tag:blogger.com,1999:blog-287224562024-03-13T13:18:41.744+00:00My Journey from Nurse to DoctorI am a final year medical student in an English city. I have just sat my finals and an now waiting for results!
After 12 years of working in Occupational Health I managed to get on a Graduate entry programme (GEP)
I use this blog to describe my experiences of changing career at the grand old age of 32!Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.comBlogger56125tag:blogger.com,1999:blog-28722456.post-20138234623877277462010-03-31T23:33:00.000+00:002010-03-31T23:33:18.124+00:00Dr Gregory....I did it!I qualified as a doctor today<br />
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I am away working in the Lakes and had to go and sit in the toilet to read the results email!<br />
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I haven't told anyone yet because just for today, I wanted to let it sink in. Am now listening to <a href="http://www.youtube.com/watch?v=V9mwuYBljUA&feature=PlayList&p=DD266A04A47D400D&playnext_from=PL&playnext=1&index=16">the song</a> that give me the courage to do medicine and am happy happy happy that I did.<br />
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xxxNurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com62tag:blogger.com,1999:blog-28722456.post-17703098114592215292010-03-29T23:53:00.000+00:002010-03-29T23:53:36.931+00:00Finals all over - Now is the torrid wait for results<strike><strike></strike></strike><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_yDOfMhAYFek/S6_bWhLptgI/AAAAAAAAAHY/aEnaGc0d61A/s1600/stressed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="144" nt="true" src="http://1.bp.blogspot.com/_yDOfMhAYFek/S6_bWhLptgI/AAAAAAAAAHY/aEnaGc0d61A/s200/stressed.jpg" width="200" /></a></div><div><br />
<br />
I sat my finals during the past three weeks and am now am in limbo waiting for results. <br />
<br />
This time next week I will be either be a doctor or a medical student waiting to resit Finals.<br />
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At my uni, Finals is made up of three parts: Two written papers and a four-hour OSCE clinical exam. We have to pass all three parts to qualify and if we fail at any part we have to do the whole thing again in June.<br />
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My first written paper was vile - I usually feel the exams are fair but this one was whacky and woolly and I'm really worried that there's no way I have passed it. The second paper was more what I would expect and was fair and clear in what was expected. And then we come to the living hell, otherwise known as the OSCE! <br />
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Our OSCE is divided into two parts. The first part takes place on a mock ward and the second half in outpatients. We have actors for the ward stuff and real patients for the long cases. <br />
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I will give you an idea of what went on for those of you that are interested in what happens in medical finals (Apologies to anyone that isn’t interested in this stuff!)<br />
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To set the scene.....100 sweaty terrified medical students lined up in a corridor. A bell rings and we are herded to our first "station"<br />
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<strong><span style="color: blue;">Station One</span></strong><br />
This was a desk with a laptop showing a plain x-ray of a pelvis. There were also some written questions. We had to identify what was wrong and I could see that there was a <a href="http://www.merck.com/mkgr/mmg/sec2/ch22/ch22f.jsp">pelvic ramus fracture</a> (like two cracks in a polo mint) The problem here was that the written questions seemed to hint at a <a href="http://en.wikipedia.org/wiki/Hip_fracture">fractured neck of femur (NOF)</a> but for the life of me I couldn't see it. Fractured NOFs can often be clear as day <a href="http://en.wikipedia.org/wiki/File:Rt_NOF.jpg">like this one</a> but this xray was not clear. I later learnt that the others thought that there must be fractured NOF and wrote that they could see one because they felt that there must be one there somewhere! <br />
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<strong><span style="color: blue;">Station Two</span></strong><br />
I was then herded into a room with a consultant and a head CT scan - TERRIFYING! He asked me to describe the scan and I got excited (Doesn't take much these days) because it was a <a href="http://upload.wikimedia.org/wikipedia/commons/b/bd/INFARCT.jpg">massive ischeamic stroke.</a> He asked me which artery was involved and I wasn't sure so guessed at the biggest one. The consultant was wonderful! He asked me if I would thrombolyse this patient and I started waffling that she had arrived within an hour and this might be a good idea....as I said this he was shaking his head saying that it was a massive stroke so I shook my head along with him and said "No - much too big to thrombolyse!"<br />
<br />
Then he left the room and an actress came in - she was supposed to be the daughter of the patient who's scan we were looking at. She had clearly been to the <a href="http://chiefshepherd.com/images/kua03_17.jpg">Hyacinth Bucket School of Drama</a> and had been practicing her "Woe is me" face in the mirror. I now realise that this was meant to be a test in "Breaking bad news" as in telling the patient her mam was going to die, but what did I do?....told her that the next 24hours would be important and we would take it hour by hour" I even waffled on about my dad having the same stroke and he was now disabled but living independently.....hell I really missed the boat with this one!<br />
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<strong><span style="color: blue;">Station 2</span></strong><br />
We were then herded into a room with five desks. At each one were written questions and every five minutes the bell would go and we would have to move to the next. The questions were fair enough but the harassed exam co-ordinators (Med school secretaries who had obviously been kicked out of their normal jobs for the day to come and help to make a bad experience even worse) got mixed up and sent some of us out and then screamed at us to get back in!…brilliant<br />
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We had to plot growth charts for a baby, prescribe an anti-pyretic for a child and describe what tests we would do for an ill baby.<br />
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I then went into a room with a consultant, an actress (Here we go again) and a massive plastic vagina. I was told that the lady was 20 weeks pregnant and was bleeding and could I do a speculum exam. This went smoothly enough except that the women (Who was sitting three metres away from the fanny) kept moaning and crying throughout. My only mistake here was that I forgot to close the speculum as I withdrew – I noticed she had stopped moaning by now and presume that my incompetence had stunned her into silence.<br />
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<span style="color: blue;"><strong>Station three</strong></span><br />
<span style="color: blue;"><strong>(Acute emergency station)</strong></span><br />
This was a disaster! Behind the curtain was another actor (Bugger) the boss from casualty and a clinical skills nurse. The scenario was that this chap had been admitted with acute breathlessness. My mind was blank so I clicked into nurse mode and held his hand. I then thought that oxygen would be a good idea so the nurse started to arrange this and asked me how much…I couldn’t remember so prescribed “a lot” of oxygen (Are you cringing like I am?) Anyway – the consultant asked me for differentials and I went for pneumonia or a pulmonary embolism. Then he gave me the patient’s x-ray – a barn door <a href="http://www.hhmi.org/biointeractive/museum/exhibit98/images/xray_abnorm.jpg">cardiomegaly with pulmonary oedema</a> so I revised my diagnosis to heart failure. I then got quizzed about what drugs I would prescribe and said loop diuretics (To get rid of some of the fluid). The consultant wanted more and in my ever increasing blind panic I decided to prescribe beta blockers. I know that there is controversy with beta blockers and heart failure because they make the heart beat slower and so can tip an already failing heart over the edge. Even knowing all this I still went ahead and said it. My Casualty boss was not impressed.<br />
