Nearly

I am about to start the last week of being a fresher.  It's quite a scary thought.  I'm not really ready for it to be the end of the year.  Not because I'm not looking forward to the exam at the end, rather I'm having a blast!  I've worked so hard to get here, and it's amazing.  The placements I get to go on, the skills I'm learning, the science.  I'm having such a good time, I don't want a break for 3 months.  As for the exam, well I really don't have the motivation.  I seem to swing wildly between thinking "I'll be fine, I can do it", to "I don't need to do it because I've passed the AMK, so I don't need to work too much for it", to "OMG I have no idea what I'm doing about anything, all the work I've done has been focussing on the wrong things and I've now run out of time to cover it all properly and I don't even know where to begin".

I'm getting rather fed up with Peninsula keep changing our timetables.  I organise meetings and work and then have a double check and it's all changed! Not useful.  It's been a pretty quiet week otherwise.  Placement is next week because of the bank holiday.  It's at a chiropractors which should be interesting.  I have an open mind, but I'm not the biggest fan of alternative medicine to be fair.  Although there are two chiropractors we get sent to on placement, I don't think this is the one where the guy doesn't believe in DNA.... (I wish I was kidding)

I'm getting married next week :)  To my medsoc wife and we shall have fresher babies in September :p  My wife-to-be and medsoc mum and a friend went out last night for pizza and sangria to celebrate my birthday.  I'm 23 tomorrow.  I had a really good night.  There was a lot of sangria and I bumped into a friend I hadn't seen for about 8 years.  It was a shame more people didn't come, but I guess that's what I get for not socialising with them that often, and spending my nights with my head in the books.  Maybe I'll see what I can do to try harder next year.

Results

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.

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!

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.

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

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 :)

Scruffy Bean

First day of the holiday and I relished pulling on comfy jeans and a slouchy hoodie.  What with work and the policy we told on our induction day at PMS "you will be doctors, you should act and dress like doctors", I haven't been able to be a properly comfy scruffy bean in ages.  I am also enjoying the after effects of a student diet and finally being able to fit back into my skinny jeans.  Although with the abundance of biscuits floating around our house, I doubt they'll be fitting for too long.  The new computer is shiny bright.  I went for an all in one, touch screen PC in the end with the hope it will be hard wearing enough to be used often but still be portable enough to move from student flat to home and around various placements and things the course will be throwing at me.  Unfortunately, I appeared to take on the role of Bean: Destroyer of Electricals as a couple of days after getting the new computer my phone died.  Ten days after the warranty expired.  Not amused.  I am currently in that awkward phase of owning a new shiny thing where you have to keep fiddling to get things how you like them.  What's worse is that I can't remember how I got my phone to how I liked it before so that's causing some frustration.  It's getting there, but it's not right yet.  On a similar times-they-are-a-changing note, anyone got any suggestions for a suitable replacement for Spotify once they change to only allow 10 hours a month and 5 plays of each song?  First Pandora, now Spotify.... Huff.

Another perk to being at home that I had sorely missed was being able to sit on a sofa.  It's not something you think about really until it's not there anymore, but I've so enjoyed being able to curl up on the sofa of an evening, be sat on by the cat (once she got over her grumps at me for abandoning her for months) and settle down to some knitting in front of the telly.  My cousin is expecting twins soon so there's much knitting to be done.

I've only been off a week, but because the last three weeks of term were odd because of placement SSU it seems like ages since I've been stuck into studies proper.  I'm torn.  I want to be back studying because I love learning new things.  However, I know I'm a little behind with lectures and I'd like to do some revision for the End of Year and the last AMK.  I'm also quite enjoying the time off not being quite as busy as I normally am, although I'm still trying to fit in GP work and Census work.  Reading all the posts about the 5th studying for finals is making me feel very guilty for not working harder at medical stuff and also pretty happy that I don't have to do exams like that.  Best of luck to you all.

RIP Laptop

I'm not sure what I do to laptops.  This is my second in 7 years, and this one only lasted  3.  I love them, I treat them well, I don't spill stuff on them.  I do use them all the time.... maybe that's it.  I was kind of hoping that because everything was backed up I'd banked some karma, you know?  I was prepared for it so obviously it wouldn't happen?  Apparently karma doesn't work like that :(  So I'm switching from a laptop to a desktop and hoping that will be a little more hard-wearing.  As such this is my final post on my beloved laptop.  I have two essays to write but can't because Word won't work in safe mode and I can't back up my work in safe mode either.  I should be packing to go home tomorrow and I should be cooking tea after a long day of comparing laptops and desktops and 6 hours of censusing.  What I actually want to do is go to the Slackers Club free film showing tonight.  It's not a film I desperately want to see, but it's free and it has an actress I like.

