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.

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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. 

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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*

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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.