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I then had to do an arterial blood gas on a plastic arm – this went fairly well but I was so glad to be out this station as made some horrendous errors <br />
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<span style="color: blue;"><strong>Station Four</strong></span><br />
Another room with five desks in. Again written questions on lumbar puncture results, prescribing antibiotics for meningitis, cataract surgery questions, hydration in children. Then got taken into a room with another actor and an ENT consultant. God was he bored – he stood with his back to me looking out the window and looked ready to cry. I had to explain cataract surgery to the actor, all nice and straightforward<br />
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<br />
Then for Part two – we got herded like worried cattle into the outpatients department. Here we would be doing three long cases – all real patients this time (Thank god – no more actors) We had ten minutes to take a history, ten minutes to examine and ten minutes to be grilled by the consultant<br />
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Each patient was with a consultant in a room and the raw fear of knocking on the door and not knowing what was on the other side won’t leave me for many years.<br />
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<span style="color: blue;"><strong>Room 1</strong></span><br />
<span style="color: blue;"><strong>Cancer Patient</strong></span><br />
This was a lovely chap with terminal cancer. All went fine and the consultant didn’t give me a hard time – just a few questions on PSA testing and presentation of different cancers<br />
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<span style="color: blue;"><strong>Room 2</strong></span><br />
<span style="color: blue;"><strong>ENT patient</strong></span><br />
This was a strange one. There was a young man who basically had a blocked nose! Was a bit of a nightmare for me because I …ahem…..might have had a little holiday during this block. The questions were a bit tricky as I am not very up on sinusitis but it went OK. I kept thinking that it was too easy and that I had missed a lethal brain tumour but hopefully not<br />
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<span style="color: blue;"><strong>Room 3 </strong></span><br />
<span style="color: blue;"><strong>Chronic care patient</strong></span><br />
This was a little tricky too. I had an elderly chap with inflammatory bowel disease and never quite worked out whether it was Crohns or ulcerative colitis. I got questioned about macrocytic anaemia and that was it…..Finals over!<br />
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<br />
So that was it – four years of hell condensed into four hours of torture <br />
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<br />
Results are out this week and I feel sick. I think I failed the first paper and if this is the case I will have to do the whole thing again June. What a terrible thought<br />
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</div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com7tag:blogger.com,1999:blog-28722456.post-24288636979297212982010-03-27T10:22:00.002+00:002010-03-27T10:33:02.667+00:00Hello Again!<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/S63ekObp8WI/AAAAAAAAAGg/PIMARomKzGg/s1600/I+Am+back!.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 160px; DISPLAY: block; HEIGHT: 150px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5453259437746286946" border="0" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/S63ekObp8WI/AAAAAAAAAGg/PIMARomKzGg/s320/I+Am+back!.jpg" /></a><br /><div>I have meant to sit down and add to this blog every week and the weeks have turned into months and the month into a whole year.<br /><br />I have finally sat down and read all the comments that have been posted and the good wishes and I am so happy to know that people have been reading and emailing me.....Thank You and I will get through the questions over the weekend and reply to everyone xx<br /><br /><br /><br /><br /><br /></div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com2tag:blogger.com,1999:blog-28722456.post-67205704344312393012009-03-28T09:36:00.006+00:002009-04-18T14:30:20.515+00:00Melons and Foufs<a href="http://4.bp.blogspot.com/_yDOfMhAYFek/Sc36ZNbgcYI/AAAAAAAAAGY/hKfWHZFx2Qo/s1600-h/melon.jpg"><img id="BLOGGER_PHOTO_ID_5318182046003130754" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 150px; CURSOR: hand; HEIGHT: 100px" alt="" src="http://4.bp.blogspot.com/_yDOfMhAYFek/Sc36ZNbgcYI/AAAAAAAAAGY/hKfWHZFx2Qo/s400/melon.jpg" border="0" /></a><br /><br />As a women in her mid thirties, I am now of an age where having children is starting to look unlikely. I have been married for ten years and have been completely settled and happy during that time but have just never had any urge to have a baby.<br /><br />I sometimes think I must be wired up differently to other women because I have never been broody and have never once thought that I would like to have a baby.<br />I don't know why but do wander if it's because I saw too much at a young age!<br /><br />I have always been fascinated with pregnant women (I do see the irony here) and took the first offer I had as a student nurse in 1993, to see a live birth. It was horrible. The women was in pure, unfettered agony and the husband was crying and shouting at the midwives. The midwife kept examining her to see how dilated she was, and every time she did, the women screamed to leave her the hell alone. When she dilated to 10cms, she needed an episiotomy (I had to sit down, the sound of crunching will never leave me) and then she couldn't push properly so they had to get this suction machine and pull the baby out. I thought it was all over but then the lady started haemorrhaging and the husband passed out, falling on top of me.<br /><br />Fast forward fifteen years and I find myself as a final year medical student in a<br />birthing centre. I can see that things have changed. The medical room of the nineties has been replaced by a birthing room, which is a big lounge-like room with a bed, sofa and rocking chair in. There were no medical instruments to be seen (They were all tucked away in a friendly looking pine cabinet)<br /><br />The midwives firmly told me that I was not here to "Deliver" a baby because in this environment, the women delivers her own baby. Midwives are scary people who don't like doctors very much (They hate medicalising birth) but are the kind of people that you definitely want around!<br /><br />The next big difference I saw was that there are no longer repeated checks on how dilated the women is (They check every four hours, rather than hourly like I have seen) The midwives let the women's body tell her when it is time to start pushing, unlike the old days when the midwife would tell the women to start pushing because she was dilated to 10 cms. The emphasis is on non-intervention, i.e allowing things to happen naturally without medical interference.<br /><br />Thinking about it, the birth in the 1990's and the one I saw last week were similar in that they were both first time young mums, having normal deliveries. The latest birth looked far less stressful because of the nicer environment but the one thing that doesn't seem to get any better is the bloody pain. These women are in AGONY!<br /><br />We are living in the 2000's.... why are women still in so much pain when they give birth?Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com16tag:blogger.com,1999:blog-28722456.post-53955427015903864372009-03-26T19:54:00.006+00:002009-03-27T14:42:50.591+00:00Fannies, Foufs and Va J Js<a href="http://4.bp.blogspot.com/_yDOfMhAYFek/SczkB-mO4xI/AAAAAAAAAGI/sy0HEvtDjWQ/s1600-h/inflatables_vagina.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 289px;" src="http://4.bp.blogspot.com/_yDOfMhAYFek/SczkB-mO4xI/AAAAAAAAAGI/sy0HEvtDjWQ/s320/inflatables_vagina.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5317875982652072722" /></a><br />....These are just some of the names that my patients have today used to describe their vaginas.<br /><br />The dilemma I have is that, according to the bloody hours and hours we have spent on communication skills over the years (My medical school prides itself on turning out docs that can speak to patients), we are supposed to use words that the patients use to discuss their condition.<br /><br />In some situations this is fine, for example :<br /><br />Patient : Hello, I have a pain in my belly and have been throwing up for days.<br />Me: OK Mr Jones please can you tell me more about this pain in your belly....