My Journey from Nurse to Doctor

Dr Gregory....I did it!

2010-03-31T23:33:00.000Z

I qualified as a doctor today

I am away working in the Lakes and had to go and sit in the toilet to read the results email!

I haven't told anyone yet because just for today, I wanted to let it sink in. Am now listening to the song that give me the courage to do medicine and am happy happy happy that I did.

xxx

Finals all over - Now is the torrid wait for results

2010-03-29T23:53:00.000Z

I sat my finals during the past three weeks and am now am in limbo waiting for results.

This time next week I will be either be a doctor or a medical student waiting to resit Finals.

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.

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!

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.

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!)

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"

Station One
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 pelvic ramus fracture (like two cracks in a polo mint) The problem here was that the written questions seemed to hint at a fractured neck of femur (NOF) but for the life of me I couldn't see it. Fractured NOFs can often be clear as day like this one 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!

Station Two
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 massive ischeamic stroke. 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!"

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 Hyacinth Bucket School of Drama 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!

Station 2
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

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.

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.

Station three
(Acute emergency station)
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 cardiomegaly with pulmonary oedema 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.

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

Station Four
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

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

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.

Room 1
Cancer Patient
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

Room 2
ENT patient
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

Room 3
Chronic care patient
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!

So that was it – four years of hell condensed into four hours of torture

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

Hello Again!

2010-03-27T10:22:00.002Z

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.

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

Melons and Foufs

2009-03-28T09:36:00.006Z

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.

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.
I don't know why but do wander if it's because I saw too much at a young age!

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.

Fast forward fifteen years and I find myself as a final year medical student in a
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)

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!

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.

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!

We are living in the 2000's.... why are women still in so much pain when they give birth?

Fannies, Foufs and Va J Js

2009-03-26T19:54:00.006Z

....These are just some of the names that my patients have today used to describe their vaginas.

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.

In some situations this is fine, for example :

Patient : Hello, I have a pain in my belly and have been throwing up for days.
Me: OK Mr Jones please can you tell me more about this pain in your belly....

It's a bit different in gynae:

Patient: "I have a lump in my fouf"
Me: "Ok then, when did you notice this pain in your fouf?"

Surely not!!!

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.

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!

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.

Gynae surgery has been an eye opener. I saw a lady having her fibroid 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!

Ah well, back to the land of foufs

Still waiting for it all to click into place......

2009-03-26T19:45:00.003Z

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.

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.

If there are any doctors reading - when does it all click into place? And do you have any advice for the final year?

xx

Stunned

2009-03-10T18:52:00.004Z

Results were out today......I passed! Can't tell you how relieved I am and stunned as the OSCE really did go very badly.

I have wrote in an older post 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.

Bring on senior rotation and my last year at medical school!

OSCE HELL

2009-03-04T18:50:00.004Z

My fourth years exams are finished.

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.

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.

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.

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.

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.

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.

We then had a written paper which was also fair and I don't think I did too badly with it.

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.

I started my new block today - seven weeks of obs and gynae. Can't wait!

HELLO!

2009-02-22T10:02:00.004Z

Sorry about the drop in posts - have horrible exams next week.

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.

I have loads to write about, and am behind with reading everyone elses blogs which is very frustrating .

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.

Back soon

New Year

2009-01-05T19:17:00.008Z

Happy New Year! Can't believe it's 2009.

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.
I have spent loads of time reading blogs over the weekend and see that my fellow bloggers 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!

However, in a perfect world, in 2009 I want to:

1. Lose 7 lbs...how hard can that be but it's that last 7 lbs that sticks like wild fire

2. Stop eating cake and Bacon Wheatos. This would help achieve point 1.

3. Try to get off my backside and at least walk a bit, each day.

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.

5. Finally start learning how to mix on the decks that have been set up in my front room for the past six years.

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!

Plumbers and Electricians

2008-12-30T19:02:00.010Z

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!

The main thing I keep getting asked is :

1. What made me want to change from nursing to medicine
2. Has my nursing background helped since moving to medicine

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.

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.

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.

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 MSK, CVS, nephrology, GI etc. We spent 12 weeks on each module, starting with the biochemistry of each clinical subject and working up to pathological processes.

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.

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.

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.

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 spirometry, cannulation 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)

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 (Presumably 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 Carmarthen college)

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.

Has anything changed since 1954?

2008-12-30T18:36:00.005Z

With big exams looming, I am procrastinating like a good'un. 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.

This is my favourite clip - still happens in most hospitals up and down the country, every day!

Star Trek

2008-12-10T22:49:00.005Z

I went to theatre a few days ago to see an Atrial Fibrillation ablation. Hells bells - it was amazing, like something off tomorrow's world.

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.

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.

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)

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.

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!

I'm not having anything done under local anaesthetic!

2008-12-04T22:40:00.004Z

Hello.!

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.

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)

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.

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.

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.

Fed up

2008-11-23T23:17:00.002Z

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.

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.

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.

Never mind...tomorrow I will be one step closer to qualifying and then we can get our lives back to some normality.

Bloody GPs

2008-10-20T11:59:00.005Z

I see that the old boot Carole Malone is having another pop at GPs again in the (Scroll down to third story) NOTW

This women is vile - her view is that GPs are now earning too much money for doing too little work. This other story in June is just as hateful.

I have followed her rantings for some time and can empathize a teeny teeny little bit. Her father apparently was very ill and got seen by an OOT 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.

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 GPs 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 GPs 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.

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 un-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 around £25000. Doctors help people too and have potential to earn a lot more.

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 bunkum answer about wanting to help people at a "Higher level" (LOL!) The interviewer said to me "OK so you want to help people, but earn more money whilst doing it"

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.

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!

When is it OK to hurt a patient?

2008-10-04T09:11:00.007Z

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.

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.

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.

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.

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.

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.

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!

So was I wrong?

Back in action!

2008-10-04T08:44:00.004Z

OMG - can't believe that it's October and two months have passed since my last post.

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)

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.

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.

The short of it is that we each had to produce a 15 minute presentation on subjects like "Was Hamlet mentally ill?"

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!)

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.

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.

Thank God that's over with!

2008-07-27T22:37:00.004Z

WHOHOOOOOOO!!!!

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.

I have watched public opinion turn against GPs this year and the rants in the press by the likes of Carole Malone 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.

Anyway - that placement is over so I now have three weeks on an "Elective" and then four weeks holiday. WOOP WOOP!!

How things can change

2008-07-09T19:22:00.005Z

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.

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"

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")

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.

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)

I also felt that the knob had a point - I did not know as much as I should have.

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.

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.

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!

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.

PS. As from yesterday, I am no longer a rectal exam virgin. EEWWWWWWWWWWWWW!

Morning tea breaks, 2 hour lunch breaks, afternoon tea breaks - I have woke up and gone to heaven

2008-06-12T22:36:00.005Z

I have now finished my seven week placement in general medicine and have this week, moved to general practice for seven weeks.

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.

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)

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.

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"

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.

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!

Breaks are for wimps

2008-06-07T16:14:00.011Z

Having been in clinical medicine for a grand total of 14 weeks, I would say that Medicine is a very macho profession:

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)

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.

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.
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

Bums

2008-05-15T18:39:00.010Z

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.

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"

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?

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.

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!)

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"

Oh well - I expect this time next week, I will no longer be a rectal exam virgin!

When will the penny drop??.......

2008-05-12T09:07:00.005Z

I really don't understand people. The older that I get, the less I understand people.

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)

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.

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.

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.

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.

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"

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"

People are funny buggers.

Men I would leave my husband for (Part two)

2008-05-03T09:19:00.002Z

Christian Ronaldo is the newest addition to my list.

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!

Being thrown to the Lions

2008-04-26T09:11:00.003Z

Hmmmmm. Medicine is very different to nursing. I never expected to say this, but the doctors could learn a hell of a lot from nurses on how to train someone to do a job.