Haven't done a lot of medical stuff since I last post.  Nothing interesting anyway.  I sat in a nurse's paeds eczema clinic and listened to teenagers explaining they hadn't followed the treatment regime they were given and look their eczema isn't any better.  What a surprise.  We were told to come back to see a Phototherapy clinic but when we got there no patients were due to arrive.  We got shown around instead, which was fairly interesting but there isn't really much to see.  It's a bit like a walk in tanning booth.  I was half contemplating telling my facilitator that my colleague hadn't been ill for a week, he'd been watching the cricket.  He wasn't able to answer the questions he was asked in the tutorial, and waiting and watching while he stalled and ummed and ahh'd was painful at times.  Especially since the answer he was looking for was the same as the one he'd given not 15 minutes ago.  However, knobbling other students isn't really me, and certainly not the type of person I want to be.  I joked at the beginning of the year I'd only have to knobble 7 students in order to pass the year since the bottom 5% have to fail.

I went to quite an interesting lecture about how Exeter is the leading centre for blood saving.  No blood is crossmatched from the blood bank for any elective surgeries.  Instead, the blood the patient loses is collected, centrifuged to remove the plasma, diluted with saline and given back to them.  Apparently blood treated in this way recruits pro-inflammatory factors and capillaries which helps the healing and antibacterial process.  1 unit of blood costs £150, which I did not realise.  Clever stuff.  It was a filler lecture because Professor Ellis was too sick to lecture.  He'll be coming back to lecture at Plymouth and we'll be linking in telematically, but he can't sign my Lecture Notes on General Surgery from Plymouth.....

Vaseline

Firstly, hello to all the new followers. I don't think I've said that yet,which was rude of me.  It means a lot that you like reading my waffle :)  So I haven't been able to do any suturing yet but I was given a very important job to do in the last surgery morning I was in.  You know on Grey's or Holby where the Surgeon yells "suction, I can't see!!" well that was my job last week.  Except since I'm on Dermatology which is slightly less invasive it was more here is a tissue pad, dab the wound clean.  But I still got to scrub in and be useful which was awesome.  The first surgery of the day I saw was removal of a pigmented lesion (mole) query malignant melanoma (possibly cancerous, probably not, better to be safe).  This operation was performed by a fifth year from start to finish with the Surgeon stood observing.  What an amazing thing to aspire to!  He made a really good job of it as well.  I know it only seems like small fry, but I don't really have a lot to compare it to, so it seemed pretty awesome to me.  The surgeon was really nice in explaining what he was doing and pointing things out.  He asked a load of questions, some of which I could answer, some were for the fifth year, and some were for the fifth year but he couldn't answer them and I could :)  There's a lot more surgery scheduled for next week so hopefully I'll get to see some more.  There are fourth and fifth years on the ward as well so we're sort of competing with them to see things and they have priority.

As for the title of this post - I have seen Vaseline used in a variety of ways over the last week; it really is a wonder substance.  The consultant tells the patients on isotretinoin (an acne treatment, it used to be called Roaccutane) to use Vaseline on their lips as one of the side effects of the treatment is very sore, cracked, dry lips.  The surgeon was using Vaseline to cover incision wounds and fill in holes in nails where he'd removed them before dressing.  This is apparently because the wounds heal better and faster in a moist environment.  Finally I was at a rowing race yesterday and in order to transport a rowing eight on a trailer it was be split in half.  We used Vaseline to waterproof the two halves of the eight before we put it back together.  A little whimsical but I figured it deserved a mention since it seemed to crop up a few times too often in my life recently.  Clever stuff apparently.

I have spent the morning lazing in bed, knitting and catching up on my TV programmes because last week was hectic.  To be fair it was my fault it was hectic, I may have possibly taken on too much.  Again.  Bit of a mantra for me recently :-/  But it won't be for very long.  SSU blocks are notoriously slack, so when I saw a job advertised for over Easter holiday and two weeks of SSU paying good money, really good money, I jumped at it.  The selection process was long and fiddly.  There were lots of emails saying you must do this 3 hours of online assessments in the next 48 hours, but at each stage I got through, and finally heard a month ago I got the job.  After going through all that I wasn't going to say no, and besides, it's only four weeks.  Then I found out my timetable for SSU and the 3 hours a week I was told it would be morphed into a good 4-5 hours everyday.  I have to do token efforts at the GP surgery, but they don't mind if I'm in clinics and can't work.  Job number 2 is mainly to be done outside of normal working hours 5-9 and weekends.  I am a census collector.  One of the smiley, friendly but menacing people who go door to door and remind/bully people into filling in their census forms.  I'm a nice one, don't worry, I'm not mean at it.  They get a half jokey "fill it in or you'll have to put up with me keep knocking on your door".  I am pooped!  I started Wednesday and did clinics or surgery 9-12, GP's 1-6 and census 6-8.30.  I have 3 patches and have done a first pass on two of them.  It's going well and it's lovely to have an excuse to be out in the sun but my did I need to spend some time doing nothing.  Now I have some errands to run and to start the essays.  Back to it!

