Realisation

I realised, as I watched the petite female registrar stick her finger up the rectum of a particularly flatulent patient - the 6th consecutive one this morning in clinic -, why colorectal surgery had never crossed my mind as a potential career path.

And never will.

How to save a life

It is a memory that will stay in my mind forever.

A teenager, just a few years younger than me, sitting between his parents as my consultant calmly explained what had already been explained to them countless times, by different people.

"I'm sorry, there's nothing more we can offer."

It's like a death sentence, being told that there is nothing left that medicine can do. No more surgery. No more chemotherapy. Nothing.

"So am I meant to just sit here and wait until I die?"

Silence.

He didn't cry then, but after the consultant had gone, he cried in his hospital bed.

I had been asked to take some blood from him - more blood tests, more investigations, more hospital appointments. His arms and hands were full of puncture wounds, his veins were thin and fragile from all the previous attempts.

How do you speak to someone you had just witnessed being told that he will die?

He looked at me and mumbled.

"You were in the room too, right? You heard what he said. Do you think I'm going to die?"

How do you tell someone that death is inevitable, as for everyone, but that they would have to face it sooner than others?

"Do you?"

And all I could muster to say was I don't know. Because I didn't. Because nobody knew. Maybe he won't make it to see next week. Maybe he'd live to be a hundred. We don't know.

I watched as he left the hospital, to go for his appointment with the oncologist. He was determined to seek second opinions, different opinions, as many opinions.

And the sad truth behind all the supposed life saving medicine they teach us at medical school is, in the end, we don't know anything. We can't do everything and save everyone.

Nobody can.

What I Found in My Lecture Notes Today

Because it is revision time, and revision time is the only time where you - well, technically I - ever carefully scrutinize the words on the sheet of paper handed to you during the lecture.

Random snippets I've found amusing:

Symptoms include tremors, blindness, deafness, paralysis, anaesthesias or virtually anything.

Cardiac tamponade: Patient will exhibit signs and symptoms of cardiac tamponade. Treat accordingly.

How to diagnose a jerk?

More to come if I'm still slogging through one year and 6 rotations worth of notes =.=

Because I am amused by simple things

5FU.

Coolest drug name ever.

So 5FU is just the shortened name, doesn't change the fact that it's still a cool name.

(And yes, I am weird like that, what, you didn't know?)

In loving memory

My first encounter with death as a medical student was 4 weeks into my first year at medical school.

We were still coming to grips with being away from home, making new friends, fresh, naive.

Medicine was simple then, we only knew the basics, how the muscles and nerves functioned, the names of the bones, the physiology of the digestive tract. A bit about ethics and law.

It was all very sudden.

She sat next to me in anatomy class, on Friday she told me how her computer was acting up, maybe it was about time to change it. We talked excitedly about our upcoming anatomy group social - it'll be fun, she said.

On Monday, during our anatomy session, there was hardly anyone there. Some people were at the school office sorting something out. Something had happened. Our tutor told us to stay behind after class. A lady walked in an just blurted out,

"Your classmate was hit by a car yesterday. She's currently on life support waiting for her parents to come before they make any decisions."

Silence.

"She might not make it."

Those words just ring in the ears.

When you hear stuff like that you can't help to think, but well yeah, medicine has improved so much, they should be able to help her.

Before you realise that, the 'they' that we claim can cure just about anything, will be us medical students in the future. We will be the ones armed with the medical knowledge and advancements that should, ideally, save her.

It brings a lot of things into perspective.

She was a medic like us. She had a bright future ahead. I barely knew her. And she did not make it.

I study medicine misguided that I'll be able to save everyone. None of my future patients will die under my care. I won't let them.

Three years down the line and I've seen countless patients die before my eyes.

People die, it's just a cycle of life.

Coming to terms with death is something they don't teach you in medschool. But perhaps they really should.

On Being Anal

During one of the clinics the consultant came up looking extremely grumpy and announced to the entire room that he was in a very foul mood because he was on call and was rudely woken up at 3am to operate on this boy who had some AA batteries stuck up his urethra (pee hole, to put it bluntly).