<br /><br /><br />It's a bit different in gynae:<br /><br />Patient: "I have a lump in my fouf"<br />Me: "Ok then, when did you notice this pain in your fouf?"<br /><br /><br />Surely not!!!<br /><br />Seriously though, I am enjoying obs and gynae. That may be a simple statement to you, but after years of hell, it is so strange to now be able to say that I am enjoying the course. I think I have also mentioned in previous posts that I am waiting for the stage when I am no longer shocked about having to do intimate examinations. I have spent my first two weeks in gynae like a rabbit in the headlights as I take a history from a lady, knowing that I then going to be examining her.<br /><br />To tell you the bad bits (And it doesn't get much worse) during my first examination the speculum broke in half in situ. Both me and the patient were mortified. The consultant reassured me that this sometimes happens with the plastic speculums but I think she was trying to make me feel better. I managed to view the cervix - have never seen one before!<br /><br />To get further examining experience, we have had to speak to ladies who are about to have gynae surgery to ask them if it is OK if we examine them once they are under anaesthetic. I am amazed at them all allowing us to do this - they have been brilliant with us. I also think it is really good for patients to know that students don't have carte blanche to examine them without their consent - if they don't consent then we don't go anywhere near them and this is reassuring, I think.<br /><br />Gynae surgery has been an eye opener. I saw a lady having her <a href="http://en.wikipedia.org/wiki/Uterine_fibroid">fibroid</a> removed through her cervix and couldn't believe how big it was - makes you realise how these women have difficulties getting pregnant. The fibroids I saw took uo most of the uterus so no room for a baby!<br /><br />Ah well, back to the land of foufsNurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com8tag:blogger.com,1999:blog-28722456.post-58650561358105909842009-03-26T19:45:00.003+00:002009-03-26T19:53:22.659+00:00Still waiting for it all to click into place......After the thrill of finally passing some exams first time, I have moved on to my Senior Rotation in Obs and Gynae. Can't believe I am a final year student.<br /><br />If any doctors are reading this, I would love your thoughts on something. Before starting out in Medicine, I assumed that in the final year, I would know loads of stuff and be able to manage reasonably well on a ward. Now I am here, I don't feel like I know enough. I know a bit about a lot of stuff, but am in no way the competent student that I thought I would be in my final year. I know I am not the brightest of students, but I look at the cleverer ones around me and see that they also look a little lost.<br /><br />If there are any doctors reading - when does it all click into place? And do you have any advice for the final year?<br /><br />xxNurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com3tag:blogger.com,1999:blog-28722456.post-42217594421604845482009-03-10T18:52:00.004+00:002009-03-10T19:17:42.264+00:00Stunned<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/Sba6PiWy7EI/AAAAAAAAAGA/oszlx-_gp0g/s1600-h/sucess.jpg"><img id="BLOGGER_PHOTO_ID_5311637586613300290" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 100px" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/Sba6PiWy7EI/AAAAAAAAAGA/oszlx-_gp0g/s200/sucess.jpg" border="0" /></a><br /><br /><br />Results were out today......I passed! Can't tell you how relieved I am and stunned as the <span class="blsp-spelling-error" id="SPELLING_ERROR_0">OSCE</span> really did go very badly.<br /><br />I have wrote in <a href="http://nurse-to-doctor.blogspot.com/2008/03/not-many-people-fail-in-medical-school.html">an older post </a>about the year 2 exams that I failed and the stigma attached to this because not many people fail exams at med school. Passing has given my self esteem a much needed boost.<br /><br />Bring on senior rotation and my last year at medical school!Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com8tag:blogger.com,1999:blog-28722456.post-30585920585946146322009-03-04T18:50:00.004+00:002009-03-04T19:51:55.718+00:00OSCE HELL<a href="http://3.bp.blogspot.com/_yDOfMhAYFek/Sa7a1zpnXaI/AAAAAAAAAF4/jQJwnFW67MQ/s1600-h/lget5010%2Bhomer-simpson-stupid-like-a-fox-the-simpsons-poster-card.jpg"><img id="BLOGGER_PHOTO_ID_5309421628649069986" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 226px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://3.bp.blogspot.com/_yDOfMhAYFek/Sa7a1zpnXaI/AAAAAAAAAF4/jQJwnFW67MQ/s320/lget5010%2Bhomer-simpson-stupid-like-a-fox-the-simpsons-poster-card.jpg" border="0" /></a><br /><div>My fourth years exams are finished.</div><br /><div></div><div>The OSCEs were a living hell - can't believe at my age that I get so stressed that I forget basic, basic stuff. I was so angry at myself after it. </div><br /><div></div><div>There were six stations. The first was was split into six smaller stations and asked about investigations such as what you tests you would do for a patient with suspected TB, what some blood tests results meant and a microbiology sample which then asked what antibiotics should be used. </div><br /><div></div><div>The second two stations were patient managements ones and were awful. We had 10 mins to go through a patients notes, GP referral letter and then write a management plan. There was loads of info to get through and in the panic I hardly wrote anything down. We were then herded into a fake ward where the patients that we had just been looking at were lying. We had to explain what we thought was wrong and that bit was kind of OK. I made one hell of a mess of both of the management plans and just can't see how I have passed it. I just hardly wrote anything and screwed up pretty badly.</div><br /><div></div><div>The next two stations were with real patients. This was OK - I had to take a history from two patients (With Schizophrenia and SVT) and then examine them, reach a diagnosis and discuss possible management with the consultants. The last station was a practical skills one and I had to take some blood off a plastic arm.</div><br /><div></div><div>The rumour is that we can fail one of the six and still pass, but I am sure I have failed both management stations and probably (I am ashamed to say) the blood station. I have been taking blood as a nurse for ten years and managed to forget to take a sharps bin to the patients side. The patient reminded me when I had put the needle in and so this is unsafe practice. Not looking good.</div><br /><div></div><div>You might think I am being silly but I did make a big mess of things. What is really bugging me is that the stuff that I got wrong is such basic stuff. It is stuff that I could have easily done as a nurse, without ever having done a day of medicine. Part of me is saying that this is what medicine will be like in the real world, but part of me thinks that it will easier when I have another year of clinical experience under my belt and am seeing these things as a doctor, day in and day out.</div><br /><div></div><div>We then had a written paper which was also fair and I don't think I did too badly with it. </div><br /><div></div><div>Results are out in a few weeks and I have to pass both the OSCE and written paper to pass. The resit is in June.</div><div> </div><div>I started my new block today - seven weeks of obs and gynae. Can't wait!</div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com6tag:blogger.com,1999:blog-28722456.post-48283240148502550612009-02-22T10:02:00.004+00:002009-02-22T10:15:40.222+00:00HELLO!<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/SaElliSrIwI/AAAAAAAAAFw/HVxfauGCY7g/s1600-h/Ronaldo!!.jpg"><img id="BLOGGER_PHOTO_ID_5305563162809672450" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 275px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SaElliSrIwI/AAAAAAAAAFw/HVxfauGCY7g/s400/Ronaldo!!.jpg" border="0" /></a><br /><br /><div>Sorry about the drop in posts - have horrible exams next week. </div><br /><div>I think the medical school is trying to finish me off and they might well succeed this time. I have a five hour marathon OSCE tomorrow and then an exam on Thursday. What a bloody vile time.</div><br /><div>I have loads to write about, and am behind with reading everyone elses blogs which is very frustrating . </div><br /><div>I was going to put a picture of a stressed women in this post, but a picture of Ronaldo's bum seems to me to be a much better diversion away from exam stress.