Quandary

Well, I passed the AMK.  Still dead centre in the middle of the satisfactory band.  I found whilst digging the other day that if I can pass everything with a satisfactory I should get a merit.  All excellent I think is a distinction, but I'm happy with a merit.  Not that I was planning on failing or borderlining anything that is.  I also passed the last SSU and the professional judgement that went with it.  This SSU is going well too.  Well, no, the essay isn't going anywhere at all but the attachment is going fantastically.  I'm seeing so many patients, getting the chance to see common and rare diseases, getting to examine, diagnose and offer a treatment plan.  I get to chat to them and take detailed histories, and answer questions fired at me from the consultants.

I had one event that put me in a bit of a professional quandary however, and I'm still not sure if I should say something, or if it's too late now.  My partner and I were sat taking a history from a patient on immunomodulators for his eczema.  He was pointing to and describing a crampy pain running in a thin band inside his right iliac fossa region which is just above your hip (Imagine your abdomen divided into a 3x3 grid with the top being a line across the the bottom of your ribs and the bottom being a line across your hips.  Right iliac fossa is lower right hand corner).  I had the patient's notes on my lap, where the consultant had requested an ultrasound scan of the right hypochondrium which is just below your rib cage and contains the liver and pancreas (right upper corner).  The consultant was worried about pancreatitis and so was running a blood test for amylase and ordering the ultrasound.  The only problem is that the pancreas is not where the patient was describing the pain, and it wan't the right sort of pain.  It's true pancreatitis pain radiates, but to the back, not down.  My partner flicked through his note book which just happened to have the last LSRC notes in it with the abdominal checkerboard drawn out which confirmed we were right.  The consultant had muddled his basic anatomy.  I should imagine he'd seen the area, incorrectly remembered it as being the right hypochondrium and recalled pain in this area could be pancreatitis.  Neither of us could summon the courage or work out the tactful way for two first year medical students kindly being allowed to interview his patient that he was wrong.  What would you do?  Whilst walking back to halls we placated ourselves with the hope the patient would say something when the jelly for the ultrasound was being put in the wrong place.  Since his creatinine kinase was up we wondered if he was experiencing death of one the transverse abdominal muscle bands (creatinine kinase goes up after a myocardial infarction as it is released by the dying muscle cells), but that really was us pushing our limited knowledge.

At my GP job I was marvelling at some old patient letters I was summarising.  When he was a young boy in the 1940's he'd contracted TB.  Upon discharge from hospital the Dr had written him up for extra milk, the way we would do now for any other drug.  It was fascinating.  I was also amazed at how long it took him to get over TB.  Knowing nothing about the disease in detail at all, he spent a year in hospital and was followed up every year for six years after that with the recommendation for extra milk and no PE.  Apart from trying to decipher the handwriting I love going through old notes.

Continuing the wistful happy vibe, if you like Mr Scruff, or are curious, I have The Voodoo Trombone Quartet on repeat on Spotify at the moment.  Hope you're enjoying the sunshine.

Loon Grinning

Be aware, the loon grinning has set it, and it won't go away for a while.  It may even be contagious.  You have been warned.  The loon grinning commenced last week on placement when the GP I was sat in with said, "Oooh, that's a nice mitral regurgitation murmur, do you mind if the student Doctor has a listen?"  (Don't worry, the patient has had it for a while and knew about it, that wasn't how the news was broken.)  I got to use my stethoscope on a real person for the first time ever! A real, sick, patient kind of person, not a medic friend I'm practising on.  Placement continued with listening to breath sounds for asthma, squeezing a huge sebaceous cyst (as big as a £2 coin), chatting to a Dr come in for a referral, and talking to a very charming lady who confirmed she ate a very good diet, elaborating that it consisted of no breakfast or lunch, a packet of Dolly Mixtures a day and a ready meal every evening.  It was really busy morning clinic and so interesting to see all the different types of cases.  The Dr was open to questions and at one stage even went out into the waiting room to see if she could drum up any more patients for us to see before we left.  I get the most from placement seeing the interaction between the patient and the Dr.  I like to see if there's any phrases or ways of handling and approaching things I can pick up in a monkey-see-monkey-do kind of way.  It really helps to put all the studying into perspective.  I'm studying for something.  One day this will be me.  It's like all access work experience and I'm still as excited as a little kid at al the opportunities I get.

In clinical skills we learnt how to do gastrointestinal exams.  Happy to say I have a liver, I have felt it. :)  We have competencies coming up after the Easter holidays where we have to do a combine cardiovascular, respiratory gastrointestinal exam - running them all together in the end of the bed, fingertips up to the head and down to the toes prescribed format.  This will be interesting because we have 10 minutes to do it and it took the demonstrator 15 when she showed us at full speed....

