Friday, 30 December 2011

Christmas: The other silly season

I hope you've all had a lovely Christmas/ Holiday period and I'd just thought I'd share a couple of corking papers in this month's British Journal of Medicine. Traditionally, the BMJ treats Christmas as a bit of a silly season when it comes to content and publishes papers which might be considered a bit frivolous at other times of the year. Anyway, these are my favourites from this year:

"Relevance of the expression “obs stable” in nursing observations: retrospective study"

"Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study"

Both papers are freely available as PDFs for your consideration.

See you all in the new year!

Thursday, 8 December 2011

Long weekends and tiny epiphanies

I think I know how the panda feels sometimes
The last three weeks I've been running a project looking at communication between doctors and patients.

The last weekend I lost my brand new (less than 24 hours old) iPhone 4S.

These seem like relatively unconnected events, other than that they both happened to me. One, however is a causative agent. One is a symptom.

I know it is the most over-used cliched post for a blogger to talk about their experiences of depression. We get it, you feel blue sometimes, get over it etc. etc. But this past three weeks have had me becoming re-acquainted with something I thought I was entirely over. In what I now view as a former life, I was lab monkey who worked by themselves for 8 hours a day in a lab where I was the only person there, for months at a time. During that job, something broke inside me. I tasted despair and such crippling psychic pain that I had days of missed work where I would pad around my crummy flat and wonder what would happen if I just stepped out in front of the bus that went to my job, rather than getting on it.

It was, to say the least, not a time I remember fondly. The more I've learned about clinical depression, the more I am sure I was suffering from it. Not that I ever sought medical advice at the time or subsequently. I probably should have, with hindsight. But whatever. I think the loneliness of working a job that was going anywhere, by myself damaged me in a profound way.

I've written about this before in a brief post when it seemed like a more distant time.

Things changed when I moved to London, started nursing and making a positive difference in the world. Everyone I helped, healed me a little bit. I worked as part of a team who spent a lot of time together, worked hard, partied hard. I got married and learned to trust and share my space with someone. Learned that maybe I didn't have to bear the occasional weight of existential dread by myself.

But running this project for the past few weeks has involved me living as an observer, watching, not interacting or involving myself in some of the sadder aspects of human existence. 8 hours a day, by myself, in a crowd of people.

I think you can see where this is going.

I didn't pick up on it at first. Then slowly things happened. I passed up on going to the gym. On going to my Krav Maga classes.

Then I went drinking on the Saturday night. I was back with old nursing friends and we tied one on. We painted a small patch of Soho red. It was an explosive release of... Something for me. And I got drunk. blind drunk. In the process lost my 'phone and didn't care, because I was too busy drinking and trying to savour being a part of a group again.

Monday I was still a bit hungover. But, I pulled myself together enough to get stuff done and in recounting the weekend to med school friends, suddenly realised what was going on in my mind. This realisation has made all the difference. I'm now spending my spare time on the ward revising and learning and talking to the medics. Engaging with the world.

I guess my point in all of this is sometimes you're not as healed as you think and maybe it's a reminder to be on your guard against demons you thought you'd vanquished.

(Oh, and the sad panda shirt is from the A Softer World line at Topatoco)

Sunday, 20 November 2011

How not to answer a question

Achievement unlocked: Completed first surgical placement
Status: Acceptable

Some consultants like you to stay quiet if you don't know the answer, some like you to take a guess because "I don't know is never right". But all of them like you to think systematically, to have a pre-programmed structure to your answer. There are some classic questions a surgical consultant will fire off and expect a quick, concise answer in reply - answer that can only be achieved by applying logical, systematic thought.

When we're taught this way of thinking it is generally with a smile on the face of the lecturer and a remark about how you can use the answer to avoid actually having any specialist knowledge in the topic or in actuality, having an answer to the question. If that sounds a little convoluted, allow me to demonstrate:

"What are the complications of this surgical procedure?"
"Complications of surgery can be divided into immediate, early and late, and further sub-divided into specific to a given operation or general to all surgeries. Immediate complications arise during the procedure or in recovery, early within 48-72 hours, late within weeks of the procedure..."

Do you see how that answer isn't an answer at all? And how it is completely right at the same time?

At first I thought it was a technique to bore the consultant and get them wave you into silence, firing off the next (and generally harder question) at the student next to you. But then when I thought about it a bit more, I realised this is such a useful way to manage your knowledge. Rather than having a randomly assorted list of things, you can partition them off, divide them up to help guide your care and treatment modalities with a clear understanding of the most likely cause and the relative seriousness of the complaint.

Whilst there having been important take-aways from this placement, such as the fact I don't think I'm going to be a surgeon, or how busy and yet elegant the anatomy of the hand is, the notion of systematic thinking and how to apply these kind of techniques to make me a better doctor is my top learning point form the past six weeks.

Friday, 4 November 2011

Fighting Trousers - Professor Elemental



Well it made me laugh and not just because he raps about "chap hop".

Poppin' my cherry

I couldn't see his mouth move, but his eyes were firm but kind:

"Is this your first time?"
"I want to hold this, and pull firmly up and back. Easy, not that firm"

His guidance was even-handed, congratulating my successes and admonishing my failings:

"When I want you to hold it, I'll pass it to you"
"No, you're holding it wrong, wrap your thumb and ring finger around it, and use your other hand for support..."

Oh dear.

Sorry, I thought of this post on the tube home and I couldn't resist. Today was my first day scrubbing in on surgery and it was brilliant. A lot of my coursemates have had negative experiences in theatre which has really impeded how much they get out of their surgical rotation. In medicine the classical educational concept is "teaching through humiliation"which is not without it's merits (I will never forget the complications of gallstones after a registrar took my umm and ahhh laden answer to pieces), but when you're in theatre, being told to GTFO because you didn't know the innervation of a particular muscle is just mean. Yes, you should bone up on stuff before your placement and doubly so if you know the operation you're likely to be scrubbing in for, but if you don't know the answer to a particularly esoteric question you shouldn't lose the rest of your potential learning.

I was felt so nervous scrubbing in but I think I really lucked out with friendly and helpful nursing staff and a my registrar being a great teacher. I was ended up in a procedure I wasn't expecting and hence couldn't answer a fair number of his questions (none of which were unreasonable), but my answers of "sorry, I don't know" didn't earn me a sound bollicking, but rather an answer and an explanation. I will not forget that the things I learnt, feeling like a plum and quietly turning red.

And I'm looking forward to the next time I get to scrub in.

Oh, come on!

So, here I am half-way through my plastic surgery placement and loving it.

It took a bit of time to get started, but mainly because I didn't play to my strengths enough and was a bit of a wallflower.

No longer.

I'm getting on well with the team and it's nice to be getting stuck in with history taking, wound washout and dressing, bleeding and cannulating like a mo' fo' and seeing some fascinating cases.

I've really been boning up on my theory, too. I can talk on the difference between an FDP versus and FDS injury, the need for aggressive management of necrotising fasciitis (or "nec fash" as we say in plastics :P), the implications of loss of sensation of different digits or why surgery is so much better than medicine (I'm still not entirely sold on that argument...)

