vessel (compared to venepuncture). I was pretty lucky and managed to get the needle in on the first attempt, and instantly got the pulsatile flashback (probably the coolest thing i saw that week)!!!!

BUT i did feel incredibly guilty during the procedure, as the patient was moaning quite a bit and telling me how painful it was whilst the blood was being drawn out. However, we took the sample to the blood gas machine.. and whilst i can be honest here and say i had no idea what i was looking for on the print out.. the registrar said the patient was good to go home.. excellent!

Whilst it was fun, I couldn't wait for the end of the week to come, and when it did.. i got my logbook signed off and swiftly moved back to London for the BIG CRAM!!

Met3B ICA EXAM

I was literally freaking out last weekend, trying to cram every bit of information i could get out of each lecture, forgetting it the next morning and trying to learn it again in the evening.... and my room is currently a dump.

In hindsight (having sat the exam this morning)... i could have probably relaxed a bit.... but more importantly i could have revised for it more efficiently!! i didn't quite believe the transition of the ICA papers from pre-clinical to clinical years... it's VERY DIFFERENT!

We won't hear the results till after we come back in the new year... so for now.. it's one more week of CSP lectures... and then freedom!

End of firm OSCE

I LOVE OSCEs!

I panic, worry, and get so nervous just before it, but once the first 2 stations are done, i start enjoying it and just have fun!

Stations:

Cannulation

Radiography interpretation

ECG interpretation

Cardio exam

Respiratory exam

Thyroid exam

PNS exam of upper limbs

First station: Cannulation

- Okay..this was not expected....i just didn't expect there to be a cannulation station! I walked into the room, and was greeted by a nurse stood next to a plastic arm on the bed, and with a tray of random things right next to it (i think some things were there to confuse us.. or er.. i just didn't know what i was meant to do with it!).

I was given the instructions, and off i went to gather my equipment.... and there was a lot to choose from.. i didn't really think much of it at the time, and just picked up what i knew was "the normal stuff".

I was rather lucky with this station, as i've just cannulated 2 patients recently (one patient just the day before!), so i was feeling confident with it. It was a bit of a weird artificial situation, talking to a plastic arm and gaining consent, but i got on with it.. and finished well within the time limit.

Then came a few questions which were quite straightforward.. "what else would you do now?" "how long can the cannula stay in for?", "why did you choose that cannula size", "what is the flow rate?"

Second station: REST station

- This was definitely a lucky draw, i had an easy first station, and my second station just involved me sitting on a chair, reading magazines in the waiting area... !

Third station: Radiography Interpretation

- Again another station i didn't quite expect. I've never had to do this in an OSCE before! I just walked in, and there was a familiar FY1 sat at the desk and a 5th year medic in the corner who was going to record my answers.

I was faced with a computer screen showing a KUB with contrast compared with one without contrast (calculi in the ureter), then one of a pancreas with several calculi within, and lastly a pretty obvious chest radiograph with a huge pneumoperitoneum. I just had to sit there and talk about each radiograph, and i'm sure they've made the exam easier for us, by choosing pretty obvious abnormalities...because i've had to do the same thing on a ward before and never been able to spot anything!

Fourth station: ECG Interpretation

This was a question paper sort of station. I just went in, sat on a desk, and had a list of questions, a pen, and a blank piece of paper to record my answers on.

Thankfully, there were more questions on management of the patient than anything on the ECG in particular, the questions sort of eased me into it, and gave me clues on what to do.. and following from my last post.. the first ECG and set of questions were for a patient with AF! - okay this wasn't so bad, i had a PBL on AF last year, so the management side of things just came from some 2nd year regurgitation...

But with 2 minutes left.. i was stuck with the 2nd set of questions... with an ECG where i couldn't even identify what was wrong >.< .... this went badly. I could only work out the rate and that was about it......... i later found out it was an ECG of a patient showing a complete heart block.. i wasn't going to get that!

Fifth station: Cardio Exam

Everything was going smoothly, until i got to the murmur. I finished off the exam and when presenting my findings to the examiner (one of my favourite FY1s) i just panicked and got so confused. This wasn't helped by the fact that the bell had gone.. and i had to move on to my next station....

examiner: quick quick, tell me your diagnosis

tofu: err errr... er... its an ejection systolic murmur.... er.. er..

examiner: so what is it? quick quick!

tofu: errr ... *first thing that comes into my head..always a bad idea* mitral stenosis?

examiner: are u sure?

tofu: errrrrr errrrrrr errrrrrrrrrr.... no? i dunno!

examiner: so what would you do?

tofu: an echo!

...and then i had to move on!

mitral stenosis is a diastolic murmur, and from what i gather.. it's pretty uncommon >.

eeks! I know this.. but under pressure, it all goes out of my head :(

Sixth station: Respiratory Exam

This was a relatively straightforward station, the patient had a right sided pleural effusion... BUT i found the exam so so so scary, simply because my FY1 was the one marking me! I just got anxious before i started examining the patient!

Seventh station: Thyroid Exam

I walked into the room, and before the examiner explained the station to me, i was pretty confident that it was going to be a thyroid exam. It was probably the first time i've seen exopthalmos in a patient, other than in a textbook.

This was a pretty good station, and i finished well within the limits, and even had time to discuss the findings with the examiner (FY1 from my ward!), investigations and management with time to spare!

Eighth station: PNS exam of upper limbs

This was the first time i've actually done a complete PNS exam on a patient with signs, with slightly reduced tone in all aspects, slightly reduced power, co-ordination was fine, was able to elicit the supinator reflex, but unable to elicit the bicep and triceps even with augmentation. Sensory was fine (tested DCML and spinothalamic tracts).

I gave a list of differential diagnoses.. and the examiner kept asking for more..this was when i mentioned inclusion body myositis.. and then remembered.. i should never mention anything i don't know a lot about!!! Thankfully i was saved by the bell - and didn't have to look stupid again!

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The OSCE was purely for our learning purposes, and after that OSCE i definitely feel a lot more confident now, and know what i need to work on before i hit the real end of year OSCEs next summer!

One more week left!