Example 1. By Thursday I think the three of us (My clinical partner, German playmate and me) were the ward sport (We imagined them taking bets in the sluice of how quick they could make us crumble)

Halfway through the morning, one of the SHOs told us to "Sort the bloods out" Wanting to look eager, and terrified of upsetting them anymore than we had already done, I said "But we have never taken any bloods"

"Then this is the ideal time to learn then, isn't it" She snarled back. Oh shit - I did a venepuncture course two years ago (It was during the lunch time of this course that I found out that my dad had been admitted with his stroke - See early posts) but have never practised it. Our German mate had also trained in it but used a German blood taking system and so wasn't really up to the job either)

I asked the SHO if she would mind doing the first one so that we knew which colour bottles to use and so that we could work out really small matters like where you stuck the needle in. She told us to "Work it out" so off we shuffled to form a battle plan. Luckily, the ward clerk saw us looking terrified and came to show us which colour bottles to use. We made an executive decision that our German mate could do the deed and followed him on to the ward. He actually managed to take the blood reasonably well from the patient and so off we shuffled, triumphant!

I hate reflecting but I would have to say that I am HORRIFIED at my actions. I should have dug my heels in and told the SHO to go and take a running jump. How STUPID was she though - surely it it dreadful practice to expect us to do something we haven't been trained to do, without at least showing us the correct way of doing it.

This would never happened as a nurse. When I qualified, you had to do 6 months on a ward before being allowed to attend a venepuncture course. You then had to be supervised in taking blood off five patients before being signed of as fit to practice.

I need to work out what I am going to say the next time this happens because from what I can see so far, being a medical student is like being thrown to the lions on a daily basis and if I don't learn how to speak up now, I am going to get eaten up.

The bubble has burst

2008-04-26T08:41:00.003Z

So, I finished my pscyhiatry placement and am now in General medicine for seven weeks. It is the end of my first week now and I have had my bubble well and truly burst.

We arrived on the EMU (Emergency Medical Unit) which is a bit like casualty but with medical patients) on Wednesday afternoon and it was like walking into a circus. No-one asked us who we were or what year we were in, they just saw that we had pink student badges around our necks and told us to "Go and clerk that patient on trolley 3"

Now then, my clinical partner is an ex physio and we also have a playmate with us on this placement from Germany. He is a final year medical student who for some obscure reason, decided to come to the East Midlands on his elective (Poor Sod was obviously told that it was a lovely part of the world)

So the three of us (Who have never clerked a patient in or seen anyone else do it) shuffled to the trolley as directed. On the trolley was a 35 year old women with a left hemiparesis who had been brought in fours hours earlier by her husband (He had a nice suit on and we were terrified that he was a consultant)The look of relief on their faces when they saw us was massive (Oh God, if only they knew) so I sat down and went through my patient history headings (Listed below for anyone who might want to know these things)

Presening complaint
History of presenting complaint
Past medical history
Drug history
Social history
Family history

Our German friend was then pushed forward to do the physical bit. He decided to do a neuro exam and proceeded to test her cranial nerves, motor tone and power. We then shuffled back off, leaving her oblivious to the fact that we didn't have a clue what was wrong with her and that she would have to go through it all again when the FY1 was available.

What a joke - is this how they think they are going to train us? What the hell happened to "See one, do one, teach one"?

I never realised that I was mentally ill.

2008-03-22T10:00:00.006Z

I am now on my first clinical placement on junior rotation, in psychiatry. My only other experience in mental health was in 1993 as a student nurse, when I was placed in a "drop in" day centre (Couldn't believe how many fags a group of people could get through). I think it is fair to say that until this week, my views of mental illness were archaic - mental illness happened to strange people who then went on to do very strange things.

I started this week by sitting in on an outpatient clinic with my psychiatrist. Most of the visiting patients were in various stages of depression and I made the mistake of commenting that I had never thought of depressed people as being mentally ill. I was depressed after my dad had his stroke a few years ago and ended up on six weeks of Citalopram. I knew I was depressed, but never for one moment thought of myself as being mentally ill!

I have always thought of mentally ill people as psychotic nutters (I had an altercation with a paranoid schizophrenic once that is probably to blame) but what I have learnt immediately, is that mental illness happens to normal people. It seems that you can be perfectly well one day and then wake up the next hearing voices and seeing little men running around the room. The latter are called "Lilliputian hallucinations" I love that name!

I also never knew that ECT was still a treatment and never knew that giving an anti-psychotic drug can stop the voices in Schizophrenia. That amazes me - how can a drug stop voices in your head? Apparently the voices start when too much dopamine flies around your brain, so drugs are given which bind dopamine receptors and when most of the receptors are bound, the voices stop. Brilliant.

My consultant has given me a DVD of "One flew over the cuckoo's nest" to watch this weekend. It looks a bit depressing but I think I had better keep in his good books after the "Depressed people aren't mentally ill" comment

Not many people fail in medical school

2008-03-21T16:39:00.005Z

Hello!

Hells bells - can't believe it has been a year. Thank you very much to those of you who have emailed me to ask how I am getting on.

Well - to bring you up to date - I am now half way though my second year which is unbelievable. I have (Just this week) started my clinical training in my first junior rotation in psychiatry. It has been an absolute slog to get here and I think that this is why I stopped writing these posts. The other reason was that I didn't pass everything that I needed to pass and so ended up in what my medical school calls "A qualifier"

On my first day at medical school, the Dean told the audience of 400 or so students, that in four or five years time, 95% of us would be doctors. The reality is that in medical school, most people pass all the exams that are thrown at them. If you, like me, are in the small group that does not pass everything - it is not pleasant.

In February, the students on the five year course did their pre clinical exams. Out of 372 students, 82 failed one or more exams and ended up in the qualifier. In my cohort of graduate entry, 50 sat the pre-clinicals and twelve of us ended up in the qualifier.

Being in the qualifier means that you have to do the whole lot of exams again - even the stuff that you passed. Personally, I passed the clinical exam and one of the written papers, but failed the second written paper. I then had three weeks to study my arse off before sitting the whole lot two weeks ago. Thank God - I passed, and so was allowed to progress to my clinical training. Eight of my fellow qualifieees have not been so lucky and are now off the course.

Having been at this now for eighteen months I have formed some strong opinions on doing medicine as a mature candidate. From what i can see, if anything goes wrong in your life whilst studying medicine, the odds for failing rocket. I think that this is the case for any subject but graduate entry medicine does not allow any buffer for illness, turmoil or wanting to have a life. As you probably know, graduate entrants do the preclinical training in eighteen months instead of 2.5 years. Despite what you may have heard, we do exactly the same modules as the five year lot, (Well apart from a bit of Head and Neck studies, but what's a mandible between friends) so over the three semesters our workload is 33% greater than the five years students.

Some of you might be reading this, thinking that people who fail and end up in the qualifier are there because they haven't worked hard. This is BS - we worked hard, but just not hard enough!
Anyway - enough about qualifiers and stuff - I passed the shitty thing so I made it!! I have no more exams until February 2009. Whohoooooooooooo!!!!!!!

Has your beard grown today?

2007-02-08T20:29:00.000Z

Today was a good day - and I can actually say that I have enjoyed the course for the first time, this week. I think this second semester has been very different to the last one and we seemed to have moved on to more clinically related stuff.

Our exam results are out next Wednesday and I think things could come crashing down. I worked hard before the exams but don't seem to have done enough during last semester. As explained in an earlier post, you can only fail one exam in the first year. If you fail more than one, you have to sit "THE QUALIFIER" which is the exam from hell, which is sat (I think) at the end of July. If you fail this, you have to sit a viva and if you fail this, things are grim. I think that if you have extenuating circumstances you may be allowed to resit the year, otherwise it is curtains.

Anyway, today we had reproduction which is taught by this amazing professor. He doesn't even look at the PowerPoint slides as he teaches and really is brilliant. He was telling us that in men, beard growth is directly in relation to testosterone levels and he mentioned an experiment that an anonymous chap did some time ago. This chap had a job where he spent a few weeks collecting specimens on an island and then came home to his missus and then went back to the island again. He must have been really bored because he decided to start measuring his beard clippings for growth every day, to see what his testosterone levels were doing.

