Almost there

I was going to go home this weekend, but one of our more senior surgical teachers offered me the chance to work with him on call this weekend, which is a great opportunity for me to practice some practical skills and get a load of sign-ups done in my logbook. Which is something I haven't been that great about doing. So I'm going to stick around and see what happens.

I've almost finished my essay's first draft. I was hoping to finish it off this morning, but I ended up sleeping a bit later than planned. I shall work on it once I've had my coffee and meditated and everything. I don't think it's going to be a prize-winning essay, but I do hope it earns me high marks. I'm aiming for high marks on everything, so that I will have a high class rank when it comes time for the foundation programme application. Also, so that I will have done the best I possibly can and learned as much as possible for me to learn. That's actually the more important reason to work hard on all of this stuff.

Have I mentioned on here before how much I enjoy being a medic? It's the most amazing, privileging thing I could every imagine. I feel so humble and grateful for the opportunities that I've been given to first of all study medicine and second of all to be granted such intimate looks into people's lives, health, and bodies. I hope that whatever field of medicine I end up in, that I don't forget what it means to be a good doctor. I see (and have experienced) poor medicine and even poorer communication skills, so I now understand why there's such a focus in the first couple of years on these.

I've been pursuing elective options more, talked to one of my F1 teachers about her elective, and am now not going to be with the RFDS at Central Operations (they don't have places for non-Australian medical students), but perhaps the Broken Hill or Western Australia base will take me on. Either that, or I could go to Sydney and work in the ER or with some other specialty there.

The more I learn, the more I realise that I shouldn't rule careers out, because gastro has surprisingly interested me. The science of food digestion and absorption is pretty boring but the work of gastro is quite interesting. I drew up a list of all the medical specialties, and I want to try to get exposure to them all while I'm a student. It's a very long list, about thirty specialties! On this rotation, I've had exposure to anaesthetics, A & E, acute care, critical care, pathology (next week), endocrinology, renal, and gastroenterology.

I submitted my list of SSMs for next term, which had histopathology at the top, forensic psychiatry number 2, chemical pathology number 3 and then the other 3 were radiology-focused. The reason I chose two pathology ones was because it would be nice to learn some of the science of medicine and pathology, and forensic psych just sounded really interesting. I also made my choices on word counts for the essays, because I don't want to write a huge essay next term.

The junior doctors are going out to Canterbury this evening and have invited us along. It's a costume party, with dead celebrities as the theme. I might like to go, but don't have my "usual" Elvis outfit. I do have a flannel shirt and can borrow some eyeliner to go as Kurt Cobain. But I'm still not sure I'm going to go. We have teaching in the morning and I could spend the evening working on my essay and swimming. But we'll see. It also depends on who else is going.

Final week as a "Clinical Scientist"

I thought that title line was pretty funny, since we're divided up the way we are, but it's a far stretch to consider what we're doing as scientifically rigorous research. However, I've read many articles on sepsis, including one in German which stretched the bounds of my language knowledge. I've been trying to get my paper written, but the flesh is weak as well as the spirit. So I'm about 500 words into it, which is about 10%. The online reference tracker is broken, so I'm using that as an excuse to not write. Today was only about an hour of work done, which was one of the most boring tutorials yet. Not because blood biochemistry is boring, but the doctor teaching us has no enthusiasm whatsoever. A high point of my day was finally getting a swine flu jab, then I read up on thyroid problems, and printed out some articles.

I spent about an hour working on our rota of shifts and clinics to cover for the following six weeks. I'm excited to change things up a bit and do some more varied work, which is based more in the clinical environment. It will be quite a lot of work, but hopefully I'll get really slick at history taking and examination of patients with abdominal complaints. This one rotation is actually quite heavy with conditions, procedures, and skills we need to obtain, compared to the other rotations this year. So things should get a bit lighter once I'm back in London, which might be nice. I'm loving the workload and having lots to do. I'll exchange the data in the spreadsheet into my ipod calendar, so I can stay organised. This thing has been a really useful little tool. I can imagine that one day soon I'll want an iphone. But not this year.

I think I'll go swimming tonight, if my neighbour is up for it. I'm not really in the mood to go out but it will be good for me. I've got a bit of a crush on her, and had a dream about her last night. ... I came back from swimming, and ate dinner with a couple other people (including aforesaid crush). I didn't get sick this time, which was good. I enjoyed the workout and feel tired out. I think I told my supervisor that last week was my last day in the ITU for my SSM. So I should take advantage of the time off and get some writing done. That's the plan, anyhow. We'll see how far I get. I want to finish this paper off, and maybe even submit for an essay prize competition. I'll need to really work it over for that, but from what I've seen of other medical student essays, I think I can do it.

The Big Smoke

So I'm back up in London for the weekend. Hallowe'en was a bit of a blow-out, and I was worried about getting egged (again) by hoodlums. This anxiety was increased by the shattered eggs we kept crossing on the pavement. We didn't manage to meet a friend at London Bridge, then we didn't get to see Nosferatu. So we came home and watched David Attenborough, a very different experience.

