Wednesday, 25 May 2011


The results came out.  Amazingly I passed that shocking competency.  I was so pleased, I was grinning all day.  Today I found I also passed the essay I had to submit after the dermatology SSU I did just before Easter break. I got marked down for silly things that were IN THE HANDBOOK AND WE HAD TO DO(!!), again, but at least I passed.  In the feedback I was told not to reference the BNF, which was a bit weird.  Anyway, it all means that I am only one exam away from being a second year.  Either the AMK I did last week, or the End of Year coming up a few weeks.  How exciting!  I'm confident for the AMK, I really think I've passed it.  Which is dangerous for me.  Given my track record it means I've probably failed it horribly and they have serious doubts about my passing into the second year.  I'm always pants at second guessing exam performance.

Yesterday at work I had to handle my first complaint.  A patient had had an operation and needed their stitches out.  The 7-10 day window they were given to have them removed in falls on a Saturday, Sunday, Bank Holiday Monday, Tuesday.  The only free appointments on the Tuesday are with the HCA.  The patient was as pleasant as you like until I told them it was an HCA they were booked in with, at which point they demanded a nurse or a doctor - someone 'medically trained'.  It didn't matter how much I explained that our HCA was lovely and fully trained to inspect their wound and remove their stitches, they were adamant they didn't want to be seen by a 'sham nurse'.  They asked to speak to the Practice Manager to put in a formal complaint that they felt they were giving us plenty of notice and our services were poor that we didn't have anyone medically trained to see them.
It would seem that perhaps some members of the public don't want a multi-disciplinary team way of working?  In case you're wondering, I sent the patient to the walk in centre where they can wait for hours to have their stitches taken out.  I'd laugh so much if an HCA did it there after all.

Sunday, 22 May 2011

Pooped Bean

Did I mention the week I've just done was going to be horrid?  It was horrid.  By Tuesday I couldn't wait for it to be Friday.  Monday I had placement at the mobility centre.  It started with a tour of the factory where they hand make all the casts and shoes and prosthetics.  It was sweet and sad all at the same time.  The factory was pretty large and the walls were lined with pictures of what the factory used to look like with all the benches full of workers hand crafting things.  Now each room had maybe one or two old men who were proudly showing us what they were working on and the design process.  They were smiling at me and telling me that because us Doctors were becoming so clever at our jobs and noticing problems faster and finding new ways to surgically correct them and since plastics became so easy to mould there wasn't such a need for hand made casts and prosthetics anymore so they'd slowly all been laid off.  They make shoe insoles and permanent leather casts, but that's it.

Next, I spent an hour watching a physiotherapist run a rehabilitation session with a man who'd had his second leg amputation 9 weeks ago and was learning to walk with two prosthesis.  Although to be fair, the physio didn't have to do much.  This man was amazing - willing to take on any challenge, keen to show all the tools the physio had, any 'game' she explained to help him master a new trick on them he wanted to do, and do, and until he'd perfected it.  He had three great danes and was determined he was going to walk other on the moors this weekend, as he had done previously when he had only one leg amputated.  Even if that meant walking round the facility time after time after time, trying to find someone to play football with him in the carpark, stepping from balance hedgehog to balance hedgehog to practise for the marshy ground up on the moor.  This man was awe inspiring, truly.  Whilst he was training another man came in in a wheel chair, not as far along in the acclimatisation stage of getting used to his leg but it was still fascinating to watch - his determination, and his strength.  He joked that he thought it was a lot easier to learn to walk the first time.

Eventually there were three guys, all getting on with pushing themselves to learn how to adapt with the new changes in their lives.  Incredibly to me, another guy came in looking at what was going to happen, smiled and said he was having his operation to remove his leg next month.  The other patients looked at him and smiled and one said, "Congratulations!  Having mine off was the best thing I ever did."  Such a strange concept.  Through listening to them talk, it turned out all the patients were ex-forces which was quite upsetting for me as  I wasn't really expecting it.  I haven't really been challenged like this before, in terms of having to put my personal circumstances on a back foot and ignore it.  I managed but I have to admit there were tears in my eyes as I was walking away from the factory.  I can't imagine myself ever being strong enough to watch Mr have to learn how to walk again.

Tuesday bought my combined clinical competency in respiratory, gastrointestinal and cardiac exams.  It went pants.  I got the most pernickety examiner and I'd gone through it so many times with my partner, all the run throughs blurred together in my head and I couldn't remember what I'd done in the test and what I'd done in practise.  I was so frustrated with myself.  On the marksheets I got some excellents, some satisfactories and a borderline.  I really don't know if I've done enough to pass once my score gets moderated.  I don't think I will have done because the evaluation reports say Exeter students do worse than Plymouth students, and I've been in a bit of a pessimistic mood lately.

