Waiting Around

Usually I'd moan about being kept waiting around on the wards or at outpatient clinics. It seems that waiting around is destined to become a big part of my life. Now I'm being left waiting around at home. By the estate agents.

Selling a home is stressful to say the least, especially when you're as adverse to housework as I am. I rushed back to London today to make sure the house was dust-free and as clean as possible before the viewing this evening. I really want to sell/rent it out. I hoovered the whole thing, cleaned all the kitchen surfaces, cleaned the bathroom and scrubbed the kitchen floor. I smell so badly of bleach right now that I'm probably in danger of toxic chemical inhalation levels.

The estate agent was supposed to be here 15 mins ago.

It's not as if I have any massive plans to go out tonight. In fact I'm cooking dinner for a friend later. My main problem is kind of embarassing.

I need to pee.

I need to pee really really badly.

I think I'm currently in danger of putting myself into renal failure. However I can't go until the estate agent arrives because it would be awful if him and the potential buyer walked into the flat as I was in the loo. I'm not sure why I'm so bothered about this but I am.

Lily xXx

The End is in Sight

I don't really have much useful to say. I've had some bad news over the last week which has thrown me off course a little bit. I need to focus on the fact that I'm so near the end of medical school that I can't let anything spook me and ruin my chances of failing.

On a lighter note, I worked out that because of bank holidays, I have less than 20 days of actual placement left, which is scary. I think it's 19 more mornings that I will turn up in the hospital as a medical student. Clearly this is only if I pass, if not I have 19 days + 1 year.

I'm finally getting there with sign ups too. I have 3 left to get in my log book and an attendance one at the end of the rotation. The relief is extreme, its nice not to have to constantly be on the prowl for sign ups.

I know I should be revising more, but I keep getting distracted with ideas of what I'm going to do with my time off after exams. I'm thinking of travelling Europe with a friend, I'm definitely having a weekend in Paris with my Dad... but that still leaves me with a couple of weeks to fill. I really want to make the most of the last long holiday I'll probably ever have.

Lily xXx

Night Shift

There are a couple of frustrating things about being a medical student. Firstly it seems like there are always loads of other students around, so you have to fight to actually get any experience. Secondly, whenever there aren't a whole hoard of students it always ends up that nothing happens so you stand around like a spare part wasting time.

Both of these things annoy me beyond belief.

As one of our sign ups for the term we have to do a night shift. The good thing about nights is that there are definitely less students around. The bad thing is that usually nothing happens and you end up being a spare part, or just kipping in the mess.

Not on my night shift.

It was a surgical night on call with the fy1, he warned me it had otherwise been dull all week. To be honest I was just pleased with the chance to wear scrubs and trainers... ultimate comfort wear.

Somehow (for once...) I ended up lucky.

The evening started off pretty typically. Catching up on the days jobs, mainly chasing blood results. I then got the chance to clerk in and examine a patient. Sounds dull, but I enjoy it. I also got to formulate the management plan and write the drug chart... great practice not only for OSCE but life as an FY1 too.

After that there was a trauma call. A drunk driver in a car crash. Thankfully she'd only hurt herself. Unlucky for her she's fractured some vertebrae, ribs and a limb. Silly silly lady. Things could have been much worse.

We then had a patient who had potentially perforated after an operation. I tried taking bloods with a needle and syringe for the first time, I've always used butterflies. Turns out I was worried about nothing... needle and syringe is easier and faster!

I learnt how to be polite, but assertive with other healthcare professionals, and that giving away mini chocolate bars gets you much further than anything else. I practised all my examinations, history taking, blood taking, ABGs, management plans, writing drug charts and even got to have a go at a catheter.

In fact in 1 night shift I did more than I've done on 3 weeks of day shifts.

I think I'll be doing more nights.

Lily xXx

Finding The Words

Those of you who've been reading the blog recently will remember my post about the young patient with cancer, and how concerned I was that no-one had told him anything.