Sitting with the consultant in his clinic still generates existential dread, though. I'm not sure that ever changes, to be fair, as I have seen SHOs and SpRs with an expression I recognise - the "oh god, I have no idea" face. I thought I was doing okay on my last clinic... Only to have One Of Those Questions come up:

Mr Hand: "What test am I asking the patient to perform?"
(the patient is making the familiar "inverted prayer" I know is Phalen's test)
Me: "Phalen's test"
Mr Hand: "And what is the positive Phalen's sign?"
Me: (silently sighing with relief) "Pain or tingling in the hands"
Mr Hand: "And when did Phalen write his paper on this test?"
Me: (OMFGWTFBBQ) "No idea, sorry"

I almost laughed because I thought he was being hyperbolic. Turns out, not so much.

*sigh*

Sunday, 16 October 2011

The first cut is the deepest

I don't know who said it, but they were wrong. And also kinda right.

This week has been my first week on attached to a surgical firm at St Clabert's and it's been a reminder of what I know and what I don't.

The first point of call was that, until this week, I'd never been further than the anaesthetics room in theatres (other than as a patient). In ward life you know of theatre people and maybe have the occasional tussle in recovery, generally about how you're not taking the patient who is groaning in pain and who's BP is in their boots back to the ward. But I'd never before donned scrubs, clogs and a hat and walked into theatre. It is a strange, controlled, precise place compared to the ward. It was refreshing to experience this change of pace and bear witness to a kind of calm teamwork that I've not seen much of before now.

And the first cut. I realised, when I saw the scalpel go in, that I had never seen this happen before, either. Don't misunderstand, I've assisted in plenty of drain insertions, ascitic taps, biopsies, endoscopies et al, but never seen a person cleaned, draped and then surgically incised. It was amazing. I didn't expect it to be a notable experience, but it left me literally agape (and then when I realised, quickly stoical - I mean, no-one wants to look like a noob in theatre).

This week has quickly taken me out of my comfort zone as anatomy is one of my weaker points and being quizzed about specific muscles and their attachments and insertions and innervations and (god forbid) arterial supply or venous drainage is just awful for me. I've had to claim ignorance and face disapproval more this week than my ego is frankly comfortable with and had to accept I really need to spend more time with Netter if I want to get the most out of this placement.

The high points have (unsurprisingly) been history-taking, clerking, examinations and ward life (both pre-op and post-op). I fully expected this to be the case, given my previous life. I love being on a ward, talking to patients, sitting with them to take a history, busting out the stethoscope, percussing, palpating, the whole nine yards. Which I guess says something about my medical bent.

So far this has been a good placement and I have several weeks to go, so more time to get comfortable in theatre, maybe even scrub in and hold a retractor or two, more time to get my muscles and nerves straight in my head, more time to reinforce the ward skills I have brought with me.

Now if you'll excuse me I have an important meeting with the intrinsic muscles of the hand...

Thursday, 6 October 2011

Malta

KinnieSliemaFizzeeA church in SliemaSliema by duskPink flowers
The Blue LagoonCactusThe sea around CominoComino public transportMore pink flowersThistles
Gecko on a rockSea Green

Malta, a set on Flickr.
Part 1

Jobs is dead

Steve Jobs for Fortune magazine



*iPhone rings*
Mrs AB:"Hey, did I wake you?"
Me: "Nah, just coming to."
"Steve Jobs is dead"
"What?"
"Steve Jobs is dead"
"What?!"
"He's dead"
"Jesus. Well, he did have pancreatic cancer, I guess."
"Yeah, but y'know, 56."
"Yeah. Wow."

The world has lost someone who did something amazing and had so much more to offer :(

Wednesday, 5 October 2011

Getting hands on

Mr. McGuire: I just want to say one word to you. Just one word. 
Benjamin: Yes, sir. 
Mr. McGuire: Are you listening? 
Benjamin: Yes, I am. 
Mr. McGuire: Plastics. 
Benjamin: Exactly how do you mean? 

So we've had six weeks of PBL tutorials, statistics and communications seminars and clinical skills sessions and now, like so many baby birds, we're being let lose from the nest lecture theatre to fend for ourselves. For a bit.

My first rotation is 6 weeks of plastic surgery, allegedly with a hand specialist. Which carries all manner of silent terrors for me as I find the anatomy of the hand and forearm crazy complicated. And being in a theatre gives me all kinds of opportunity to fail to observe some anachronistic aspect of human interaction and get bawled out for my troubles.

But the upside is I have a fair bit of post-surgical HDU nursing experience and know the general tone of surgical ward life. And in many ways my current form was birthed on the wards of an NHS hospital. I don't mean that in a creepy "buffalo bill" kind of way (well, maybe a little bit...), but who I am now is very much the product of having lived and worked in the healthcare environment for quite some time. I hope I can fit back into the pace of things like a hand in a glove. No pun intended.

And then there is the undeniable fact that surgeons are the people who reach into the very living flesh of another person and fix them. This is something incredible to be sure. I can understand where the idea that surgeons sometimes see themselves as gods might come from - If you can make someone better with your hands and bit of know-how, you could forgive yourself for being changed from the experience, too. I look forward to seeing the fixing happen first hand (again, no pun intended) and to find out how the life of surgeon actually works, when they're not writing up post-op fluids or taking down dressings at 9am (don't get me started...)

I don't know if I am a surgeon (though I have nursing friends who promise to disown me if I become one!) or a medic, and to be honest, I don't know if it's relevant for me to wonder this without more experiences to form an opinion. To pass the first year without resit or hinderance showed me I can do this, that I am med student (hear me roar!). What I make of my opportunities and experiences waits to be seen, I guess!

PS There will be Malta pictures, once Flickr stops being in a strop with me.

Thursday, 18 August 2011

A break from your (ir)regular programming




Myself and Mrs Absentbabinski are on hols this week in Malta, so no posts of any consequence for a few more days. It is lovely and if you like swimming in the Mediterranean sea and 32 degree (celcius) days of unending sunshine, I can highly recommend it.

I dare say there will be a debrief post and a few pics when I get back. Assuming London hasn't been razed to the ground.

In the meantime, "Saha" as they say over here.

- Posted using BlogPress from my iPad

Wednesday, 10 August 2011

London Riots

Although the news has been full of them, the London riots have ended up being more rumour than riot for me. I have passed damaged shop fronts on the bus and I have seen footage on the TV of violence, arson and ineffectual policing, but so far I guess I have been lucky enough to not have them directly effect me.

Working at my hospital yesterday, the day was full of rumour, half-truths and supposition which I found myself getting drawn into more easily than I expected or wanted. They were boarding up the high street, then there was a riot on it already, then that was discounted. Then there was talk of other places being targeted. Nothing to support this other than something heard from someone else who had a friend who knew about it. It's weird how the contained group of nurses all fell to recirculating rumour in lieu of fresh information. Then the hospital quietly advised non-essential personnel to leave by 4pm and said they would be locking the main gates before night fall. I began to feel ever more uneasy. 

From the third floor of the hospital I could look out over South London all the way to Canary Wharf and it was amazing to me how there was no difference I could see. Life was just rumbling on, same as it ever did. When my shift ended I legged it out of the hospital and headed to the train station. Every group of people, no matter how innocent they looked, made my spidey-sense ping and it was all I could do not to sprint for the train. As I got to the station I was passed by two horse carrier lorries, blues and twos going and zooming off to an incident somewhere. On the platform I overheard a group of police officers on their way to work debating whether or not annual had been cancelled.