He found that when he was on the island, his beard clippings got shorter over the first week and then (As he was preparing to come home to his wife) they got longer. Thinking about his missus raised his Testosterone levels and made his beard grow! I thought this was great! I don't live with my husband at the moment (Only at the weekends), but after eight years of marriage, I should think his beard shrivels back into his face towards the end of the week.

What's he been thinking about then!

I have been reading a brilliant blog by the Angry Medic. His posts are spot on and much easier going than mine! I sometimes hear a funeral march playing in my head when I am writing these posts so seeing a happy, young man who is also a first year medical student puts things into perspective for me. I keep going back to this point, but I would so love to have done this course at 18. I think I would have had a ball.

More good things - I dreamt about Patrick Dempsey last night. We were on holiday in Tenerife (As you do) and he was walking around in little shorts (I'm surprised I didn't wake up a bearded lady). The funniest thing was that, being the married old bugger I am, I even felt guilty in my dream. It was a very clean dream though! He just seemed to be keeping me company and bringing me cups of tea by the pool. I watched four hours of Greys anatomy last night, which must have been the culprit.

Last bit of news for today - Snoop and P Diddy are in Manchester on March 29th and I have managed to get great seats. Nice one!

Struggling to be selfish (Not me, some of my course mates)

2007-02-07T23:32:00.001Z

For the first time this week, I have spoken to four people who are thinking of thowing the towel in and leaving the medical course - I am really gutted for them. They seemed to me to be flying through and looked like they would be brilliant doctors.

In my previous post, I said that I thought that you had to be extremely selfish to do my course and i think that this might be the problem for some of them - they are struggling to be selfish. I think they are finding being an older student (With responsibilities) impossible and just don't feel like they can become as selfish as they need to. It's so difficult when you are an older person with a partner, house, children etc. You need to ignore your responsibilites a lot of the time, just to keep up with the work and I understand their problem 100%. In my past life, I spent 100's of hours educating staff on achieving work life balance and can now see that it is easier said than done when the only way of keeping up with what you have done that day is to sit down for hours and hours.

The tough reality is that my family could do with me back in Wales so that I could help sort out my dads' situation and help my mum with the dogs. Being two hours away means that my mum is having to sort out a lot more of my dad's problems than she should have to (She has been divorced from him for 18 years!) and without her doing this, I wouldn't be able to stay on the course. What makes life so much easier for me is that my husband has given me the freedom to do the course. He would have been well within his rights to kick up a massive stink, but instead, he got a job down the road and went with the flow. We are still not living together but meet up in Tescos every Wednesday night (Hilarious I know)and then see each other all weekend.

Speaking to the people who are thinking of leaving has hit a nerve with me, because I am managing to be very selfish. I feel a bit guilty tonight because although I winge like a bugger most of the time, I have not thought of leaving the course - I just live with being selfish, which perhaps doesn't make me a terribly nice person.

Hmmmmm.

All about the Benjamins?

2007-02-01T10:35:00.000Z

This week has been enough to blow my head off and splatter my frazzled brain over the ceiling.

It's our new semester and the seven new modules (Listed in last post), have already lost me. The membranes module on Monday was about "Flip Flop" (WTF?) and I learnt that lipids in a bilayer can flip flop, but proteins cannot (Please correct me if I am wrong). On Tuesday, I learnt that the chest has four pectoral muscles:

Pectoralis Major
Pectoralis Minor
Serratus Anterior
Subclavius

We have to learn the origins, insertions, blood supply, nerve supply and function for each one.

Today we have started on histology of the heart muscle and tomorrow we start reproduction (In the PowerPoint sense) On Friday we are doing something about disease mechanisms and today we went on to a ward for the first time and took a history off a patient.

That's the bugger you see - you learn so much in a week that remembering it all two weeks later is a massive problem. I am going to look for a memory textbook at the weekend to see if I can work out a strategy for learning all this stuff. I think there is a proven way of building long-term memory and I need some help. If any of you have some suggestions on how I can try to expand my brain power (Please don't suggest getting a bigger head) I would be very grateful.

I was thinking again today of why I really came into Medicine. Is it all about the Benjamin's? I have found that no one really speaks about coming into medicine for the money - it seems to be distasteful. I have to admit that, come graduation day, this is going to be me:

SHOW ME THE MONEY!!!

Yeah right - a junior doctor here is not on big bucks ( See here for our UK salary scale) but they do qualify on more money than many of my experienced nursing mates are now earning. What does cheer me up is that GPs are earning brilliant salaries, but if the Daily Mail has their way, they will have taken massive pay cuts by the time I get there.

The one thing I totally agree with is that there are easier professions to enter if money is your only goal. Even three months into the course, I can see how horrendous it can get and just doing it for the money wouldn't get you through. I have to be completely honest though - future earning potential is a large part of why I am putting myself through this purgatory.

OK, OK I might annoy people saying that and get emails saying that I should want to be a doctor so I can care for sick people and make them well. My reply to this is that if this were my only goal, I would carry on being a nurse. I would also argue that my old nursing job allowed to me to care for my patients to a far, far higher standard than I will be able to do as a doctor in the NHS. I worked as an Occupational health manager for a multi national American company, looking after 800 employees and I was fortunate enough to have the budget and time to be able to ensure that whatever they needed, they received. My patients were ruined!

I do daydream about being rich someday - on the way to Uni, I walk past some amazing houses (Oadby has some of the best I have ever seen) and they often have "MollyMaid" (Cleaning company) cars outside. I want a house and a cleaner - so shoot me! I have been in the health game for ten years and know many consultants who live in AMAZING houses, but work such long hours that they never get to see them in the light. At least their wives feel the benefit though. My husband will be more than happy to live in the executive house (With my mother, father and ten dogs in the attic) Perhaps I will become the family cash cow. I can live with that!

As a nurse, salary wise the ceiling was low and I hit it at the age of 27. At least as a doctor, there is scope for higher earnings.... I am rambling now. My last word is that there are now many nurses and physios going into medicine, but have you ever heard of a doctor coming into nursing or physio? I haven't and I am 100% sure that money plays a part in this.

I am a selfish git

2007-01-26T16:26:00.000Z

Me after my genetics exam, (On finding out we were starting the Introductory clinical course three hours later)

OMG - I am SO tired.
After two weeks and seven exams, they finally finished at 1030 yesterday with the genetics module, which was absolutely horrible. The genetics module, for me, was a murky blott on the landscape, where the module leader decided that we were not to have any proper teaching or help during the group work sessions. This led to us sitting there going around and around in circles and when someone had the cheek to complain, they were told that these complaints are the same every year and we should trust the way the module was run. This resulted in a demoralised group of students and very little learning. Why does a little voice in my head cry out "If you have had the same pissing complaints, year after year, is it not time to start bloody listening to them? What do we know eh - we are only students.

Anyway - the exam was awful, with a big Hardy Weinberg claculation at the end. Don't ask me about Hardy Weinberg (Another group session where not only did the group tutor not help, but actually told us that he did not know the answers.....GREAT! All I do know about hardy Weinberg is that it's two blokes who were kind enough to create a maths calculation so that we can work out frequency of genetic disease - really handy thing to be able to do..... Not)

I think Leicester must want blood from us as we then started the introductory clinical course at 1330! We were like a big field of cabbages sitting there reeling. The five year course don't have to do it until next year so we joined the second year and although I moaned like a bugger, I am actually quite chuffed as we are doing a course that the five year cohort will have to wait a year for - and it brings it home that this course is so much faster.

I really had my worries about the GEP. I heard some horror stories about it from other students and got worried enough to also apply for the five year course. If anyone is thinking of doing this (Applying to two courses at the same uni) get in touch as I have some views on it!

Having done three months of the course I would have to say that I think that the GEP is well worth doing. I live with three students on the five year course and there hasn't been a massive difference between the two courses so far. Basically you have no life regardless of whether you are doing it for five years or four, so why not work a little harder and get it over with! The only real difference in semester one was that we did an extra module during the week (Health Psychology) and an extra add-on module called "Health in the Community" (Not exactly an inspiring way of spending time, especially if you are over 25)

This semester, we are doing 6 modules:

Membranes and receptors
Musculo skeletal system
Reproduction
Cardiovascular
Health and society
Mechanisms of disease
There is also a clinical course (The one we stared yesterday) where we go on the ward every week and do history taking, system examination, problem solving etc.

