Posts Tagged ‘Medical Student’

Ethics: don’t be a shit person

September 20, 2011

One day, I hope to be a clinical educator and lecture medical students in ethics.*

I could save universities time and money with my easy one step process to ethical enlightenment.

Step one: Don’t be a shit person

I would have lecture slides each with various fonts stating “Don’t be a shit person”

(there would, of course, be hyperlinks to direct them to the definition of “shit person” and maybe a demonstrative youtube video)

Students could buy a pocket book from my online store to help them through various difficult situations in hospital.

Each page would say:

“Don’t. Be. A. Shit. Person.”

There would be an Iphone & Ipad app.

I’d also sell those silicone wrist bands with “D.B.A.S.P” on them.

Thus ending the tortuous pain of medical students everywhere who attempting to write 3000 word ethical essays analysing cases that could essentially be summed up into one sentence (see above).

*Not. Really. Unless I get to roll out the above plan. Then it’s on.

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On being a patient

September 12, 2011

Accessing health care when being a medical student is a curious thing.

We didn’t have a doctor as kids. My GP dad would occasionally dole out half-hearted advice while he was tiredly doing something else like “Have a glass of water” or “you’ve got blah blah infection – take this (out of date, leftover, with someone else’s name on it) tablet/cream”. I don’t remember taking a lot of paracetamol or nurofen. Or getting a lot of sympathy for anything. As a result when I moved out of home I never went to a doctor for anything much.

Over the last three years medical school induced hypervigilent awareness of my body  has led to many “oh GOD I have cancer IN MY LUNGS/STOMACH/TOE” moments. But despite this hypochondria, or maybe because of it,  I actually managed to delay seeing someone for a condition that I actually had. Oops.

EARLY 2010, LATE AFTERNOON, DR’s OFFICE, SUN STREAMING THROUGH WINDOW

Me: So just here for the pill again thanks.

Dr (making conversation waiting for script to print): soooo how long have you tricycled* this?

Me: Well…I don’t really tricycle…I just keep taking active pills to avoid it  for as long as possible until I get a breakthrough. Previous GP suggested that because my menstrual weeks are total write offs. Sends me batshit** crazy and makes life hell. So avoid. At all costs.

Dr: Hmmn. Do you have any deep dyspareunia, pelvic pain, low back pain, pain on defaecation or midcycle pain?

Me: Uh, yes. Yes. Yes. Yes. And yes. But probably not more than anyone else.

Dr: Even though you’re on the pill?

Me: err…huh?

Dr: Most women don’t experience that. I’m going to refer you to a gynecologist.

Me: Oh-kay.

Dr: Here’s your script. And referral. Go and see him.

Me (thinks): should I have a glass of water?

He gave me the referral last year. I ignored it. For nearly year. Until a weird week on women’s health. I had the usual experience of having my period (cue: hot flushes, chills, dizziness, inability to concentrate, tearfulness, and aforementioned Sx) but with the bizarre complication of simultaneously sitting in on consults listening to female patients describe in detail exactly how I felt. I mentioned this to my hospital partner who looked at me like I was crazy and suggested I go to a gynaecologist. Now.

Then I used the stupid referral. It had gathered dust and I made the appointment exactly 2 days before it would have run out.

The gynaecologist is lovely. Despite looking disconcertingly like George Costanza. We got intimate with the transvaginal ultrasound (not my first time so am a totally natural with the small talk) and he explained my pelvic pathology to me on the screen (because people do that when you’re a medical student…even when sometimes you want to just be a patient). He does lots of infertility cases and other obs/gyne things but his ‘favourite disease’ is endometriosis. Which is awesome because it’s my favourite too I have it.

Sooooo on George Constanza’s advice I booked in for a laparoscopy + diathermy. Feeling very strange about going into surgery having done my surgery term. It’s not just a list of distant unimaginable risks to me when I read the consent form because I know what the procedure looks like. I’ve seen them blow up stomachs with CO2. Seen them put people under. Seen the slack-jawed vulnerable look on unconscious faces.

What the consent form should say is:

Are you cool with getting naked, hopping up on a bed, having us knock you out with gas, shoving a tube down your throat, taping it to your mouth and then taping heaps of sheets to you, shoving some cameras and metal instruments in your gut, blowing your gut up with CO2 so we can see better with our camera, and then using a little burny torch thing to fry off all the pesky ectopic tissue off your bowel, sacral uteroligaments, ovaries and what not?  It’s totally cool though, we do it all the time. We’ll probably be talking about our weekends or what was on TV last night while we do it. We’ll try not to let you die, or cut off your ovaries while we do it. Rarely happens. Yup? Cool.

Sign here.

