Medicine Block- Week Four

Wednesday

Nothing really happened on Monday and Tuesday as I had two days off placement so let’s begin with Wednesday. We had our first GP day and we had a brand new surgery to WMS as a couple of surgeries didn’t want students in so we went to a surgery that we had coincidently, been to already. We had been to the surgery in our Specialities week for a baby clinic so actually, it was a nice surprise to find out it was somewhere familiar.

As nice as the staff are though and as welcoming as they are, GP is just not the same without patients. Phone lines are dodgy meaning you can’t always hear the patient clearly, and let’s face it. Listening to a phone call is nowhere near as good as meeting patients in real life.

We left for lunch feeling a bit downcast. Our expectations were already high due to a brilliant GP surgery last year but with no patients, we were both a bit underwhelmed. We went to a local “restaurant” to take advantage of the Eat out to Help out scheme and popped into Lidl to stock up on their pizzas….. Lidl bakery pizzas are the best thing ever.

We went back for the afternoon to wait for our one patient of the day to come in. We spent two and a half hours working on our audits and I had a call from an ENT consultant about my infections. Literally, the first words out of their mouth were ” I can see you are a Medical Student but to me, you are a patient so talk to me as a patient”. I have never loved a voice on the end of a phone that much.

We eventually got to see our patient and then trundled off at 5:30pm.

Thursday

I still felt really down about GP yesterday so I was hoping the wards would be a bit better and cheer me up. I forgot they had scheduled the F1 and CT1 for nights and our PA had just moved wards. We were just left with the reg as the doctor on the wards who suggested we do the bloods. Pathology turned up a tad later and were happy that we were getting on with the bloods.

Of course, Sods law meant we could only do 2 out of the seven. We asked the reg what to do and we had to trundle to the pathology department with our tails between our legs. I already wasn’t feeling great with heavy limbs and we got told off because we had “accepted” the bloods and should have done them ourselves.

I pretty much wanted to go home after that. I spent the rest of Thursday huddled up on my sofa drifting in and out of sleep. Friday wasn’t much better either and I ended up just drifting round the flat. I was desperate to go swimming so I thought I would book and go on the Saturday. Maybe that is what I needed, a good swim session to blow off steam.

Saturday

I got up ready to go. Put my swimming costume on and a pair of jeans as its easier just to sit around in it all day and motivates me to go. I ate some breakfast and BAM. Knocked down. I had a hot water bottle, a blanket, thick socks, a hoodie and a duvet on top of me and I still wasn’t warm.

I was aching in every joint and it was the sickest I had been in a while. It took me two hours to drag myself to take a cold and flu drink praying the paracetamol would help. I spent the day drifting in and out of sleep with my joints aching and breathless due to my chest. With the amount of breaths I was taking, I thought I was going to land up in hospital at some point. I also had to have my curtains shut as any bright light was just ridiculously painful. I took my temperature in the evening as this didn’t occur to me till about 5pm :

Nervous laughter
Considering I had been sleeping the whole day, that heart rate was also terrifying to see. You can literally see it climbing as I get sicker throughout the day.

Safe to say, I was scared by this point. I booked a COVID-19 swab for the next day and tried to get some sleep. It was a restless night and I woke up drenched at one point and every adjusting of position brought on a new wave of nausea and joint paint. On top of all this my hip decided it wanted to join in so was killing me for half the night. However, huzza, we had broken the fever:

I’m sorry, I can’t get this to rotate.

I felt so much better but due to how sick I was the day before. I had forgotten to take my anti-depressants so I was awkwardly stumbling around the flat waiting for the chemicals to kick in. I also had forgotten to charge my phone so here I was hoping that everything would sort itself out for the drive over to Richo where the swabbing site was.

Thankfully, I regained my land legs and my battery was enough to get me there and back. The site was very efficient and no less than 10 minutes after I arrived, I was having a plastic stick shoved up my nose and sent on my merry way. I had forgotten how much it hurt from last time and was sneezing/eye watering my way out of the site. It’s hard not to gag when you are already feeling sick and someone is triggering your gag reflex. It was nice though as I had my friend in Cardiff to take the mic out of me/ support me from all the way in Wales 😀

It’s Monday now and I am feeling fine! My chest is still a little rusty and I’m feeling a tad dizzy but otherwise I am fine. I’m just waiting for a Boris text to tell me I am FREEEEE.

