Monday, 31 January 2011

30 Day challenge: Day 2

from m22+'s flickr photostream
Day 2: Where would you like to be in 10 years time?


I was going to start this post with a fatuous statement about wanting to be a doctor in 10 years time and leave it at that, but then I realised this question is one that has a dozen different angles to it. So I will try and answer it from a few of them.

Career in 10 years time? Well, I would hope that I will be well into my Specialism Training (for the non-Brits in the audience our doctors spend 2-3 year post-qualification on the Foundation Year programme before entering specialist training or the "ST" years. This leads ultimately to the role of Consultant in a specialist field). I don't know now what speciality will take my fancy, but I want it to be one where I make a real difference to as many lives as possible. And one that satisfies my desire to learn and develop skills. And hopefully a speciality that pays enough that I can help support my family and give them as many opportunities as possible.

Location in 10 years time? I've talked with my wife about going back to America (she being an American) - It's something I think would be very exciting and would offer a lot of opportunity to me and would, I think, make her feel more comfortable than living in the UK does. We've also talked about the possibility of moving to Australia or New Zealand - both places I think would be interesting places to live and would have similarities to the UK, but enough differences, too. I'm not really desperate to stay in the UK.

Physically in 10 years? I want to be faster and stronger than I am now. There is a line in Hagakure that states (and I misquote, probably) "a man should gain strength until the age of 50". Now read into that what you will, but it sounds like a pretty good aim to me. I want to run a marathon before I'm forty and work to gain a black belt in a martial art. These seem like reasonable goals to me.

Mentally in 10 years? I want to be happy with all that I have achieved and all that I have planned out. I figure if pursue my goals with good spirit and punch just above my weight, these too should be reasonable goals.

Right, introspection over, my pasta is pretty much done.

Laters~

Sunday, 30 January 2011

30 day challenge: Day 1

Estelle Darling over at Word Lust introduced me to this notion and I was looking for a fun way to increase my output here so I thought I'd give it a go.

Day 1: Your current relationship


Mr and Mrs AbsentBabinski
I have been married for the best part of a year now and it has been a lovely development in my relationship. We lived together for a couple of years before we got married and it felt the natural progression and to her credit my wife is one of the major reasons I can pursue my medical career. She has been the bread winner since we started dating and will continue to be so for the next 10 years I suspect. She is also long suffering and knows just the right thing(s) to say when I have my regular "Why did I leave nursing? This is crazy! I should be earning money for us!"

She is my confident, and my best friend. And the person I hope to spend as many years of my life with as I can.

We have totally different tastes in so much, but we make it work. In fact we have the dubious honour of annoying my wife's friends by not arguing about... Anything, really. I think that's why we work, we might have different tastes and views but we respect and love each other.

Someone once told me that when you apologise, you're not admitting you're wrong - you're stating you respect the relationship you have with the other person more than being "right" (whatever that means). And that's what guides me through the harder bits of being married.

Do not look for patterns. Look for patterns.

George would be proud :)
Inspired by a bit of med school doublethink. On Tuesday afternoon last week we were told "Do Not Look For Patterns!" when it came to ECGs, by one of our clinical skills lecturers.

Shortly afterwards, we had a consultant cardiologist state "You should be able to identify around 20 different patterns on an ECG by the time you qualify".

So in a bid to upset no-one, I present a link to a cheat sheet I found whilst finishing off this week's LObs (Learning Objectives, it's a PBL thing)

ECG cheat sheet from ECGpedia

I've bookmarked ecgpedia for future reference. I think we shall become close friends over the years.

Tuesday, 25 January 2011

Why does my heart, feel so bad?

Actually it doesn't. But I thought of that title for this post and couldn't come up with a better one.

Clinical skills this week was ECGs, which I have done hundreds of times as a nurse, not really understanding what I'm looking for, sticking the dots on, pressing go and calling the doctor. I know what a QRS complex should look like and that lead II is my rhythm strip but that's about it.

To be honest at this stage of med school, we're not expected to know much more than that, but we have been given a bit more knowledge and explanation for what we should expect to see on which lead. It feels great to have a little bit less mystery in my world and a bit more knowledge that I can apply. I'm sure it will take the remainder of my course to really get to grips with ECG's, but I'm happy that I've understood everything they've explained so far.


yup, I think I'll live
I've been told that ECG's and CXr's are the hardest things to analyse, but the most useful. So I guess I might spend a bit extra time with this, even if it's not going to be an OSCE station, I think the clincal application warrants it.

