Yeah right you fell

A patient walks in holding his hand in pain, saying that his hand has been hurting since this morning. He claims that he just "woke up" with the pain, and on examination there is swelling of his hand along with tenderness around the 4th/5th metacarpal.

It was pretty obvious what had happened, but we asked him again, and still he insisted that he just woke up with this problem.

So we sent him off for an x-ray.

Which, to nobody's surprise but perhaps the patient's own, came back looking something like this:

Pointy arrow says "hello fracture!"

For the uninitiated, this is a distal fracture of the 5th metacarpal, also known as Boxer's fracture, due to the nature of how this injury is commonly sustained.

Despite what patients will have you believe, the only way you can fracture your metacarpal like that is by punching something (or someone, you never know).

In my short A & E stint I've become a bit of an expert at looking at these fractures, thanks to the crazy amount of people who turn up in the department claiming that they fell or don't know where this pain came from it just magically popped out of nowhere or straight out admit they've been punching walls in anger etc etc.

I'd like to see someone try falling onto their closed fist.

You have to give this guy credit for sticking to his guns, even though we told him there was no other plausible way he could've fractured his hand unless he's gone around punching walls, he still insisted he woke up with it.

Perhaps he's been punching things in his sleep? I worry for his wife.

Why anyone shouldn't be a doctor

In a phone conversation with my parents the other day, my mum asked if I had enough money to survive, after paying the extortionate amount that is my tuition fees.

I will do, if people click on the adverts *hint hint*.

Anyways, one of the FY1s showed us her paycheck the other day. Even the consultant was shocked by the amount, because it was the same amount he used to get as a house officer. Over 30 years ago. The cost of living has most definitely risen since then, but not our wages. Figures.

My friend who is on a placement year gets the same amount. In fact, most of the auxiliary staff in hospital get the same amount, if not more.

I wonder whether it's too late to reconsider another career path.

All you wannabe medics out there, heed my words, the life of a doctor is not all glamourous as it seems. You're generally overworked, unappreciated and underpaid. And hugely in debt.

Back to the phone conversation with my mum, I was half expecting her to say something along the lines of, "If you don't have enough money, you can ask me for some."

Instead she said, "If you don't have enough money, go ask your brother for some."

I suppose this is one of the reasons they are happy he's got a job.

Writings from the A & E

The strangest things walk in through the A & E department sometimes, that when you look at the triage form you think, maybe the triage nurse didn't really mean what she meant.

Some examples of presenting complaints as seen written on the triage form:

• Swollen finger after repeatedly poking someone with it yesterday.
• ? Deliberate self harm - has stuck metal can in vagina
• Fell down stairs, hit both arms and ironing board. Both arms swollen.

People should compile a book about most random A & E presentations. Or is there already one?

Illegal Transactions

My friend called me up and asked to meet at the train station so she could pass me something that needed to be returned to the hospital.

That something was this:
Adam, Rouilly: Opthalmoscopy Training Head

It looked like we beheaded someone, cracked their skull open, removed the brain and was exchanging the remains in the middle of the street in broad daylight.

I got so many weird stares from people when I walked home with it swinging in my arm. I suppose it's not really usual to see disembodied heads in the hands of some random person walking on the street.

But luckily nobody called the police and accused me of murder.

So you had a bad day

Woke up rather reluctantly this morning, went to the car, and discovered that some bird(s) had done some rather amazing diarrhoea all over it - it must've been some really ill bird(s). Never mind that the car is parked indoors.

Drove to GPLand, which is usually about 15 - 20 minutes away, but took a bit longer than expected because of traffic, but managed to reach GPLand on time, only thing that parking at the practice was full so I had to find some random residential road and park up there, all the while worrying about people breaking into the car because it was a very dodgy area.

I hate being in GPLand, so that's already bad enough. GP Tutor didn't look to happy when I said that I had to leave early because I had to go see my supervisor at 3pm. Then she sent us out on a home visit equipped with just the address of this person.

