I could not be more relieved that 2009 (academically, at least) is over. This term has been the hardest I've ever dealt with - not in academic content, but in emotional crapola. However, the two days immediately following the end of term made up for that (partially - family incidents aside).
20 hours of Ortho! It was my reward for surviving the term, and after the battle with Dr Granny, I needed it, and I oh-so-earned it. And it was immense.
7 cases
3 assists
1 solo washout & fragment removal (OH YESH!)
1 attempted intubation
1 failed intubation
17 minutes of bagging V-Tach guy
7 patients still alive when I left...
And Isecretlywanttobeananaesthetist - shush! Mainly cos I'm not 'attached' to a dept when I'm in theatres - I'm there on my day off, for fun, for extra experience. So I tend to wander into the gas room pre-op and the gas men (or mostly, darling ladies) adopt me, take me under their hugely knowledgable wings, and teach me. Last time, I got my first real cannulation and intubation, not to mention various induction stuff. This time, I got a ton of ECG teaching (super-great timing!), a masterclass in facemask seals, teaching on the treatment of V-tach, talked through central line insertions, epidurals, intubation (again)... I <3 Anaesthetists. Maybe I could certify in Ortho & Anaes...
Crazy repeated convo's everytime I met someone new (or not new - some of the surgeons remembered me!) - "So you're 4th year?"
"No, second."
"So why are you here?"
"It's the Christmas holidays"
"So why are you here?!"
"Um... I wanna be an Orthopod..?"
Clearly, volunteering to come in on a) your day off, b) a day when we are snowed in, and c) the morning after the Christmas party, makes you a nutcase. I can live with that - I got to touch the talus from inside a leg!
But now, I am off to marvel at sexy cars and contemplate which one my first surgical pay packet (oh, 6 years time, move faster!) will go towards....
Sunday 20 December 2009
Thursday 10 December 2009
Not a black dreamer.
I could kill. I could also hug.
Homicidal tendencies are due to a big error with our electricity bill, making us liable for nearly £200 worth of power. I wish "I'll cut off the direct debit" held as much weight as their "we'll cut off the power" threat.
In other news, my two days in trauma theatres next week are confirmed. EEEEEEEE!!!!! Now the major problem will be keeping it a secret! If any other second years find out that theatre exposure is possible, my lovely reward for surviving the term will be ruined.
Other factors that threaten to ruin the end of term are impending bankaccountemptinessdoom, all of my friends attending a christmas dinner I am not invited to, and attempting to batter my head of year with a small child. Or other weapon of choice.
An assessed clerking was handed in several weeks ago. It was returned yesterday. I got a score of around 50%. Needless to say, I am not ecstatic about this. I'm boiling over with fury at an inept system which punishes the honest and rewards the liars. Certain people (and I can name at least four, so far) did not clerk a single actual patient, yet handed in a full (fictional) clerking and receieved almost perfect marks. One of my friends was marked down for saying he examined the olfactory nerve in his cranial nerve exam. The markers don't believe people could have the ingenuity to bring an orange to ward teaching for this purpose. I was honest about the fact that I didn't examine certain pulses (didn't want to undress patient), reflexes (patient refused) and vibration & pain sensations (there are no tuning forks on the ID ward, nor Neurotips - also, I find it unnecessary to subject the patient to pain, however mild, for a formative assessment). It was also commented on that I did not perform fundoscopy. We've never been taught fundoscopy, and I wouldn't have a clue which side of an opthalmoscope I or the patient should be on. The patient may have learnt plenty about my retinas, but I didn't do it.
This is war. My tutor today told me to "stop trying to fight the system, because you will end up fighting yourself". Surely if it's me vs me, that's a win-win situtation? I know what he means, and I know that the knobs who lie now will lose out later, but the fact remains that... that... yeh, it's not fair. I should get over it.
Homicidal tendencies are due to a big error with our electricity bill, making us liable for nearly £200 worth of power. I wish "I'll cut off the direct debit" held as much weight as their "we'll cut off the power" threat.
In other news, my two days in trauma theatres next week are confirmed. EEEEEEEE!!!!! Now the major problem will be keeping it a secret! If any other second years find out that theatre exposure is possible, my lovely reward for surviving the term will be ruined.
Other factors that threaten to ruin the end of term are impending bankaccountemptinessdoom, all of my friends attending a christmas dinner I am not invited to, and attempting to batter my head of year with a small child. Or other weapon of choice.
An assessed clerking was handed in several weeks ago. It was returned yesterday. I got a score of around 50%. Needless to say, I am not ecstatic about this. I'm boiling over with fury at an inept system which punishes the honest and rewards the liars. Certain people (and I can name at least four, so far) did not clerk a single actual patient, yet handed in a full (fictional) clerking and receieved almost perfect marks. One of my friends was marked down for saying he examined the olfactory nerve in his cranial nerve exam. The markers don't believe people could have the ingenuity to bring an orange to ward teaching for this purpose. I was honest about the fact that I didn't examine certain pulses (didn't want to undress patient), reflexes (patient refused) and vibration & pain sensations (there are no tuning forks on the ID ward, nor Neurotips - also, I find it unnecessary to subject the patient to pain, however mild, for a formative assessment). It was also commented on that I did not perform fundoscopy. We've never been taught fundoscopy, and I wouldn't have a clue which side of an opthalmoscope I or the patient should be on. The patient may have learnt plenty about my retinas, but I didn't do it.
This is war. My tutor today told me to "stop trying to fight the system, because you will end up fighting yourself". Surely if it's me vs me, that's a win-win situtation? I know what he means, and I know that the knobs who lie now will lose out later, but the fact remains that... that... yeh, it's not fair. I should get over it.
Saturday 5 December 2009
Tweeeet.
I was supposed to finish the GI system today. I'm still 2 lectures off. Bah!
I was supposed to wrap the Christmas presents tonight. They're all sat on my bed. Unwrapped.
I was supposed to not buy any more alcohol til at least next week. I have a new bottle of wine in my fridge. Now half empty. Bonus - I did not get ID'd for it. Antibonus - I'm supposed to be over 25 for that to happen. Shit. Boyf suggested that I have gained wrinkles from excessive drinking.
Boyfriend may have said "We shall see" and then "You may get lucky" when I said that I didn't think we would get married in the next decade (his idea, not mine). Am 80% happy and 20% scared shitless. Do not want to plan a wedding in the next five years.
Flatmate has gone out with friend (amid much giggling) so I have the flat to myself. Myself and Sauvignon Blanc are bonding. We are nearly best friends already.
I am out of Oreo's. This is a national disaster.
I am currently discussing my black cloud treatment with a relative stranger, in full internet view of many medics I know in real life. This is my confession.
I was supposed to wrap the Christmas presents tonight. They're all sat on my bed. Unwrapped.
I was supposed to not buy any more alcohol til at least next week. I have a new bottle of wine in my fridge. Now half empty. Bonus - I did not get ID'd for it. Antibonus - I'm supposed to be over 25 for that to happen. Shit. Boyf suggested that I have gained wrinkles from excessive drinking.
Boyfriend may have said "We shall see" and then "You may get lucky" when I said that I didn't think we would get married in the next decade (his idea, not mine). Am 80% happy and 20% scared shitless. Do not want to plan a wedding in the next five years.
Flatmate has gone out with friend (amid much giggling) so I have the flat to myself. Myself and Sauvignon Blanc are bonding. We are nearly best friends already.
I am out of Oreo's. This is a national disaster.
I am currently discussing my black cloud treatment with a relative stranger, in full internet view of many medics I know in real life. This is my confession.
Friday 4 December 2009
*Pharm dance*
2 posts in 2 days - something must be wrong!
So far all that is majorly wrong (ignoring big uni FtP issues, family issues, flatmate issues...) is that I still have two weeks left of term! This means about twenty more hearty lectures, one community session, and two ward sessions. [And two days in trauma theatre, but that isn't confirmed yet, so ssshh.]
And today, on Haematology? The Jelly fire was still a-burning. The Prof finally deigned to teach us himself, and he's a darling. A veritable Theo Paphitis (sp? I like my dragons firebreathing, not just plain wealthy) with a mild sense of humour. Split to the 8 winds, with a list of 9 patients to see, we regrouped an hour later with 5 histories. Maths is lost on medics, clearly.
Beardy presents his case. I don't even recall what it was, but I've got a 33% chance of guessing - everyone has lymphoma, leukaemia, or myeloma. And I know nil about any of them. Yet. Only just into his HxPC, Beardy gets pulled up on some error, suggests that I take over. Queen of the presentation. I like. I decline (having not even gathered the notes for my case, never mind his) and he continues, until the medication list arises. What is... Aciclovir? Ciprofloxacin? Dexamethasone? Omeprazole? Azathioprine? Bing, bing, bing, bing, bing. Somehow, the rest of the group left their Pharm head at home. Or never owned one in the first place. I recommend eBay. After drug five, Theo has given up even looking at anyone else for an answer. Oh yeh! Oh yeh, oh yeh, oh yeh... *pharm dance*
Now what the hell is MAXICHOP? Aside from the latest in machete wielding ballroom styles...
So far all that is majorly wrong (ignoring big uni FtP issues, family issues, flatmate issues...) is that I still have two weeks left of term! This means about twenty more hearty lectures, one community session, and two ward sessions. [And two days in trauma theatre, but that isn't confirmed yet, so ssshh.]
And today, on Haematology? The Jelly fire was still a-burning. The Prof finally deigned to teach us himself, and he's a darling. A veritable Theo Paphitis (sp? I like my dragons firebreathing, not just plain wealthy) with a mild sense of humour. Split to the 8 winds, with a list of 9 patients to see, we regrouped an hour later with 5 histories. Maths is lost on medics, clearly.
Beardy presents his case. I don't even recall what it was, but I've got a 33% chance of guessing - everyone has lymphoma, leukaemia, or myeloma. And I know nil about any of them. Yet. Only just into his HxPC, Beardy gets pulled up on some error, suggests that I take over. Queen of the presentation. I like. I decline (having not even gathered the notes for my case, never mind his) and he continues, until the medication list arises. What is... Aciclovir? Ciprofloxacin? Dexamethasone? Omeprazole? Azathioprine? Bing, bing, bing, bing, bing. Somehow, the rest of the group left their Pharm head at home. Or never owned one in the first place. I recommend eBay. After drug five, Theo has given up even looking at anyone else for an answer. Oh yeh! Oh yeh, oh yeh, oh yeh... *pharm dance*
Now what the hell is MAXICHOP? Aside from the latest in machete wielding ballroom styles...
Thursday 3 December 2009
Trumpet blowing - it's all brass, baby.
Clinical teaching is now every Thu/Fri morning and today: I was on FIRE! Roar, an all that.
We're on our Haem/Onc rotation until end of January, and I already lov- uh, like it! Consultants seem reasonably willing to ignore us completely and make the SHO's teach us, which is fine by me. More likely to show up on time, better versed in current exam technique, less likely to bollock us for minor errors, young, cute...
So, today. We went out in groups of three (dire, I know, but Onc has very few patients well enough to be poked and prodded!) to take a full history +/- pick'n'mix exam (i.e. pick an exam, regardless of presenting complaint). Paired with supermurmurboy (picked up a grade 3 pansystolic mitral regurg last week, almost by accident. Grr) and orangegirl, we had a lovely bloke (bing! DO NOT CALL PATIENTS "bloke" WHEN PRESENTING!) who had a nasty tumour which was met'd on presentation. Sugar sweetie pie, he was. Honestly. History taken, 80% Jelly, 15% orangegirl, 5% supermurmurboy. Win! I do not just talk incessantly. Much. Except in the face of patients who are really willing to chat about their cancer, and be (badly) examined, with 2 fellow students who have their face in their notes. I just find it rude to let silence fall while we all scribble. So I continued with the history. And still wrote twice as many notes as supermurmurboy. Even the patient noticed. Blame the large, doctory handwriting.
Either way. Hx done. I attempted a very bad abdo exam (argh! OSCE in 1 month 26 days!) and completely forgot to start with the hands, or face... straight for the belly. FAIL. Crappy exam still found my first case of hepatomegaly!
Back to the teaching room for barbeque time. Present Mr. Cancer. "This is a xx year old bloke *cough* male with advanced x cancer metastasised to his x and x, admitted for cycle 7 of FOLFOX." Woo, I can name a chemo regime! Bonus points for describing the constituents of said regime. Superbonus points for discovering that leucovorin was a correct answer (shucks to you, Onc Dr). Yes, I geek.
Quickfire round of pharm, causes of abdo pain, symptoms of heart failure, causes of pleural effusion, investigation of frank haematuria... BING, BING, BING, BONUS BING! Orangegirl, pinkgirl, armygirl, supermurmurboy, nobface and beardy all in relative silence. *Inner glow*
Out on the ward to do a group meet-and-greet Mr Pleural Effusion. Nobface does the worst attempt at patient contact yet seen, complete with incoherent mumbling, a straightfromtextbook knowledge but nil practical practise display of a resp exam, and stunned faces from the rest of us.
Causes of tracheal shift. "Pneumothorax". "What kind?" "A big one?" Genius, Jelly, genius. Do not pass Go. Do not collect MBChB.
Turns out Casualty and ER finally win at something. Tension pneumothorax is a real diagnosis, and really fixed by jabbing a cannula dramatically into the chest. I cannot wait!
Despite "big one", OncDoc is still looking at me for all the answers! YAY! I even came home and spent hours reading about sorafenib and other NICE-banned RCC drugs and more FOLFOX stuff! I never thought I'd say I like Oncology. I like curative stuff! You broke bone, me fix. Not, you have a horrific and mostly fatal condition, I'd like to fiddle with this bag of fluid, or maybe that one?
I fail at life, but I heart clinical medicine!
We're on our Haem/Onc rotation until end of January, and I already lov- uh, like it! Consultants seem reasonably willing to ignore us completely and make the SHO's teach us, which is fine by me. More likely to show up on time, better versed in current exam technique, less likely to bollock us for minor errors, young, cute...
So, today. We went out in groups of three (dire, I know, but Onc has very few patients well enough to be poked and prodded!) to take a full history +/- pick'n'mix exam (i.e. pick an exam, regardless of presenting complaint). Paired with supermurmurboy (picked up a grade 3 pansystolic mitral regurg last week, almost by accident. Grr) and orangegirl, we had a lovely bloke (bing! DO NOT CALL PATIENTS "bloke" WHEN PRESENTING!) who had a nasty tumour which was met'd on presentation. Sugar sweetie pie, he was. Honestly. History taken, 80% Jelly, 15% orangegirl, 5% supermurmurboy. Win! I do not just talk incessantly. Much. Except in the face of patients who are really willing to chat about their cancer, and be (badly) examined, with 2 fellow students who have their face in their notes. I just find it rude to let silence fall while we all scribble. So I continued with the history. And still wrote twice as many notes as supermurmurboy. Even the patient noticed. Blame the large, doctory handwriting.
Either way. Hx done. I attempted a very bad abdo exam (argh! OSCE in 1 month 26 days!) and completely forgot to start with the hands, or face... straight for the belly. FAIL. Crappy exam still found my first case of hepatomegaly!
Back to the teaching room for barbeque time. Present Mr. Cancer. "This is a xx year old bloke *cough* male with advanced x cancer metastasised to his x and x, admitted for cycle 7 of FOLFOX." Woo, I can name a chemo regime! Bonus points for describing the constituents of said regime. Superbonus points for discovering that leucovorin was a correct answer (shucks to you, Onc Dr). Yes, I geek.
Quickfire round of pharm, causes of abdo pain, symptoms of heart failure, causes of pleural effusion, investigation of frank haematuria... BING, BING, BING, BONUS BING! Orangegirl, pinkgirl, armygirl, supermurmurboy, nobface and beardy all in relative silence. *Inner glow*
Out on the ward to do a group meet-and-greet Mr Pleural Effusion. Nobface does the worst attempt at patient contact yet seen, complete with incoherent mumbling, a straightfromtextbook knowledge but nil practical practise display of a resp exam, and stunned faces from the rest of us.
Causes of tracheal shift. "Pneumothorax". "What kind?" "A big one?" Genius, Jelly, genius. Do not pass Go. Do not collect MBChB.
Turns out Casualty and ER finally win at something. Tension pneumothorax is a real diagnosis, and really fixed by jabbing a cannula dramatically into the chest. I cannot wait!
Despite "big one", OncDoc is still looking at me for all the answers! YAY! I even came home and spent hours reading about sorafenib and other NICE-banned RCC drugs and more FOLFOX stuff! I never thought I'd say I like Oncology. I like curative stuff! You broke bone, me fix. Not, you have a horrific and mostly fatal condition, I'd like to fiddle with this bag of fluid, or maybe that one?
I fail at life, but I heart clinical medicine!
Thursday 26 November 2009
Stop punching bears, boy.
Today, one of my friends had surgery to repair an injury caused by "punching a bear, like Chuck Norris". Orrr... falling up stairs. Lol.
Either way, he's now (hopefully) post-op, with a couple of K-wires.
And I totally get why surgeons don't operate on family and friends. I'm nervous enough sitting at home waiting for news. I can't imagine how terrifying it would be to be in theatre, observing, never mind being actually responsible for the outcome.
Still partially want to have been there - not seen a metacarpal ORIF yet!!
Either way, he's now (hopefully) post-op, with a couple of K-wires.
And I totally get why surgeons don't operate on family and friends. I'm nervous enough sitting at home waiting for news. I can't imagine how terrifying it would be to be in theatre, observing, never mind being actually responsible for the outcome.
Still partially want to have been there - not seen a metacarpal ORIF yet!!
Tuesday 24 November 2009
Stormclouds and fairy wings.
Just came up with an awesome audit proposal over lunch. Future A&E doc is in on it. Plus the flat cat. I think my secret is safe with the interweb. *whistles innocently*
Meeting with the tutor in two weeks, so we shall see if he think it's feasible. I probably have to re-earn the right to audit, though. My week off put me at least three weeks behind. A month later, that's shrunk to two weeks. By Christmas, it should be ok. Maybe.
The big dark cloud has swung back over my head and I just cannot shake it off. Not properly. For a few blissful minutes, I can push it away with a glass of wine. For an hour, with a furiously competitive badminton game (impressive, on my shitty lungs). But it always comes back, with a vengeance.
Now it is stealing from me. Taking words from my mouth. More and more times, I discover that the word I want isn't there. It's on the tip of my tongue, blocked by something invisible. I write instead, my handwriting spiralling across pages. But letters are missing, misplaced, miswritten. P's become b's. S's get inverted. My hand shakes with it's own frustration.
But I am hanging on to everything else. I know I passed the formative. Five hours of painstaking copying from scribbled clerkings produced an extended clerking that will pass - with a few red scribbles criticising my use of abbreviations, no doubt. My videoed patient interview today was pretty good. Not amazing, but better than alright. I got all the symptoms and concerns out in my time limit, and showed some degree of competency in communication skills.