I kept thinking “oh, but this is where I tell YOU about the risks. I’m supposed to be sitting behind that desk…wha?”

Being a patient is WEIRD.

*taking three consecutive packets of active pills, and skipping the inactive, thus not having a period during that time. 

**like, actually batshit crazy. Think Exorcist. Followed by lots of apologising. 

On being a groundhog (or Sympathising with Bill Murray)

September 10, 2011

Hamster in a wheel feeling.

Bleary eyed cup of tea.

Out of milk.

Never mind. Have it black. Put the toast on.

Bread…where is the…oh.  Out of bread.

Never mind. Have cereal instead. Pour in bowl.

Shit. Out of milk.

Damn it.

Get in car. Spill tea on dress.

Repeat tomorrow.

Fatigued in the afternoon.

(Fatigued in the morning.)

(Fatigued in the evening.)

Stepping over the mound of unwashed laundry in the bathroom.

Stacking the dishes higher.

Piling the articles to read higher.

Balancing the “to do” list on top of them.

Eating the fridge bare until crackers and canned tomato sound like a reasonable meal.

Still finding time to avoid all basic household tasks and life skills in order to trawl the internet reading blogs.

We’re in procrastination season.

Nine weeks and counting down until…

FINAL EXAMS.

(For third year…obviously not final exams ever.

Because they don’t

actually

exist.

Sob.)

Wisdom from the Psych Ward

September 9, 2011

Wisdom gleaned from current patients:

– God is a 40 something male with very clean fingernails. On my ward at the moment.  I can’t tell you much more as he doesn’t want anyone else to know…

– The Greeks are the oldest bloodline dating back to the beginning of mankind. Thus they are better than anyone. Much better than Germans. French people are okay though.

– If you find a strong woman don’t marry her. Strong women can’t be tied down and married.

– To counter depression you need to balance it out with exercise and diet. If you are really intelligent you need to counter it with lots more exercise and a better diet because being intelligent makes you even more off balance and depressed. Either that or you should walk barefoot. It keeps you balanced and in touch with the earth. Which brings me to the next pearl:

– Shoes should be banned in schools. Children growing up need to feel the earth between their toes. But then they should wear thongs in the classroom. Of course. (Which isn’t a bad thought really, until you read in the file that the particular patient has a history of attempting to abduct children from his old primary school…no doubt to liberate them of their shoes)

– Everything and everyone is corrupt. We could all be shot on the street. There are conspirers everywhere. Especially Beyonce. She’s the worst.

– The mastermind behind 9/11 is a 50 something homeless man with a predilection for amphetamines, cannabis and the occasional hit of street morphine.

 

serendipitous dining

September 6, 2011

I stayed back late at uni to go to a friend’s lecture on ECGs (because I think they look like great fabric patterns and not much more). It turned out to be more beneficial as this decision led to a series of events that resulted in one of those nice perfect opportunities.

It finished up at 7:30 so I popped into a great Japanese place that does amazing hot chilli noodles with kimchi. Waiting for my takeaway I spied my surgical registrar from earlier in the year eating with another colleague. We had had a great relationship, and struck up a funny friendship. She smiled and waved. I waved back. Once I had my steaming noodles I stopped at her table on the way out to say goodbye.

Her colleague is lovely as well and asked a few questions about my new rotation, how our exams went, chatting about his new students, enquiring into how we enjoyed surgery etc. Before I knew it I’d been leaning against the wall near their table for nearly fifteen minutes. I made a move to leave but they insisted I stay and eat my noodles at their table.

It was one of those lovely, spontaneous meetings that had great flowing conversation, laughter and great stories. They’re both surgical registrars with high ambitions, tough jobs and insane work hours, yet they had so much joy about uni, life, travel, career options,hospital gossip and of course, food. It was really refreshing, especially after a whole day at uni, to see that at the end of all these, even in the midst of a gruelling program people are still people with *gasp* great personalities, and hilarious conversation.

I mentioned how much I missed the teaching this reg had given during our time with her, as its not available in all the other rotations I’ve been on (she had done diplomas in medical education and really made a point to get us involved). She said that she’d just changed jobs and didn’t have any med students so any time I wanted to spend time with her if I had a day off I could spend it with her, doing plastics.

I nearly choked on my noodles. Acting nonchalant I was all like “Oh yeah, that would be great, thanks. I’ll totally take you up on that.How great are these noodles, hey?”

