A new path

I never thought I would see the day when the word surgery didn’t make my heart flutter and my face turn into a big grin. Yet, here we are. I’m sitting here looking at the brain light that Henry Marsh signed for me and my heart is breaking to know that I simply don’t want to follow the path that I have loved and dreamt about since I was in six form.

It sounds like someone has told me that going down this career path is simply not possible anymore. However, it has been a revelation through my own reflections and thinking about what I want from my career. I posted a lot about GOSH in the summer and how the director said about making the speciality fit you and not you fit the speciality. However through events that have happened over this year and simply thinking about what I want for my career I realise that it would literally be putting me in a square hole when I’m a round peg..I wouldn’t ever fit in anywhere properly and I would rather have a career where I fit in and where I love my job the entire way through, rather than struggling for upwards of 12 years to get to a point where I’m happy.

I partook in a national audit this year which has been the main source of why I don’t want to pursue the speciality anymore. I am completely new to the research side behind medicine and had managed to set up this entire audit in a week. However the people I was running the local audit for were not happy enough with my progress and we are blaming me for people not replying to emails and for general blockages in this audit.At times it was more stressful than my medical degree and I felt like I was doing wrong when in fact I done everything I could physically do. I also began thinking about the surgical conferences that I’ve been to.Everyone is so professional and seems to want to elbowed people all the way to get to talk to people or to answer questions. I’ve heard of tales of surgeons in London who will virtually backstab other people to climb the career ladder. I know not every surgery is like this but I’m not that type of person. I’m very informal I’m very silly and I don’t take myself seriously at all I’m not very academic and I’m just that little bit quirky.

My mental health has been an extreme problem for me for the past year. The academic stress from the only first year exams but The added pressure of making sure that you were preparing your surgical portfolio from virtually first year of Med school. You feel like you’re never doing enough. The audit, greater exposure to surgery, new interests, complete loss of old ones and of it it’s got to the point where I now have to sit down and think what is more important to me at this stage. Burning myself to the ground but coming out with a amazing portfolio or enjoying med school and pursuing a career path which is become more and more appealing to me.

I still want to go down paediatrics Route, that is never going to change. I still want to one day work at GOSH, and I’ve been thinking about specialties allied to surgery. I like the constant environment the small team and the low patient to staff ratio. This has led me to 2 specialities. Anaesthetics and intensive care.

Every anaesthetist I’ve ever met has been lovely especially the ones at gosh who couldn’t teach me enough. I like the idea of being able to both administer medications and take charge of your patient in surgery but also being called to assist in other areas of the hospital with things like difficult cannulations or airway assistance. Intensive care has also caught my eye because it’s very low patients to staff ratio But provides the mental challenge that I love. 

I don’t feel sad about giving up the pursuit of a dream of which I was so passionate about. I’m happy that for once I’m putting myself first and my needs ahead of my career. Part of me still loves the brain, The anatomy is just amazingly complicated and the physiology baffling. But there’s just something amazing about an organ we still have pretty much no idea how it works. I still enjoy neurosurgery I find aneurysms fascinating and watching them being fixed is just amazing. However I just can’t picture me fixing them anymore.

So I guess that’s a big revelation from last term, then do you know what, I am so much more happier for it.

Dictated but not signed (that’s why there’s so many grammar errors!)

CCE Specialties Week 3

Monday

So, back at it. Thankfully it’s a 9am start so it’s not too bad for getting up and on the bus for. We are on care of the elderly this week and to be honest, I wasn’t expecting too much out of it. (I was to be proven wrong). Got to the ward for 9am and we sat in the board round which is where they discuss every patient on the ward (essentially a ward round in one room on steroids). It was great to be sitting there because I was taking it on myself to pick up the lingo being used and decode abbreviations.

As we went along we were included in the discussions and I have a feeling I was being watched by one of the docs because I was scribbling like mad making notes and because I had my tablet – I was able to google and answer my own questions.

After we were assigned to a consultant who took us to see a patient. Since there were three of us we each did one of the history, general exam and focused exam. The consultant was also interested in the use of tablets (I’m single-handedly revolutionising the NHS). I had to do the general examination so was having to dust off the chest of OSCE knowledge which I don’t think has been properly opened since May…. It was ok, remembered most of what we had been taught. My main problem was getting the patient to answer the questions I had asked rather than going off on tangents. I felt too bad to keep interrupting so I’m hoping I develop this skill over time.

He then took us into the office and taught us important skills to remember in OSCE’s as he was an examiner (and I am half convinced he was my examiner for my abdominal station) so we were taught common mistakes and how to avoid them. I couldn’t beleive my luck, first day there and we had already been given amazing teaching.