So I know I can do this clinical stuff. I damn well know I want the end product. I just can't hack the mind-drain in between.
Meeting with the tutor in two weeks, so we shall see if he think it's feasible. I probably have to re-earn the right to audit, though. My week off put me at least three weeks behind. A month later, that's shrunk to two weeks. By Christmas, it should be ok. Maybe.
The big dark cloud has swung back over my head and I just cannot shake it off. Not properly. For a few blissful minutes, I can push it away with a glass of wine. For an hour, with a furiously competitive badminton game (impressive, on my shitty lungs). But it always comes back, with a vengeance.
Now it is stealing from me. Taking words from my mouth. More and more times, I discover that the word I want isn't there. It's on the tip of my tongue, blocked by something invisible. I write instead, my handwriting spiralling across pages. But letters are missing, misplaced, miswritten. P's become b's. S's get inverted. My hand shakes with it's own frustration.
But I am hanging on to everything else. I know I passed the formative. Five hours of painstaking copying from scribbled clerkings produced an extended clerking that will pass - with a few red scribbles criticising my use of abbreviations, no doubt. My videoed patient interview today was pretty good. Not amazing, but better than alright. I got all the symptoms and concerns out in my time limit, and showed some degree of competency in communication skills.
So I know I can do this clinical stuff. I damn well know I want the end product. I just can't hack the mind-drain in between.
Monday 16 November 2009
Want to blog about the awesome event I was involved in tonight, but it would kinda give away who I am and where I am. Still potentially outing myself, as several people have heard the following rant recently. I hope they're internet illiterate...
I recently attended a conference about getting into a particular specialty that I adore - Orthopaedics. I spent a small fortune to go - transport from uni to London is not cheap at short notice, and neither is accommodation there. I gave up my weekend, which I desperately needed to catch up on lectures, to be sleep deprived for this week, in which I have to hand in an extended clerking and sit a formative exam.
There are two other girls in my year who are interested in surgery. They are both academically better than me; or at least, they study more and therefore gain better results in exams. I have no doubts that I will get grilled by at least one of them, if they were to find out about this conference.
Is it fair that I have no intention of either telling them I went, nor giving them any information I gained from it?
I found the course, I gave up time and money to attend, and I feel that I should reap the benefits. If they want the benefits, they can damn well do their own research.
The most recent statistics I have seen for training posts for last year state that there was 1 place for every 54 applicants in Ortho & Trauma. Call that 2% success. I do not go to the best medical school in the country. I am perfectly aware that our record at passing postgraduate exams is poor.
As an aside; I am aware that all medical schools are GMC regulated, and therefore 'equal', but with brutal honesty - there is no equality. There is no way I gaining the same scientific knowledge base as someone who attends Oxbridge. I am not being taught by the Profs who wrote the books (I believe one of our consultants edits a very famous textbook, which I shall not name, however he doesn't teach us). Whilst I cannot attend another medical school to make an accurate comparison, I somehow feel let down. My medical school offers such a poor range of intercalated degrees that I am trying to move elsewhere to do mine - if I could stay at my intended uni and not return to my current one, I would. Ideally, I want to be in London. With HEMS. With a National Centre of Excellence for Adult Trauma (and soon Paeds, too, under the same roof). With the Royal National Orthopaedic Hospital.
Back to my point - my medical school doesn't give me the greatest starting point of a career, and therefore it is up to me to do the work. I don't see why I should share the information I have gained with those who I am effectively competing with to get the hell out of here.
They are clearly doing the same. I asked, mildly inquisitively, if either was applying for our uni's summer studentships. I got a vague "maybe, not sure" from both of them. I am 80% sure both are applying.
One of my friends, in another year, is "getting through Medicine, and bringing as many people with me as possible". I love this. We're all in it together. Do I have a problem with helping the guy who wants to be a BASICS doc? The girl who wants to run A&E? The wannabe GP's? Not at all.
Just the future surgery girls.
Conclusion later....
I recently attended a conference about getting into a particular specialty that I adore - Orthopaedics. I spent a small fortune to go - transport from uni to London is not cheap at short notice, and neither is accommodation there. I gave up my weekend, which I desperately needed to catch up on lectures, to be sleep deprived for this week, in which I have to hand in an extended clerking and sit a formative exam.
There are two other girls in my year who are interested in surgery. They are both academically better than me; or at least, they study more and therefore gain better results in exams. I have no doubts that I will get grilled by at least one of them, if they were to find out about this conference.
Is it fair that I have no intention of either telling them I went, nor giving them any information I gained from it?
I found the course, I gave up time and money to attend, and I feel that I should reap the benefits. If they want the benefits, they can damn well do their own research.
The most recent statistics I have seen for training posts for last year state that there was 1 place for every 54 applicants in Ortho & Trauma. Call that 2% success. I do not go to the best medical school in the country. I am perfectly aware that our record at passing postgraduate exams is poor.
As an aside; I am aware that all medical schools are GMC regulated, and therefore 'equal', but with brutal honesty - there is no equality. There is no way I gaining the same scientific knowledge base as someone who attends Oxbridge. I am not being taught by the Profs who wrote the books (I believe one of our consultants edits a very famous textbook, which I shall not name, however he doesn't teach us). Whilst I cannot attend another medical school to make an accurate comparison, I somehow feel let down. My medical school offers such a poor range of intercalated degrees that I am trying to move elsewhere to do mine - if I could stay at my intended uni and not return to my current one, I would. Ideally, I want to be in London. With HEMS. With a National Centre of Excellence for Adult Trauma (and soon Paeds, too, under the same roof). With the Royal National Orthopaedic Hospital.
Back to my point - my medical school doesn't give me the greatest starting point of a career, and therefore it is up to me to do the work. I don't see why I should share the information I have gained with those who I am effectively competing with to get the hell out of here.
They are clearly doing the same. I asked, mildly inquisitively, if either was applying for our uni's summer studentships. I got a vague "maybe, not sure" from both of them. I am 80% sure both are applying.
One of my friends, in another year, is "getting through Medicine, and bringing as many people with me as possible". I love this. We're all in it together. Do I have a problem with helping the guy who wants to be a BASICS doc? The girl who wants to run A&E? The wannabe GP's? Not at all.
Just the future surgery girls.
Conclusion later....
Friday 13 November 2009
Drug-induced.
On a train. From one end of the country to the other. On Friday 13th. Grr.
Awesome recent patient I wanna blog about [Hello, Dean of Medical Undergraduate Education. I am blogging about a fictional patient that most certainly is currently not an inpatient at your teaching hospital].
I am always totally blown away by patients. The little old lady that walked out on her husband after sixty years of marriage. The guy who was made redundant by the only company that would ever employ him. And most recently, the ex heroin addict who ranted for ten whole minutes about people who drink alcohol.
I say this with a beautiful, chilled cider in hand.
While I agree that alcohol hurts people, and that it is pretty dangerous, I have absolutely zero urges to become tee-total. I'm not sure how a heroin addict (I won't say ex-addict, since I think that betrays the current Methadone addiction) is competent to judge those who drink. Firstly, alcohol is a legal drug. Heroin is clearly not. I understand that there are those who believe that, were alcohol discovered today, it would be instantly classified as a Class A drug. However, there is also the side that believe alcohol is good for you - a glass of red wine a day prevents heart disease, for example. (I'm a firm believer in this, but since the idea of what you should drink daily keeps changing, I'll stick to varying my tipple).
Even Jesus drank alcohol! Everything is good for you in moderation, except heroin. This guy even tried to justify his addiction by claiming that he never injected. Does this mean I can do coke if I just lick it? No - because the overall effect is the same. You're still putting an incredibly harmful substance into your body for no reason.
Awesome recent patient I wanna blog about [Hello, Dean of Medical Undergraduate Education. I am blogging about a fictional patient that most certainly is currently not an inpatient at your teaching hospital].
I am always totally blown away by patients. The little old lady that walked out on her husband after sixty years of marriage. The guy who was made redundant by the only company that would ever employ him. And most recently, the ex heroin addict who ranted for ten whole minutes about people who drink alcohol.
I say this with a beautiful, chilled cider in hand.
While I agree that alcohol hurts people, and that it is pretty dangerous, I have absolutely zero urges to become tee-total. I'm not sure how a heroin addict (I won't say ex-addict, since I think that betrays the current Methadone addiction) is competent to judge those who drink. Firstly, alcohol is a legal drug. Heroin is clearly not. I understand that there are those who believe that, were alcohol discovered today, it would be instantly classified as a Class A drug. However, there is also the side that believe alcohol is good for you - a glass of red wine a day prevents heart disease, for example. (I'm a firm believer in this, but since the idea of what you should drink daily keeps changing, I'll stick to varying my tipple).
Even Jesus drank alcohol! Everything is good for you in moderation, except heroin. This guy even tried to justify his addiction by claiming that he never injected. Does this mean I can do coke if I just lick it? No - because the overall effect is the same. You're still putting an incredibly harmful substance into your body for no reason.
Sunday 8 November 2009
Swweeeet!
Why does sweet chilli sauce contain half a billion ingredients, the majority of which I don't own?!
Ok. Substitute white vinegar for white wine. It's the same thing, surely?
No fish sauce. WTF?
No lemon juice. Don't think orange juice is a great substitute.
Chilli sauce is colour of blood and bubbling ominously. Flatmate thinks I'm a food witch.
[/successful cooking]
Ok. Substitute white vinegar for white wine. It's the same thing, surely?
No fish sauce. WTF?
No lemon juice. Don't think orange juice is a great substitute.
Chilli sauce is colour of blood and bubbling ominously. Flatmate thinks I'm a food witch.
[/successful cooking]
Saturday 31 October 2009
Reflections...
So... 2 months later, I return. With no great increase in blogging ability, but a slight degree of hyperness from M&Ms and a new shiny blue inhaler *excited puffing noises*
I'm back at uni for second year, and it's a big leap. The drudgery of 9-4 days packed with lectures is still there, but finally it's clinically relevant (sometimes) and intermingled with seeing patients! 2 hours of ward time a week is hardly something to write home about, but it certainly seemed like being thrown in at the deep end to start with. Our consultant isn't exactly big on teaching - I think he's an oldschool "see one, do one, teach one" kinda guy. Except without the "see one" part. I didn't mind particularly, seeing as I was one of the "lucky" guys who got Communication skills in the first block, so I was pretty confident in introducing myself and getting a history underway.
I feel so bad. I don't even remember who my first patient was. I could tell you anything about any of the people I saw over the summer in Surgery, but on my real uni placements? Zilch. I remember the last three, vaguely. Gastroenteritis, cellulitis, pneumonia. With 3 social histories and interesting backgrounds, because these are people, not diseases. We'll ignore the fact that my surgery notes are all '92YOF (L) #NOF -> CHS (GA)'.
Fact: I'm not a great people person. I can get a good history, even with my limited experience. I can chat for hours about grandkids, holiday destinations, and the bloody awful weather.
Fact: I would much rather be shoving a large dose of propofol into their veins in order to whack a great tube down their trachea and start slicing their limbs open. It's who I am.
This term so far in numbers:
Weeks - 5 (6 including Freshers/audit week)
Patient Histories taken - 4
Patients examined - 1
Examinations taught - 4
Surgeries observed - 21
Surgeries assisted in - 4
Patients cannulated - 1
Patients intubated - 1
How confident I am that I could now do a CHS by myself - 85%
Days spent as a patient - 3
Days off uni - 5
I'm back at uni for second year, and it's a big leap. The drudgery of 9-4 days packed with lectures is still there, but finally it's clinically relevant (sometimes) and intermingled with seeing patients! 2 hours of ward time a week is hardly something to write home about, but it certainly seemed like being thrown in at the deep end to start with. Our consultant isn't exactly big on teaching - I think he's an oldschool "see one, do one, teach one" kinda guy. Except without the "see one" part. I didn't mind particularly, seeing as I was one of the "lucky" guys who got Communication skills in the first block, so I was pretty confident in introducing myself and getting a history underway.
I feel so bad. I don't even remember who my first patient was. I could tell you anything about any of the people I saw over the summer in Surgery, but on my real uni placements? Zilch. I remember the last three, vaguely. Gastroenteritis, cellulitis, pneumonia. With 3 social histories and interesting backgrounds, because these are people, not diseases. We'll ignore the fact that my surgery notes are all '92YOF (L) #NOF -> CHS (GA)'.
Fact: I'm not a great people person. I can get a good history, even with my limited experience. I can chat for hours about grandkids, holiday destinations, and the bloody awful weather.
Fact: I would much rather be shoving a large dose of propofol into their veins in order to whack a great tube down their trachea and start slicing their limbs open. It's who I am.
This term so far in numbers:
Weeks - 5 (6 including Freshers/audit week)
Patient Histories taken - 4
Patients examined - 1
Examinations taught - 4
Surgeries observed - 21
Surgeries assisted in - 4
Patients cannulated - 1
Patients intubated - 1
How confident I am that I could now do a CHS by myself - 85%
Days spent as a patient - 3
Days off uni - 5
As can be seen from those last 2 items, I've had a change of perspective recently. A week ago, I was fine. Coughing a little, noticing a tonsil getting a bit bigger, you know the drill. Sunday, I was on the phone to NHS 24 complaining of increased shortness of breath, a MAHOUSIVE anterior chain lymph node, and some haemoptysis. Obv, OOH GP app (I love NHS acronyms - ooh!). The 15min walk to the hospital took 40 mins.
Acute SOB on arrival to the point of sitting in the consultation room for over 3 minutes without being able to utter a word.
Decreased air entry on R side, no creps, no crackles, no rubs.
No temp, no cyanosis.
That bloody 'no temp' got me a hospital admission for ?PE. I am a 20 year old female of normal weight, with mild hypertension and no FH of embolism (or any vascular disease, bar an AAA). Grr.
It was an experience though, one that I am (retrospectively) grateful for. Whilst the medical school are uber keen for us to understand the perspective of nurses, physios, pharmacy staff, midwives, you name the rest of the MDT, there hasn't been much focus on the patients. Except for 'take a patient centred history'.
I don't feel that my admission was entirely explained to me beforehand. I understood that I was going over to the main hospital (OOH being in the hospital grounds) for an xray to confirm infection. If it came back negative, we'd consider the ?PE idea.
I arrived on AMAU (Acute Medicine Admissions Unit - the clue was in the name, really, wans't it?) with my referral letter in my hand and was shown to a bed. A little bemused, but we'll run with it. Next, there's a nametag on my wrist, and a nurse is asking for my next of kin details and trying to strap me up to a monitoring device. Jeez, I walked the 100 yds here without dying, chill out.
Bonus event - reasonably cute F2 came to clerk me *be still my tachycardic heart* I criticise his clerking skills, pout at his 'NAD'ing of the systematic enquiry, and shamelessly flirt my way through an examination of my heart, lungs, and abdomen. ECG looks... like a sheet of squiggles. He assures me it's fine, and stabs me. Three vials later, I am nursing a bruised ACF.
This was supposed to a reflection, not a narrative. Um... Rob-the-F2 really put me at ease. He took me seriously without making me feel that my condition was uber serious. He made it ok to ask inquisitive questions and give honest answers, even for the questions we expect patients to lie about (alcohol intake, etc). At the end of our talk, I knew the best and worst outcomes and the plan of action either way. I was prepared. We built a great rapport in the first few seconds, just by him knocking down the doctor-patient barrier - sitting on the bed, chatting to me instead of firing questions. He made me forget that I was an inpatient with a potentially fatal condition - I could look back and analyse how he communicated with me and I know he would tick all the boxes of open posture, eye contact, etc, but more than that - I felt that he cared.
It was a stark comparison to the consultant. It was clear that he was there to see me purely because consultant review was compulsory, not because he felt I deserved his visit. In the mere 30 seconds he deigned to spend with me, I failed to catch his name (and ending up assuming he was the consultant, since I could not imagine any other member of medical staff being so aloof), had a cursory respiratory examination in which the stethoscope barely touched me, and watched, shocked, as he gave his report to the nurse rather than to me directly, and swept out, leaving her to translate.
The nurses on AMAU were great. Despite caring for an ever changing group of very different patients (the only thing we had in common was being female!), they always knew who we were and what was wrong. I wasn't subjected to unnecessary interventions just because of protocol. For example, bedtime obs weren't taken - I was clearly well and busy studying. Only twice while on AMAU that evening did I become slightly short of breath again, and they were immediately there, ensuring I was ok and not requiring assistance. Not a complaint did I hear about patient requests for food, water, commodes...
At 2100hrs, having been admitted at 1800, I was taken to X-Ray. Having seen porters treat patients like a parcel that needs delivering, I was impressed to find two caring people who spoke to me, instead of over my head to each other. At X-Ray, radiology were prompt in attending to me, discreet in letting me change my bra and tshirt for a gown, and clear in their instructions. Whilst it was mildly uncomfortable to compress myself against a cold plate, they continued talking to me even whilst the images were being taken - other X-rays I have had have left me feeling alone in the imaging room while staff hide silently behind the screen.
It was not long after my return to the ward that my nurse, Jenny, came to inform me that the CXR was entirely normal. John returned the favour from Beerienteering in coming to sit with me for hours on end, devouring the fruit from my tea, and keeping me highly amused (and breathless with laughter). The staff were awesome in letting him stay way beyond visiting hour was over and ignoring my constant mobile phone activity :)
Finally, at midnight, the bloods came back. Negative. Normal white count, normal CRP, negative D Dimer. So, no infection, no clot. Suddenly I feel like a massive waste of NHS time and resources. At least no one is mean enough to discharge patients with no transport at midnight, so I was transferred to Short Stay (Medicine) for a short nights sleep.
Supposedly. Sleep on a hospital ward is like asking for ice in hell. On settling into bed (no extra pillows, dear, just keep raising the head of the bed. It's vertical? Oh.), I was hussled out of it for obs. Surprisingly, yes, my sats will drop if you force me out of bed. The corridor lights shine all night long, the cardiac monitors beep away, the IV pumps scream shrilly at the end of their saline supply - not to mention the snoring of old dears. I counted the hours with the arrival of the nurse to do hourly BM's on a lady who stayed resolutely asleep throughout. At 4am, the bed next to me was occupied. At 6, the obs machine did another tour. At 7, the cleaners arrived. 8, breakfast (soggy or cold. What a choice!). All in all, not conduicive to recuperative rest.