We only had one normal two week case block and now we have started another SSU.  I have been allocated  'The Impact of Eczema on Children and their Families'.  I've been attached to the dermatology ward and when I went for my contact session today she gave me a timetable for the rest of the week.  I'm in clinics everyday.  It's AMAZING!!!!!  There were a couple of optional sessions in there, like tomorrow morning.  She said "if you like you can come in tomorrow, get changed into some scrubs and observe some minor surgery.  It'll mainly be removing skin cancers and depending on where it is you can do some suturing if you like.  You don't have to come in though if you don't want, you can have a free morning."  Would I like to come and observe and do stitching? HELL YEAH!!!!!  Seriously, I am so excited.  I have not stopped grinning, and the little bean inside me is bouncing up and down like you wouldn't believe.  She had me at scrubs to be honest, I love a bit of dress up.  I've got some general clinics, some phototherapy, some patch testing and possibly a trip onto the wards to see some inpatients with skin complaints.  And this is just week 1!  I have 2 more weeks of this.

Stress Relief

I have been missing in action somewhat for the last week and a half.  The essay needed to be done after all, surprise surprise and I wrote an awesome one if I say so myself.  I was really proud of it - well researched, technically strong writing and a good conclusion.  Even my superior agreed when she saw the first draft.  And then I had to massacre it and cut 350 words.  That doesn't sound a lot but it only had to be 2000 in total and not a single word over.  It was so dry once I'd finished it I really didn't like it anymore which was really disappointing since I worked so hard on it.

As soon as that was submitted it was only a couple of days until the next AMK and I was feeling The Fear.  Between the first one and the second one we did a load of case units but between the second and third we did one unit on cardiology which I always just don't understand and a highly specialised SSU project.  I really wanted to keep making an improvement and stay in the top half of the class.  Late teens early twenties is my goal for this one.

I sat it this afternoon and it was horrible.  There were a load of gastro questions - ask me again at the end of next week when I've finished the gastro unit please, and a load of questions I recognised bits about from seeing them on patient records at work but don't know the specifics of to be able to answer.  And for once there were a few where I knew bits about what they were describing, but they hadn't asked the right question for me to be able to answer it.  For example they gave a perfect description of shingles without identifying it as such.  Fingers crossed the question is what is it....nope, how do you treat it.  I don't know, I didn't look at that bit.  Grr.  Can I have half a point for being clever and knowing it's shingles?  There were some I got down to a 50:50 and I honestly still can't say I got it right or not.  I'm afraid to look up the answer.  Oh, and diverticulitis.  It comes up every time and every time I think ooh, what on earth is that, must look that up and forget.  Gah.  Well, I know now.

I missed pancake day this year.  I was studying and couldn't take the time to make them.  I had suggested to my housemates before the workload became all encompassing we do a house pancake evening, because the only thing we've done together since we moved in was go to a disciplinary hearing.  They all said it was a good idea and we should do it.  Pancake day comes and they get some course mates over a pancakes for lunch.  Gee thanks guys, nah, don't worry I didn't want any  Thanks for asking... -_-

At the weekend I coxed the crew I'm supposed to be racing with at Women's Head of the River next weekend.  I can't go because I can't afford to get the membership and enter the race.  We had a new coach who's coached the New Zealand National team so he should be pretty good but he was pushing them so hard he almost broke them.  Race piece after race piece, more pressure, row faster, row for longer.  It was tough. For two hours I was in charge.  I was their on board coach, talking them through the pain, motivating them, getting them to row their best, keeping them strong, tweaking their technique, steering them.  I was responsible.  That's my stress relief.  Yelling at people to do their best at obscene times on a Sunday morning.  Dressed in so many layers you could push me over and I'd bounce up again.  Leaving work and study behind me focussing entirely on being what my crew need from me.  That is my stress relief.  That, and if you'd have been a fly on the wall of my kitchen a few hours ago I had the radio on full blast playing dance music and I was dancing round the kitchen like a loon cooking bolognese stuffed pancakes :)

Work, Work, Work, ?Study

"Do you like living your life at a maniacal pace?" Ha!  Obviously SSU was not going to be a nice chance to slow down.  My Practice Manager said this to me in the week as I was rushing from lectures to work.  I work as an administrator at a local GP's surgery and they must be pleased with me because I'm getting more responsibilities, more training and a pay rise, which is good.  Unfortunately I'm being thrown in the deep end some what as there are quiet a few sickness absences so since I seem to be a quick study I'm shown something once and left to do it.  Since my last post I've done a twelve hour shift which started with manning the appointment line (only my second time) for the Monday morning rush which was absolutely crazy busy but I managed it which I was so pleased with.  It ended with the late clinic and lock up where I was the only member of admin staff and there were two Doctors in and a full clinic.  The next day I was handed a pile of 41 dictations with 7 urgents to do since the girls that normally do them were off sick.  These are interesting, but involve a lot of sleuthing as the Dr's tend to say "letter to so and so" and you have to work out who that may be, what they do and how to contact them, whether it needs to go via choose and book so the patient can pick their hospital and slot if it's a speciality that it can be done for, or if you should be looking for an address for them or their secretary.  Google is a God-send!  Again the day ended with a solo shift on the front desk with the late clinic and the Dr running 30 minutes late.

