ISCE debrief

In the middle of June I sat my ISCE's (Integrated Structured Clinical Examinations), integrated because we have to do a history, exam and skill all in one. We had six 25 minute stations to do in two groups of three split over two days. We were given 12 scenarios a few days before of which 6 would be our exams and the other 6 would be the re-sits if we failed. Last time I mentioned this, I had a comment from someone saying it wasn't fair if we knew what was coming up. The rumour is we get the scenarios because dyslexics complained a minute outside the station wasn't enough time to read and put them at a disadvantage. It wouldn't be fair to just give them the blurbs and no one else, so we all get them. Find a few friendly dyslexics and persuade them to complain?


Day 1

Gastrointestinal and urine dipstick with documentation
First station and I was pretty nervous because I didn't know what to expect. My examiner was jumping all around the room, peering over my shoulder, getting really close, interrupting me and was completely off putting. I later found out he was the head of ISCE's, so I guess he had a vested interest in making sure I was doing everything right. My patient was a real one with irritable bowel disease I think, which flares when she gets stressed or angry. Luckily for this one I don't have to give a diagnosis or management plan. I took a full history, did a gastrointestinal exam and then I had to do a urine dipstick and document the results. I missed a few bits from the history and the examiner got me flustered closing at the by interrupting me to tell me the things I didn't do when I hadn't actually finished yet. I had to politely tell him I just wanted to close with my patient and then I could answer any of his questions. I had plenty of time left, I think he was just over excited and I was emanating waves of calm. He wasn't supposed to ask questions anyway. He also made me wash my hands for a third time after taking off my gloves because I'd done a urine dipstick so now had uriney hands. I don't think he noticed I actually took my gloves off inside out so that wouldn't happen. He told me off for not taking proper notes, but was happy enough when I said I could write down all the details if he wanted them, they were all in my head. I wasn't being examined on that bit of documentation. All in all it went fine and I finished to time.

Diabetic review with cardiovascular Exam and BP with documentation
This was a weird one. I had an examiner, a real patient and a moderator marking the examiner. The case was a diabetic review which I did fine, taking a BP which also went fine, though I completely forgot how to document it and how to put it on the obs chart. The graph had a space for resp rate and pulse. I'd done pulse but didn't bother with resp rate so I turned round to check it. The patient looked a little expectant, as I was literally just staring at him, so I told him I was checking his breathing rate. I then remembered from class you really aren't supposed to say that as he'd start focussing on his breathing and I wouldn't get a natural result so I thought I'd better distract him. Unfortunately, the first thing I could think to say was "Don't worry, I'm just checking your breathing rate, erm, think about cats!" Cats, really brain? Brilliant. I just hoped my examiners had a sense of humour. I then had to do a cardiovascular exam on him, which was odd, as it didn't really follow from a diabetic review supposedly carried out in a GPs surgery in my opinion. It went fine, I even noticed he had some arthritic nodules on his hands so did some screening questions and got him to agree to go to his Doctor about it. Not sure I was supposed to do that, but hey, I'm thorough at least. I finished with masses of time left, and the two examiners stood in the corner comparing their notes on me and "hmm-ing" to each other which was awful and made me so nervous.

Mental Health with a mini mental exam and mental state exam
This was an actor with early onset Alzheimer's or dementia of some kind I think. She was really forgetful, thought she was in London not Exeter, thought it was a couple of years ago, had big lapses of memory like not being able to remember how to get home from town, couldn't remember her children's birth dates or what her husband had died of and her family were worried about her. This one was going quite well. I got a really good history and remembered all my questions for the mini mental and was writing up under the headings for the mental state exam just in case the examiner wanted me to present back, which luckily she didn't. Then I thought I'd blown it when I was trying to assess if she'd accept help by telling her it wasn't 2009 it was 2012 and she was in Exeter not Devon. She started getting really upset (understandably), but I managed to calm her down and get her consent for help. Again, I finished early, but it went well. I could over hear other people with the same case and could hear them getting really frustrated going round in circles with their actor who was playing at forgetting what they'd just said. All of a sudden they'd switch back to 'who are you, where am I?'. I'm so glad mine didn't.

Day 2

Respiratory with peak flow and documentation
I was much calmer and did a pretty thorough history. I was really pleased with this station. This was a real patient with a history of COPD. They'd also had breast cancer twice, a double mastectomy, stomach cancer, rheumatoid arthritis, ankylosing spondylosis and was a carer for their equally sick husband. She was an amazing woman to talk to. She had all this wrong with her, but she was still so cheery and upbeat about it all. I did a pretty good history but when it came to the exam the examiner was a real pain. She interrupted me and asked if I could talk through what I was doing and what I was looking for. It completely put me off and I lost my train of thought. I started to, but had to stop as thinking of all the differentials and possible signs was really putting me off my flow. She said it was all right if I didn't, just that it helped some people. She then looked really grumpy at me when I asked to do the peak flow on the examiner like we'd been told to and not the patient. I don't think she wanted to get up from her warm corner under a blanket (it was really cold) but I was supposed to explain to the patient and get the examiner to do the peak flow, so, tough basically! I finished this one perfectly on time.