We then were handed over to Another doctor who has one of the best reputations in my year for being a good consultant for medical students. We were pretty keen to get sign offs done so I had asked to take bloods which qualifies as a mini-cex (yup, second year brings it’s own new language). I was told to take bloods off a lovely old lady who I found a good vein on, inserted the needle and nothing. No flashback, no anything. I sighed. Obviously , I had done something wrong. I withdrew the needle apologising and then before I knew it, BLOOD EVERYWHERE. I panicked getting the flow to stop and silently cursing because apparently, I had indeed hit the vein.

I felt awful but I decided to hand the bloods back, the last thing she needs is me causing more pain. I had to leave after that as I had to get home for my driving test but I was still kicking myself on the train home three hours later.

Wednesday

Back again and after failing my driving test, I wasn’t exactly in the best of moods. However, we turned up for half nine and immediately jumped in to reviewing new patients with the doctors. The first patient I saw was someone who had collapsed at home and was suspected to have a bleed in their brain. It was interesting examining them as they had a positive babinski sign (a way to identify upper motor neurone lesions) which I had never seen before. My heart really did feel for her as she was alone (visiting hours were a while away) and unable to respond to any of the doctors questions or instructions.

We continued going around on the ward round and then after were treated to some F1 teaching. Our F1 was also an ex-warwick grad which is great because you do feel like there is hope at the end of the tunnel for us !

We then asked to do a case based discussion which I led as being off for two weeks, I was severely behind in my sign offs. We talked to a lovely lady who was admitted after a fall with low blood pressure but otherwise well. She had some liver, pancreas and bone problems and we were chatting about her family, her job and her medications. I was surprised as she said she was only on one which puzzled me slightly but I guess that’s medicine.

We finished off the history with a abdominal examination (as she said about her liver) and a quick chest just to check for heart and lung sounds. There was nothing really of note so we said thank you and goodbye and then toddled off to see the notes. Her daughter caught up with us at that point and asked if we had seen her notes. We replied no as I wanted to go in blind like I would do in an OSCE and the daughter filled us in with the correct history which changed a lot. I felt bad for the patient as she had hidden things from us for reasons which I could understand but having the full history made everything so much more easier to work through.

Over lunch Kaludio and I discussed her and went back to the ward early to go through her bloods and work out why there were the abnormalities there was. I loved learning this way as I know it’s going to stick and I can feel the improvement in learning in comparison to death by powerpoint last year. I guess clinical life is for me after all.

We then attempted another blood but this time we had the flashback, but no blood decided to go into the tube. It was frustrating as we had a lovely man but we slumped back to the desk annoyed. What was going wrong? Our F1 appeared behind us and we were telling him about the constant unsuccessful blood taking but he reassured us saying that elderly veins were difficult, you could find a good vein and it would wander out of the way before you got the needle into it. We were taught some techniques to get the blood to flow so Im hoping that I can practise this technique one more time before the end of our time on the ward.

We also received the result of the brain scan our patient had gone for earlier and it was the worst possible news. There was a tumor growing and my heart dropped. Im being careful what I say so I can’t say much else but it led to my consultant having to break bad news to the family and discussing future care with them. Whilst our consultant was there, we were waiting at the desk when all the doors in the ward were shut and a blue metal trolley was rolled into one of the side rooms. We both knew what this meant and went home that evening reminded of just how serious flu can be.

Thursday

Arrived back on the ward earlyish this morning to catch up with what was going on with the patients we had seen yesterday. I was intrigued to see if anything had changed with the three patients we had seen yesterday. It turns out not much had but we had some new bloods for one of our patients so I spent 15 minutes working through them as I was presenting the case today. It was a interesting case and there was a lot to get our brains going. It was also a bit of a difficult day as they were understaffed so we were asked to come back – perfect excuse for a mid morning tea.

We arrived back to do our case based discussion with our consultant which went well. We had managed to identify everything he wanted us to catch and then we had a discussion about further management. So, sign off done. We then were sent away again and to come back after lunch as there wasn’t much to do so came back and then managed to watch a cannula being inserted as we were both a bit apprehensive about inserting them before some quick teaching on hyperkalemia. The ward was ridiculously busy that day however so we left after to allow them to get on with their roles and to allow the 4th years to get sign offs done before their finals in a few weeks. I tried to get work done in the evening but I’ve got a feeling I’ve got a cold coming so I just went to bed hoping to be better for tomorrow.

Friday

Brain decided to get me in an hour earlier than I needed to be today, as if I wasn’t tired enough already. We decided to buy some treats for the ward as they had been so accommodating to us during the week which we checked before we left the ward at 12 and had been hovered up in the two hours we were there #beststudentsever.