I find that all GPs that I've been attached to expect us to have extensive knowledge of the surrounding area down to every random lane, despite the fact that we do not live anywhere near there. Thank god for Google map.

Anyways fast forward to rushing off to meet my supervisor for 3pm. Luckily we managed to make it in time because he just finished surgery. He told us to wait while he took a quick break, so we waited. And waited. And after an hour decided that perhaps we shouldn't really be waiting anymore. Went off to find him only to discover that he went home. Nice.

Then it took me 50 minutes to get back home because traffic was just crazy.

I wonder if this counts as a bad day?

Anyways, digressing a bit (I tend to this a lot), on my 50 minute journey home down a straight stretch of road I saw 6 ambulances and 2 police cars.

A & E seems to be very busy this week.

Saw, drill and hack.

Orthopaedic surgeons are like carpenters.

Their theatre is like a handyman's garage with lamina air flow, and their tools probably came straight out of your standard toolbox, only difference is that it is all sterile.

Throughout the surgery the surgeon kept talking about how foundation is the most important bit when building a house and how you need to have grout and cement to hold the bricks together - all the while drilling holes and sawing and hammering nails into this poor old lady's femur.

I think orthopods would naturally be very good at DIY jobs.

Pre-hospital Trauma Trained

Trauma course weekend is over, now to await the ever elusive results... and then be a fully certified... actually what would I be after I get the cert?

I suppose "qualified" is a bit too strong a word.

Anyways, I can now assess a trauma scene for danger and maintain an airway!

And that's about it really. I can now go buy that hoodie from university that I've always wanted, the one that says MEDIC on it, because at least if someone gets knocked down by a car in front of me while I'm wearing it I would know exactly what to do - shout for help and scream like a little girl.

I'm on A & E all this week, and it's fresher's week, so I'm hoping to see some broken bones and random drunk accidents.

You can probably already tell that I'm a pretty sadistic person.

Car vs Tree

Today I was told in a lecture that you should never ever crash your car into a tree.

Because trees are horrible things to crash into.

If you have to crash into something, you're better off crashing into a group of small children, or even a brick wall.

I somehow doubt the man who gave the lecture would make a good paediatrician.

Yet another life's lesson learnt on the trauma course. It's pretty good, really.

It's the weekend! Or not.

I have signed myself up for 3 days of pre-hospital trauma course organised by the faculty, whilst they insist it is not compulsory it sure does sound like it - medschool has a way of doing things like that.

Basically it's a 3 day course teaching us the ropes of pre-hospital trauma life support, which cumulates to a written and practical exam on Sunday which would hopefully see me getting a certificate saying that I am trained in trauma life support.

I've picked up the course material and read through select sections of it, actually just the "what to do when caught in a shootout" section, because that sounds like it could be very useful information to know.

And I feel like sharing it with the general public. So! What I've learnt in a nutshell:

In a shootout, never hide in police/ambulance cars because they make easy visual targets for the shooters. Unlike what they tell you in movies, cars make for very bad cover. Bullets can go straight through them. If you need to take cover behind a car, the engine block is your friend. What you really want to be doing when caught in cross fire is to keep as much distance as possible between you and the scene.

Also, police dogs can't tell the difference between good and bad guys.

End community service message.

On a sidenote, I wonder whether it's any reflection on our society today that our trauma course teaches us how to approach a scene of violence and riots.

I has mojojojojojo

It is common stereotype that orthopaedic surgeons are big, muscly and love their power tools. There was some mention about intelligence but I won't go there.

So why is it that all the orthopaedic surgeons I've encountered so far are, to put it simply, eccentric?

I sometimes get the impression that they have been sniffing crack on top of having some sort of attention deficit disorder. (Rest assured that is not the case, it's just my personal feeling.)

I didn't quite know what to say when the consultant walked into clinic this morning and excitedly proclaimed to all who were present:

"Guess what? I've finally got my mojo back!"

Which was swiftly followed by two thumbs up, a smirk, and a wink.

I wonder what Austin Powers would have done in that situation.

