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Care of the Surgical Patient – Week 5

The final week! Woah this block has gone by so quickly….

Monday

This week was always going to be a quiet week for me, so it’s not a surprise my first session was online breast teaching. I had gone through this a lot before, so there wasn’t too much new material. This meant it was a good revision and re-visit of an important topic.

I then had bedside teaching in the afternoon, which was a good opportunity for me to chase up unfinished tickets. These tickets are the bane of our lives here. It’s why I try to get mine signed off on the spot. I still have outstanding ones from SECOND year.

Thankfully, we had the same CEF who was due to sign off a ticket for me, so it was easy to get a reminder to them. We visited a patient who I thought I had seen before, but turns out they were a new admission. I still swear I had seen them before ….

There was also another patient admitted to the ward who I definitely was familiar with as I clarked them in my first week of surgery. I got to have a catch-up with them, and we had a good old chat. I love it when patients remember you and you remember them. As Med students, we move around so fast that we rarely get to follow patients up and see them through. i hope they are ok now 🙂

Tuesday

My final day in surgery. I got myself in early as I was going to have to get in early anyway, so I might as well spend the whole day in surgery. I tried to scrub in, but the surgeons said it would be very unlikely.

So, I decided to hang around with the anaesthetics team and I got to do my first intubation, which was amazing and significantly easier than doing it on a dummy. I felt great, I had wanted to do one for ages, and it just made my day and distracted me from only scrubbing in once out of the 15 weeks of surgery block I have had.

I did get to see a gallbladder removal, which was pretty cool, as it’s the only “basic” procedure I had not yet seen. I got to see the bladder after, and they are not kidding when they say bile is green. I almost could not believe that had been in a human only moments earlier.

I also got to feel cancer of the bowel. You can easily forget just how different to normal tissue, cancer can be. I got to feel it, and it became obvious as to why people present with large bowel obstruction with these types of cancers.

It was a long day, and I was in a lot of pain by the time I had left. I was thankful to the scrub nurse who was also trying her best to get the surgeon to allow me to scrub in, but alas it wasn’t to be. I didn’t necessarily need to help, but it would have been nice to be closer to the action to see.

Wednesday

Day off today! Well, sorta. I had arranged with Dr Gill to film again. However, I enjoy this, and it actually gives me a chance to go over examinations I haven’t done since I was in first year.

It’s nice to have a chat with someone who’s managed to get through the other side of Warwick. I also seem to have been adopted by the ASMR fan club. Which is kinda nice to be honest.

Thursday

Final day of the block ! Well, at least in my head. I headed in at 8:45 am (ended up being 8:30am because I can’t get to anywhere on time for the life of me). I ended up chatting to the nurses when my consultant rocked up behind me and told me off for being early. That’s a new one.

We headed over to the ward where we were going to do my OSLER. I had a patient who was nice, easy to get infomation out of…

but.would.not.stop.talking.

I was being timed, so I had only got 1/2 through the history when time was up. I need to practise being able to interrupt more, but in a polite way. Sometimes, I just don’t need to know your great great uncle had constipation (not a real example).

The same went for the examination, I just need to be a lot quicker about these things.

I did, however, get the diagnosis right…ish. Completely forgot about appendicitis and stumbled my way through the questions at the end.

Not my proudest performance, but I am glad I got through. My consultant gave some really useful feedback, and although I definitely need to improve. I feel like I am on the right track. I also managed to get my block sign off done there and then so once that signature was down. That’s surgery block completed.

I had also bought a tens machine over the evening, so I was also walking without crutches for the first time in a while, which felt AMAZING.

As you can tell, it was a good day.

In the afternoon we had our final SIM session but I was having to multi-task at the same time as we had our disability away day.

I am part of the disability network crew here, which has been newly set up to help students who have disabilities get through the course. I had in charge of everything to do with neurodiversity (unsurprisingly) and during the away day (basically, a blanked out section in staff’s timetables, so they can attend training etc) I did a talk on transitions.

Med school is hard for someone like me who craves routine or at least a decent plan. However, sometimes, it just isn’t going to be possible to do that, especially in the world of healthcare where day to day activities can be impossible to predict.

I want to try and help as much as I can to make things easier, and I spoke about how much the change from phase one to phase two clinical learning burnt me out and how, come December, I didn’t want to come back to Warwick (spoiler alert: I did).

I introduced my concept of a mentoring scheme to the staff which went down well (and nearly 7 weeks later I still haven’t emailed them about it) and overall it was a really positive day.

We finished up the SIM session whilst the disability away day was still going on, and I listened to the rest of it whilst I was driving home. Yes, home home.

I got stalked doing academic day at home

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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 😀

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Care of the Surgical Patient – Week 2

Tuesday

Thankfully had the Monday off due to the bank holiday. Much needed as I was exhausted most of the Sunday so caught up on nothing ….

I had my first bedside teaching session with Mr O which I was a tad nervous for but I could cope without my crutches for the morning which was an improvement.

We saw a couple of patients across a couple of different wards. I keep forgetting to take my goggles out of my bag, so I ended up wearing one of those annoying visors for it all. We focused on History taking and examinations in context of the level of a final year. This was terrifying, but it is the sad fact now that technically, I am in my final months of medical school. In a way it’s kicked me into motion as I feel like I am learning things that are going to help patients and me in the long run, and not just for an exam

It was a great two hours, and we ended up in a deep discussion about the gallbladder and biliary tree (as you do). We also ended up chatting about Australia as it’s a place I would like to go to some day, maybe to work, maybe just to holiday. We also ended up chatting about vascular surgery and emergencies he had worked on in the past, and I was in awe.

Even though my hip was on fire, I actually really enjoyed this time spent. It’s not often we get to sit down (OK, in this case stand) with our consultants and have chats like these, so I was grateful for the extensive teaching and just the ability to sit down and have a chat.

In the afternoon we had a tutorial on the thyroid. Now, endocrine is not my strong point, I get muddled what causes hyperthyroid and what causes hypothyroid, don’t even get me started on anything else.

However, in the two and a half hour tutorial we had, I did not zone out once. No PowerPoint insight but I got the most out of a teaching session I had ever had. It was in the form of a general discussion and with a paediatric surgeon (so God in my eyes) and I learnt so much. Granted, I am writing this two weeks later and still haven’t had a chance to re-visit my notes but I came out of that session a lot more confident.