I know that I'm probably saying yes to too many shifts at the surgery, and that I should be taking more breaks whilst I'm there.  But the work is so interesting, time slips by without me noticing and I'm not tired until I get home.  Equally, it's a viscous circle on the hours front.  I need to study so I can keep up to be able the knowledge to pass the tests to stay on the course. Although the work I do is related and I am learning bits whilst I'm there, it's not really the sort of knowledge that will help me at the moment.  I know my available time will get less and less as I go through the next five years, so I really need to make the most of the time I have now to work and save up so I can afford fees in the years to come.

What's not helping is the fact our SSU facilitator is off ill.  She has a different approach to everyone else, which is that she's setting us small questions to do for each session we see her, while everyone else just has an essay to write.  She told us to hang fire on the essay and not to start it yet and we'd go through some topics and discuss titles when we next see her.  She then cancelled that session because she was ill and sent us an email with some more questions to do for when we next see her which is next week, so now I don't know if she's expecting an essay or not.  I tend to be a bit of an ostrich about things I don't like and ignore them and get on with other stuff.  Since work is keeping me busy I don't want to think about essays and am happy to assume we don't need one, but I don't think life'd be that kind.

Ah well, time management - tick (sort of), multi tasking - tick, learning new skills - tick, being a responsible member of a team - tick, sleep - not really.  I'll be a Doctor yet :)

Frozen Doctor Syndrome

I've seen a few examples of this in the last week and what with it being interview time, and me being in a contemplative mood again I thought I'd share.  There are people that 'do' and 'can' when the situation calls for it,  and there are people who 'can't' and 'don't' and I'm not sure you can really tell which category you fall into until the situation occurs and you are tested.  To put this into context, last week I watched Junior Doctors on BBC3 and it mentioned frozen doctor syndrome where the new F1's freeze and don't know what to do when faced with situations that require quick thinking and fast actions.  This is probably because of any number of very valid reasons - they don't want to be in the way, they don't know where things are, they haven't dealt with such an intense real life situation before or they are scared of getting something wrong.  A few weeks ago, one of my housemates tore a ligament in his ankle jumping off something.  The swelling hasn't really gone down and he was making do with strapping it and sort of keeping off it, but he's quite an active person and so has been going to the gym to do upper body work.  Whilst at the gym with our other housemate he met a load of medics and they were skipping (as you do, apparently).  For whatever reason, he thought he'd skip too to show off, and of course went straight over on his ankle and collapsed on the floor.  The medics all stood around staring at my friend screaming in pain on the floor.  One of them managed to mutter RICE, but by that time our other housemate had gotten some ice and a blanket and a bench and was coming back to pick our friend off the floor and ice his ankle.  Both of my housemates do sport science, so whilst he was an idiot to try and be a hard man and skip in the first place, I'm proud of their quick thinking, and wonder whether the medics were kicking themselves for not thinking to do that themselves.  I guess slightly on their side is the fact that they weren't in a setting they would be expected to use their skills and knowledge, but I think I'd still be a little embarrassed.  Even though we know nothing, we are perceived to be knowledgeable and capable, and RICE is kinda first aid basics, no?

I have been tested myself in the past, though thankfully not often and nothing too bad.  Back at Southampton my mentee had an epileptic fit on my driveway, sustaining a nasty head wound as he dropped.  Then earlier this week I had a knock on my door at 2 in the morning from my house mate, blind drunk, terrified and vomiting blood.  I'm happy to say that I appear to be a person who can and does, although inside I'm terrified and I have no idea where the strength  and calm I display in the outside comes from.  At least so far, with the situations I have been presented with, I am.

I think it's a difficult skill to interview for, because it's not about what you say, it's about what you do.  I have visions of one of the interviews going into pretend anaphylactic shock or something to see how the candidate reacts.  As if interviews weren't terrifying enough.  I'm sure that not all Dr's require these sorts of skills in their line of work, and that the more you are involved in situations like that the better you'll be at handling them, but it must be useful to be a person that 'can' and 'does' from the outset.  It gives you a base to work from and build in the actual knowledge of what to do to be useful.


If you can keep your head when all about you
Are losing theirs...you'll be a Man my son!
If by Rudyard Kipling

Semi-Responsible Bean

I love Peninsula.  Just when I was starting to panic a little that everything was getting on top of me SSU comes along and I get a chance to breathe which is nice.  Other people seem to be stressing about coming up with a title for their essay so they can get started but my facilitator doesn't seem too bothered about us getting to the stage where we are ready to come up with a title yet.  So I have a few days to just relax and do what is for me, a bit of microbiology revision.  So today I had my first lie-in in ages :)  Awesome.