We had tried to get a OSLER done but with the busyness of the ward, we thought it would be best to just leave it. It’s not fair to nag the staff when they are running around trying to get patient care done. I did meet a patient who was on the ward though who had learning difficulties. They needed some comforting and it was nice to sit there and talk to them as it reminded me of my uncle back at home. I’ve grown up surrounded by adults with learning difficulties so it’s second nature to me and I really enjoy it when I have the chance to talk to patients with these extra needs.

We then left UHCW early and I was keen to get back to do some of my presentation list. It was nice to be back in my flat , in comfy clothes just working through what we need to do. I much prefer this solo method of working. I am retaining everything more easily and I actually feel like a medical student instead of just learning information off a powerpoint slide for the sake of an exam.

I’m also making progress in improving my mental health. I’ve managed to pass on an audit which was causing me a lot of stress (even though it would have been good for AFP applications) and I am making sure I keep some of the day to myself away from Medicine (even though I may be spending too much time away from Medicine at the moment as I am so tired). I’ve got a doctors appointment to review my meds and I just feel a lot more fufiled in what I am doing.

So here we are, back in the swing of things , ready for clinical life to begin.

A sickly return

You may be wondering why I have not written here in, well, months. I was due to start CCE1 (core clinical education one) on the sixth on January. This meant I was flung out into the Hospital to start my clinical teaching , except my immune system had other ideas…..

4th January

Moved back to Warwick today. Woke up with a ear ache (please note the word ache here) and shrugged it off with some paracetamol and ibuprofen and moved back. I wasn’t amazingly happy to go back, I’ve been apprehensive about going back and failing my driving exam two days before did not help matters. However, I got my miserable arse back to Warwick and waved my mum and grandad off after they moved me in and went to do the dreading unpacking stage. I was a bit dizzy wandering around my flat but I again shrugged it off as I had a lot to organize on Sunday such as my notebook, materials for the audit, materials from Wilko I could not get the day before and just general cleaning to do before making sure I got one final good nights rest.

I went to bed after watching Dracula but was rudely awoken 4 hours later with pain radiating from my right ear. I quickly took some more paracetamol and ibuprofen and went back to sleep.

4 hours later (I’m not even joking) I woke up again. This is when I panicked. I’ve had this type of pain before (Block one Week 2). I ended up calling 111. I could see my pain relief was not going to last the time I needed it to (I had 10 hours left of the 24-hour paracetamol limit with one dose left). I was told that I would be called back by a health professional so I took my last dose and some codeine from my last ear infection (yes, I know it’s bad to self prescribe but I had climbed the WHO pain ladder and this was the next step), and tried to get some more sleep. I could tell it was going to be a long day. I woke up 4 hours later with no call (and no missed calls), I was in a lot of pain. More than I had during the night and I had to bite the bullet and take some more paracetamol. Pain level 7/10

I called 111 back to check I hadn’t been forgotten and casually mentioned the 5th dose. Things blew up, it was like I had downed a whole bottle of paracetamol rather than the one innocent dose 4 hours before my 24-hour limit. I know paracetamol has a really high toxicity level, but I had no choice. I eventually got to 111 health professional and they said go to the walk in centre. I sighed. Here we go again.

5th January

I dragged my sorry arse over into Coventry. I had some new earphones for Christmas that were wide so I could cover my ears. I found my right ear had become completely deaf meaning that something, somewhere was either closing off my ear canal or stopping the signal going through the ear drum. I got to the walk in centre (pain 9/10) and was triaged and put on urgent. The Dr saw me and only prescribed antibiotics with no pain relief. I was told the only way I could get stronger pain relief was to go to A&E. So, guess where I high tailed it to.

I spent 4 hours waiting in A&E (pain 10/10), one cannula inserted and blood taken (and split all over my jeans) and was eventually seen by an ENT doc. She said that I had an infection of both my middle and outer ear. I was impressed with myself, how I managed that I have no idea. She was lovely, but slightly unsure what to do so we discussed oral antibiotics and I hopped home with oral antibiotics and more codeine. My lovely friend rosie came and met me at A&E bless her with some goodies as I think we were anticipating being admitted due to how illI was, however I was discharged as she arrived and I got a ride home- so thank you rosie !

You maybe thinking I am a bit of a drama queen. However, the point was that my tablets were not lasting long enough for me to take them at safe levels, I needed longer/stronger pain relief, and did not get it. I was at the highest level of the pain ladder I could be at with the materials I had and not tolerating it well. I could literally time when the pain would hit again and it wasn’t psychology. I was sleeping whilst the pain relief was present and waking up when it started again.