When questioned as to how this came to be, the boy merely replied that the AA batteries were lying on the floor, he tripped and fell and the batteries somehow managed to lodge themselves in his penis in the process.

I am told that this is a very common occurrence.

Today's news for example. Clickity click.

A vicar claims a potato got stuck up his bottom after he fell on to the vegetable while hanging curtains in the nude.

Notice the trend here?

This is a very gross generalisation, but if you are ever in A & E and someone presents with a random object stuck up an orifice, the history almost always goes along these lines:

"I was [insert random daily activity here], in the nude, as you do, when I tripped and fell onto [insert suspiciously phallic object here]."

Someone should really audit how much it is costing the NHS to treat people who have the tendency to fall onto random objects which then get stuck in their many orifices.

Although apparently, the American Journal of Proctology makes for an interesting read on what foreign bodies have been removed from the rectum.

The moral of the story here is to never do anything naked lest you get something lodged somewhere you don't want it to be.

I think.

Translator, at your service

Ah, the many roles of a medical student.

Today's didn't involve gallantly defending testicles from cosmic rays - far from it.

I was summoned to clinic by one of the consultants who needed help translating for a patient who he hoped spoke the same language as I did. Lucky for him, I did and communication was established.

All I had to do was ask if he had shoulder pain, which he evidently did, however that simple question launched him into a very excitable rant in a mix of English and his mother tongue about knee pain and back pain and other various miscellaneous information - everything but shoulder pain.

He then requested that he be taken to the toilet to have a wee, so I pushed his wheelchair to the toilet and recruited a nurse to help out, who then decided that since I spoke the language I could handle it without her help, and left me alone. I can't imagine language to be a barrier to helping someone go to the loo, but what do I know, I'm just a medical student.

So there I was. In the toilet. With this man who whipped out his equipment without so much as a bat of an eyelid.

We then spent a good 15 minutes in there - him on the toilet seat, having a good old rant about his son and his grandson and what they do for a living, his experience in the navy, his wife's job, how everyone complains that he talks too much so he tries not to - like it is the most natural thing in the world to have someone you've just met in the toilet with you while you peed and told them your life story.

Business done, I wheeled him back to the consultation room where the doctor continued his examination, and decided to give him joint injections for the pain.

I held his hand while the consultant stuck needles in his knees and shoulder, explaining to him what's going on. Once it was all over I dressed him and tied his shoe laces and wheeled him to the reception where we organised transport for him to get home.

He was a very nice man, highly animated, and he kept shouting bilingual thank you very much i am eternally grateful for your help everybody in this hospital is amazing, even as he left.

Yet another satisfied customer.

I think NHS should put me on permanent payroll for the amount of times I had to extend my services as translator. And then for doing the nurses' job. And occasionally the house officer jobs. It's a good 3 - in - 1 deal.

Medical student, jack of all trades, for hire?

Get a life, seriously

I think I am very privileged to be in medical school in the UK. A lot of people who are desperate to get admitted are rejected every year.

Sometimes, I wonder what the people that apply to medschool and get rejected are like. Especially after hearing what my admissions tutor had to say.

Til this day he is still getting death threats from someone he rejected eight years ago.

Which probably explains the notice on the wall.

But seriously. Eight years? Ordinary people would've moved on by now, gotten a job, got married, settled down and live a comfortable life. Maybe the occasional "my life would be so much more complete if I did medicine" mope. And then when their kids grow up threaten that they should go into medicine or they will be disowned.

Kudos for the determination, but the freaky stalker I will kill you and you will regret not accepting me into your institute needs just a bit of working on.

Probably a good thing he didn't get into medicine.

Pearls of Wisdom

Our lecturer today, who had more abbreviated letters after his name than the entire alphabet put together, imparted to us something of great value and truth.

The key to success in your MRCP, FRCS, or whatever fancy exams you take to advance your medical career - he said - lies in putting your examiner to sleep.