I am loving the teaching we are getting at the moment. I feel so much more supported than I did last year when we were essentially left to get on with it. The only downside is that we have so much teaching, it’s hard to sneak in to surgery. You then add the addition of the second years and the Bucks students, and we realized we have three sessions of theatre for a 5-week block in theatre. One of the draw backs of a small hospital I suppose!

Wednesday

I was scheduled to be in for the afternoon for theatre but ended up moving to the morning and had the best morning ever. Sure, anal fissures and colostomy reversals aren’t glamorous but I have found myself getting into colorectal. Huh, maybe instead of Neurosurgery I am destined for the other end of the human body.

I had a great surgeon who not only responded to my email in 5 minutes on the same day, but was also great for teaching. There was a fairly simple operation to begin with so I hovered around and mainly helped with the anaesthetists. I got to perform my first jaw thrust (100% easier on a human than a manikin) and got to see the induction of surgery and was soo close to inserting a ET tube but panicked at the last second because I was too afraid of knocking teeth out….

The second case will be a case that sticks in my memory as it was the first time I scrubbed into a surgery.

I have been waiting for this day for THREE YEARS. THREE YEARS. I enjoyed it so much. The nurses help me scrub in as it was my first time and I managed to stab the inside of my nails cleaning them out too hard, but I didn’t care. I was there, standing at the table touching the patient which felt sort of illegal.

I got to see the operation up close, and the team found something for me to do. OK, it was very much slowing things down for them, but I got to clip the end of the sutures (which is something the scrub nurse normally does, but they were so lovely getting me involved). It was amazing to see the detail of anatomy I last encountered in first year and at the end the main surgeon scrubbed out, and I got to stand in their place helping to cut the end off the sutures. I also got to inject sub-cut local anaesthetic, and place the bandages.

I was beaming (and very grateful to take off the gowns) at the end and I ate lunch on a high.

As, I was meant to be in surgery anyway in the afternoon I thought I would try my luck and attend the anaesthetic side with our years DST. It was the first time we had actually met in person which felt strange! I really enjoyed this and we talked though the purpose of each medication and discussed the new technique of surgery where everything goes into the IV and nothing ventilated.

I also got to place my first IGel and I sat chatting with the trainee about their experience of anaesthetics. I have considered aesthetics, aligned with surgery, it is the sort of environment I wanted to be in, but I am not completely sold on it yet. I like the idea of being involved with ICU and paeds but, I don’t know. I want something more fast-paced, but I like the lifestyle and knowing where you need to be and what is roughly going to happen each day.

I ended up going home that night exhausted but- it was such a good day.

Thursday

We had some further teaching on Thursday morning with the surgeon I had yesterday. Despite starting at 10. K and I found ourselves killing the first hour in the education building as we have to get in early for parking. Ironically, they have taken away 100 odd spaces to building more car parking. Great in the long term but a pain if you have a weirdly timed teaching session.

It was nice to catch up with K though, I really do miss our lunches together.

It was another general discussion session again, so I gained a lot out of it. We talked about chrons and followed through a pretend patient from first presentation to tertiary treatment. You can tell which sessions I tend to get the most out of because my writing is literally everywhere, and I tend to come out with ink all over my hands…

In the afternoon, we had another Simulation session. I had led the week before so this week I decided to get some prescribing practise in. If you aren’t the helper or the official prescriber, it is easy to drift off in these sessions and gone are the days when drifting off was OK.

Instead, I listen to what is going on and practise prescribing on a fake prescription sheet, This helps for the PSA I will take next year and for getting used to the BNF. I am slowly getting used to this, it’s going to take practise, a lot of practise and part of me wishes we had done some earlier in the course but oh well.

In the evening we had a fantastic Women in Surgery event which I attended online. Surgery is VERY male dominated, and it’s easy to see why. However, the surgeons on this talk were awe-inspiring. It was with all grades of trainees from us medical students all the way to ST7 and common questions were balancing training with kids, and time management. My favourite tip was – if I can pay someone £20 a week to clean my house, so I don’t have to, then I am paying someone £20 a week and that’s two more hours I get to do what I want with.

One talk stuck with me a lot more which was basically saying “Stuff being a woman in surgery, you are not a woman in surgery, you are a surgical trainee, that’s it, see yourself as equal to your peers, and you will succeed….

I currently am sorting out a day’s observation with this surgeon when I get a spare moment.

Friday

Really starting to feel the tiredness now, however, no rest for the wicked and medical strudents.

I was in Stratford today which is somewhere I was for first year, so it was like coming back to an old friend. I had a clinic with Mr O in the morning, so I was looking forward to it. Of course, I was looking forward to it. Despite it only being a 20 min earlier exit than usual, I treated myself to a McDonald’s which was only round the corner from the hospital….. a bit ironic really.

I arrived at the clinic and seemed to have forgotten the big thing with clinics. The ‘no patients” bit. I did get to see two people though (which apparently is rare) and got to see haemorrhoid ligation (actually pretty cool) and talked through referrals from the screening programme and GP (IRON DEFICIENCY ANAEMIA).

Honestly, I have loved having Mr O as my consultant.

I then spent the afternoon having a wander round beautiful Stratford. Well, I was there, so it was a no-brainer really. It is so, so beautiful !

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Care of Surgical Patient Week 1

I’m going to level with you here, I was not expecting much from this block at all. Surgeons and surgery have this expectation attached to them that you are going to be ignored mostly for the block and spend five weeks in the corner staring at people moving their hands around. For once, I am so glad to be so far from being right.

Monday

New block, new me. And this time also a new hospital. Warwick hospital is the one hospital attached to the medical school that I have yet to see. And we were finally here for surgery block. Monday was just a day of inductions but K and I had decided to drive there the week before just to get to know where we need to be heading.

I arrived at the hospital and began to walk from the car park to the medical education centre which involves me walking through the hospital as I didn’t know any other way. Over at George Elliot all they have boxes of masks at each entrance, and it means that all staff and visitors have no excuse for not wearing a mask. So, I had turned up expecting this.

Warwick has decided to not do it this way. Great for budgets, not so great for me. I had to walk through half the hospital with no mask on as I didn’t have one in my pocket. It just so happened it was the busiest I’ve ever seen a hospital corridor, and I’ve got so many dirty looks. Thankfully, I managed to grab one from the canteen halfway up the corridor.