My wife had been working up in North London in a shop and had had the police come around and tell her to shut up shop and go home. In the middle of the afternoon. She had tried to do a bit of food shopping on the way home only to find all the supermarkets by us shut and some even boarded over with plywood in preparation for violence.

I am torn between worrying about the next few nights and thinking that this will blow over soon enough. The Met have made lots of noise about intensifying policing in the capital and their no-nonsense approach to public order offences is well known around the UK. They are issuing plastic bullets and allocating water cannon.

I'd also like to raise my voice to join the choir of Londoners appalled by the behaviour of a violent and antisocial minority. The best description I have come up with is an amalgam of disenfranchised people, who have been raised on a diet of mass consumerism, with nothing to lose and little fear from prosecution. Arguably a very dangerous combination. That there has been such a united front against these people is something which gives me hope for the city and the species in general.

Saturday, 6 August 2011

Are you sure this is a valid prescription?

Vodka of the Gods

Seen yesterday on the PRN side of the drug chart:

Vodka 50mls PO

on the same chart, regular side:

Chlordiazepoxide 20mg QDS

The nurse who picked this up bleeped the pharmacist who briefly did a good impression of a beetroot and then looked like they were about to lay an egg.

The pharmacist's main issues were:

a) Why wasn't this patient (who was an alcoholic) being detoxed?
b) Where did the doctor think they had medicinal vodka in the hospital?
c) What was the doctor thinking prescribing alcohol *and* a benzodiazepine together?

Sadly, the pharmacist left before the doctor arrived to sort out the chart. My favourite part of this was the doctor's eye-rolling and suggestions that the pharmacist was being over the top in getting upset about this. Oh, and then asking around the ward if we knew what alcohol pharmacy *did* stock.

So many of the shifts I've worked over the summer have been guides on what not to do as a doctor. Behaviour-wise and common sensical.

How the sausage is made

Angry_Bread_Large
This post was inspired by a bank shift yesterday

You're a patient in a hospital in the UK, it's 10am and your consultant has just come 'round on the ward round and told you that you're all better and you can go home! Hooray!

Of course, it's not that simple and the nurse tells you that you need a doctor's letter and some medications to go home with. You smile and say fine, but does the nurse have a general idea when you're going? The nurse thinks you should expect to leave around 2pm, so you call your relative to come pick you up.

So what's happening in the background as you are getting dressed and being congratulated by your ward-mates on your imminent release?

1) Consultant tell nurse-in-charge patient can go home at 10am
2) Junior doctor is told to organise discharge by nurse-in-charge
3) Junior doctor rolls eyes and grumbles about doing it at the end of the ward round
4) Junior doctor promptly forgets entire conversation about this discharge
5) Lunchtime comes and goes, nurse bleeps junior doctor multiple times - gets TTA (list of medications to go home with) and discharge letter by 1pm
6) Nurse notes date on discharge letter is wrong, bleeps junior doctor. Promises to fix letter are made and promptly forgotten
7) Pharmacist gets TTA, processes it promptly
8) Ward gets medications, nurse bleeps junior doctor about discharge letter
9) Nurse fends off irate patient about what is taking so long and how ridiculous it is and how the patient shouldn't self-discharge etc. etc.
10) At 4pm discharge letter is complete. Nurse prints, explains and dispenses TTAs. Patient goes home annoyed but happy (if only to be leaving)

I'd really forgotten how much I hate organising discharges. Give me a sick patient. Give me an oozing, stinking wound. Give tears and fears and innumerate emotional horrors of being in hospital.

Just don't give me a day where I spend it chasing other people to do their job so I can send my patient home. I get so tired of being the face of the machinations described above. Basically, I can't do anything more and yet I get to soak up the anger and frustrations of the patient. It is very, very tiring.

Saturday, 30 July 2011

Where do we go from here?

Always Be Nursing
I've not blogged in a while and I feel pretty bad about that. It undermines the first rule of blogging, which is "Always Be Creating Content" (he said, paraphrasing Glengarry Glen Ross).

That said, it's been a busy few weeks for me. There were end of year results which were thankfully passes across the board. My school gives you percentages, the mean, the pass mark and (as I think I've mentioned before on this blog) a mark of A for acceptable, CC for cause for concern or U for unacceptable. So, for the first time in a while I'm a straight A student, though in real money I'm a slightly above average student which I'm totally happy about.

It wasn't until I received my grades for this year that I realised where I was in my life, academically speaking. I'd approached medical school with a "I wonder how far I can get" attitude - Which is to say at every step of the way I've not been living and dying by the result. I passed the GAMSAT (the Australian version of the MCATs) and was pleasantly surprised. I passed the interview and was pleased again, but I hadn't walked in with the fire of a zealot in my eyes (which I think helped - some people want to be a doctor so much it hurts their chances). Repeat for every exam so far, apart from this last set. I guess that previously I have been a nurse in my mind. Like some kind of interloper, a spy from the wards seeing how the other half live. Learning about the bigger picture beyond bedpans, food charts the myriad other tasks of nursing.

Not that I wish to denigrate nursing, far from it. Whenever people ask about why I went from nursing to medicine (something that happens with regularity on the wards whilst I'm bank nursing, I've discovered), my answers fail to satisfy. The best I can come up with is that I want a different set of challenges. The stuff that really stresses me out in nursing is organising discharges and chasing down junior doctors to remind them to do paperwork or arranging transport or chasing pharmacy for drugs I need sent up *now*. It was stuff that would forever plague me as a nurse and really took the shine off the stuff I genuinely enjoyed - people and their problems.

I'm sure there will be plenty of paperwork BS in doctoring, but it also opens up a world of other challenges that I think will outweigh the new stresses.

The point I'm trying to get across in a ham-fisted way is that having passed the first year has made me realise that I am all in. I really want to be a doctor and I'm less a nurse than I was this time last year. I am changing. There will always be a part of me that enjoys the intimacy that nursing affords, but I am becoming Other. It'll be interesting to see where this goes.

Friday, 8 July 2011

Because it's Friday...

And I'm a total sucker for a girl with a uke. Sue me:


She has, I think, one of the most tender voices. And if you can spare another 2 minutes:

Wednesday, 6 July 2011

Hyperarousal

A lecturer this term stated that, physiologically speaking, you can only maintain an adrenaline-fuelled state of hyperarousal for about 60 minutes. This was disputed by some of the ex-soldiers in my class, but I guess for civvies like myself, it sounds about right.

I held tightly onto this when the OSCE's came around. Written exams never provoke the same level of sympathetic response in me. It's not because they're a "you know it or you don't" event so much as they're a "sit on your arse and only move your hand event".

OSCEs by comparison are a full-systems-go-hello-my-name-is experience with actors or simulated patients and an individual examiner. OSCE stands for Objective Structured Clinical Examination and is just that. There is a task to be completed. You're running through mental check lists: Look, Feel, Percuss, Auscultate if it's something like a cardio exam or Passive, Active, Resisted when you're examining someone's wrist and elbow or even the classic History of Presenting Complaint, Medical History, Family, Social, Medications, Allergies when you're taking a history. You stand outside a cubicle, a buzzer rings, you read your handout, figure out which checklist you're going to need, memorise the patient's name, another buzzer rings and you're in.