I am SO glad that the exams are finished - the last three weeks have probably been the toughest I have ever known. What has become really clear to me is that you have to be a selfish git to study medicine. I really mean that. You have to put yourself first and blank out friends and family needs because at exam time, there is so much work that the only way of getting through is sitting in a room studying from when you get up until when you go to bed. A few people have commented that they have even felt guilty sleeping during the past few weeks. The Good news is that this only seems to happen around exams and the rest of the time, we get away with not having too much to do.

Anyway, back to being a selfish git - this has been hard for me and I am sure other mature students must feel the same way. If you are 18 with no husband, animals or homes to run, perhaps things would be easier, as you can get away with just sorting yourself out. When you have commitments, it really is hard ignoring them, but as I said, I found the only way was to blank everyone out and just be ....a selfish git!

So here I am at the end of exams with three dogs that stink (No time to clean their teeth) A deserted dad, a moaninh mum, a smelly husband (No time to remind him to wash and his knickers are all dirty because I just haven't had the time to wash them)a dirty house and an ironing basket that reaches the ceiling. In all this disarray, the new course starts Monday and the workload looks MASSIVE.

Here we go again.

Breakthrough!

2007-01-22T23:06:00.000Z

So it's Monday and we are half way through exams. I have not left my room for three weeks and have no life or thoughts other than revision, panic, revision, panic.

The good news is that I had a breakthrough at the beginning of 2007. When I look back, I realise that I felt like I have been playing at being a medical student. I have never actually felt like I deserve to be here, and have felt unlikely to make it through the first year.

My reasons for this that my dad had a massive stroke on May 17th which left him unable to speak or look after himself. He was still in hospital when I started at medical school and it was horrendously hard to concentrate and learn, when he was faced with not having anywhere to go or anyone to look after him. He moved into a rehab flat in Mid November and then the fun really started because he decided he would get regular taxis to his bungalow. I would then get phone calls to say the rehab flat workers didn't know where he was and I would end up coming home from Leicester (Two hour drive) to find him and persuade him to go back. The stress of this has been indescribable and things got worse when, on December 23rd, social services decided he had been in the rehab flat for long enough and give him 48hrs notice that he was going into a care home. Nice Christmas present.

Christmas was awful - just a constant round of trying to keep his spirits up and travelling to and from his care home.

When I visit my dad, there doesn't seem to be any sense of him being glad to see me or that he is grateful for the effort I have made. I think he is gutted that I have not dumped medical school and looked after him full time and bitter as hell that this has happened to him in the first place. My guilt of having him in a care home is constant and my only way of coping is to block it out and not think about it.

Part of me is angry at him because he has abused himself into this stroke by drinking, smoking and eating crap for the past twenty years and has let his house get into such a state that social services have now deemed it unfit for living in. The other part of me knows that his dad also had a stoke at the age of 60 and so perhaps he would have had one without the extra risk factors.

I have been dragged down by all of this - I wouldn't be human if I hadn't.

My breakthrough occurred straight after New Year when I really started hammering the revision. I realised that I could do the work and that that more than anything, I really want to do the course. All I can do is hope for the best with these exams and then start afresh next week when we start semester two.

Where has the time gone!

2006-12-31T19:18:00.000Z

Bloody hell! I finished uni on 15th December and am now 2 weeks into a four week holiday, before starting back on 15th January for two weeks of exams.

September - December was a 12 week semester, studying six modules (And some other "fascinating" extra modules) which will be examined when we go back in January. I am sitting here, completely overwhelmed with revision and wandering how on earth I can get through it all.

The situation with my dad is going from bad to worse and having this in the background makes revision so much harder, if not impossible. Having refused (He still can't speak a word, but manages to get his opinion across perfectly well) all offers of help from his social worker, the worse scenario possible happened....on the Friday of Xmas weekend, he got moved into a residential care home. He is 61 and apart from not being able to speak and walking with a stick, he is pretty much OK. In his care home there are 30 residents, all in their 80's, 90's and 100's. Most need a lot of care and this place is completely wrong for him. It is horrendous visiting him there and the stress of having a young parent in a care home is always at the back of my head. I can't believe that all of this has happened.

And so back to the revision

When I go into hospital.......

2006-11-17T21:13:00.000Z

If I ever go into hospital as a patient, I have decided that this is the dream team of people who I want to look after me. I admit that two of them are purely there for me to drool over.

I had to pick Karl Kennedy as he never leaves the hospital and Duffy and Charlie are the greatest nurses ever!

I should be looking at genetics rather than spending time doing this, but since my workload got so heavy, I love finding an excuse to not study and do anything else!

I couldn't have said it better!

2006-11-05T00:22:00.001Z

I read this post tonight from 'topher's blog at "The Rumors were true". He is a medical student in the Carribean and I had to put a link to the post here, because it is describing exactly how I feel about trying, and failing to get on top of the workload.

I love reading some of the medical student blogs and this one and "That med school guy" are brilliant. It's strange to think that students in Canada and the Carribean are having the same problems as little old me, in the Midlands!

I am happy - it's the weekend and I am being a housewife.

Then Monday will come around and the merry go round starts again!

Men I would leave my husband for....1

2006-11-02T19:56:00.000Z

I have been married for a long time and as lovely though he is, there are some men that would have me running for the hills.

Of course, these men are also unavailable, out of my league and unlikely to be interested in a little women from Wales. I have no doubt that my husband has a similar list which will contain really classy women like Jodi Marsh and Jenna Jameson.

This chap is just......beautiful!

A month in Medicine.....

2006-11-01T12:20:00.000Z

.......Or five weeks in to be exact.

This week we have studied:

mRNA transcription
enzymes
DNA mutation, damage and cancer
Child psychology
Cognitive behaviour change
Histology - connective tissues
Examining the musculo skeletal system
Cohort studies

Phew and it's only Thursday!

I continue to be shocked with the volume of work that there is. I would say that this is the first week where I feel organised and as though I am keeping on top of the work given each day. This is a BIG problem as I am now 5 weeks into an eleven-week semester. My last five weeks worth of work is unorganised and I haven't a clue when I will be able to go through it, ready for revision. I feel like it has taken me a month to settle into the course, but the shitty thing is that we are half way through our first semester and I needed to be settled in from the beginning.

The message which I so wish I had taken on board is that you need to be organised from Day 1. I am in quite a mess because of this and I can't blame it on having going out on the beer every night. I haven't been anywhere but seem to have frittered the time away.

I have settled into my hall of residence, which is brand new and fine. The downpoint is that there are 730 people here and only two mature students! I haven't found this to be a problem but other mature students might want to avoid New Hall for this very reason. Nixon Court and Opal Court have many mature students and are very near to the medical school.

To make things more complicated my husband has just got a job down the road teaching. He's in digs in Coventry and between us we are paying £650 a month in rent. It makes sense to rent a house and live here together but I am not sure if I can get out of this Hall contract. We shall see!

I think I would quite miss living in Halls though - I have gotten used to not having to be a housewife in the week - no cooking and no cleaning his knickers from Monday-Friday. The upshot of this is that I have to bloody clean them all at the weekend, but I shouldn't moan as I love it really.

I have been tagged!

2006-10-14T22:37:00.000Z

Thank you!

Charlie Brown from http://thatmedschoolguy.blogspot.com/ has tagged me.

I have to admit, I really didn't have a clue what this meant but I had a look around and it seems that I have to write down 20 things about me. I will post ten now and finish the rest off when I can. Great stuff!

1. I love hip hop music - especially Jay-Z. I am a real nerd (You can only guess how naff a white housewife from Wales looks trying to rap) and know the lyrics of most of his songs. The best thing I have heard lately was on the Radio One Westwood show on Tuesday night. It is a live piece where Tupac joined Notorious B.I.G on stage and it blew me away! I got to meet Tim Westwood last night and probably bored him senseless talking about it. All the other girls were hanging around him, trying to latch on to the aftershow party, and I just wanted to bend his ear about the music!