Also, today I had a little bit of a taste of proper medical decision making, which was a little weird to be honest.  I was at work at the GP's on the front desk for the second time ever, under supervision taking the phone calls.  I kept having phone calls from patients wanting appointments for the same day, of which there weren't any left.  From taking a description of the problem I had to decide if they needed a call from the Doctor which could turn into a home visit or late appointment if necessary, or an appointment later on in the week. I know that this is small fry compared to what I will be faced with, but having so little experience and faced with a crying mother on the phone because her toddler still has a fever from yesterday when the Dr saw them, I found it quite strange to try and strip away her emotion from what she wanted me to do, logically assess the situation and balance that with how annoyed the Dr might be with me if I keep adding appointments to the end of their clinic.  Luckily I had my boss next to me who was really patient with me as I consulted with her on every case like that, and the magic words "Sorry, I'm new to this, I'm in training, I'll just check" to brandish.  I honestly have no idea how the receptionists with no medical training at all handle those sorts of things, because it felt a bit like being a triage nurse.  I guess it just comes with time.

I learnt a secret the other day I'll let you in on.  When I first got my stethoscope, obviously the first thing I did with it is put it round my neck.  Poking around on some other blogs I've seen some of the older medics and Dr's laughing at the young ones wearing the steths round their necks.  However, no one will ever tell you why it looks silly, or where you're supposed to put it.  The secret apparently is that if you keep it round your neck it gets warm, and if the tubing gets warm repeatedly it gets stiff and may even snap.

Sniff, again

Well, I'm ill again so now is as good a time as any to give you an update.  Since the last post I have learnt respiratory exams and cardiac exams.  I have signed up to be part of a new society called Save a Baby's Life that will aim to teach basic life support in GP's surgeries and parent/child groups.  I taught a lesson on HIV to a class of year 11's at a local school.  I have done more hours at the GP's surgery than I thought could fit into my time table.  I found out I was successful at applying for another job that I entered in for ages ago and have completed on-line training to be... a census collector :)  I have struggled through a PBL case unit on the heart - the first topic that I really don't understand.  I know it's not hard, it's just that the heart has never seemed to 'click' and make sense with me.  I have received peer feedback forms from my new PBL group and discovered that while the last group thought I was too loud, this one thinks I'm too quiet, half think my sources are great and half think they aren't and one appears to want me to put all my sources on the group discussion board  on-line before the session  thereby giving them all my answers 0_o  I have come to the conclusion you can't please all the people all the time and perhaps I really shouldn't care about what my peer feedback forms say.  This has been compounded by the actor in my clinical skills communications class telling me to my face that my history taking was fantastic, I covered everything and did everything really well...and then scoring me as 'poor' on his feedback form.  Grrrrrr.  I have also been called to a disciplinary meeting with the rest of my flat because our fridges have some damage to them. Namely the door fell off one of them and one of the plastic bits has broken in the other because they get so much use.  It has escalated to this stage because when they came round to get one of us to sign a form to claim the damage and pay for it none of us would because we believe it is wear and tear which we are covered for and don't have to pay for according to our contracts.  I have had training at work on how to man the front desk and how to carry out carer medicals to check that people who care for others are getting all the support they need and are fit an healthy themselves.  I have been a tea lady again.  I have been rubbish and haven't replied to emails I got  (sorry :( ).  I have been nostalgic as a round of GAMSAT interviews took place.  I have accompanied Mr to a wedding of one of his best friends at Sandhurst and had a lovely day and met really wonderful group of people which I really don't think I'd have had the courage to do a year ago; to go to an event where I only know one person and not stay sat in the corner of the room and observe quietly, but to actually talk to people and be brave.  I am starting to understand what it is to be part of the army family.  I found out I'm mushy to the core and I cry at weddings, but it's their fault for having such beautiful readings.  I watched Never Let Me Go for free at the cinema the day before it premièred as part of the Slackers Club run by E4 and the Picturehouse and found it to be very plain, simple, clever and so sad.  I rowed in the first ever Peninsula Women's 8.  I have laughed until I cried and I have danced until my feet ached.  For two weeks I did not go to bed before 3am and then got up at 8am everyday.  I found out that Mr loves me even when I'm snotty, covered in tissue fluff and snoring like train /mush.

I now have a streaming cold and feel like pants.  It is entirely my own fault, sort of.  The stuff that I planned to do wasn't supposed to all come at once, with a load of other stuff cropping up that had to be done immediately.  So, I guess I've also found out that I'm pretty good at running on autopilot, ish.  I haven't done all the stuff I should have done, or wanted to and have now made my life more difficult by catching this cold when I still have a lot to do.   Fingers crossed for me please because Glandular Fever is currently going round and I really couldn't handle it if my cold turned into that.  But, I also have my fingers crossed for you and I hope you interviews are all going well.  Believe in yourself that you can do it, because if you don't believe you'll never convince the interview panel you're right for the place either.

Headway

Probably not a surprise, but things got busy again, hence the long delay in posting.  Sorry!  I had the best intentions....

