Saturday, 25 February 2012

Study Week

For the first time in my uni career I've had the luxury of a study week.  At Southampton I enviously watched all of my house mates and friends having their study/reading weeks and I have just finished a whole week off.  No lectures, no deadlines, it's been bliss.  Now don't get me wrong I LOVE my course.  I love being a medical student.  I cannot wait to see what's coming up next, I don't take for granted any of the opportunities I have but oh my hasn't it been nice to have a break.  Constant Reader will know that it's very unlikely that I took this week off to sit in my room twiddling my thumbs, that's just never going to happen.  I worked at the surgery, I did some bits with Mum and I had a life and went to the pub to see a school friend I haven't seen in 9 years who's been bugging me to meet up with them for months, and every time I say yes, and then the next time I look up weeks have gone by.  I didn't do any work and I feel very guilty about that.  On the other hand, it was amazing! Everything I have to do fit into my time.  Apparently I can only fit three lives in my one.

Coming up I have sooo much to do, I'm really feeling the pressure, which is why I feel so guilty for not studying during study week.   In my defence I was ill for the whole week, which didn't help.  I have two presentations, an AMK, 6 competencies, PBL and 2 essays.  I used my study week to catch up on my life, can I have another to catch up on work now please?

Monday, 13 February 2012

Under Pressure

This year our GP placements take the form of a full day in the same GP surgery and we get to go about once a month.  We go in pairs, and mine splits us up, so we have a morning each with a different GP and then we swap over.  It depends on the GP you're with how much you get to do, but it generally works that if you answer all their questions correctly and seem keen you get to do some hands on stuff yourself.  That's aside from the competencies we have to demonstrate and have assessed over the course of the year.  My last placement went very well.  I was with a GP in the morning who let me be very hands on, which was nice.  At one point I thought she was going to ask me to do a vaginal smear, but as she was asking me questions about it I pointed out we hadn't been taught that yet, so she did it and let me assist instead.  She had me fill three tubes of blood from a person, which I got first time and was very pleased with myself, as I struggle in the clinical skills lab when I swap over the tubes and lose the vein.  I rocked my competency and got an excellent in it, so was feeling on top of the world really.

In the afternoon I went in with a GP I hadn't sat with before.  We had a couple of problem patients come in and I really admired his patience in dealing with them.  One came in to clarify the medication list they'd been given when they came out of hospital.  From listening to them, it sounded more like they understood the medications, they just wanted a healthcare professional to make a bit more fuss over them.  They'd enjoyed all the attention in hospital, as they'd been  pretty poorly but then got better and was sent home and they just wanted the fuss to continue a little longer.  Another patient came in and I swear they must have been actuary because they wanted to know the rates of MRSA and C Diff in the local hospitals as they had to pick somewhere to have their knee replacement done.  They'd only go somewhere that had never had those diseases.  Then they tried to 'test the system' and get the GP to tell them when they'd had an investigation done and what the outcome was so they could be satisfied the record keeping was good enough.  I understand it's probably just they were scared about their operation, but I'm not sure that wasting the GP's time in that way was the best way for them to deal with that.  I did love the way the GP dealt with the stress though.  Once the patient had left the room he stood up and said 'I think we need a chocolate coin after that one, don't you?' and chucked me one from a little stash he had in a cupboard.

The final patient that came in was a bit of a worry though, and I really want to know how they got on.  The patient presented with a three month history of a cough, night sweats, putting on a lot of weight, bowel movements of normal frequency but varying consistency, anorexia, stomach bloating and feeling sick.  They'd been for a chest X-ray for the cough and that had shown what was possibly a small shadow behind the clavicle, but may have been artefact.  They had come for the results of the X-ray and to tell the GP about the anorexia, weight gain, night sweats and bloating.  The patient was due to have an ultrasound of their liver at the end of that week, as a previous examination had shown it was enlarged, but the liver function blood tests had come back normal.  Now, all sorts of alarm bells and big red flags are flashing and waving in my mind, as this sounds like textbook cancer of some sort.  I exchanged a couple of glances with the GP, and the look on his face told me he thought the same.  I felt so bad for the poor patient, and really uncomfortable,  They had no idea.  They'd just been through a really messy divorce, had a whirlwind holiday romance and gotten remarried, this was the last thing they needed.

I wasn't sure how the GP would handle it, whether he'd tell the patient what it might be, or whether he'd wait until there was conclusive proof.  What I didn't expect was what the GP said next: 'Do you mind if the medical student examines your tummy first?'  The patient was more than happy and jumped up on the bed and removed their shirt.  Then I really felt the pressure.  I knew there was something to find, and I really wanted to find something, to give this poor patient the answers they'd come to their GP searching for.  Normally we do exams on each other and there's never anything to find,  We go through the motions and can answer the questions of oh I'm looking for this to indicate that, or that to indicate this, but we know we won't actually find anything.  I was an idiot and completely missed out the whole, stand at the edge of the bed, observe, start at the hands and work up business.  I've done it so many times, but I knew the answers weren't there, so I skipped those bits.  Luckily that wasn't my competency test.  I was just so anxious to get to the cause.  I felt their stomach and there was general tenderness, not localising to anywhere, a massively enlarged liver, no fluid,  and the whole abdomen was firmer than it should be.  Not tense, but not normal.  Apart from that there was nothing, no obviously palpable mass, just a generalised, feeling of something being not right.