Wednesday bought the last AMK of the year.  I thought it went quite well.  I enjoyed it actually. I answered more questions than ever, again, and I took longer at it, again.  There were more questions I knew the answers  to because of my degree and revision, and educated guesses I could take from seeing things at work.  On the other hand, everyone else seems to have hated it.  I'm not sure if that's a good thing and I'll therefore have done really well, or if I was really wrong with all my guesses.  Because they are meany, we don't get the results in the normal two weeks, it'll take 5 and half.  Which means I don't know if I've done enough to pass the year and if the end of year exam is necessary for me to pass or just a formality.  Meanies.

Then it was Thursday, and Mr's birthday, and no, I hadn't sent him a birthday card, or present :( Bad girlfriend.  Hope he understood.  I also had an essay to write for the next day - on Ethnicity, Race and Health.  It was to based on a chapter from a sociology book we'd been photocopied and given.  I had real trouble with this one because I didn't actually agree with anything they had to say.  Apparently the genetic differences between different races were too minute to be significant and therefore there's no such thing as race or ethnicity, they are just social constructs.  We shouldn't treat people any differently because of what they look like, which I do believe in, but to say there's no difference between people from different parts of the world is ridiculous and PC to the extreme.  Hopefully, I got a mark in the AMK for remembering the NICE guidelines suggest one line of treatment for the under 55s or non Blacks/Afro Caribbeans and another for the over 55s or Blacks/Afro Caribbeans because they have lower levels of renin and so ACE inhibitors don't work as well.  Should I ignore this fact then because the difference isn't 'significant'?  It's rubbish.  I managed to write it in the end, ticking the I'm not a racist box and putting my own point of of view across.  They did say there wasn't a wrong answer and I've got to do better than one of my peers who decided to end his essay with "well, it could be worse, at least I'm not Irish".  Not entirely sure that's what they were looking for.

To get over this week I made the best cake using up some rhubarb I had - rhubarb and custard cake.  It's amazing.  This has been a bit of an essay, so I shall leave it there.  Tomorrow I start the last case unit of the year, how sad.  I wish you all good luck in your exams!

Friday, 13 May 2011

Hormone Soup

This week has been one of those where I'm reminded just how pants it is to be a girl.  Crippling stomach pains, crying at the most tenuously soppy things, broody at anything baby related (even the maxillocraniofacial babies), grumpy for the tiniest things and the next minute bouncing off the walls hyper with the slightest good thing (surprise strawberries in my veg box from Mr this week!!!).  It's a wonder half the population function like normal human beings to be honest.  I've managed to keep the worst of it behind my bedroom door, so I haven't snapped at anyone or gone mushy at them which is good.

Since exams are looming it is also time to welcome the stressy bean ball back.  Panicking that I haven't done enough and I won't be able to fit it all in before the exams.  Insomnia because I can't switch my brain off from worrying enough to sleep.  Not eating properly because I'm picking at bits throughout the day whilst I work.  It's not good.  What makes it worse is I know I'm over reacting.  I know it's just the stupid hormones exacerbating normal nerves over something that matters.  And that when I'm like this it's not me.  I'm not a soppy person.  I'm not broody.  (I'll admit to being a little grumpy sometimes though).  Next week I have the final AMK of the year.  If I pass this I pass into second year and it doesn't matter about the End of Year 1 test.  On the other hand, if I fail the end of year it's a good indication I'll fail year 2, apparently.  The day before the AMK I have a combined clinical competency in cardiovascular, respiratory and gastrointestinal exams.  The day before that I have to give a five minute presentation on why the placement I will have been to that morning deserves £50,000 of theoretical money.  I am not looking forward to next week.  One bit.

Friday, 6 May 2011

The Many Hatted Bean

I had a toughie today, I really had to restrain myself.  I was at job number 2, the GP surgery and was working on the front desk on my own.  A mother rang up clearly upset.  She was asking for an appointment as soon as possible for her young son because the anti-histamines weren't working and she didn't know what to do.  She said she kept giving him more but all they were doing was making him sleepy and difficult to wake in the mornings which she was feeling very guilty for.  Without thinking, whilst looking for open appointments my med student hat slipped on and I asked what was wrong, although I had pretty much guessed from her description.  I was correct, her son had eczema.  He's fine in the morning, but his skin gets redder and itchier throughout the day, so she wanted an afternoon appointment so the Dr could see how bad it was and how the anti-histamines weren't working.  She was so upset and beating herself up about giving him poor care, and I really wanted to tell her that all anti-histamines are given for is to make them drowsy enough to sleep through the itch at night.  I've just done my dermatology placement see, I know about eczema.  I don't like to think the Dr didn't explain the treatment regimen to her, I would hope it's just she didn't quite understand.  After all, if we get an itchy rash because we're allergic to it we take anti-histamines, but it doesn't work that way in the little ones with eczema.