You learn to introduce and consent in roughly ten seconds. Maybe 20 if you need to explain a more intimate exam. You're gently smiling, making the right amount of eye contact and trying to remember the first point of call on your checklist.

Checklists beget checklists beget checklists. Remember where you are. Comment on what you don't see. You can't be negatively marked so call out everything. Start at the hands, don't miss the capillary refill.

I sat in the one of my uni's many coffeeshops with my course buddy CRM and we listed 10 things to look for in the hands alone. Just call them out, you're bound to hit most of the ones you need for this specific exam. And anyway, in real life, you'd be looking for everything anyway, not just the finger clubbing of respiratory issues or the leuconychia of hepatic problems.

So back to my lecturers comment. when I turn up to uni before the exam, I sit on my adrenal response. Lots of revision of my checklists, not thinking about the exam. Drink me some coffee, try a little synthetic stimulant replacement. About 30 minutes before the exam, I imagine what it must feel like to stand at the door of a plane in the sky, about to do a parachute jump.

And Woosh

There it is.

At my word, unleash catecholamines.

Energy, alertness, fine tremor, my sympathetic response. My ancestors used this to run from wolves, I use this to stay focussed on a simulation of real life for 50 minutes. Which, incidentally, really doesn't feel that long when you're doing it.

But it's over for another year (god willing and I don't have resits).

I didn't have to revise anything today. It felt amazing.

Friday, 1 July 2011

So, Google+

So I finished my Musculo-skeletal exam this morning and came home to find a Google+ invite in my inbox. It's pretty neat and I can see me enjoying using it more than Facebook - if my cadre of friends get involved.

However.

If you add people who aren't on Google+ yet to a group and post a message to your profile that they can see, Google+ offers to send them an email. Useful right? Not so much if you've lumped everyone together and you say something which your friends might find funny, but your parents/ in-laws not so much

At first I was like



But then I was like


I've spent the last 4 hours furiously revising clinical skills. And will be doing that tomorrow. And Sunday. So whatever. Ask me about finger clubbing and spider naevi and sub-acromial bursitis.

I dare you.

Monday, 27 June 2011

barriers to revision

It's too durn nice to be stuck inside revising all day. I think I'll go for a run at lunchtime.

Wednesday, 22 June 2011

Exams

[insert obligatory post about exam season here]

Seriously though, I'm looking down the barrel of exams I feel unprepared for on topics I'm not particularly interested in.

Consequently I've not had time to think of something interesting to say about the psych lectures we've been having recently, other than I'm quite enjoying it and I'm actually looking forward to the idea of a mental state interview in the OSCEs this time around.

And I'm dog tired. I think I feel a bit burnt out and look forward to a summer holiday free of medicine. Just got to head down and just get it done.

P.S. the upshot of doing psych lectures at this time of the year is I can tell how well I am/ am not coping by asking myself all the screening questions about anxiety disorders!

Friday, 17 June 2011

ICU consultants part 1

scene: morning ward round


(A phone beeps)

Consultant: It's my daughter. "Dad, what's the stuff that platelets produce when they come into contact with collagen?" Anyone know?

Turns, looking questioningly at the room full of consultants, registrars an SHO and myself

(hushed silence)

Registrar: Why is she asking?
Consultant: She's doing her A-levels. Seriously, no-one knows? (turns to me) do you?
Me: (thinking that it's been more than three weeks since the last time I had to think about the coagulation cascade) No idea.

In retrospect, and with a quick visit to wiki, I guess she meant Thromboxane or ADP?

Monday, 13 June 2011

Sucked in, Dennis

I like much of the blogosphere I latched onto the tale of Amina Abdallah Araf al Omari who presented herself as a "Gay Girl in Damascus", with great interest. Here was a woman who's religion and sexual politics put her in harms way and who blogged about her experiences with clarity and spirit.

I felt particularly moved when I read the post covering a night-time attempted abduction by Syrian governmental agents and how her father had saved her life with words and composure.

Then I felt the outrage only a liberal can know when I read a post from her cousin detailing Amina's abduction from the street. I felt a cold sense of dread that the next post would be a requiem, describing how her body was found in a back alley, obviously tortured and abused.

Except it wasn't.

The whole thing was a literary exercise by an 40 year old American man, studying in Edinburgh.

I couldn't have felt more angry, though I wasn't sure if I was more angry at myself for having been so credulous and breathlessly ready to repeat "her" story to coursemates, or the guy who made this story up for the untold damage he has wrought on anyone who tries to tell a similar tale (except truthfully).

When the abduction tale was posted, Syrian officials were quick to say "We've looked into, this person doesn't exist." I, like many I suspect, thought to myself "Well, they would say that wouldn't they?" Turns out they were telling the truth. And the next time another person in an oppressive regime speaks out online and provides insight to living in danger because of their political belief, sexual persuasion or whatever, well that person will have to fight that bit more to get people to heed their call.

So any number of limp, ashen-faced apologies from Tom McMaster will not appease my annoyance with him. Especially as he had the gall to chastise his readers (and subsequent critics) in the initial post where he coughed to his "brief experiment in nerd psychology".

Okay, I'm spent. Back to your regular programming.

Friday, 10 June 2011

On illness and Admin

Sick Note.
From jk5854's flickr photostream
So what started as a bit of pharyngitis has made a concerted effort to claim everything south of my carina as lebensraum by way of a detour up into my nasal cavity.

This led to me taking today off school as I didn't really want to spend the morning mouth-breathing my way around the DR and then spend the afternoon coughing and spluttering my way through the expert forum (kind of like a Question Time for the week's lead lecturers).

This in turn gave me a day to spend either lying in bed feeling a bit sorry for myself or, once that got boring, addressing issues of admin. A close friend on the course is an army type and has introduced me to all sorts of interesting turns of phrase: "popping smoke", "bring the rain", "danger close" and "admin". This is a phrase that covers everything from polishing your boots to packing your bags to making sure you're carrying enough ammo. There is "good admin" and "bad admin". And I have, of late fallen into the latter camp.

So once the paracetamol, phenylephrine and industrial grade caffeine had kicked in I set to my admin. I've cleared up quite a few bits of IRL BS this week and this morning was an opportunity to finish up some notes, send off emails about next year's project to the person who will hopefully be my tutor, pay some bills, secure my place in next year's Brighton Marathon and then have a bath.

And it was everything I thought it could be. I got to lie still and read for pleasure (something I'm not very good at giving myself time to do) and then I washed from top to toe, had a shave and felt almost reborn by the end of it. I'm still working my way through Full Catastrophe Living and the more I read, the more the idea of giving myself a few minutes everyday of paying attention to my body seems healthy and appropriate.

I find it slightly ironic that I need to be sick enough to not go to school to force me to stop for long enough to just "be". This is something I need to work harder at doing. That and paying attention to my admin.

Wednesday, 8 June 2011

Panniers

So I've been cycling to school for a while now and have been getting increasingly bored with sweaty-back syndrome caused by carrying my capacious backpack. So in a bid to treat this frankly life-altering condition (carrying a spare t-shirt, knowing that if it rains my books will be soaked, getting my sweat on with the least amount of exercise) I bought a pannier rack and this badass pannier bag.