Just after 9, the lone consultant prowled the ward, trailed by an Advanced Nurse Practitioner (sounds like an expensive F1 to me). I was impressed. The doctor had clearly read my notes, noted my medical student status, and actually treated me like a healthcare professional instead of using dumb lay words. She knew all my test results, knew the admission story, and had a plan formulated, ready to adapt it to my latest nursing obs and my side of the tale. I was in mild pain, felt like shit, and could barely muster the energy to sit up enough to eat my cereal. I was flopped on my pillows, supported semi-upright by the adjustable bed head, and managed a weak handshake. My sats were fluctuating at 95% on air. In telling me I was staying another night, she managed to convey sympathy and understanding through her tone. I bartered, begged, pleaded to be allowed to escape at lunchtime for my patient interview assessment, but my inability to walk across the room unwinded closed it. In my upset, she made me see that all the preparation I had done for my assessment could be used for all patient contact, and that assessment of my skills today would show me in a poor light. I felt reassured that I was in the right place and that the team were doing their best for me. I was booked for a V/Q scan later that day, although the concept of the scan wasn't explained in detail - I think she assumed I knew what it involved - falsely, as I had only heard about it for the first time in the previous week's lectures!
That afternoon, I was wheeled down to Nuclear Medicine by an exceptionally cheerful porter, who told me the greatest skill in working in a hospital was not pissing off the porters. Another gem of knowledge for later... Largely fed up of being wheeled about by this point - I understand that letting an SOB patient walk to the other end of the hospital is ridiculous, but not being allowed off the ward at all without a chair and an escort? There are no vending machines on the ward! Anyway... I was deposited in a hallway, like a package, small tag explaining my purpose an all. Shortly after, my wheelchair was rudely grabbed and pushed back down the corridor, with no introduction or explanation of our destination. Once parked in a small room, a short form and a pen were thrust at me. Nope, not a consent form, just an "are you pregnant?" form. I, in my anxious state [needlephobia], piped up, wanting to know risks, complications, side effects of the radioactive media, consequences, etc. Informed consent this was not. "There aren't any". Yeh, gamma radiation, supersafe. Let's give it to kids to play with. Firstly, you're making someone with poor lungs inhale an unknown substance. At least tell me what it is! Reassure me that you've put some oxygen in there so I don't become hypoxic! Secondly, you're gonna put a needle in my vein. No risks, no complications? How about infection, nerve damage, nicking the artery as some starters for ya? And since the stuff you're injecting is in a lead barrel, you can't even draw back to check you're in the vein.
Inhalation of unknown radioactive substance complete, I was wheeled (backwards this time. That's not wheeling, that's dragging) back up the corridor, into a large room. Somehow I was telepathically supposed to know that I should get out of my chair and onto the 'bed'. Thankfully, mardy woman was joined by someone slightly nicer. Strapped to the bed, I was slid towards the machine. Cue James Bond flashbacks of laserbeams about to slice me in two. House images of the crazy robotic dream episode where he slashes a patient open. Fun times. Up to my hips in large, white doughnut, there's a large flat plate coming closer and closer to my face. 1 inch away, it stops. Now what? No one explained that I just had to lie there while it (silently) detected my gamma radiation through it's lead colander (hehe... collimator, I know). Plate moves out a few inches. Rotates around me. Repeat. Fifteen minutes later, extract me. Tourniquet applied without warning. Sharp scratch. "Sharp scratch.." Bit late, bitch. Apparently my vein is pulsating. That's such a comforting comment to make in front of me. Sure you didn't just make my arteries glow?
Repeat on the claustrophobic plate thing. Extract, Return to wheel chair. Deposit in hallway like lost baggage.
Another lovely porter, who regaled me with how embarrassing it's gonna be for him having a bladder investigation done here where he knows everyone, as a 'one up' on every medical student seeing me in my pj's in a wheelchair.
I would now like to reflect on the behaviour of certain nurses/HCA's on Short Stay. While some (Kristina) were absolutely wonderful, some (no names) were plain rude. Just because the old dear didn't hear you the first time, there is no need to loudly sigh, mutter about her, and roll your eyes. Also, to the nurse who disliked being asked to do something, it's your bloody job. Thankfully, when you woke me at 6am for obs, my brain got you confused with a dream and there was a large hairy gorilla doing my obs. It amused me for the rest of the day.
That was a shit reflective piece. However, I got everything on paper/screen, so I can actually write a decent reflective piece later. And edit this crapola.
Sunday 23 August 2009
Boyfriend = deadmeat.
Ortho starts on Monday! Super excited for my first ever placement as a medical student!
[EDIT: Shit, that's tomorrow. I know no anatomy! I will be shot down!]
Erm.... since last posting, I have:
-cried, like, six times.
-bought new undies (matching, for the first time in my life!)
-broken the 'o' button on my laptop to the extent that it requires a small beating to produce each letter.
-bought new trainers, that I don't like, but have no way of returning...
-virtually furnished the new flat (yeh, I mean virtually as in internet-window-shopping, not actually purchasing. Not my job, not my money).
-very nearly dumped my boyfriend.
Ha, that last one was less mundane than the rest. All I will say, for posterity's sake, since I haven't really mentioned it anywhere else, is that he was a twat. He went in a strip club, and then lied about it for six months, to 'protect' me from the truth. Needless to say, I went nuts. Crying, hair pulling (I had trichotillomania as a child, and it's never really left me), hitting lying scum every time he came near me [as an aside, he did wipe my snotty nose and dry my eyes, regardless of the punches he sustained while doing so], and, once I'd calmed down a little, went upstairs to our room and pulled all the cards I'd ever sent him off the walls, and all the photos of the two of us together, and put them, together with every one of my possessions that resides at his, into the drawer under the bed, ready for disposal/collection at a later date.
[EDIT: Shit, that's tomorrow. I know no anatomy! I will be shot down!]
Erm.... since last posting, I have:
-cried, like, six times.
-bought new undies (matching, for the first time in my life!)
-broken the 'o' button on my laptop to the extent that it requires a small beating to produce each letter.
-bought new trainers, that I don't like, but have no way of returning...
-virtually furnished the new flat (yeh, I mean virtually as in internet-window-shopping, not actually purchasing. Not my job, not my money).
-very nearly dumped my boyfriend.
Ha, that last one was less mundane than the rest. All I will say, for posterity's sake, since I haven't really mentioned it anywhere else, is that he was a twat. He went in a strip club, and then lied about it for six months, to 'protect' me from the truth. Needless to say, I went nuts. Crying, hair pulling (I had trichotillomania as a child, and it's never really left me), hitting lying scum every time he came near me [as an aside, he did wipe my snotty nose and dry my eyes, regardless of the punches he sustained while doing so], and, once I'd calmed down a little, went upstairs to our room and pulled all the cards I'd ever sent him off the walls, and all the photos of the two of us together, and put them, together with every one of my possessions that resides at his, into the drawer under the bed, ready for disposal/collection at a later date.
Sunday 16 August 2009
Bye bye homelessness :)
Lab stuff is finally over. Did some immunophenotyping, and immunfluorescence, but mainly cell culturing and making up and aliquoting media.
Also in the meantime, I have been out for 3 birthdays (18th, 20th, 20th) and a bbq (SEVERE food poisoning from a Quorn sausage :( We are absolving the Taboo (with apple sourz & vodka additions) from all responsibility for subsequent sickiness). Plus a weekend in Reading with my bestest friend from all the way back to the first days of primary school!! Not seen her in 4 years so we had an awesome gossipy catch up :)
Work has been cancelled this week (the perils of casual labour), except for Thursday, so my £300 expected profit has dwindled to... £60. That ain't paying no rent....
...on my new flat which we just bought!!!! I'm not homeless any more!! I'm very excited (a little miffed that this is the flat we viewed in April. We've since made 2 offers on it, and have finally been accepted, conditional to downstairs agreeing to some rather essential maintenance of our kitchen (it's had a disagreement with the main building and is slowly pulling away...) and negotiating a reasonable moving date)!!
Also in the meantime, I have been out for 3 birthdays (18th, 20th, 20th) and a bbq (SEVERE food poisoning from a Quorn sausage :( We are absolving the Taboo (with apple sourz & vodka additions) from all responsibility for subsequent sickiness). Plus a weekend in Reading with my bestest friend from all the way back to the first days of primary school!! Not seen her in 4 years so we had an awesome gossipy catch up :)
Work has been cancelled this week (the perils of casual labour), except for Thursday, so my £300 expected profit has dwindled to... £60. That ain't paying no rent....
...on my new flat which we just bought!!!! I'm not homeless any more!! I'm very excited (a little miffed that this is the flat we viewed in April. We've since made 2 offers on it, and have finally been accepted, conditional to downstairs agreeing to some rather essential maintenance of our kitchen (it's had a disagreement with the main building and is slowly pulling away...) and negotiating a reasonable moving date)!!
Thursday 6 August 2009
Wednesday 5 August 2009
Various. Rambles. Etc.
Expect a shit post - watching Bizarre ER on iPlayer at the same time...
No more exciting trauma stuff... I'm in the local uni's research labs doing stem cell work.
MASSIVE REVELATION: I am not cut out for lab-based research.
Too slow, too imprecise (results wise), no clinical background on any of the patients. In fact, no patients. Wait a second... serious deja vu occuring.
Oh yeah, I did a day in the NHS cyto & molecular genetics labs. 3 years ago. It sucked. It made me realise that I wanted to do medicine, and not just medical sciences.
The same is still true. Give me people. Sick people. And not just their haematomas! That is all I have to say on the matter.
[Although I did get quite attached to 'my' cells today. Even though they were stupid lazy cells and have died instead of proliferating. What happened to standing up for the non-smokers, eh guys?]
In exciting news (honestly), I may have an Ortho placement! Finally got hold of the right admin people (a month after my first attempt), just need to beg several uni-based people to do various documents!
Diary looks busy - 3 birthdays in the next week, plus 2 or 3 more lab days, a trip down to Reading to see my first ever best friend (still goin strong since 4 years old! Oh yeah!), 4 days employment (money money money!!! I have missed you!!), the week in Ortho, Christian festival (downside: camping. Upside: free entry for volunteering), and then the parentals go back to school! Sometime in that period, a house needs to appear....
No more exciting trauma stuff... I'm in the local uni's research labs doing stem cell work.
MASSIVE REVELATION: I am not cut out for lab-based research.
Too slow, too imprecise (results wise), no clinical background on any of the patients. In fact, no patients. Wait a second... serious deja vu occuring.
Oh yeah, I did a day in the NHS cyto & molecular genetics labs. 3 years ago. It sucked. It made me realise that I wanted to do medicine, and not just medical sciences.
The same is still true. Give me people. Sick people. And not just their haematomas! That is all I have to say on the matter.
[Although I did get quite attached to 'my' cells today. Even though they were stupid lazy cells and have died instead of proliferating. What happened to standing up for the non-smokers, eh guys?]
In exciting news (honestly), I may have an Ortho placement! Finally got hold of the right admin people (a month after my first attempt), just need to beg several uni-based people to do various documents!
Diary looks busy - 3 birthdays in the next week, plus 2 or 3 more lab days, a trip down to Reading to see my first ever best friend (still goin strong since 4 years old! Oh yeah!), 4 days employment (money money money!!! I have missed you!!), the week in Ortho, Christian festival (downside: camping. Upside: free entry for volunteering), and then the parentals go back to school! Sometime in that period, a house needs to appear....
Sunday 2 August 2009
BASICS Day 2
Been in a bit of a shock over the last 24 hours as boyf's lil bro has got someone pregnant. That'll be the last time I let him near any of my friends!
In nicer news (as I think the above is going to be 'dealt with', unfortunately), I had another day out with the BASICS doc on Friday.
Still no big gruesome jobs, so we had a fairly quiet day. We were both a little miffed as we came on station at 8am, and the big entrapment-RTC had come in at 6.45am, and we hadn't been alerted. Fairly sure it wouldn't have required any more than a paramedic, but it would have been the most interesting thing to happen all day!
So, in the absence of real work to do, we headed up to the Para training centre and played about with their SimMan. It's the first time I've been allowed on a real mannikin, as our BLS ones are just a head & torso - these ones have eyes and proper airways and moveable limbs and breath sounds and variable heart rhythms and are shockable! OK, I got a little excited.
Basically covered the ALS course in a little under two hours (minus the complicated [and for me, unnecessary] drug bits).
I can now:
-do basic airway opening: head lift & jaw thrust (both ways)
-insert a nasopharyngeal airway
-insert an oropharyngeal airway (in adults and kids)
-insert a laryngeal mask airway (or I-Gel)
-fit and use a bag-valve mask with catheter mount
-intubate, with a laryngoscope and endotracheal tube
-secure all those airways with tape, ties, or a Thomas tube-holder
-remove all those airway adjuncts and tubes
-'burp' a patient to assist intubation (cannot remember exactly what it stands for, but it's to do with lifting the larynx and deviating it to the right to get the structures in the neck to align better for intubation
-determine equal bilat air entry from looking at the chest
-identify V-fib, V-tach and explain when and why we shock
-use the LifePak de-fib (at a cost of £15k each!) to recognise input from paddles or leads, use the advisory/analyse mode or manual mode to charge (to the correct number of joules) and shock
-CANNULATE!!!!
I was pretty proud of that last one. Two pinks into a fake arm, with perfect flashback and no vein puncture on the far side! Just need to wait another year or two til I can do it on a real arm...
We just got out the training centre when we were alerted to a collapse in a well-known food hall on the High Street. When we [finally] got up the High Street (you wouldn't believe how many people can ignore a car with a big DOCTOR sign and flashing lights all over it), there was already a Fast Responder parked up, but when we got out it turned out that he was there for another patient! Not only that, but there was another just round the corner with a third guy!
Our chap was parked in a chair between two checkouts, having gone very hot and faint. Don't recall whether he LOC'd at any point (then again, neither can he!). Pretty bradycardic at 50bpm, with low sats (92%, I think), so we got some highflow o2 on him. The store provided a wheelchair to get him out of the crowds of the checkout area and into a little office so we could get an ECG started. The two first responders from the other incidents were with us by now (thank goodness, seeing as we only carry a very basic 3 lead). 3 lead showed AF and some other abnormalities, so we moved out to the truck (on a stretcher) - amazingly, people still don't move out of your way if you have an occupied stretcher, plus a (very heavy) o2 cylinder and a (equally heavy) Lifepak. Clearly, your organic lunch is far too important.
He was pinking up by the time we got him loaded (with every man and his kid stopping in the middle of the high street to rubberneck), so just popped a line in (pink, how very similar to the CANNULA THAT I PUT IN EARLIER ALL BY MYSELF - ok, I was somewhat itching to have a go. I settled for picking the right gauge, digging out an alco-swab and tegaderm, and setting up a saline flush.), did a 12-lead, and strapped him in for the journey. 12-lead confirmed AF, plus LBBB - turned out he had a previous MI and was under the consultant cardiologist at the hospital anyway. I travelled with the crew for funsies, and met up with Matt at A&E, since the patient was on his o2 cylinder that he wanted to reclaim.
Not long until we got another call - epistaxis in a supermarket carpark (I have no idea what was with all the food-location accidents, but it was damn annoying as it was gone lunchtime!). Raced the ambulance there (they're bigger and more noticable, so traffic moves out the way faster, but we're nippier and everyone thinks we're the cops) and then the two vehicles drove in circles around the car park. Why can't casualties identify themselves?! Wave at us, or something! Either way, it was a case of walking him onto the truck, sticking a vom bowl under his nose, and taking him in. We reckon it'd be an ENT consult (he was losing a fair amount of blood, and it wasn't his first major bleed) and home...
Since we were already parked at the front door, we nipped in for a sandwich. It's got to be the only place in town that you can walk into in ambulance attire and not freak the staff out - the ambulances sit on standby in the carpark almost every day!
Back on station, sat down with a cool drink, halfway through our sandwiches - convulsions. Yay! 13min drive on blues to a manky estate. The occupants are a little surprised to see us - they'd cancelled the ambulance! The wonderful control to mobile technology had let us down again, but as we were there, we insisted on a quick look at our patient. 18YOF with H/O multiple convulsions, under consultant neurologist at the hospital, had been seen by ambu staff multiple times.... for pseudofitting. Grr! Even Matt recognised her, from having climbed five flights to the top floor of the local college when she wanted to get out of participating in a science lesson. I hate attention seekers. Either way, she was absolutely fine when we saw her - a little quiet and resistant to questioning, but obs were all spot on.
Some kind person had put our sandwiches in the fridge to save our lunch getting nicked - yet more proof that the ambu staff are absolute stars!
Finally - RTC! Big leap off the sofa for this one! Battled our way through south town to get out to the bypass, and nearly caused an accident turning across the road to reach scene - someone braked to let us through, and the cars behind were too busy looking at all the blue lights on the roadside to notice the big red ones dead ahead. Needless to say, there was a lot of brake-screeching.
On scene, couple of coppers looking pretty relaxed, one dented [local business] car, and one other car, plus an ambu-truck. Turned out that there was only one patient, who was already in the truck, getting his sore neck checked out. We stuck our heads in to say hello, and on seeing me, our 20-something YOM perks up - "why couldn't I have had her treating me?!" Thank goodness the only female member of the truck team was outside conversing with a cop...
It's one thing battling traffic on blues, but coming back through the same traffic without lights is just hell. Spotted a local first responder in a car park alongside, so slipped off the road to have a chat, and check out his council-sponsored LIVES-liveried estate car! Very impressed! If only my village had a car like that, I'd be able to join! It had some pretty neat tricks of beating the no-blues rules too - white strobes in a lightbox with LIVES across it, that is pretty inconspicious with the lights off, and some orange strobes further back, plus a bright yellow bonnet with the reverse 'EMERGENCY' wording across it (for reading it in mirrors).
And then we sat. On station. With pressure sores developing. And not even the motivation to make a coffee. But there was plenty of shit telly. And the occasional member of ambu staff passing through. And we could speculate as to why two fire trucks, plus two separate cars of fire officers had passed the window in under five minutes, all on blues. That's one lucky cat in a tree. An hour passed. We got very excited at everyone else's radio calls. Ooh, prison! Ooh, old dear fell over! Ooh, swine flu! However, none required our presence. Another hour. "OK, just go til half five and we'll give up". Half five arrives... "we'll drive back to the hospital very slowly and then log off if nothing's happened". Arrive at the hospital... "I'll drive you home, and then log off". Hmm...
As luck would have it, we got to within 1/2 a mile of my front door - 999 CARDIAC/RESPIRATORY ARREST. Oh yesh. Rapid u-turn, blues on, race back down the road into the city, through town (6pm traffic!), down into the rough end, to our one and only horrible drug addled tower block. Erm - we don't have a flat number. The CRU and the truck are there, so I hop into the truck and try to get the computer to spit out the address, to no avail. We phone Control. Much easier.
Bypass the entryphone system (who answers the phone while working on a cardiac arrest?!) by sneaking through a rapidly closing door after two lads. Just in time to meet both crew walking out of the lift, followed by a bloke. Walking after a cardiac arrest? Wow - these guys are good! Actually, no (although they are awesome). Alcoholic C/O abdo pain and peeing blood.
