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!