Medicine Block – Week Three

So, you know I said last block I would have a shorter blog? Well, the timing of that sentence wasn’t quite right. This week was the week when I returned to being an actual full time medical student.

Monday

Thankfully just some tutorials today that started at 10am, BLISS! These tutorials are meant to help us pitch our own work right and if you are lucky, complete the work for you. We had a full day of workshops so it was just sat in a virtually empty lecture theatre all day.

There’s not really much to write about apart from the fact it was BOILING outside, this was of course, the week of the heatwave. However, to end the day off in the right direction, Kaludio and I took a trip to the infamous Gelliot Ice cream bar. Yes, it is amazing as it sounds:

Berry sorbet and bubblegum ice-cream

Tuesday

Tuesday brought a bit of a weird half day and a first for us. When learning clinical skills in the last block we had an afternoon of teaching and then a couple of weeks later (when you have normally forgotten everything), you are assessed. This time round it worked a bit differently. We were sent online learning modules and I self-taught myself ECG’s (OK, I basically knew that already) but NG tubes were something I really was not expecting to learn on my own and go and be assessed on the next day. (NG Tubes are feeding tubes passed through the nose, down the back of the throat and into the stomach. They are not pleasant to have inserted but can be the difference between life and death in serious cases).

Nasogastric (NG) Tube Placement - Oxford Medical Education

Thankfully the nurses running the TDOCS were lovely and supported us through each one so it was the highest mar I have ever received for a TDOC (lets ignore the fact everyone got a perfect score).

We had nothing for the rest of the day so I decided to get some tests done of my own. I had been “prescribed” and X-ray before lockdown for my hip and it was starting to hurt again so I took myself down to get it done. It was weird sitting there as a patient in the surgical gowns, especially when you are trying to get something to stay shut at the back which isn’t designed to stay shut at the back.

Did you wear a gown if you didn’t take a picture to prove it?

After I thought I had my outpatients appointment for my ears but after an hour of sitting in the sun I suddenly realised I had not only got the wrong day, but the wrong week. Nice one Abbie.

Wednesday

Nice normal day back on the ward today. Well, I say normal but this was a heatwave and our scrubs really do not allow the body to breath so within 5 minutes of getting onto the ward I felt soaked through. The ward temperature was nearly 30 degrees Celsius and we were just melting on the ward round.

Kaludio and myself managed to duck into the air-conditioned equipment room to gain some body regulation at one point and walking out of there to the ward felt like we were getting off the plane in Spain. I couldn’t understand how patients were sat there with blankets on. We also had the nicest consultant that day, they were teaching us around the ward round and at the end offered to do our sign off’s for the block. RESULT. He also insisted that we should not be in the wards but outside enjoying the sun, something which our F1 agreed on.

We stayed to put some cannulas in the patients that morning as most were going to need IV fluids to prevent Acute Kidney Injuries developing in the next couple of days. I had a patient who’s veins were just beautiful so my job was easy. The ward was also treated to ice-poles which was just the best thing to ever happen:

we were beat to the blue ones but red is a good substitute !

We finished our jobs at 12pm so we decided that Ice Cream was also needed – cue Ice Cream trip #2 of the week:

Lemon Crunch and Bubblegum

Thursday

So very close to the end of the week. I am so tired, I don’t get how I was pulling the ridiculous hours I was during Speciality block AND keeping up with three presentations a week off the list.

However, today was significantly cooler as we had an incredible thunderstorm the night before which just lit up the entire nights sky. We had the ALERT course we were originally meant to do back in March. It was good as it made you aware of why we do the A-E assessment but it wasn’t until the afternoon that I realized just how far I had come along. We got free food and drink throughout the day (que me panicking as I watched my calorie budget drop due to the sandwich I ate which was nearly 1/3 of my daily count).

In the afternoon we were ran simulations of a deteriorating patient where we had to conduct an A-E assessment. My first one was a bit shaky but my second one I just got praise and advised to be a bit more flexible with my diagnosis as I can be a bit narrow sighted.

I felt like I could have been an F1 in A&E and that evening I went home with the biggest confidence boost I have ever had. I was finally beginning to feel like this was going to happen, I was going to be a half competent doctor one day.