After that dilemma I made it to the medical education building and I had to sneak in behind someone as I didn’t have an ID card for the door yet. You can see how this morning is going.

Anyway we get there, and I managed to find a room and I set myself up for the day. Our first lecture was virtual, and it was just getting to know the clinical education fellow he was going to look after us for the five weeks of a surgical block. It was very weird all being on a virtual lecture, but all sat in the same room.

Thankfully, our second lecture was a face-to-face, and we had a formal induction to surgery at Warwick hospital. I know my blog is looked at and read by a good few number of people, but I never expected to get recognized. So, I was a bit lost for words when we had to introduce ourselves and the person running the session said ” no need Abbie I know you’re off Twitter”.

I do this weird thing in my brain where I forget that people on Twitter also real in real life, and it always takes me back when someone mentions what I’ve done on Twitter in reality. It was a laugh though, and I guess it’s just made me remember that real humans read my tweets.

We didn’t have too much information given to us before we arrived at Warwick, so on this day I was just a Fountain of questions and wanting to know everything about surgical block before we got started. I have to say this hospital was amazing and I got every single question answered.

We had a tour of the wards that we would be going on, and we got told exactly what time we should be there every morning, where the changing rooms were, where the best places were to get a free cup of tea or coffee, and what areas were green and amber which is a unique addition to life in Covid land.

I’d start the day with 25% hope this block, I left with 95%.

That day we also got retested for our Covid masks as I didn’t particularly trust the one that I was tested for at a previous hospital. We got to use the less scientific version at Warwick which basically involves you tasting a spray that they spray into a hazmat suit type headgear, and you do some weird movements just to see if the mask lets any of the particles in.

Going home that day felt weird. K now owns a car so we no longer travel in together as where we live it doesn’t make sense for us to drive to each other’s houses. So I got in the car, and normally we have a bit of an informal debrief at the end of the day joking and discussing what we have seen.

I know I didn’t have that and I was very aware of the empty seat next to me. Honestly, it feels like he has died 😀 . It does mean however, I can blast my musical songs out loud and have no judgement put upon me.

Tuesday

Slightly earlier start today with it being 8:30 rather than 9 o’clock. I still haven’t managed to figure out the new timings from my house to Warwick hospital so inevitably I was running late.

We had wound care teaching which was basically going over how we would assess and re-dress a wound. I am a total popaholic and nothing is more satisfying than seeing a big wound be absolutely drained of all the puss that’s in it.

We also were taught how to do flu swabs which is very current with the bug that’s flying around. It was a long morning as most of it was just being talked at, but at the end we had to demonstrate that we knew what we were doing and we were all passed with flying colours.

Everyone else decided to go home after that, but I found that I haven’t been working as well in my flat then I should be, so I decided to stay on at Warwick and go and work in the rain that we had been given for lunch.

This also meant that I was going to stay for the virtual lecture that we had in the afternoon about stomas and polyps. Which was both a mistake and the best thing I’ve ever done. I was expecting to be sat on teams watching someone talk us through a camera, can imagine my shock when the surgeon who was teaching us walks in the room that we had been assigned and there’s only me there.

However, the surgeon was the surgeon that I’d been assigned to, and it was actually one of the best teaching sessions I have ever sat in. Sort of intimidating when no one answers the question online, so you feel obliged to, but we struggle on.

This was also the day when I realized Warwick surgeons are amazing. My assigned consultant brought up the fact he would sort bedside teaching and OSLERS with K tomorrow, without me having to bring it up. I think I nearly fell over, I’m so used to chasing people up for WEEKS. I still have a ticket from year 2 unsigned.

He also had a Harry Potter lunch box, 100 points to Gryffindor.

Wednesday

My first day of clarking. i have never clarked a patient before despite being in third year. This was something I was more than keen to change. I was assigned to the sorting hat ward for the day and, yes, I was a changed Medical student after.

I will never forget my first patient. I was nervous, stuffed up my ECG and couldn’t find a vein. But it was OK, I had not done an ECG in MONTHS and had completely forgotten where the pads go. However, I loved chatting with the patient, finding out what was wrong and escalating to the reg. It felt like all the studying and ridiculous amounts of work were paying off.

One of my patients was admitted and was unfortunately given a heavy diagnosis, but I had gotten on well with them on the ward and I knew it was going to be nice to follow up this patient through his journey at the hospital.

I was exhausted by the end of the day but so happy. Finally, being able to interact with patients and chat to them and do what I have been trained to do. That is what the pandemic took away from us and still takes away from us today.

Thursday

That morning I joined the post take ward round which started at 8am (ouch). This would give me the chance to A) find out what a post take ward round was and B) see the progress of the patients I clarked yesterday.

I was amazed at the progress of one of my patients. It is amazing what a simple bag (or a couple of bags) of fluid can do! They were severely dehydrated when they came in so seeing their progress was incredible.

I also helped the F1 out by managing the notes, so they were not juggling millions of files. It’s not much but kept me going whilst we saw the million and one other patients I had never met before.

In the afternoon, we had our simulation session. I love simulation as it gets us to practise as if we were independent FY1’s instead of med students shuffling round the back of the ward round. It was also a session to catch up with each other as our weeks are so busy now, I don’t even get to see K.

That’s another thing the pandemic has taken away. The chance to see others and catch up. There are some of my friends that I haven’t seen in over a year.

We ran several simulations of surgical emergencies that come into A&E. I volunteered to lead one which resulted in a diagnosis of acute gallstone pancreatitis. I really enjoyed it but I learnt that I need to slow down. Too easily I slip into recalling my notes and not taking head of the situation and asking for help, simply because, I forget I can ask for help.

That evening I was also struggling with a chronic hip problem. So, I had hobbled back to the car and by some miracle managed to get an appointment the next day.

Friday

In early again for endoscopy this time! I was intrigued as it’s something we are told about all the time but never see. I was with my consultant again so I knew it would be a productive morning. I got to see a vast array of different signs and this is going to sound really weird, but the inside of the ileum (the last part of the small intestine), is beautiful.

Jejuno and Ileum Normal -The Gastrointestinal Atlas -  gastrointestinalatlas.com
This is an image from Google but shows the villi which look like sea anenomy.

The teaching I got was incredible as well. I am not sure what it is about third year but suddenly, I feel like I have a place on the ward and people like having us there. They want to teach us and get involved. This is what I am here for.