This last week I've been working on my sepsis presentation, which is for my SSM. My clinical partner has been obsessing about the foundation applications by way of procrastinating on his work, so it's got me thinking about the future, too. I keep thinking that I want to do emergency medicine. I know I have loads of time to decide, and it doesn't hurt if I change my mind, but it's one thing I can see myself doing and really enjoying. But that's with a very limited perspective. I still haven't spent a day with the Infectious Disease docs yet, so I should try to do so this coming week. I've also been obsessing about my elective, and my peripheral attachments abroad.

For the attachments, I've applied to go to either Lille or Prague via the exchange office, but I also wrote to the hospital in my parent's city. I also looked into going to one of the big names in the US, New York, San Francisco, etc, but they're unwilling to take a foreign student for a "core" rotation. I also looked into going where my partner's family lives, Charleston. But they're really anti-foreign, somehow unsurprisingly. I'm chickening out on the French-speaking thing, so I'm wondering if I ought to try to go to Germany, since my German is much better than my French.

For my elective, I'd wanted to either go with the Flying Doctors in Australia, or with Paul Farmer in Haiti. I've written to both, and could apply now for the RFDS, but Dr Farmer won't know until next year whether he's going to be in Haiti. That's leaving it a little too late for me. But I will try to arrange an elective and then if I can go to Haiti instead, shall do so. I'd thought it would be nice to go to the US, but they work too hard there. I want to not only get some different clinical exposure, but also see some of the country I'm in. I could also compare rural Australia to rural Haiti. Hmm. What I was thinking would be nice is to spend some time in Sydney at an A & E department, then go with the flying doctors. But I'm just putting the pieces into motion and seeing what comes back.

In between obsessing, I've also got quite a bit of studying done. I learned to suture a bit better this week, have become pretty good at taking blood and putting in cannulae, and I've also clerked several patients, so I feel pretty confident about my history-taking skills. I've now got the next seven weeks to perfect my history, examination, and diagnostic skills, plus learn about the common pathologies affecting the systems we're working on. We went to a bigger DGH for some urology teaching, which was pretty good, but it made me glad I was with the people I'm with. There were a couple of down-right twats on the other firm. Well, one twat and one prat. But still, I was very grateful that I've got such a nice group of people.

There was a bit of weirdness and confusion when we left on Friday, and I was planning to travel up with one group of people, but ended up with another group and worry that they think I ditched them. It wasn't like that, but I know that I spend too much time worrying over what others think of me. They were talking of a birthday party for me, which should have the theme of "Sugar Daddy", which is pretty funny.

A Third of the Way Through

So this week marked the first 4 weeks of my rotation. Only 8 more in which to master all the medicine I need from the mouth to the anus, plus a few other bits like the endocrine, renal and hepatic systems. Eep! I've actually learned a lot in the last few weeks, and I imagine once I start on what's called the clinical apprenticeship portion, I'll learn even more. I'm aiming to finish up my sepsis presentation by the end of the week, so that I can go home for the weekend and enjoy myself. If I don't get it done, then I'll need to bang it out, because I'm due to present it at 9:20 on Monday morning. Then I'll try to get the essay done during the next week, so that it will be all out of the way prior to doing all of my clinical work. One good thing I found out is that the essay is about 2,000 words less than we were originally told.

My partner came down to Kent for the weekend, and though my bed is a bit too small for the two of us, we had a good time. Yesterday, it rained and the winds blew, but we went on a walk along the beach, then had fish and chips, and visited one of the local attractions, a shell grotto which is one of the most amazing and weird things I've ever seen. Today, the wind was still blowing, but the sun was shining and we went to a farmer's market, walked along the beach again and then got a sunday roast (which wasn't very good). We caught up on our nature documentaries, played some pool and foosball, and also saw "The Imaginarium of Doctor Parnassus" which was rather odd, but grew on me with time.

I've been doing a little more research into my elective, because I want to get planning for that and not leave it until the last minute. I wrote to Dr Farmer and the registrar at Harvard, to see if he was going to be running his course in Haiti that year. If not, my other plan is to join the Royal Flying Doctor Service in Australia and then the Phelophepa Healthcare Train in South Africa. I'm actually getting more excited by the latter idea now that I've been looking into it more.

Now that winter is settling in upon us, I've begun my annual fantasizing about moving back to the US, as well. That seems to be a result of short, dark days and the wet and cold dreariness of winter in these parts of the world. However, the work culture over here is so much healthier than in the US, what with our annual leave and working hours limits. And, I actually like the people here, the foods and traditions. I wish we had more cafe culture, but hey ho.

Back on the grindstone, sort of

I came back to Kent yesterday afternoon, having missed a morning teaching session, and spent some time reading and checking up on some of the patients I've seen. One patient died in ITU from sepsis, which was the expected conclusion. I've been doing more reading about how to identify the early stages of sepsis, how to treat it, and what other complications there are. The other patients are doing well. One went home, the other is stable. I've been finding that I really enjoy working with older people. I took some bloods.