Here comes the embarrassingly nerdy confession. I love plastics. Not the “boob and nose job” aspect of it (which does predominate in my particular area…) but the finesse and skill of the surgeons. The art. The sewing. My name is MedicallyBlonde and I totally get off on suturing. To the degree that my freezer holds six pig trotters, ready for defrosting when my suturing buddy comes over and we drink wine and …well…suture on a friday night.*

The opportunity to be able to shadow a plastics registrar and consultant is beyond exciting. I don’t want to actually *be* a plastic surgeon (although if there was some kind of dream world where I could be one for one day a week and the rest be a GP that would work), but I want to have the neatest suturing skills possible. Because if a patient comes into my (imaginary future) GP practice with some trivial laceration I want to be able to do it as close to how a plastic surgeon might. I’m competitive about that particular skill. Venepuncture and ABGs can be damned, but by god I need to do a perfect stitch. It might come from being an OCD knitter. And crocheter. And embroiderer. It was that damn cross-stitch they teach you in primary school. Got me hooked.

So there. I’m officially a dork. I love basic suturing and…dermatology. The uncoolest aspects of medicine. I just get off on skin in general. Just pass me the thick bifocals and I’ll sit in the corner reading my derm books and playing with my 4.0 nylon.

*what do you think of my trotter-work? 

how to write a form (or “the clinical years”)

September 6, 2011

I should be recording the events of this year.
This ridiculous, ridiculous year.
This year that started on the 10th of January, with one week holiday in June and 47 something weeks of uni with early starts, late nights, being stuck in surgery, being humiliated, being triumphant (in the smallest of things), being crushed, being humbled, witnessing the slowest of deaths, the swiftest of deaths, the slowest of births, the swiftest of births, the phelgm, the blood, the tears, the families (oh god, the families), the residents, the registrars, the consultants, the nurses, the hospital food, the free lunches, the hilarious patients, the sad patients, the angry patients, the stitch cutting, the blood taking, the holding of surgical instruments, the firsts, the moments of clarity (with their emphatic promises that you will NEVER go into that speciality/do that procedure/watch another one of those/do another one of those ever again), the learning. The godforsaken learning.
So much learning.
The fevered collection of tips and tricks scrawled onto scraps of papers, or hands.

How to organise your day as an intern, how to tick all the boxes, where to put the Xray form in, who to call when the login won’t work for the blood results, where to find staff phone numbers on the intranet directory, how to write a request form, a consult form, a *insert anything* form, where to get a coffee at any hour of the day, how to request an MRI or angiogram and actually get it, how to answer a question without actually answering it, how to look interested whilst mentally doing your shopping list, how to actually say something other that “um… increase in squiggly lines” when interpreting an ECG, how to placate to angry famillies/coworkers/patients/cafeteria staff, how to avoid killing someone.
That last one is reaaaaally tricky.
My expectations have shrunken so that instead of aiming to be super-mega-doctor. I’m going to start with “Not killing people” and then build on that.

I’ve noticed that all this learning, accumulating has become addictive. If I spend too much time off, wandering, floating through op shops, visiting family or reading books I actually start to get down. I get itchy, feeling like I should be doing more. Overwhelmed by this guilt of “Oh god. I could have learnt SO much in this day and I frittered it away”. There is something unsettling, unnerving about becoming aware of the potential of a days learning. What a day wasted can mean.

Despite this, there are days (often concurrent) when I live in my pyjamas, eat over the sink, forget to brush my hair and don’t go into uni at all. The perfect antidote.

Careless Surgeon

March 21, 2011

Because I’m on surgery this rotation:

Stepping on toes

March 21, 2011

Uh oh.

I recieved an polite email from an acquaintance who is a chiropractor regarding the studies done that show the minimal risks of spinal manipulation of the neck. I was slightly confused until I  read further down what had happened.

A few months ago, a close friend and I were having dinner. She mentioned how much she hates having her neck ‘cracked’. I told her about a funny lecture we had from a radiologist who declared that we were never to go and let a chiro or osteo touch our neck unless we ordered an ambulance beforehand – he’d seen way too many vertebral artery dissections leading to strokes and death all from patients having their necks ‘cracked’.

That was the radiologist’s opinion. He got a laugh out of the lecture theatre and then continued to show us head CTs of strokes.

I didn’t think anything of our neck cracking conversation until I opened my email recently. My close friend had been with this acquaintance a few weeks ago and had complained of a headache. The acquaintance had casually attempted to put her neck back into alignment. My close friend protested a little too much and then spilled the beans on what I’d told her. Thus acquaintance felt it necessary to defend profession and send email.

AWKWARD.

Is this a trend to come? My instinct is to keep my mouth zipped from now on, and not mention any of my opinions to anyone ever again, even if it is just over dinner (a slightly lonely prospect). Yet at the same time, I feel that if my friend was inherently uncomfortable about a procedure, then she should not have to protest and cite arguments to avoid it happening.