I had to get big scrubs to cover my hip brace, so I ended up having to yank the trousers up every two minutes.

Saturday

Yes, I am slightly questioning why I am up for an 8am handover on a Saturday but we were scheduled to follow the SHO for the on call. This is essentially where any department can bleep the SHO (mainly ends up being A&E) for a surgical review and the SHO can decide if they need to be admitted or reviewed by a senior clinician or discharged.

I was also getting used to my new additions. I was given some crutches by the physio as the pain from the hip is ridiculous, but these were getting very annoying very quickly. They hurt my hand and basically signalled I was going to be a slight inconvenience. However, I need them. Hopefully, I can just rest my leg for the week and might not need the assistance in a weeks time.

Around mid-day I lost my SHO and wandered back to the ward and ended up finishing the ward round. It sort of came to an anticlimactic end, and I was left hovering round the ward not sure what to do. However, I got wind of a cholecystectomy happening in the afternoon and decided to hang around for that.

I went down to the amber theatres and waited. Turns out it was not going to be happening for at least the next three hours so I thought I would sneak in and watch a nail being inserted into the bone whilst I waited. The team were all really lovely making sure I was catered for with my leg and I was having a good old chat with the rep for the system they were using getting to know all the instruments and what they were there for.

I was also having a good old giggle with myself as being an orthopaedic surgery, they had literal drills to get the screws in. Something I am normally used to seeing in my dads tool kit.

Finally, at 6pm the time came for the operation I had hung around to see. Except this time it was an appendectomy rather than the cholecystectomy. I was so glad I waited. This appendix needed out and was nearly falling apart as they handled it. I was also having a discussion with the anaesthetist about the agents they used and what each drug does. We don’t get a huge amount of teaching with peri-op so I wanted to make sure I had a good idea about what was going on.

Happy, I had finally wiggled my into theatres.

I eventually escaped at 8pm promptly ordering a pizza on my way home. Well, I did go in on a Saturday after all!

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Care of the Medical Patient Week 5

Where did this block go? I feel like we only started it 2 seconds a go.

Monday

We had planned to go in and attend a ward round with one of the Warwick MVP lecturers today. V is a lecturer most people want to get into clinics with, but we found he does a ward round on Ravenclaw Common Room every Monday, so naturally we wanted to go. I was looking forward to it as the Ravenclaw common room is a mixed ward that takes patients from A&E etc so there was going to be a lot of variety.

We were heading up to the ward and wouldn’t you guess, the two students who we bumped into trying to get into Gastro Clinic the other day, who were also going to the same ward, to shadow V. Why we don’t co-ordinate these things I have no idea……

It was fine though as they graciously gave way to us, and we hung around for V to show up, and hung around , and hung around. We eventually ended up bleeping V and turns out he was helping the finalists OSLERS. A bit rude of the finalists taking V away like that 😉

We ended up going for a wander to the Neuro ward (more like I dragged K there) and low and behold, a familiar face was there from second year in the form of a doc who used to do great teaching with us. Relieved, we decided to say, and we were in time for the ward round. Which did surprise me a bit as it was 9:40 by this point.

I could get used to DGH life.

We actually got such a good morning which was brilliant as this was something we were not expecting. The consultant was engaging with us and was teaching us with every single patient. I really enjoyed just being there. Everyone was there because of something that had gone wrong with their nervous system, and I was so there for it.

There were a couple of conditions that I had only read about in textbooks so I was loving the day for learning and being exposed to a speciality I have been DYING to see since day one.

We finished up chatting to a patient who had a really rare presentation that K NAILED whereas I had not a clue what may be going on.

***SPOLIER ALERT FOR MY YEAR GROUP*** (not that anyone reads this)

We ran and grabbed lunch, so we were in time for the afternoon COMET. Thankfully, this one was NOT on palliative care but on one which we all know about. Covid-19. That sneaky thing had managed to make its own COMET, and I was so here for it. Finally, back in my comfort zone and doing the logical side of medicine.

We had an A-E station of a critically ill COVID-19 patient, an ABG station (my brain has never had to work so hard) and a ventilation technique station which I relied mostly on my googling during COVID-19 to answer.

I know I still struggle, but hopefully , a bit of time and more experience will help.

After, I had to get back quickly as I had JASME chats which I was hosting. I hate hate hosting because , well, social skills, but it was a fantastic discussion today, and it’s nice to have a fully engaged panel.

After, I pretty much slept as it had been a long day. I swear my stamina is dismal at the moment.

Tuesday

Today we decided to go for our last morning on CCU which we were gutted about. We really like this ward and have come to know the doctors really well. Ok, K was secretly hoping one of the CEF’s would be there (they were not) and I was hoping to catch Dr V (who was also not about). Instead, we spent the morning semi blending into the background whilst the consultant grilled the docs in front of us.

However, we did have a lovely patient who we began to examine before the ward round cut in but during the round he came and chased us to show us more of his signs and to tell us more about his medical history. That was a first for us ! He also had a TEXTBOOK heart murmur so at least we got to see something useful.

We went to the Neuro MDT at 11:00 and low and behold, the same two people who we bumped into yesterday were there AGAIN. Honestly, same page thinking.

It was OK though because the consultant was lovely, so we were all there (huge room so plenty of space for social distancing) and we sat there and watched the MDT for three patients. After which the consultant paused and told us to go.

Honestly, in AWE of this guy. Recognizing we didn’t need to see 20 patients being talked about and that we had got all the use out of the MDT? Perfect.

K and I decided to call it a day there. We did have a hunt round our other ward for a blood (which there normally is) but nothing came up. Hence, we ran off to enjoy the weirdly good weather.

Wednesday

Up early today as we finally have Dr N’s clinic booked in. Which of course started at 8:30, I was pretty happy to get up though as I was looking forward to going over the endo side of medicine. Something we have hardly been able to touch.

It ended up being a bit less Endo and more Philosophy and calming us down about finals (something I needed more than K) but that didn’t really matter. I actually enjoyed the break and we began chatting about how technology in medicine is moving and what the future may look like. The finalists had just sat their OSLERS so we were also chatting about the layout of that and what to expect.

Another early finish that day. K and I have been in every day this block, so we are trying to slow things down this week, so we get some sort of rest for Surgery. We did end up driving over to Warwick though as we both wanted a practise before Monday during rush hour. I actually really enjoy the drive. I’ll have to go over to old Warwick if I finish early one day just to soak up the town that the uni is named after (and situated nowhere near).