Sexual health history and giving information about Chlamydia with documentation for an MSU request
This was an actor who was worried about a one night stand she'd had following a split from her long term boyfriend. She'd heard the guy she slept with was a bit of a lothario and so wanted to be checked out for Chlamydia. I actually found this one quite difficult. The sexual health history was fine and filling in the form for her to drop a urine sample back later was fine, but I found the giving information bit really hard. She didn't have any questions or concerns, she'd come to get checked out so it wasn't as if I had to convince her. I didn't want to scare her too much because I felt it wasn't necessary. She was smart, she knew already about the fertility problems, so I really didn't have an in. I told her the basics, gave her a leaflet and closed. I could hear other people drawing diagrams so that worried me a bit, but I still don't think it's a good thing to be all doom and gloom and worst case scenario and scare the patient. That was frustrating; I wish she'd had questions to answer. I finished really early.

Ophthalmology with cranial nerve exam and ophthalmoscopy
This was an actor whose history pointed to a pretty standard migraine with aura. I was happy to end on this one, it was nice to have a clear diagnosis. I took a complete history and moved on to the exam and skill section. This is where it all went a bit wrong. Because it was a standard migraine, doing a cranial nerve exam really didn't fit. I forgot papillary reflexes and I forgot to examine the external eye. At the end I went back and did the papillary reflexes when the examiner asked if there was anything else I wanted to do and what hadn't I used yet. Panic! We had to do ophthalmoscopy on a polystyrene head with ping pong balls for eyes. They have blood vessels and clock faces in them and we had to read the times on the clock. Because it was a head held by the patient I completely forgot the whole 'don't look in the light, look at a point on the wall behind me until I tell you', but I did get all the times, even the ones on the clocks that were orientated diagonally. At the end, the patient asked if I'd finished, and though she meant finished all my stations I thought she meant in the exam and was wracking my brain for anything else I missed. External eye exam didn't present in this search. I said I hoped so and she smiled, looked at the markers sheet and mouthed I'd done really well.

All in all, I thought they went alright. They weren't perfect, but I wasn't looking for perfection and we'd been told neither were the examiners. We just had to be safe and polite and competent. I thought I'd done enough to pass. I also needn't have worried, I didn't have any examiners I knew, although I did see their names on the sheet, I didn't have them. Once ISCE's were done, that was it, second year over. I did one more week at the GP surgery and then moved back home and went back to the Pensions Admin company.

Old Bean

I am sitting in my favourite coffee shop in Exeter.  I'm  really going to miss this place next year.  It's full of big tables, comfy sofas, free wifi, amazing food and drink and lots of different types of people.  I used to have English classes in here when I was at college, and it's Mr's favourite place when he comes down to visit.  It is a chain, but it feels independent.  I'm here because we'd agreed as a small group to come here and do our final PBL session of the year.  Our facilitator is on holiday and we have a form to fill in, so I suggested we end the year where we started, as our first ever session was here when it was a bank holiday.  Everyone thought it was a lovely idea.  Or so I thought.  None of them have turned up, just me.  So, I thought I'd sit and have an indulgent lunch (parma ham, pesto, mozzarella, sun blushed tomatoes and basil in an artisan white bread baguette with a butterscotch steamer) and blog instead. 

I'm celebrating.  It was my birthday yesterday.  Because of the two bank holidays, I had Mr down for a whole four days, it was wonderful.  We went hiking 10 miles up the canal banks to a pub only accessible by foot, we went to the cinema, we had cocktails in teapots, we baked brownies, we went out for a birthday meal with my parents and we laughed a lot.  If all goes to plan I won't see him now until the end of August, which sounds strange, but is a good thing.  I'm also celebrating because I've been named secretary of the Plymouth branch of PUPS, the paediatric society at uni.  I didn't think I would get it because I figured if it went to a vote I wouldn't be popular enough to win.  But happily it didn't go to vote and I was successful.  Whether that was because I was deemed the most appropriate candidate by the current committee or because I was uncontested I'll never know, but I'm happy. 

I've been a bit glum the last few days.  Facebook shows me all the things my school friends have done and how they are doing and it just feels like everyone my age has so much more to show for their time on this Earth than I do.  They are married, have kids, have jobs, have houses, and what do I have?  Letters after my name and mountains of debt.  Mum tried to point out I have my career, but I don't actually have that yet.  I'm still living in awful student accommodation, still years away from settling down, no clue as to where my future will be, no back up plan, still not a real person yet.  I am feeling old.  My first act as an old Bean was to drive an hour and a half to meet mr half way as he'd driven off with my keys at midnight.  So I'm no wiser for being older. 

I'm in full panic mode for ISCE's now.  I told myself I'd give myself the bank holiday weekend off to enjoy my birthday guilt free with mr, but all I saw was my housemates studying and I just kept thinking, oo, I don't know that, I should look at that.  I think I'll be fine.  My history taking is quite good, I just need to sit down and remind myself of the specific system questions to ask, the mini mental state exam (although I've pretty much got that), the mental state exam to report back findings, obstetric booking history and diabetic review.  The exam is six stations split over two days.  Each station is a history and a skill on real patients or actors.  Each station lasts about 21 minutes.  One station will be written, so either a medication review, a genetic family tree or interpreting an ECG.  One station will definitely be a mental health station on either a depressed, anxious, OCD or manic patient.  Some people in our year know the stations because they've seen a copy of the list sent to GP's in the area that will be the examiners.  They aren't sharing the info though.  Some time this week though, we'll be given a list of twelve stations, or which we'll have six.  Then I'll have the weekend to polish up history taking and run thorough skills in my mind before the exams on 12th and 13th June.  I know my boss, my academic tutor and my PBL facilitator are all examiners.  It might work in my favour as they know me, but then it might not because I won't get to make a first impression.  I'm most worried about my boss.  He's one of the GP Partners at the surgery I work at, and one of our marking criteria is a box they need to tick to say I can see this person as my Dr.  I hope he can disassociate me from being his secretary.  I definitely have the fear. 