He staggers onto the truck. None of the crew are looking amused.
We have a short chat with the CRU guy about diagnosis of distal radius fractures (I still have no idea if there's a magic test for this - pain on pronation was suggested though), and head off again. My PPE had already been deposited at station, so I was in the spare 'DOCTOR' jacket :D
So that was my time with Matt. A genuinely lovely bloke with a huge passion for pre-hospital care, a great ability to teach, and a wonderful way with patients (and pretty hot for a greying 35yo.... )
I've inquired about joining first responders in uni town, and will be joining BASICS Scotland on a student membership as soon as I have a scottish address :) Now I just need my own mannikin to play with, or all these skills are gonna disappear faster than that nice weather...
In nicer news (as I think the above is going to be 'dealt with', unfortunately), I had another day out with the BASICS doc on Friday.
Still no big gruesome jobs, so we had a fairly quiet day. We were both a little miffed as we came on station at 8am, and the big entrapment-RTC had come in at 6.45am, and we hadn't been alerted. Fairly sure it wouldn't have required any more than a paramedic, but it would have been the most interesting thing to happen all day!
So, in the absence of real work to do, we headed up to the Para training centre and played about with their SimMan. It's the first time I've been allowed on a real mannikin, as our BLS ones are just a head & torso - these ones have eyes and proper airways and moveable limbs and breath sounds and variable heart rhythms and are shockable! OK, I got a little excited.
Basically covered the ALS course in a little under two hours (minus the complicated [and for me, unnecessary] drug bits).
I can now:
-do basic airway opening: head lift & jaw thrust (both ways)
-insert a nasopharyngeal airway
-insert an oropharyngeal airway (in adults and kids)
-insert a laryngeal mask airway (or I-Gel)
-fit and use a bag-valve mask with catheter mount
-intubate, with a laryngoscope and endotracheal tube
-secure all those airways with tape, ties, or a Thomas tube-holder
-remove all those airway adjuncts and tubes
-'burp' a patient to assist intubation (cannot remember exactly what it stands for, but it's to do with lifting the larynx and deviating it to the right to get the structures in the neck to align better for intubation
-determine equal bilat air entry from looking at the chest
-identify V-fib, V-tach and explain when and why we shock
-use the LifePak de-fib (at a cost of £15k each!) to recognise input from paddles or leads, use the advisory/analyse mode or manual mode to charge (to the correct number of joules) and shock
-CANNULATE!!!!
I was pretty proud of that last one. Two pinks into a fake arm, with perfect flashback and no vein puncture on the far side! Just need to wait another year or two til I can do it on a real arm...
We just got out the training centre when we were alerted to a collapse in a well-known food hall on the High Street. When we [finally] got up the High Street (you wouldn't believe how many people can ignore a car with a big DOCTOR sign and flashing lights all over it), there was already a Fast Responder parked up, but when we got out it turned out that he was there for another patient! Not only that, but there was another just round the corner with a third guy!
Our chap was parked in a chair between two checkouts, having gone very hot and faint. Don't recall whether he LOC'd at any point (then again, neither can he!). Pretty bradycardic at 50bpm, with low sats (92%, I think), so we got some highflow o2 on him. The store provided a wheelchair to get him out of the crowds of the checkout area and into a little office so we could get an ECG started. The two first responders from the other incidents were with us by now (thank goodness, seeing as we only carry a very basic 3 lead). 3 lead showed AF and some other abnormalities, so we moved out to the truck (on a stretcher) - amazingly, people still don't move out of your way if you have an occupied stretcher, plus a (very heavy) o2 cylinder and a (equally heavy) Lifepak. Clearly, your organic lunch is far too important.
He was pinking up by the time we got him loaded (with every man and his kid stopping in the middle of the high street to rubberneck), so just popped a line in (pink, how very similar to the CANNULA THAT I PUT IN EARLIER ALL BY MYSELF - ok, I was somewhat itching to have a go. I settled for picking the right gauge, digging out an alco-swab and tegaderm, and setting up a saline flush.), did a 12-lead, and strapped him in for the journey. 12-lead confirmed AF, plus LBBB - turned out he had a previous MI and was under the consultant cardiologist at the hospital anyway. I travelled with the crew for funsies, and met up with Matt at A&E, since the patient was on his o2 cylinder that he wanted to reclaim.
Not long until we got another call - epistaxis in a supermarket carpark (I have no idea what was with all the food-location accidents, but it was damn annoying as it was gone lunchtime!). Raced the ambulance there (they're bigger and more noticable, so traffic moves out the way faster, but we're nippier and everyone thinks we're the cops) and then the two vehicles drove in circles around the car park. Why can't casualties identify themselves?! Wave at us, or something! Either way, it was a case of walking him onto the truck, sticking a vom bowl under his nose, and taking him in. We reckon it'd be an ENT consult (he was losing a fair amount of blood, and it wasn't his first major bleed) and home...
Since we were already parked at the front door, we nipped in for a sandwich. It's got to be the only place in town that you can walk into in ambulance attire and not freak the staff out - the ambulances sit on standby in the carpark almost every day!
Back on station, sat down with a cool drink, halfway through our sandwiches - convulsions. Yay! 13min drive on blues to a manky estate. The occupants are a little surprised to see us - they'd cancelled the ambulance! The wonderful control to mobile technology had let us down again, but as we were there, we insisted on a quick look at our patient. 18YOF with H/O multiple convulsions, under consultant neurologist at the hospital, had been seen by ambu staff multiple times.... for pseudofitting. Grr! Even Matt recognised her, from having climbed five flights to the top floor of the local college when she wanted to get out of participating in a science lesson. I hate attention seekers. Either way, she was absolutely fine when we saw her - a little quiet and resistant to questioning, but obs were all spot on.
Some kind person had put our sandwiches in the fridge to save our lunch getting nicked - yet more proof that the ambu staff are absolute stars!
Finally - RTC! Big leap off the sofa for this one! Battled our way through south town to get out to the bypass, and nearly caused an accident turning across the road to reach scene - someone braked to let us through, and the cars behind were too busy looking at all the blue lights on the roadside to notice the big red ones dead ahead. Needless to say, there was a lot of brake-screeching.
On scene, couple of coppers looking pretty relaxed, one dented [local business] car, and one other car, plus an ambu-truck. Turned out that there was only one patient, who was already in the truck, getting his sore neck checked out. We stuck our heads in to say hello, and on seeing me, our 20-something YOM perks up - "why couldn't I have had her treating me?!" Thank goodness the only female member of the truck team was outside conversing with a cop...
It's one thing battling traffic on blues, but coming back through the same traffic without lights is just hell. Spotted a local first responder in a car park alongside, so slipped off the road to have a chat, and check out his council-sponsored LIVES-liveried estate car! Very impressed! If only my village had a car like that, I'd be able to join! It had some pretty neat tricks of beating the no-blues rules too - white strobes in a lightbox with LIVES across it, that is pretty inconspicious with the lights off, and some orange strobes further back, plus a bright yellow bonnet with the reverse 'EMERGENCY' wording across it (for reading it in mirrors).
And then we sat. On station. With pressure sores developing. And not even the motivation to make a coffee. But there was plenty of shit telly. And the occasional member of ambu staff passing through. And we could speculate as to why two fire trucks, plus two separate cars of fire officers had passed the window in under five minutes, all on blues. That's one lucky cat in a tree. An hour passed. We got very excited at everyone else's radio calls. Ooh, prison! Ooh, old dear fell over! Ooh, swine flu! However, none required our presence. Another hour. "OK, just go til half five and we'll give up". Half five arrives... "we'll drive back to the hospital very slowly and then log off if nothing's happened". Arrive at the hospital... "I'll drive you home, and then log off". Hmm...
As luck would have it, we got to within 1/2 a mile of my front door - 999 CARDIAC/RESPIRATORY ARREST. Oh yesh. Rapid u-turn, blues on, race back down the road into the city, through town (6pm traffic!), down into the rough end, to our one and only horrible drug addled tower block. Erm - we don't have a flat number. The CRU and the truck are there, so I hop into the truck and try to get the computer to spit out the address, to no avail. We phone Control. Much easier.
Bypass the entryphone system (who answers the phone while working on a cardiac arrest?!) by sneaking through a rapidly closing door after two lads. Just in time to meet both crew walking out of the lift, followed by a bloke. Walking after a cardiac arrest? Wow - these guys are good! Actually, no (although they are awesome). Alcoholic C/O abdo pain and peeing blood.
He staggers onto the truck. None of the crew are looking amused.
We have a short chat with the CRU guy about diagnosis of distal radius fractures (I still have no idea if there's a magic test for this - pain on pronation was suggested though), and head off again. My PPE had already been deposited at station, so I was in the spare 'DOCTOR' jacket :D
So that was my time with Matt. A genuinely lovely bloke with a huge passion for pre-hospital care, a great ability to teach, and a wonderful way with patients (and pretty hot for a greying 35yo.... )
I've inquired about joining first responders in uni town, and will be joining BASICS Scotland on a student membership as soon as I have a scottish address :) Now I just need my own mannikin to play with, or all these skills are gonna disappear faster than that nice weather...
Wednesday 29 July 2009
Wheely dangerous
Spent yesterday (I think, even our RTC victim was better orientated to day/date than I currently am) with the local LIVES volunteer doc (who is also an ST1 Anaesthetist and previous A&E Nurse & Army Paramedic), trawling the county for car crashes and cardiac arrests.
It must have been the quietest day in ambulance history. We had 8 1/2 hours without a single call. And even that was only a tiny piece of scone gone down the wrong way. We drove 30 miles on blues to get to it, as it came through as a cardiac arrest. I never even saw the patient, since there was a crew already on scene.
Instead, we spent the day on what amounts to an 'Intro to Pre-Hospital Care' course :)
Toured our local A&E (and left shocked at finding anaes units with halothane in them - even I recalled that my notes say it's no longer used! To be fair to them, there was a note on the halothane section recommending use of another agent).
Went to the local Fire station and checked out their search and rescue vehicles - they are literally massive store cupboards on wheels! Scissors the size of my body for cars, ropes thicker than my arms, huge lights for nighttime accident scenes, blocks to stabillise RTC cars... Plus everything you could ask for to completely destroy a car in a matter of minutes, from chains, glass cutters, scissors, separators, and 'ram's - hydraulic cylinders that are wedged under dashboards and extended to pull the entire dash forwards and up, away from anybody's legs! Strangely enough, they also had everything you could need to pull a cow out of a ditch...
Headed out to the smaller ambu-station that sits mid-way between us and the coast, where we found a single crew with their feet up watching morning telly :)
In that same town is our LIVES headquarters, so we went up there too. Had a lovely chat with two of the guys there, about how LIVES works, how it's funded, what it's capacity is, success rates, job variability, growth of local responder groups, AED access in public places, etc. Also checked out the recording from an AED brought in after an unsuccessful resus on a cardiac arrest. The guy had been down for 20 minutes before the responder got there, with security staff doing CPR until then. The trace was coarse VF, so he got 2 shocks. It was so easy to see where the CPR was occuring and when the responder stopped to do rescue breaths, and the timings of everything. After 2 shocks, he went down to asystole, but CPR continued for 26 mins total. The ambu crew took 33 minutes to arrive. Sounds shocking, but it was in a pretty remote area, and the responder was actually on scene just 4 minutes after the call was made.
After visiting HQ, we travelled on, out to the coast. The station out here is pretty tiny too, with 3 ambu's. Gorgeous weather, so we had a wander along the sands with a portion of chips each! Town was packed to the gills with chavs and oldies. We thought we'd check out the hospital too, and boy were we in for a shock! Residential street, with a (very) large house on one end. Yup, that house is the hospital. The original 'cottage hospital' sign was still above the door! Inside, we were almost on the set of The Royal. The house had been marginally converted and added onto over the years, but the A&E dept. was a corridor with the original rooms stripped and a hospital trolley added in each. Resus was a curtained off wider room at the end. Forget the horror of halothane gas machines, there were no gas machines! The radiographer went home at five, so no scans after-hours. Any trauma was taken straight out of town, 20-30 miles down the coast. We exited in complete hysterical giggles. I honestly didn't believe places like that existed. It was genuinely like being in The Royal!
The station was still dead, couple of Cat C's at lunchtime but nothing for us, so we headed north to another seaside down. It was so depressing that we drove straight through. Now was when we got our 'cardiac arrest' call! Quick satnav instructions, lights and sirens on, and we were off!
Horrendous roads, horrific corners, at horrible speeds. I think we did a minimum of 50, and that was in the corners. [Disclaimer: at no point did we exceed the emergency driving regulations of being more than 20mph above the speed limit.] Arrive at the nursing home. Para wanders out, looks a little surprised to see us, and explains it was a momentary choke-vomit-back to normal. Quick break to let the adrenaline of the drive wear off, and we were back on the roads, heading back towards HQ town. Well-deserved cup of coffee, an episode of eggheads, and we got our big shout. Entrapment/RTC!
We drove 40 miles in increasingly heavy downpour, down tiny bendy back roads that our rural county is well known for (and contribute greatly to our road carnage!) as fast as we could safely go. More info comes in as we travel: the main casualty is pregnant, and there are several other casualties. The entrapment remains.
10 miles out, I check the map for the exact road we're after, as Control can't put coordinates through to our Satnav like they can on their own vehicles. I get my fluoro coat on, and try and work out how to get the helmet on, so there's less time faffing around when we arrive.
1 mile out. I have no saliva left, my heart is about to implode, and I'm shaking like a leaf. Quite how Matt manages to drive, and think about all the eventualities on scene, while every drop of adrenaline surges through, I have absolutely no idea. The helmet goes on.
At the end of the road is the Police - Accident cordon. Oh shit. This is not a minor.
Around a corner, and there it is. All I can see is blue lights. As we slow, and a policeman moves the second cordon to let us on scene, I can identify a fire truck, an ambulance, a police car, and a paramedic team leader car. But no mashed car... yet.
As we pull round the ambulance to move to the far end of the scene (our car is less visible than a massive red fire truck, and it gives us time to assess the scene while parking), I spot the underside of a car. Off the road, in a field. In a ditch, to be precise.
We jump out, and I grab our trauma bag while Matt gets his helmet & extrication gloves on. As I deposit our stuff at the equipment dump site (a big tarpaulin the fire service lay out for all of us to put our gear on, so it's central to the scene and in no-one's way), I can see that we're not here for our extrication skills any more. The fire service are carrying a long board (occupied!) away from the ditch.
[I'm dumping our stuff off, and a copper nearby greets me. My immense nerves immediately blurt out "I'm just a medical student! I'm with the doctor (point at Matt)!". Gibbering wreck indeed. I think I was incredibly scared he was gonna assume I had some degree of medical competence and get me to do something! I'd never looked at my helmet before this call (it's carried in it's own fluoro bag) and I was expecting it to say 'OBSERVER' all over it. It doesn't. It says 'AMBULANCE'. Shit]
Matt runs back to the car to check out the damage while the paramedics deal with the patient. A quick glance at the wreckage patterns and physical damage to the car, and we're headed to the ambulance.
Our patient is loaded as we don our gloves (the medical examination ones, not the extrications and I try and overhear everything everyone is saying. We have a lone female patient (other casualties were very minor injuries and are with the police, giving details), 8 months pregnant, driving the vehicle when it flipped.
She's got a fair amount of dried blood in her hair and all over her face and hands, plus one foot (shoeless). First things first; she's talking, so we have an airway. And if you can talk, you're breathing alright. We do a formal assessment as well, cutting through her bra (hope it wasn't her favourite!) to examine her chest for open wounds and have a good listen for equal air entry. Her pulse is fine (turns out she's only 8 weeks, not months, pregnant, so all those physiological differences we discussed on the way in are irrelevant here), BP is normal, and she's satting at 99%, so all good.
The paras/fire service have her firmly tied on a long board, with a collar and head blocks. We get her out of those (with either the para or Matt holding her head straight at all times, checking that the other has full control before letting go) and start poking. She's tender over 3 cervical vertebrae, so that collar is going back on in a second.
Tenderness is also found over the zygoma, temple, and around the back of the head. No open lac is found for all the blood, but her hair is pretty clotted up already. She's quite capable of telling us where it hurts, and can identify the day and date better than I can (I could have sworn it were Monday, and as for the date.... ), so that along with the lack of other neurological symptoms (pupils, etc) is a reassurance.
[While Matt is doing his poking and prodding, the para grabs me to the feet. "I think her ankle's dislocated - it just looks wrong. What do you think?" Erm.... I think I'm supremely underqualified for this! However, my bedtime reading of Essential Ortho came in handy. She had pretty pudgy ankles (due to obesity, not pregnancy) that obscured any tuberosities or prominences, and a very curved foot. I had a quick press along the front of the tibia, and there were no depressions, abnormal movements or points of weakness (and no sudden screams from the head end!) and the same along the dorsum of the foot. We took the other shoe off to compare, and it seems she just had really tiny curved feet! I couldn't find any evidence of either fracture or dislocation, and Matt had a check of both ankles/feet on his secondary survey and found nothing either (he had the advantage of being able to ask her to flex/extend her ankles and wiggle her toes, which I couldn't do because she was busy answering his questions about head injuries!), so I was pretty pleased with myself on that count. I will add that I did explain that I was only a student before I did anything/said anything else.]
Matt's pretty sure we won't travel, given her stable condition and fairly minor injuries (given the mechanism of injury), so we cannulate. 1 grey stops at a valve, so he leaves that dangling while he gets another one in further up the dorsum of her hand. Some choice words from the patient to fill the back of the truck with blue air, but given that I can pass out at a tiny 22g needle, I don't blame her with two 14g's in her hand! I use my new ambulance skills to anticipate the alco-swab, saline flush, tegaderm, and dressing pad (for the failed cannulation attempt) - ok, small contribution, but it makes me feel useful. I get to hang the saline, too, if only because the para is about four inches shorter than me!
We negotiate an A&E destination, recommend a trauma call to the receiving team to be ready in case of any deterioration en route, and leave them to it. The fire truck and all but one police car have gone by now, having done their bit. The fire truck in particular hightailed it out of there as soon as the patient was out! The ambulance pulls away as we strip off gloves and gather ourselves together.
Time for a longer look at the scene, now the casualties are sorted. The skid marks on the road are obvious from the corner (opposite to the direction in which we arrived), swerving across the wet road. There's a gouge out of the tarmac with some scrapes of car paint that show exactly where it flipped (I never realised it could cut holes in the road!), and the flattened long grass at the roadside shows where it slid across, to land pretty squarely on it's roof, wedged in the ditch.