</div><br /><div>Back soon</div><br /><div>xx</div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com8tag:blogger.com,1999:blog-28722456.post-15923489375386116222009-01-05T19:17:00.008+00:002009-01-05T20:41:23.196+00:00New Year<a href="http://3.bp.blogspot.com/_yDOfMhAYFek/SWJgBy1vzSI/AAAAAAAAAE8/vSVrGm6sdQM/s1600-h/LazyMansDogWalk.jpg"><img id="BLOGGER_PHOTO_ID_5287894496429722914" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 200px; CURSOR: hand; HEIGHT: 140px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_yDOfMhAYFek/SWJgBy1vzSI/AAAAAAAAAE8/vSVrGm6sdQM/s200/LazyMansDogWalk.jpg" border="0" /></a><br /><p>Happy New Year! Can't believe it's 2009. </p><p>I had a sinking feeling on NYE as this year is likely to be horrid. I have big exams in 7 weeks and then finals this time next year.<br />I have spent loads of time reading blogs over the weekend and see that my fellow <span class="blsp-spelling-error" id="SPELLING_ERROR_0">bloggers</span> are making lists of what they hope to achieve this year. I dread writing lists as I never seem to get anything done and then feel worse! </p><p>However, in a perfect world, in 2009 I want to: </p><p>1. Lose 7 lbs...how hard can that be but it's that last 7 lbs that sticks like wild fire<br /></p><p>2. Stop eating cake and Bacon <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Wheatos</span>. This would help achieve point 1.</p><p>3. Try to get off my backside and at least walk a bit, each day.</p><p>4. Get into a regular routine for studying, rather than having loads of last minute stuff to do. This one needs to be a priority or I am likely to have a nervous breakdown by the end of the year.</p><p>5. Finally start learning how to mix on the decks that have been set up in my front room for the past six years. </p><p>Bugger - knew I shouldn't have written that stuff down because it would have been exactly the same things on the list, every year for the past five years!<br /></p>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com6tag:blogger.com,1999:blog-28722456.post-62221633130533290382008-12-30T19:02:00.010+00:002008-12-31T13:34:10.096+00:00Plumbers and Electricians<a href="http://4.bp.blogspot.com/_yDOfMhAYFek/SVqBj69I3XI/AAAAAAAAAE0/pD8Q2ExZew8/s1600-h/plumber.jpg"><img id="BLOGGER_PHOTO_ID_5285679566793792882" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 321px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_yDOfMhAYFek/SVqBj69I3XI/AAAAAAAAAE0/pD8Q2ExZew8/s400/plumber.jpg" border="0" /></a> Thanks for all the emails that keep arriving, it's brilliant to see that someone reads this. Do leave me a comment if you visit - makes my day every time!<br /><br />The main thing I keep getting asked is :<br /><br />1. What made me want to change from nursing to medicine<br />2. Has my nursing background helped since moving to medicine<br /><br />I will answer the first question soon, but have to say that as far as the second question goes, my nursing background has not helped me in the slightest.<br /><br />In my humble opinion, nursing and medicine have little in common. I never thought this to start with - I presumed that I would be half way to being a doctor with my nursing degree and twelve years experience but this just is not the case.<br /><br />I was a 1992 "Project 2000" nursing student, a course which was criticised for being too academic and not clinical enough. For the first 18 months we were classroom based, studying sociology, psychology and physiology.<br /><br />For the first 18 months in medical school, we studied biochemistry, genetics, histology, epidemiology, cell biology, pharmacology (None of this was covered in any fashion as a student nurse) and clinical modules such as <span class="blsp-spelling-error" id="SPELLING_ERROR_0">MSK</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_1">CVS</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_2">nephrology</span>, GI etc. We spent 12 weeks on each module, starting with the biochemistry of each clinical subject and working up to pathological processes.<br /><br />After three years I have realised that thinking that nursing was going to give me a leg up the medical ladder was very, very wrong.<br /><br />Nurses and Doctors are like plumbers and electricians. They both work in the same environment and are specialised in what they do. They cannot do each others jobs, simply because the jobs are different. By them doing their different jobs and sticking to what they know best, the house gets built.<br /><br />If the plumber is off sick, the electrician can't cover their job. I don't think doctors could cover the nurses job any better than a nurse could cover a doctor's.<br /><br />To wander off the trail a little, I think one problem is that although the jobs are completely different, there are tasks within each role that cross over (Bloods, interpreting <span class="blsp-spelling-error" id="SPELLING_ERROR_3">spirometry</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_4">cannulation </span>etc) Over my twelve years in nursing, I saw the boundaries between nursing and medicine blur, as the managers realised that nurses were not only cheaper, but could so some of the doctors tasks (I have trundled on about this here)<br /><br />In my old job in occupational health, this quickly lead to a reduction in the docs hours as managers assessed which parts of their roles could be sliced off and handed to the nurses. Then, lo and behold, the same managers realised that "Technicians" were cheaper than nurses. Hey great - lets shave the nurses role (<span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">Presumably </span>so that she could do some of the docs job) and pay the technicians half of what the nurse earns. Don't think I am exaggerating here, over a period of five years, the doctor's hours reduced from 5 a week to 4 a month and when one of the OH nurses left, she was replaced with a fork lift truck driver who had taken a OH technicians course at <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Carmarthen</span> college)<br /><br />To get back to the original subject, I will be interested to see if my view changes in my last 18 months as a medical student, but so far nursing just hasn't helped me as a medical student.Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com10tag:blogger.com,1999:blog-28722456.post-33044543817499224082008-12-30T18:36:00.005+00:002008-12-31T13:36:09.902+00:00Has anything changed since 1954?<a href="http://3.bp.blogspot.com/_yDOfMhAYFek/SVpuNVhBUNI/AAAAAAAAAEk/blw2ul58cho/s1600-h/doc+in+the+house.png"><img id="BLOGGER_PHOTO_ID_5285658288065695954" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://3.bp.blogspot.com/_yDOfMhAYFek/SVpuNVhBUNI/AAAAAAAAAEk/blw2ul58cho/s200/doc+in+the+house.png" border="0" /></a><br /><div></div><br /><div></div><br /><div>With big exams looming, I am procrastinating like a <span class="blsp-spelling-error" id="SPELLING_ERROR_0">good'un</span>. I managed to watch "Doctor in the House" again today. Some of the acting is a bit duff (The "Welsh" chap sounds like he is from Glasgow) but lots of things seem exactly the same.<br /><br /><object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/oVWjAeAa52o&hl=en&fs=1"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/oVWjAeAa52o&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><br /><br /><br />This is my favourite clip - still happens in most hospitals up and down the country, every day!<br /></div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com0tag:blogger.com,1999:blog-28722456.post-82661040407016954862008-12-10T22:49:00.005+00:002008-12-10T23:20:14.913+00:00Star Trek<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/SUBLuRkhEhI/AAAAAAAAAEc/A8wV9JN4YPE/s1600-h/ablation.jpg"><img id="BLOGGER_PHOTO_ID_5278302021640851986" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 193px" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SUBLuRkhEhI/AAAAAAAAAEc/A8wV9JN4YPE/s200/ablation.jpg" border="0" /></a><br /><div>I went to theatre a few days ago to see an <a href="http://en.wikipedia.org/wiki/Atrial_fibrilation">Atrial Fibrillation </a>ablation. Hells bells - it was amazing, like something off tomorrow's world. </div><br /><div></div><br /><div>Ablations are done when drugs and cardioversion have failed to convert the heart back to sinus rhythm. It's a long procedure, done under local (This continues to shock me - imagine lying fully awake for five hours whilst someone burns your heart) and the patient tolerated it really well. They start by pushing tubes up through each femoral vein and then they push a round ended tip into the right atrium. Things get a bit scary (For me anyway - everyone else seemed quite blase!) at this point because they have to then push the tip of the catheter through the wall of the atria, through what would have been the foramen ovale when the patient was in the womb. Creating a hole in the heart seemed worrying to me, but apparently it heals and is fine. </div><br /><div></div><br /><div>It got really exciting then - they push another catheter into the heart and start to build a 3D image of the patients heart. It's hard to explain, but every time the catheter tip touches the atria, the software recognises it and maps like a geometrical image. It was unbelievable - it takes about an hour and then they have a model that looks a bit like the one at the top of this page, only much clearer. Once this is done, they start the ablation which basically means making lots of small burns on the atria with the aim of interfering with the electrical signals and hopefully prompt the heart to flip into sinus rhythm.