So much work, so little time

Today we got given our BnB2/HD2 PBL write-ups.  I think they’re meant to be about 2000 words and is essentially one particular scenario studied in greater depth – though anything over a page of A4 would count as greater depth as my average PBL notes are ‘minimal’, to say the least.

This adds to the already impressive pile of work I’ve accumulated recently.  I’ve got to:

• Finish my SSC2a presentation
• Do my SSC2a essay
• Finish my Medsoc presentation
• Do my Medsoc essay
• Do my PBL write-up
• Do the next PBL
• Revise for the BnB2/HD2 exam in two weeks

And to think I had planned to enter an ophthalmology essay competition…

SSC2c – Lab Physiology

So the two weeks of SSC have begun.  I specifically picked this module because I thought it would be a doddle.  And it is easy.  But its so time consuming I can kiss goodbye to my two weeks revising (off).  Did I mention the lab is bloody freezing?  Not a happy lab.

Basically, the school has bought a load of new modules for the practical labs that do everything from EEG to gas sampling to psychometric testing.  They’re good bits of kit – at £9k each, you’d kind of expect that.  It’s our job to run through every program and see how well it works.  Each program takes maybe an hour and a half, and there are about 15 for me and my buddy to do.

Bear in mind that I still have to do my SSC2a stuff yet – a presentation and journal article critique.  Nerg.

A happy lab - geddit?

Dissection SSC results

The dissection exam was first thing this morning and, as promised, it was a nightmare.  No pictures, diagrams, charts or anything.  Just a statement about a part of the body and five choices below it that we had to mark as true or false.

Horrible stuff.  I finished in 10 minutes, mostly because I needed the toilet, but partly because I just wanted it all to be over.  This year has been quite a slog so far.

Results were out a few hours later – I got an A- for attendance (I was late once) and a C+ for the test.  The C+ is quite embarrassing, admittedly, but I’m not overly fussed.  I got a B overall.

On other news – I feel better about my SAQ performance on the CRMET2 exam; after talking to my friends who all scored similarly and several people who outright failed.  We all griped about it (especially after looking at the marked scripts!) but my tantrum is over now lol

Dissection so far

I’m really rather pleased at the timetable for dissection.  We start at 10am, have a half hour talk from the best anatomy teacher ever, and then get to work.  We have set stuff we have to do but it’s quite flexible, so we can either finish quickly or really take our time.  After lunch we basically do the same again.

The sessions often take just an hour and a half but the amount of learning done in that time, for me, is immense and I’m genuinely glad I got to do this SSC.

So far I’ve been cut twice.  Both times by my colleagues.  The first time I got stabbed in the finger by a scalpel, and the second time  someone just decided to go ahead and slash the back of my fingertip.  Hint: never offer to hold something for someone if they’re going to be cutting it…

I’ve been seriously grossed out, too.  Over the last few days I’ve seen a few things that have made me go “mmm, nice…”, but today I was almost retching on two occasions.   The teacher running her hand through the greater omentum was one (it looked like a sheet of lumpy butter), and my friend accidentally tearing out the stomach – causing it to spill black goo everywhere – finished me off.  Not for the faint-hearted, all this dissection business.

We’ve got tomorrow off and next week is just 2 and half days in with a test on the Friday – what a fantastic end to the year!

Some of my favourite quotes from the week:

“Wow, that’s an excellent view of the sphincter…”

“Oh gosh you think the stomach is bad, wait ’til we get to the colon!”

SSC: Dissection

Not a picture of dissection.

Oh yes.  I got the big one.  Thorax and Abdomen dissection, with Professor B.

Throughout the last year and a bit we’ve seen plenty of prosections – prepared dissections of a particular organ or section of the body – so the thought of seeing bits of dead people isn’t an unsettling one any more.  But it was still a little daunting being presented with an entire untouched cadaver and having to hack away at it.

And that’s essentially what we’re doing.  Sure you have to be delicate around certain structures that you want to preserve (the cursed nerves, for starts), but ultimately you don’t have to play gentle.  It’s nothing like surgery.

I’m not terribly sure how much I can actually say on here, legally, about the specifics – the whole area is a minefield of legislation.  Suffice to say that I’m really enjoying it so far, the days are fairly laid back and I’m seriously padding out my anatomy knowledge.  Recommended!

