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.

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.

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 ;)

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 :)

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.