</div><div> </div><div>I went to speak to the patient the next day to see what he had thought of it all - he was bright as a button and only remembered small bits of what had happened (A little bit of midalozam seemed to have helped)</div><br /><div></div><div>Then, today I got a bit upset in clinic. I think of myself as quite a tough nut as far as people go - I am useless with animals but I tend to be fine with people and not much upsets me.</div><br /><div></div><div>An old chap came in with his daughter. His heart had been going a bit slowly and so it was recommended that he had a pacemaker. Unfortunately he was deaf and did not speak much English. He had also lost his wife a few months ago and was understandably very down. As he left the room, after not speaking all through the consultation, he came up to me and and said that it is important to love one person for all of your life and that when you have loved someone all your life and then they die, you want to die and go with them. Sounds a bit naff when I am writing it, but it made me fill up. Crying in front of the consultant is not a good look!</div><br /><div></div><br /><div></div><br /><div></div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com4tag:blogger.com,1999:blog-28722456.post-67326785027971806232008-12-04T22:40:00.004+00:002008-12-04T23:21:26.682+00:00I'm not having anything done under local anaesthetic!<a href="http://2.bp.blogspot.com/_yDOfMhAYFek/SThk_qOZO-I/AAAAAAAAAEU/-p8dPgXLo7s/s1600-h/pain.jpg"><img id="BLOGGER_PHOTO_ID_5276078008293735394" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 197px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://2.bp.blogspot.com/_yDOfMhAYFek/SThk_qOZO-I/AAAAAAAAAEU/-p8dPgXLo7s/s200/pain.jpg" border="0" /></a>Hello.! <div>I have finished my month in respiratory medicine and now am stuck in cardio for three weeks. I think it's a bit crap that this three weeks is all I have in cardiology for the whole of my clinical training. Seems like too little experience for such common illness. This is made worse by one of my consultants wanting me to attend a pacing clinic three times a week. I went this week and watched a patient have an implantable defib fitted under local (more about that later) than I watched another patient having an implantable defib fitted. Then I watched another patient having an implantable device....OK you get the picture.</div><div> </div><div>I'm a bit annoyed at having to stand in theatre three times this week watching patient after patient having the same thing done. I learn very little from this - watching one so that I am aware of what happens is great, but having to watch it again and again isn't. I feel like my time would be so much better spend on the wards, trying to work out how to look after barn door heart failure, arrhythmias etc. It's hard though because if I dig my heels in and go to the wards rather than theatre, I might well end up in a situation where the consultant refuses to sign my end of module forms (Details of attendance, performance etc)</div><br /><div>What has also scared me is that having one of these devices fitted is a bit nasty. They take around 2 hours and the patient has it all done under a local anaesthetic. They lie there and seem to be in agony when the local is being given. Things get better then apart from one patient who seemed to feel the whole thing and was squirming throughout. I was starting to feel a bit light headed to be honest - it's not nice watching someone in pain during an operation. </div><br /><div>It seems that the risks of G.A make it much safer to do this under local. Also, they are not often able to give the patient midazolam (Sedative) because it makes the blood pressure drop which they tell me isn't good in the middle of heart procedures. </div><br /><div>I hope I never have to have anything done under a local - on my last block an old chap was having his carpel tunnel done under an axillary block and told the surgeon he could feel her cutting his hand. Hells bells.</div><br /><br /><div></div><br /><br /><div></div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com2tag:blogger.com,1999:blog-28722456.post-81941291602032743402008-11-23T23:17:00.002+00:002008-11-23T23:34:27.700+00:00Fed up<a href="http://4.bp.blogspot.com/_yDOfMhAYFek/SSnoT755jJI/AAAAAAAAAEE/A7pamfUfIvw/s1600-h/sad.png"><img id="BLOGGER_PHOTO_ID_5272000268009573522" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_yDOfMhAYFek/SSnoT755jJI/AAAAAAAAAEE/A7pamfUfIvw/s400/sad.png" border="0" /></a><br />Every weekend, I go back home to Wales 150 miles away to see the family and my dogs. Friday night is brilliant - get home at 8 and watch crap TV with the dogs on my knee. Get up and go to work all day Saturday to earn some money to keep the lights on. Have a nice meal on Sat night. Nice, normal stuff.<br /><br />Sundays are horrid; by now we are getting used to being back home with the family and nice surroundings. We remember how nice and easy our old life used to be, before leaving local well paid jobs for me to study medicine. I take the dogs back to my mums, and then pack the car up before hitting the motorway to come back here.<br /><br />I am sitting back in my little flat now - am very depressed! Would rather be back home with my three smelly dogs on my knee, reading the Sunday papers with my mum. These are the hard parts of giving everything up to do medicine when you are an oldie.<br /><br />Never mind...tomorrow I will be one step closer to qualifying and then we can get our lives back to some normality.Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com1tag:blogger.com,1999:blog-28722456.post-76442751042376608872008-10-20T11:59:00.005+00:002008-10-21T07:49:34.984+00:00Bloody GPs<a href="http://3.bp.blogspot.com/_yDOfMhAYFek/SPyEQWnjeYI/AAAAAAAAAC0/1jYwBAPpXPE/s1600-h/bloody+doctors.jpg"><img id="BLOGGER_PHOTO_ID_5259223881346152834" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="http://3.bp.blogspot.com/_yDOfMhAYFek/SPyEQWnjeYI/AAAAAAAAAC0/1jYwBAPpXPE/s400/bloody+doctors.jpg" border="0" /></a><br />I see that the old boot Carole Malone is having another pop at <span class="blsp-spelling-error" id="SPELLING_ERROR_0">GPs</span> again in the (Scroll down to third story) <a href="http://www.newsoftheworld.co.uk/columnists/carolemalone/article48215.ece"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">NOTW</span></a><br /><br />This women is vile - her view is that <span class="blsp-spelling-error" id="SPELLING_ERROR_2">GPs</span> are now earning too much money for doing too little work. <a href="http://blogs.notw.co.uk/carole/2008/06/lazy-docs-make.html">This other story </a>in June is just as hateful.<br /><br />I have followed her rantings for some time and can empathize a teeny teeny little bit. Her father <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">apparently</span> was very ill and got seen by an <span class="blsp-spelling-error" id="SPELLING_ERROR_4">OOT</span> locum who did not know his details. She feels that his care suffered greatly because of this. I can understand being distressed if you feel that a parent was not receiving optimal care...I have been in the same boat and it's horrid.<br /><br />But this women has gone on a one women mission to attack GP pay, hours and reason for being: she is nothing short of spiteful and venomous in her writings. As far as she is concerned, medicine should be vocational and <span class="blsp-spelling-error" id="SPELLING_ERROR_5">GPs</span> should still be working day and night to ensure that their patients are always seen by their family GP. Oh yes....let me add that as well as <span class="blsp-spelling-error" id="SPELLING_ERROR_6">GPs</span> working day and night, they should go back to earning what they were five years ago. i.e. a hell of a lot less than now.