End of SSC

And so it passes.  Great two weeks.  Yesterday we observed the other approach to an aneurysm – a craniotomy to “clip” the vascular bulge.  We got in early to help/get in the way of the anaesthetist.  The patient was largely a comatose mess when we saw him; the GA seemed more of a formality.

We all “had a go” holding a face mask over the patient – harder than it looks, and scary knowing that you’re doing the breathing for this person!  I was horrified at how he wasn’t breathing, how rough we had to be with the guy, and how much he weighed being completely paralysed from the GA and NMJ blockade.  He was like a cadaver.  If he wasn’t warm to the touch I would have suggested he was dead.

I didn’t hold the facemask on properly, so he started to snore.  Go me.

The neurosurgery was slow, tedious, and not as gory as I was expecting.  The patient is pretty much totally covered over, with only the area to be operated on being exposed.  It has the effect of detaching you from the idea that this is a person.

Disappointingly, the aneurysm never “appeared”, at least to my eyes.  It was all very bloody, with the neurosurgeons pointing out landmarks that looked nothing like the diagrams and CTAs I’d studied.  Eventually they clamped something and then left the closing up the registrar.  We left just before he screwed the bone flap back on – some 4 hours after the start of the Op.  Neurosurgery is not for me.

Today we attended another meeting with the consultants discussing interesting cases.  Great stuff again.  Then we had a test with Dr. R to see if we had actually learnt anything over the last 2 weeks.  I scored 8/10 for the written test and made up for the errors in the one to one viva.

Well, it was only for 2 weeks but they were well spent.  Great choice of SSC, would recommend it to anyone.  And now it’s time for revision.  Sigh.

Interventional Radiology

Basilar artery aneurysm

In early today to the X-Ray department.  I arrived on time, but a doctor I hadn’t met before had just finished briefing the rest of my group on what to expect.  We were going to theatre.

Having never been to theatre before (except as a patient), I was at once excited and anxious at the prospect.  I swallowed down the mild panic that I might faint or be sick on the patient, before realising we would only be allowed so close.  We had to change into “blues”, so I was glad to have worn decent underwear – you really don’t wear anything else under those loose-fitting, thin tops and trousers.

The patient had an aneurysm on the anterior connecting artery of the circle of Willis, which had been found incidentally on a scan for neck pain, apparently.  An endovascular procedure was to be carried out to take care of “the ticking time bomb”.  This essentially involves passing a small catheter up from the femoral artery all the way to ACA branch of the internal carotid.  A tiny platinum wire would then be coiled inside the aneurysm and left there to promote thrombosis and eventual fibrosis (thus massively reducing the chances of a future rupture).  The whole thing was imaged using continuous digital subtraction angiography and 3D CT.  Elegant stuff.  Lots of radiation.

We watched the whole procedure from behind a low (and I stress fucking LOW) screen of leaded glass where the radiographers sat watching the screens.  Occasionally we ventured out to have a look at a piece of equipment.  Not quite sure why we had to get changed.  Dr. R didn’t bother.

The Op lasted about 3 hours, the trickiest part being where the radiologist had to get the guide wire round a tight corner at the start of the ACA.  Nothing terribly dramatic happened, like the aneurysm bursting or anything, thank goodness.

I must admit, as interesting as the Op was, I was more fascinated by what the anaesthetist was doing.  Okay, at times he really wasn’t doing a great deal – telling us funny stories about accidents with the MRI machine, for one – but when he changed a syringe of propofol (“MORE WHITE MEDICINE, DOCTOR!”), for example, I was watching and questioning away.

Eventually the aneurysm showed up on the screen stuffed full of wire, sitting there snugly.  We thanked the lead gown-laden theatre staff for their humour and made a hasty escape to lunch.  It’s hard work, all that standing around.

One of our group was taken off to meet the patient whose operation we’ll be observing tomorrow.  They’ve got a similar problem to today’s patient, but they’re having full-blown-open-skull surgery instead, for whatever reason.  Should be charming.

Applied radiological anatomy

Radiology - not like this, at all.

This SSC has been, arguably, the best part of the year.  6 of us basically go and sit with a radiological consultant, Dr.R. for a few hours each day.  He runs through various powerpoint presentations of X-Rays, CTs, MRIs and angiograms, describing normal anatomy and quizzing us.

It’s a buzz to get so much stuff right and feel that you are genuinely learning and being taught – one of the doctors commented that he thought we were in our final year, so good was our knowledge.  A bit of an exaggeration, to be sure (I hope), but it’s nice to receive these compliments.

