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 :)

Bicycle vs. Car

Sooooooooo...

One big meaty hole, to go, please.
I've officially had my first proper crash on the streets of London. It hurt but it was one I could walk away from. I was on the cycle, she was in a car and decided to turn left immediately in front of me. I pulled on the panic handles and slid into the passenger door on her car and then slightly underneath it. Or at least my bike did, I tumbled off to the side and lay on my back for a while considering how quickly everything had happened.

I got up and exclaimed, using some rather salty language how surprised I was at this occurance, and how the woman driving should pay more attention to other road users.

No damage was done to my bike and I seemed to have no more than skinned knees and elbows so we left it at that and went our separate ways.

2 hours into my PBL session and one of my knees was still bleeding from what looked like a puncture wound caused by the head of an allen bolt. As my PBL-mates became progressively more grossed out by the blood dripping down my leg, I decided to head on down to the A+E dept (one of the joys of having your med school attached to a hospital). I got an x-ray for my troubles (and first hand experience of surgical emphysema - it crackles!) and a good scrub down with betadine at the hands of the A+E consultant.

It's not going to stop me riding around London, though I might go a little slower. I'd forgotten how painful it is to have a hot shower with skinned knees.

Saturday, 5 February 2011

30 Day challenge: Day 7

Day 7: Your zodiac sign and if you think it fits your personality


My zodiac sign is Libra and I think it fits me rather well.

Some of my more Libran qualities:

  • A desire for balance
  • Even-handedness
  • A love of luxury but a dislike of ostentation
  • A strong belief in my cause, whatever it is
  • A preference for peace over conflict
  • A love of public service
  • A dislike of confusion, being rushed and sloppiness
I am, however, more than familiar with the notion of Cold Reading and how 5 million people cannot have the same day (if you take the population of the UK to be roughly 60 million people). It is (as Granny Weatherwax would say) Headology and a bit of fun so long as you don't take it too seriously. Certainly, not something to put too much faith in nor spend money on.

Friday, 4 February 2011

30 Day challenge: Day 6

Day 6: Write 30 interesting facts about yourself


No :P

Hang on, let me try for ten and see how I go:

1) I was first of goodness knows generations of my family to go to university
2) I'm the first of goodness knows generations of my family to go to medical school
3) I'm almost certainly the first of my family to marry an American.
4) I double-barrelled my surname with my wife's when we got married (it sounds awesome, fyi)
5) I was once described by my high school biology teacher as a "trouble maker" (he loved plants; I thought botany was boring)
6) I rarely sleep more than 5 hours a night (a hangover from shift work, I'm sure)
7) I was rated as "nice" by the female contingent of my course (the other option was "nasty", so y'know, score!)
8) I love using my MacBook and will earn enough this year to treat myself to a MacBook Air by Christmas (student discounts rule!)
9) I'm a dirty lefty. In several different ways.
10) I'm out of Jack Daniels, so I'm drinking Gin and Juice.

10 was a push. I get why the task is 30, 'cause the whole thing is a 30 day challenge etc etc... But I'm not that interesting and I figure I'd end up with a frankly desperate list if I got to 30. Which would please no one, least of all me.

Hope you're all enjoying the start of the weekend :)

Thursday, 3 February 2011

30 Day challenge: Day 5

Day 5: A time you thought about ending your life


I don't think I ever have seriously thought about ending my life. I've been depressed, but never suicidal. Well, I guess that's not *entirely* true.

Before I did my nursing training, I had a crappy job that paid enough to fund my boozing and smoking and food, but not much more. It had no future and gave me no satisfaction from a day's labour. During the time I worked there, I think I became clinically depressed. I don't know for sure as I never went to see a doctor - I didn't like the idea of a mental health problem on my permanent record. I would miss days of work because I just didn't feel like getting out of bed. I would sit, in the dark, and think about how pointless my life was. Nothing gave me any genuine pleasure. My mother said she could hear it in my voice.

There were times when I would stand at the bus stop waiting to go to my shitty job and wonder "if I just step out in front of this bus, would it be any worse?"

The answer, of course, was yes. And I knew that. I think it was more self-indulgent emo-kid behaviour than genuine suicidal ideation, to be honest. And all the bad thoughts dissipated when I left where I was living and started nursing. In retrospect, I could make a compelling case for what I experienced being that kind of whiny misery that you have to white, middle-class and male to really *own*.

So maybe it wasn't depression at all. Maybe I was just being a self-indulgent asshole. That sounds plausible, though maybe a bit more pedestrian. Recall bias and not having had an objective assessment at the time makes it hard to tell, but I guess it was an experience from which I am still learning.

Wednesday, 2 February 2011

30 Day challenge: Day 4

Day 4: Your views on religion


I know this is a total cop-out, but there is no way I can come up with a comprehensive, well thought-out blog post on my views on religion at this time of night after I've just spent my evening breaking the back of Respiratory Distress Syndrome (suffice it to say, more complicated than I expected).

Can I take a pass on this and I'll come back to it? Maybe I'll do two posts on Saturday or Sunday? I'd like to cover this topic, so I'd like to do it justice.

Short and dirty is, I'm an atheist. But it's a bit more complicated than that. And my personal choices don't nearly encapsulate how I feel about the notion of religion in general or other people's lives or choices.

Like I said, more complex than my brain can handle right now. So I call a Mulligan and I'll get back to you.

The Checklist

Dr Steven Novella has just done a nice post on the importance of Checklists in general. I was introduced to the notion of the WHO's surgical checklist by one of my lecturers (I forget the main thrust of her lecture) who wanted to emphasise how lives are saved by double- and triple-checking aspects of care. When we did a mock OSCE on Tuesday one of the stations was drug administration, something I've been schooled in for quite a while and it gave me chance to share one of the checklist tools I was given in my nursing training:

The 5 rights of drug administration
Right patient
Right drug
Right time
Right route
Right dose

I've seen plenty of corners cut in my time on the wards, and how it was down to people doing extra work that there weren't serious complications. I hope I don't forget this when it's my turn to do either the right thing or the easy thing. I don't think they're often the same thing.

30 Day challenge: Day 3

Day 3: Your views on drugs and alcohol


An Old Fashioned from ReeseCLloyd's Flickr stream
In an act of unintentional irony, I am blogging drunk.

Which I guess tells you a lot about my attitude to alcohol if nothing else. In my defence, I should point out that I'm not in school tomorrow or working or doing anything (other than maybe going for a run tomorrow morning) which require me to be up early. Not that I generally drink to excess. Generally.

I think drugs is a topic that can be very complicated. For an individual, I think it can represent any number of subtleties in their personality. All the dreadful aspects of the drug trade and all the ills it brings on the world aside, I think if you can't handle your high, you should probably leave any mind-altering substance well enough alone. I particularly think that becoming intoxicated and getting behind the wheel of an automobile is one of the most awful things a person can do.

I can't think of much to write on this topic without sounding judgmental in one way or another, so maybe I need to go away and think on this some more. Maybe that's the point of this exercise - to go and explore topics you thought you had pegged?