2. I am missing the "I want a baby" gene It has been replaced with the "I want a King Charles Spaniel" gene

3. I am developing claustrophobia and a bit of OCD. I never had this but now I do and I can't sit in the middle of rows. I have to sit on the end (Seems to work for me) I also have to keep my curtains open so I can see out of the window and make sure that my pens always have their tops on (Shit - I am scaring myself, admitting this stuff) I must be lots of fun to live with.

4. I used to be a classical ballet dancer. I danced in a group who toured around Amsterdam and when I got back home the Chinese whispers had gone around my town and I was now a stripper in the sex clubs of Amsterdam. I love this rumour!

5. I am passionate about animal welfare. I despise modern farming methods and seeing animals carted around the roads when they are being transported makes me cry.

6. I have no life since September 20th this year when I started medical school. I am drowning - the work just keeps coming and I can't get on top of it.

7. I have been married for seven years to a very nice man. He used to be a footballer and played for Wales! I am now living 140 miles apart from him which is interesting. He didn't like dogs when we met but is now as bad as me and sleeps with our dogs between his legs, on his head and on his pillow.

8. I am a terrible cynic.

9. I despise bad manners, like when you hold a door open and they don't say thanks, or when you let a car pull out in front of you and they don't acknowledge it.

10. This is getting hard!

Studying at medical school

2006-10-09T18:32:00.000Z

Hells Bells.

There really is a lot of work to get through and to learn. Where does one begin?!

I think for UK students, having A levels in Biology and Chemistry is a great (Perhaps vital) starting point for my course. My graduate group have mostly worked for the past few years and so although we have covered these subjects, the details can be rusty. I am quite lucky because I have spent the past three years studying chemistry to A level and I had the best teacher in the world (Brian Jones, I salute you!)

Each day, the five year students do one module in the morning, and the four year group do that, and an extra one in the afternoon. I have had an email off a fellow nurse asking about my timetable, so here it is:

Monday a.m Biological Molecules
Tuesday a.m Genetics and the basis of disease
p.m Health Psychology
Wed a.m Health and disease in populations (Epidemiology)
Thurs a.m Tissues of the body (Histology)
Friday a.m Metabolism

As well as this the four year course (GEP) have a clinical skills module. We started this last week (On our first day!) when a SHO came to show us how to do cardiovascular examination. This will be built on during the next four years. We also have other things like communication skills and multi-disciplinary team (MDT) skills. The latter went down like a lead balloon with many of us on the GEP. Having spent the last eleven years working in a MDT I would rather not have to do this, and could use the time trying to get my head around genetics. But there you go - I can't complain too loudly because this is the only problem I have with my course and I can't exactly roll up to the tutors’ door and say, "You can bugger orf. I am not coming to your MDT skills lectures because I am ahem......an expert" I am not an expert at MDT working, but I have done it to death and don't feel that this module will make me any more of an expert than I currently am. So there!

So that's basically what we have to do over the next eleven weeks. We then have four weeks off at Christmas, which will be taken up with revision, as our exams are first week back. We have exams on all the listed modules and have to pass the lots of them. Nice!

With all these modules, my innate worry is where do I bloody start? The uni boffins have told us that we can't learn it all and so have to form "structures" in our minds which we can "hang" our knowledge on. They mean that we have to understand what we are doing (Too much to learn, parrot fashion) and try to keep relating things to the bigger picture. Clear as mud then. I have read an excellent posting from "The haversian canal" on learning at medical school:

http://nielsolson.us/archives/2006/03/recent_thoughts_on_medical_education.php

This nice chap writes really well about learning at medical school and also wears a Navy lieutenant uniform, which is never a bad thing.

I have also taken heed of poor Charlie Brown at
http://thatmedschoolguy.blogspot.com/

He is a little further into his first months at medical school than me and is very stressed. His advice is to revise, revise, revise. Not sitting here writing my blog then!

This post is a bit long so I will go. I have to end by telling you about my Jay-Z experience. I LOVE Jay-Z and have seen every live show he has done in the UK over the past five years. I paid ....a.....fortune....on ebay for front row seats at Wembley. Like a weeks wages (In the good old days, when I worked for a living) All I can bear to say is that I got stuck in a 5 hour traffic jam (At the M5 at 1900 on a Sunday night - where the hell where you all going?) and got there for the last 10 minutes. This brings tears to my eyes. See how close we were:

I just about had time to take this photo and then he went. I can't put into words how gutted I am.

Half way though first week at medical school

2006-10-04T16:23:00.000Z

Today was a good day! We had histology this morning followed by dissection and then cardio vascular examination this afternoon.

The histology was great - we looked at epithelial cells and the way the day was laid out was really well planned. We had a lecture first on the basics of simple and stratified epithelia. We then went into the dissection room (DR) and looked at bodily structures and epithelial linings.

I haven't mentioned the DR in my last two posts because I am a bit worried about how much I can say without causing trouble. I have to mention it though, because it is so integral to what we are doing. These words obviously represent my thoughts and not those of the university (Sorry about the formalities, but I know this is a sensitive area)

The dissection room is a strange place to be. Ours is superbly set up and in a big hall with around 40 Cadavers in there. We were introduced to it last week and despite eleven years of nursing, the shock factor for me was big.

It just seems so strange to walk into a room where there are so many dead people. We were in groups of around 15 people and our demonstrator peeled back the sheet.... and there was our body. I am not sure if ours was a man or a women because we could only see from the chest up. I didn't pass out or anything like that but just felt very odd and a bit sad. We had been given an intro to the DR during intro week and apparently, dissection is becoming less and less common in UK medical schools because of the huge cost associated with it and also because less people are donating their bodies. I wander whether Gunther von Hagens has a lot to do with this.

We Will Cut you up in front of a live studio audience!

For me personally, I think it will be of massive value to be able to see structures and where everything fits in. One of the speakers last week (A professor of surgery) said that he has found anatomy to be lacking in many junior doctors and my medical school seem very focused on ensuring we know our stuff. Once I get over the queasy feeling in my stomach, I will love it!

During histology today, we looked at a human head and I was very, very unnerved. I tried to concentrate on the tissues we were supposed to be looking at, but I couldn't help looking around to see if anyone else was thinking "Shit - This is someone's head!" I couldn't help thinking that this was someone (Again, not sure if was a male or a female head - I am going to make a fantastic doctor) who had perhaps been speaking to their family a few weeks or months ago, or walking down the street. Very strange experience.

Phase One - week one! Thought of the day.....90% of our DNA matches that of a banana!

2006-10-03T21:48:00.000Z

Bloody hell! It is day two of the course and there is so much work to do already.

Yesterday we had two modules: Biological molecules in the morning and clinical skills in the afternoon. Both were very good and I am SO glad that I have just done the years of chemistry, because I would absolutely have a real struggle on my hands without it. We never did any chemistry as a student nurse and in one three hour session yesterday, we touched on loads of principles from the AS chemistry course.

First note to any nurses thinking of doing medicine = go and do a chemistry course - I would recommend AS level at least .

The clinical skills session was on examination of the cardio vascular system and was an introduction to basic clinical skills - all good stuff. My nursing covered perhaps 50% of it but there was plenty of new stuff such as listening to the apex beat and other heart sounds that will be completely new to me.

Day two, we had genetics all morning and Health Psychology all afternoon. The genetics is going to be, erm.. challenging to me because it is all new, but the psychology was pretty much what I have spent the past ten years doing.

I am living in a really nice hall which is 100% improvement on last week. It is small but clean and now i have my internet and TV set up, I am fine. It is costing me around £3700 per year which includes food.