Right.

Apparently that's how he got through medical school and all those other degrees he has under his belt.

"When asked a question, rattle on with the textbook answer, as all the previous examinees would've said it, and the examiner would be so bored of listening to it again that he'd fall asleep. Speak eloquently and fluently on the subject, so as to not awake him from his peaceful slumber. If he's not awake he doesn't know what has happened and therefore has to pass you."

It makes sense when you think about it, all but for two major flaws. Firstly this is only applicable for viva type examinations where you verbally answer questions in front of a panel of examiners, normally one who asks the questions, and the other one (whom you want to be drifting off to dreamland) writes comments about how you handle the question.

The other gaping problem with this whole putting your examiner to sleep business lies in the fact that you really have to know your shit well enough in the first place to just drone on and on about it for 20 minutes.

But I suppose it can't hurt to try.

Fresh Meat

It's always nice to see wide-eyed, eager, fresh-faced freshers stepping into tertiary education in medicine. They turn up to lectures on time, do all the late night studying of anatomy that is required of them, ask questions in class - basically they are just very, very keen.

Also, it's nice to then break their spirit and drag them down to your level. The level where everyday you wake up and wonder, why the hell did I choose to do medicine dammit as yet another nice old lady vomits on your shoes. Misery needs company.

Sometimes I'd like to tell them to run while they still can. I'd listen to their complaints about the timetable and teaching and tell them the sad truth. 9 o'clock lectures getting you down? Wait till you go to critical care where the outreach team starts their day at 7.30am.

I tell them to quit their whining, they are having it easy because their syllabus has changed and they don't have to do the extra modules and essays that we had to do, during my time.

Nothing says seniority more than those three words. During my time.

Makes me feel old, all these 1990 babies. They are from a completely different era!

Anyways.

Dibs on at least one of these eager freshers switching to Philosophy by next Wednesday. Any other bets?

The Many Roles of A Medical Student

I think being a medical student can be a very versatile job. You never know what the nurse, junior doctor, registrar or consultant is going to tell you to do next.

During my medical student career I've been a whole lot of things - wallpaper, retractor holder, phlebotomist for an entire ward, kidney dish holder, personal assistant, chart finder, clerking machine, coffee and toast maker, x-ray form filler - you name it.

Today however, I was given a role I never thought could possibly exist.

I was the protector of testicles.

It was an orthopaedic list, the x-ray machine was used, and the anaesthetist who wasn't wearing a lead coat quickly ducked behind me, saying "Ok don't move I need you to protect my testicles."

The surgeon who had taken his lead coat off and left it somewhere while his registrar went on with the hammering soon followed suit, ducking behind the anaesthetist who was ducking behind me - and I can only imagine this to be a very comical sight of two full grown men hiding behind a medical student half their size.

I guess this could be considered a rather noble role of ensuring that there will be a next generation to look forward to. Their future children damn well better be thanking me.

Job Satisfaction

A very pleasant 80-ish year old gentleman hobbled into clinic, obviously in a lot of pain. His 2 week old knee replacement gave way and he had fallen on it.

The joint was very swollen and any movement would cause him great agony. He could barely walk or bend his knee, and he lived on his own. Simply put, he was in pretty bad shape.

Plans were being made to admit him for inpatient physiotherapy and some much needed care, but like all NHS hospitals across the country, beds were scarce. So while waiting for the bed managers to sort something out, the consultant decided he'll try this man on a patella stabilising knee brace with hinges to allow flexion.

The orthotics department obliged with a knee brace and it was fitted on the old chap, who lo and behold, immediately was able to stand up, walk, and bend his knee - things he couldn't do a few seconds ago.

It's amazing how such a simple device, such a simple intervention, can make such a huge difference. From having to be admitted to hospital, he was now able to go about his daily life and attend physiotherapy as an outpatient instead. Suffice to say, the man was ecstatic.

It's like one of those rise-and-walk moments, without the choir of angels singing.

I guess sometimes simple is better.

Instant job satisfaction.

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?

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.