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Care Of The Surgical Patient, Week 4

Monday

My second shift in the SAU! The team looked slightly alarmed when I walked in with the crutches, but I just assured them that once I am on the ward I can make do without. I am every physios nightmare patient.

I enjoy SAU, I like being independent and doing all the clarking, coming up with differentials, doing the bloods and I even steal the obs off the HCA’s. However, today was painfully quiet.

I just sat there on the low table, feeling a bit awkward. I had teaching later on in the day which meant I could escape for a bit, but when there are no patients, there’s not a huge amount you can do.

Lunch arrived, and I hobbled off the ward to grab something before teaching. I wasn’t in the best of moods – pain and nothing to distract me from it. Plus these crutches were doing my head in, getting in the way, slowing me down, making everyone look terrified every time they spot scrubs using them.

I tuned into the second of the case based discussions, which was delayed slightly and was again disrupted by bad signal. I remembered I would be at the “big hospital” in a few weeks, and I know the signal there is extremely poor. I remember being in second year and getting a flurry of notifications every time I passed a good spot.

I sound like a complete grump!

I headed back to the ward after to be met with no patients again. I was deciding if to leave or not as I needed to go and get petrol when they decided to grab some surgical patients from the very busy A&E. I immediately jumped into Med student mode and got to take a very interesting history off someone with jaundice. I came up with my differentials and wrote everything down, and waited again.

and that was it.

Some days in Med school are going to be amazing, others, well others will end with you hobbling out of the hospital after 6 hours only having done one history and one examination.

In the evening, the wilderness society had their ticket release for the weekend trip. These are hugely popular and even though I tried, I didn’t get a ticket. They sold out in under a second – more popular than Glastonbury !!

Tuesday

I was meant to be going in to do the post take ward round today. However, after only clarking one patient the entire day before, it wasn’t going to be useful as I would be touring a load of patients I hadn’t seen before.

It might be being a bit cocky, but as I go through the course, I am learning what sessions are useful and what are not. I like Warwick in the fact that attendance is hardly monitored. They trust us enough to know what works for us and what doesn’t. We are expected to show up for formal teaching, but not the wards.

However, you can tell at finals and OSCE’s who exactly has been in and who hasn’t. I generally do go in, and I am already trying to find other stuff to do in Psych block, but I have learnt to recognize when things aren’t going to be useful. Instead, I stay at home and do book work, so the morning isn’t wasted wandering around a ward round where I have no idea who the patients are.

Wednesday

I was meant to be in for a clinic in the morning, but the consultant never replied as to where or when I had to meet them. So, I used the morning to do some work at home and catch up on the huge laundry pile staring me in the face.

We did have teaching in the afternoon about anaesthetics and pre-op meetings. This was useful as we don’t get taught an awful lot about anaesthetics, but we do get tested on it. We went through what happens in a pre-op meeting, what you have to look for and how to recognize a high risk patient.

We then got set homework… I can’t remember the last time I got set homework. I got set to do post-op confusion, I was in a bad mood (honestly I don’t know what is wrong with me) and managed to find a BEAUTIFUL leaflet from the royal college of anaesthetists on my exact topic – Thank you RCoA !

We had to present them the next day, but I hate PowerPoint with every fibre of my being, so I just made a small round up poster instead.

Thursday

We had the second half of our peri-op teaching in the morning presenting back our homework and learning about anesthetics and managing post-op complication such as over/under working colostomies and bowel obstruction. I have become very familiar with bowels over this block.

In the afternoon, we had our penultimate SIM session. I got to lead a session where the person was bleeding out from a burst aorta. Lucky for me, I got the only session where the SIM dies at the end.

I wasn’t too affected. I wish I had picked up the source of the bleeding earlier and managed my fluids better, but the scenario was always going to result in the patient death.

I always get the happy cases don’t I? 😀

Friday

On the Friday, we had a workshop covering prescribing. This is slowly becoming a bigger part of the curriculum now, as our PSA exam is one we have to sit in our final year.

