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...

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)

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.