It begins. Again.

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.

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.

Of roles and expectations

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

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

The patient will see you as a caraciture

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

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

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

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

It is both a privilege and a responsibility.

Runner's Hip

What is this hip pain?

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

Like I say, 4 weeks ago.

TFL to its friends

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

S - Site - Superficial to the greater trochanter

O - Onset - 4 weeks ago

C - Characteristics - Hurts when I run, not much else

R - Radiation - Nope

A - Alleviation - Not running (!)

T - Timing - Uh, no

E - Exacerbating factors - Again, running/ not running

S - 2 normally, 8 running

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

Creative Writing?

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

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

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

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

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

He knew it was time to go back.

One down, a few more to go

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

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

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

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

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