Wednesday, 17 November 2010

Of roles and expectations

I've just finished listening to another excellent episode of Pseudopod, a weekly podcast of horror short stories and this week's was particularly interesting for me. It focuses on a woman who comes to a village under the guise of helping when in fact she has a darker motive.

Alasdair, the host of the podcast, does a wonderful job (as always) of deconstructing the themes of the story. For anyone in healthcare they are juxtaposed between being an everyday part of the job and so very important that if you stop and think about it, our responsibilities are staggering.

The patient will see you as a caraciture
People put their lives in our hands and, more often than not, accept that whatever we do for them or ask them to do is in their best interests. When I push the drug trolley around people accept that because I am dressed like a nurse, seem quite comfortable and friendly, I must be giving them the right medication at the right time etc. etc.

Every nurse I know has made at least one drug error.

Every doctor I know has made at least one drug error/ misdiagnosis.

And yet they come to us. Because we look the part, because they believe in us, our uniforms, our stethescopes, our strange language. There is another component, I think. We have entered into a social contract. We have chosed our roles and promised to fulfull them to the best of our abilites. That, I would argue, is the reason people come to us.

It is both a privilege and a responsibility.

Runner's Hip


So nearly 4 weeks ago I was finishing up a 6 mile run and there was a sudden, sharp pain in superior lateral aspect of my thigh, which made walking so painful I figured I'd pushed myself a little too hard and I had a few days of hobbling.

Like I say, 4 weeks ago.

TFL to its friends
I carried on hobbling and stopped running and felt annoyed. It got slightly better after a couple of weeks, but one running session took me right back to square one. So, off I went to the GP, running through SOCRATES in my head:

S - Site - Superficial to the greater trochanter
O - Onset - 4 weeks ago
C - Characteristics - Hurts when I run, not much else
R - Radiation - Nope
A - Alleviation - Not running (!)
T - Timing - Uh, no
E - Exacerbating factors - Again, running/ not running
S - 2 normally, 8 running

My GP went through a range of motions with me, poked and prodded and said "You've damaged a muscle". Indeed. As it wasn't constant and didn't limit my range of motion, we could rule out any joint damage or ligament-related hilarity, thankfully. Nope, the culprit is Tensor fasciae latae. So now I'm taking a further 2 weeks off running and chowing down Naproxen 500mg BD in a bid to tell my body to calm the eff down with the immune response already. In general my GP was against the idea of running "Swimming, yes. Cycling, yes, Rowing, yes. Running? No, no, too much impact", but I think that was idealogical rather than lifestyle advice!

Tuesday, 9 November 2010

Creative Writing?

He lay in bed, staring at the ceiling and knew he had to go back to work.

It wasn't that his current life was easy or that he especially wanted to go back to the proving ground of the wards, but he knew that going back was important - both financially and because he felt himself getting soft.

As his wife lay with her head on his chest, gently twitching as her breathing became deeper and slower, he looked up at the ceiling, his eyes burning like coals. He ran through permutations, likely complications he had been schooled in: hyperkalemia, hyponatremia, common analgesics, IV fluid prescriptions, the contents of the drawers of the crash trolley, urine output, FBC, biochem, coag, CVC management, venepuncture - the list rolled on and on in his mind.

His wife moaned in her sleep and turned over, freeing his arm and allowing him to bring both hands across his chest. Still staring up at the ceiling in the dark of their bedroom, his mind wandered on. He knew that going back to the wards meant going back to the places where people went sick, where the job ground you down to a fine powder that could be, and often was, blown under the door at the end of a shift. MAU, HAU, Acute Elderly Care, Respiratory Medicine, these places wouldn't be easy and he would earn every penny, every shift.

He realised he hadn't exhaled for what felt like a lifetime. Lying there in the dark, he had held his breath as his mind raced and ran over the likely issues that would arise on a Saturday night shift on an elderly care ward. And he wasn't scared. He needed the money, he was good at the job and for better or for worse, he missed the satisfaction of handing over his patients at the end of the shift and feeling like he had done something useful with the last 12 hours of his life.

He knew it was time to go back.

Wednesday, 3 November 2010

One down, a few more to go

So last Friday was the first exam I have done in Med School. And it was "just" a formative. Being a formative is nice because it meant that we could use it as a way to test how appropriate our work in PBL has been.

Allow me to expand on this - PBL involves a lot of self-directed study and this provides an opportunity to decide how deep you want your own learning to go. This can go either way; you can study too little and not have the detail the exams expect you to have, or you can go too deep and learn way more than you need and consequently expend more time and effort than you need.

I felt the exam went okay. You never can tell before the results and I don't intend to jinx myself! It did demonstrate to me that although it was a formative and a learning experience, people were still quietly obsessing about doing well. The talk was all "I just want to pass", but I suspect otherwise.

Still we worked hard and then partied hard for Halloween. My costume was bloodied scrubs and a theate hat (the obvious choice?) and my drink of choice was Guiness until I was told it was time to go home. It felt very good to tie one on in a most cathartic way. And totally wasn't "using alcohol to relieve stress" like the questionnaires say ;)

Now we've moved on to the immune system and infectious disease which is pretty cool and definitely something I have more interest in than reproduction, so hopefully the revision for this bit will be easier!