We didn’t get the full plugged in version but it was helpful to remember things by just placing our hands on the body.

Thursday was also the day the whole A level thing kicked off but I will dedicate another post to that as it deserves more than a paragraph.

Friday

END OF THE WEEK

I made an agreement with the rest of my car share to have a half day as we were pretty tired. Oh what dreams we make.

You quickly find out that when you plan to have a half day, you end up having the longest days ever on placement.

We rocked up to the ward round and were asked to prep the notes for the two newcomers. I toddled off and wrote up basic history and recent investigation tests and once I was finished I toddled back to the nurses station. Whilst I was gone the F1, CT1 and PA had all arrived and asked me to present the case back to them.

The consultant turned up and God did my anxiety rocket. I had to re-present the patient back to her and discuss some points (tip for future Abbie – trends are as important as numbers) for treatment. The consultant then went, go and sort her out then. I stood there. What do you mean?

Well, go and have a chat – take some bloods so we can check how she is doing, document it and I’ll catch up with you in a bit. I stood there flummoxed but equally excited. I got to play F1 for an hour.

I know I have a problem with my anxiety levels but boy I did not realise the extent of them until this time.

I interviewed the patient, did their bloods, got everything ready for sign off (turns out I could put my own signature on them as they “never check the signatures”) and presented back in time for the regular ward round. It was a straight forward case but god was it a rush. I felt like a capable human for once in my life.

We stayed and did some more cannulas and bloods before lunch (one of which we had to get the reg to do as it was so difficult) but we were hinted at the possibilty of NG tubes after lunch.

Coming back we had two patients who needed NG tube insertion. Klaudio did the first who had lost capacity so was difficult, but we later found out he had managed to nail his first NG tube!

Mine, well mine was slightly more difficult. The patient had mobility issues and some movement issues, so it was more difficult to place the tube. They also kept giving and removing consent and there was a big decision to make if they had capacity or not. We tried to find this out but it was proving very difficult.

After two attempts (both consented for by the patient) we gave up as it was not sitting properly and I didn’t want to cause any more distress. IT was left as a weekend job as it was not getting done on the Friday. We ended up playing a weird medication quiz as our F1 wrote up the drug chart for another patient with our ward pharmacist adding the sound effects and it was just an hilarious way to end off the week.

It hit half five however, and my hip began to signal it was time to go home. I got back at 6:15pm and was exhausted. I’ve been suffering with hip pain for a while but hopefully that X-ray will show something that I can fix !

It’s weeks like these you have to hold on to as you will end up with weeks when everything just goes to pot and you give up. I really did feel like I was going to be a doctor after the end of this week. Let’s hope Covid doesn’t screw up more than it has done already.

Medicine – Week 2

Wednesday

I never thought this day would come. I’ve been trying to keep myself busy with work and working out but I was desperate for Wednesday to roll around. We headed up to the ward and were joined by two new fourth years (even though I keep calling them third years because they are the year above but we are still second years). It was nice to meet people I haven’t actually seen in second year yet and we were all strictly told to prepare the notes. Cue the next four hours of panic trying to make sure the notes were prepped ready for the next patient whilst simultaneously trying to figure out how to write in these notes.

It was tough but I really enjoyed it, I felt a solid part of the team and I know this is what we will be doing as final years and F1’s. It was also good to get to know the layout of patient notes and the clinical system which I prefer a mile over the system over in UHCW. I also was having frantic calls to IT as my login still hadn’t been approved.

It was also good as we were seeing the patients we had written the notes up for ourselves so we could follow the plan through and it also lead to us being able to grab jobs as they came. I ended up getting two bloods done and one other attempt but they were really hard to bleed and were not very well so we decided to leave it because we didn’t want to cause them any more distress. I’ve sent this ticket off to be signed off as a Mini-Cex ( I want to get my sign off’s done ASAP) so I am hoping the reg will be nice. I am stressing a bit in this area as we don’t have anyone on our ward who is ST3+ which are required for our sign off’s so I am hoping that by grabbing any opportunity we can, our tickets will be completed.