<br /><br />I wander how big a part vocation actually plays in people's decisions to study medicine? I don't think that there is any doubt that we all do this because we want to help people - I think the job would be <span class="blsp-spelling-error" id="SPELLING_ERROR_7">un</span>-doable without a personal need to try to help. But...and I know this will be controversial......If one has a vocation to help people, how do they choose between being a doctor or being a nurse? Nurses help people all day every day, work their arses off and earn <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">around</span> £25000. Doctors help people too and have potential to earn a lot more.<br /><br />At my interview for medical school, I was asked why I wanted to move from nursing to medicine. This was hard! The old chestnut "I want to help people" wouldn't wash, because you can do this as a nurse. I gave a right old <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">bunkum</span> answer about wanting to help people at a "Higher level" (<span class="blsp-spelling-error" id="SPELLING_ERROR_10">LOL</span>!) The interviewer said to me "OK so you want to help people, but earn more money whilst doing it"<br /><br />How can I argue with this?! Medicine for me is about providing excellent care but also about fulfilling my potential and earning a better wage than I could as a nurse. Admitting that good pay is one of the attractions of going into medicine remains a taboo area and not something I ever hear people talk about.<br /><br />Another interesting point is that I know many nurses who are moving into medicine. I have NEVER heard of a doctor moving into nursing. I think this says it all!Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com0tag:blogger.com,1999:blog-28722456.post-11091198245780461612008-10-04T09:11:00.007+00:002008-10-04T10:35:27.376+00:00When is it OK to hurt a patient?<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/SOdEcC7bRnI/AAAAAAAAACs/HcNoTvbrQog/s1600-h/pain.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SOdEcC7bRnI/AAAAAAAAACs/HcNoTvbrQog/s400/pain.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5253242738964121202" /></a><br />As mentioned, I am LOVING this orthopaedics block! My consultant has a reputation of being a scary screamer but so far she has been brilliant with me and my clinical partner and so life is good.<br /><br />What is good about this placement is that my consultant is a shoulder specialist which means that most people who come to see her have impingement, instability, a-c pain, humerus fracture or a frozen shoulder. This might not seem very exciting but it has meant that we have become good at diagnosing and managing these complaints. On my GP block, every bloody patient that came had something different...you got your head around working out what the chest pain was due to and then they left and a new patient came in with a toe problem.....I liken the experience to swimming backwards in poo.<br /><br />Anyway - in clinic this week, a 50 year old lady attended with severe shoulder pain. Her passive arm flexion and abduction was 60 degrees, after which active movement was possible but with horrid pain. We were asked to take a history from her, examine her, make a diagnosis and then present the case to the consultant, who would then come and examine her again and discuss treatment options.<br /><br />I took her history and then started to examine her. After looking at her cervical spine movement, I began the arm movements, managing to get her flexion to 180 degrees, albeit with clear pain. In fact, the pain was so bad that she started crying and she wasn't a wimpy lady - it was just clear that she was in agony. I decided at that point not to continue to abduct her arm because the other tests indicated that she had supraspinatus impingement which was likely to produce a painful arc. So I left the abduction and did some of the other examination which she managed, without reproducing too much of her pain.<br /><br />When we left the room to go and find the consultant, my clinical partner voiced his concern with what I had just done. He felt that I should have continued with the full exam, despite the fact she was crying with pain. He felt that by not persisting, I had failed in my examination. I told him that I felt that continuing to examine her, despite pain and tears would actually be unethical. This didn't go down terribly well with him but I stood my ground because although I might not be a font of medical knowledge, my nursing background has given me a lot of insight into patient care.<br /><br />Since my first contact with patients as a medical student, I have been very aware of the fact that when we examine patients, it is usually for OUR benefit, not for the patient's. We know so little that examining is how we learn, but in this case I knew that continuing with the exam was causing her significant pain and that once I had presented the case to my consultant, she would then have to go all through it again. <br /><br />My clinical partner was not amused that I stood my ground on this one and I think the reason for this might be our backgrounds. He is an ex-physiotherapist and I think it's fair to say that physio's often cause pain, albeit for the good of the patient's recovery! <br /><br />So was I wrong?Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com3tag:blogger.com,1999:blog-28722456.post-51293613003431588402008-10-04T08:44:00.004+00:002008-10-04T09:11:19.452+00:00Back in action!<a href="http://3.bp.blogspot.com/_yDOfMhAYFek/SOcyNp9TSXI/AAAAAAAAACc/63usVj9Nu-4/s1600-h/arty+picture.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;" src="http://3.bp.blogspot.com/_yDOfMhAYFek/SOcyNp9TSXI/AAAAAAAAACc/63usVj9Nu-4/s320/arty+picture.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5253222700533631346" /></a><br />OMG - can't believe that it's October and two months have passed since my last post. <br /><br />To bring things up to date.....I HATED GP placement because my GP was a bullying prat. After GP block, I had a three week "Elective" We had to choose between pathology, Haematology, Radiology or Humanities.(Pathology was my first choice - I fancied working with nice, quiet, dead people after seeing so many live, moaning, ones during my GP block)<br /><br />Fortunately, or unfortunately (I'm still not sure) I got allotted to my last choice which was humanities. What an experience! Apparently there is a national movement towards trying to introduce humanities into medicine. By that, I mean poetry, opera, photography...all the arty subjects which I was crap at in school. There was no "Humanities" per se in the 1980's - I am told that this is now a GCSE subject.<br /><br />Anyway...on the intro morning the chap running the course tried to explain what the humanities elective was trying to achieve i.e. broaden medical student's thinking by looking at areas we never normally would. We spent two hours discussing the word "Humanities" I think I give up the will to live after 20 mins.<br /><br />The short of it is that we each had to produce a 15 minute presentation on subjects like "Was Hamlet mentally ill?" <br /><br />I'm a bit rough around the edges and not usually into opera, radio plays or literature but I enjoyed the presentations and am not sorry I ended up on the elective after all! I have even found an arty medical picture for you (See above!)<br /><br />After this, we had a month's holiday. I am being credit crunched to within an inch of my life so couldn't afford a holiday but had a lovely month doing nothing and watching Jeremy Kyle every morning.<br /><br />Then, three weeks ago I started on my orthopaedics block and am LOVING it! Hells bells, that's the first time since I started Medicine in 2006 that I have said those words. So far the course has been anything except enjoyable - it's just one long slog really, with little bits of hope thrown in every now and then.Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com0tag:blogger.com,1999:blog-28722456.post-21320937840219196952008-07-27T22:37:00.004+00:002008-12-11T21:07:18.408+00:00Thank God that's over with!<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/SIz9moSYe-I/AAAAAAAAACU/uQ78G06rBbY/s1600-h/happy.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SIz9moSYe-I/AAAAAAAAACU/uQ78G06rBbY/s320/happy.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5227832107561679842" /></a><br />WHOHOOOOOOO!!!!