End of Term Feeling

As usual with me I have been busy-busy.  We finished the MS case unit, thank goodness and have also done an alcoholic liver disease one.  We are about to start our final case unit of the year.  Final case unit?  All ready?  How is that possible?  It's on Parkinson's and should be pretty light as we've done most of the extra stuff they wanted bundled in when we did the MS case unit.  I had a placement at the GP surgery for the day and completed my final competency for the year in history taking, which I'm pleased to say I got an excellent grade for.  I got to take lots of blood and do some INR tests and blood pressures - all pretty standard now, though I remember how excited I was on my first placement to take blood.  I've come so far in just a year.  It's sad, it's all going by so fast and I'm changing so much.  Not that change is bad, just that I can see the change in me when normally it creeps up on you over time and you don't notice it so much.

I went to the BSMS first annual medical student paeds conference over the May bank holiday weekend and had a blast.  I met loads of twitter friends in real life which was surreal and left the conference on the Sunday evening feeling inspired and shattered.  I had always fancied myself as a paeds neonatologist, but I'm now leaning more towards paediatric general surgery.  It's so exciting!  I've always thought I wouldn't be clever enough to be a surgeon, but the talks we had were so inspiring and fascinating, the little bean in my head was jumping up and down shouting "that's so cool, I wanna do that, that's so cool!"  So there's a good excuse for me to pick up the knitting needles again to maintain my dexterity.

I sat the final AMK of the year last week.  I started off thinking that it was really hard, and there was all sorts of stuff that I should have revised and didn't and I panicked a little.  From about half way through I found my mojo again though, and when I went back to do a final sweep of the questions I was iffy on I was much more confident.  I've answered 91/125 in the end.  I knew I didn't answer enough last time, so I've definitely answered more this time around, and the last time I answered that many I got my excellent.  However, it's easy to tie yourself in knots going round in circles about whether I was too confident, took too many risks, made silly mistakes, thought I knew more than I did, or made calculated judgements, know more than I think I do and should have more confidence in my abilities.  So, I'm going to stop torturing myself, accept that I can't change anything now, be happy that I've passed the other three of the year so I've passed the knowledge module and this doesn't matter too much, and just focus on the fact that I came out of the exam smiling.  I am happy with my performance, whatever happens.

I've made my SSU choices for next year.  I should hopefully get one from minimum access gyneacology, orthopaedics with a special interest in paediatrics, daydream believer (aneasthetics) and when does a normal labour become an abnormal labour;  one from surgery in children, A&E in Plymouth, A&E in Torbay (inc ambulances) and military medicine on the naval base in Plymouth; and finally, one from hyperbaric care, cardiopulmonary bypass, cystic fibrosis and healing the 'hole' (wound management and healing issues).  Because I'll be a third year these will all be in theatres or on wards and they are all so exciting I'll be disappointed whatever I get because I'll be missing out on the others, but that's awesome.  I've gone for kiddies, ortho and a&e because they are the three specialities I could see myself doing.  Paeds general surgery has my heart for now, but it's important to keep an open mind.  The other options were ones I thought looked really cool or that I didn't know much about.

Now we've done the AMK and the sun is here it just feels like the end of term.  I'm finding it hard to settle down and start panicking about ISCE's coming up in a few weeks, but I think so it everyone to be honest.  It's just as well it's nice weather because I've broken my toe and can't wear normal enclosed shoes, I'm living in flip flops.  Silly bean.  Mr came down this weekend to celebrate his birthday a little late because I was exam cramming, and we had a lovely day sat by the canal in a pub in the sun drinking cider.  I made him a death by chocolate ganache cake and we went out with friends for steak and cocktails in teapots.  It was perfect.  I have my fingers crossed at the moment because mr finds out his posting for the summer soon.  He either goes really far away, back to where he was in winter for two months (which was what we were expecting) and so we can go on our holiday we have booked, or he gets pulled off that and sent somewhere else in this country for three months, and has a leave ban so we can't go on holiday.  I've got my bags mentally packed and little bean has her floppy sun hat and bikini on, I really need this holiday.

I'm Back!

It has been far too long since my last post.  Constant reader I'm truly sorry.  We had a consolidation week where I worked at the GP surgery.  Then we had two weeks of Easter break where I worked at the surgery.  Next came three weeks of SSU, where I worked at the surgery.  Spot a trend?  I've done a lot of work at the surgery and not much else.  We're back onto the normal timetable now and our case unit back is MS, which seems to be full of Neurology and cranial nerves, which I hate.