In the afternoon we were booked into our lecturers Chronic Fatigue Syndrome clinic. It was a syndrome I was interested in as I had completed that part of the presentation list the evening before. We had also heard our lecturers clinics were good for learning and getting our skills scrutinised so we signed up and were not disappointed. We were given coffee (bonus) and had to ask two questions with every patient and tell our lecturer a fact from this textbook after every patient. The more I learnt about CFS the more intrigued I became. There’s no direct link, no direct cause and no population is specifically presents in apart from it is generally after a viral infection.

One thing I am eager to find out is how Covid-19 will affect the refferals to these clinics as many survivors of Covid-19 have reported unusual tiredness months after the initial infection.

It was a good afternoon and we left clinic debating about this syndrome.

Thursday

Im going to admit it now, this was a slow and quiet day. The consultant only appeared for the board round so the team were having to do the ward round themselves. We found it harder to know what to do and so took ourselves off for our own studies. I took a history (as the last history I took was in March) and we both had a go at listening for tricuspid regurgitation on a lovely patient but I could not hear anything. Looks like I am going to have to go over cardiac examination again.

We also attempted a blood but this again, didn’t go so well. We knew the MDT meeting was coming up so we took ourselves away as we didn’t want to get in the way of an already stressed team. The MDT was good again and I noticed a slight improvement in my scan reading skills to the last week. However, we didn’t manage to get into any clinics so we managed to go and see a dexta scan. This is an x-ray to test for osteoporosis but after the first one, you’ve seen them all.

We ended finishing up early at 3pm. You have good days and quiet days here, I like that though. I got a history done and that’s more than I could do in a week on speciality block.

A Note.

These blog will be different to what I was doing before, but that’s because our degree is different to what it was before. We will probably be different to the cohorts that have come before us and these Covid-19 changes will follow us throughout our careers. It’s OK though, it’s about learning to see the benefits of these changes and tackling the challenges head on. So, I don’t know what will happen in the future of this blog, but luckily for you guys it will be shorter posts and less moaning of how tired I am !

Medicine Block : Week1

THE BEE IS BACK!

Wow, it’s been a while hasn’t it. I’m not sure how this blog is going to work from now on forward because the medical degree I was once on, has changed dramatically.

I am now only in placement for two days a week. Later on this month I will also be starting GP so that adds an extra day but there isn’t going to be a lot to type about.

Lockdown has been hard and there has been times when I never thought we would never get back into placement. However, Warwick has been great at, keeping us busy and we have been completing our third your research project in replacement of our placement blocks. They have also been brilliant with communication and keeping us updated with what is going on but doing that project was a nightmare.

I appreciate a research project is nothing compared to some med schools which have piled on the work for their students but I was so glad to click submit.

We all had to do systematic reviews which I desperately did not want to do. I had my project planned out and I was really excited about it. I also had an incredible supervisor, so when I got that email I was devastated. There were worse things going on in the world then though.

Anyway, long story short my third year project is complete and I am hugely thankful it is over. I’ll write another post about it soon but for now, let’s just stick with the medicine.

Day one of two

That was such a depressing title to write. That is how it is going to be though. We arrived Wednesday morning, donned the classic blue mask on entrance and signed in. We were only 20 minutes into the day and the mask was beginning to annoy me, guess I am going to have to get used to it again.

We also ended trekking back and forth over the whole hospital to pick up our scrubs. Warwick had said scrubs would be provided as we have to wash all clothes at 60 degrees and the fact is, my primark clothes just are not going to cut it. We received three pairs of some dark blue scrubs which are actually really nice! Problem is for me is that I am a tad too big for the medium top ( I like slightly baggy clothes) and the large is too big. End of the tale is that I am now attending placement in a tent.

We headed up to our assigned ward and introduced ourselves. It’s a world away from UH where I once was. We were put to work straight away writing in the notes, preparing for the ward round whilst waiting for the consultant to turn up for the ward round. Due to the type of block we were in, I’ve never actually been on a ward round before so this was a first.

They are kind of useful, I like seeing how the team functions and how the consultant develops treatment plans but there isn’t a huge amount of learning. Especially when the consultant is in pain or in a rush so they don’t get time to explain things. I only point this out because I wasn’t expecting to have teaching, but when we finished the consultant apologized to us for not teaching and explaining things. I nearly fell over, this is normal?

