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!