As far as I was aware, from the notes and from what the consultant said, he'd been told his diagnosis last week. He seemed a bit more upset and agitated, but was in a lot more pain. I thought, considering everything, he was taking this bad news pretty well...

Then today I was involved in a conversation with the palliative care team, his nurse on the ward, the FY1 and I. Turns out he'd only been partially told.

I felt sick.

He'd been told that there was shadowing in his imaging, and that this was being further investigated. So really he had no idea. The doctor never explicitly used the word "cancer". The consultant was adamant that the patient knew what he implied. The rest of us weren't so sure.

It was left down to the palliative care team to go over to him and break the news properly, making sure he understood everything.

I've always thought it's important to say things as they are. Words like cancer and death are scary, but it's only fair that the patient knows what's happening. Or at least that's my opinion.

I know that when my Mum was dying in hospital it was a long time before we were told she had cancer and was dying. In fact it was only a couple of weeks before she died. I have no doubt that the team caring for her were aware long before us. Probably like my team they were waiting for histology and a proper management plan. Surely though, for someone with obvious mets, it's important to at least tell them that they have cancer.

I can't help but think that if we had a bit more knowledge about my Mum having cancer that she might have had the chance to die in a hospice, which is a lot nicer than a hospital. I also think it would have been a lot kinder on my Dad and I if we'd been told more and prepared a little more for things.

I just wish I was a bit more influential in the team so that I could help this family a little with what is clearly going to be a difficult time.

I don't think histology or the finer points of management matter that much to patients or relatives. What matters is knowing a realistic prognosis and the major options for the future. Home, hospital or hospice care? Saying goodbye to loved ones. Getting affairs in order. Sorting out finances and wills.

I'd like to know what other people think, or situations other people have been in? What would you do if you were the consultant?!

Lily xXx

Looking Lazy?!

Time management is becoming a big part of this last rotation. Evidently as I have finals I need to spend a while revising for writtens and a while examining patients each day. I also have to show up to see my firm.

At the moment I'm trying to strike some kind of compromise. I'm turning up at 8, going on ward round, hanging around until lunchtime to do jobs and then buggering off to study. I hope they don't think I'm just being lazy.

I also still have sign ups to get. One of them is a sign up for breaking bad news, something we're not allowed to actually do to real patients by most doctors. A few friends have had theirs signed off by doing role play with doctors, but thus-far I haven't been that lucky. Argh.

Lily xXx

Student Beans

So I did an interview for Student Beans...

I think this is the closest I'll ever get to feeling famous, and it feels pretty good. I'd like to apologise to the poor person who's face they've shoved on the interview as we all clearly know I'm anonymous (and ginger...)

It's slightly disheartening that in a few days they can make a better looking banner for the interview than I could make for my blog in 3 years. Clever peoples...

Lily xXx

Bad Timing?

It's not often I blog about something serious, but this is something that's really been playing on my mind.

There's a patient in the hospital I'm in, who is relatively young and has very aggressive metastatic cancer. He's been an inpatient for a week and no-one has told him. No-one has even given him a clue to his diagnosis.

I feel really uncomfortable about this.

The CT he had showed all these lesions, and further tests have been carried out. The reason I've been given for no-one on the team breaking the bad news is that they feel he's the kind of patient who won't respond well to being told half the story, so they want to wait until histology is back and the multidisciplinary team have made a treatment decision.

I don't agree.

I think we should at least tell him that there are suspicious looking lesions on his scan, that the tests we've done so far are specifically to look at these lesions and to find out what they are, and that until the whole team have discussed it we can't give him much more information. Then at least any bad news won't be totally out of the blue.

I have a sinking feeling that no-one is telling him, as no-one wants to be the one to tell this patient the devastating news. I think the doctors are all just waiting for the specialist nurse to come along with the results and tell him.