I am not as homesick this week but still feel like I have wandered in to an 18-30 holiday and am waiting to go back home and get back to normal. It is only today that I am starting to feel like a medical student - last week I felt like an intruder who had crept in to the back of class. It is a massive, massive change for me and I am giving myself time to settle down. The one thing that is crystal clear is that the pace of work is so fast that I need to work for a good few hours each night, right from the beginning. I remember starting my nurse course and having to give a 2,000 word essay in after three months on the course. With this course, I have at least 6 exams in 12 weeks time and need to pass all (They only allow you to fail one module in the whole year in order to go to year two. If you fail more than one module, you have to sit a qualifying exam in the summer which looks horrendously stressful)

Induction week at medical school

2006-10-03T21:12:00.001Z

Many apologies for the lack of posts but I have not had an internet connection until now. I haven't spent the whole week sozzled - honest!

Well - I am finally here. I really never thought that I would make it, but I did and here I am in D halls on my induction week. The medical students arrived on Sunday and are all staying in halls so we can "Bond" .There are around 270 five year students and 60 of us older, graduate students. The week has been very well organised with daily "Welcome" lectures, uni familiarisation and nightly organised socials in the town centre.

I have found this week very, very hard. As an older student, I suppose that I am stuck in my ways and I have given up an awful lot to come here.

When I arrived in my room in D Hall on Sunday, my heart sank. What a dive! My room had disgusting brown dirty carpet tiles which had lots of silverfish crawling in them and squashed mosquitoes on the walls. I could see the mattress springs though the sheets and when I got in bed, the mattress was so saggy that I had to sleep in a boomerang shape. The others on my corridor thought it was fine to come in at 1,2 and 3 am and shout as loud as they could.....Ok you get the idea - I hated the place!

I wanna go HOME!!!

As well as the accommodation, I found it very overwhelming being around so many new people, although they all seem a nice bunch. I have never, in my life, been homesick and thought that I was much too old for that kind of thing now, but I have missed my old life and just wanted to come home, put my uniform on and go to my nice normal job with people I know and then come home to my nice house and eat nice food with my nice husband!
I suppose the good thing with being a bit older is that I know I am likely to be much happier next week when I move into my proper accommodation and get started on the course. What I can safely say is that the medical school seems excellent and the four years are likely to be quite a slog!

Must have been a lack of competition

2006-09-15T07:50:00.000Z

Well bugger me! I got the job.

I checked my mobile yesterday and realised that the nice lady who interviewed me had left a message a few hours after I left. This message had been there for two days (More cringing) so I don't know what they must think of me.

Of course, I now can't imagine how I am going to manage it because I have also agreed to do some hours in the tampon factory too (I don't actually make the tampons, I help to look after the people that do) and also to do a few hours a week in my lovely welding factory (Demoted to doing the filing, in a room with no windows)

Am still very calm and wandering why I am not hysterical and running around the factory, beating my chest in anguish. Still time though.......

I start on the medicine course in four days time and from them on this blog is going to be a barrel of laughs as I winge and moan my way though the course. With this in mind, I am going to tell you a bit about myself so if you are not interested, come back next week and I promise the posts will then be about life at medical school.

I have realised that in my last post, I placed my husband under my dogs in my list of important things. This is not good, but can you blame me - look at them:

Kings Charles Cavaliers come in four shades and I have three of them. I really want the fourth (A Blenheim) but my husband has banned me (He is far enough down my list as it is)

We have had cavaliers since I was five years old and I love them so much that every time one has died, we have been so cut up that we have sworn never to have another one again. Then a few weeks have gone by and we have gotten so depressed that we have gone out and bought another one. I lost my last two from heart failure (Very close to each other) seven years ago and three weeks later we ended up buying three more. My husband was never a dog person but is now just as bad as me and I can safely say that we have the three happiest dogs I have ever met. They are our babies and are clever enough to realise that if real babies were to come along their reign would end. To ensure that this never happens, they like to come to bed and three dogs and two people do not, a happy bed, make.

We alternate through the night between two beds, trying to get away from them, but they are never far behind - Victoria would be horrified

A Strange Week......

2006-09-13T17:42:00.000Z

This is my last full week of work and it feels very strange. I am one of those boring people who hates trying new things and loves routine and I have got up the same time, gone to the same job and got home the same time every working day for ten years. Although my title still has the word "Nurse" in it somewhere, my job is office based in a large manufacturing mill which makes toilet rolls and tampons (Rock and Roll)

My new life is going to be a challenge (Hmmm - Understatement) and I just can't imagine not having to go to my two jobs anymore. In fact, I would have thought that I would be a hysterical wreck this week, but I have been strangely calm. I think this is denial! Wait for the weeping, wailing post next week.

GOODBYE OFFICE MATES!

I have told very few people that I am leaving so I'm happily wandering along telling everyone that I will see them next week. My reasons for not telling people is the denial thing but also that I am worried about what people will think of me. I have this horrible feeling that I am not going to belong anywhere - the nurses will think I have decided I am too good for nursing (Absolutely untrue) and the doctors will think I am this nurse who has ideas above her station. I also think that what I am doing is quite unusual ( I don't know any nurses who became doctors) and so as people are finding out, I am finding that they all have a viewpoint. I have so many doubts about what I am doing (Leaving my sick dad, dogs, husband, secure job) that I don't need to hear anyone else's doubts. Phew - getting a bit deep and meaningful there!

On a lighter note, I am looking for a little job to help out the money side of things and went for an interview yesterday with a local GP "Out of hours" centre. WHAT A NIGHTMARE! I got lost and so arrived a little late. As soon as I arrived, they gave me a card and told me to sit down for ten minutes and read it through. The card read:

"Mr Jones 72 rings you up at 1145 on a Friday night to say he has had abdo pain for 72 hours which is now getting worse"

What clinical history would you take?
What treatment would you recommend i.e. Does he need to be seen?

Looking at this now, it looks very straightforward but after trawling in my car for an hour and a half, my head was spinning. My first thought was "They think I am coming for the doctors job, not the nurses job" My second was to bolt for the door but it had a keypad lock on it so there was no escaping! (I had an Ally McBeal moment, imagining me smashing the door down with a fire extinguisher)

You know sometimes when you have had a cringeworthy experience and you get flashes of what you said, coming back over the next few days? That is where I am at now. I absolutely sucked!

They asked me what my differential diagnosis would be (I bit my lip to stop myself from saying that I would ask the nearest doctor) They then asked me what I knew about the medical centre where I wanted to work - which is called "Flintdoc". I had not done my homework and so actually knew very little apart from that this was where you telephoned when your GP had gone home for the day. Instead of smiling sweetly and admitting this, I came up with the answer of all answers....."The centre supports the community of Flint" CRINGE.....

What should a mature medical student worry about? Bloody everything!

2006-09-07T17:49:00.000Z

I am worrying about everything this week. My top ten worries are:

Where is the money going to come from?
Am I mad, leaving my jobs? (Will I regret giving them up and leaving my lovely boss?)
Will my husband be able to put up with my new life? I am going to be away for at least three nights a week.
Where is the money going to come from?
Am I clever enough to do this course? (I am not a boffin)
Will my dad be OK? (See earlier posts)
Will I hate living in halls of residence and find it hard to live with 17yr olds?
Will I be accepted by doctors? (I have already had some comments from doctors along the lines of "GEP medicine isn't as rigorous as normal medicine" "The training isn't what it used to be" "You must be bloody mad - go and be a dentist" and the comment of all comments from a consultant who has worked with me for ten years....."Aren't you a bit thick to be going into medicine?" Cheers mate!
Will nurses hate me? I worry about this so much that I have hardly told a soul that I am going to do medicine!
Where is the money going to come from?!!

"We used to have a doctor, but now the Nurse IS the doctor!"

2006-09-03T16:42:00.000Z

Occupational health is a lovely area to work in.

At least it used to be in the old days when nurses did their work and doctors did theirs. Somewhere along the way, the managers realised that OH nurses could do much more of the doctor's role than they had previously realised.

I remember one of my first jobs in 1996 in Bromborough. I was sent to do a days work performing lung function tests on employees exposed to flour dust. When I arrived, a lovely old GP (He was 76 years old) met me and had a bit of a moan that I hadn't got there a bit earlier so that I could make him a cup of tea before the patients arrived.