I was so disappointed.  I know what the answer will be, but I wanted to give them something real to take away with them then.  Instead, the GP just had to tell them that there may be lots of causes, some sinister, some not, and to wait for the results of the ultrasound.  Medics amongst you will be familiar with the five F's that make up the differential diagnosis for distended abdomen: foetus, food, fluid, flatus and f*in' big tumour.  Is it best to keep the truth from the patient when it's glaringly obvious what the problem is, even though it's scary, or is it best to have them worry about it sooner before any definitive proof?  Or is that one of the really good parts of being a GP? That you have a get out clause for giving bad news.  I guess it depends on the patient and how much you feel they can take, but it felt so tense in the room with the GP and I sharing the same suspected diagnosis and the patient being so anxious.  Especially since if it has metastasised to their lungs that's a really bad sign for their prognosis.  That said, it was on the wrong side for that.  I thought stomach cancer went to the top left lung, and this was top right.  They were very tender in that area when palpated so there's a small chance it could be something else, but it's not likely.  I will try to find out what happened to them next time I go.

Monday, 6 February 2012

The Dreaded Phone Call

When I was at work the other day I got a phone call and for a moment my heart stopped beating.  I don't get a lot of signal at work, so I didn't really catch what they said, but the conversation started with:
Them: Hello, is that Miss Bean?
Me: Yes...
Them: This is xxxx from mr's battalion, corps

My heart stopped and I immediately thought the worst.  Although I am his person, if something were to happen to him, it likely his parents would get the smart men in suits to the door to break the bad news.  Though they may send me some too, I would probably get a phone call, which was what I thought this was.  Mr is far away at the moment, out of the country, in another time zone for 4 months.  Although he's had the odd couple of weeks in the EU on exercise it's the first time he's been away on tour, so far away, for such a long time and out of contact.  We do pretty well with our long distance relationship, but this is tough.  My best friend has left the country, I can't just pick up the phone and tell him about my day, or hear about his.  We normally ring each other everyday from bed before we fall asleep to talk to each other and he keeps me grounded and sane and makes me laugh and smile everyday without fail.  I am so lonely without him.  It's about 81 sleeps until he comes home now, but we don't have a definitive home date yet.  Then he's back for a few months and then off out again for a couple more months.

I keep seeing everywhere happy couples, pregnant ladies, slushy film plots, my housemates nipping off for the weekend visiting their other halves and it's Valentine's Day coming up - all just reminders that my mr isn't here and isn't going to be here for a really long time.  It's worse in a way to being single, because at least you don't expect anything then.  But we haven't broken up, we're really happy, it's going well and still he isn't here.  Because of the ridiculous time difference and his insanely long working day hours if I'm lucky there's a five-ten minute window when I can skype him in the evening and it's his lunch break.  If not, I can stay up really late/early in the morning to talk to him when he's finished work, or he has to get up even earlier to talk to me before he starts work.  It's pretty impossible to work with.  Safe to say, I'm not a happy bean at the moment.  I'm not doing bad, but I'm so lonely.  Friends that I talk to keep saying how they don't think they could do it, mostly because it's too long, but some said it was because they couldn't trust them.  Thankfully, we don't have that problem.  I laughed when they said two weeks away was too long.  Ahh, to be one of those normal couples where good bye means I'll see you tonight, not I'll see you in a month or three.

Happily, what it actually turned out to be was an invite to a Ladies Night Dinner his mess are holding for all the wives and girlfriends of the guys who are overseas. And breathe....  I can't make the dinner night because it is a school night for me, so I kindly declined the invitation.  With that, the nice man on the end of the phone told me that if I needed anything at all while mr was away I only had to ask and they were all there to support me, even though I don't live on base.  Or any where near base, for that matter.  That, surprisingly, made it all a little better.  A slight admission from them that they are being real b*****ds splitting people up like this, and that there's a support network there to do whatever they can to help to apologise.

So, although this has been a bit of a mushy post from me, hopefully it's enlightened you a little into the life of an Army Officer WAG.  I certainly never thought about the other halves when I saw bits about the army on the news until I was one.

Sunday, 5 February 2012


So, I've been putting off writing my next post because I know Constant Reader would be waiting for my exam results.  Now, I know I knew they'd be going down, but I was hoping they'd surprise me and hold steady.  I wasn't even asking for an improvement, just a steady.  Obviously, from my silence you can tell that hasn't happened.  I went down to 23.4, which is only 0.1 above what I got at the end of year 1.  So I'm pretty disappointed in myself to be honest.  I feel miles better than I was then, I know so much more, I don't know what happened.  Even more annoying is that the class average was 24, so I'm below that too.  Absolutely gutted.  I know I shouldn't, because it's a pass, and it's nigh on class average.  Plus it's not a massive dip from my last but one test, so it's not an indication I'm dropping too much.

I got my SSU result back - the essay I wrote in 24 hours through the night because a peer stole my idea and the one I came up with on the spot in the consultant's room really wasn't working.  I got 19/20 so I'm pretty pleased.  The only negatives were that I didn't elaborate enough on some of the studies, but I couldn't because of the word limit and that something I wrote about procedure was wrong, but it isn't my fault if he doesn't follow procedure.  So a negative and a positive, but being realistic, they are both good scores so I shouldn't complain.  The lowest mark in the AMK this time in my year was 6.9, and someone who spent all Christmas break posting clever lines about how complicated their essay was (in other words, how clever they were in that particular subject to understand such clever things) only got a 13/20.  Taking that into consideration, Bean's not doing bad :) With that in mind, I'm just gonna forget it, bop away to some funky music and rock the next one.