I’m sure we have all stuck an ear bud in our ear. We’ve all had a good wiggle meaning some of you have inevitably hit your ear drum (or tympanic membrane if you want to be fancy). That pain is bad isn’t it. Now imagine that, but constant at the highest arc of the pain you feel. Imagine it radiating to your jaw so you can’t move it. I couldn’t eat anything but a cookie from Sainsbury’s because it was thin and soft enough for my jaw to cope that entire Sunday. Every time the tablets stopped working, I was back in the pain with it getting worse and worse with every return and of course, I could not take any pain relief. Every time the pain returned I called mum to see if I could distract myself, I held my ear over my radiator as I couldn’t put a hot water bottle anywhere near it without causing additional pain. I tried holding my head at different angles trying to see if it was fluid in my middle ear pressing on the ear drum that was causing the pain, that did not work. I tried freezing a water bottles to see if cold would work but again, I could not get it anywhere near my ear. I tried sleeping upright, holding my head upside down. Nothing.

By 7pm I was on the floor in agony, I hadn’t eaten all day and dreading the 3 hours of agony I would face after the pain relief wore off after the 3 hours it worked (yes we are down to three hours now). I considered going back to A&E but the thought of even sitting in a taxi for 15 minutes to get there made me nauseas. I had been everywhere I could, seen everyone I could, done everything I could to try to cope and now was the time I wasn’t coping.

999

You’re going to read that and think how pathetic I am. I sat there for half an hour in the pain I was in trying to not call, I had no other option however. I was at the end of my wit and at the stage where I was thinking about how to knock myself out to try and escape the agony I was going through. I had messaged a friend of mine who is a F1 in Manchester to ask if I was being pathetic, I felt so ashamed. 999 is meant for heart attacks, strokes, people fitting, not for pain. I had no other choice though, I was done.

I had taken another dose of tablets and two hours later, I had a knock at my door with two lovely paramedics and campus security. I felt so ashamed because I was pretty level due to the tablets working when they arrived so it looked like I was being dramatic. However, they came in, lovely as ever and immediately spotted my stethoscope on my desk still not packed away. ” You’re a medical student aren’t you?!?” Great- now they are going to think I am a complete waste of time. However, they were still lovely and took my vitals, Temp 38, Heart rate 134, high blood pressure. The paramedic looked at me ” You know what this means don’t you Abbie?”. Sepsis. Great, again.

They said they were going to take me in because of this, but before they were going to give me pain relief. Second cannula of the day inserted and 3ml of IV morphine inserted. Here we go.

I was sat in the ambulance with my blood pressure/rate still high but temp falling (it was cold and I was in my PJ’s and a baggy shirt). I was able to just chat with the paramedic about training and TV crews etc and just felt better being there. I think it was the prospect of finally getting this pain sorted that calmed me down and I knew I was going to be treated and cared for. We got to A&E and 10ml of morphine later, I was back in minors slumped against a pillar, half asleep in the morphine haze.

BAM. On cue the pain was back. This time , I had no pain relief with me. I had gone to the desk to ask if they knew when I would be seen – an hour to go at least. Thankfully, I still was pretty sleepy from the morphine so I could managed until about half an hour later when I had nothing. I had tears streaming down my face trying to hold back from screaming. Someone had spotted this across the room and came and checked if I was OK. She was lovely and understood but I did feel embarrassed, that should be me comforting people.

I eventually got called in 4 and a half hours later since I arrived and was relieved to think I was finally getting some treatment. I’m not going to go into details about what happened because I am in education at that hospital and I don’t want to get into trouble for moaning however, half an hour later, I was turfed out with no further pain relief given (apart from the dose of tablets that I was due anyway and some oramorph as a compromise) and feeling like I had been abandoned by the trust and system I love more than anything. And that hurt more than the infection.

The only thing I was offered (as i had explained what had happened before) was a visit by the ENT consultant who said I could get IV pain relief but I would have to go back to the waiting room once the IV had finished. This meant three hours of agony in the waiting room, struggling to get attention for more pain relief for an unknown amount of time till a bed became available. Three hours sitting in that minors waiting room, in agony with no idea how long I would be there, in a top I have had on for two days now, alone (despite the numerous offers of people coming and waiting with me, but it’s bad enough one medical student there). In the end, with the things that had happened to me in A&E during the time I was seen, I could not face being there any more.