It's awful. If this cancer is as aggressive as we think it is then the guy mightn't have that long left and will probably want to spend as much time with his partner and kids as possible. With the extra time he may be able to organise care at home or in a hospice, or even a last family holiday before he is too sick to go anywhere.

Every time I see him I want to cry and scream with frustration as he has no idea.

I'm dreading ward round tomorrow. Part of me hope's he's been told, even though I think he'll be fuming with us for withholding information. The other part of me doesn't want that confrontation.

I can't stop thinking about it.

Lily xXx

Referred Panic

I went into ward round this morning. Did the usual... scribbled in the notes, smiled at the patients, checked the obs charts, made sure the nurses witnessed me alcohol-gelling my hands until they almost dissolved and made the right tutting noises at everything the registrar tutted at.

I thought I was doing well.

After ward round the (exceptionally lovely) surgical registrar came to the mess, put the kettle on and made us all some toast. Then we got to chatting. Firstly we chatted about the general madness of patients being on antibiotics too long because no-one thinks when they check the drug chart. Secondly we chatted about how stupid hospital politics are, trying to make us send home dying patients. Then we talked about finals.

I just casually dropped it into the conversation that my finals are in 2 months and 3 days. The registrar was stunned... "Go... go now and study! In fact don't spend much time on the wards... study study study!!" The panic in his voice made me jump a little.

This has got me into a panic. I still have sign ups to get and yet I have a lot of actual studying to do. I'm only averaging 63% at onexamination questions and I've realised I've forgotten all the basic science I ever knew. I had to draw and relearn about kidney nephrons and how diuretics work today. That's really basic first year stuff.

This week certainly hasn't been as productive for sign ups. I got 7 last week... this week so far I've got 1. Tomorrow I'm aiming to get another 1, at a push 2 and ideally I'd get one on Friday too. I don't think it's through lack of effort, I just think I've got the easy ones done now and the last few I have left are a little more complex.

I also need to find out when my consultant is next on call so I can clerk a patient in and get my case study done. Hopefully next week.

I'm not sure why I get these recurrent bouts of panic. I guess it's because I'm so close to the end and I'm just worried that something small will trip me up.

Lily xXx

Scut Work

I know I shouldn't moan. I'm really lucky, I'm doing the course I want, I've got as far as final years, I have amazing friends etc etc. Even though I know this I'm going to have a big moan right now...

It's traditional that med students do the "scut work", basically the jobs no-one else wants to do. For me this splits into educational scut and useless scut. Educational scut includes things like taking blood from 5 different patients in a row. It's not particularly interesting, but at least I'm honing my blood taking skills. Stuff like helping nurses with enemas, setting up fluids, collecting stool samples are all also scut in my mind, but useful as I'm learning how basic clinical skills are done.

Today however I got landed with useless scut. Discharge notifications and referral letters. I think a certain amount of discharge notifications and referral letters are useful to write, as it's a big part of being an FY1, however being pimped out to another team when I'd done all jobs and writing 3 discharge notifications and 3 referral letters on top of the ones I'd done for my firm was so frustrating. To make it worse their med student was putting in cannulas and doing bloods, two bits of scut that I want to do lots of to get some practice.

It's tough as at the start of the rotation we're told not to let people take the piss with getting us to do all the paperwork. An hour or so a day is seen as the maximum for us as we really need to either be consolidating our clinical skills or we need to be studying for our finals.

It's just pissed me off that 90% of my morning was wasted.

I've also pissed myself off by wasting 2 hrs this afternoon napping.

Lily xXx

Awesome

I've started saying "awesome" all the time. I'm now saying it so much I'm even annoying myself.

I'd love to know who started me off with this annoying habit.

"MR X needs a new cannula." "...awesome"

"Can you write the discharge summary for this patient?" "yeah... awesome"

"These free sandwiches are stale." "Really?! ...awesome"

Next time I say it I'm going to slap myself.

Lily xXx

On Fire

...thankfully not literally. Although my boiler currently sounds like it's about to explode.

I just wanted a little boast.