We head down into the ditch to have a closer look. The roof is squished in, down to about head-rest height I reckon (couldn't estimate properly as the seats had been fully reclined to get the patient out through the boot. She'd been suspended via seatbelt, but unclipped herself and tried to self-extricate, but not got far.), and quite crumpled. The back end is relatively unharmed, suggesting a front flip, rather than side. The back windscreen is way back towards the road and the front is attached round the edges, but fully splintered from ground contact. The side windows have all been shoved out too. Inside the vehicle, the dashboard is completely intact and appears undamaged. Blood patterns on the roof inner show dripping and dragging rather than any spurting (how CSI?!). Shoes and umbrellas are scattered underneath the car. Round the side, we find speaker casings, windscreen wipers, and the front grille (still with logo attached) scattered across the field for around 10 yards. The front of the car is tricky to see, with the bonnet and the ground keeping each other company. I have tons of photos of the wreckage (plus impromptu ones of Matt (also taking photos) and of the copper who came to put his 'Authorities Aware' sticker on the wreckage) - tis entirely legal to take photo's, so long as anything involving patients is fully consented first.
So, get the bags (completely unused, but soggy) back into the boot, get helmets packed away, and dry off with the in-car heating :) Then we headed up to the A&E where our patient had disappeared to. Rang R on the way to organise my lift home from the station, and that's when the shock hit. Partly cos he flipped his car a couple of years ago. I didn't even know him them, let along have seen the wreckage, but looking at that car in the ditch, I could only imagine how terrifying it must have been to flip over at speed... He came away with a fragment of windscreen in his knuckle, and a torn earlobe. Lucky sod :) I do believe I told him (on this phonecall) that he was never ever driving again. I calmed down over a cup of tea in a pub en-route (to give A&E time to assess our patient and get some scans/treatment organised) though.
Turned up at A&E (about 2100hrs by this point) and wandered round to resus, only to be accosted by a nurse and doctor. Ahem, is the entire fluoro jump suit (marked in huge letters with the words 'ANAESTHETIST', 'DOCTOR', 'BASICS', and 'LIVES') not clear enough? Plus, we knew the patients name, injuries, and location/type of accident. We'd hardly just wandered in off the streets.
Turns out they'd only just assessed her. We popped in to say hello anyway, and she was sufficiently compus mentis to recognise Matt ('that nasty doctor' - who was perfectly nice until he wanted to put big needles in!).
Got back to the main ambu station about forty minutes later and called up to check on her progress. Still not scanned, but at least the CT had been ordered by now.
I got a text at just gone midnight to confirm that she only had scalp lacs, and no skull fractures! All good news! A&E staff were suspecting a depressed skull fracture cos her head was pretty 'boggy' at the back, but turns out it can feel like that with scalp lacs because of the looseness of the aponeurosis and the way blood can fill that gap, outside of the skull. So she'll be in til today for observation, and possibly for O&G input to check on her baby, but at 8 weeks, with that amount of padding, I'm pretty sure s/he's just fine :)
All in all, I'm incredibly grateful for the day I spent with Matt. Even with only one call, I learnt a hell of a lot, and I haven't even seen him do anything outside of a paramedic remit yet!
The adrenaline rush of turning up on scene not knowing exactly what awaits you, while knowing that it must be serious seeing as we haven't been stood down en-route, is just.... immense.
I've already started putting out feelers for what I can do in pre-hospital care, even at this stage of my career. I can't wait to see what the future holds....
It must have been the quietest day in ambulance history. We had 8 1/2 hours without a single call. And even that was only a tiny piece of scone gone down the wrong way. We drove 30 miles on blues to get to it, as it came through as a cardiac arrest. I never even saw the patient, since there was a crew already on scene.
Instead, we spent the day on what amounts to an 'Intro to Pre-Hospital Care' course :)
Toured our local A&E (and left shocked at finding anaes units with halothane in them - even I recalled that my notes say it's no longer used! To be fair to them, there was a note on the halothane section recommending use of another agent).
Went to the local Fire station and checked out their search and rescue vehicles - they are literally massive store cupboards on wheels! Scissors the size of my body for cars, ropes thicker than my arms, huge lights for nighttime accident scenes, blocks to stabillise RTC cars... Plus everything you could ask for to completely destroy a car in a matter of minutes, from chains, glass cutters, scissors, separators, and 'ram's - hydraulic cylinders that are wedged under dashboards and extended to pull the entire dash forwards and up, away from anybody's legs! Strangely enough, they also had everything you could need to pull a cow out of a ditch...
Headed out to the smaller ambu-station that sits mid-way between us and the coast, where we found a single crew with their feet up watching morning telly :)
In that same town is our LIVES headquarters, so we went up there too. Had a lovely chat with two of the guys there, about how LIVES works, how it's funded, what it's capacity is, success rates, job variability, growth of local responder groups, AED access in public places, etc. Also checked out the recording from an AED brought in after an unsuccessful resus on a cardiac arrest. The guy had been down for 20 minutes before the responder got there, with security staff doing CPR until then. The trace was coarse VF, so he got 2 shocks. It was so easy to see where the CPR was occuring and when the responder stopped to do rescue breaths, and the timings of everything. After 2 shocks, he went down to asystole, but CPR continued for 26 mins total. The ambu crew took 33 minutes to arrive. Sounds shocking, but it was in a pretty remote area, and the responder was actually on scene just 4 minutes after the call was made.
After visiting HQ, we travelled on, out to the coast. The station out here is pretty tiny too, with 3 ambu's. Gorgeous weather, so we had a wander along the sands with a portion of chips each! Town was packed to the gills with chavs and oldies. We thought we'd check out the hospital too, and boy were we in for a shock! Residential street, with a (very) large house on one end. Yup, that house is the hospital. The original 'cottage hospital' sign was still above the door! Inside, we were almost on the set of The Royal. The house had been marginally converted and added onto over the years, but the A&E dept. was a corridor with the original rooms stripped and a hospital trolley added in each. Resus was a curtained off wider room at the end. Forget the horror of halothane gas machines, there were no gas machines! The radiographer went home at five, so no scans after-hours. Any trauma was taken straight out of town, 20-30 miles down the coast. We exited in complete hysterical giggles. I honestly didn't believe places like that existed. It was genuinely like being in The Royal!
The station was still dead, couple of Cat C's at lunchtime but nothing for us, so we headed north to another seaside down. It was so depressing that we drove straight through. Now was when we got our 'cardiac arrest' call! Quick satnav instructions, lights and sirens on, and we were off!
Horrendous roads, horrific corners, at horrible speeds. I think we did a minimum of 50, and that was in the corners. [Disclaimer: at no point did we exceed the emergency driving regulations of being more than 20mph above the speed limit.] Arrive at the nursing home. Para wanders out, looks a little surprised to see us, and explains it was a momentary choke-vomit-back to normal. Quick break to let the adrenaline of the drive wear off, and we were back on the roads, heading back towards HQ town. Well-deserved cup of coffee, an episode of eggheads, and we got our big shout. Entrapment/RTC!
We drove 40 miles in increasingly heavy downpour, down tiny bendy back roads that our rural county is well known for (and contribute greatly to our road carnage!) as fast as we could safely go. More info comes in as we travel: the main casualty is pregnant, and there are several other casualties. The entrapment remains.
10 miles out, I check the map for the exact road we're after, as Control can't put coordinates through to our Satnav like they can on their own vehicles. I get my fluoro coat on, and try and work out how to get the helmet on, so there's less time faffing around when we arrive.
1 mile out. I have no saliva left, my heart is about to implode, and I'm shaking like a leaf. Quite how Matt manages to drive, and think about all the eventualities on scene, while every drop of adrenaline surges through, I have absolutely no idea. The helmet goes on.
At the end of the road is the Police - Accident cordon. Oh shit. This is not a minor.
Around a corner, and there it is. All I can see is blue lights. As we slow, and a policeman moves the second cordon to let us on scene, I can identify a fire truck, an ambulance, a police car, and a paramedic team leader car. But no mashed car... yet.
As we pull round the ambulance to move to the far end of the scene (our car is less visible than a massive red fire truck, and it gives us time to assess the scene while parking), I spot the underside of a car. Off the road, in a field. In a ditch, to be precise.
We jump out, and I grab our trauma bag while Matt gets his helmet & extrication gloves on. As I deposit our stuff at the equipment dump site (a big tarpaulin the fire service lay out for all of us to put our gear on, so it's central to the scene and in no-one's way), I can see that we're not here for our extrication skills any more. The fire service are carrying a long board (occupied!) away from the ditch.
[I'm dumping our stuff off, and a copper nearby greets me. My immense nerves immediately blurt out "I'm just a medical student! I'm with the doctor (point at Matt)!". Gibbering wreck indeed. I think I was incredibly scared he was gonna assume I had some degree of medical competence and get me to do something! I'd never looked at my helmet before this call (it's carried in it's own fluoro bag) and I was expecting it to say 'OBSERVER' all over it. It doesn't. It says 'AMBULANCE'. Shit]
Matt runs back to the car to check out the damage while the paramedics deal with the patient. A quick glance at the wreckage patterns and physical damage to the car, and we're headed to the ambulance.
Our patient is loaded as we don our gloves (the medical examination ones, not the extrications and I try and overhear everything everyone is saying. We have a lone female patient (other casualties were very minor injuries and are with the police, giving details), 8 months pregnant, driving the vehicle when it flipped.
She's got a fair amount of dried blood in her hair and all over her face and hands, plus one foot (shoeless). First things first; she's talking, so we have an airway. And if you can talk, you're breathing alright. We do a formal assessment as well, cutting through her bra (hope it wasn't her favourite!) to examine her chest for open wounds and have a good listen for equal air entry. Her pulse is fine (turns out she's only 8 weeks, not months, pregnant, so all those physiological differences we discussed on the way in are irrelevant here), BP is normal, and she's satting at 99%, so all good.
The paras/fire service have her firmly tied on a long board, with a collar and head blocks. We get her out of those (with either the para or Matt holding her head straight at all times, checking that the other has full control before letting go) and start poking. She's tender over 3 cervical vertebrae, so that collar is going back on in a second.
Tenderness is also found over the zygoma, temple, and around the back of the head. No open lac is found for all the blood, but her hair is pretty clotted up already. She's quite capable of telling us where it hurts, and can identify the day and date better than I can (I could have sworn it were Monday, and as for the date.... ), so that along with the lack of other neurological symptoms (pupils, etc) is a reassurance.
[While Matt is doing his poking and prodding, the para grabs me to the feet. "I think her ankle's dislocated - it just looks wrong. What do you think?" Erm.... I think I'm supremely underqualified for this! However, my bedtime reading of Essential Ortho came in handy. She had pretty pudgy ankles (due to obesity, not pregnancy) that obscured any tuberosities or prominences, and a very curved foot. I had a quick press along the front of the tibia, and there were no depressions, abnormal movements or points of weakness (and no sudden screams from the head end!) and the same along the dorsum of the foot. We took the other shoe off to compare, and it seems she just had really tiny curved feet! I couldn't find any evidence of either fracture or dislocation, and Matt had a check of both ankles/feet on his secondary survey and found nothing either (he had the advantage of being able to ask her to flex/extend her ankles and wiggle her toes, which I couldn't do because she was busy answering his questions about head injuries!), so I was pretty pleased with myself on that count. I will add that I did explain that I was only a student before I did anything/said anything else.]
Matt's pretty sure we won't travel, given her stable condition and fairly minor injuries (given the mechanism of injury), so we cannulate. 1 grey stops at a valve, so he leaves that dangling while he gets another one in further up the dorsum of her hand. Some choice words from the patient to fill the back of the truck with blue air, but given that I can pass out at a tiny 22g needle, I don't blame her with two 14g's in her hand! I use my new ambulance skills to anticipate the alco-swab, saline flush, tegaderm, and dressing pad (for the failed cannulation attempt) - ok, small contribution, but it makes me feel useful. I get to hang the saline, too, if only because the para is about four inches shorter than me!
We negotiate an A&E destination, recommend a trauma call to the receiving team to be ready in case of any deterioration en route, and leave them to it. The fire truck and all but one police car have gone by now, having done their bit. The fire truck in particular hightailed it out of there as soon as the patient was out! The ambulance pulls away as we strip off gloves and gather ourselves together.
Time for a longer look at the scene, now the casualties are sorted. The skid marks on the road are obvious from the corner (opposite to the direction in which we arrived), swerving across the wet road. There's a gouge out of the tarmac with some scrapes of car paint that show exactly where it flipped (I never realised it could cut holes in the road!), and the flattened long grass at the roadside shows where it slid across, to land pretty squarely on it's roof, wedged in the ditch.
We head down into the ditch to have a closer look. The roof is squished in, down to about head-rest height I reckon (couldn't estimate properly as the seats had been fully reclined to get the patient out through the boot. She'd been suspended via seatbelt, but unclipped herself and tried to self-extricate, but not got far.), and quite crumpled. The back end is relatively unharmed, suggesting a front flip, rather than side. The back windscreen is way back towards the road and the front is attached round the edges, but fully splintered from ground contact. The side windows have all been shoved out too. Inside the vehicle, the dashboard is completely intact and appears undamaged. Blood patterns on the roof inner show dripping and dragging rather than any spurting (how CSI?!). Shoes and umbrellas are scattered underneath the car. Round the side, we find speaker casings, windscreen wipers, and the front grille (still with logo attached) scattered across the field for around 10 yards. The front of the car is tricky to see, with the bonnet and the ground keeping each other company. I have tons of photos of the wreckage (plus impromptu ones of Matt (also taking photos) and of the copper who came to put his 'Authorities Aware' sticker on the wreckage) - tis entirely legal to take photo's, so long as anything involving patients is fully consented first.
So, get the bags (completely unused, but soggy) back into the boot, get helmets packed away, and dry off with the in-car heating :) Then we headed up to the A&E where our patient had disappeared to. Rang R on the way to organise my lift home from the station, and that's when the shock hit. Partly cos he flipped his car a couple of years ago. I didn't even know him them, let along have seen the wreckage, but looking at that car in the ditch, I could only imagine how terrifying it must have been to flip over at speed... He came away with a fragment of windscreen in his knuckle, and a torn earlobe. Lucky sod :) I do believe I told him (on this phonecall) that he was never ever driving again. I calmed down over a cup of tea in a pub en-route (to give A&E time to assess our patient and get some scans/treatment organised) though.
Turned up at A&E (about 2100hrs by this point) and wandered round to resus, only to be accosted by a nurse and doctor. Ahem, is the entire fluoro jump suit (marked in huge letters with the words 'ANAESTHETIST', 'DOCTOR', 'BASICS', and 'LIVES') not clear enough? Plus, we knew the patients name, injuries, and location/type of accident. We'd hardly just wandered in off the streets.
Turns out they'd only just assessed her. We popped in to say hello anyway, and she was sufficiently compus mentis to recognise Matt ('that nasty doctor' - who was perfectly nice until he wanted to put big needles in!).
Got back to the main ambu station about forty minutes later and called up to check on her progress. Still not scanned, but at least the CT had been ordered by now.
I got a text at just gone midnight to confirm that she only had scalp lacs, and no skull fractures! All good news! A&E staff were suspecting a depressed skull fracture cos her head was pretty 'boggy' at the back, but turns out it can feel like that with scalp lacs because of the looseness of the aponeurosis and the way blood can fill that gap, outside of the skull. So she'll be in til today for observation, and possibly for O&G input to check on her baby, but at 8 weeks, with that amount of padding, I'm pretty sure s/he's just fine :)
All in all, I'm incredibly grateful for the day I spent with Matt. Even with only one call, I learnt a hell of a lot, and I haven't even seen him do anything outside of a paramedic remit yet!
The adrenaline rush of turning up on scene not knowing exactly what awaits you, while knowing that it must be serious seeing as we haven't been stood down en-route, is just.... immense.
I've already started putting out feelers for what I can do in pre-hospital care, even at this stage of my career. I can't wait to see what the future holds....
Monday 27 July 2009
BASICS blues time!
Out again tomorrow, but with a BASICS doc :) Very excited, as even if we don't do anything I get a day of chatting to an experienced anaesthetist about anything and everything to do with medicine, emergency care, and anaesthetics.
Fingers are still crossed for a MajAx tho....
Fingers are still crossed for a MajAx tho....
Sunday 26 July 2009
Blue light reflections
At times this week, I have genuinely wished I had done this placement before I accepted my medical school place. Much shorter training, more immediate patient responsibility, opportunity to give immediate treatment, on-scene trauma work (not that I've seen this yet), and the whole adrenaline rush of driving on red :D And the thrill of giving immediate emergency care doesn't seem to wear off. The EMT I was with on my night shift was shaking as much as I was on our last case.
I know that if I actually trained as a para, I'd eventually want to go back to med school and be a doctor, but in the immediate future... I can't help but wish. 5 years is a lot of debt.
Emergency med is looking increasingly appealing. I've read all the warnings that A&E is becoming just a triage site for the specialties, but there are hopes that EM will move out into pre-hospital care, and that potential future excites me more than the current state of EM. Pre-hospital gives the chance to use the usual skills of resuscitation and stability of the emergency patient, but without the huge amount of back up a hospital A&E provides. More initiative required. More improvisation. Dealing with a patient with DIB with a trache, the trache didn't have any fixtures for attachments to add o2 lines or a BVM or a neb, so a pedi mask was altered with various bits of tubing and tape to fit over the trache to administer o2 and nebs.
I'm awaiting an email from the ambu manager about potential placements with their anaesthetics reg who does voluntary BASICS work with them. Also air ambulance, for more experience with sicker patients and (fingers crossed!) trauma.
I have learnt so much from this week. Not just about how the ambulance service works, and how it fits in with the other professions and the overlap of care, but also about patient care. I can do basic obs with more confidence, and in the back of a moving vehicle. I've got more tips on how to cannulate, when I'm eventually let loose on patients. I can identify warning signs of major problems. I've learnt about BP lowering on the left in an AAA. About the decision process of pharmalogical intervention, in the case of adrenaline, atropine, and adenosine/amiodarone (I'm not entirely sure which one I mean, since it's just 'that one beginning with A' to me...), and morphine/entonox, plus pre/post morphine use of cyclizine (50mg diluted in 10ml water/saline). Immobilisation of fractures. Assessing for injury.
And that old chestnut - everyone lies.
I know that if I actually trained as a para, I'd eventually want to go back to med school and be a doctor, but in the immediate future... I can't help but wish. 5 years is a lot of debt.
Emergency med is looking increasingly appealing. I've read all the warnings that A&E is becoming just a triage site for the specialties, but there are hopes that EM will move out into pre-hospital care, and that potential future excites me more than the current state of EM. Pre-hospital gives the chance to use the usual skills of resuscitation and stability of the emergency patient, but without the huge amount of back up a hospital A&E provides. More initiative required. More improvisation. Dealing with a patient with DIB with a trache, the trache didn't have any fixtures for attachments to add o2 lines or a BVM or a neb, so a pedi mask was altered with various bits of tubing and tape to fit over the trache to administer o2 and nebs.