We then helped the docs on the ward with their duties. Halfway through a new doctor joined us, and I am talking new. Finally, we had someone else that was just as lost as we were! He was lovely and spent the majority of the morning trying to get IT to work – classic NHS.

We got split up between the two docs and the PA (Physicians Associate) on the ward. This is probably going to sound bad but , I didn’t realize just how advanced PA’s are and what they can do. Our PA was practically running the ward and I am looking forward to having more interaction with PA’s. I got to spend the morning helping make radiography requests before running off to lunch.

In the afternoon I got to attempt my very first ABG. I missed the artery and normally you “rummage” around slightly to get the vessel but with it being an ABG and not a venous blood sample, I was nervous as I knew the structures running around that area so the SHO ended up taking over. I still felt some source of accomplishment though!

Kaludio and I also got to try and take some blood off one of our patients. They were an ex-midwife so we were happily chatting away to them whilst we were trying to get some samples finding out abut their time in the NHS. Unfortunately, three med student attempts and two PA attempts later and none of us were able to obtain a sample, so we ended up leaving it there.

Overall, it was a pretty good day. I felt like I had accomplished something and I was excited to get back in on the Thursday, albeit at the slightly later time of 8:30am.

Day Two

We trudge in for a slightly later start but surprisingly, a “harder to get out of bed” start. I practically dragged myself to get ready, thankfully due to the scrubs, very little effort needs to be used when getting ready in the morning.

We headed back to the ward and ended up awkwardly killing time waiting for the ward round to start. We had a different consultant today and actually it’s interesting to see the differences in everyone’s medical practise and how they run ward rounds.

It was slightly long as we had seen all the patients the day before but it meant we could listen on more closely for management plans and how they differed day to day especially when it related to scans we had requested the day before.

That day we had a particularly hard hitting patient to see and although I can’t say much else, it was a first for me and I ended up just staying with the patient whilst the ward round moved on. We sat and had a chat which I hoped helped them for as long as I could get away with not following the ward round.

We heard of an MDT meeting that afternoon so we stayed on the ward to help out with any bloods we could do and then ran off for lunch. We got to the MDT meeting and got to listen in to discussions about GI cancer which included a couple of patients we were familiar with. It was good to sit there as although most of the discussions were over our head, we got to examine scans which was helpful as I need to get it out of my head that you look at CT/MRI from the head down. It’s actually a bad thing I have got this in my head as all the organs are in the wrong places in my head and it takes me twice as long to interpret a scan as anyone else.

At the end we managed to catch a consultant and headed to their clinic. These are very different to pre-Covid-19 as there are now no patients physically in the room. We sit and listen on a phone to discussions which still is helpful, but I am worried about how the lack of opportunity to do patient examinations how impact our progression as doctors. We still have our normal OSCE’s come January and with significantly less patient contact both on the wards and through consultant/ GP clinics, I can’t see how we will be expected to be as prepared as previous years,

Anyway, we learnt some lab examinations needed to make diagnosis of IBD and treatment options for those struggling. It’s a common presentation and a lot of the time, people are having to have cameras put into their GI tracts to find out what the problem is.

It was a useful clinic and we finished at a nice round 5pm and headed home.

Friday

This is the only entry for the remainder of year 2 about academic days. We only had our CBL today which should have marked the end of our teaching for second year. Normally, I would be stressed up to my eyeballs with exam revision ready for September so, it felt strange to hit this milestone so early.

We also had a discussion about getting back in the med school after the case concluded. I personally can’t wait as I knew I had 5 days of no face to face contact ahead of me. I understand why some of my course mates don’t want to come in due to fears over mixing the virus but when we are in a clinical environment for learning, I struggle to see how sitting in a classroom would make any difference. That’s probably just me though. There was also a comment about travel efficiency which ok, yes it does seem overkill to get us to come in for something that can be done online but it’s the human interaction that you then loose.

Academic days aren’t just for lectures and CBL but for some of us it’s the only time we get to see others who are in different rotations or are at different trusts, and it’s that I really miss about not having a physical learning environment. I got a little miffed about this comment as it’s a 10 minute drive to the MTC for most people and compared to the utter solitude and lack of seeing people you want to see outside a clinical environment (without risking mixing in pubs or restaurants), I think a 10 minute drive is a small thing.