Even though I've been pretty ill this week I've got 7 sign ups! That leaves me with only 10 left to do. Feeling much more chilled out now that I've got a big chunk of them done.

Unfortunately I can't say my revision has been as successful. I've been scaring myself with onexamination questions, which are brilliant, but show that I have a lot of weak areas. I'm lucky enough to have an amazing FY1 who's quizzing me and teaching me all the time... Apart from this I'm not really sure how to revise. I'm trying to make mini revision cards of stuff I should know by heart when I answer a question wrong or find a weakness. I'm also trying to read the Oxford Handbook and Surgical Talk.

How else can I revise for writtens guys?!

Lily xXx

The Final Hurdle

I've started my last placement before finals. It seems like the last hurdle before the exams and hopefully qualifying.

I've got off to a bit of a pants start, having to take today off as I practically put myself into acute renal failure, by leaving a kidney infection untreated. Bad move. Except for that though, it's going well.

The accommodation is standard hospital accomm. It's neither exceptionally good, nor bad. We all have a large-ish single room with desk, bed, wardrobe etc. There's then a bathroom shared by the 5 of us in each flat. What is weird is that they've split up my clinical partner and I, so I've hardly seen her all week.

My firm for the first 4 weeks is interesting. I have no consultant, so need to find someone else to sign my book and case study. Otherwise the FY1s are lovely, and the registrars, although seeming a little gruff at times, also seem nice. Nice for surgeons anyway.

Yesterday before I ended up so sick I couldn't work I also managed to do something that was worrying me. Take bloods successfully... first time! Because I've been at GP since Xmas, I was worried that I'd have forgotten how. Very glad that I've got the first blood under my belt. Now I need to get the first cannula of the year and I'll be happy.

Some of you will also be aware of how worried I am about log book sign ups. Not including my case study or educational contract I had 15 left to do this term... I've done 5 already. Big relief. Unfortunately they were 5 easy ones. Hoping to shadow an fy1 on nights next week and maybe get another couple of sign ups there. Would also be useful to get my case study done then as it's when we're on call.

Anyway I'm off back to bed. Hoping a day of sleeping will have me well enough for the wards tomorrow.

Lily xXx

Om nom nom...

Those of you who know me in real life will be well aware of how much I love my food. I spend hours cooking and am known as a bit of a cookery dragon. No-one dares to interfere. My wooden spoon is sacred.

Strangely when I'm away on placement I just can't bring myself to get the same joy out of cooking. Pokey, dark, cramped kitchens full of other people and strange equipment don't really do it for me. This gets me kind of down.

I'm dreading my 8 weeks of living on chocolate mini rolls and tortellini. So I'm just warning you, if I'm grumpy its nothing to do with you, its the dull food.

Lily xXx

HELP!

I'm feeling soooo stressed out...

Being in lectures for a week has made me realise "ARGH!!!! FINALS!!!". This was made infinitely worse from a talk by an FY1 who opened her lecture with "This time last year I'd read all of Kumar and Clarke, could recite each page of the Oxford Handbook... and just didn't know where to go from there" ... Seriously. Fuck off. If I've got to that stage by finals I'll be laughing. She made me feel sick.

I'm also freaking out about sign ups. I've got an 8 week placement left and a hell of a lot of sign ups left to get, including hard stuff like "breaking bad news" that no-one will let us do, and no-one will sign up for doing a role play. Meh.

My final stressage is my flat. I'm either going to sell it or rent it out. This is really making my head want to explode. It sounds like a minor thing, but it means keeping the flat clean. I am so untidy, so this is such an effort. On an amusing note I single handedly tiled the bathroom floor with lino tiles... go me!!

Anyway I should probably go and actually pack for my next placement at another DGH. I'm moving in on Sunday night. It's strange but I've got to the point where guessing what hospital accommodation is like fills me with joy. I think this is because I've stayed in so many dives now that nothing bothers me, I just see the funny side...

Lily xXx