<br /><br />Have finished my GP block and am SO happy! I have massive respect for GP's after this placement as I never before realised that they have such a tough job. At least on a ward, you get to be part of a team and can order tests and scans to help. I reckon that if you were less than confident in your own ability as a doctor, being a GP would be impossible. Most of the time, the patients coming to see you have common conditions such as UTIs and chest infections, but every now and then it seems that one of them actually has something serious and the skill seems to be picking these up.<br /><br />I have watched public opinion turn against GPs this year and the rants in the press by the likes of <a href="http://blogs.notw.co.uk/carole/2008/06/lazy-docs-make.html">Carole Malone</a> make me sick. I have no doubt that this backlash wouldn't have happened if GP's were not found out to be earning such good money. It really, really annoys me to see that so many people begrudge GPs earning decent money. <br /><br />Anyway - that placement is over so I now have three weeks on an "Elective" and then four weeks holiday. WOOP WOOP!!Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com3tag:blogger.com,1999:blog-28722456.post-2866445917764558942008-07-09T19:22:00.005+00:002008-12-11T21:07:19.091+00:00How things can change<a href="http://4.bp.blogspot.com/_yDOfMhAYFek/SHUWpTJT1fI/AAAAAAAAACE/2rUrJJDyNV4/s1600-h/devil_2.jpg"><img id="BLOGGER_PHOTO_ID_5221104241775728114" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_yDOfMhAYFek/SHUWpTJT1fI/AAAAAAAAACE/2rUrJJDyNV4/s320/devil_2.jpg" border="0" /></a><br />Oh shite - how things have changed since my last entry, when GP land all seemed so good. I didn't know if I would write about this but I am going to because it has had such a profound effect on me.<br /><br />On the first week of this placement, I was timetabled to do a clinic with a GP whom I hadn't met. Before I went in, a few of the receptionists commented that the GP was a bit of an odd one but I thought nothing of it and went in like a lamb to the slaughter. My first impressions of him: "Who is this knob"<br /><br />This guy ripped me to shreds in front of every patient. Nothing I said was right - he even picked me up on how I pronounced "gastrocnemius" (Apparently I did not say the "c" succinctly enough) He also told me off for wearing gloves to test a urine sample (WTF???!!)("Why are you wearing gloves - you could drink that urine")<br /><br />Even after one clinic with him, my self confidence was battered - I stayed on a downer all night. The next day, I was back in medical school for training, and a different GP and my fellow students watched a video of one of my consultations. The GP made me stop my video three times, asking who this GP was and why he kept interupting me. I later had a call from the medical school to say that they were concerned with what they had seen and did I want to do anything about it.<br /><br />Now it is worth me reminding you that I am no spring chicken - I am actually the same age as this GP. I am not a complainer because I feel that in medical school, complainers get labelled as problem children. I decided not to do anything about him but to give it time and see if things settled (I am starting to sound like a proper GP)<br /><br />I also felt that the knob had a point - I did not know as much as I should have.<br /><br />So over the next three weeks, I continued to turn up and his behaviour towards me became progressively worse. The culmination was this week, when I sat on the sofa and decided that I was not clever enough to do medicine. I was pretty much at rock bottom and realised that this chap had managed to bring me so low that I had lost every shred of my confidence.<br /><br />So I finally did something - I told the practice that I couldn't do any more clinics with him. I now feel like the problem child that I knew I would feel like but the thought of sitting in his clinics is so horrific that I will put up with it.<br /><br />It amazes me that knobs like this can have profound effects on us when we are adults. I would have thought that as you get older, your ability to cope with these characters gets better and I would not have thought that at my age, working with this bloke could have been so detrimental to me. I also realise that although my medical knowledge is...shall we say sparse in many areas, this is actually OK because I am only a 2nd year medical student!<br /><br />The conclusion of this is that I have hated this placement. The other GP's have been brilliant with me, but I have a bad taste in my mouth because I feel that they all know what he is like and decided to put me with him anyway.<br /><br />PS. As from yesterday, I am no longer a rectal exam virgin. EEWWWWWWWWWWWWW!Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com7tag:blogger.com,1999:blog-28722456.post-13844705546942473142008-06-12T22:36:00.005+00:002008-12-11T21:07:19.221+00:00Morning tea breaks, 2 hour lunch breaks, afternoon tea breaks - I have woke up and gone to heaven<a href="http://2.bp.blogspot.com/_yDOfMhAYFek/SFGtQTDF6xI/AAAAAAAAAB8/gkHlAaqacZg/s1600-h/dog-doctor.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;" src="http://2.bp.blogspot.com/_yDOfMhAYFek/SFGtQTDF6xI/AAAAAAAAAB8/gkHlAaqacZg/s320/dog-doctor.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5211136739347131154" /></a><br /><br /><div>I have now finished my seven week placement in general medicine and have this week, moved to general practice for seven weeks.<br /><br />My first impressions are that, bloody hell this is a civilised profession - they have start times and finish times and tea breaks, where nice ladies on reception bring them tea (In china cup and saucer - result) They earn loadsamoney and only have to do a little bit of OOH cover. It seems to be the antithesis of hospital medicine and these doctors actually seem to have a life.<br /><br />It is interesting then, that when I got together with my group today lots of them are hating their GP placement and can't wait to get back to acute care. They felt that most patients rolling through the door didn't need to come to see their GP (Minor skin rashes and ailments that are already getting better when they attend) They also felt that after a morning of seeing children with Hayfever, they wanted to climb out of the window and run to the hills (Or the nearest hospital)<br /><br />Me, on the other hand LOVES it!! Well I would if I wasn't so terrified - I am absolutely bloody cacking it. I got so stressed on Tuesday that I had to nip outside to try to breath. The problem you see, is that on the wards, we are in groups of six / seven medical students and so when questions are asked, one of us can usually pipe up. In GP land however it is just me and the GP. There is nowhere to hide and it is butt clenchingly terrifying.<br /><br />For example, a nice lady Mrs A brought her two children in this week. She had recognised that both of them had hayfever and she wanted a prescription for piriton so that she could leave and return her children to school. Instead, what she got was Anna the pale, shaking, medical student. This was the first visit that the GP told me to handle from beginning to end and hell, did I make a meal of it. She got asked about her kids' bladder and bowels (Commonly affected in hayfever....not) and about other "pertinent" points such as "Have they been abroad lately"<br /><br />I made a mess - a real hellish mess. I know that if I had not had the GP sitting in the corner I would have been absolutely fine. I could easily have handled this, prescribed and sent them off to school. Instead, I went to pieces and I can just picture the mum pissing herself laughing to her mates about what this freak from Wales had been waffling on about.<br /><br />I think that if I could find a way of developing my confidence, I would be half way there. I have spent my time at medical school feeling like an impostor and even now don't feel like a real medical student. I need to get me some ego!