Thursday

Our last day! Well, unofficial last day, but we have decided to give ourselves the last day off. Today we had a booked in palliative care experience morning which I had been slightly dreading since the fateful COMET.

However, it turned out to be a good morning. We started off linked on to the MDT via a tablet and then got to shadow nurses as they went to see the patients they were looking after in the hospital.

I got to go back and see one of the patients on the ward who I had met before in a MDT meeting. They were struggling to get them to feed, so I sort of took it on myself to try and have a go myself. I did everything, hand them the spoon, put the bowl under their nose so they could smell the food. I even went on the hunt for biscuits and cakes just in case they took their fancy. Nothing. I think between us all, we had tried everything except pick the food up and physically put it in their mouth, which is kinda the definition of torture. They were not refusing food for a palliative reason but due to dementia so it more of encouragement rather than just leaving the food in the hope they might eat it.

I am surprised about how much I enjoyed that. I wish I could have seen others but K and I are both shattered so I think we were running out of charge by lunch. That day we also had to do the end of block admin so we handed back our keys and had our last lunch and ice cream. I think I should have a loyalty card for that ice cream bar. At least my bank is going to be slightly happier now and hopefully my waistline will start to shrink a bit.

But it is good ice cream.

Friday

I wish I could say I had a lie in. I WISH. Instead, I dragged myself out of bed much earlier than I would have liked to and headed over to the big teaching hospital for an MRI of my slowly “getting to the point where I want to chop it off” hip.

It has been playing up a lot. Meds don’t help it and physio has not helped (I think it has made it worse) so we decided to give it a scan to see what was going on. So, here I was 7:30am, in a hospital.

Even though I had planned my clothes to have no metal in them, it still was terrifying being loaded into the machine. Just in case you haven’t realized by now, I have quite bad anxiety so all I could think about was being glued to the machine because I had forgotten one bit of metal.

However, I didn’t get sucked into a lifetime of chilling in the MRI machine and spent half an hour getting scanned. I always forget how small the openings are for MRI machines, so I was a bit panicky when I got loaded in but after a while it was OK and I had a nap.

They also scanned my knees (which is also great because they are stuffed up too – thanks mum for making me grow up dancing which I think has shot my knees) and I got to take a peek at the scan. They showed me very quickly the images, but I was not looking too hard at them because if I miss read them and thought I had seen something, I will be worrying about it for the rest of the time till I have my next appointment. However, it was pretty dam cool seeing my own hip and knee joints.

I treated myself to some M&S croissants (glared at the colin cake) and got myself back home for meetings.

The first was with a rep from Elsevier as I was being inducted into the ambassador programme. The best part about it was I DON’T HAVE TO DO ANY PLUGGING.

I am so over being a rep for a place and having to plug everything onto my uni Facebook pages because I know it annoys people and people don’t read it. However, this programme sounds amazing and I can’t wait to get involved.

I also had one final meeting which was my end of block sign off. Despite me sending the forms about 6 times however, nothing got through to Dr V so it was an awkward 10 minutes.

We then get to the best part of the day. Pizza. We haven’t seen the two gals who we used to travel with EVERY DAY since November so we arranged to meet up and catch up on all the car stories we had missed.

What a pretty good way to end the block …….

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Care of the Medical Patient Week Four

Got to be honest, been putting this one off as I didn’t want to relive last Thursday considering I made an idiot of myself.

Monday

Since the disaster of the lost weekend thanks to my vaccine, I decided to make this a half say. We went in for a morning of teaching which was meant to be face to face but found it all to be moved online.

I am so grateful to have the teaching as we barely had any last year but the trip to the hospital is 23 miles round so we could have been saved the journey. Projectors are also not amazing at reproducing X-rays of lungs so it took away some of the teaching. However, it was a much-needed review of asthma, COPD and TB. TB was something which I sort of knew but needed a review so it was good to go over this condition in detail.

After, I went home supposedly to do work but that didn’t happen. Stopped off at the new Aldi on the way home (I am re-converted) and joined in for a peer teaching course. They started running this course last year at Warwick and it’s designed to make us better peer teachers which is something I want to upskill on and I know it will make me look better when it comes to Medical Education Fellow jobs (something I know I want to do when I leave Medical School). It was really enjoyable however, I started to bang my head against the wall. Why does no one talk in teams?! It makes the session go on for longer and makes it painful to watch.

I then went straight from that to sort of getting some work done that evening but I am struggling so much with getting work done at home. I am tired most of the time and I think I have worn out my study space. I need to mix things up when I have the time but I never seem to find this time.

Tuesday

Today we decided to get some clinic time in Gastro. The car park was a nightmare so I sent K in early to get into the clinic but we were already beat, by some of the consultants own students. It is a bit hard to argue with that. We wandered around and thanks to some lovely HCA’s and Nurses, I managed to get into Foot Clinic.

I had braced myself for a morning of uclers (which wasn’t helping my already feeling ill because of not eating breakfast and sensitive to smells state) but actually turned out to be a really useful and informative morning. I spent the majority of my time with the podiatrist who was answering all my questions, and we got on well.

To my surprise, I actually coped well with the uclers as they were all really well maintained and healthy. That’s my own bias kicking in really. I do feel ashamed for having that initial reaction to the clinic, but I am so glad I did join.

I was shown how to examine uclers, how to care for them, and then unfortunately, what to do when the foot was in danger. I even got to try and do a foot Doppler. I was asked “do you want to do one?” and may have said “Yes” a little too quickly.

i really enjoyed this morning but had to go before the end as I had teaching at 12:30 on frailty. We had a PA who delt a lot with strokes, so I was in my element. Even on her exit she said, well I’m going to see a patient at home now so if anyone wants to come? I replied ” Don’t, because I will follow and come with”.

I don’t know what’s happened recently, I feel like I have suddenly come into my element and this confidence has come out of nowhere.

We then had THE BEST TEACHING in radiology ever. No PowerPoints in sight (+1000 points to Ravenclaw) and a doctor who was funny and told us to PUT DOWN OUR PENS.

They then proceeded to pull out lots of PHYSICAL X-ray graphs and we played spot the diagnosis. I learnt so much and it was so engaging. This is teaching we need, and I took a lot away from just listening to a lecturer who was engaged.