I'm awaiting an email from the ambu manager about potential placements with their anaesthetics reg who does voluntary BASICS work with them. Also air ambulance, for more experience with sicker patients and (fingers crossed!) trauma.
I have learnt so much from this week. Not just about how the ambulance service works, and how it fits in with the other professions and the overlap of care, but also about patient care. I can do basic obs with more confidence, and in the back of a moving vehicle. I've got more tips on how to cannulate, when I'm eventually let loose on patients. I can identify warning signs of major problems. I've learnt about BP lowering on the left in an AAA. About the decision process of pharmalogical intervention, in the case of adrenaline, atropine, and adenosine/amiodarone (I'm not entirely sure which one I mean, since it's just 'that one beginning with A' to me...), and morphine/entonox, plus pre/post morphine use of cyclizine (50mg diluted in 10ml water/saline). Immobilisation of fractures. Assessing for injury.
And that old chestnut - everyone lies.
Friday 24 July 2009
Not a creature was stirring, not even a mouse...
Night shift was awful/awesome (delete as appropriate depending on clock-reading).
2100hrs - 80YOF - allergic reaction to angio dye. Massive hives for 3/7, then reacted to first dose of prednisolone - swelling of face, limbs, etc. Unreadable Sp02 to start with, but was fine on 02.
2200 - Miles out into the countryside to an 80YOM - off legs. Ca lung, smoking like a chimney. Didn't want to go to hospital cos they wouldn't let him 'sneak out for a fag'. 45 min handover at hosp = lifestory of every hospital escaped from to have a fag. Giving the nurses hell when we left...
0000 - 17YOM - transfer to our local hospital. Car V Ped, knocked out by wing mirror. #base of skull, orbit, ankle. Beautiful 'eye-shadow' bruising. Talked like a steam train all the way in.
0130 - did something. Night shift amnesia. [EDIT - standby at far-north station. Woke me up a bit, having drifted off several times on the drive, whacking my nose and chin on various metal boxes arranged around my seat. Didn't spend long there, as got sent back to hospital to stand-by there]
Slept from 0230 til 0400.
0430 - 50YOM - constipation. Excruciating pain, relieved on Entonox. Learnt that taking a patient to A&E pain-free (due to morphine, etc) means no treatment.
0530 - 71YOM - Multiple convulsions. Evidence of CVA. GCS 3 on arrival at scene. Massive fit on loading into the truck. Stopped without pharm intervention. BVM 02, switched to face mask for transport. Cannulated. Rang ahead to A&E to prep resus. 2mg lorazepam on arrival as starting fitting again. Another line in. U&E, FBC, Clotting, Group&Save bloods, and ABG done. OPA inserted as decerebrate-ness (?) implied inability to hold own airway. ABG came back as acidosis (6.9) - no idea whether resp/met, but prob resp as COPD? Dunno, all first year exam material has gone. Pupils fixed/dilated. Shit prognosis. Bit of an oxymoron on quality of life - lived in complete squalor, but was king of his castle. Could get around fine normally, only seen by 999 every few months for COPD (another insistent smoker!). I think the para's were sad to see him at his end - the "cantankerous old git"s are sometimes highlights of the day/night.
I hung around in resus for quite a while (not entirely sure whether this was out of medical student curiosity or the hottie F1 - shame on Jelly). Got some awesome teaching off the F1 too, about basic management, assessment of GCS, analysis of ABG results, etc.
It was a strange shift, overall. A great end, experience-wise, in terms of it being the only blue-light run into A&E I've witnessed, with treatment en-route, and teaching too, but obviously a shit end as well. I daren't inquire as to how the guy is, cos I already know the answer, and I don't like it.
Why do I want this career so much?
2100hrs - 80YOF - allergic reaction to angio dye. Massive hives for 3/7, then reacted to first dose of prednisolone - swelling of face, limbs, etc. Unreadable Sp02 to start with, but was fine on 02.
2200 - Miles out into the countryside to an 80YOM - off legs. Ca lung, smoking like a chimney. Didn't want to go to hospital cos they wouldn't let him 'sneak out for a fag'. 45 min handover at hosp = lifestory of every hospital escaped from to have a fag. Giving the nurses hell when we left...
0000 - 17YOM - transfer to our local hospital. Car V Ped, knocked out by wing mirror. #base of skull, orbit, ankle. Beautiful 'eye-shadow' bruising. Talked like a steam train all the way in.
0130 - did something. Night shift amnesia. [EDIT - standby at far-north station. Woke me up a bit, having drifted off several times on the drive, whacking my nose and chin on various metal boxes arranged around my seat. Didn't spend long there, as got sent back to hospital to stand-by there]
Slept from 0230 til 0400.
0430 - 50YOM - constipation. Excruciating pain, relieved on Entonox. Learnt that taking a patient to A&E pain-free (due to morphine, etc) means no treatment.
0530 - 71YOM - Multiple convulsions. Evidence of CVA. GCS 3 on arrival at scene. Massive fit on loading into the truck. Stopped without pharm intervention. BVM 02, switched to face mask for transport. Cannulated. Rang ahead to A&E to prep resus. 2mg lorazepam on arrival as starting fitting again. Another line in. U&E, FBC, Clotting, Group&Save bloods, and ABG done. OPA inserted as decerebrate-ness (?) implied inability to hold own airway. ABG came back as acidosis (6.9) - no idea whether resp/met, but prob resp as COPD? Dunno, all first year exam material has gone. Pupils fixed/dilated. Shit prognosis. Bit of an oxymoron on quality of life - lived in complete squalor, but was king of his castle. Could get around fine normally, only seen by 999 every few months for COPD (another insistent smoker!). I think the para's were sad to see him at his end - the "cantankerous old git"s are sometimes highlights of the day/night.
I hung around in resus for quite a while (not entirely sure whether this was out of medical student curiosity or the hottie F1 - shame on Jelly). Got some awesome teaching off the F1 too, about basic management, assessment of GCS, analysis of ABG results, etc.
It was a strange shift, overall. A great end, experience-wise, in terms of it being the only blue-light run into A&E I've witnessed, with treatment en-route, and teaching too, but obviously a shit end as well. I daren't inquire as to how the guy is, cos I already know the answer, and I don't like it.
Why do I want this career so much?
Wednesday 22 July 2009
Yelp, Wail, HiLo, *snap*
Another day with the nee-naws :D This time on teh Community Response Car, so I've only seen 4 calls in 14 hours.
89YOF - angina, dizziness, nausea. Relieved with GTN and cyclizine. Transported by truck.
87YOM - welfare check for fall yesterday (refused transport to hosp). Demented as a duck, but physically fine.
60YOF - tripped over doorstep ?#tib/fib. Swollen ankle with anterior protuberance. I wanted to poke, but restrained myself. I did the BP by myself though! :D
89YOF - fell off chair. Unharmed. Picked up. Put back in chair.
So... I learnt that old people fall a lot. And that drawing up saline syringes for cannula flushes is harder than it looks. Also that doing anything with soggy saline'd gloves is almost impossible.
And doing ANYTHING with a patient is terrifying! I got left alone to do obs on our #ankle while our CP went to the car for entonox, and even connecting the cuff up to the machine was tricky! The only pulse I could find in her feet was my own.
Fingers crossed for a busy night shift tomorrow. I still have half a billion different cases to tick off my mental list. Old faller, haematemesis, fracture, and convulsion don't make much of a dent in it...
Quite glad I didn't do this placement before I started med school, or I think I'd have dropped out and gone to para school instead.
89YOF - angina, dizziness, nausea. Relieved with GTN and cyclizine. Transported by truck.
87YOM - welfare check for fall yesterday (refused transport to hosp). Demented as a duck, but physically fine.
60YOF - tripped over doorstep ?#tib/fib. Swollen ankle with anterior protuberance. I wanted to poke, but restrained myself. I did the BP by myself though! :D
89YOF - fell off chair. Unharmed. Picked up. Put back in chair.
So... I learnt that old people fall a lot. And that drawing up saline syringes for cannula flushes is harder than it looks. Also that doing anything with soggy saline'd gloves is almost impossible.
And doing ANYTHING with a patient is terrifying! I got left alone to do obs on our #ankle while our CP went to the car for entonox, and even connecting the cuff up to the machine was tricky! The only pulse I could find in her feet was my own.
Fingers crossed for a busy night shift tomorrow. I still have half a billion different cases to tick off my mental list. Old faller, haematemesis, fracture, and convulsion don't make much of a dent in it...
Quite glad I didn't do this placement before I started med school, or I think I'd have dropped out and gone to para school instead.
Monday 20 July 2009
Blue light taxi
Woo! 12 hours on an ambu shift! I am shattered.
36YOM - kidney stones. 200yds from the front door of A&E.
85YOM - Known AF. Palpitations.
85YOM - Needed catheter replacing.
86YOF - Fell in bathroom. Denied anything medically wrong. Denied all pain. Ended up with a shattered shoulder. Old women and their hospital phobias....
42YOM - Alcoholic liver disease - haematemesis. H/O CVA.
85YOM - Care home. Low sats. Vomitting ++.
41YOF - Fitting in public place. First episode. Post ictal on arrival.
39YOM - ?Fell/assaulted. Lac to head. Active bleeding through 3 dressings. ETOH. Found by police with metal bat.
Got tomorrow off to recover, then back on for another 12 hours, then 24 hours off til night shift.
36YOM - kidney stones. 200yds from the front door of A&E.
85YOM - Known AF. Palpitations.
85YOM - Needed catheter replacing.
86YOF - Fell in bathroom. Denied anything medically wrong. Denied all pain. Ended up with a shattered shoulder. Old women and their hospital phobias....
42YOM - Alcoholic liver disease - haematemesis. H/O CVA.
85YOM - Care home. Low sats. Vomitting ++.
41YOF - Fitting in public place. First episode. Post ictal on arrival.
39YOM - ?Fell/assaulted. Lac to head. Active bleeding through 3 dressings. ETOH. Found by police with metal bat.
Got tomorrow off to recover, then back on for another 12 hours, then 24 hours off til night shift.
Tuesday 14 July 2009
Whistle as we work
Ooh, I also have my research placement another step closer! Meeting with my supervisor at the end of this week (hopefully - otherwise it'll be next week, and I'll be semi-comatose with exhaustion).
And EMPLOYMENT! Well, one evening of it, but 4 1/2 hours of pay is better than none!
And EMPLOYMENT! Well, one evening of it, but 4 1/2 hours of pay is better than none!
Monday 13 July 2009
NEE NAW!
I am going on an ambulance :D
For 36 hours.
Over the space of 4 1/2 days.
2 days, 1 night.
2 double-man crews, 1 Community Response Unit.
And I am unbelievably excited!!!!
For 36 hours.
Over the space of 4 1/2 days.
2 days, 1 night.
2 double-man crews, 1 Community Response Unit.
And I am unbelievably excited!!!!
Saturday 11 July 2009
Summer has... started?
Greetings (to myself, clearly, since my blog readership = nil).
Since last time... Earnt £114 selling strawberries. Got extremely tanned doing so. Went to York with the boyf to celebrate one year together! Had an awesome time doing the round of museums and places like Clifford's Tower & The Minster, and then spent the day itself out at Brimham Rocks, which I ADORE. Been going to Brimham since I was a kid, and R loved it just as much, scrambling up 30ft boulders without a care in the world. Amazing views right across the Dales, too. Anyway, 1 year down, many more to go, I hope :)
Got a few employment options to pursue now.
There's shifts going as a factory packer in the city, which honestly sounds like the suckiest slave labour ever. Gonna inquire about wages before I even consider that, I think.
Option 2 is ringing up the events company I worked for at the show and asking what they have. My friend who also did the show is spending the weekend at York races with the company, so looks like work IS available. And £50/day isn't at all bad...
The third choice is actually sending out my forms for the Independant Hospital! They've been in my handbag for weeks cos I can't ever get round to finishing them!
I have progress on the CV-relevant funtimes too - the ambulance service is all sorted, and I'm going in on Monday to meet my placement supervisor and chat about what I'll actually be doing, and then the following Monday I'm in!
I got a consultant from my work experience times (07!) to agree to let me tag along for a week with him too, so that's my Ortho experience for this summer totally sorted! I'm pretty psyched for this - it's been two years since I've seen theatre and I cannot wait to get scrubbed, and this time I might get to assist, or at least stand by the table! Woo! :D
As for the rest... Well. Research Supervisor is currently unresponsive. And I can't confirm my audit back in UniTown until some of these placements start dropping into place and I can actually offer firm dates.
A flat to stay in while doing my audit would be uber-helpful, too. I'm actually looking into 1-beds right now, as a 'just-in-case'. We've bid on 3 properties, and so far - zilch. Mum & I have kinda set a mental deadline of end of August before we start panicking! Gah! We just need this place to be perfect, since it's a sale, not a rental, and therefore it's gonna be our (me, K, & E) home for the next 3 or so years (until K gets married, and I intercalate).
Chill, Jell-o. Pour out another glass of the Vin-o and chill-o.
Since last time... Earnt £114 selling strawberries. Got extremely tanned doing so. Went to York with the boyf to celebrate one year together! Had an awesome time doing the round of museums and places like Clifford's Tower & The Minster, and then spent the day itself out at Brimham Rocks, which I ADORE. Been going to Brimham since I was a kid, and R loved it just as much, scrambling up 30ft boulders without a care in the world. Amazing views right across the Dales, too. Anyway, 1 year down, many more to go, I hope :)
Got a few employment options to pursue now.
There's shifts going as a factory packer in the city, which honestly sounds like the suckiest slave labour ever. Gonna inquire about wages before I even consider that, I think.
Option 2 is ringing up the events company I worked for at the show and asking what they have. My friend who also did the show is spending the weekend at York races with the company, so looks like work IS available. And £50/day isn't at all bad...
The third choice is actually sending out my forms for the Independant Hospital! They've been in my handbag for weeks cos I can't ever get round to finishing them!
I have progress on the CV-relevant funtimes too - the ambulance service is all sorted, and I'm going in on Monday to meet my placement supervisor and chat about what I'll actually be doing, and then the following Monday I'm in!
I got a consultant from my work experience times (07!) to agree to let me tag along for a week with him too, so that's my Ortho experience for this summer totally sorted! I'm pretty psyched for this - it's been two years since I've seen theatre and I cannot wait to get scrubbed, and this time I might get to assist, or at least stand by the table! Woo! :D
As for the rest... Well. Research Supervisor is currently unresponsive. And I can't confirm my audit back in UniTown until some of these placements start dropping into place and I can actually offer firm dates.
A flat to stay in while doing my audit would be uber-helpful, too. I'm actually looking into 1-beds right now, as a 'just-in-case'. We've bid on 3 properties, and so far - zilch. Mum & I have kinda set a mental deadline of end of August before we start panicking! Gah! We just need this place to be perfect, since it's a sale, not a rental, and therefore it's gonna be our (me, K, & E) home for the next 3 or so years (until K gets married, and I intercalate).
Chill, Jell-o. Pour out another glass of the Vin-o and chill-o.
Friday 26 June 2009
Miss Jelly, MBChB, FRCS - Give me ten years...
Just did the Virginia Medical Specialty Aptitude Test. I am a surgeon through and through. Top 6 were all surgical. Ortho was at No5, with Cardio & Thoracic at 1 & 2, but I really don't fancy CT at the moment. Too competitive. Hammer + chisel + patient = Happy Jelly
I KNOW it's far too early to be looking at specialties. Survey my class and the answers for future specialty are 95% "Don't know; probably GP or Paeds". However, two of the chef's I worked with this week, once they discovered I was a medic, decided that they could see me as a GP. After watching me slice up a very human-flesh-like piece of pork with a vengeance (and a chef's arm also on the chop board for comparison), they changed their minds.
So far, the specialty list (in my mind, at least) is:
1. Ortho
2. Emergency Medicine
3. Anaesthetics
Nothing fiddly, nothing that keeps me out of scrubs, nothing dull (I went to Rheum Outpatients with Mum today and nearly fell asleep. It's never lupus.)
I KNOW it's far too early to be looking at specialties. Survey my class and the answers for future specialty are 95% "Don't know; probably GP or Paeds". However, two of the chef's I worked with this week, once they discovered I was a medic, decided that they could see me as a GP. After watching me slice up a very human-flesh-like piece of pork with a vengeance (and a chef's arm also on the chop board for comparison), they changed their minds.
So far, the specialty list (in my mind, at least) is:
1. Ortho
2. Emergency Medicine
3. Anaesthetics
Nothing fiddly, nothing that keeps me out of scrubs, nothing dull (I went to Rheum Outpatients with Mum today and nearly fell asleep. It's never lupus.)
Mental
Ninety quid up, several energy levels down. Bonus was entrance to the Member's Bar for an extreme Pimm's sesh after sign out :D
Now I'm back to the land of the unemployed, although I have an application form on my desk for the local Independant Hospital, which cares for adults under the Mental Health Act. My mum worked at a similar place for kids before I was born, which is enough for her to warn me against it, but it would be awesome experience for clinicals. And getting paid to do what I've done previously as a hospital volunteer would always be appreciated.
I think I can cope with it, and it would only be for a few months, until I go back to uni, and then there would be the opportunity to work with them again in future holidays. We'll see...
Now I'm back to the land of the unemployed, although I have an application form on my desk for the local Independant Hospital, which cares for adults under the Mental Health Act. My mum worked at a similar place for kids before I was born, which is enough for her to warn me against it, but it would be awesome experience for clinicals. And getting paid to do what I've done previously as a hospital volunteer would always be appreciated.
I think I can cope with it, and it would only be for a few months, until I go back to uni, and then there would be the opportunity to work with them again in future holidays. We'll see...
Wednesday 24 June 2009
And the meat went MOO.
I am totally zonked.
Day 1 of the show is over. Who puts the vegetarian on the Carvery?!? Either way, back into the world of work at last, with the prospect of more casual labour for them at other events. And sneaky access to the Members' Bar once I was signed out! Appalled that the rich Members get the cheaper Pimms!!
One more day to go. Then cash in hand! Woohoo! That'll pay for the anniversary weekend! R's present arrived today :) Gorgeous red fountain pen with a personal engraving. It's awesome!
Bath. Bed. And somewhere in that, wash my bowtie.
Day 1 of the show is over. Who puts the vegetarian on the Carvery?!? Either way, back into the world of work at last, with the prospect of more casual labour for them at other events. And sneaky access to the Members' Bar once I was signed out! Appalled that the rich Members get the cheaper Pimms!!
One more day to go. Then cash in hand! Woohoo! That'll pay for the anniversary weekend! R's present arrived today :) Gorgeous red fountain pen with a personal engraving. It's awesome!