It was mainly things we had covered before, but we also got taught how to prescribe controlled drugs such as morphine. These are the drugs which are kept in a locked cupboard and are normally the source of all key finding on the wards.

After we had a session on surgical urology which involved some very painful looking pictures, but I actually really enjoyed it and learnt a lot.

We then had another online tutorial (which gave me a chance to get back to grab my tablets from the pharmacy and some lunch) on endocrine, which I hate with a passion. I can never remember what is hyper/hypo thyroid, what is steroid related etc.

I think it’s safe to assume I will never be an endocrinologist. However, it was useful, and I just need to keep at it to make sure I have all stations covered for finals.

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Care of the Surgical Patient Week 3

Monday

Was meant to go in for theatre today but ended up missing it due to being in absolute pain with my hip the night before. I got about 3 hours sleep in all and the thought of being in pain and tired all day in surgery did not seem like something I wanted to push myself through.

I decided instead to take the day off and try and give it some rest. Sometimes you just have to know when you are beat.

It ended up working well for me. I got some washing done and caught up on a bit of work, having several naps between it all. I felt bad that I wasn’t in surgery, but I know I would have got there and clock watched all day.

Tuesday

Back up and at it! Kinda. It was a work from home day, and today I got to join a new team for their meeting. As part of JASME I got to step up and be the rep at the EDC which is the Educator Development Committie. Essentially, they are a group that look at evidence based research that supports the developing educator.

I was excited to be part of this as one of my areas of interest with Med Ed is encouraging the use of different technologies when teaching. It is clear that the days of packed (or not so packed) lecture theatres are behind us. It was also nice to see a familiar name. Well, sorta familiar name. I wanted to apply to Leicester when I was 18 and the head of the EDC team is a lecturer at Leicester. His name kept ringing bells and i was FRUSTRATING.

I then had a bowel cancer tutorial at the end of the day which was good although felt a bit disappointing. It was a hybrid teaching session which, just, don’t work. I am also starting to become tired of online teaching. Poor signal makes an hour session last forever, and it’s even easier to monologue for an hour. I appreciate the convenience of it, it just doesn’t work all the time.

In the evening, we had a careers talk about working in New Zealand. It’s always been my dream to go to Australia/ New Zealand, so this was perfect for me. I plan to go during my FY3 year unless I end up taking time out to do a masters. I am not sure where my career path is going, but it’s good to have information now. It was by two Warwick grads, one here in the UK and one still living out there. I can’t picture myself going permanently. I am slowly growing out of the idea of moving back home for long. I want my independence and to live my own life but I don’t want to be half the world away from my family.

Wednesday

Wednesday morning I had my bedside teaching session with my consultant. I was a bit nervous, I knew it would be bowel related, and I was confident in my abdominal examination, but this was surgery. A whole other ball game !

It was actually a really good morning. I did take away a lot and the best thing is we spent a good two hours talking about Australia and New Zealand in a hospital corridor.

Honestly, they’ve matched me with the right consultant.

I was looking forward to the afternoon as we had a suturing workshop. This was the second of my degree and although they are more of a novelty (it’s rare to be asked to do some sutures) they can technically be tested on. However, I enjoy suturing, it’s sorta therapeutic:

This was my attempt at a mattress stitch.

Thursday

Online discussion again. I get online learning for lectures, it works, but I am beginning to hate the discussions being held online. However, I can’t moan, I did this in my socks, with a cuppa tea next to me.

In the afternoon we had our simulation session again. The crutches are beginning to do my head in already, but luckily I found a space next to the building to park, so I only had to hobble a little. I also annoyingly keep arriving stupidly early to these things. I was so organized up till a week ago when I just seemed to lose the plot.

I do like these sessions, though. I like being able to see my group and catch up. Sometimes you just need the reassurance that others are doing the minimum outside of placement too to keep you going!

It’s also the perfect excuse for cake:

Oreo brownies 😀

Friday was academic day – oh the joys 😀