Still Alive! Happy New Year!

Wow these last 2 months have been a whirlwind hence I haven't had time to make a post (apologies!). Essentially just wanted to check-in and wish everyone a Happy New Year. 2013 for me has been a whistle-stop tour. I've made many accomplishments and is certainly another memorable year. Some highlights:

• Presenting a poster at a national conference
• Meeting new people
• Going back home for my elective 
• Commencing another research project (fairly large one too)!
• Applying for my first proper job!
• Learning more skills (medical and surgical)
• Being happy :)

This year had blown by and it has essentially been a year where I had to gain even more confidence especially knowing next year, I will be given responsibilities (no more fooling around!). This second half of the year was just hectic. The minute I came back from elective, it was just non-stop meeting deadlines and never-ending work. Even now I'm supposed to be busy as I've got my first set of final exams in a few days (cruel). I despise revising through the holidays...it's very depressing. 

Anyways better get back to revising. I'll hopefully get some free time soon and be able to write an entry about the job application process and what that was like. 

Wishing you all a Happy New Year. I know for sure it'll be a big and very important year for me. Bring on 2014!

Radiology: Dark Room - Perfect for Snoozing.

So I had my attachment in Radiology. I was a bit hesitant about it, as I'm not great at sitting still, though I was excited to actually be taught how to read X-rays, CT/MRI scans and maybe see a bit of intervention radiology done. As expected first day I was sat in a dark room in front of a computer screen with a radiologist. Had great teaching on how to read chest x-rays, but eventually it got a bit boring and repetitive. Eventually I found myself zoning out, but luckily the radiologist had to go to a meeting so allowed me to go home. Thought to myself: "Jeez how am I going to survive a full day tomorrow in a dark room?"

Next day, same thing in a dark room, but smaller room...which was fairly stuffy and warm. Perfect environment for a snooze. This time we were going through MRI scans of the head. Complicated, but interesting. Had a bit of a late night the day before trying to do job applications, so I found it hard to wake up. Eventually again, found myself drifting off. I was sat behind the radiologist and because he had quite a long list of things to do, he would go back into his own world and dictate a report. While he does that, I felt my eyes getting heavier...and let's say at one point I nearly fell off my chair. Then off to ultrasound in the afternoon. I followed the sonographer, and again they work in a dark room. It was fairly straight forward, except at least there's a little bit of patient contact. Despite this, found myself falling off the high chairs while trying to focus on the screen.  I think it didn't help that I didn't get any hands-on as this attachment was more just to get a feel for the specialty.

So this dark room saga and me dozing off continued for a few days. I guess I didn't learn as much as I had hoped. I think with radiology, it is one specialty where you just need to sit down with a book of examples and go through them at your own pace. It is nice to have someone there pointing stuff out, but I found that the radiologists does them really quickly as they're well-experienced, but for an untrained eye like mine...I really need to sit there and admire the abnormality and compare it with "normal".

Really not that exciting of a week. Starting another specialty next week...by the looks of it, it isn't that exciting. I do have Orthopaedics coming up in a few weeks so definitely looking forward to that. It's been awhile since I've been in theatres (since electives) and it'll be nice to be back in there!

I'm Baaack!

Shocker - I'm back! Most of you probably thought I fell off the planet or medical school had simply killed me. Actually what had happened is that after my placements in May I had left for my medical elective for 2 months. I went back to Canada to do my medical elective in..........you guessed it: Orthopaedics. It was tough - and that's putting it lightly. I have not worked as hard as I had during my medical elective than any of my last 4 years at medical school. So once I got back I was seriously burnt out while my friends were burnt from their lovely sun filled elective in the beautiful/tropic parts of the world such as: Thailand, Vietnam, Fiji...I am feeling my blood pressure go up again. To put it in even more simple terms - I was miserable during my elective and very jealous of my friends who had a tropical and fun-filled elective to discover themselves.

Why was my elective so tough?

Well North American medical school will always have its stereotype to uphold. My mornings started at 6:30 am and my day didn't end until 6pm and that's me sneaking off early. Despite being a visiting elective student I was expected to still do 24 hour on-calls. Yes there were a few days especially in the first 2 weeks where I wanted to go and hide in a corner and cry. I've never been told off so much in medical school as much as I had during my first 4 week rotation. Apologies I have to leave out details as it will make me very easily identifiable if I start specifying EXACTLY what sub-specialty I was doing. I remember telling my parents several times I would quit. I nearly walked out of clinic many times. I walked out of the operating room once after being unfairly treated. This elective definitely pushed my limits to the max. When I reached my 2nd rotation of 4 weeks - I was back in my comfort zone. Let's say the first 4 weeks was a very steep learning curve and one I hope to never go through again. Looking back at it, I'm glad I got my ass-whipped as not only did I never work so hard before, but I have never learnt so much before in such a short amount of time. I had to gain A LOT of self-confidence and was pushed to the deep end of the pool during my elective and I'm glad the consultant pushed me that hard. I would have never learned...but with that, I sacrificed the enjoyment of the elective. I guess it's a fine balance.

When I returned to the UK I was just so burnt out. I didn't get much of a summer holiday. I was back to placements and well let's just say placement seemed extremely SLOW compared to Canada. I had a hard time adjusting back and consultants thought I was overly too proactive. It's a very different system here in the UK. In Canada I felt like I had to fight for my learning opportunities and I learned by falling flat on my face a million times. In the UK, we are spoon-fed our learning opportunities. There isn't a huge competition atmosphere in the UK. I was with other medical students in Canada and I found myself fighting to get to scrub in and fighting to see patients. As a student in the UK I feel like sometimes we take it for granted the amount of learning opportunities we get. Anyways there isn't much to talk about my elective. If I had to sum it up in one sentence it would go like this: Worked my ass off, but came out more mature and wiser and perhaps a hell lot more worn out. To be honest I still don't know what to think of my elective. Don't get me wrong, I was lucky to have got an elective in Canada in a major city in a very popular specialty, so I don't regret it at all.

Hopefully I'll start updating a bit more, however, final exams are coming up so I am a lot busier than usual now. Currently doing my General Practice rotation so who knows maybe I'll find time. Sorry again for the lack of updates...just had a rough few months.

Urology - Week 1

Sorry for the lack of updates. The weird thing with this rotation is that I'm running through all the other specialities: ENT, Ophthalmology, Urology, Haematology, Dermatology, and Oncology. I only get either 1 or 2 weeks in each specialty. You can imagine I only get a quick glimpse of everything and so far nothing interesting has happened.

Because I am now on Urology and have got 2 weeks here, I thought it would be worth doing a bit of an update. So we were inducted into the specialty on the Monday and were pretty much scared stiff. The urology department at our hospital is an academic department as well so they have academic ward rounds and really encourage full participation from students. You will probably wonder: "So what's wrong with that? That's great isn't it?" Well yes, that's great as we get loads of teaching, but that means we got to work twice as hard as we are expected to do presentations. I don't mind working hard, it's just our presentations have to  be a case study on an inaptient. With how our schedules are, we don't have much time on the wards as we are timetabled to be in clinics/theatre. We were also told that consultants expect us all to be prepared for clinics/theatre and expect us to do our reading beforehand.

Biggest heart sinker? On theatre days we are expected to go to Theatre Admissions Unit (TAU) at 7:30am to get a brief patient history for all the patients on the list and be prepared to tell the surgeon all about the patient in theatre. Don't get me wrong, I love going to theatre, I just don't enjoy this horrifically early wake-up. I've been quite lucky with not needing to go to TAU in prior placements as the consultants I have been placed with don't require me to go to TAU and talk to the patient ahead of time so I usually get to theatre at around 8:30am. Anyways so Tuesday was my theatre day and I was placed with the academic lead for Urology (perfect...). Being a bit scared, I obviously head to TAU at 7:30am and talked to the 2 patients who were on the theatre list. As I was finishing up the consultant shows up and was actually quite surprised to see me in TAU. I was then promptly quizzed about the 2 patients and about their procedures. Luckily I did a bit of reading before I saw the consultant so everything was fresh in my mind. Think I impressed him as I got the nod of approval and the brief grilling seized.

At theatre, I met with the registrar and was warned I will probably get a full grilling on anatomy and should do some reading while the consultant isn't around. Read up on the prostate and bladder, which wasn't too difficult. I've always remembered the general rule for surgery is to know the blood supply, lymph drainage, and nerve supply for that organ, and you'll be alright. 30 minutes into a cystectomy, the consultant asked me for the blood, lymph, and nerve supply for the bladder. Check. Check. And check. The greatest bit was when he looked over to me in awe and proceeded to go quiet until lunch time. Just going to dust my shoulders off now. Now here comes a curve-ball, I was then shown a muscle and was asked what it was. Thankfully due to my "love" for orthopaedics and hip/knee anatomy, I immediately recognized the muscle as the psoas. Then another dead pan from the consultant who then went quiet again. Then he asked about the path of the Obturator nerve and what it innervates. Easy as I've been quizzed on that before by an orthopaedic consultant for fun not too long ago. As I finished my answer, the consultant put his scissors down and remarked that he'll sign me off for the next 2 weeks. He seemed really impressed and well I obviously felt good for once and not like a complete idiot. I was quite lucky with the questions though as usually it is a hit or miss. Was a fairly good day!

Rest of the week was fairly...dull. Went to a haematuria/cystoscopy clinic and did a bit of ward work, where I found myself being the cannula/bloods monkey again. Was nice being able to put cannulas in again as it has been awhile since I've put one in and I was worried I would lose the skill, but looking at my 100% in one go rate on the ward, think I'm still alright! All in all - okay week. Not very stimulating. Not very interesting. Escaped presentation - think it was partly due to my "good play" in theatre. Hopefully next week will go just as well!

1 Week ENT.

Well I'm back to "work". Had a week of ENT...which has been fairly uneventful. Went to a few adult and children ear/head/neck clinics. The clinics actually run quite quickly, but I'm not sure if it is because the surgeons are efficient or the cases in general are more simple. Think it is the former. Anyways it has been a fairly frustrating placement. Because it is half-term, a lot of the consultants are away so a lot of clinics/theatre lists are cancelled. Obviously being a medical student, we don't get told about the schedule changes, so we don't find out until we get to clinic/theatre. Just one of those skills you need as a student: Adaptation. Need to be able to think on your feet and figure out what are you going to do with your time. I found myself running between hospitals quite a bit - I guess it's a good workout! Absolute pain though.

To be entirely honest - my impression of ENT surgeons before I started the placement was: "a bunch of arrogant surgeons". I am so glad I was proven wrong. They were all really nice and are really keen to teach. Don't know where did I get that impression from. Then again most impressions/stereotypes are no longer accurate. One thing I will admit is that the surgeries that ENT surgeons do are remarkable and beautiful. So delicate and intricate, but it works! I assisted in a myringoplasty and laryngectomy. Just amazing. Myringoplasty is where a perforation in the ear drum is replaced by a graft which you get from the fascia lying over the skull. Everything is done under a microscope. Admittedly my eyes were hurting after, but it was quite a beautiful surgery. They work in such a small space and still manage to do it with a lot of precision. Also watching them place a graft over the perforation and finding ways to support the graft while it heals with the rest of the ear drum...just can't describe it in words. Whoever thought up of these surgeries - genius. On the other hand - laryngectomy - massive incision requiring neck dissection. Saw so much great anatomy. Also got to scrub in and close up in the end (after hours of retracting). This surgery showed me why some people absolutely dread surgery. Never understood it until that day. My hands were cramping so much that I couldn't feel them anymore at one point. Guess my reward in the end was closing up. Suturing will always make a keen medical student's (interested in surgery) day better. Got to learn a new type of suturing technique, which is quite challenging. Took a few goes for me to get a hang of it, but eventually I managed to get a hang of it and I don't think I did too bad. Got it checked over, and got the nod of approval. Was quite satisfied with myself!

The thing I noticed in my very short 1 week stint in ENT was that you see a lot of cancers in adults and a lot of ear infection/tonsillitis in children clinics. Such contrasting conditions. Overall the attachment was too short...but in a way I was relieved that it was over because it was so disorganized. I was really fed up with running around looking for the right clinics and going between hospitals to go to a different theatre list. Then the consultant wouldn't be expecting a student and you have to explain, etc etc. Life of a medical student!

Quick Update.

As some of you have noticed...I have disappeared for a few weeks. I do apologise for the sudden disappearance. After my A&E placement, I pretty much dashed off to the airport and was off for holiday. So now I am back and will be starting my next rotation of specialties in a few days. I start with Opthalmology and ENT for 2 weeks. 

Stay tuned for some new adventures! 

My Audit Project: Start to Finish.

May 2012 - I started on my first audit project which was in Orthopaedics. I technically started planning this audit project with my supervisor back in January 2012. When we first discussed this project, the project was just intended to be a good learning experience for me and I pretty much saw it as something to keep me occupied during my Orthopaedics placement. I don't think any of us really thought of going far with this project. It was essentially a "we'll see how it goes" kind of thing. Admittedly, I didn't take the project that seriously either. I spent maybe an hour here and there in medical records. Our sample group size wasn't very big either so I wasn't exactly pressured to spend hours and hours to collect all the data. To be fair the audit project took about 3 weeks to complete (as in gather all the data, come up with numbers, and type up a rough report to hand in). As you can probably see now, I didn't take it very seriously. As I started getting results and numbers from the audit, my supervisor began encouraging me to think about submitting it to national/international conferences as he believes people might be interested in our results. I remember actually laughing off what he said and told myself: "That'll be the day!". Eventually he started to sound a lot more serious about it and continuously encouraged me to submit an abstract to conferences.

Because I had typed up a report (albeit quite roughly), I at least have a base for an abstract. An abstract is essentially a 250-300 word summary of your project. It would include an introduction, aim, methods, results, and a conclusion. I took a sentence or two from each of my sections in my report and put them together and there we go: I've got my 250-300 word abstract ready for submission. I submitted an abstract to 1 national and 1 international conference. As I submitted it, I still told myself: "Why would anyone want to select MY project? It'll be a joke." 3 months after submitting my abstract, I heard back from the conferences. I was accepted to do a poster presentation at a pretty "prestigious" (apparently) national conference. I couldn't believe it. I was over the moon. I mean I never expected to get anything from this project. Like I earlier said, it was a bit of a "keep me busy" project that I didn't take seriously. You can imagine I wasn't very confident about it and really truly didn't think I'll get anything from it. I even told my supervisor in the unlikely event of me getting anything out of this project, it will be a massive bonus. I heard back about the national presentation in December 2012 and in about 2 months I had to churn out a poster. Where do I even start?!

I have never done a poster before. I mean I presented my project a few months earlier at a local audit meeting so I had a powerpoint presentation of my poster, but not an actual POSTER. I asked around and was given a template. To be honest, I was still very lost. Because it was my holiday when I had to work on my poster, I pretty much sat myself down in front of my computer and spent the whole day making the poster. I used powerpoint to make the poster and after many hours of continuous work, I had my first draft for my poster. I remember sitting back and looking at my computer screen with a large grin. I can finally see my project "come to life". All that work, I can finally see it. After many drafts and sending my drafts to my supervisor, I believe I had my final draft. 2 weeks before my conference, I made some last minute changes to the images and minor adjustments and sent it for printing.

"Your poster is ready to pick up." - the graphics team had called. It was my day off and I quickly rushed out to go see my poster. When I saw the poster I just could not believe it. My work in true physical form. I obviously took a minute to be a bit of a narcissist and admire my work. I couldn't help but feel a sense of pride and joy. Just looking back at the long journey, I just could not believe it.

Then it was time to go to the 3 day conference. Poster rolled up and secured in a tube. No one has seen it other than me so my supervisor and other surgeons who helped haven't seen it. We all met up and went to the venue to register and put up the poster. Just walking into the venue and seeing everyone there (250+ people) and 95% of them were Registrars or Consultants in Orthopaedics, it was actually quite intimidating. It didn't help that I looked BY FAR the youngest in the meeting and 1 of the handful of women there as obviously Orthopaedics is quite male dominated. When I took the poster out to put up, while my supervisor and other doctors stood around, it was nice to see my name as the first author and the title of my project standing out among the other posters in the hall. I got a pat on the back and was congratulated. It has finally happened. My first national poster presentation. Throughout the day I was introduced to many consultants from around England and met some pretty famous ones who I have only heard about. It was such a great and new experience. When it was finally time to leave, I left my poster with my supervisor.

A few days ago I received an email from admin in Orthopaedics saying that I should go visit the Orthopaedics Department. I kind of dismissed it and didn't pop around until yesterday. As I walked down the hall in the department, there it was - my poster. It was displayed up on the wall, which registrars and consultants like to call: "The Hall of Fame". I stopped in front of my poster to be a bit of a narcissist again and admire my work.  

What this project has taught me is that if you work hard, "the sky's the limit". The opportunities are infinite - you just need to go look for it and grasp onto it when it passes by.

So what's next for me? Because my project was a lot more successful than we all thought, I am now hoping to submit a more polished report for publication. I mean these projects are quite fun, and a good experience so I am in the midst of planning with another consultant to do another project with a much larger sample group and on a different topic. After going to the conference, I am very motivated to keep doing projects and working hard. Who knows where my projects will take me next? America? Canada? Asia?

"The sky's the limit."

A&E Night Shifts.

Many apologies for the lack of updates...A&E is proving to be a lot busier than first thought. My first week was a bit shaky as I started off with a week of night shifts. I really did not know what to expect. I made sure I sorted out my sleeping schedule and got plenty of sleep right before my shift. No matter how many placements I go on, the first day will always be slightly awkward. Literally stood around for a good hour by the doctor's desk waiting for a friendly doctor to say hi and welcome my group and I. Nope. Eventually we stopped a doctor and was quickly told: "Get stuck in! There is the box of the patient notes. Take a history and stalk the box and see which doctor picks up the patient you saw." Was quite perplexed and shrugged and just "got stuck in". Eventually attached myself to a doctor and found myself with a list of jobs, which included putting cannulas in and taking bloods. Just coming off from Anaesthetics proved useful, as I was still confident in putting in cannulas and was popping them in with ease. Though not having another pair of hands to help like we do in the anaesthetics room in theatre was proving to be quite tricky (and messy). Eventually it got to about 4am, and you notice yourself starting to lapse in concentration. I was definitely starting to miss veins and needed to "fish around" before getting into a vein when inserting a cannula. What's really annoying is that no matter how late I eat my dinner, I will get hungry at 4am. Luckily the doctors were really chilled and are always prepared. The registrar brings food for the team on night shifts so when A&E was calming down, we all sat around and snacked. Thankfully my first night wasn't too busy and the doctors told us to leave at around 5:30am. It was eerily quiet when leaving the hospital. And the roads were even quieter.

Anyways the next few days of nights progressively got quieter and quieter which was quite "abnormal". Just my luck. Didn't manage to see as many patients and didn't get to feel that useful/productive. At least the nights treated me well! Then I had to start my weekend night shifts. Saturday night...should be interesting! Swear the first 5 patients I saw had "intoxicated +++" written at the top of their notes. It was actually very frustrating to try and get histories out from them or their friends. What was a bit shocking was that there were students coming in from other cities to experience the night life here and end up getting completely plastered (and ending up in A&E). I personally would never go to a foreign city and get absolutely plastered. I guess I would be a bit more "aware" in a foreign city as the last place I want to end up in is in A&E. But of course, everyone has their own version of "fun" and I'm just a boring...old...medical student. Other than the non-stop flow of "intoxicated +++" people, it was a fairly uneventful night. Didn't really get to do very much either.

All in all, night shifts weren't actually that bad! But I do think I got off quite lightly as my friends who were on night shifts said they saw a few cardiac arrests and a few trauma cases. Oh well.

I'll try and make a few more posts this weekend. Need to catch up! Apologies again!

Final Week - Anaesthetics

Wow these last 4 weeks have blown by. Like I've said in my last post, I've seen a great improvement in my practical skills and confidence in doing invasive procedures. It really is true: practice makes perfect!

Because I have made quite an effort to get my logbook signed off early, I took my final week in anaesthetics as a "flexible week". I had a sudden urge to go watch some orthopaedic surgery so I decided to go observe a list. As I walked into the orthopaedics theatre and asked the consultant if I could observe, I was then offered the opportunity to scrub in (which made me very happy). It was so good to be back in orthopaedics and scrubbed in. Geek moment: I was pretty excited while I was scrubbing in. It brought back the good memories I had from last year whilst on my Orthopaedics attachment. Last year, I only helped drape the patient once or twice as there was usually a registrar there, so I would stand back and watch. Let's just say draping a patient for Orthopaedics isn't the "easiest" thing when you're still quite new at it. Because there are plastic walls around the operating area, you really have to be aware of your surroundings to make sure you stay sterile. The draping is also quite the task itself as there are quite a few layers to put on and I will admit that it required a lot of concentration and focus for me to make sure I maintained sterility. When the draping was complete and I didn't screw up, I couldn't help but feel like this:

Anyways, we did an exchange of a total knee replacement. It was fairly straight forward and it was nice being able to assist. Just felt really good. The tasks I were doing were fairly simple, for example, suction, diathermy, etc, but you still feel like you're helping...in a way. At the end I got to do some suturing and close up the wound. Admittedly quite rusty, but after 2 dodgy stitches, I dusted off the cobwebs and got back into it. Of course, being a responsible person, I redid the 2 dodgy stitches (in case you were wondering...). The consultant checked my stitches over and I got the nod of approval and then tidied up. The surgery took about 1.5-2 hours, but it certainly felt much shorter. We took a lunch break and I bumped into my anaesthetic group mates. They noticed that I was looking quite happy and some of them know me quite well could guess immediately that I got to scrub in and assist in surgery. I then bumped into one of my good friends and even he asked why was I oddly happy. When I sat down for my lunch and did a bit of reflection - I really do think surgery is for me. It makes me happy and I really enjoy it. I mean I've seen a few exchange TKRs last year, and it just doesn't get old. Every case is different. We had another operation in the afternoon which was quite straight forward. By the end of the day, I was quite tired and my feet were sore, but I was happy. I felt like I had a productive day. I felt like I learned a lot. I was at the hospital since 8am and got off at 5pm. I would usually be craving to go home, but after the list, I wanted to follow-up with the patients in recovery/post-operative surgical unit. It was a really good day. Probably the happiest I have been on placement this year.

The next day was a huge contrast. I went back to anaesthetics and met up with the consultant anaesthetist at 7:45am. The first thing he told me was that he is too busy and that there won't be any opportunities for me to get any hands-on. He also told me to be prepared to stand to the side for the rest of the day. I couldn't help but get annoyed as I made the effort to come in at 7:45am, ready to learn, and then to be told that I won't get to do anything. I thought the consultant was maybe just over-exaggerating, but I quickly found out that he really did mean it when he said I will be standing to the side. I just stood in the anaesthetic room in one corner and watched everything....and proceeded to zone out. All I could think about was that it was a huge waste of time. Then 2nd case, same thing. I was just stood there. I even asked if I could help out and was promptly ignored. I made the decision that I could be more productive if I went home. By 12pm, I grabbed my bag and told the consultant that I'm going home. He wasn't too impressed that I was leaving early, which surprised me. I was not learning anything and he wasn't teaching. What was the point in me sticking around? I firmly told the consultant that I could be a lot more productive at home and complete some of my assignments. I was fed up and just left. In a way it was rude of me to do that, but at the same time, the consultant knew he was going to have a student around and if he doesn't want a student around, then say something to the administrators so he doesn't get assigned a student. Ridiculous.

Despite the sour ending to my week, at least there was a very high point in this placement, which was unfortunately not anaesthetics related. I'll just treat the orthopaedics day as a treat to myself for getting all my work done early. A few years back, I used to want to do anaesthetics, but this attachment has reaffirmed that it isn't for me. I can see why people would enjoy it, but I really do think I am more suited for surgery. I just enjoy being hands on and fixing things. I enjoy the theatre life, but not sat at the head of the table. My next placement is A&E for 4 weeks. Again, I am quite nervous as I have been placed in the main hospital, which is quite busy. I know what to expect, but I'm not sure if I'm ready for its quick pace. We'll see. I'm excited in a way. Plus more opportunities to work on my clinical skills!

Slow Week - Anaesthesia

To be fair, every placement has a "slow" week. Mine is usually the first week...somehow out of my 4 week placement, I managed to have another slow week. Last week, I spent most of my time checking out the intensive care unit and the high dependency unit. I'll just say in my opinion, it is probably the "less exciting" part of the job. Lots of ward rounds! I really don't know what to take away from this week. Having said that, I did manage to get a lot of physiology teaching from a consultant anaesthetist. It was actually a really good refresher. The way he taught was based on quizzing (which I hate, but love at the same time). I was picked on most of the time as I was the only medical student and that the knowledge should be "fresher" in my mind. It made me realize that I actually haven't really forgotten about physiology. From the quizzing/grilling, I realized that I just lack confidence in my answers and should just be brave and say what I think the answer is. It's a shame that it takes massive pushing and pressure for me to get an answer out. Guess it's one thing I need to learn and obviously shows I need to hit the books a bit harder to build some confidence in my knowledge. The foundation knowledge is definitely there and I just need to "go for it".

Thankfully to end the week, I got to go back to theatre and was placed with a really good anaesthetist who let me do a lot of skills. I was putting in all the cannulas, holding the oxygen mask, and inserting LMAs. It felt really good. In the first week, despite being very determined to get some hands on, I was quite scared and nervous performing these skills. Now, I'm on it the minute the patient comes to the anaesthetic room. Gloves on. Equipment ready. Ready to go! It also showed me that with practice, you'll get better at the skills. I had to cannulate a tricky patient. I missed the vein on entry, but managed to salvage it and got the cannula in without needing to try in a different spot. Added bonus was that the consultant complimented me on it, so it was a definite boost to my confidence level! Thinking back to the last 2 weeks and seeing my placement come to an end - I think I've made leaps and bounds in terms of clinical skills. I built a lot of confidence in my clinical skills and in general feel just a bit more competent. My day in theatre really showed me how far I have come from the beginning of placement and I think I have accomplished what I have set out to do - to improve on my clinical skills.

I do realize that my posts have been fairly short...as to be honest - there's not much to really talk about. I don't get to speak to as many patients as most are asleep. This placement was mainly refreshing my pharmacological and physiology knowledge and improving on my clinical skills.

Sorry for the boring read! I promise the end of this week's post will be more interesting!

Having a Bad Day?

Medicine is a constant reminder of how fragile and unfair life can be. Life can throw curve balls and do some pretty unexpected things. I was in clinic and met a lady who is 40 years old and have been getting treatment for cancer. Unfortunately, it has been found that it has metastasised to other parts of her body such as her bowels and her lung. What really struck me was that as I entered the room, having read the notes before seeing her, I was expecting a frail lady who would look quite ill. Instead, I was greeted with a very healthy looking lady. If I had seen her in the hallways, I would not have guessed she had been battling cancer for almost 2 years and now facing another fight against the metastases. While going through her medication list, she was on high doses of analgesics and one can imagine how much pain she is usually in. As we got further into the consultation, what once was a calm looking lady turned into a nervous and worried person. She is supposed to undergo radical surgery in a few days and I really do not blame her for her nerves. I was taken aback by how calm she was at the beginning. It really puts things into perspective. I had a bad week last week with back pain, but after hearing the patient's story, my back pain seemed like nothing. It is nothing compared to what she's going through. And it really amplifies the fact that if you think you're having a bad day, there are people having a much worse day than you. It's easy to forget how fragile life can be. 40 year old woman - most are fit and healthy. Cancer is something still seen as a disease that affects the older population. It was inspiring to hear about her fight and her courage. Pretty sure I didn't whine/complain about anything for the rest of the day.

Life can throw curve balls affecting you physically and your health. But I wanted to talk about mental health. By being in a stressful job, it is important to keep your mind "happy" and not allow work overwhelm you. Your emotions can greatly alter your way of  functioning. Recently, there has been a lot of mental health awareness campaigns going on especially back home in Canada. I personally know quite a few friends affected by mental health issues such as depression. I thought it would be worthwhile for me to write a mini blurb here and raise awareness to those who read my blog. Statistically, about 1 in 4 students are affected by depression and approximately only 1 in 4 people seek help. The main reason for the lack of seeking for help? Stigma. Mental health is still a "taboo" subject and it shouldn't be one! It is a common problem affecting many people. Not many people want to speak up and get help. You can't just "laugh" off depression or mental health illness. I know way too many people suffering with this. What bothered me was how even in the health service, health professionals are almost afraid to ask about psychiatric illness. The number of times where I've seen various professionals very quietly ask if there is any history of psychiatric illness or if he/she suffers from depression. We ask about heart/lung/bowel problems loud and clear, but when it comes to mental health it gets all "hush hush". If there wasn't this "stigma" surrounding mental health, will there be more people seeking for help? I would like to think yes. I've had friends who suffered in silence and I have nothing but praises for those who gathered enough courage to seek help. From what I hear, it can get very dark and lonely. There is so much help out there. People shouldn't be suffering in silence. Stigma is unacceptable. The reason for raising awareness is to eradicate the stigma associated with mental health. 1 in 4 people are affected. That is common. Look at your group of friends. Live in a house with 3 others? Do your part and raise awareness.

Week 1 - Anaesthetics.

Interesting week here in England. Had a snow storm the day before my first day of placement. A lot of my friends got a snow day, but I haven't heard from my hospital so I ended up leaving later than usual for the central hospital. Because of all the snow - it was actually a very pleasant drive as there were hardly any cars. What is usually a 30-40 minute drive, ended up taking me 10 minutes. I was thinking to myself that I was such a genius to drive as the roads were clear (bit slushy)...until I got to the hospital. The parking lot wasn't cleared and it was packed with snow/ice/slush. Made it a bit daunting to park my car. When I got out of my car, I stepped in about 2" of snow...well there goes my black shoes. Tippy toed my way into the hospital only to overhear people saying that there will be more snowfall in the afternoon. "Shit." was probably the only thing that came into my mind. And then I thought to myself: "How am I going to go home...what an idiot. Shouldn't have driven."

Anyways I made it for my induction and most of us managed to get in. A few people got snowed in as they live on a hill and couldn't make their way. We got our logbooks which has various skills that we need to be signed off on by the end of 4 weeks in anaesthetics/critical care. Such things include putting in cannulas, inserting a laryngeal mask airway (LMA), intubating, drawing up antibiotics, etc. I was quite motivated to get my logbook done as quickly as possible so I walked into the theatre I was assigned to - ready for action. I was then greeted by a consultant anaesthetist, who seemed a bit annoyed. I was quickly told to leave and come back in an hour. Almost felt like I smacked into a brick wall. It kind of threw me off and I got nervous again as the consultant didn't seem too friendly. I went to get some food and returned an hour later and was promptly told to go find a patient in the ward and get a patient history from him. In my head I was getting annoyed as I wanted to work on my logbook, not go and speak to patients. By the time I returned to theatre the consultant had relaxed and apologized to me for being a bit rude earlier. I really appreciated the apology and the consultant gave me a few tasks to do such as mixing and drawing up antibiotics. I was then taught how to insert a LMA and how to hold an oxygen mask to the patient's face. It was really good and exciting. I also got a lot of teaching about regional and local anaesthetics during surgery which was an added bonus. Because of the snowfall, some patients cancelled and we ended up having a short theatre list. I was out of the hospital by 3pm and luckily the snow had just stopped, so I made a run for it before my car gets snowed in. Thankfully made it home with my car (to the surprise of many). Also had the feeling of: "not so dumb after all!"

I would say I had a really good first day as I got a few things signed off and was ready to go for day 2. Unfortunately, it was a bit of a mess as there was teaching going on and the lists were starting later than usual (and I made the effort to go in for 8am when lists weren't starting until 11am). Then I realized that this is something everyone has to accept - as a student and as a doctor. Not everything will go to plan and you just need to adapt and find something productive to do. There were a few theatres running so I decided to go for a wander. Funny enough I ended up scrubbing in for a few procedures and assisting. Yay...but obviously deviating away from my placement goal: to learn anaesthetics! It was a nice bonus and certainly better than sitting in the coffee room for 3 hours. I at least did something productive and I felt like I was helpful. Later in the day I met up with a different anaesthetic consultant and I got a bit of teaching (not as much as I had hoped) and unfortunately did not get a single thing signed off. Great - here's hoping next day will be better. Next day...same thing. I tried to hint to another consultant anaesthetist that I would like to get involved as I had put on my gloves and stood at the top of the bed ready to lend a hand. Instead, I was ignored. I asked if I could insert a few cannulas and was told that it would be too difficult. By now, I had lost a lot of motivation and ended up just standing around for the whole day. I don't think this is really the anaesthetists fault as they are all very nice people and love teaching. I learned loads, it was just a bit more annoying that I couldn't do anything practical. Just another thing as a student you have to accept - sometimes you can't get in on everything. Unlike my group mates, I haven't been kicked out of theatres due to too many students. I've been lucky that I've still been able to stick around and observe and get some teaching. I've also been in orthopaedic theatres so the orthopaedic surgeons were also teaching me about their procedures, which I found really interesting. Essentially other than the first day, this was the story of my week. Just not getting any opportunities to do practical skills.

So I went home and thought what I can do about this as I have a log book that I need to complete. I think next week I will approach with a different mindset and make it clear first thing to the consultant that I am very keen on helping out and trying out some practical skills. Sometimes being subtle and polite doesn't work so I'll just have to be brazen and go for it. Fingers crossed that I will get to do a bit more next week!

Back to Work.

So I'm back from my winter holiday and have had a week of lectures which was an introduction to Specialties and Acute and Critical Care Medicine. Essentially how this year works is that I will go through 4 core rotations: Acute and Critical Care Medicine, Specialties, Community and Palliative Care, and General Care Medicine. Each core is about 8 weeks each. Within each core there will be sub-attachments/sub-specialties. Anyways I'm starting with Acute and Critical Care Medicine and my first 4 weeks will be in Critical Care so I will be getting to know the anaesthetists! Then my next 4 weeks will be in A&E/ED (emergency department). I am quite excited about this year as this year is quite focussed on specialties and I will have plenty of opportunities to be in theatre this year. Yay!

To give you an idea what sort of lectures we had this week - we went through topics in Urology, Opthamology, Haematology, Anaesthetics, Dermatology, Trauma, Oncology, Infectious Diseases, and ENT. To be fair, covering all of that in 5 days was ambitious and tiring. It just stresses the importance for you to go home and do some extra reading before you go into that specialty placement as a 1 hour lecture is not going to cover enough for you to get through the placement. Because of this, I spent my weekend reading up on Anaesthetics and Critical Care. In a way I am really excited for this attachment as I am placed in the main hospital and it is quite busy so I know I will be able to get a lot of hands-on experience instead of swivelling in my chair. I also spent the weekend trying to get as much sleep as I can (12 hours today!) as I'm starting at  8 am every day. I felt a bit of me cry, but at the same time if it's a good attachment I don't see waking up being an issue.

Hmmm....to be honest there isn't much to talk about from this week as it was really dull and I won't bore you with the details. Hopefully next week will be action-packed and hopefully can give you all a more exciting read!