Bath. Bed. And somewhere in that, wash my bowtie.
Sunday 21 June 2009
Dum de dum...
The job situation is looking up (slightly). I have 2 days of waitressing next week for the local agricultural show, and probably some work on a strawberry farm for a few weeks.
Still nada from all those CVs I've scattered around town.
The ambu's have got back to me, finally, so organising my placement with them is starting to progress! At least once I have that sorted, I'll feel like this summer is sort of worthwhile.
Still nada from all those CVs I've scattered around town.
The ambu's have got back to me, finally, so organising my placement with them is starting to progress! At least once I have that sorted, I'll feel like this summer is sort of worthwhile.
Friday 12 June 2009
Domestic bliss
Just got back after a night at the boyf's. He's been working non-stop recently, so we took advantage of him finishing at 7pm yesterday and not starting til 10am today to go out. Went to see The Hangover, which is awesome! The whole audience were wetting themselves laughing - it was more surreal than purile, thankfully! I wasn't really in the mood for toilet jokes, but finding Mike Tyson's tiger in the bathroom? Definitely :D
Another day of doing nothing, I think... Domestic stuff, plus a quick trawl of houses for sale in uni-town, since I'm still homeless there, and a lengthy trawl of cars for sale in home-town. Not that I need a car until I get a job, but there's no harm being prepared!
The boyf has finally asked me to cough up some cash towards bills to ingratiate the housemates. Not that they've started complaining yet, but given the unreserved hatred of the last girlfriend to assume residency, I'm more than happy to throw some cash in their direction! It's fair enough, I do live there about 3/7 of the time, and I'm not paying rent anywhere else yet.
I'm moving in for a week in about 10 days, while the housies are on holiday - I'm being turned into a domestic goddess while R is out at work! He's expecting dinner on the table when he gets in and everything! So long as he doesn't expect me to clean out the rat trap, I don't mind...
Hometime is just being spent getting creative! I've turned a scrap of knitting into a funky wrist cuff, complete with gothic studs, and made some buttoned patches to turn into new cushion covers for when we finally get a sofa in the new uni house. The next step is to finally get those penny earrings done, but the cat disapproves quite strongly of me using the drill...
Another day of doing nothing, I think... Domestic stuff, plus a quick trawl of houses for sale in uni-town, since I'm still homeless there, and a lengthy trawl of cars for sale in home-town. Not that I need a car until I get a job, but there's no harm being prepared!
The boyf has finally asked me to cough up some cash towards bills to ingratiate the housemates. Not that they've started complaining yet, but given the unreserved hatred of the last girlfriend to assume residency, I'm more than happy to throw some cash in their direction! It's fair enough, I do live there about 3/7 of the time, and I'm not paying rent anywhere else yet.
I'm moving in for a week in about 10 days, while the housies are on holiday - I'm being turned into a domestic goddess while R is out at work! He's expecting dinner on the table when he gets in and everything! So long as he doesn't expect me to clean out the rat trap, I don't mind...
Hometime is just being spent getting creative! I've turned a scrap of knitting into a funky wrist cuff, complete with gothic studs, and made some buttoned patches to turn into new cushion covers for when we finally get a sofa in the new uni house. The next step is to finally get those penny earrings done, but the cat disapproves quite strongly of me using the drill...
Tuesday 9 June 2009
If this is summer, where is sunshine?
I'm home. Shattered. Still jobless, with 11 CV's out. Neither of my projects this summer have got back to me either.
However - I WON THE PSYCHOSOCIAL PRIZE!!! Jointly, with a guy who totally deserves it, but WOO!!! Very chuffed with myself for that.
Spent the day with the boyf :) Spent last night over there, got totally bepuzzled by the finale of Ashes to Ashes, went to the aquarium today, saw lots of fishes, fell in love with flatfish again, and grew more and more irritate by the high pitched shrieks of "I've found Nemo!" from every single small child there. Saw the entire in-law family, including having tea with Uncle C and Granny S! Fortunately it went well, accompanied with a hastily procured bunch of flowers! Well, she did sew my damaged skirt up this term, as well as providing the most lavish tea I've seen in a while!
Totally love-hate with R right now. Head over heels in love with him, but more and more annoying things are coming out. Possibly because he's working 13 hour shifts nearly every day off the week, and I'm post-prozac with jetlag. But gah! Temper, temper! And if I have to tattoo the word 'tolerance' onto his eyes, I will!
All things being equal, I'll admit to freaking out over his tale of the lost V. I had a fairytale romantic story in my head, due to the subsequent heartbreak around the ex, and that was cruelly dashed by the truth of drunken encounters at a party, before they were officially together. I was pretty gutted to find that out, to be honest. I still hate that I wasn't his first, and I guess I kinda thought that if it couldn't be with me then I had hoped it was lost honourably. But past is past. I can't get on my high horse, since my V was lost pretty dishonourably too, in the aftermath of his infidelity. I can say with as much false conviction as possible that I did it because it made me realise that I loved him, and that I was willing to overlook that mistake in the light of apologies and remorse. But subconsciously? I'd almost lost him, and I didn't want that to happen. So I gave away the one thing I still had to give. I'm not proud of that. I don't regret sleeping with R at all. I just regret the timing. We all make mistakes.
Gah where did my cheery 'start of summer' mood go to?! I have beautiful 'exam congratulations' roses, very scrumptious 'prize congratulations' chocolates (both from R) and a swish bottle of wine from the parentals to celebrate both those occasions!
Girly lunch later this week with a very sunburnt friend, to find out exactly how gruesome her legs look and whether the Fucidin is helping... Oh, the silly things we do in the name of vanity....
However - I WON THE PSYCHOSOCIAL PRIZE!!! Jointly, with a guy who totally deserves it, but WOO!!! Very chuffed with myself for that.
Spent the day with the boyf :) Spent last night over there, got totally bepuzzled by the finale of Ashes to Ashes, went to the aquarium today, saw lots of fishes, fell in love with flatfish again, and grew more and more irritate by the high pitched shrieks of "I've found Nemo!" from every single small child there. Saw the entire in-law family, including having tea with Uncle C and Granny S! Fortunately it went well, accompanied with a hastily procured bunch of flowers! Well, she did sew my damaged skirt up this term, as well as providing the most lavish tea I've seen in a while!
Totally love-hate with R right now. Head over heels in love with him, but more and more annoying things are coming out. Possibly because he's working 13 hour shifts nearly every day off the week, and I'm post-prozac with jetlag. But gah! Temper, temper! And if I have to tattoo the word 'tolerance' onto his eyes, I will!
All things being equal, I'll admit to freaking out over his tale of the lost V. I had a fairytale romantic story in my head, due to the subsequent heartbreak around the ex, and that was cruelly dashed by the truth of drunken encounters at a party, before they were officially together. I was pretty gutted to find that out, to be honest. I still hate that I wasn't his first, and I guess I kinda thought that if it couldn't be with me then I had hoped it was lost honourably. But past is past. I can't get on my high horse, since my V was lost pretty dishonourably too, in the aftermath of his infidelity. I can say with as much false conviction as possible that I did it because it made me realise that I loved him, and that I was willing to overlook that mistake in the light of apologies and remorse. But subconsciously? I'd almost lost him, and I didn't want that to happen. So I gave away the one thing I still had to give. I'm not proud of that. I don't regret sleeping with R at all. I just regret the timing. We all make mistakes.
Gah where did my cheery 'start of summer' mood go to?! I have beautiful 'exam congratulations' roses, very scrumptious 'prize congratulations' chocolates (both from R) and a swish bottle of wine from the parentals to celebrate both those occasions!
Girly lunch later this week with a very sunburnt friend, to find out exactly how gruesome her legs look and whether the Fucidin is helping... Oh, the silly things we do in the name of vanity....
Wednesday 3 June 2009
Final Fresher's Fondness
I missed out 2 whole days of blogging! May the bloggod spear me with his lightening emoticons.
So... Monday - Amnesia. I may have slept.
Tuesday - RESULTS! I passed all 3 of my modules, my little flatmate passed all hers plus her resit, and my big flatmate passed too! And... I'm in line for a prize for the psychosocial module! So far I'm in the top 3 out of our year group! Still pretty much in shock over that, seeing as I was getting pretty nervous as to whether I'd even passed that exam!
Early start tomorrow for tutor meeting and then Prize Viva! Trying not to revise... trying, and will probably fail by bedtime.
R and I's 1 year anniversary is fast approaching, and our relationship is stepping up a gear too - I'm moving in for the week that his housemates are on holiday. I'm not entirely sure how well this will go. He's working a lot of overtime, and I'm currently unemployed. Domestic bliss it will not be.
What is domestic bliss is that I made cakes today! From the remnants of flour, sugar, cereal, sultanas, smarties, and milk laying around the kitchen. Creative, huh? And they don't seem to have poisoned anyone yet, so bonus points! All the crockery, cutlery, and other cooking-concerned condiments are packed away in boxes, ready for the great Halls Exodus on Friday. As if the pile of boxes isn't already at head height...
So... Monday - Amnesia. I may have slept.
Tuesday - RESULTS! I passed all 3 of my modules, my little flatmate passed all hers plus her resit, and my big flatmate passed too! And... I'm in line for a prize for the psychosocial module! So far I'm in the top 3 out of our year group! Still pretty much in shock over that, seeing as I was getting pretty nervous as to whether I'd even passed that exam!
Early start tomorrow for tutor meeting and then Prize Viva! Trying not to revise... trying, and will probably fail by bedtime.
R and I's 1 year anniversary is fast approaching, and our relationship is stepping up a gear too - I'm moving in for the week that his housemates are on holiday. I'm not entirely sure how well this will go. He's working a lot of overtime, and I'm currently unemployed. Domestic bliss it will not be.
What is domestic bliss is that I made cakes today! From the remnants of flour, sugar, cereal, sultanas, smarties, and milk laying around the kitchen. Creative, huh? And they don't seem to have poisoned anyone yet, so bonus points! All the crockery, cutlery, and other cooking-concerned condiments are packed away in boxes, ready for the great Halls Exodus on Friday. As if the pile of boxes isn't already at head height...
Sunday 31 May 2009
More sun, more cider, and more s.... annoying-the-male-friend's-new-girlf
Tis apparently the last day of summer up North, and my sunburn will attest this fact for many weeks to come. The fronts and backs of my legs are nicely pink (3/4 days to tan), however that leaves a very white stripe down the side. I am adidas. I have been reeboked. Whatever. I look ridiculous.
And last night I managed to step on an upturned drawing pin. The Mother has kindly checked the vaccination records, and informed me that my tetanus has run out. Yay. So my day at the beach tomorrow is being interrupted by a GP appointment for a top up. Probably appropriate, seeing as I spent today wandering barefoot outside, with an open puncture wound.
Hopefully this run of bad luck can end tomorrow. We have a second viewing of the flat we saw on Friday night, because our other flatmate was away - another excuse to meet HOTTT property owner and reassess the place without having our moneyman over our shoulders.
Results on Tuesday! I even took my anatomy book sunbathing with me today, in the hope of prize orals! Or just cos I'm a geek. Either or.
As for the new girlf of my favourite male uni-based friend (as, of course, R is my best male friend). She is under the bizarre delusion that I have designs on her man. I don't, obviously, but it is hilarious to watch her bristle at finding him and me sunbathing together, otherwise alone.
And last night I managed to step on an upturned drawing pin. The Mother has kindly checked the vaccination records, and informed me that my tetanus has run out. Yay. So my day at the beach tomorrow is being interrupted by a GP appointment for a top up. Probably appropriate, seeing as I spent today wandering barefoot outside, with an open puncture wound.
Hopefully this run of bad luck can end tomorrow. We have a second viewing of the flat we saw on Friday night, because our other flatmate was away - another excuse to meet HOTTT property owner and reassess the place without having our moneyman over our shoulders.
Results on Tuesday! I even took my anatomy book sunbathing with me today, in the hope of prize orals! Or just cos I'm a geek. Either or.
As for the new girlf of my favourite male uni-based friend (as, of course, R is my best male friend). She is under the bizarre delusion that I have designs on her man. I don't, obviously, but it is hilarious to watch her bristle at finding him and me sunbathing together, otherwise alone.
Saturday 30 May 2009
I'm walkin' on sunshine!
Miraculously, the hangover merged with the drinking, so no aftereffects were felt this morning. It was pretty amazing to walk home at half three in the morning and see the sun peeking over the horizon though! It was ridiculously light!
I'm loving this lifestyle of lady at leisure. Spent 4 hours sat on the lawn today with a book, a bottle of cider (I never said ladies of leisure did so tee-total), and an absence of suncream. My shoulders have sizzled like a good slice of back bacon.
I'm loving this lifestyle of lady at leisure. Spent 4 hours sat on the lawn today with a book, a bottle of cider (I never said ladies of leisure did so tee-total), and an absence of suncream. My shoulders have sizzled like a good slice of back bacon.
Friday 29 May 2009
*pisseddd*
Hehehehe :) Uni may be over for teh year, but it's schooool night!!! Tis times like these I heart my geek glasses.
I learned to french plait my own hair!!! I have french pleated pigtails!!! Why couldny' I have learnt this ten years ago? Gah!
School tie, check.
White shirt, check.
Visible bra, gah, check.
Emo nail varnish, check.
Fluoro leg warmers, double check.
Woooo!! I havnt been oyut on a fridya night in agesss!¬
I learned to french plait my own hair!!! I have french pleated pigtails!!! Why couldny' I have learnt this ten years ago? Gah!
School tie, check.
White shirt, check.
Visible bra, gah, check.
Emo nail varnish, check.
Fluoro leg warmers, double check.
Woooo!! I havnt been oyut on a fridya night in agesss!¬
Life - going up!
The sun is shining, exams are over, the hangover is gone, and we have a viewing on a flat next week! Life is goood!
Thursday 28 May 2009
Goodbye Prozac.
You have been my friend, and my enemy. I officially sever all contact with you; we shall not even be acquaintances. You are a significant footnote in the history of my life. But this is my new decade (I just hit 20). I will go on, and your green and yellow curves will drag me no further.
1 week today, I will be me. Just me. Not chemically altered Jelly.
For a year and three months, I have been a slave to Prozac. It has been my staple breakfast. Skipped pills gave me hell in the following days. Nothing compared to the week of horrific nausea (I am reliably informed by a GP friend that I did actually go green for the first day - big thanks to that same friend for the Metaclopramide!), but still noticable and enough to put fear into my heart, fear that if one skipped pill produced that depth of low, then how would permanent absence of that life-saver be?
Time to find out. It was my New Year Resolution. It's on my 101/1001 list. I have seen my mother sink so low as to end up hospitalised, and her subsequent intense long-lasting pride at kicking the SSRI habit. My experience of depression was much milder than hers. So I know I can do this.
I have insight (in the psychological definition) into my condition. I can tell when I'm sinking. I know the triggers (bloody hormones!) and have coping strategies. Now is the right time to do this. I've had a fantastic first year at uni, proved to myself that I deserve to be a medical student, sailed into second year, and there's an awesome summer ahead of me. I have amazing friends, brilliant housemates, and the best boyfriend I could wish for. And I have God. Despite our correspondance being minimal over recent years, I know He is always there for me. Through Him I can do all things.
"But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint" Isiaiah 40:31
An aside: microwaved scones with butter = the BEST snack ever.
1 week today, I will be me. Just me. Not chemically altered Jelly.
For a year and three months, I have been a slave to Prozac. It has been my staple breakfast. Skipped pills gave me hell in the following days. Nothing compared to the week of horrific nausea (I am reliably informed by a GP friend that I did actually go green for the first day - big thanks to that same friend for the Metaclopramide!), but still noticable and enough to put fear into my heart, fear that if one skipped pill produced that depth of low, then how would permanent absence of that life-saver be?
Time to find out. It was my New Year Resolution. It's on my 101/1001 list. I have seen my mother sink so low as to end up hospitalised, and her subsequent intense long-lasting pride at kicking the SSRI habit. My experience of depression was much milder than hers. So I know I can do this.
I have insight (in the psychological definition) into my condition. I can tell when I'm sinking. I know the triggers (bloody hormones!) and have coping strategies. Now is the right time to do this. I've had a fantastic first year at uni, proved to myself that I deserve to be a medical student, sailed into second year, and there's an awesome summer ahead of me. I have amazing friends, brilliant housemates, and the best boyfriend I could wish for. And I have God. Despite our correspondance being minimal over recent years, I know He is always there for me. Through Him I can do all things.
"But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint" Isiaiah 40:31
An aside: microwaved scones with butter = the BEST snack ever.
*celebratory exams-are-over dance*
And it's all over. Second year here I come! Conditional to results, etc...
OSPE went pretty well, aside from mistaking the trachea for a bladder - it was a VERY vague CT! I'm 99% sure I'v passed this module, just need to wait and see if I get a decent mark from it! Fingers crossed for an 18 or above...
Celebrations began as soon as the OSPE let out. Pub lunch, girly shopping under the influence :) Then a quick nap before the evening started! Quickly exceeded the previous alcohol intake record, and yet didn't feel drunk... this morning is less hungover than normal too. Oh no! Tolerance!!!
Finally on the downhill slope to summer and home now. 8 days til the parentals arrive - just need to tackle the issue of 'how on earth do I get all my stuff into the car?!'
OSPE went pretty well, aside from mistaking the trachea for a bladder - it was a VERY vague CT! I'm 99% sure I'v passed this module, just need to wait and see if I get a decent mark from it! Fingers crossed for an 18 or above...
Celebrations began as soon as the OSPE let out. Pub lunch, girly shopping under the influence :) Then a quick nap before the evening started! Quickly exceeded the previous alcohol intake record, and yet didn't feel drunk... this morning is less hungover than normal too. Oh no! Tolerance!!!
Finally on the downhill slope to summer and home now. 8 days til the parentals arrive - just need to tackle the issue of 'how on earth do I get all my stuff into the car?!'
Tuesday 26 May 2009
24 hours til freedom!
Finally, the balance has tipped in favour of less exams to go than have been done!
I have super cool new shoes on the way, a fabulous new dress to celebrate in, and I think I did pretty well on today's exam! And the sun is shining!
I did kill the imaginary patient who was in DKA however. I gave him dextrose and no insulin. Although I did prevent a hyperkalaemic arrhythmia by prescribing something I'd only ever heard of from House!
I have super cool new shoes on the way, a fabulous new dress to celebrate in, and I think I did pretty well on today's exam! And the sun is shining!
I did kill the imaginary patient who was in DKA however. I gave him dextrose and no insulin. Although I did prevent a hyperkalaemic arrhythmia by prescribing something I'd only ever heard of from House!
Monday 25 May 2009
1 down, 2 to go!