My SSU was called 'Wot you chattin about'.  I thought it would be about neuro-linguistic programming, but it turned out to be about active listening, being present/in the moment, quietening your internal narrative and finding your place in the world.  I had to write a diary everyday for three weeks about my observations and feelings, write a monologue that was my truth about an important moment, or something I want to say to someone but can't, learn and perform a monologue from Shakespeare and write a final report which I did as a self exploration of active listening and presence and their place in a healthcare setting.  It was a bit fluffy, that I can't deny, but actually I really enjoyed it.  I haven't done any amateur dramatic stuff for years, and the sessions were all about trust exercises and team building.  It was good fun, as long as you were happy to look silly for a few hours.  The facilitator encouraged us to try active listening on three people a week, and do some things differently to the way you normally do them - walk on the other side of the road, cross your arms the other way or take your jumper off a different way.  The active listening was pretty good, as I did it at work a lot and some of the conversations I had with the patients I could tell that it really meant a lot to them to have a stranger really listen, and they went away visibly happier.  It was great that such a simple thing could make such a big difference.  It felt like we'd make a deeper connection, and was lovely.  I should stop wittering about my SSU in case you all think I've turned hippy on you.  Anyway, the short story is I haven't posted because after writing a diary every day for three weeks I was all reflected out and I really liked the SSU and think I may have done well in it.

My results came out and I passed all of the competencies.  That was a relief because I was certain I'd failed one of the competencies.  All of them were satisfactory with one excellent for 2 person basic life support.  So now all that's left is one more AMK and my ISCE's which are like OSCE's - lots of competencies all on one day.  *Shiver*

Mr came home!!  He's been away overseas for four months and he finally came home.  We had a lovely couple of weeks doing not a lot and it was awesome.  We did go and see Cabin in the Woods which is an awesome film, I was bouncing up and down for a good few hours after loon grinning and repeating 'Ahhh, that was amazing!', but I am a bit of a Joss Whedon-o-phile.  We went to the christening of my cousins beautiful twins, the funeral of my two up boss at the pensions company - a wonderful, inspirational, kind hearted, legend of a man, cruelly taken much too soon.   We also found and booked our holiday for this year.  I've handed in my resignation for the surgery and confirmed my dates to go back to the pension company in the Summer.

All in all I'm a pretty happy bean, and that concludes the whistle stop tour of my last six weeks.  It sure is good to be back with you all.

Hell Week Debrief

Hell week is over and I'm a week through Easter Holidays.  I got my AMK results back and I'm very happy to say I'm back on track.  I'm up from 28.4 to 38.4 and back in the top half of the cohort.  I was a little more cautious this time and answered less questions; too few to be honest.   They say you should aim for half right and half wrong, and I got 54 right and 24 wrong, so I should attempt a few more next time.  I'm still waiting for the results of the competencies.  I think I've passed all bar one but it might work out ok in moderation.  I was so annoyed with myself because it's the iv cannulation one I've probably failed - the one I practised over and over until I had it down slick.  I made such a silly mistake, worse because I didn't know it was a mistake.  I got flashback and it started dribbling out the end so I put my thumb over the hole to stem the flow.  I had gloves on and the last thing I touched was an alcohol swab so I thought it would be fine, but apparently that's still contamination.  So frustrated with myself!  I've heard Plymouth people got failed if they didn't get flashback so I'm hoping when they moderate the scores I'll come out all right.  I'm not too worried about it because you get several chances to pass and that was the only mistake I made so I'm sure I'll rock it next time.

Hell Week

This coming week I'm asking for all your good thoughts my way please, we're about to enter what we are affectionately calling Hell Week.
Monday: PBL feedback session presenting our findings to our small group
Tuesday: Competency exams in IV cannulation, cranial nerves and motor examination
Wednesday: PBL feedback and the third AMK of the year
Thursday: Competencies in choking baby, choking child, paediatric basic life support, basic airway management and adjuncts and basic life support with 2 rescuers
Friday: Part 2 of PBL feedback, if we haven't done it Wednesday morning because we are trying to reschedule it so it's not the morning of the AMK.

Not looking forward to this week much.  It's a spectacular fail in timetabling, or it's just a ploy to test us to see how we cope under pressure.  Either way, not a happy bean.

Differential Diagnosis Of...

After the nice break for study week we were straight back in with cervical cancer this fortnight.  It was quite a light case compared to the last two, which should be nice, but just gives me a feeling of unease that I've missed something.  Our PBL facilitator is a consultant at the hospital and normally rips it out of us each week.  He talks really quietly, and it's not unless you listen carefully you realise he's just said something sarcastic about what an utter moron you are for deigning to offer such a ridiculous answer.  It's good practice for next year on the wards, but until now every facilitator we've had has been sickeningly sweet and lovely.  Well, with the exception of my last one of course, whose reply to me being 10 minutes late for class and hopping in on crutches was "I've sprained my ankle and I still managed to cross London with three tube changes to get to my lectures on time and I didn't need crutches".  Well bully for you.