(P.S. Anyone else see a bit of the old exercise-induced left ventricular hypertrophy? :P)

Sunday, 23 January 2011

Boom

Now I know I shouldn't be too full of bravado but yesterday was a very nice surprise:







I'm really hoping whatever damage I did to my hip has resolved itself. This means I could still, *just*, be on for my half-marathon in March.

Maybe.

Wednesday, 19 January 2011

Nurse, med student, patient

Last week was all about Asthma and as an asthmatic I had the opportunity to fill the role of expert patient for my PBL group.

"Expert patient" was a phrase I heard bandied around during my nursing training as a kind of gold standard of educated, engaged patient - someone who "knew more than the doctors". I found by and large patients just wanted to be told what to do and those that knew their condition inside out were more of an annoyance "I don't take my pills now/ do you even know what you're doing/ why can't I keep my tablets on my bedside table?" than a useful resource.

But here I was, telling my group about the ins and outs of asthma, medication and emergency care. I've never really thought of myself as someone with a chronic illness - I've never missed work because of it, never had an ED admission because it, exercise as well as anyone on my course (110% of predicted lung function and capacity, what up). But in my backpack is my salbutamol inhaler (just in case) and I take beclomethasone 50mcg BD, so I guess I am chronically *ill*. It was the main reason I didn't get into the RAF after my nursing training. It gives me pause for thought when it's really cold out. I know what it feels like to have your bronchial smooth muscle contract, leaving you fighting for breath. It's terrifying.

My mother was a stickler for me knowing my condition, I used to read her BNF in high school and learnt early on about corticosteroids and beta agonists. Then as a nurse I learnt about nebulisers, anti-muscarinics, how to read a blood gas and how to correct it and what to do when the shit hits the fan.

The week really pushed two thoughts to the front of my mind:

  1. There is value in the expert patient. I am one - I know how to manage my chronic disease and I would kick up a storm if I thought a healthcare professional was treating me incorrectly
  2. Respiratory medicine is something close to my heart. I'd never even considered when, sat with coursemates and coffee, the question is asked "What speciality do you think you'll get into?"
Food for thought.

Tuesday, 18 January 2011

Keep death off the roads. Drive in the cycle lane.

I have become a cyclist.

Which is to say, any given weekday morning 0800, I don my Hi-Viz orange jacket and trusty skid lid and take my life in my hands battling the half-awake drivers of South London.

I spend 30 minutes practicing my defensive cycling (generally involves pointing at drivers poking their noses out of side roads and into *my* cycle lane), working up a sweat and a sense of modest superiority.

It does generally mean that PBL mates and lecturers alike see a little more hairy calf than anyone wants to see, but hopefully I'm burning off the Christmas calories.

And I've discovered that to be a cyclist on my course is to join a clique I didn't know existed. People are coming up to me asking how my ride in was, suggesting websites to buy gear and generally giving me props for riding in whatever the weather. What other mysteries will this lifestyle open up to me?

Another mnemonic for you med students out there

A new week, a new case, same old stuff to run through. Once you have your disease of the week, you can go through all the important bits of it, systematically.

DR DEAC PIMP

Definition
Risk factors

DDx
Epidemiology
Aetiology (apologies to my transatlantic cousins!)
Cause

Pathophysiology
Investigations
Management
Prognosis

Wednesday, 12 January 2011

Well, that's disappointing

Going through my Google Reader feeds, I've come across an eloquent assessment of the frankly appalling reponse by the General Pharmaceutical Council of the UK regarding the sale of homeopathic preventive "treatments" for malaria:

Homeopathy for Malaria

Dr Novella does a great job of pointing out how egregious this response is and what impact it might have on future behaviours of purveyors of sugar pills and dangerous advice.

Because this week is Asthma

Our PBL case this week is Asthma. Which means I know what YouTube clip I'll be sharing in tomorrow's session

Thursday, 6 January 2011

It begins. Again.

One christmas in on the road to being a doctor
An Absentbabinski in repose
You win some, you lose some. First day back was more successful than I expected! Second day back was pretty depressing.