After the lecture I attended a meeting with some staff and students to organize our disability away day. We are finally making progress with the scheme and I am really excited with what the potential this scheme has.

Wednesday

Manage to wiggle our way into a Neuro clinic today of which I was beyond excited about. We got to sit in with one of the Neuro’s from UHCW as they saw patients with movement disorders.

I was so happy to finally be in a clinic of something that normally gets such a bad rep at Medical School. I love Neuro and we do not get ANY time in rotation in it. I’ve had to learn all of medicine these past few weeks on a cardio ward.

We got to see the SLICKEST upper and lower limb neuro exam ever (the reflexes were incredible and that is the exam I aspire to be able to pull off one day). We were also taught the specifics of Parkinson history taking and specific tests we can do to look for Parkinsons in patients.

We also found out our teaching in the afternoon had been moved to 3:30pm as was online! Cue K and I high tailing it home. Well, when I say home. I had some important filming to do first:

Yes, it’s the return of everyone’s favourite YouTube ASMR doc! This time it was the ear exam which is ironic considering I have stuffed up ears and am currently waiting for my next ENT appointment to figure it out. I’m telling you, the concentration I had to pull for the hearing exam was hard as the recurrent infections have affected my hearing.

Thursday

Here we go, not my finest moment. We decided to head to breast clinic in the morning as it was a highly rated clinic, and it lived up to its reputation!

I ended up hanging with the radiographer who in between converting me to radiology, spent the morning teaching me how to read Ultra Sounds, Mammograms and the process of taking a biopsy. It really was a good morning and they were so encouraging of me even when I pointed out something obvious like a “rib”. As they were so lovely, I let the fact they kept calling me Abigail slide…….

Then we had a palliative care comet. I was actually pretty excited about this as I missed my surgical comet thanks to a COVID-19 quarantine. I was in the corridor waiting (it works like an OSCE but gets you to learn on the spot things and has no bearing on your grade) and joking around with everyone. I love the team at Gelliot, and I am gutted to be leaving them next week. However, I got into the second station and fell apart.

We had to talk to a “patient” about their wishes for their last few days to weeks and fill out a RESPECT form with them. It could not have gone any worse than it did. I completely forgot how to structure a conversation, and it threw me when the patient responded with “Call me Mrs Smith please”.

Suddenly I became incapable of getting words out. I froze and lost any capability of making a sound. I was offered to re-start the session but I just completely lost it and came out of the session a bit shaken.

In the next session it was a bit more straight forward, but I was still a bit shaken from the previous session. I was asked the first question, and it all just came tumbling out. I became a blubbery mess, and it wasn’t because I just had to talk to a “dying person”.

The finalists had started their finals this week, and it just hit me how near we are to the end. Next year I will be a doctor and suddenly have responsibilities. Now, not knowing something wasn’t a case of a few marks, but could be potentially lethal. I didn’t feel ready for that. Now, I was so ashamed if I didn’t know something. I’ve been trying to work at night and feeling like I am getting nowhere because of the sheer amount of work. I’m sat here trying to remember things and just can’t retain any material.

Thankfully, I had amazing staff sitting there with me and I tried to pull myself together to carry on the session. It really wasn’t the situation, it was just the straw that broke the camel’s back.

After K and I stopped off at McDonald’s to get milkshakes because we deserved it after all that. I took time to myself that evening. It took me 4 hours to recharge to speak again and in that time I just sat sewing my scrubs getting them just the way I like them, covered in neurons and stars ……

Friday

Academic Day. Nothing huge to report. Sat behind a computer all day. I had tried to go for a swim in the evening but my hip literally allowed me all of 10 minute in the pool. I had to get out and take 45 minutes to get changed plus an extra 30 minutes to do a 10 minute walk home. The takeaway was a ‘I’m feeling sorry for myself” treat ,:D.

One more week to go.

Posted in Blog, Medical, Medical School, Medical Student, medicine, Uncategorized

Care of the Medical Patient – Week Three

Wow , two weeks left of this block. Scary

Monday

Bank holiday

Tuesday

We decided to not attempt the ward round before teaching at 11:30am today. It was the day after a bank holiday, and you just know it was going to be chaos. That did mean however we were roaming the hospital car park for 40 minutes trying to find a space. We were in one car park when I witnessed a doctor scale a grass bank in their 4X4 and park neatly ontop of the bank.

My KA and I were not even going to attempt that.

We eventually got a space and were only 2 minutes late which in medical student speak, is bang on time. We had an hour on palliative care and then had a free afternoon which Klaudio and I were determined to fill.

We ended up in Respiratory clinic as we had not had that much exposure to lung related things thanks to COVID-19 (closest I have been to a Resp ward was on the day we got taken out of placement and were sent away within two minutes). I really enjoyed the clinic and it was good to see other areas of medicine and look at x-rays in clinical context.

The consultant also wrote with a fountain pen which I have not seen being used in forever. I’ve tried to get back to using a fountain pen but alas, has not happened due to having weird handwriting and a lack of patience with them!

I felt good. We ended up leaving at 6pm but you know what, it was a productive afternoon, I learnt a lot, and thats all I can ask for.

Monday was also the debut of my bumblebee scrubs – of which I love to pieces.

Wednesday

Our first day without anything pre-scheduled for a while. We headed up to our other ward Beauxbatons (can you get the theme I am going with here) which we normally steer clear from. However, today was changeover day and we were hoping to get some new F1’s to adopt us.

And we landed a JACKPOT. i walked into the doctor’s office and 70% recognized the FY1 sitting there. She started talking and yep , it was B who I did Revue with !! (It’s hard to confirm identities under masks).

The rest of the doctors began filing in and we knew this ward was now going to be one we could rely on. Klaudio and I joined in on the ward rounds which were super quick as there were various welcome meetings to get to. We had a patient who was scared and worried about dying. The ward round moved on but I couldn’t leave them like that. I grasped their hand and said that it was going to be ok and that they were not going home to die. They smiled and seemed to relax a bit. I believe they had dementia so just that little hand hold meant a lot to them.

After the ward round ended we tried to get some bloods but if veins were opposing magnets to needles, this patient certainly had them. They were more than willing to be a human pin cushion but that isn’t what we want for patients. So the standard two tries later and we left it to the doctors. It was so frustrating as these veins were incredible…

In the afternoon we tried to get into another clinic. This time ENT. I seem to have an affinity to this speciality, but that is purely because of my medical history. I was excited and we hung around for half an hour because we were early, then time for the clinic arrived but no consultant. We checked the notes to make sure there were face to face of which there were but still no consultant.