I think that went ok... more common sense questions than any request for factual information, but as I have been frequently told, I have no common sense. Anyway, now I've proved I can come up with five reasons, beyond low income, to explain why a mother cannot provide healthy food for her children, without using the 'she has deeply ingrained psychological issues from her own obesity and feels the need to mold her children to her own body shape. Feeding them healthily would be like suicide' line, or similar bull.
Must go relearn hormones. As if I don't have enough of them already...
Must go relearn hormones. As if I don't have enough of them already...
Sunday 24 May 2009
15 hours....
First exam tomorrow! For some reason, I'm more scared than I was before January exams! Probably because I know I can pass these, as strange as that sounds. The stress is over whether I can get a decent mark to reflect this year. I want a distinction in at least one module, dammit! A 10 & a 16 do not reflect how I feel this year went!
Chill....
Gonna put my feet up with a new DVD (The Last Kiss), and possibly skim over models of stress.
3 days, and this will all be done with :D
Chill....
Gonna put my feet up with a new DVD (The Last Kiss), and possibly skim over models of stress.
3 days, and this will all be done with :D
Saturday 23 May 2009
2 days!!
A 9-5 library day, and on a Saturday, no less! Partially cos the flatmate had a resit so I wandered down to campus with her. And to mock her for having a Saturday exam - haha! Felt a lot better about my academic abilities after seeing how many people were resitting too.
The Fear is really settling in now, with two days to go. And now nothing is going in. Brain full.
The Fear is really settling in now, with two days to go. And now nothing is going in. Brain full.
Friday 22 May 2009
Exam Countdown: 3 days.
The boyf has gone on a girly shopping trip with some mates to London today, so to avert my green eyes, I did a 7 hour library haul. Hopefully cracked enough info into my thick skull to pass Monday's exam, just got half of the anatomy curriculum to cover and I'm done.
One of my mates has got into Urban Exploring, in the local hospitals/asylums - we seem to have quite a few! Not sure what that says about the locals....
Anyway, the photos are beautiful! Really would love to get into it, but a criminal record for trespassing doesn't look so great on a surgical CV!
Home in 2 weeks! Can't believe that first year is over so quickly. No more halls. No more anatomy class. No more having 35 other people in the house to talk to when I can't be arsed to revise! I'm definitely gonna miss having all my friends within 100 yards... Just found another possible flat, with a roof garden! Fingers crossed our investor (slash flatmate's Dad :p ) likes the look of it too....
One of my mates has got into Urban Exploring, in the local hospitals/asylums - we seem to have quite a few! Not sure what that says about the locals....
Anyway, the photos are beautiful! Really would love to get into it, but a criminal record for trespassing doesn't look so great on a surgical CV!
Home in 2 weeks! Can't believe that first year is over so quickly. No more halls. No more anatomy class. No more having 35 other people in the house to talk to when I can't be arsed to revise! I'm definitely gonna miss having all my friends within 100 yards... Just found another possible flat, with a roof garden! Fingers crossed our investor (slash flatmate's Dad :p ) likes the look of it too....
Thursday 21 May 2009
The Fear is here.
And shows no signs of waning.
Thankfully the library has finally succumbed to demand and agreed to an extra hour on weeknights. Although the only weeknight before exams start is... tonight. ARGH!!!
Finally got down to the anatomy lab today. I think that induced the Fear. I know NOTHING. I picked up a 'uterus', only for someone to go "ooh, a bladder!" We may only have 2 body regions to learn for this exam, but there's a pretty huge amount of stuff crammed in there! Not to mention Mr Anatomy's obsession with lymph. Bleh.
On the good side, I got my MRI results back! I've fractured the distal tubercle of my scaphoid, and longitudinally fractured my lunate. And according to the (fourth!) set of x-rays, the scaphoid injury is an old one! So much for my claim of never having broken a bone! Ah well, still get my extra time in exams :)
Anything else happened? Erm... nah. As for the outside world, I haven't seen it recently. Ask me again on Wednesday.
Thankfully the library has finally succumbed to demand and agreed to an extra hour on weeknights. Although the only weeknight before exams start is... tonight. ARGH!!!
Finally got down to the anatomy lab today. I think that induced the Fear. I know NOTHING. I picked up a 'uterus', only for someone to go "ooh, a bladder!" We may only have 2 body regions to learn for this exam, but there's a pretty huge amount of stuff crammed in there! Not to mention Mr Anatomy's obsession with lymph. Bleh.
On the good side, I got my MRI results back! I've fractured the distal tubercle of my scaphoid, and longitudinally fractured my lunate. And according to the (fourth!) set of x-rays, the scaphoid injury is an old one! So much for my claim of never having broken a bone! Ah well, still get my extra time in exams :)
Anything else happened? Erm... nah. As for the outside world, I haven't seen it recently. Ask me again on Wednesday.
Tuesday 19 May 2009
Bedtime!
Urgh. I was rudely awoken by an alarm clock at 6.30am (lots of rude awakenings recently. Don't people have manners? Don't people understand my need for sleep?!). Unfortunately, it was mine.
The MRI centre is 90 mins from my flat, on foot. Uphill. My toes are still bleeding. But I got a nice nap for 20 mins, with a cosy pillow, and some massive retro headphones. Great, aside from the CLUNK CLUNK CLUNK of some gigantic magnet spinning my protons (I think. A level Chem seems a long time ago). Fun, exciting new times anyway.
The other half finished his exams today, and (conditional to results) is now a second year! And promptly rang me to rub it in my face. Lovely man. Possibly our first functional phone call (yes, in over ten months of dating, 70% long distance, this is the first. Don't begrudge us our fights), with no awkward silences, no bickering about talking over each other, and it was a genuine 'I missed you and wanted to hear your voice' call, so aww *cute smushy face*
The 'after-MRI' bit of my day, like post-1030, has been... insignificant. Failed retail therapy - where have all the cool t shirts gone? Slogans, pictures, patterns? I already have a cupboard full of plain tops, dammit! Last time, I resorted to TopMan. My Grr shirt is my new favourite thing, ever.
I did come home with a ton of pick n mix sweets though, most of which got consumed instead of lunch, and left me in a hyperglycaemic haze until dinner. Which was great for my afternoon of anatomy revision. Aclands knowledge can be absorbed through the ears, bypassing the need for the mind to be switched on. My boyfriend agrees. And he's a psychologist, k?
Finally, expect death. All water outlets are being tested for Legionella this month. Suspiciously, 5 of my flatmates now have the early symptoms of Legionnaires.
The MRI centre is 90 mins from my flat, on foot. Uphill. My toes are still bleeding. But I got a nice nap for 20 mins, with a cosy pillow, and some massive retro headphones. Great, aside from the CLUNK CLUNK CLUNK of some gigantic magnet spinning my protons (I think. A level Chem seems a long time ago). Fun, exciting new times anyway.
The other half finished his exams today, and (conditional to results) is now a second year! And promptly rang me to rub it in my face. Lovely man. Possibly our first functional phone call (yes, in over ten months of dating, 70% long distance, this is the first. Don't begrudge us our fights), with no awkward silences, no bickering about talking over each other, and it was a genuine 'I missed you and wanted to hear your voice' call, so aww *cute smushy face*
The 'after-MRI' bit of my day, like post-1030, has been... insignificant. Failed retail therapy - where have all the cool t shirts gone? Slogans, pictures, patterns? I already have a cupboard full of plain tops, dammit! Last time, I resorted to TopMan. My Grr shirt is my new favourite thing, ever.
I did come home with a ton of pick n mix sweets though, most of which got consumed instead of lunch, and left me in a hyperglycaemic haze until dinner. Which was great for my afternoon of anatomy revision. Aclands knowledge can be absorbed through the ears, bypassing the need for the mind to be switched on. My boyfriend agrees. And he's a psychologist, k?
Finally, expect death. All water outlets are being tested for Legionella this month. Suspiciously, 5 of my flatmates now have the early symptoms of Legionnaires.
Monday 18 May 2009
Oh Library, why do you hurt me so?
I have spent eight hours locked in there already today. Stupid, stupid exams. Stupid, stupid dumb blondes who sat across the room from me all evening and whispered and giggled. How do you like Vanders, eh? Nice, eh? How do you like it shoved in that oversized food hole?
The only thing tougher than revision right now is writing a dumb cover letter for my CV, for a research project that I thought I'd already guaranteed my place on. How many times can you wax lyrical about molecular pathways in one side of A4? I'm aiming for a new world record.
Finally, MRI tomorrow morning. 9am, so no revision time wasted. Except for the fact that said hospital is not on any transport routes that I'm familiar with, and therefore is a 90 minute walk. I do not 7.30am. I like it even less when I'm outside in it.
The only thing tougher than revision right now is writing a dumb cover letter for my CV, for a research project that I thought I'd already guaranteed my place on. How many times can you wax lyrical about molecular pathways in one side of A4? I'm aiming for a new world record.
Finally, MRI tomorrow morning. 9am, so no revision time wasted. Except for the fact that said hospital is not on any transport routes that I'm familiar with, and therefore is a 90 minute walk. I do not 7.30am. I like it even less when I'm outside in it.
Sunday 17 May 2009
I live in Halls. Hellhole Halls.
A Saturday fire alarm and a confiscated kitchen item should have been warning enough. Bad things do not come in twos.
Number three arrived at 4am. Grr, already.
Then add smashed windows, intruders, destruction of flat contents, and the calling of police and window-repair-men, and grr does not even partly cover it. Fortunately, it wasn't my flat, but it was 2 floors down, and with single glazing and very thin floors, it sounded like it was in my bedroom. And it was damn scary!
Cue much gossiping the next morning, considering only I and one other girl had the nerve to come out of our rooms to find out what was going on. Drunken psycho's, I believe was the conclusion...
Either way, the Ghetto has certainly told us why it deserves that nickname. Thank goodness for the new flat being in posh-trendy area :D
Number three arrived at 4am. Grr, already.
Then add smashed windows, intruders, destruction of flat contents, and the calling of police and window-repair-men, and grr does not even partly cover it. Fortunately, it wasn't my flat, but it was 2 floors down, and with single glazing and very thin floors, it sounded like it was in my bedroom. And it was damn scary!
Cue much gossiping the next morning, considering only I and one other girl had the nerve to come out of our rooms to find out what was going on. Drunken psycho's, I believe was the conclusion...
Either way, the Ghetto has certainly told us why it deserves that nickname. Thank goodness for the new flat being in posh-trendy area :D
Saturday 16 May 2009
Going for the world record in procrastination...
Greetings Saturday. Would you mind awfully if you could just stop, and restart? Please? No? Oh. Kthxbye.
No weekend lie-ins today, due to some moron burning his breakfast. If there's gonna be a fire alarm, it would have to be on the wettest, coldest day of May, wouldn't it. Yay.
And as if that didn't put a downer on the weekend already, our toaster got confiscated. Yes, confiscated, like a Pokemon card in a primary school. It's crime? Fusing the electrical circuits of our entire floor. Oops.
I just wanna get out of halls. Like, now. Ok, so there are only three weeks left til I'm home but, gah, I just wanna stop living out of boxes! My frickin underwear lives in a box, for crying out loud! My bedside table is a box!
Is it too much to ask for real furniture? Meh, if I can survive the long (currently unemployed) summer, I get my own room, in a flat shared with ONLY two other people, with a SOFA and a BATH and a DINING TABLE THAT WILL SEAT MORE THAN TWO PEOPLE! Oh, and a real cooker (damn you, Baby Belling. Just die already!). Plus... the bonus of only buying a 2 bed house, to be occupied by 3 people is [drum roll] we have to convert the lounge into bedroom number 3. Which means (a) bigger room, (b) bay window, and (c) antique Victorian tiled fireplace!
I'm so psyched! Proper bookshelves, and a chest of drawers, and a comfy desk chair... Gah, furniture freak.
Finally (and then I promise I'll go study. Or go to the shop to stock up on Nutella. Oh, there's no point. I have no toast to schmear it on. Today SUCKS), I'm trying to order my steth for the start of second year, and have no idea which colour to buy. Yeh, life changing decision. There're all dark and murky! Except the fluoro orange, which just looks bizarre, the baby blue and pink, which look like you already picked out Paeds as your specialty, and bubblegum pink. If it had actually been BRIGHT pink, it'd be dangling round my neck already. However, it's just kind of a normal pink with a sheen to it?
No weekend lie-ins today, due to some moron burning his breakfast. If there's gonna be a fire alarm, it would have to be on the wettest, coldest day of May, wouldn't it. Yay.
And as if that didn't put a downer on the weekend already, our toaster got confiscated. Yes, confiscated, like a Pokemon card in a primary school. It's crime? Fusing the electrical circuits of our entire floor. Oops.
I just wanna get out of halls. Like, now. Ok, so there are only three weeks left til I'm home but, gah, I just wanna stop living out of boxes! My frickin underwear lives in a box, for crying out loud! My bedside table is a box!
Is it too much to ask for real furniture? Meh, if I can survive the long (currently unemployed) summer, I get my own room, in a flat shared with ONLY two other people, with a SOFA and a BATH and a DINING TABLE THAT WILL SEAT MORE THAN TWO PEOPLE! Oh, and a real cooker (damn you, Baby Belling. Just die already!). Plus... the bonus of only buying a 2 bed house, to be occupied by 3 people is [drum roll] we have to convert the lounge into bedroom number 3. Which means (a) bigger room, (b) bay window, and (c) antique Victorian tiled fireplace!
I'm so psyched! Proper bookshelves, and a chest of drawers, and a comfy desk chair... Gah, furniture freak.
Finally (and then I promise I'll go study. Or go to the shop to stock up on Nutella. Oh, there's no point. I have no toast to schmear it on. Today SUCKS), I'm trying to order my steth for the start of second year, and have no idea which colour to buy. Yeh, life changing decision. There're all dark and murky! Except the fluoro orange, which just looks bizarre, the baby blue and pink, which look like you already picked out Paeds as your specialty, and bubblegum pink. If it had actually been BRIGHT pink, it'd be dangling round my neck already. However, it's just kind of a normal pink with a sheen to it?
Friday 15 May 2009
5'll make you feel alright!
I am so ridiculously sick to the back teeth of '5 things' on Facebook!!! I use FB to catch up with goss from old school mates, stalk people I'd rather not talk to, and keep up to date on who's going out with who. I do not care if you have an empty beer can within arm's reach, and four other boring and ordinary items. Equally, it's not gonna make my day to discover that you have hand picked the 5 most bizarre items in you house to sit next to before filling that quiz out.
And if you can't beat them....
1. A plastic skull - gained using the best of medical communication and informed consent while celebrating the closure of the Union. I also have a yellow pool ball from that evening. The table itself wouldn't fit down the stairs...
2. A wine glass. Empty, obv.
3. Half a billion padded envelopes. I'm trying to save enough to pad my room. Cheaper heating bills....
4. The Anatomy Colouring Book. Cos colouring is the new studying.
5. A stretchy rubber ball that looks like a lion, complete with stretchy tufts of mane. My mother sent it, for stress relief. Erm, thanks.
[If anyone doesn't get the title, I refer you to popular 90's music]
And if you can't beat them....
1. A plastic skull - gained using the best of medical communication and informed consent while celebrating the closure of the Union. I also have a yellow pool ball from that evening. The table itself wouldn't fit down the stairs...
2. A wine glass. Empty, obv.
3. Half a billion padded envelopes. I'm trying to save enough to pad my room. Cheaper heating bills....
4. The Anatomy Colouring Book. Cos colouring is the new studying.
5. A stretchy rubber ball that looks like a lion, complete with stretchy tufts of mane. My mother sent it, for stress relief. Erm, thanks.
[If anyone doesn't get the title, I refer you to popular 90's music]
Rambles.
Firstly, since when did Jaffa cakes get to one-mouthful-cake-gone size?? I want damn face-sized jaffa cakes! Same with Wagon Wheels. I could go on all day about food that has shrunk (don't get me started on Creme Eggs).
Secondly, library hours have been cut thanks to the dumb 2 mile round trip UP a hill and DOWN a hill each way. Thanks, stretched-a-little-too-far calf muscle. You HURT. And you coincide with my regular i-should-really-get-my-ballet-pumps-out flights of fancy. Plie with pulled calf? Nu-uh. Gah. And ibuprofen isn't helping. Greetings, superstrong cocodamol. You come with peace...
Ohmigosh there's only 9 days til exams start and I know NOTHING. Like, I spent 4 hours in the library today. Studying. Interspersed with sitting on the stairs eating Monster Munch (no retro snacks near the books!), texting R about... well, nothing, and fielding phone calls from people dying to offer me summer employment. Ok, I stretch the truth a little. There was one measly phone call. Offering me an interview for next week.
Yay!
I am 420 miles from the coffee house that wants to interview me. And unable to leave town because of revision, and MRI's and stuff.
Nay.
So, I offered to interview in June, when I'm back, and they did the whole letting-you-down-gently thing of 'well we're interviewing for 3 spots next week, so if some of those don't work out we'll get in touch, and we'll keep hold of your CV just in case'. Woo. Cross them off my list for this summer.
Ah well. I have the last-resort of begging R's Dad (hereby known as FIL - Father in Law, despite the lack of, you know, marriage or anything) for work. I'm not sure what sane business owner would employ a little 20 year old girl (that still sounds so weird. No 'teen' anymore) to lug around 21ft metal poles and shizz, but ya never know.
Secondly, library hours have been cut thanks to the dumb 2 mile round trip UP a hill and DOWN a hill each way. Thanks, stretched-a-little-too-far calf muscle. You HURT. And you coincide with my regular i-should-really-get-my-ballet-pumps-out flights of fancy. Plie with pulled calf? Nu-uh. Gah. And ibuprofen isn't helping. Greetings, superstrong cocodamol. You come with peace...
Ohmigosh there's only 9 days til exams start and I know NOTHING. Like, I spent 4 hours in the library today. Studying. Interspersed with sitting on the stairs eating Monster Munch (no retro snacks near the books!), texting R about... well, nothing, and fielding phone calls from people dying to offer me summer employment. Ok, I stretch the truth a little. There was one measly phone call. Offering me an interview for next week.
Yay!
I am 420 miles from the coffee house that wants to interview me. And unable to leave town because of revision, and MRI's and stuff.
Nay.
So, I offered to interview in June, when I'm back, and they did the whole letting-you-down-gently thing of 'well we're interviewing for 3 spots next week, so if some of those don't work out we'll get in touch, and we'll keep hold of your CV just in case'. Woo. Cross them off my list for this summer.
Ah well. I have the last-resort of begging R's Dad (hereby known as FIL - Father in Law, despite the lack of, you know, marriage or anything) for work. I'm not sure what sane business owner would employ a little 20 year old girl (that still sounds so weird. No 'teen' anymore) to lug around 21ft metal poles and shizz, but ya never know.
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