I spent an hour or so in A & E yesterday evening, and it seems as though the people working there aren't terribly happy. But is that because they would rather be doing something else, and are just working in A & E as a means to an end? Or is there something inherently soul-destroying about the work? I really enjoy being in there and seeing all of the different stuff going on. One of my classmates is also hooked on trauma, and we wonder if it's something that will wear off as we get older and wiser.

This morning, I went to operating theatre with the anaesthetists, which was interesting. I read up about anaesthesia and analgesia prior to going in. I inserted a cannula for the first time, and then intubated a patient after they were put under and given a muscle relaxant. That was pretty amazing to do, even though it was under very controlled conditions with an expert standing right next to me. But still. Feeling a bit cocky, I went over to the surgical ward and tried to insert another cannula. But this time it seemed to go in fine, but I couldn't flush it with saline, so a more senior doctor had to come put a different one in. In the afternoon, I was meant to go to another teaching session, but missed the start by a few minutes and couldn't find my colleagues. I later found out it was a complete waste of time, so didn't worry about it.

I spent most of the afternoon hunting down and reading articles on sepsis. This evening I tried to get to a meeting but missed the bus by a few minutes and the next one didn't come for half an hour. So I walked back home and made some phone calls instead. Now I'm watching a show on Channel 4 (online) about Aileen Wuornos.

Home for the weekend

I'm back in London for the weekend. It's rather odd, being down in Kent and feeling like I'm out at sea or on another planet, because I hardly ever leave the hospital grounds. Our accommodation is only about 5 minutes walk from the hospital, so I only ever leave to go get groceries or go to a meeting, or the occasional night or day out with the junior doctors. I'm hoping next weekend to get out and see some of the sights. But today was devoted to time with the hubby, watching movies and running errands. Mostly to do with cat piss. I guess there's a reason I haven't had pets for most of my adult life. I don't like cleaning up after them.

My grand round presentation went well yesterday and I got very high marks for it. I did put quite a lot of effort into it, so I was glad to receive high praise. I'm loving my work in the hospital, and feel awed and grateful every time I'm walking the halls. I get a buzz from being in A & E, and I'm not sure if that will wear off or if that's because it's calling to me. My SSM this term is on critical care, and I hope to do something in A & E next time. Especially if I'm placed at King's.

The application for rotations abroad next year is due this Friday, so I need to sit down and work on those this week. I'd planned to do so today or tomorrow, but so far that plan hasn't materialised. I've been reconsidering my elective plans as well, since I haven't heard anything from Dr Farmer. Maybe I could go to South Africa, work on the healthcare train that travels around, or go to Australia and work with Aboriginal communities. I need to stop thinking so much about and instead take some action on it. Which means filling out the applications.

The morning after

I woke at 11 this morning, wondering what made me think it was a good idea to shadow the on-call SHO until 4 in the morning. I did get to see a few practical procedures being done: IV drug administration, male and female catheterisation, several abdominal examinations, digital rectal exam, and I got to fill out a drug chart. I saw 3 operations over the course of the day and night. Two appendectomies and an inguinal hernia reduction. So all in all it was a very good learning experience.

However, I've neglected my Grand Rounds presentation which is tomorrow afternoon. I have all of the research done, and just need to finish up a few slides and run through it once or twice, think of the questions that my firm head may ask, and make sure I know everything there is to know about ulcerative colitis.

I've encountered a number of specialties so far the last couple of weeks, and each has got me thinking about whether I may want to pursue it or not. I do really enjoy surgery and a big part of me wishes that option was open to me. The direct effects of cutting someone open and fixing what's wrong, the skill and clinical acumen I've seen amongst surgeons is amazing. Anaesthetics has a certain appeal but many of them seem like unhappy people. The pain specialist seemed like he was pretty happy, though. Critical care is a branch of anaesthetics for the most part but can be entered through emergency care. I've only run into the microbiologist a handful of times, but he seems rather happy and has a good sense of humour. I'm going to spend a day with a pathologist in November, so I may get an idea of what that involves. The A & E people seem pretty stressed out and everyone else says that it's the worst job in the hospital. I really enjoy being down in A & E and seeing all of the commotion and shuffling through of ranges of ages and backgrounds, the extreme variety of pathologies. But would that wear thin after a while? I'll find out next year when I'm on that rotation, perhaps. I like most of the gastroenterologists, and that seems quite interesting. I attended endoscopy clinic the other day which was fascinating and kind of gross to hear people gagging on the tube. It was a bit unclear whether I could do gastro because of my health condition, though. Our nephrologist teacher was kind of a pompous ass, but still a decent teacher and the endocrinologist is intimidating. I think endocrinologists are the most intimidating and brilliant people I've encountered thus far. I suppose when I do neurology I'll be even more amazed. I read in my logbook that we're encouraged to reflect on the different specialties we encounter, what we like and don't like about them, what a career in that specialty might involve, etc. So in a way, this is important work!

Now I must away to a medical grand rounds by the junior doctors, where there's free food.