6th January

I eventually got back home at 3am and went straight to bed. Looked like uni was out of the question so I decided I would take the day off, grit my teeth and try to get through it. The cycle of pain was horrendous, I was becoming exhausted and add to the fact that I was feeling nervous about the prospect of jumping into clinical teaching without the prep on the Monday at uni. I still could not eat, I could not cope and now the pain was down my neck, and I was now feeling twinges in my left ear. My warden (essentially my boss) popped in as she had seen the Ambulance report and reported on how awful I looked and told me to go home, I later checked in the mirror, I could have passed as Frankenstein’s bride.

I made it to 5:30pm when I gave up, I could not manage on my own any more. I knew I was going to get nothing in terms of treatment from A&E in Coventry and I didn’t know where else I could turn. I was on the phone with mum and she decided to come and take me home. My superhero of a mum drove 150 miles to Warwick and back that evening to rescue me. It was the worse 2 and a half hours of my life in the car. I had tried to not take any more tablets as we were heading straight to my local A&E at home but an hour in I had to give in to some Ibuprofen, and a further half an hour later, some codeine which did a good job of sedating me so the pain was still agonizing, I was just a couple of GCS points lower from reacting.

We got to Darent A&E at 11:30pm and within half an hour, I had another cannula (3rd one in 24 hours) and was receiving IV paracetamol and IV saline. Unfortunately, the pain was still there, we were breaching 11/10 pain scale and two hours later I was given further IV morphine, IV antibiotics and anti-sickness through my cannula. 4:30am rolled around and we were sent to Darent’s sister hospital in Medway (15 min drive) as that’s where the ENT boffins lived.

I was in trouble though, IV morphine was having no affect on the pain. The pain was breaching the strongest pain relief that was on offer and I was exhausted already.

7th January

I was quickly triaged at Medway but made to sit around again. The morphine was wearing off and the pain was rearing up yet again (12/10), I was exhausted after battling this for 48 hours now. I was deaf in one ear, hadn’t eaten and probably put my liver through more battles than what it coped with the night after we finished first year exams. According to my mum, I was rather loud in my cries of exhaustion and agony. I was quickly given IV paracetamol and oramorph (probably to shut me up more than anything) and I ended up chugging ibuprofen as I couldn’t cope. Finally, the pain started to drop to 10/10.

I was seen by a lovely F3 who took the time to look at me and gave me extra treatment and finally, put me on track to getting over this thing. The worst part was where the wick was put in (a cotton tampon for the ears essentially) my already inflamed and tender ear. She had also given me stronger oral pain meds so I was able to cope with everything which was the greatest blessing.

We eventually got home at 6am and I collapsed into bed and told my mum she was not allowed to go to work (thankfully her work were really understanding).

I spent Tuesday and Wednesday in a haze of drugs, pain and sleep, thankful that I was soon going to actually have my immune system on my side as well as the antibiotics. I woke up Thursday to go back to Medway and have the wick taken out, but it had fallen out the night before which is a perfect thing. This meant the inflammation had gone down meaning there was no “grip” to keeping the wick in place. The docs and nurses at Medway were slightly relieved as my ear drum had not burst in my right ear but I had developed a polyp in my left, so some suctioning and 4 wicks inserted later, I was back at home, deaf but better than the Monday.

The next 3 days were annoying as I couldn’t hear anything, and I could feel the wicks in my ear but I was on the mend and more importantly, able to eat !!

We ended back at Medway on the Sunday to have the wicks removed and to see how I was recovering. I was so happy when the wicks were removed (even though there were traces of blood on one) but it turns out the infection was still there. I was discharged with my antibiotics that day though which was great!

I know this has been a long moan and dramatic. However, when you tell people “I had nearly two weeks off for an ear infection” it sounds pathetic to me, but it was the worst pain I have ever felt in my life. When you think about it, the ear is served by 7 cranial nerves. All seven of those nerves would have been screaming at me all at once, sending pain impulses. So, hopefully, you’ll be able to understand.

Image result for innervation of the ear

I decided to not go back to Warwick until Wednesday this week because I am a bit nervous about going back and ending back at square one. It’s Monday today, and I still have a few aches in my right ear (not to mention itching in both ears) which are making me nervous but I can’t hide at home. I’ve already missed my paediatric week which I am gutted about and I am not too sure about if I am going in Thursday as it’s the neonate ward due to infection control. I am also a resident tutor and I feel I have let my team down enough so I want to be back doing the job I am meant to be doing.

So, that’s it. I wanted to explain what had happened mainly because I want to show I was not taking liberties and over reacting to a slight ache. I have regular ear infections so I know what an “ache” feels like and trust me, this was no ache.

Well, that’s my infection done for second year, (not) looking forward to my third year one !

I treated myself to a get well present