We waited half an hour before deciding to call it a day. It was frustrating but what can you do. The HCA’s were lovely at updating us but I felt sorry for the patients who were hanging around with the possibility of their appointment being cancelled.

We treated ourselves to ice cream for our patience:

I only have two weeks left to make the most of this ice cream bar ….

Thursday

Wow, it was so hard waking up today. Despite having Monday off, we are both shattered and feel like we have done a whole week already. it was time for our ILS course which is Intermediate Life Saving.

Basically, we had covered a lot of this already, but it was a step-up from just carrying out an A-E approach to MANAGING a crash call.

I really enjoyed this day. I LOVE simulations and it gives me a chance to practise what I have learnt and feel just that little bit of a professional. Thankfully, only one five minute lecture for the whole morning and we were off learning how to manage airways and ventilate an unconscious patient.

We then got to learn how to use the defib, how CPR felt in real life (my arms are still not right typing this out on a sunday) and how difficult a one handed jaw thrust and mask holding is. We also got some free snacks which I am always more than up for.

Klaudio and I had our OSLERS in the afternoon which step up this year. We get assessed based on final level. I wanted to get off on a good foot, but I did keep in the back of my head that I am literally 3 weeks into the so called “learn management” year so not to hate myself if it goes badly.

I got a patient with a good history, but I was hit with the classic chatty patient. My history was 15 minutes long which was frustrating. It’s just a skill I really need to hone down. As much as I am interested in the patient, I just need the information I need out of them before I find out what their great uncles on their dads side employment was….

It was an unusual presentation. Though arrhythmias are meant to be our bread and butter by now, this particular one I had not seen before in a clinical context. It was hard coming up with the management and I defiantly stumbled my way through this.

I think I did ok. Results are still to come in, and they don’t matter with regard to the degree but the Type A personality of mine want’s to do well, naturally.

Friday

End of the week at last. I think Klaudio and I only managed to drag ourselves out of bed due to it being the end of the week and we are going back to Hogwarts ward.

We got told a consultant who loves to grill us would be there today so we were a tad nervous but it ended up being our favourite consultant AND a doctor we had already worked with on another ward. So shaping up to be a good morning !

We have also discovered that although we cant get onto the PC’s (because even though we have logins, we get get onto the system) we have access to the printer. We took FULL advantage of this and photocopied the ward notes (IE – handover sheets) so we could follow along on the ward round but of course made sure to dispose of them before we left.

The ward round was brilliant. The male bay ended up being the weirdest round as all the patients were up in their chairs having a good old chat between them with some even moving around to chat perched on the end of beds. There were some BRILLIANT murmurs including the classic one you expect to hear on wards and some sweet patients.

I was helping a lovely patient put her socks on after the consultant took them off and she asked if I was a doctor or a nurse. I was shocked. No one had ever asked that before. They just assume I am a nurse and call me so. I giggled and said I was TRAINING to be a doctor. She said ” oh that’s nice, I never know what to call you lot”. I said orange badges mean students and how nurses have uniforms etc but said I was really grateful for her asking.

I don’t mind being called a nurse. They do such amazing work and I admire the way they can handle all bodily fluids. I am a whimp and even the sight of flem sends me retching. I suppose it’s just annoying but not too much of a fuss with patients. They are ill afterall.

I made sure her toes were cosy and carried on with the ward round. The team were so lovely and we felt so included and were sharing the giggles and teaching.

We then ended up in the last bed which was in a side room. The TV was on in the background and we checked on the patient and had a discussion about his care.

However, something was distracting me. On the TV behind the consultant was BBC news. Prince Phillip had pictures being shown in a weird montage that was slow and fady. I remember thinking he was either dead or it was his birthday. I couldn’t see the writing though and the news reporter was only wearing a black jacket and not all in black.

However, it soon went to breaking news, and I was able to read he had died. We all knew it was coming but it’s so sad with him being weeks off 100. This day was getting more packed by the minute.

In the afternoon our amazing consultant spent a good half an hour (probably more) teaching us about Aortic Stenosis and my brain was on fire. This was incredible. However, he did assume we were second years so wasn’t teaching us management. It was a good 15 minutes in before I got an opportunity to correct him. I wish we had different badges or lanyards to denote year groups like other medical schools instead of resulting to my technique:

That afternoon I went to get my second jab at the place where it all started, UHCW !! I was excited to go and turns out the BBC are filming at UH for the new series of Hospital (my favourite programme):

All my sign offs completed !
These bump devices were used to maintain social distancing

And that was the end of a looonnngg week. Im thankful I left my jab till last thing on the Friday as the side effects came out of NOWHERE. I was knocked out for the majority of Saturday sleeping all day bar a couple of hours. My joints ached, I had the headache of a lifetime and was shattered. However, one sleep later and I was good to go.

What a week.

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Care of the Medical Patient Week Two

Monday

Straight of the bat at 9am with a bedside teaching session. These are sessions where we get a doctor (aka someone who knows what they are actually doing) to take us and teach us conditions at the patients bedside. We had a fascinating patient with both a lung and heart problem which baffled us no end. You mean patients can have more than one thing wrong with them?!?

I managed to get my history “just” under time, but it is difficult to get the histories down under time with real patients as everyone wants to chat. In our exams, SIM patients are given a script so know exactly what they need to say and when – hence OSCE’s being timed.

Anyway, this was an interesting patient as it was difficult to nail a diagnosis from the history. You learn pretty early on in medical school that you should have an idea of a diagnosis at the end of the history. Your examinations and investigations serve to rule out other differentials rather than back up your own. However, at the end of this case. I had no idea.

We had a discussion about our case afterwards and it was one of the best teaching sessions I have had, so now Klaudio and I officially have a favourite doctor.

After our session we ended up rushing back home as we had an online lecture for which we thought we had to be on teams for.

Turns out we could have just stayed at the hospital as it was a virtual/ live event. Oh well, more time to work and then an earlier time into bed for me! (Yes, I am an old granny who likes being in bed by 11pm).

In the evening I also released my TikTok parody to Dr Glaucomaflecken which got a lot of views on TikTok, all except from Dr Glaucomaflecken. I will make it my life’s mission to get him to see it (or maybe not because of you know – whole whole becoming a doctor thing).