Placement was with a charity called Headway who offer support following brain injuries.  I went to a morning group session where people can drop by and meet with others in similar circumstances.  It was all very informal and people can take whatever they want from the sessions.  One person was there talking through with a staff member difficulties he was having.  He had told his case worker that he didn't need them any more because he could do his own washing and cooking, and the staff member was trying to explain that this wasn't what they were there for.  He'd been having trouble filling in his benefit forms so the group were trying to convince him to let someone help him with them.  Others were there to use the computer, some were setting personal goals with another staff member to help them address difficulties and work out what they wanted from their Headway sessions, one man was bombing around in his wheelchair whose task for the morning was supposedly drawing pictures of birds, but actually he was having a great time bombing round getting into what everyone else was doing.  He spent some time complaining to me about how long he was having to wait to get his wheelchair fixed since it was so poorly designed - he slumped badly to the left and the controls were positioned so that he couldn't do anything on his lap because they got in the way of his dominant hand.  It seemed like such a simple thing to sort out for him and really important too, there was just so much bureaucracy in the way.  Another group of people were playing Scrabble, my buddy was playing Frustration with someone and I was sat with someone working on a project about the brain - apparently he'd remarked that the picture of the brain on the wall was good but it didn't tell you what each of the different bits did, so they told him why doesn't he research it.  He'd gone to his Mother's who'd printed him out some information from the internet but he'd decided since it was his project he should handwrite the information and so was meticulously copying it out.

Before the people arrived the staff member were telling us that it might look like they are just playing Scrabble but they are also developing their vocabulary, learning about dealing with a social setting, about fair play and fine motor skills.  They also told us that some people don't have a clue as to the scale of their injuries - they may just think they had a bump on the head and not realise its impact.  I didn't entirely understand this at the time, but I I was chatting to this man who was telling me about his life: his father had died, he'd been in two car accidents neither of which were his fault, his wife had spent all his inheritance and left him for someone else but it would be all right because he had this project on the brain to do now.  o_0  This poor man had so many terrible things happen to him, but because he had something to focus on he was fine.  Inspiring and heartbreaking all at once.  His injury had caused him short term memory problems and he was having trouble recognising where he'd already copied bits from and would start to write something but then forget where it was coming from, even though it was right in front of him.  Sat across from me was my buddy playing frustration and the guy he was with seemed 'normal' enough - there was no physical disability and he was fairly quiet but happy playing his game with a wicked sense of humour, getting my friend to feel his hand because his hand hurt and then laughing because you can't feel pain like that.  The staff had told us that he likes to steal things like keys and phones so he can give them back to you later and tell you he found them because he likes to be helpful.  He had another quirk that was every now and then he'd quack like a duck.  Totally bizarre!

It was an amazing placement.  It was challenging to my views, a fantastic experience and a lot of fun, but equally really upsetting and quite uncomfortable.  I really didn't know how to approach these people. Most of them didn't have any outward signs that they had anything wrong with them so it was hard to know what level to pitch your conversation to them, whether you were just being patronising, what they needed help with and what they were just being lazy about and  whether it was my place to correct them if they got something wrong.  It's great for developing communication skills as they made need things explaining in many different ways to them, and in some cases it was like talking to a child.  They all stared at us when they first got there, some coming over to chat because we were new and others completely ignoring us. I sort of felt like I was in a zoo, although I guess they've had plenty of people staring at them in their time.

If you're looking for work experience or extra curricular brownie points I'd definitely recommend looking to see if you have a local Headway branch.  They can always do with volunteers, it's really different in terms of normal work experience and it will certainly broaden you and your skills and challenge you whilst still being fun.

F1 Choices

Don't worry, I'm not that organised that I'm thinking about F1 yet, I just got a very interesting email from my medical school I thought I'd share to see what your thoughts were.  As you no doubt would have heard, this year for the first time overseas students were allowed to apply for F1/F2 jobs, and in December this year 180 UK graduating medical students weren't allocated foundation jobs, although apparently they will all be placed by August.  This is important because you don't get full GMC registration until you have completed your F1 year.  Furthermore, medical schools take on more and more students each year because apparently there's a shortage of Dr's in this country, although it seems there's a demand for trained Dr's but not the resources to train us.  To try and stop this from happening again the Medical Schools Council have come up with three options:

1. Extra assessments like situational judgement tests, clinical skills test and communication tests to help allocate F1 jobs.  
2. Grant full GMC registration on graduation
3. Link F1 year with the undergraduate degree so you stay in your locality to do your F1 job, and then compete for F2 jobs.  

Admittedly, I haven't looked into how the whole foundation places thing works yet, as it's miles off for me and I figured it would probably all change again by the time I got there, so I'm not as knowledgeable about it all as I'd like.  However, options 1 and 3 don't really seem to address the problem to me?  3 just moves the point at which there will be a problem - fantastic, well done you've graduated and done the horrible stressful F1 year and become registered, now if you want to practise as the Dr you've spent years trying to become, take your student debt and leave the country, or find another line of work.  How is that right?  