Our current facilitator doesn't like fluffy stuff, hard science and management plans only please.  It's not enough to know what drug to give in a situation, we have to know dosages and timings as well.  Don't get me wrong, I love him and wouldn't have anyone else.  I feel like I learn so much more, it's just taken a bit of adjusting too.  He always prepares a slideshow of real life cases he's seen relating to the topic for the fortnight, and we play a what's wrong and what would you do game.  Gynae though, is really far from his speciality and he's been eerily quiet this time.  We'll give an answer to a question and cast a sly glance his way to see if he's about to erupt or if we've done well.  He's just been sitting there nodding silently.  His only contribution was to dissolve into fits of giggles and ask us differential diagnoses for a female with pneumoperitoneum.  We hesitently suggested trauma or infection.  Parachuting apparently, something he remembered from his med school days.  The air goes up and out through the tops of the fallopian tubes.  I just have images of fimbriae flapping in the breeze.  I know, I know, there's fluid, but that doesn't make such a pretty picture.  Colposcopy is apparently more likely to cause this through the same mechanisms though.

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?

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.

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.

Results

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.

My first time

My friend and I are sat with all our equipment prepped in a sterile dish, gloves on, surveilling the patients in front of us apprehensively.  Introductions done, procedure explained, consent obtained and the area swabbed with an alcohol wipe - one wipe top to bottom, and we could put it off no longer.  I reached for the cannula, removed the cap, wiggled it to check it wasn't stuck, put the bung to one side and willed a vein to jump out and dance at me.  Vein selected, palpated and pinned I advanced the needle through the skin which was tougher than I thought it would be.  Nothing.  I wiggled a little, still nothing.  I looked at my friend who peered and said "you have to pump the thingie to make the pressure for the flashback".  I dutifully reached around the back of the severed rubber arm and pumped the balloon but still no flashback.  My friend reached over and gave a few more pumps for luck while I advanced the needle a little further.  Just then, "aaaarrrrghhhhh!" I shout, as bright red fake blood squirts out of the end of the cannula all over me.  "Oooohhh, tourniquet off, needle out a touch, advance the cannula, pinch the vein, needle out, thumb over the end, needle in the bin, bung on!" yells my friend, helpfully.  I try and comply and wish for a few more fingers and pairs of hands to do all of that at once, as blood continues to spurt everywhere - a little too much pressure added maybe?  I got in a bit of a mess with the sticky thing, as it doesn't stick well to rubber but I got the gist and before long I was looking proudly at my first ever cannula, happily splattered in fake blood.  I looked at my friend who was trying to flush his with saline.  He was having a little difficulty and the saline wouldn't go in, so he put more force behind the syringe.  The saline squirted out around the port, spraying us both.  Despite our mishaps, job well done and we've been told it's much easier on real people.  I did get some odd looks at work later though, with my hands stained in cherry red blood.  Totally worth it though.  And now, if I'm asked if I'd like to try putting a cannula in I can honestly say it's not my first time.  I just won't tell them about the bit where I screamed in the middle.

Exam post mortem and my new friend

The exam went ok, I think.  I'm not really sure.  I haven't found any yet that I got wrong through overhearing other people discussing questions.  I fall in the group of people that doesn't like doing post mortems on exams.  I am very competent all on my own at beating myself up and second guessing my answers, I don't need any help thank you very much.  I can't change what I did so it's best for my sanity and sleep cycle if I just forget about it.  I answered less questions than last time, which could mean I have done better as I will have gotten fewer minus points for getting questions wrong, or worse as I didn't answer as many so didn't have a chance to get points.  Aargh, see? Neurotic about Track, neurotic about exams, maybe it's a medical student thing?  Or me, just me :)  My last minute cramming sort of worked.  There was a question about B symptoms in leukaemia.  I read a little about B symptoms, but only that they existed, I didn't read what they were.  If I'd just have read the rest of the paragraph!

I have moved back home for two weeks whilst my parents are away on holiday to cat sit.  This weekend was the loneliest time in my life.  The two people I talk to every day, Mum and Mr have left the country, and I had to move back to my parents house.  Normally I like to be on my own but it's different because in my house I can always hear the noises from other people.  Here it's just me and a cat that hates people.  She had very little human contact and she's only two, so she doesn't really know how to be a domestic cat.  Every time I stand she runs away.  I enter a room and she leaves it.  She sleeps all day then yells at me to go to bed so she can play all night with me gone.

Today, we had a breakthrough.  My computer is set up on the dining table and today she has come to sit next to me on the corner of the table, staring at the computer screen.  I've been watching the streams of our lectures, and the take the form of a split screen with a view of the lecturer and a view of the powerpoint.  Freya keeps watching the lecturer and every now and then bopping them in an "Ah, shut uppa ya face" sort of way.  It's hilarious.  Now she's weedled her way into the space between my bum and the back of the seat.  She's curled up in a little ball, very happy and purring.  There's a big bully cat who keeps coming in and eating all her food and she just yowls at it, terrified.  Every time she yowls I come running with a water pistol, whether it's 3am or 9 am (and believe me we've done all times in between).  She runs away, I see off the cat and she creeps back to make sure it's gone.  I think that may have won me some brownie points.  That and I haven't actively tried to eat her yet.  I've gotten back into my normal routine and done my big cook for the weeks' evening meals and lunches (pork and mushroom stew and a vegetable pasta, if you wondered) and so with that and Freya's offering of friendship, today hasn't been quite so glum.  Also, it turns out the boiler in my student house has broken and they haven't any hot water or heating, so it turns out this was all timed quite well after all.