As the day progressed I did the lung function tests and sent the employees through to the doctor with the results. I wasn't allowed to interpret the results (God forbid that a nurse could do this!)

Ok...I know this is very old fashioned and that most of the employees did not need to see the doc with their lung function results. Around 90% of them were normal and I could have dealt with these perfectly well. However, the employees went back to work pleased as punch that they had seen a doc and the managers were happy that their money had been well spent.

Fast forward 10 years and we have gone from one extreme to the other. I did a shift in the Midlands a few weeks ago. When I arrived I was given a list of people on sickness absence to contact. I called them at home and spent a long time on the phone with each of them. Many had complex illnesses, the details of which I struggled with. I had to use the Internet to look some of the details up whilst I was on the phone to the employees so as not to sound as though I didn't have a clue, and to be able to advise whether the new drugs they had been prescribed would render them unable to drive and affect their ability to do their job.

By the end of the day, the managers wanted a report from me, detailing how long these people were going to be off, if they were likely to come under the DDA etc:

I found this difficult because in my other jobs, this is the doctors’ role, not mine. As a nurse I was never taught these disease processes in such depth as to be able to now estimate likely times of recovery. I am good at my job - I have a degree in OH nursing and eleven years full time experience, but I have always worked with a doctor. I asked the company if they had a doctor and they looked blank and said that they used to have a doctor, but "The nurse is now the doctor"

I am lucky in that I have worked with an excellent OH consultant during the past ten years and when I was writing my reports to the managers, I visualised what he would have said in the same situation. I managed to complete the reports and did a reasonably good job. The off shoot of this is that the penny pinching managers have won! They saved hundreds of pounds by using me rather than a doc and I was stupid enough to do the work that they wanted to a good enough standard for what they needed. I should have looked at them like they had two heads and said "Actually mate, this is the docs job"

I know that many of my OH colleagues would criticize my views on this, but I am appalled that we are now doing the doctor's jobs. If for one minute I thought that we were being given these new roles because they thought we were an amazing group of nurses I would perhaps put a sock in it, but lets be honest here - IT'S ALL ABOUT MONEY!!

I cost £25 per hour. The doc costs £150 per hour. Easy maths. I agree that we can do much of the OH role but I also know where my competency ends and when to look to a doctor for advice.

My big worry is that when I have qualified as a doctor, I might well want to come back to occupational health. By then though, there is a good chance that all the docs will have been replaced by nurses.

I'm back!

2006-08-31T17:53:00.001Z

It's been a strange few months and I managed to lose all of my access details to here, so have not been able to get on to my blog.

I am starting medicine in three weeks time - it definitely has not sank in. I gave my notice in to work last week and the girl who is taking over my job has given her notice in too, so there is no going back for me. If the other nurse had not given her notice in, I know 100% that i would have changed my mind this week - I am so worried that I am doing the wrong thing. I earn good money and work part time days - I LOVE my job and am giving it up to go and sell my soul to the NHS. I think I am mad at the moment - absolutely mad. I am trying to cheer myself up by buying a pink stethoscope - it's not working though!

I have been reading an excellent blog from http://thatmedschoolguy.blogspot.com/2006/08/orientation-day-5-6.html

Jason has just started med school in canada and is making some great comments about his first days. I am going to do the same thing and hopefully this blog will be useful for would be medics who want to know what they are letting themselves in for.

It is 13 weeks now since my 60 yr old dad had his stroke. He is walking with a stick but still has no use in his right arm and no ability to speak. It is saddest thing I have seen and I don't think he will ever be able to speak again. He is limping up and down, wandering why people aren't able to understand him. It breaks my heart and I am sure you can understand the guilt i have, flying off to do medicine when he is going to be heading for warden controlled accomodation.

Oh bugger - this is turning into another depressed post - please bear with me as i promise to get happier

Doing medicine as an oldie

2006-06-06T10:19:00.000Z

For the first time, I have butterlies in my stomach today! I am excited about having the chance to go to do medicine. I have my fingers crossed that things will work out with my dad and am going to keep planning with a view to being able to take my place in September.

Money is a big factor - have been looking at a professional studies loan from the HSBC so that I can pay off my debts before starting. These loans allow you to defer payments until back in the world of work but the cost is massive. If you borrow the maximum of £25,000, the repayments work out around 400 per month for eight years. Scary!

I have had a few emails from people who have read my blog (It's a nice feeling to think that someone would want to plough through these posts) asking how an oldie gets into medicine. If any of you have been watching the recent ITV programme "Vital Signs", you will be under the assumption that one day you can wake up, decide to be a doctor, walk into the nearest medical school and ask for a place!

Hmmmmm.....today I am going to be a doctor!

If only this were the case.....getting into medicine as an oldie in a labour of love and much jumping through hoops is needed, although there certainly more opportunites than there were ten years ago. I qualified as a nurse in the mid nineties and went to Kings College to complete my nursing degree. One day, I knocked on the dean's door to speak to him about becoming a medical student. He laughed at me - no joke! His words were along the line that in his experience, nurses struggled to do medicine and so he would not be happy to consider me (He was eating an egg sandwich as he said this and at one point he spat some egg onto my sleeve)
I remember walking out feeling like shite on his shoe and pretty much come back to Wales with my tail between my legs.

Anyway, then it was unusual for schools to look at non-traditional students but now things have changed. There are opportunites for older students from non-traditional backgrounds, but the competition is fierce. I found out most of my information on two helpful internet forums:

http://www.admissionsforum.co.uk/

http://www.newmediamedicine.com/forum/

There are two options for the oldie wanting to study medicine:

Applying to medical school for a traditional five year course (Will need A Levels or degree or access course)
Applying to one of the newer Graduate entry programmes (GEPs) A 2:1 degree is normally needed, unless it is one of the schools that use the dreaded GAMSAT test - you can apply for these schools with a 2:2. Georges and Notts use GAMSAT - not sure if any others do

Both of these courses have the same outcome, but GEPs attract an NHS bursary in years 2,3 and 4 and allow you to start work as a doctor a year earlier. For a traditional five year course, graduates will not be able to get a student loan to cover course fees and so will need to find £3000 each year from 1-4, and then an NHS bursary in year 5.

Either way, a massive amount of debt seems to be the only way of getting through medical school as an oldie!

Fluid Balance charts

2006-06-05T07:53:00.000Z

Back to my dad.

His swallow has been assessed (After ten days in hospital, where he had been drinking normal fluids) and they have decided that he should drink "thickened fluids" as he does not have a cough reflex. This means that if fluid starts going down "The wrong way" i.e. into the trachea, he will not cough and so he could aspirate (The fluid go into the lungs, with chance of causing pneumonia) :

"The cough reflex is a protective physiological mechanism that defends against aspiration of harmful substances into the respiratory tree." The stroke association

On hearing this, I gave him a drink of tea, with a teaspoon of "Thick and easy" in it and he looked at me as if another head had sprouted out of my neck. Thickened fluids are pretty grim things. They are so grim that he has stopped drinking them and so the nurses have had to get a venflon re-sited and put him on IV fluids. When a patient is on these, they need to have a fluid balance chart to record what is being put in and what is coming out. If nursing care is at a good standard and the charts are filled in correctly, they are a great help.

The problem is that the charts are not being filled in. For the past four nights, my mother and I have given him drinks and filled the charts in accordingly. My mother (Ex nurse of 27 years) and myself are the only ones filling them in. The nurses are not recording things going in or things coming out.

This is so hard to deal with: My father is likely to be on this ward for a long time and antagonising the ward staff is not a good way to go, but filling in fluid balance charts is just such a basic, basic task of nursing care. As they are empty of information, it is assumed that he is not drinking. My mother and I know that he is drinking, but as long as the charts are empty, he will remain on IV fluids.

Breaking bad news

2006-05-31T07:57:00.000Z

Bugger. Bugger. Bugger.
I am so annoyed with myself.

My dad has been in hospital for two weeks, following a dense stroke. The way I found out about
this was horrible.