Case Scenario: Hot Stuff

Mrs. Melaena Stools is a quiet 58 yr old lady who presents to your surgery late on a Friday evening. She is a patient of your partners who is in Japan watching the world cup. Unfortunately her records have gone missing and are believed to be in the back of your partner's Lotus. She has been limping in pain after slipping on a loose grape in her local supermarket.

Mrs. Melaena Stools? Seriously. For the non-medics out there melaena = blood in stool.

And I find it completely random that the question talks about Japan, world cup and a Lotus before telling you that she slipped on a loose grape.

And why is the case scenario titled Hot Stuff?

I really wonder who writes the case scenarios for our tutorial sheets.

Because I want whatever s/he is smoking.

Cycle. Is good.

Cycle. Get yourself knocked down by a great big red double decker bus, more like.

In a Galaxy Far Far Away

I am so addicted to this, it is taking up my life.

Star Wars: The Complete Saga

And to think I've only completed, like, 20% of the game so far.

Everyone I've introduced the game to are thanking me for bringing them to the dark side.

Speaking of addiction, I may very well be an internet addict according to this criteria.

• Do you feel preoccupied with the internet (think about previous online activity or anticipate next online session)?
• I'm online all the time. What's there to anticipate?
• Do you feel the need to use the internet with increasing amounts of time in order to achieve satisfaction?
• I need to use it all the time... mmm internet. And using the terminology "achieve satisfaction" just... sounds wrong.
  
• Have you repeatedly made unsuccessful efforts to control, cut back, or stop internet use?
• I've never bothered trying. So I suppose that's repeatedly unsuccessful attempts.
  
• Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop internet use?
• Hahaha... yes.
  
• Do you stay online longer than originally intended?
• There is no such thing as "longer than originally intended". I'm on all the time.
  
• Have you jeopardised or risked the loss of a significant relationship, job, educational or career opportunity because of the internet?
• Uh. Would it sound really pathetic if I said yes? What can I say, I'm antisocial to begin with.
  
• Have you lied to family members, therapist, or others to conceal the extent of involvement with the internet?
• Does anyone really care how involved I am with the internet?
  
• Do you use the internet as a way of escaping from problems or of relieving a dysphoric mood (for example, feelings of helplessness, guilt, anxiety, depression)?
• I have a freaking blog. What do you think?
  

Although to be fair this criteria is based on the pathological gambling criteria, and internet addiction is not really recognised as being a mental health issue as it is not being considered for the Diagnostic and Statistical Manual of Mental Health (DSM V).

Also the criteria was written in the age of dial-up and 56k modems.

Are you an internet addict? You need to answer 'yes' to five or more of those questions. Tell me your results in the comments!

You mean he was born with two hands?

We were at the nurses' station discussing the patients we saw yesterday and what interesting signs and symptoms they had.

The patient in Bed 5? The one with the hands?
Yeah, and the patient in the side room has a good abdomen.
What about that man with the toe?

I know exactly what they mean - we're not excited that a patient has, in fact, two intact hands and some toes, but that his hands have something medically relevant to our clinical learning.

Because I'd be very worried if all those patients were suddenly lacking basic anatomical assets.

I find that nowadays with all the need for patient confidentiality I end up referring to the patients I've seen after their main diagnosis; a few examples being Infective Endocarditis Guy, Diverticulitis Woman, Man with Paper Eating Dog.

I sometimes wonder whether this is a good idea, because in a way it encourages the thought of a patient as a diagnosis rather than a person - a notion that seems rather incredulous but sadly true.

On a completely unrelated note, at least I don't refer to the jaundiced patients as part of The Simpsons family.

I think I really need that X-ray

I don't quite know how to describe this, but there is a lump that sits slightly above my left costal margin.

It is only slightly tender, and does not really stop me from breathing or coughing up my internal organs.

I do recall falling on that side when I flew off the bike.

It feels like it's part of my rib cage - probably the 10th rib - I can feel the outline of the rib and the intercostal spaces.

It is a curiosity indeed.