The Fear

So, as is usual with me, it's the night before the AMK and I have the fear.  I have the fear so bad, I'm pretty numb with it to be honest.  I am about 99% certain I won't be able to beat last time's score, so I'm just psyching myself up to telling my family and friends I've gone down.  It doesn't even really feel like there'll be an exam tomorrow.  I've got PBL in the morning with a new facilitator who's pretty strict and pro-science/anti-fluffy stuff so hopefully he'll impart some pearls of wisdom as there's literally 15 minutes between finishing the session with him and the coach leaving to take us to the exam venue.  Before an AMK you'd usually find me pretty spaced out doing last minute cramming in my room, on the walk to the coach, going up the stairs to the exam hall, to the very last minute.  People tell me it's not good and if I don't know it by now I never will, but I know for a fact that I got at least one mark last time because of last second cramming - an odd sentence I read in a dermatology section about livestock handlers and skin diseases, and a question about orf came up.  It works for me.

Mr is now ridiculously far away for a stupidly long time.  It's not even really worth counting sleeps it's so far away - 108 sleeps.  I can't even comprehend how many fingers and toes and noses I'd need to count all of them :(  New Years was lovely though.  It filled up really early, so we were there in the rain from 7pm and my evening included a fun hour long queue for the loo.  The fireworks were worth it though - absolutely amazing.

I'm off to go cook tea - squash gnudi om, nom, such a student diet.  See you on the other side, and happy new year.

End of Year

Tomorrow I am training up to London to spend New Year's watching the fire works with mr.  If you're watching on the telly I'll be the one in the bobble hat at the front :) I am currently languishing in essay hell.  One fluffy essay on work life balance is written and submitted but the one off the back of my SSU I'm having much more difficulty with.  See, before we went into a tutorial session with the facilitator, one of my two placement partners asked what essay titles we'd picked.  When we went in to talk to the facilitator, the facilitator asked each of us in turn and the person that was asked before me, the person that had asked what we were doing outside, gave my idea as their own!  Bearing in mind that outside they had told us they were doing something completely different and they are also absolutely disgustingly, sickeningly, sweet and lovely, so you'd never believe they were capable of doing such an under-handed thing.  I was not amused.  It left me struggling to come up with an idea on the spot so as not to look under prepared in front of the consultant.  Now it turns out that there isn't anything to write about in that field and I am a little stuck.  The thing that my essay has turned into is way to big to write a 2000 word essay on and cover properly, but if I go wildly off topic and pick something else, the facilitator will wonder why as it was so different to what I was originally going to do.  I can't complain about the other student because that just looks like I'm moaning and I certainly can't do the same as them.

This year has gone pretty well, looking back through some of my blog posts.  Exams have all gone well, I had a lovely holiday with mr, I've been on some amazing placements, proved to myself that I actually can do this medicine lark, met some inspiring people, and started to try and come out of myself a little more and be a bit braver.  Next year I will be trying to do some sort of fitness each day, make a real effort to stop ignoring emails and messages form friends and actually find time to meet up with them like I said I would and try to moan at you lovely readers a little less.

I hope the new year will bring you everything you want, be it luck, a medicine place, health, friendship, love or wealth.  Happy New Year!

Christmas

Well, the cancer clinic was as dire as I thought it would be.  It was the closest I have come to crying in clinic, which I know is totally inappropriate, but I had to look away and steal myself to stop a tear rolling down my cheek.  A patient came in with their sons and was told that the headache and cough they'd had for the last couple of weeks wasn't a head cold like their GP had told them but a met from lung cancer they also didn't know they had.  They have weeks left.  They joked if they'd have known they would go like this, they wouldn't have stopped drinking all those years ago.  The GP had told them once the headaches had gone they'd do something about helping them quite smoking.  It took a good while for the patient to decide if they even wanted a diagnosis.  That seems alien to me.  Is it better to not know?  To not have a name to call the evil you have to try to fight?  Not knowing would be worse for me.  Funny how different people are. 

I've moved home for the two weeks of christmas holidays.  I am working full tim at the surgery, and spending the rest of my time on my knees trying to find the balls that my cat has lost.  I'm trying to show her I'm the magic ball finding lady, not the terrifying lady she thinks I am at the moment.  She's forgotten the hours we spent under the sofa together and runs away from me now.  Which is doublly sad because I am normally one of those crazy cat ladies/cat whisperer that has cats follow them home and roll over for tummy tickles the first time they see me.  Not my own cat though. 

New Year's is all booked for me and mr to see the fireworks on the embankment in London again.  It will be our third year.  Not sure what we're doing in the daytime yet but train tickets, hotel, restaurant vouchers from tescos points all booked and sorted.  I can't wait.  It's a little sad, but in some ways I'm looking forward to that more than Christmas.  I was trying to find a Christmas card for him, but all the couples card's kept saying about how special it was to spend Christmas with your loved one and how magic they make the day.  One day.  I hope you've all bought the Military Wives Choir song, it should def be Christmas Number 1. 

Hope you're all having a nice break for Christmas and those interviews and offers are rolling in.  Good luck and Happy Christmas!

Colourless, green, yellow or black?