Tuesday

Online Learning

Wednesday

Full day on the wards to ourselves ! We decided to head to radiology to see some pacemaker insertions as we didn’t get to see our lovely patient get their pacemaker the other day. I had forgotten how heavy lead gowns are and felt as if I had the weight of the world on my shoulders (which – is very representative of a medical degree).

It was a fascinating procedure and the doctor running the procedure again was lovely and talked us through what we were seeing on the x-ray. It did slightly clear things up, but I have to admit – I believe X-rays will be forever a black and white mystery to me.

I was in awe of the technique. A whole life-saving device inserted via a couple of wires. The procedure went on a little longer than expected but wow. Taking our gowns off at the end was a relief, I think I had forgotten just how heavy they were. The doctor came out at the end and sat down with us and took us through what was going on. I even began to understand why the x-ray machine was moved in certain positions and what the reason was for the minor delay.

I don’t know. I’m not sure if it’s because we are third years, but Medicine is starting to feel more serious now, like I am actually studying for the rest of my career, not just an exam.

Heart pacemaker: MedlinePlus Medical Encyclopedia

We ended up grabbing a lunch after and attempted wards. We went to our Hogwarts ward as we knew the doctors better there and we were not disappointed. Our favourite doc was there plus a Warwick Grad FY2!! I swear 1:2 doctors we meet are Warwick grads. Must be something in the water keeping everyone round Coventry.

We ended up chatting to the patient who had their pacemaker fitted the other day and then chatting further about ECG’s and pacemaker affects on ECG’s. We may be getting a bit cocky, but I think Klaudio and I are finally getting used to ECG’s.

Thursday

April Fools Day!!! I had been thinking about how I could get a prank in before 12pm and I DID IT. Managed to convince Klaudio that the beloved Ice Cream bar at Gelliot was closing. Well, I managed to have him fooled for all of 10 minutes but I count that as a win.

We had a case based discussion session which was useful as we talked through taking a history of a patient presenting with a fall ( a lot more to consider than you might think) but it was a bit rushed. There was a miscommunication between Warwick/ Hospital and us so it ended up being more of a mini-cex session than CBD but it’s ok, still got something out of it!

I then went to meet my consultant who was reporting cardiac MRI scans and it blew my mind the sheer detail of the picture. We talked through his timetable and what wards he does and when so I hopefully will have a better idea of planning my week out!

We decided to cut the day short after that as we were both shattered for some reason so went home to do some work in the beautiful sun that we were getting treated to.

and you know what….. I actually did manage to get things done on a week that I had found it difficult to get into the swing of work. Gangrene on a Thursday evening. Mmmh mmh mmmmmmh

#Problemsofamedicalstudent

Im thankful we have masks to cover up the acne that is caused by the masks.

Friday

Good Friday

Posted in Uncategorized

Care of the Medical Patient Week 1

Monday

Online Learning (I’ve decided not to describe these as we all know what Teams teaching is like).

Tuesday

Online Learning

Wednesday

AND WE ARE BACK !! Wow, it really has been a while, huh? It honestly felt like second year was never going to end. One and a half years trapped in a year that kinda feels like a stop over between clinical and non-clinical but now, we are full pelt to the finish line.

Technically, I am now a finalist as our Years Three and Four are merged into one year but a shot of … well… horror and terror shoots through me when I say that.

We had a intro to the block and headed straight to Ward Hogwarts where we had been assigned. I was a little hesitant as I was through with the whole hanging round the wards thing hoping for something to do.

Boy was I about to be surprised.

We had a ward round on our tiny little ward which was a tad crowded but I have never had so much teaching on a ward round in my life. The consultant encouraged us to interpret ECG’s for them and I even felt confident to step forward and examine patients during the round. I kept catching eye contact with Klaudio with both of us shocked at this level of teaching.

We had interesting patients including diabetic feet (something amazing with this patient but can’t go too much into detail), COPD, Atrial Flutter and Fribilation (will I ever get my head around the difference between these two, stay tuned to find out). We even chatted to someone who was due to have a pacemaker fitted! Our consultant also seemed to be a lover of bedside echos and spent time orientating us to the image in front of us.

It felt so good. We heard there was going to be a cardioversion in the afternoon so ran off to get lunch and make it back for the procedure.

A cardioversion is shocking a heart which is in A Fib/ A Flutter back into sinus rhythm. It sounds backwards to shock a heart which is not in V.Fib but is actually the gold standard treatment for A fib and A Flutter ! We had to go up to theatres as our patient was a bit risky but wow. It was amazing to see.

They were made a bit drowsy to begin with (well, you would want to be drowsy too if you were going to be shocked) and their heart rate was roughly 150 upwards. One shock administered later and it dropped to 80bpm. That was a drop of 70bpm in less than 10 seconds.

Medicine is amazing.

Thursday

Back in again, but we had teaching in the morning. I love having this amount of teaching. It really does help with guiding what we should be learning. First topic up was Stroke. Except our teacher was not in the room.

I remember back in Primary School we would come up with concepts for the future and one of the suggestions was a virtual teacher, and here I am living the reality.

It felt a bit big brotherish to have a massive face up on the screen with us sat in the room but did end up working well and I enjoyed the rest of the morning !

Unfortunately, having teaching in the morning means the rest of the day is a bit awkward. You miss ward round and bloods so there tends to not be much else to do. Oh, well.

Friday

First Academic Day of Third Year ! Wow, and what a hit of reality this was. The whole first half of the day was taken up with talks about UKFPO (the process of applying to our FY1 jobs) and our various extra exams such as the SJT and PSA.

I think during the morning it was a slap of reality. I can’t believe that I am so close to finishing. I don’t feel like I’ve been here long enough for that to be the case. I remember first year like yesterday and second year was a nightmare I am willing to forget.

I sat there listening to all this information about the application process and the exams just having a crisis. This was all getting too real.

But we survived, and I spent the rest of the afternoon learning about prescription writing in hospitals and wrote my first ever mock prescription:

That felt pretty good.

We also had our first CBL session which meant another new group. We actually have a good mix of interests and personalities so the session was ok! I never thought I would spend 2 hours talking about UTI’s and Nitrofurantoin (Antibiotic for UTI’s).

And that was it. My first full week in my Care of the Medical Patient Speciality Block.

Here we go.