Yesterday we saw the Gamma Knife machine at a Harley St. clinic – an awesome, and slightly scary, piece of kit.  The staff there were nice to us, probably pleased with our enthusiasm and awe at their work.  One of the surgeons there quizzed us heavily on AVMs which, considering we’d never heard of them before, pushed us to use our current knowledge to the limit.

He was pleased with our efforts, and introduced us to the patient who was going to be “cooked” (LOL) that day – a nice lady with an AVM that was causing her to have awful headaches.  In all honesty, I learnt more from that surgeon in 5 minutes on taking a history than I have from the whole of this year combined.  I just love being taught by practising clinicians.

Today was an ungodly start at 8am.  We sat in on a meeting of consultants and registrars discussing the radiological findings of various patients.  Some of what was said was beyond me at this point, but my anatomical knowledge was reinforced by listening to the consultants briefly describe each scan.  It was good.  Our consultant is clearly a big hitter in his field – if in doubt, everyone in the room would look at him and call, “What do you think, R?”.

A short break and then into another lecture theatre where registrars presented interesting cases to an absurd number of neurologically-related consultants.  I’ve never seen so many bow-ties in one group of people.  It looked terrifying to me, but they seemed to have a good rapport with a number of the older doctors so we didn’t watch anyone squirm too much.

One presentation was a young guy, about my age, who was fit and healthy before presenting to AnE unable to bear his own weight.  After a lengthy talk from the SpR, he was wheeled into the room where his lower limb reflexes were demonstrated to be absent and he was questioned.  After he left, the SpR’s consultant – a scary, impatient man – stood up and lead a discussion about the case.

His eagerness to quiz the medical students in the room about the case made my skin go cold briefly before he picked a final year guy to give an opinion.  “Guillian-Barre Syndrome, maybe?”, the guy piped up.  Good answer.  None of the consultants could do any better, but everyone started quibbling about how certain aspects of the presentation were unusual.

It was great to watch all these experts battle out opinions on diagnoses, treatments and prognoses.  Again, our man was called on to give his revered opinion.

I’ve really enjoyed the SSC so far.  It has made me think that perhaps one day, I’d like to be one of those guys sitting in the rafters calling down an opinion derived from years of experience and knowledge to my peers.  I just wouldn’t wear the bow-tie.

More Hypnosis

Oh God.  I feel that awful cringing sensation you get when you remember acting the drunk arse at that party.

I think I got hypnotised again today.  Either that or I got extremely relaxed and acted like a tool.  I fell off my chair, twice, with a beaming great smile on my face.  The worst part is that I knew that I was doing it and didn’t stop myself.

Luckily no-one but the demonstrator noticed.  What is happening to me during these sessions?

I genuinely can’t decide whether in some way I’m playing up to what is expected of me, or I’m actually in a state of hypnosis.  Maybe it’s the same thing…

It would be better if I “awoke” with amnesia.  That happened to someone today, too.  Lucky sod.

Clinical Hypnosis

For the next two weeks, I’m doing an SSC entitled “Clinical Hypnosis”.  I think I picked it because it sounded easy, and could possibly be interesting.  To pass, I’m assessed on my ability to formally hypnotise a fellow student using what I will learn.

Yesterday, a guy called Rick talked to 20 of us about how he got into Hypnosis as a profession, and what he made of it.  It made for interesting listening, even for cynical Medical students.

Then he hypnotised the class, I think.  Something certainly happened for me.  I’ve never been hypnotised before, so I had no idea what to expect and my heart was pounding as we started.

Maybe it was the fact that I only got 5 hours sleep the night before, but I drifted off and achieved unparalleled relaxation just listening to his voice.  My hands seemed to disappear.  Everything felt so heavy.  I kept thinking, “I could just open my eyes and prove all this is bullshit”, but somehow couldn’t bring myself to do it.

My friends told me afterwards that on the three occasions I was “under” during the day, I was slumped out in the chair swaying from side to side and looking utterly absent.  But I can remember what happened, in a warped, fragmented kind of way.

I don’t know what I experienced.  Hypnosis?  Maybe.  I felt quite exhilarated by it, though.  Even my BioMed friend was having a good time.

Today wasn’t so good, partly because I didn’t experience what I did yesterday (partly because the new teacher approached us in the wrong way).  But I’ll keep an open mind for our third class on Thursday.