Can you guess what I'm doing at the moment?  I am about to start my final week on a respiratory outpatients SSU.  I had been thinking that maybe respiratory could be the speciality for me and whilst I have enjoyed these two weeks, but now I've done a little - nope.  Another speciality choice crossed off the list.  It has been the most depressing couple of weeks.  It is probably not the most depressing - oncology, palliative, I can see those as being sad; I would go into them prepared.  This was an ambush of sad.

First patient of the day comes into the room, consultant looks at the scans.  We are sat behind the consultant staring in awe at the proceedings, not quite believing we are in an actual hospital seeing actual patients and trying really hard to look like we've done this loads of times before and sort of know what we're doing.  The consultant has quite a thick accent so I find I have to concentrate a lot on what he's saying to understand it.  What gives the game away though is the look of utter shock on the patient's and their relatives face.  The look someone gets when their whole world falls apart.  That the shortness of breath their loved one has been feeling and the slight cough is actually ideopathic pulmonary fibrosis and there's nothing that can be done.  That they have about 2-3 years left of increasing shortness of breath and decreasing quality of life as the fibrosis rips through their lungs, spreading like cancer.  Repeat this for two clinics a day for two weeks with one and a half days of to work at the GP's and that's my last two weeks.

The consultant was explaining to a patient that they could be put on this experimental anti-fibrotic drug.  It isn't licensed yet and the drug company will give it to the hospital for free to so that if it does end up being licensed the hospital will be more willing to pay for it because they have patients on it already.  The drug may not work, but you might think it's better than doing nothing.  The patient looked at me and asked what I thought they should do.  I had no words.  As they left, the patient thanked me for my time, patted me on the shoulder and told me to enjoy my life.  I know that death is a big part of being a Doctor.  I'm not naive enough to think that everyone can be saved.  I just wasn't expecting to meet it so soon.

A patient was seen with a whole list of problems, but they are happy, up beat, they have a strong family network, they still do things, but they'll be dead in 6 months.  It's incomprehensible   It just makes me want that parallel life with me curled up with mr on a big comfy sofa in front of a roaring wood fire with a couple of dogs and cats lying about the place.  I want my life now, I don't want to keep waiting for it.  It doesn't help I'm currently trying to write an essay on work life balance (as in my lack of one and the changes I plan to make to get one), and that January is creeping ever closer.  In January mr starts the longest period of time we've ever been apart.  He goes from being far away, but not too far that I can't go visiting some weekends, to ridiculously far away.  He's not going anywhere scary, but he is going far away for roughly 98 sleeps.  We don't have the exact dates yet.  Thank goodness for whoever invented Skype.

It might be a little hard to believe from the way I'm moping, but between writing this post and the last I did cheer up considerably.  I had one of those special moments girls get when they go clothes shopping and realise they've dropped a dress size.  Fantastic feeling.  I also finished all my Christmas shopping, I just have to put a few more coats of varnish on things I have been making for family presents, finish writing the cards and I am done.  Tomorrow is home visits and the cancer clinic.  Psyching myself up for it with hot chocolate and biscuits.

Down in the Dumps

I'm afraid I'm not the happiest, smiliest bean ever, so please bear with me while I have a little woe is me rant.  Or not.  Skip it if you like, but don't say I didn't warn you.  Results night I was walking down the stairs at home to answer the door when my ankle gave in and I slid down the rest of the stairs on it, landing in a small heap at the bottom.  Sadly nothing stronger than water passed my lips and I was having a quiet night in, not celebrating like a rock star falling off the table I was dancing on.  One of the good things about being from my University town, is that when my housemates were running around trying to decide who could drive my car (as none of them have one) or whether they should call an ambulance, whilst trying to fight me and RICE my ankle while I just wanted to cry and lop my foot off because it hurt too much and could they please stop touching it with the cold solid thing, I could call Mummy and Daddy bean to drive me to the Walk in Centre because I broke a bit of myself.  3 hours later I emerge with a PIL on foot and ankle injuries, a copy of my X-Ray (batted my eyelids sweetly at the Dr), a sprained ankle and a shiny pair of crutches.

It's been over a week now and I'm still on crutches.  People tend to fall into two categories, those that think I'm being lazy and for goodness sakes it's just a sprain, and those that have also badly sprained their ankle in the past and cheerfully tell me a sprain is worse than a break and is there anything they can do for me.  All I know is if I take 6 steps without crutches my ankle will ache for the rest of the day, or if I try flex my foot, like to do stairs, it aches, or if I rest it on something, it aches, and that it is still swollen.  Still.  Stupid ankle.  My lovely Mr came down and put it in a tubigrip for me this weekend, which is helping, although I nearly kicked him when he put it on it hurt that much.  It's helping so much I would be down to just one crutch except that last night I managed to put my hand on an electric hob on max and am sporting a rather painful burnt palm now.  Crutches are blooming hard work, especially because all the exercise I do normally is lower body not upper.  Everything aches.  It's laughable really; before I wasn't sleeping because I was a stressy-head over exam results.  I was really looking forward to a full nights sleep when the results came out and it turned out I didn't need to worry.  Now I can't sleep because my ankle has perfected this dull, nagging, persistent ache that pain killers aren't touching.  Argh!  I went back to the WIC at the weekend and they said to stay off it for another 2 weeks.  That means my Winter Ball on crutches, and my first week on SSU on the Respiratory Ward on crutches.  Brilliant, just perfect.  Should I mention this is all on top of the inner ear infection I already have that the GP said was viral and I just had to ride out?