</div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com2tag:blogger.com,1999:blog-28722456.post-33665631103853384512008-06-07T16:14:00.011+00:002008-12-11T21:07:19.487+00:00Breaks are for wimps<p><img id="BLOGGER_PHOTO_ID_5209180024873845394" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; CURSOR: hand" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SEq5ohmqgpI/AAAAAAAAABs/PGJl143lQIQ/s320/images.jpg" border="0" />Having been in clinical medicine for a grand total of 14 weeks, I would say that Medicine is a very macho profession:<br /></p><ul><li>Doctors don't take breaks....ever. We start ward round at 9am and it finishes around 1300. Four hours standing to attention with no 5 mins put aside for a quick drink. When the ward round finishes, clinic starts and so there is no room for lunch either. At 1700, teaching starts and that will carry on until the consultant gets bleeped away (Or until he finally realises that he has a wife and baby who expected him home three hours ago) </li></ul><p><br />I don't know any other profession that expects it's colleagues to function like this. Every factory and ward I have ever worked on honours basic tea and meal breaks. As a nurse - the wards were manic but a part of the senior nurses role was to make sure that the nurses got their breaks. Medicine seems to be about seeing how long you can stay on your feet before falling over. If you succumb and fall over - that is a sign of weakness. If I was not in medicine, I would assume that they don't take breaks because they are too busy, but on my ward this is simply not true. They don't take breaks because that is not what doctors do.</p><ul><li>Medical students get brain washed into thinking that this is normal very, very quickly. I suppose most of them have never worked before and so perhaps presume that this is how every one works.<br /></li><li>Surgeons are even worse - as a student it's generally best to avoid the OT at all costs. On the day I was daft enough to wander in, I found myself holding a retractor for a six hour stretch. I was too scared to ask to go for a wee because the surgeon commented in the first half hour "I hope you're made of sturdier stuff than the anorexic waif we had in here yesterday. She passed out after a few hours and then said it was because we made her stand up for too long</li></ul>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com1tag:blogger.com,1999:blog-28722456.post-37848881236414634982008-05-15T18:39:00.010+00:002008-12-11T21:07:19.823+00:00Bums<a href="http://3.bp.blogspot.com/_yDOfMhAYFek/SC9ir2kqhEI/AAAAAAAAABU/QMft3FJNZ3o/s1600-h/rectal+exam.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;" src="http://3.bp.blogspot.com/_yDOfMhAYFek/SC9ir2kqhEI/AAAAAAAAABU/QMft3FJNZ3o/s320/rectal+exam.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5201484600159405122" /></a><br />I have never been unfortunate enough to need to have a doctor put his finger up my bum. I hope I never need to, but the thought of me having to do that to someone else isn't much better.<br /><br />I nearly had to do my first rectal exam today - I managed to go the loo at an excellent time and so my clinical partner was landed with it. He was told to "Go and do a rectal" on an constipated alcoholic patient. The SHO told him that it had to be done "To see if there is poo in his rectum"<br /><br />WTF???? Of course there is going to be poo in there! If he hasn't poo-ed for four days, where is it going to be, other than in his rectum?<br /><br />I kind of hovered around the bed whilst my clinical partner got his gloves ready. The SHO told him what to do and so, after covering himself and the bed in KY jelly, he did the deed. Although we had the curtains around the patient, The SHO managed to shout really loudly "Put your finger in and tell me if there is hard faeces there" The other patients sniggered and the visitors around the next bed went very quiet.<br /><br />My clinical partner didn't say much for the rest of the day and struggled to eat his free curry (Drug reps are wonderful people!)<br /><br />It's hard to think that these things will soon become as routine as taking blood - just part of the everyday routine. The funny thing is that if I was training to be a vet, I don't think that I would have any worries about sticking my finger up a dogs' bum. It just seems a dreadful thing to have to do to a man. I wander too, how necessary some of the rectal exams are. I can understand their need to assess prostate size and prescence of malignany, but I am not too convinced about doing them for constipation, like the one today. I asked the SHO why this was needed for constipated patients and he really couldn't answer me, only to say that "This is how we assess the level of constipation"<br /><br />Oh well - I expect this time next week, I will no longer be a rectal exam virgin!Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com3tag:blogger.com,1999:blog-28722456.post-10990676415853909482008-05-12T09:07:00.005+00:002008-12-11T21:07:20.002+00:00When will the penny drop??.......<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/SCgTQGkqhAI/AAAAAAAAAA0/VAs-R9-c1nE/s1600-h/crazy_harry.jpg"><img id="BLOGGER_PHOTO_ID_5199426937162466306" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SCgTQGkqhAI/AAAAAAAAAA0/VAs-R9-c1nE/s320/crazy_harry.jpg" border="0" /></a><br /><br /><br />I really don't understand people. The older that I get, the less I understand people.<br /><br />Take Mr A. He is a 57 year old male who came into hospital a week ago after experiencing numbness down his right side whilst working in the garden. I first saw him two days after his admission on the ward round. His numbness had subsided but not completely gone away and so he was advised that he had suffered a stroke (If his symptoms had completely gone away within 24 hours it would have been a TIA)<br /><br />The consultant sat down with him and went through his risk factors for stroke. He had smoked 20-30 a day since the age of 20. His cholesterol was reasonable at 5.4 mmols / l and his blood pressure a little raised at 140/92. His father had died from an MI aged 62.<br /><br />The consultant explained to him that he had had a mild stroke and was at quite high risk of having another one in the next month. He told him that now was a good time to give up smoking and explained how this mild stroke was a warning sign which needed to be heeded. The consultant also said that he was worried that Mr A might have furred up carotid arteries and arranged for a scan to assess the level of furring.<br /><br />Mr A was clearly terrified and I really felt for him. I visited him after the consultant had left and we chatted about what had been spoken about. His main fear was about his neck arteries being clogged up because he was scared of the treatment that might be needed. We agreed that it was good that this stroke was a mild one, because he was not going to be left with any impairment and so it could be taken as a warning sign.<br /><br />Next day and Mr A went off for his scan. It was good news.....his carotid arteries were not furred up and so no treatment was needed. Mr A was a happy bunny. So happy, in fact that he took himself straight off to the car park and.....yes, you guessed it, got his fag packet out and started to smoke.<br /><br />My colleagues and I sat in the canteen and watched him smoking. We were pretty dumbstruck to be honest. When does the penny drop? When do you throw your arms in the air and say "You know what, I have smoked for 37 years and I have just had a stroke that I have completely recovered from. I am a lucky bastard because I have had a warning sign that things need to change"<br /><br />Instead Mr A's arm in the air moment was "I am a lucky bastard. I have smoked for 37 years and don't have any furred up arteries. I haven't done myself any damage......bring on the fags"<br /><br />People are funny buggers.Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com4tag:blogger.com,1999:blog-28722456.post-89287573346633983232008-05-03T09:19:00.002+00:002008-12-11T21:07:20.410+00:00Men I would leave my husband for (Part two)<a href="http://1.bp.blogspot.com/_yDOfMhAYFek/SBwuR8_nYlI/AAAAAAAAAAc/_GMWGz3qFf0/s1600-h/Ronaldo+bum.jpg"><img id="BLOGGER_PHOTO_ID_5196078956044313170" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_yDOfMhAYFek/SBwuR8_nYlI/AAAAAAAAAAc/_GMWGz3qFf0/s320/Ronaldo+bum.jpg" border="0" /></a> <a href="http://2.bp.blogspot.com/_yDOfMhAYFek/SBwuSM_nYmI/AAAAAAAAAAk/O-RH5H5W2qA/s1600-h/ronaldo+on+a+plane.jpg"><img id="BLOGGER_PHOTO_ID_5196078960339280482" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_yDOfMhAYFek/SBwuSM_nYmI/AAAAAAAAAAk/O-RH5H5W2qA/s320/ronaldo+on+a+plane.jpg" border="0" /></a><br /><br />Christian Ronaldo is the newest addition to my list.<br /><br />My husband and I both have a list of people who we would leave the other for. This might shock people but bearing in mind that my list is Ronaldo, Patrick Dempsey and Jay-Z and my husbands list is Pamela Armstrong and Carmen Electra (He wanted to add Gemmma Atkinson to his list but I dug my heels in) I don't think any of us are going to be packing our bags any time soon!<br /><br /><div></div>Nurse To Dochttp://www.blogger.com/profile/08482747601599927322noreply@blogger.com1