Like a true help-deferring patient I have decided that it is nothing to be overly worried about, and that if it doesn't go away in a week, I shall go to see someone about it. Ah, temporalising.

Somehow I have the feeling that this is probably a bad choice.

Oh well.

I'll keep you updated.

I am a poor engineer

Oh hello. Like poor medic, I'm one of the many tens of thousands (possibly millions) of lowly students currently slogging away at one of UK's many fine educational institutions. Greetings.

As an inaugural blogjack on my part, I shall now announce to everyone that the possibility of all of you dying within the next month (days?) has increased exponentially with the final quadripolar magnet of CERN's Large Hadron Collider has been put into place.

Speculations abound about what happens when the particle accelerator gets fired up. Will antimatter be created? Will a blackhole come into being and the world as we know it gets sucked into oblivion? What about us mere mortals? Will we be spat out into the tenth dimension? Good questions really, this lot...

Luckily, or unluckily, them buffoons physicists responsible for this conundrum are now divided into two camps; one wants to go ahead with the most expensive physics experiment in history, the other don't really want to die.

So yeah. Go ahead and make love to loved ones and make peace with hated ones.

On a less depressing note, lets look over the notion of the LHD being the harbringer of death and pay a little more attention to the wonderful fact that it's a tunnel thats freaking 27km in diameter underneath Switzerland! Oh oh and the cryogenics infrastructure is awesome too! Constant -271 degrees C! I'm like... wtf!

Geeky isn't it?

Empire Strikes Back

I am your father.

The OHCM thinks that George Lucas was a big Gaudi fan.

How else can you explain the Darth Vader lookalike chimneys?

An Ode to The Rather Interesting Bruise on My Knee

Blue black purple grey
Swollen spots make me wonder
When will the pain go

So yet another weekend has come and gone.

Yet another rotation has come and gone.

Trauma and Orthopaedics tomorrow. Perhaps I really should get my knee checked out.

Gravity Kills

Today I went cross country cycling.

I probably won't be going again for a while.

To cut a rather long and boring story short, I flew over the handlebars while going downhill in the pouring rain. A lot of things can be said about how I really shouldn't be allowed to cycle anywhere but on a flat dry ground with no one within a 100m radius, but we'll save that for another day.

So.

I was rather apprehensively going downhill when I saw a huge dip, and thought, oh crap, this can't be good.

Next thing I knew - sky, ground, sky, ground, sky, ground, ground, ground - this is gonna hurt really bad.

Gravity is an evil thing indeed.

On a sidenote, it's interesting that while my life was flashing before my eyes (and so was the sky and ground), the first thing that went through my mind was, If my parents found out they are so gonna kill me. 21 years of bringing me up and I repay them by breaking my neck in a forest.

Where was I? Oh yes.

And while I was sprawled out on the muddy ground, my bike decided it missed my presence and skidded and hit me.

Life is good.

So there I was, undecided whether being in a foetal position would involve less blinding pain, when it occurred to me that I was on the ground in the middle of a downhill track.

Great.

I somehow managed to drag both myself and the bike off the track, and thus assuring myself that yep, ABC (Airway, Breathing, Circulation) intact to a certain extent.

Once the pain had subsided slightly I decided that it would now be a good time to survey the damage.

Limbs. Intact. There's blood down one leg but it looks rather superficial. Grazes to the hand and face, nothing serious. Knee is swelling up quite a bit, but that's to be expected. Full range of movement in all joints. Check.

Now what.

The friends came out to help and we decided to go back to the forest centre. Which involved more cycling. In the rain.

And everyone I cycled passed gave me really horrified looks, which worried me slightly because as far as I was concerned I was pretty okay. I was CYCLING back, how bad could it have been. I think it must've been the bloodied leg.

It was bad enough that I had to cycle myself back for some form of treatment, but when we got back to the centre no one knew what to do with me. The staff showed me a first aid box and threw out its rather random contents and sifted through it.

Then he looked at me and said, "I don't know what all these things are for..."

Sigh.