Option 1 assumes that medical schools haven't prepared you well enough for F1/F2 years.  Although I'm sure it's true not all medical students are created equal, surely (but maybe naively) if you weren't good enough to be an F1 you wouldn't have passed finals - is that not how the medical school conveyor belt works?  Equally, I thought GAMSAT was expensive enough, I'm shocked at how much the Royal College of [insert profession here] exams are that I've heard about, how much am I going to have to pay to do the assessments to let me do the job I've trained for?  By the time I graduate, it will have cost a lot of money to train me, what a waste if I can't get a job.  And what am I supposed to do with the £60,000 of student debt I'll have by that time?

As for option 2, I'm not sure why you aren't GMC registered after graduation anyway, so I can't really comment on that, but it seems that makes it easier for our home students to push off and take their skills elsewhere, and leave the Dr-ing to the overseas Dr's coming in to do.  What do you think?

Awesome day

Well yesterday was a pretty awesome day :)  In parts, bits of it were a bit weird, but it started and ended well, so overall - super smiley bean.  At 8am I logged in to student logbook whilst quickly bolting down some breakfast, to see the magic words "AMK - satisfactory".  I passed!!  I had wanted to do better than last time, stay in the top 50% of my cohort, get a satisfactory, and I was secretly hoping for double figures, but would admit that that may have been pushing it a little.  I am super happy to say I did all that.  last time I got 8, this time I got 14.  I cycled to work to spend the day being a waitress for some people who had hired out the seminar room at the GP's and I was their tea lady ._.  Meh, I got paid for it.  Can't complain.  In the evening, I went to a lecture, given by Professor Parveen Kumar who co-wrote the bible that is Kumar and Clarke's Clinical Medicine.  It was nice.  We were told there would be some GI teaching, but it turned out to be a lecture on how we could change the world with medicine.  It was very inspirational, but practising medicine in a third world country is not my sort of thing.  She was talking about electives and how to go about making a change that is worthwhile and beneficial to the local culture, without imposing your views on them.  I also got my copy of Kumar and Clarke signed :D  And I totally don't care if that makes me sad.  I now have two signed books - my Kumar and a Rosie and Jim book my Mum had signed by John Cunliffe for me when I was 4 and ill in hospital.  So... I'm pretty buzzing at the moment.  Wandering around with a fuzzy grin on my face. Doesn't happen too often, but I'm enjoying it.  For Harry Potter fans I was in the inspiration for the Leaky Cauldron earlier on this week - they do awesome pizza.  And the inspiration for Diagon Alley is my favourite place in Exeter, although it was before I realised it was connected to the book.  Apart from that, this week has been pretty quiet.  Another case unit, this time about asthma, which is perfect timing as mine has just started to flare up again because I was a silly bean and cycled somewhere in the cold last week with no scarf on.  Boring stats lectures, hours at work and lectures.  All pretty standard.  I hope your interviews are coming through as you want, and good luck at them :)

Influential, dress-up bean

Placement this week was with a school nurse.  My schools didn't have school nurses, so I didn't really know what to expect. I was envisaging spending two hours watching nurses give out paracetamol and sticky plasters.  Instead it was a two hour lecture on the school nurse system and their roles and responsibilities, mainly focussing on the child protection aspect.  This finished with the nurse telling us a couple of stories of previous cases she had worked on - one about teen pregnancy and one on sexual child abuse.  The stories took place over many years and you could tell she really cared about the people she was looking after, and even got quite emotional.  I certainly didn't recognise that school nurses would get continuity of care like GP's did.  A midwife looks after you from birth to 10 days (up to 28 if they have specific concerns), then a community health visitor looks after you from 10 days to 4.5 years.  The school nurse then takes over until you are 18.  Most of their referrals come from teachers or students, but every time a policeman picks up a young person they call the school nurse the child is under to inform them.  It was really interesting, but would have been better suited to a lecture than a placement.

Tuesday I got to play dress-up!!  In clinical skills we learnt how to scrub in for surgery and theatre etiquette.  Is it really necessary to wash your hands 9 times?! Ha, my blisters were not amused.  We also learnt to suture, which I thought would have been easier because I went to that workshop on it, but it turned out the lady demonstrating does it a different way to the guy that taught me before, so it wasn't as straight forward as I was hoping it was going to be.  Ah well, more time in the self directed learning lab for me.

Today I had a very nice lunch - it was free :)  We had an email sent round asking for students from all years to go to an hour long meeting about community placements and give our feedback to the deans and placement staff.  I went, but there was only me and one other student, a fourth year.  It was pretty cool to be in a room with all theses GP's and important staff looking at us and actually being interested in what we have to say.  To the extent that I think they'll be making some changes based on our opinions which was pretty awesome.  I'd say if you could go to any meetings like that at your uni, definitely go.  It's quite fascinating to see the inner workings of it, and I'm not normally into things like that.  And as I said, I think it might have done some good.

Tomorrow will see me strapping on a set of plastic breasts as we learn how to do breast examination in clinical skills, and on that visual... good night :)