On the 19th May, I was on a phlebotomomy course at my local hospital which is 10 minutes away from home and 5 minutes away from my mums house. My mum was on holiday so i decided to walk the three dogs around to her house so that I could go there at lunch time and walk them around the block. When I got there at lunch time, I had a look through all of the post which had mounted up in the hall. There was a postcard there from my dad's brother which said "Charlie is on trumpton ward - cerebral haemorrage"

When I read this, the world froze and stood still for a while. My dad is extremely fit and 59 years old. I couldn't comprehend what was written, so I telephoned the ward. The conversation I had with the ward "Nurse" who answered will stay with me forever as a shining example of how not to communicate. I explained about the postcard and got silence in reply. I asked what had happened to my dad (I do nurse-bank work in the casualty department next door to this ward and they do know me as an associate). She replied that she was unable to tell me (Fair enough but not particularly good when your world is crumbling) so I said "It says here that my dad has had a brain haemorrage, is this what has happened?" I could actually hear the snigger in her voice as she said "Something like that, you will have to come to the ward"

So go the ward I did.....another nurse met me and I explained the postcard story. She told me that my dad had had a really bad stroke and could I go and sit in the corridor whilst she was doing the ward handover? I sat in the corridor for 40 minutes. I just wanted to see my dad (The last time I has seen him, three weeks before he was roofing a house, moaning and smoking).

Having been a nurse for ten years I understand the way that wards work, but now on the other side for the first time I understood what people go through when someone close to them becomes ill. I got quite angry at this point and all but barged into the ward to see him.

For a few days after, the shock of how I had found out about his stroke really haunted me. It is two weeks later now and the shock has passed, but I promised myself that I would remember how bad I felt and try harder to empathise when dealing with relatives who are going through this.

So what did i do this morning? I really buggered things up. My mum rang from Heathrow to say she was back from holiday and waiting for a flight to Manchester. What did i do? I told her about my dad's stroke. It just came out and I never expected that she would get so upset. Even after the experience that I had, I ignored the shock factor and told her. What a stupid thing to have done when she is stuck away from home. I just can't believe how stupid I have been. So now, she will be upset all the way home and her friends will be annoyed at how cruel I was to tell her over the phone when she is away.

My mum and dad were married for 25 years and divorced about 18 years ago, but have always stayed in touch. I wouldn't describe them as friends really, just people who have known each other most of their lives and have no reason not to stay in touch.

I will try to finsh work early today and go home to see her. I will make myself remember how hard the past two weeks have been for me and remember that she too is going to have a rough time whilst the impact of what has happened sinks in.

I don't know why I am writing all of this down. Perhaps it should feel cathartic - it is upsetting to write and if I am honest, I don' t think that I will want to read about this dark time in the future.

If anyone is reading this though and you have a mum and dad who are fit and well and going about their mundane, normal daily business, take a few minutes out to chat to them today.

I would give anything now to be able to call my dad and have a normal, everyday chat with him.

Where should a mature medical student live!

2006-05-28T22:17:00.001Z

If you have read my other entries you will realise the impact that my dad's stroke is having on me. However, I am going to carry on with my plans to go to medical school in September, in case he makes a good recovery.

The big issue for me at the moment is where I should live when i start the medical course. The uni halls seem to be nice enough places but the catered halls will mean me living amonst 17yr olds away from home for the first time. I have visions of me trying to sleep whilst they all do the conga past my room at 3am every night.

Self catered halls might be better perhaps. My other option is to be a sub warden in the halls - I figure that then if they try to conga past my room, I can at least put my "Old responsible" head on and stop their nocturnal fun! If I do the warden job, I get free accomodation which will save me £4000 a year. Not to be sniffed at. For a look at the true horrors of young lads living in halls have a look at:
http://www.wacktopia.com/bigandclever.php

I especially like the bit "Every now and then we'd get a visit from our local sub-warden, a thirty year old irish tw*t who would patronisingly tell us that "I know its your first time away from home lads but try to keep the noise down a bit and stop setting fire to people's hair" or something like that whilst pasting up "Wacky Generic Student Drinking Night" posters"

Hmmmm.

another day in the sideward

2006-05-26T20:01:00.000Z

OK - so this Blog is supossed to be about my journey from nurse to doctor, but my fathers' stroke (see last entry) has put medicine into the background.

I think I have learnt more about basic nursing care this week than in all my years of nursing. I am a big fan of Dr Crippen's blog, http://nhsblogdoc.blogspot.com/ and having seen the lack of basic care given to my father this week, I absolutely 100% agree with Dr Crippen's call for a return to good nursing skills.

My dad is on in a stroke rehab unit. The one thing that has surprised me this week is that although I am sure it is hectic in the morning, the rest of the day seems to follow a nice steady pace. There are always nurses at the nursing station and my hours of watching have convinced me that although heavy, it looks a nice place to work.

This is why I have been surprised at the lack of care. Each night when I have arrived, my dad has been wearing food stained clothes with a bulging catheter bag and sitting with his bare feet on the floor. In front of him, every night has been a cup of congealed cold tea. My dad has never been the fussiest of people and won't give a hoot that he has liquidised cauliflower down his front, but he looks uncared for.

I certainly don't mean this to turn into a moany blog, but as a nurse I can clearly see what is lacking.

What a cruel world

2006-05-25T13:25:00.000Z

My father had a stroke last Wednesday. He is only 59 years old and has worked as a joiner since the age of 16. The risk factors for him were present - long term smoker, heavy drinker and father dying of a CVA when he too was 59. I spend my working life doing lifestyle councilling - testing cholesterol, blood pressure and lecturing men about reducing their risk factors for CHD. Ironic really - my dad told me to bugger off when I tried to lecture him about smoking and drinking. Ten days ago he was tiling a roof, whinging about Tony Blair. Now he is alone in a side ward, unable to speak with no movement down his right side. What a cruel world.

I'm finding it very strange to be on the other side, watching the nursing and medical care. I visited him at 1800 last night to find him sitting in his little room staring at the wall. The nurses had kindly closed his door and shut the curtains, so the only stimulation for this youngish (To me) man was a magnolia wall. Having been a joiner all his life, my dad would be sitting there studying the door hinges, wandering how on earth he had gone from roofing a house to sitting in a chair, dependant on the nurses for everything.

Despite ten years nursing, I don't know much about strokes. I work in non clinical occupational health and have been away from the NHS for many years. From what I understand, he could recover some speech (I would give up all of my teeth if I thought this would help him).

I made the mistake of reading up on his condition on the internet. I read that for every three people who have a stroke, one will be dead within the year, one will recover fully and the other will recover with some disability. Looks like a lottery to me - he has as much chance of being back on his roof in 12 months as he does not being here at all.

Personally, this has massive impact. I think there is a big chance he is going to need care and there is no-one but me available to give it to him. How can I let a 59 year old man go into a nursing home? Perhaps the medicine will have to stay on the backburner. It is early days though - fingers crossed he makes a good recovery.

The first entry

2006-05-25T12:48:00.001Z

Hello
I am Anna, a 32 year specialist nurse practitioner. I qualified as a nurse in 1995, as a product of "Project 2000" nurse training (Which was so wonderful that it was promply dropped when they realised that a student could be 18months into their training without having seen a single patient)

I am an avid reader of blogs - and always planned to do my own, so here I am.

Ten minutes into my nursing course, I realised that I wanted to do medicine. I can't put my finger on why I wanted to do this, it was just a strong feeling that came to me as soon as I began nurse training. At school, I was pretty ropey and excelled in drama and home economics - hardly an ideal route into medicine. No-one really aimed as high as medicine in my social group, and we weren't encouraged to look at this option.

Although I realised that i wanted to do medicine in 1995, it has taken me 11 years to get to the point that I am at today. Here I am after all this time with my degree in specialist nursing and three years of chemistry (A complete slog) behind me. I have an unconditional offer to go on a GEP in the Midlands. How fanstastic!

I am going to use this blog to explain the transition that I go through, from a nursing sister with ten years experience, through medical school. The course does not start until September, so I am going to use the remaining time to describe how I am going to get to medical school as a mature student!