I met up with my new PBL group and quickly realised there were quite a few strong personalities which will take some time to start to gel. I figure this is as much about the types of people who go into medicine as much as anything else.

The theme of the week is hypertension, so the practical was cardiovascular exam - allowing me the chance to bust out my new hunter green Littman Classic. I know it's corny, but you drape a stethoscope around your neck and suddenly you feel a bit less ridiculous running through the "Hi, I'm a first year medical student..." spiel.

The comms session was filmed this week which was pretty exciting. We sat with an actor practicing history taking whilst the lecturer filmed the 5 min "performance". I really enjoyed it, partially because I felt challenged by the situation, but also because it gave me a chance to do something I enjoyed as a nurse - talking to patients. If I could be sure the actor wouldn't mind I'd upload the vid to YouTube and give you the chance to rate me!

The downside of the week was two-fold. I had to face up to having not got the best results in my first summative exams. The marking is split into Basic Clinical Science (BCS) and Personal Professional Development/ Community Population Health (PPD/ CPH). My BCS marks were sound (as I expected), but my PPD/ CPH mark fell short. So even though I passed the exam overall, I was called up as a "cause for concern" on the PPD/CPH. I think it was a bit overly dramatic, seeing as how I was told that I would just have to up my efforts in future exams to ensure I keep the mark for PPD/ CPH well above passing in future exams. The head of exams also suggested some materials I could look at to help clarify some of the concepts I seemed to struggling with. So not awful, but still a bit galling.

This was followed up by a lecture on hypertension that forced me to face up to the fact I am pre-hypertensive. I've known for a while, but not really wanted to address it - typical male/ medical response to the notion of illness. I've been feeling pretty stressed about the exam results, money (surprise, surprise) and just generally the future (various things I'll go into in a future post, I'm sure), so having a lecture remind you that you really need to change some aspects of your life, because you are inherently unhealthy just left me emotionally drained. Not great.

I think I need to read Desiderata more frequently:


Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.

I'm sure part of this is just nerves from restarting the med school journey again, which will subside when I get back in the saddle. The other bit will probably be resolved with me passing my next exams with marks to spare and once I start getting shifts on the staff bank.

Monday, 3 January 2011

What New Year's Eve looked like to me...

Where have you been?

Everyone just wants to have a good time
When I started this blog I had such high hopes of being able to update regularly and for the first few months I think I did okay. Then revision and associated exam pressure descended on me, and you know what? Med School is *hard*. And revision takes *a lot* of your time, trust me.

Anyhoo, I've been mulling over stuff to write now that the holidays are over and I have 24 hours to breathe before school starts again tomorrow. I'm not the most inventive chap on the planet, so here's a couple of lists for you:

What I've been doing:

  • Revising
  • Having my first proper exams
  • Getting very, very drunk
  • Getting my results (passed, but need to pull some grades up to stay in a good place)
  • First Christmas as a married man (a lot of fun - combination of family traditions from both sides, with a little something that is just us)
  • First NYE in London that I've not been working
  • Planned out and tested my riding route to school (Father Christmas brought me a bicycle so now the road is my friend and I am a vision in Hi-Viz orange)
  • Playing a bit of World of Warcraft (Don't judge me!), though this stops today because, well, I can't trust myself to not play it too much!
Things to come (pre-loading worries for the new year)
  • Actually getting some nursing shifts at my new hospital (Lost forms, general apathy towards the notion of work and hospital bureaucracy have all working against me for the past few months)
  • First OSCEs (getting to be examined on skills I've been rushed through - yikes) 
  • Essays, essays, essays
  • Money worries (I know this will be part of the leitmotif of medical school, but that doesn't make it any easier to deal with)
  • New PBL groups! A chance to get to know another six of my coursemates a little better than before. (Something I'm actually looking forward to!)
  • Losing weight - The scales are no longer my friend and nor is the app on my iPhone that declares me to have a BMI of 25.1 - I am now overweight. Boo to that.
I've not made resolutions, because I figure I'm only going to keep on doing something if I either enjoy it and/ or want the results of it enough. I'm not sure that promising to do/ not do something really works for me. 


I hope the people who read this have had good times in the past year and will have even better ones in the upcoming 12 months.