And the change has been dramatic. No more sweaty back, having a waterproof storage medium (it's made from super hardy trucker tarp), it's large enough to hold my smart dress for clinical days.

It's all good. If a little dorky.

Incidently, this was meant to be a test post of emailing a post from my iPhone. Turns out you need to be careful with your formatting. Duly noted.

Wednesday, 1 June 2011

"You've not blogged in a while, have you?"

Thank you, Liz!

My apologies for not having posted in oh-so-long. It's not that I don't have anything to say - I am the kind of dude who always has an opinion and little needs to be done to wheedle it out of me. I am however, the kind of dude who also has priorities and sadly med school has taken up my mental runtime a bit too much of late. I'm not suggesting that I've kicked it into high gear and I'm producing more work than previously, it's just that the work is taking up more of my conciousness than previously.

I guess it's not a useful place to be in especially, but I am doing what I can to nip it in the bud and try and remember how to work *and* play.


Can I direct you to a podcast about priorities? Well, I'm going to anyway. Back to work is a nominally a podcast about business practice (don't worry, it's not as dull/ pompous as it sounds), but a fair amount of the issues that Merlin Mann addresses are relavent to study, too - especially when he starts banging on about priorities and "what can you not ship?".

Can we talk about not doing, too? This is another step I've taken to address the general horror of medical school. I've started practicing Mindfulness which I hope will be fruitful in future weeks. I picked up a copy of Jon Kabat-Zinn's "Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness" from the school library and I'm working through it slowly. There's a lot in there and integrating 15mins (and working up to 45mins) of meditation into my daily routine is not easy in terms of finding time. I am learning to be more in the moment and observing what is happening around me without judging it. I am *not* turning into some kind of crunchy beardy type who moves to Vermont and knits their own yoghurt - I am turning into someone who is more in control of their life. There will be more on this as I pursue mindfulness.

I've started a pilates class before school starts, too. Turns out that standing an breathing is waaaaay more complicated than I thought. Just as well I found out now so I can do something about it before the situation gets any worse!

We've transitioned from musculo-skeletal to neuro and psych in modules at school. The former reminded me that I am not a surgeon and after yesterday's primer on neuro-anatomy, I think I can rule out neurology, too. I did enjoy dabbing at coursemates with cotton wool though for the sensory neuro exam, though. Psych is something I have limited experience with, but I look forward to finding out about it and the idea of an assessment that doesn't involve touching someone is novel to me!

Friday, 8 April 2011

First days of Summer

Like having your own private pool
In London there are several Lido's (open air pools) dotted about and seeing as how we've entered April, some of them are opening for business.

A friend of mine suggested going for a swim on Tuesday night at our local Lido and I thought "why not?". The great thing about going for a swim in an open air pool in the middle of April is that no-one thinks this is a good idea, so you rather have the pool to your self. Just remember your wetsuit.

The not so great thing about it is how cold it is. I didn't mention these are unheated pools, did I? Now I'd heard how being dropped in cold water can suck the air out of your lungs but I'd never experienced this. Turns out it's about as much fun as it sounds, and swimming in cold (the air temp was around 10 degrees Celsius, make of that what you will) water is a hell of a lot more tiring than you might expect.

We briefly (half a length) practiced some front crawl, until the pain in our frontal sinuses was so great it made our eyes buzz. Then we changed over to some old-school, head out of water breast stroke. It was a lot of fun, we swam about 1km at a very reasonable pace and even had a bit of chat whilst we went. I think we'll be back next week.

Obligatory London landmark shot
Yesterday was a fair bit warmer and meant that cycling to school was glorious. We had PBL all morning (case of the week: RA) and towards the end of the session there was an almighty crash outside our room and plaintive "can I have some help, please!" was heard. Ah, I thought, that's not good. I opened the door and narrowly avoided a pool of something brown. Iced-coffee. A young woman was kneeling next to her friend who lying on her side in the corridor straight and stiff as an ironing board, jerking slightly.

Seizure, right.

"She's having a seizure," the friend said "She's got a history of this, but I've never seen her this bad."

The girl having the seizure was grunting through a clenched jaw, but I could seeing nostrils flaring so I was pretty happy she had an airway. We rolled her onto her side just to be safe, though. I ducked back in the room, past my classmates who had got up to have a look. Because I'd cycled in, I had my emergency trousers in my bag (my thought being "get something soft under the patient's head). I managed to gently maneuver them under the still seizing girl's head. More people came out to see what was going on, a couple offered to call someone (even in the medical school the crash team will come running) and I directed the rest back to their rooms. I knelt behind the girl's shoulders letting her ride it out saying supportive things to the friend. It occurred to me that there wasn't much else we could do. Airway? Yup. Breathing? Yup. Circulation? Uh huh. Waiting 'till the crash team turn up? You betcha.

A couple of doctors sprinted up the corridor, the friend gave a potted history and I went back into dicussing RA. Slowly more people turned, there was monitoring attached, oxygen given and she looked like the seizure had stopped and she was going postictal. Good, I thought, now how do I get my trousers back?

Tuesday, 5 April 2011

Talk meat to me

So for our date night last week, Mrs Absentbabinski and I went off to Bodean's in Clapham and ate the finest Kansas-style barbecue that South London has to offer.

I had the "famous" Bodean's Burn Ends (see left), which comprised of about a pound of barbecued beef and pork which was the most delicious thing I have eaten in months. The restaurant is the wonderful line of booths with ESPN playing on flatscreen TV's and ice-cold Sam Adam's or Blue Harvest (my choice and hers, respectively).

We had clam chowder to start and that may have been a bit of a mistake. Understand that in London, when you order a main it is very rare that you end up too stuffed to finish it. Bodean's does American fare so faithfully that a few mouthfuls of the delicious pulled pork the meat sweats were upon me; by the final mouthful of beef I was beginning to regret my greed. I couldn't finish the fries. Mrs Absentbabinski had a sirloin steak that she struggled with. There was no probability of desert - A rarity in our household. Belt buckles were loosened. Top-buttons undone and brows dabbed. We both felt nauseous on the bus home. Every burp smelt of barbecue sauce and self-disgust.

Would I go back and repeat this? Oh hell yes.

Tuesday, 29 March 2011

First Bank Shift

"Everyone gets everything he wants. I wanted a mission, and for my sins, they gave me one." - Capt. Willard, Apocalypse Now


"Hi, Absentbabinski? Are you still available to work tomorrow?"


It was 8pm on a Friday night and I was just starting on my first drink. I could say no. I could get my drink on and have a lie-in tomorrow. I could also start paying my credit card bill off.


"Sure, what ward?"
"Jeremy Kyle - It's Elderly Care (ah, shit) or there's A+E?"


I've never worked A+E and I'm not cleared to give IV meds at St Clabert's, so I'd end up being an annoying, over-paid HCA. I guess it's eldery care, then.


"I'll take Jeremy Kyle. Long day?"
"Long Day, 0730 start"
"Okay, thanks"


A quick bit of mental arithmetic tells me I'll have to get up a bit before 6am. So time to stop drinking, get my Best Dress together and pack my lunch.


I end up in bed at 10pm (a personal best for me), dreading a ward full of crazy old people and staff who couldn't care less. It's a bit of an open secret that (at least in the NHS) elderly care is staffed with either the most caring, skilled and professional nurses who will always be ready to help or... Well, people who aren't the above.


Cue a night of broken sleep and fear.


When I get on the ward the night staff are smiling. Smiling. They had a busy night but they're friendly and helpful and explain how the ward runs. They point out the changing room and when handover will start. I quickly realise they are the former of the two classes of nurses and I think "I'll be able to do this".


We get handover, I introduce myself to my patients and grab a drugs trolley. I've got two patients with IV Abx, but everyone else is on the usual blood pressure meds, anti-arrythmics and laxatives. I can do this. I only have to argue with browbeat encourage one patient to take their tablets. My patients are by and large lovely. I take waaaay to long to finish my drug round (my motto for the day is "I haven't done this for six months!"). There are only a couple of washes I do because the HCA I'm working with is efficient (more so than I am) and industrious. I get two admissions but they are straight-forward, old people who've fallen down. As per elderly care I have more than my fair share of pooey bottoms but I don't care - in fact on some level I like it. It's one of the bits of nursing I've always loved, helping someone do something that they can't do for themselves. And making the experience as normal and natural as possible. 


The shift was really good. I liked the people I was working with, and to their credit they decided I wasn't that much of a liability and asked if I'd like to come back next time they're down a pair of hands. 


I said "sure".

Monday, 28 March 2011

A case of the Mondays (again)

Overslept
faffed around
jeans crumpled after they've been tumble-dried
No time to make the bed
Waited in line at the train station, only to find I had money on my oystercard
Missed my train
Running late
ATM only dispensing 20's, no 10's

Realise school starts an hour later than I thought.
Been sat by myself only to have a good friend say she'd been here for an hour downstairs.

Hilarious.

P.S. These diamond shoes are too tight and all these Benjamins won't fit in my wallet.

Monday, 21 March 2011

Oh, and another thing

So I went for a run on Sunday:


Not a great time for a half-marathon, but I was glad to get in under two hours. Next time, I'll have done more training.

This just seems plain wrong

So I found this on someone's YouTube video whilst I was looking for a nice Pulmonary Embolism video. I know I shouldn't be surprised, but it's just depressing that this kind of thing goes on; naturopathy is pretty much one of the worse kinds of bunkum but seeing someone promoting it and denouncing actual medications that work to prevent death? It just seems wrong.

I always figured that the alt med users were like atheists in foxholes when they became seriously unwell. You bad-mouth medicine whilst it can't cure your muscle aches/ lethargy/ "bloated feeling", but when you get diagnosed with cancer or have an MI you're all about the "western medicine". Guess I was wrong. Sadly. Apparently you can get a DVT and think that "blood cleansing" is the way to go.

Friday, 18 March 2011

Knowledge-worker hands

One of the things that revision time always gives me is time to reflect. Nominally, I'm sat on my bed looking through powerpoint presentations, or reading old notes, trying to condense pages of information into bullet points so that I can remember and regurgitate it on demand.

Revision is boring. Occasionally I have learn something for the first time because I missed (by choice or by the fairly dreadful course planning) the lecture, but mostly I am revisiting or, indeed, revising, my knowledge base. Whilst I slog through the material I will confess my mind starts to wander a bit, and one topic that I keep on coming back to is my role in life as a man, whatever that means. And like any good physical exam, I start at my hands.

The phrase "knowledge worker hands" I stole from Merlin Mann, and it refers to that nice soft palm and fingers experience that comes from living via the keyboard or whiteboard. When I nursed, my hands were invariably dry or cracked from the alco-gel or the soap I used dozens of times a day. There were callouses from pushing and pulling things all day long. I came to see them as nurse's hands. Working hands.

Since the start of my course, my hands became softer, better hydrated, fewer (if any) callouses. And I have begun to feel a certain disdain towards them. Maybe it's a loss of identity, or a natural distrust I have of soft hands on a man (utterly ridiculous, I know), but my hands became knowledge worker hands.

I've started climbing recently and I now sport callouses and scrapes and an ever increasing grip strength. I've started practicing Aikido again, after many years away from it and realised that I had lost any sense of the "killer grip" my new sensei talks about. The grip that when applied to your wrist causes your hand to claw up. I've picked up my guitar again and I notice my fingertips are soft and hurt after a short time of playing. I wonder if this is all a response to how I see medicine in some way. I know that it is hard and demands so very much, that surviving the long hours and ability to think on your feet is a skill. But my hands soften and that bothers me on a very fundamental level. I don't really understand why. Maybe this is material for a midlife crisis that's just been delivered a few years early.

My feet are runner's feet. My hands must not be knowledge worker hands.

Go figure.

Thursday, 17 March 2011

I am med student, hear me roar

I am up to my elbows in revision, scratching around my notes and the internet to try and make sense of nephritic vs. nephrotic syndrome or RDS vs. Transient Tachypnoea of the the Newborn, so I've not had time to come up with a topic for a blog post recently. I did, however, find time to have opinions about stuff on a friend's podcast, so if you wonder what I sound like, wonder no more:

Hear me talk

Disclaimer: I didn't think through everything I said, so take what I say with a pinch of salt. I'm not one for talking in absolutes if have time to think about what is coming out of my mouth.

Right, back to the books.

Ciao

Wednesday, 9 March 2011

What are you afraid of?

Mrs Absentbabinski managed to score some free tickets to "Ghost Stories" this week. It's a play which is a little slice of genius and genuinely scary in parts. One of the stories (and I don't really think this is a spoiler) involves someone being awake and at work in the early morning and it made me think about night shifts and the quiet terrors they can generate.

I was reminded of the numerous night shifts at St Clabert's hospital (name changed to protect the... Innocent?) Generally once the excitement of drug rounds and cups of tea had settled and people were dropping off to sleep, I would take wandering around the ward (if I had nothing more immediate to do). The ward was divided into 4 six-bedded bays, one per nurse. I would slip into mine and sit in a chair at the far end of the bay and just listen to the breathing of my charges.

Around 3am I am fairly sure that there is some nadir of lots of the hormones that keep the crazy voices out of your head. At this time, if I had nothing more pressing on my mind, I would become convinced that one of my patients would try and die on me. It was irrational and I knew this. But I was sure that something was terribly wrong, so back I would walk, into the bay and I would stop at the foot of each bed listening and playing the beam from my pen-torch over the patient, just to sure.

I would also worry that there was something outside, that is to say that out in the grounds of St Clabert's, something evil was pacing around, just waiting for an unsuspecting nurse to look out of the window and see it and... Well, whatever would happen would be awful. Go figure.

I don't miss night shifts, and ironically I think the things that really should have got my pulse racing (the 3am biochemistry abnormal results, the haematemeses, the  people who would go off (mentally) the minute the sun went down, these things never really scared me. They were tangible and I was trained and/ or experience enough to be able to deal with them. The occult, hidden (and often ridiculous) things that the night holds, they pressed all the right buttons in my lizard brain that had been left running the ship whilst my higher functions had gone off for a nap.

Sunday, 6 March 2011

Acceptable, again

My school has an interesting way of grading our exam results: Acceptable, Cause for Concern and Unacceptable. You also get to know the range of the class’s score and the median result. But no A’s or B’s or curving the grade.

And I’m acceptable. More accurately I’m a bit above-average. And that is something I’m entirely happy with, because frankly, I’ve needed a win for a while now. I’ve been bogged down in feeling like I wasn’t good enough to, like I should stop this nonsense and head back into nursing where I could make a buck, be good at something and not feel like I was a pretender. My grade for the mock OSCE put me a little above average which is where I have been throughout my educational career. Primary school, secondary school, A-levels, previous university life - above average. Not top of the class, not a notably able student who’s full of promise, just a pretty good student.

So I can go into revision for the next round of exams (2 and a bit weeks time) with a more positive feeling than I went into the mock OSCE. And I've just finished a weekend at the family homestead, being fed and watered, drinking someone else's booze and seeing how my father is getting along. Aside from not being allowed raise his arm above his head, he's doing just great, which has also taken a load off my mind (and his, I rather suspect - and the rest of the family!)

Which reminds me, thanks for all your continuing words of support and comfort, it's really meant a lot to me.

I hope you've all had as good a weekend as I have :)

Monday, 28 February 2011

Contagion

from riz94107's photostream
It was inevitable. I have succumbed to some horrid little virus and I am laid up in bed.

My wife brought this back with her one day from the school in which she works. Those bipedal plague factories by which she insists on being surrounded. After going climbing yesterday I came down with shivering a blocked nose and sudden urge to clamber into bed. We'd invited some friends around for dinner and I thought would man up and try and play mein host.

We got to the end of dinner and I felt like I had not got better at all. Since I was a child I've known I was getting unwell because my flesh felt like it was crawling off my bones. A bit like a spidey-sense, but not nearly as cool. 

I'm not running a temperature and I suspect by tomorrow I will be well enough to return to school. I doubt my PBL group will have suffered due to my absence and we kinda know what the disease of the week is before the case even starts which is nice. The one thing that being ill has allowed me to do is sleep. I slept for greater than 8 hours last night (waking once for my alarm which I'd forgotten to turn off). And it was glorious. Even with an over-arching crappiness that surrounds me, I can't remember the last time I slept for so long. I don't know when it will happen again.

Saturday, 26 February 2011

Uh oh, part 2

Right, well then.

I guess this is going to happen more and more. I've not sworn people to secrecy, but I'm not going to mention it in class. Primarily because I don't want to be "everyone read my blog" guy in class. If people find it, read it and figure out it's me, fine.

It does raise some interesting issues around confidentiality, though. I've asked one of the ethics lecturers about my potential concerns about blogging and the impact it might have on my standing with the British Medical Association re: appropriate behaviour for a medical student. He said he'd contacted the BMA and the MDU (medical defence union) about numerous issues around breaching confidentiality and said he'd not got much in the way of a firm answer. This came up because he'd lectured us on how discussing your day with your spouse was a breach of confidentiality (at least in a literal, textbook way), even if you changed the names to protect the innocent and whatnot. I know most medical types shoot the shit in the pub after a bad shift, talking in generalities in public, and most might unload to a wife or husband or whomever at home to clear their heads - never mentioning a name or age or ethnicity or anything that might identifiable information. That this is fundamentally a breach of confidentiality, I find troubling and a little difficult to wrap my head around. So that gave me pause for thought about all of this.

Certainly within the field of blogging, we all say we anonymise patient information but there is always the chance (however microscopic) that someone might recognise themselves and decide to pursue legal advice - something no-one wants to have happen. My lecturer seemed to think that there weren't any hard and fast rulings on issues of confidentiality re: blogging because no case had come up yet, coupled with the fact that the BMA didn't want to prevent doctors (and presumably medical students, too) from what is arguably reflective practice, albeit done in public.

I have seen some people have signed up to the healthcare blogger code of ethics which I think is an excellent idea and I have every intention of signing up after I finish this post. I mean to behaviour in an ethical way and never to breach a patient's (or a co-worker's, for that matter) confidentiality. It is so essential to medical practice, so very valuable to a healthy and successful relationship with your patient or your own healthcare provider, that we should never belittle it. It is a standard that we should hold as high as any other as it reflects on us as professionals and as people, too.

As for my blogging, no-one has suggested anything I have done is inappropriate and this is something I coming to value more and more as the course becomes more demanding. So I shall keep on as I am doing until I hear otherwise, hopefully entertaining and maybe even educating y'all as I spill my brainguts to the internet at large.

Thursday, 24 February 2011

It's what I'd go into debt for

I'm not kidding myself that it's a need, or that I could afford it, but...

I want one soooooo much

Twofer

Yesterday was something of twofer for me:

1) Onto the wards (briefly)! Practiced history taking with some lovely patients who were both engaging and actually knew the details of their medical history. It was great to sit and talk, smile and commiserate (not simultaneously, I hasten to add) and generally play Healthcare Professional. I even got to practice some skills (TPR, BP etc.) which was a nice opportunity to flex a little muscle memory and gave me chance to flick through the end of bed notes. It looks like St Clabert's uses very similar paperwork to the stuff I've used before, so that was comforting.

I've realised that I'm the kind of person that will use this blog to voice the times I'm really not in a great place, but I hope that I can use an equal portion of it to the times when things are going really well. I think it's just a facet of this year that due to its pre-clinical nature there will be more of the former than the latter ;)

2) I used to set-up Octreotide infusion for patients undergoing liver resections or Whipple's procedures and never really understood why. There was something called "carcinoid prophylaxis" that I was doing, but I never had the time to look into what it was and the relative importance of it. I knew that it could cause merry hell with their blood pressure and was potentially dangerous, but not the why behind it. That all changed when I talked with one of our lecturers who was a consultant endocrinologist. He was a really nice guy, who engaged with the class and spent a happy hour dropping knowledge bombs. It turns out that octreotide is a potent analogue of somatostatin and has a similar mode of action. We were using it pre-operatively to reduce the secretions of carcinoids - a bit like in this paper. This is the kind of knowledge I find really sticky. It interests me, has a clinical link and I can see this sitting in my brain for years to come.

Uh oh.

A Facebook message from someone in my PBL group:


Wait, what?


Ah. Okay. Guess my notional anonymity has pretty much gone, then. To his credit, my colleague has said he won't announce it to the class, so thanks for that. And, y'know, feel free to comment ;)

Tuesday, 22 February 2011

How much is enough?

words of wisdom from Wonderella
Today was rectal exam day.

But more importantly, it reminded me how I don't have enough time or energy or ability to be the best.

And how, on a low day, this is really dragging me down.

I don't understand it all, my clinical skill set from nursing is yet to be useful and I am surrounded by over-achievers, Rainman's marginally more socially adept cousin or full-on alpha males. And me, I just want to pass.

I know I can be a good doctor. I know this. Get me on the ward, give me the chance to flex a little communication skill, let me lay hands on a genuinely ill person or something where I can show my quality. I'm tired of the let's pretend of clinical skills where say all the things we don't see (no sign of clubbing, splinter haemorrhages, xanthelasma etc etc) , the PBL sessions dominated by pointless displays of obscure, clinically irrelevant, scientific knowledge, the lectures that wander around the point without actually helping me learn.

I laughed when I saw the entry on Stuff Medical Students Like about "Time". But it's funny because it's true, to quote Homer. I don't feel like there is time enough in the day. It is some small degree of schadenfreude that most people I talk to on the course say this. I think the worst bit of it all is that I feel guilty for any time I spend not doing something to help me with medicine. Go to the pub? Go to the gym? Go to the cinema? This is all time I could better spend learning about Vitamin A metabolism or the pathways of the facial nerve or any number of the myriad little bits of information I need to have at my fingertips, because as one of today's lecturers said:

"One day you're going to be sat in A+E at 3am and not have a bloody clue what is sat in front of you"

And that, I guess, is what scares me the most. That I don't feel I have enough time now to be the best and one day, someone's life may well rest on me remembering that symptom X is a tell-tale sign of disease Y which if not picked up will kill them in a couple of hours.

So I work as hard as I can, but I don't feel like I've covered everything. And it doesn't matter how many times I can answer the lecturer's questions, the one time I can't, some else can - which undermines any sense of confidence I have about the topic. It's sick really.

On the upside, Father's had his angio which showed, to quote the radiologist "pristine coronary arteries", so that's something :)

Sunday, 20 February 2011

A delay in resuming normal programming

Sorry for not having posted anything this week, it's been due to various factors: essay writing, OSCE fallout, exhaustion and Father's illness. People have asked for updates so I thought I'd pop them into a post rather than in the comments section.

He's still in CCU, awaiting an angio (hey, this is the NHS after all and he's not on his last legs so he gets to wait), no meds, no real interventions to speak of, brady sinus ~40bpm and proving something of an oddity to all and sundry.

Apparently his consultant is known to have sat on the edge of Father's bed, head in his hands, and say things such as "we just don't understand what's wrong with you". Which whilst being less than useful is more humorous (in a bleak sort of way) than anything else.

My mother is doing okay, I think she feels the strain of it more at night when she's away from him. She was an RN for many years so she has a bit more insight than most as to how things work in a hospital and I'm able to speak medicalese to her when she asks questions I can answer about Father's treatment. That said, she is doesn't want to read the leaflet about the complications of having an angio.

I am... Maybe not coping as well as I thought? I'm not really sure. Outwardly, I'm not really phased by this. I know, rationally, that people get ill. Especially people over 60 (as my Father is). That he was otherwise fit and healthy goes someway to explaining how he appears to be almost entirely symptomless. He is not acutely *unwell*. He's probably going to have a pacemaker fitted "just in case" - because medics can rarely leave well enough alone. He is at very, very low risk of complications from the angio. He will go on for many years to come with little in the way of long term complications from this experience. The numbers are with him on this one.

And yet.

Myself and Mrs Absentbabinski sat with bowlfuls of chilli watching the TV on Friday night and I just didn't have an appetite. I wasn't even watching the TV. I wasn't really doing anything at all. I wasn't even thinking, directly, about Father. I was just zoned out. A bit shell-shocked and very, very, tired.

So maybe I'm not doing as great as I thought I was. But I'm okay. And so is everyone else. We shall see what Monday's angio brings, I guess.

Tuesday, 15 February 2011

And now a word from our sponsors

from phunkstarr's flickr photostream
So this was going to be a post apologising for not having put anything up over the weekend and talking about OSCE's, stupid sociology essays and my favourite blogs/ applications.

However...

I've just had a 'phone call from my mother telling me that my 60-something, otherwise fit and healthy father has just been admitted to the local CCU with a pulse in the 30's and feeling a bit "funny".

That he drove to the GP who told him to pack a bag and present at A+E and then drove home is testament to the fact he doesn't feel unwell, per se.

But from what I could gather from my mother on the 'phone he doesn't have a P wave on his ECG. And a borderline troponin. So they're hanging onto him over night and talking about maybe a pacemaker as a treatment.

I know that without all the facts any research I do is just so much guesswork and I'm bound to focus on the worst possible diagnosis I can find. But I don't know what else to do. Mother told me she would call tomorrow to let me know what the consultant said after the ward round tomorrow morning.

All I can do is wait, bury my nose in Kumar and Clarke and feel a little bit nauseous. I think it's the nerd in me that finds this the easiest way to try and process being told this kind of thing, even down to feeling annoyed I can't see his ECG for myself. My friend Hazel suggested it was the alpha male in me - something which made me smile as I don't think anyone has ever described me as an alpha male in my life.

I guess it also goes someway to explaining why I ended up in medical school.

This is not a great feeling at all.

Friday, 11 February 2011

Damn your eyes, Sir!


Fuuuuuuuuu-

Hang on, let me try something

)

Nope, that's not going to do it.

Monday, 7 February 2011

30 Day challenge: Day 8

Day 8 11: Put your iPod on shuffle and write 10 songs that pop up


I didn't get bored with the concept of a post a day, but the intervening topics didn't really interest me, so I skipped to this one. Being in the UK I use Spotify a whole lot, so I'm going to go with 10 randoms from my starred playlist. I'll link to them in Spotify and maybe YouTube or something

Skanking Song - [spunge] (or this link)

It reminds me of fun times when I was young enough to not be the weird old man down the front of gig. There was dancing and cider and stolen kisses from girls I never saw again, good times.

Take Me Anywhere - Tegan and Sara (or this link)

This is a song that totally reminds me of San Francisco, going over there to meet up with a girl I met online and actually ended up in a bit of a relationship with. It's a bit of goofy indie pop that makes me feel hopeful about life.

This Addiction - Alkaline Trio (or this link)

I'd just started nursing when I fell back in love with Alkaline Trio. Yes, I know it's emo power-pop and I'm too old and happy for that sort of nonsense, but it's great to run to and even better to thrash around to in the kitchen when you're cooking dinner.

Anaesthetist's Hymn - Amateur Transplants (or this link)

I love the Amateur Transplants. They are a pair of junior (probably not that junior anymore) doctors who have a knack for doing comedy covers of songs. And this is easily one of their finest examples. And it gets the role of the anaesthetist in the OR just right.

Autoclave - The Mountain Goats (or this link)

Possibly my favourite band right now. John Darnielle has a wry, self-deprecating sense of humour and a soulfulness that comes across in his music so clearly. This song is a warning to potential partners, but it's all said with a smirk.

What Sarah Said - Death Cab for Cutie (or this link)

The other band I spend a great deal of time listening to because of the lyrics. This is just an incredible song which sums up the despair and loneliness of waiting for a loved one to die or get better in an ICU.

Samson - Regina Spektor (or this link)

I'm kind of embarrassed that I've only just found out about Regina Spektor. Her voice is beautiful. Oh, and have a look at the Laughing With video. That too, is pretty awesome.

Meddle - Little Boots (or this link)

This is another kitchen classic. It may even lead to throwing shapes and being generally a bit embarrassing.

Mr Brightside - The Killers (or this link)

Oh, this is a being dumped song that dovetails nicely into either the Alkaline Trio track or the Tegan and Sara, seeing as they all vaguely remind me of the same girl. That said, it's a cracking track in its own right and well worth a listen.

Sick 2 Def - Plan B (or this link)

This is the sound of an angry guy born on a London council estate. It's a dark, challenging song, not for the faint-hearted, but the lyrics are inspired and show an intelligence beneath the posturing and violent language.

Hope you enjoy some, if not all, of the above. Let me know what you liked or what you didn't :)