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....
Showing posts with label ambition. Show all posts
Showing posts with label ambition. Show all posts
Sunday, 20 December 2009
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....
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.
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.)
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...
Wednesday, 13 May 2009
PhD in Tea Making, coming right up!
Ohmigosh crazy days. Not only did PhD boy seem to like the idea of a tea-lady for the summer, his supervisor is ok with it too! Just got to send off the CV and I'm in!
Just gotta send the boyf skulking into the uni halls to find out what PhD boy is like... hot, I hope :p
I'm so excited!!! And I did six hours in the library today, so go me! Haematology is actually pretty straightforward. And fun - all those cascades and factors! I like nitty bitty details :D
Best start learning my factors in bone healing :D
Just gotta send the boyf skulking into the uni halls to find out what PhD boy is like... hot, I hope :p
I'm so excited!!! And I did six hours in the library today, so go me! Haematology is actually pretty straightforward. And fun - all those cascades and factors! I like nitty bitty details :D
Best start learning my factors in bone healing :D
Jelly-shaped Lab Rats
I may be another step closer to being published! Well, published dead last, in the capacity of 'my contribution was making tea and supplying biscuits'. Just emailed a guy at the uni back home to see if I can get involved in his project this summer - and it's Ortho-related! So, fingers crossed, I may have an ACL audit, and this!
UKFPO - I am so gonna batter you with how many points I can accumulate :D
UKFPO - I am so gonna batter you with how many points I can accumulate :D
Saturday, 9 May 2009
101/1001
Saw Project Zero over at Lily's and figured it'd be a great procrastination idea :D I figure 1001 days will run into my 4rd year,so some of the 'whoah - big ambition' ideas won't look so scary then...I have til February 4th, 2012!
1. Cut spending to under £50/week.
2. Start horse-riding again.
3. Join a university club or society.
4. Go to at least one surgical skills workshop.
5. Get a paper published.
6. Assist in theatre.
7. Get under 9 stone again! And stay there....
8. Get engaged.
9. Dye my hair (first time for everything!)
10. Own a piece of jewellery that costs over £100 (not inc engagement ring).
11. Figure out why I want to do Ortho.
12. Learn to love my body.
13. Go skiing.
14. Read at least 250 new books (fiction!).
15. Own at least five items of furniture.
16. Blog at least once a week.
17. Make financial plans for the future, including investing my savings.
18. Learn to organise my bills.
19. Learn to tile a wall.
20. Learn basic plumbing.
21. Learn how to fix the 'lectrix.
22. Learn to fix a car.
23. Become proficient at woodwork.
24. Cook a three course meal, from scratch.
25. Cook Christmas dinner for at least four people.
26. Visit Rome.
27. Visit Prague.
28. Visit Paris.
29. Go to Asia.
30. Go on an impromptu road trip.
31. Watch the ballet.
32. See a musical in the West End.
33. Give blood.
34. Sign up for the Marrow Register.
35. Watch the sun rise with someone I love.
36. See the stars, and be able to name some.
37. Decorate my new bedroom.
38. Move my favourite things from my parents' house to my new flat.
39. Not cry for a month.
40. Not seriously injure myself more than once per academic year.
41. Take up Ballet again.
42. Exercise at least once a week.
43. Paint my big canvas.
44. Have a professional photo shoot of me and R together.
45. Be a research guinea-pig.
46. Have a place on an intercalated program applicable to my career plans.
47. Find my style.
48. Re-do therapy. Myself. No CPN's up here...
49. Visit Edinburgh.
50. Dance in the Uni Dance Soc Showcase.
51. Cannulate.
52. Recycle all recycleable rubbish.
53. Ride a roller-coaster. A real one. At Alton Towers.
54. Swim in the sea at night.
55. Steal a road sign (preferably 'man putting up umbrella').
56. Attend an Aberdeen FC Vs Celtic game at Pittodrie
57. Ask a stranger where they bought their shoes.
58. Get a credit card, and use it responsibly.
59. Have a joint bank account.
60. Make friends with my neighbours.
61. Be in two countries at once.
62. Go to a Ceilidh.
63. Own a pet.
64. Declutter my wardrobe.
65. Attend a uni ball.
66. Tend a garden.
67. Find the study style that suits me.
68. Get a 20 at least once a semester.
69. Have sex outdoors.
70. Stop buying greetings cards - make my own.
71. Make up with Hannah.
72. Visit Sweden.
73. Climb a munro.
74. Come off Prozac.
75. Meet a giraffe.
76. Ride in an ambulance.
77. Witness trauma treatment on-scene.
78. Ride in a helicopter.
79. Work at the London Olympics.
80. Have a job in uni town.
81. Make a curry from scratch.
82. Have a professional bra-fitting.
83. Wear heels to uni.
84. Talk to my lil bro at least once a week - and not just to say 'is mum/dad in?'
85. Find a new favourite author (sorry, Ms Picoult...)
86. Work as a barmaid /waitress.
87. Work as a check-out girl.
88. Work as a secretary.
89. Work as a manual labourer.
90. Buy new heels without feeling guilty.
91. Replace the lop-sided ponytail with a new look.
92. Celebrate New Year in a different country.
93. Save a life.
94. Write a will.
95. Study first, procrastinate later.
96. Have a FaceBook free fortnight.
97. Go to the cinema alone.
98. Buy/sell on eBay.
99. Shop vintage.
100. Love, don't begrudge.
101. Write a new 101/1001 list...
1. Cut spending to under £50/week.
2. Start horse-riding again.
3. Join a university club or society.
4. Go to at least one surgical skills workshop.
5. Get a paper published.
6. Assist in theatre.
7. Get under 9 stone again! And stay there....
8. Get engaged.
9. Dye my hair (first time for everything!)
10. Own a piece of jewellery that costs over £100 (not inc engagement ring).
11. Figure out why I want to do Ortho.
12. Learn to love my body.
13. Go skiing.
14. Read at least 250 new books (fiction!).
15. Own at least five items of furniture.
16. Blog at least once a week.
17. Make financial plans for the future, including investing my savings.
18. Learn to organise my bills.
19. Learn to tile a wall.
20. Learn basic plumbing.
21. Learn how to fix the 'lectrix.
22. Learn to fix a car.
23. Become proficient at woodwork.
24. Cook a three course meal, from scratch.
25. Cook Christmas dinner for at least four people.
26. Visit Rome.
27. Visit Prague.
28. Visit Paris.
29. Go to Asia.
30. Go on an impromptu road trip.
31. Watch the ballet.
32. See a musical in the West End.
33. Give blood.
34. Sign up for the Marrow Register.
35. Watch the sun rise with someone I love.
36. See the stars, and be able to name some.
37. Decorate my new bedroom.
38. Move my favourite things from my parents' house to my new flat.
39. Not cry for a month.
40. Not seriously injure myself more than once per academic year.
41. Take up Ballet again.
42. Exercise at least once a week.
43. Paint my big canvas.
44. Have a professional photo shoot of me and R together.
45. Be a research guinea-pig.
46. Have a place on an intercalated program applicable to my career plans.
47. Find my style.
48. Re-do therapy. Myself. No CPN's up here...
49. Visit Edinburgh.
50. Dance in the Uni Dance Soc Showcase.
51. Cannulate.
52. