Percussion

Tap tap tap...

Had to write a quick note about this: heard my first abnormal sound on percussion today!

The patient was a 50 year old man who was suffering a pleural effusion. The doc let me percuss his posterior lung fields and sure enough I heard a “stony dullness” around the level of T9. The look of shock on my face must have been a picture!

The doc complimented my technique and assured me I’d never forget the sound. I don’t imagine I ever will.

Get a sense of scale

Found this site while browsing just now:

http://learn.genetics.utah.edu/content/begin/cells/scale/

It’s so easy to forget the scale of whatever you’re talking about, in science.

Reality hits home

Today was the second day of MedSoc, and it was quite upsetting.

I was quite nieve about the whole palliative care side of medicine, and the fact that the last visit to the hospice was very sedate really didn’t prepare me for the harsher side of what these patients are going through or how it would affect me.

We started the day with nothing to do.  After a few hours of sitting around trying to get involved we were introduced to a patient who had agreed to let us take a history.  We blasted through his notes quickly before hand; I took particular interest in the vast swathe of meds he was on but took note of the fact he was depressed about the future.  Best not to steer the conversation in that direction, then.

He sat and talked to us for around half an hour, all very medical at first but soon delving below the surface to how upset he was about the terminal diagnosis of his condition.  I asked him what books he was reading at the moment, to change topic, and he started to talk about a holiday he’d really been looking forward to with his wife which he’d been forced to miss due to ill health – and then he burst into tears.

I was utterly stunned, and had to try hard not to start crying myself.  The guy was so sweet and his situation so grim that it was really hard to bear.  After a while we managed to sort him out and finish the history.

Walking back out into the day centre to all the other patients, sitting there laughing and chatting and smiling together, I suddenly saw them as the terminally ill people they were, and how much each one must be or have been suffering.  All the stethoscopes, scanners, theory and drugs suddenly seemed like such a small part of the profession, because at the end of the day doctors and the other carers are the people who deal with the personal side of life and death.

And it dawned on me then that I couldn’t do this branch of medicine.  I’m not strong enough.  And my respect for all the people I saw in front of me, and those that care for them, suddenly shot up.

EPC – Extending Patient Contact

AKA: MedSoc 1 all over again.

Since Tomorrow’s Doctors came out, there has been a greater push to get us early years meeting more patients.  EPC is Barts’ response.  I exaggerate a little – it’s not quite the same as MedSoc 1 but it isn’t far off.

I’m based at a GP surgery over in Essex (again!!), and must say that the placement was fairly enjoyable if a little forced and prescriptive.  There’s more focus on seeing actual patients (as you would expect with a name like EPC) and much more talk about the disease and clinical skills involved.

MedSoc was more of a touchy feely discussion every 2 weeks.

Other than that, CR2 is nearly over…on to Met2!

MedSoc 2

I honestly can’t remember how much I wrote about MedSoc last year, and I’m too lazy to quickly look through past posts, but I generally felt negatively about it.

It wasn’t the GP, my fellow students, or the quality of the placement – all those things were fine if not great.  It was probably just that the whole thing made me feel a bit uncomfortable, all that sitting around in a small group talking about how we feel about stuff.  And it was miles away.  Eugh.

So you can imagine that I was not looking forward to this year’s placement – in a hospice for terminally ill patients (palliative care), miles from where I live, with just one other student.  Groan.

This cut especially deeply when other students reported being in The Royal London shadowing surgeons for their MedSoc placements.  I’m not bitter or anything ¬_¬`.

Well, today was the first day.  I arrived late after getting a taxi from the station, but luckily the consultant was running late on a ward round so I was saved by her PA.  Not that I needed to be – she was unremittingly welcoming and pleasant!  After a quick tour and chat about what was going to happen (no-one really knows quite what to do), we were set loose on the day patients.  This was tough.

One woman I tried talking to was new to the hospice.  Couldn’t get a lot out of her.  Then I read her notes and figured out why – the joys of palliative care.  But all the staff were unbelievably pleasant to us and made us feel welcome.  I even relaxed a bit towards the end of the day.

So that’s that.  A good day all in all, with real effort put in by the centre to make us feel welcome…

Heave ho

I probably should have saved that title gag for when I first feel a parasternal heave, but nevermind…

This story on the BBC caught my eye:

http://news.bbc.co.uk/1/hi/england/lancashire/8296483.stm

I’ve actually seen exactly this situation happen in a hospital, and I can see the thing from both sides.  Patients need to get into a bed and can’t do it themselves (they are patients, after all…), nurses don’t want to “do their backs in”.  Which is fair enough.  They’re not building site labourers, after all.

I do just wonder why 4 nurses couldn’t have managed the feat, though.  Surely there’s little risk involved to each one, as 15 stone of woman is quite easily lifted by so many people?

The only way round situations like this, as always, is more money.  Patient cranes are hideously expensive, I believe.

Yawn

Due to a freak of timetabling, I’ve effectively got the day off. Right then: up at 9am to make the most of the day and get that PBL on angina done early.

Roll on 2pm with nothing done but a bit of BBC news reading. Eugh…

First week back

Sorry for the dirth of first week posts.  It says it all, really – it’s been mostly routine and unexciting.  Delightfully we didn’t have any introductory lectures or anything or the sort; it was straight back to business.

We’ve started on CardioResp2 so it’s all hearts and lungs again (duh).  I’ve had my cardio clinical skills sesh already – it was basically the same as last year with a bit of general exam and potential pathology (murmurs, etc.) chucked in.  I actually didn’t get to do a whole exam on someone as I was the puppet patient this time around.

And I finally made a point of pointing out my thoracotomy scar.  Not wanting to show off, obviously, but when the teacher deliberately states “look for signs of previous surgery…” and people completely miss a 6″ scar under my left arm, it makes me a bit mad.  I’m proud of that thing.

Other than that it’s just been a couple of PBLs, which are delightfully more clinical this year, and a few fairly interesting lectures.  ECGs are starting to make more sense now, which is pleasing.  All in all, a decent start to the year, but nothing special.

Second year

So here we are.  2nd year.  I remember seeing lots of poetic reflections about not being the youngest year anymore etc. on blogs this time last year.  I can’t think of anything interesting or relevant to say.

Still, to my loyal readers:  welcome back.

Moving in

Well, I’m all moved in to my new place now. I’m in a flat in Bromley-by-bow with 3 other guys. It’s a bit smaller than my previous dwellings but I think I’ll be happy here.

I would post a picture or two but I think that would be a bit creepy…wouldn’t it?

Looking forward to getting back to University but I have to work one last weekend first. The term dates have thrown me off a bit this year; we’re back on the 28th but there is freshers fortnight before that.

I’m sure I’ll start with good intentions of going to this and that but, like last year, it won’t happen. Must be more sociable.