Placement was pants, utter pants.  I had such a good placement last time and this was just awful.  It started badly when I asked my partner to give me a lift in because I can't drive at the moment, and they asked me to walk what would normally be 30 minutes to meet them so they could drive a really convoluted way, instead of the direct route which goes straight past my house.  I had explained why I needed the lift and when I told them the direct route they got really defensive and said since I was asking the favour I should be nicer to them.  They then were so paranoid that we would be late they arrived 10 minutes early to pick me up and we arrived 40 minutes early.  I was with 2 GPs.  One completely ignored me and didn't involve me at all.  The other was the nice one that I had last time only this time the questions he asked me I hadn't a clue about (diagnosing Paget's from the clues of bilateral hearing aids and hip pain, and spotting CREST) and he just made me feel like an idiot for not knowing them.  My attempt at taking blood didn't work as the patient's vein disappeared when he straightened his arm out, and only once I'd tried did the patient say "Ah yes, the hospital always has trouble taking my blood".  My ankle was killing me after that day as the GP was full of come over here and have a look at this boy's spots/man's cyst/lack of an inguinal hernia/letter that I'm holding in my hand/etc.

Finally, the forces have been in the spot light a lot recently, with Remembrance Sunday, Military Wives Choir and Frontline Medicine recently.  Being completely and utterly selfish and probably just a big bag of silly girly hormones again, but I'm finding it really hard to be supportive for Mr.  My heart bursts with pride and love for him, but I don't know as I'm ever going to be strong enough to be left behind, waiting for him to come home safe.  The first of his intake from Sandhurst was killed on tour recently and it's made it all hit home.  I keep beating myself up about it because as sad as I get and for all my doubt in my own strength, it's not about me, it's about him, and I shouldn't be so.... pathetic.  Hundreds of women do it, there's no reason why I shouldn't be able to.   I just don't want to have to try.  I was watching the choir programme and they were saying that they had chosen this life and so that's how they get through it, but I didn't chose this, I fell in love with a guy I met in a club.  I need to man up, stop dwelling on it and deal with things as and when they arise.  I need to take my own advice, that it's not about me, it's about Mr.  And maybe one day I will.

In happier news, I passed my clinical competencies in IM injections and musculoskeletal exams with excellents, and the GP passed me on cardiovascular exam competency.
Hopefully I'll be happier next time,
Hop-a-long

Results

Results came out at 11.30 today.  I PASSED!!!  Not only did I pass, I did rather well, a bit of a closet clever clogs really :p  I got 41, which is up from my last score of 28.  I am in the top 5% of the year so I got my excellent and a bit of snooping through the exam reports tells me that I'm actually 6th in the whole year.  To say I am excited right now is an understatement.  I even passed the passmark for the 5th years.  I am shaking I'm so happy.  To have been so worried about it and to have it all turn out all right, and even better than all right is just fantastic.  I'm off to go bounce off some walls now :)  Thank you for your lovely comments yesterday, they really cheered me up.  Have a great weekend.  I'm up early tomorrow to go to a day of Podmedics lectures.  Now my only worry is maintaining that score!

Fret, fret, fret

I should be excitedly telling you how I aced the AMK, or crying because I failed the AMK and am feeling pretty dismal.  I have dutifully waited the normal two weeks.  I am getting my insomnia and then sleep walking when I finally do drop off, as is usual when I'm fretting about something.  Results day should have been yesterday.  Tuesday we got an email saying that due to unforseen circumstances there was going to be an unavoidable delay in the release of the results, for another two weeks!  This bean is not amused.  I'm not sure I'll last that long on this little sleep.  It's all very well saying it's no use fretting, and why don't I try going to bed early but it's not that simple when you're this side of the fretting, and when it's not your results, or not your family you have to tell if you fail.  We then got an email from the Dean telling us of for a facebook group that had been discussing AMK questions and the rumour is that we've done better this time than we were supposed to, hence the delay as they try and work out how to moderate it.  This was the first time I'd heard about any such group and really just adds to the fretting, as it presumeably means that a whole load of people have done very much better than me and when the grade boundaries are set according to how everyone else did that really doesn't bode well for me.  I don't know how you picture the little bean in your head but she's pacing up and down right now and could probably do with a swift slap across the cheek and being told to calm down. 

Apart from that this case unit has been pretty massive - covering endocrine, diabetes, the eye and the leg in the space of two weeks.  I have done my usual shifts at the GP surgery and so having an inability to shut down and go to sleep means my productivity is up pretty high, as long as you don't mind your bean rocking a zombie look the rest of the time.  After this case unit there is a study week, so as long as the GP's don't claim me I should get a bit of a break then which will be nice. 

The new cat is now out from under the sofa.  She now lives under the table, but at least she's more accesible there.  She adores getting tickles but isn't comfortable enough yet to come and ask for them.  If you want to contort yourself to get to her and give her them that's fine, but if you don't that's ok too.  Hopefully we'll start giving her the run of the house soon as she's confined to the living room for now until she's less fraidy.  It is very therapeutic going over every day to tickle a cat though.  Should be prescribed.