A little later on, a patient was being very particular with the appointment slots they wanted, and I came across a colour of appointment slot I didn't recognise.  We use different colours to denote different classes of appointment, for example purple would be admin, green slots are bookable only on the day, red for bloods, orange for imms (the nurses get upset if they have to do more than two baby imms in a clinic, they don't like making the babies cry)  etc.  This one was a sludgey green and when I asked my colleague she peered over my shoulder and said 'oh, that means there's students in.  So you see a student and the Dr just observes.  Are you sure you're alright with that, you don't have to, you can see a proper Dr.'  She made it sound so awful, as though it was unimaginable anyone would want to be seen by a student because we're all such horrible people, aren't we?  It was a fifth years clinic as well, so they're pretty much qualified, especially given our strange exam style.  Ooo, I so wanted to tell her to be quiet and stop painting us in such a bad light.

I also had a bit of a silly bean moment.  I was summarising patient notes, and one set said a patient had had a termination, and the tests carried out on the fetus showed it was a mole.  I'd never heard this term before and was puzzling as to how a person can be pregnant with a cute, blind, fluffy thing (a la Moley from Wind in the Willows).  Especially because one of the random facts stuck in my brain is that humans are the only animal that cannot breed interspecies.  When the sperm reaches the egg, if it's not human sperm the egg locks down and it can't penetrate.  Cool, huh?  Anyway, after some googling I found it's a molar pregnancy and it's when the egg doesn't have any DNA, or the egg is fertilised by two sperm.  This results in either a 46 chromosome all coming from the sperm, or a 69 or 92 chromosome foetus that doesn't develop properly and can form a cancer.
Photo from photobucket

Oops.  Ah well, can still hide under the big "I'm a Fresher, don't laugh at me, I know very little" placard for a little while longer.  Job number 3 finishes tomorrow, no more censusing bean.  And I should be able to fix my car, once my parents give me back the money I lent them.  I've applied for another job, it's perfect.  Ha, another job, I can feel Mr groaning and rolling his eyes, telling me I don't need another job, I need to study.  Which is true, but I need both.  Dilemma.  Anyway, this one is to potentially replace job number 1 and be my full time summer job.  It pays slightly better and is set in the hospital, collecting data for an endocrinology randomised control trial.  Reading the blurb about who they are looking for, you couldn't write one better suited to me if you tried.  The only problem is that the closing date for applications is June 10th, the last day of term.  Ideally, I should be telling job number 1 I want to come back now.  I can't really tell them I want to come back and then pull out at the last minute if I get this awesome job, because that's not fair and they'll never have me back again.  On the other hand, if I leave it they may not factor me into their work planning and budget.  Plus HR are unbelievable slow at sorting contracts and log ons and swipe cards to enter the building (since they de-activated mine and they can't re-activate it *sniff*).  Sooo, I don't really know what to do.  I've been hankering to get back into research since my dissertation, and if they want to pay me to do it, all the better.  I may even be able to wheedle my name onto the end of the authors list of the paper, you never know.  But I can earn £3000 for definite at job 1, which is a major chunk of money, and not to be sniffed at.  Even if I am finding the job incredibly dull since starting my double life as a wide-eyed in wonderment med student.  I don't know!  Inspiration and a firm decision either way kindly accepted.  Can pay in chocolate, since I found when going home for Easter that I hadn't actually eaten last years Easter eggs yet..... 

PS.  Mr gets awarded a shiny sword today for being very clever and coming top of his Army training course. I'm very proud of him and although I couldn't be there to watch him get awarded it, I'm sure he looks very nice in his fancy uniform with a new shiny sword.  *Beams* <3

Monday, 2 May 2011

Back to it

Last day of the holidays today.  I am sat back in halls, I don't think too many people yet it's very quiet.  Which is good because they can't hear me singing along full pelt to the Rent soundtrack (~guilty pleasure~).  Well typically I didn't get half the things done I wanted to. I did the essay, all bar the pernickity formatting hoops to jump through.  It's not bad.  It's not amazing, but it'll do.  Now I have to waffle another 2000 words on how I work in a group and how it makes me feel.  And revise because in two weeks I have my last AMK and combined competency in two days.

My bags are all still packed around me.  I hate unpacking.  I like it when everything has a place, but not the act of putting things in their place.  Can I just click my fingers please?  Mr came down for five whole days.  It was amazing.  A shame I had to spend most of it working or writing my essay, but it's nice to just do normal things, every visit doesn't have to .  We used vouchers and went for a couple of really nice meals out, and had a big family get together with Mum's side of the family for a late Easter gathering.  It was lovely.

There's only six weeks left of term.  That is a very strange thought, six weeks of being a first year.  It's gone so quickly and I've enjoyed every moment.  Even though it's this far through, and I moan about work I have to do, I honestly wouldn't want to be anywhere else.  I still can't quite believe it.  The Student Room is filling with next year's Freshers and in a funny way I'm a little bit jealous.  It doesn't seem that long since it was my exciting news.  Fingers crossed it'll continue and I can be an over-excited second year too :)