Still, I feel awful about stepping on toes. No one would like to feel like their profession and livelihood is being derided. That was never my intention. Yet no matter how many ways I phrase it in my reply to this acquaintance, I still sound like a stuck up medicalised square. I think I’m going to stick with “Thanks for the info. I found it a great read”.

Then avoid eye contact at birthday parties for the next ten years.

Niece

March 20, 2011

My niece was born a few months before I started medicine so I tend to be simultaneously amazed at her development, whilst comparing it disparagingly to my own. It occurred to me that she would be four by the time I graduated, and would be someone I could have a CONVERSATION with. It blew my mind at the time. It still does. As uni revealed itself to be, uh, quite difficult, it occurred to me that she may be much older before I actually graduated. I began to count time by her clock.

In two and a half years she has learned to hold her head up on her own, to focus her eyes, to follow sounds, to grasp objects, to roll over, to crawl, to gesture, to feed herself, to communicate using language, to walk, to scribble,  to crack a joke, to demand things of bigger people, to hop on one foot, to hide her messes, to use a potty, to hold her pencil properly, to dress herself, to refuse to wear things she ‘no LIKE!’, to have a voice, to name everyone in the family, to have a proper tantrum, to stomp, to dance, to jump on beds, to slurp spaghetti, to burp loudly, to use a mobile phone, to work the ‘moooo-veee’ machine, to twirl around with a big full skirt, to get dogs to ‘sit DOOOOWN’, to jump through puddles in big yellow duck gumboots and to laugh manically whenever someone on TV gets hurt.

Two years ago I couldn’t locate a femur. Lately, I’ve been allowed to see patients on my own. Without anyone. BY MYSELF. Having a chat, taking their history, doing a rudimentary exam and playing ‘doctor’. Of course I have to then get the registrar…who then has to go and get the consultant. But for those few moments when it’s just the patient and I, I feel like my niece when she’s clunking around the house with ladies size 8 shoes, a mobile phone and a handbag, announcing to everyone she’s going “OWT”. I feel a little teensy bit grown up.

Then later when talking to the reg or the consultant…and we’re actually having a medical conversation about the patient, a disease process, a prognosis…it catches me: I know these words, these nuances, these unsaid implications. I’m having a CONVERSATION.

 

 

Rhinoceros Unicornis

March 17, 2011

Endocrine Surgeon: …another concerning risk at the moment is the potential damage to your parathyroid glands during the thyroidectomy.

Patient’s wife: What are they, doctor?

ES: Well, our med student can answer that.

Me: hmm? urh, well, they, uh, regulate calcium in the blood and…uh…

ES: Yes! (Spins on chair) Did you know they were the last organ to be discovered?

Me: No…wow.

ES: What year were they discovered?

Me: ummm…I don’t know.

ES: I want you to find out what year, who discovered them and what colour the animal was that they were discovered on.

Me: haha. Seriously?

ES: uh, yes.

Patient: Was it a monkey?

ES: No.

Patient’s Wife: A dog?

ES: No. Stop narrowing it down for her.

So far I’ve got:

The parathyroids were discovered by Richard Owen in 1850 in an Indian Rhinocerous (Rhinoceros Unicornis, now the emblem of the International Association of Endocrine Surgeons) that died after a fractured rib punctured its lung and was bequeathed to him by some Zoo in London. He used to get all kinds of animal carcasses offloaded to him for his research. His wife apparently walked in to find the Rhino lying in her hallway. She was pissed. He also critiqued and argued with Darwin. He was badass.

Parathyroid glands were then first discovered in humans 30 years later in 1880 by Ivar Sandstrom, a swedish medical student. This piece of information upset me somewhat and led to feelings of  incredible inadequacy. Not only have I failed to be involved in research thus far, but I have almost certainly missed the boat in terms of discovering new organs.

But back to the Rhino. I know it had been living in the Zoo for 15 years before its death. The Zoo had paid 1000 guineas for it. It fell and fractured a rib leading to a punctured lung. It then vomited slimy blood streaked vomit for weeks leading up to its collapse and death. What I CANNOT find, no matter how many google searches I run, is WHAT COLOUR THE FREAKING RHINO WAS.

It’s not black. Its not albino either.

Endocrine Surgeon smiled and said “Well done. But no. Not black. Not albino. More research. You’ll understand why its important when you know the answer.”

Anyone have any idea?

Is this some sort of in-endocrine joke that I’m not getting?

 

added to note:

I’m an idiot who read wikipedia wrong in my haste yesterday;

This prehistoric-looking rhinoceros has thick, silver-brown skin which becomes pinkish near the large skin folds that cover its body. Males develop thick neck-folds. Its upper legs and shoulders are covered in wart-like bumps. It has very little body hair, aside from eyelashes, ear-fringes and tail-brush.

I still don’t get the joke.