So I said, "Trust me, I'm a medic" and proceeded to mend myself.

Apparently I looked pretty okay for someone who just did a spectacular endo on the fastest section of the trail.

So, not only did I fall and hurt myself (and my pride), I had to get myself back and then self-medicate.

And in true Schaudenfreude style, my friend told me that when I fell he almost whipped out his camera to take pictures of my misfortune, but managed to restrain himself only because I was on the floor moaning in pain.

Good friends like him are hard to come by these days.

And that's why there's no pictures.

Anyways, whilst I am still in considerable amounts of pain, I am alive, and have developed slight paranoia over the possibility of developing septic arthritis or a kidney contusion.

The swelling and pain have gone down slightly, and I haven't been peeing blood, but we'll see.

I'm guessing tomorrow will not be a good day to be me.

Breakfast

Mmm.. OHCM

The Happy Lobster eats OHCM for breakfast.

What do you eat?

The Square Root of Three

I watched Harold and Kumar Escape From Guantanamo Bay just now. Hilarious shit.

I really liked the poem that Kumar recites in the movie, because it's so geeky and I'm a nerd like that. So here you go, revel in arithmetic geekiness in all its glory:

The Square Root of Three by David Feinberg

I’m sure that I will always be
A lonely number like root three

The three is all that’s good and right,
Why must my three keep out of sight
Beneath the vicious square root sign,
I wish instead I were a nine

For nine could thwart this evil trick,
with just some quick arithmetic

I know I’ll never see the sun, as 1.7321
Such is my reality, a sad irrationality

When hark! What is this I see,
Another square root of a three

As quietly co-waltzing by,
Together now we multiply
To form a number we prefer,
Rejoicing as an integer

We break free from our mortal bonds
With the wave of magic wands

Our square root signs become unglued
Your love for me has been renewed

The traveling OHCM

Hola!

The Oxford Handbook of Clinical Medicine (OHCM) has gone traveling!

Send in your pictures of the traveling OHCM to share with the one loyal reader and other imaginary friends that frequent this blog.

The Girl Who Leapt Through Time

時をかける少女

I watched this last weekend on a whim after reading about it on ANN. Yes, medical students do have time to do other things like blog and watch anime.

In a nutshell, I thought it was amazing.

I loved the art, the characters and how the story flowed so seamlessly. My lack of adjectives hamper me from describing exactly how amazing this movie was, and is probably why I'm a medical student and not, say, a movie reviewer.

The anime is an adaption of the 1965 novel by Yasutaka Tsutsui, and revolves around a 17 year old girl who discovers that she has the ability to 'time leap'. She sets about doing rather odd things with her newfound powers - undoing blunders, eating pudding - without truly understanding the consequences of her actions.

Because there always is a moral to the story when it comes to Japanese anime.

She comes to realise that her little actions in manipulating the course of history have dire effects on the people surrounding her, but is it too late to make everything alright in the end?

RUN TIME: 98 minutes

DIRECTOR: Mamoru Hosoda

WRITER: Satoko Okudera

CAST: Riisa Naka, Takuya Ishida

PRODUCERS: Jungo Maruta, Shinichiro Inoue, Yasutaka Tsutsui

Today in GP Land

I sometimes find that the strangest things happen in General Practice Land.

"What can I do for you today sir?"
"I need an appointment letter for hospital."
"It's written here that we have requested another letter to be sent, you should've gotten it by now."
"My dog ate it."
"Yes, and we asked for another letter for you."
"It came this morning and my dog ate it."
"You mean he ate it again?"
"He's eaten 3 of my appointment letters."
"What kind of dog is it?"

Student-led surgeries, in theory, are a good opportunity to put into practice things that you've learnt in medical school. But the harsh reality is all you ever get in your two hour a week slots are people coming in for repeat prescriptions and people with runny noses demanding antibiotics.

Sometimes it's not just about knowing the diagnosis and treating the patient. Sometimes it really is just differentiating those who really need help from those you can offer reassurance to and send them on their way.

It was a Shihtzu, by the way.