Dr Gregory....I did it!

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

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!

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

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

....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......

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

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

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!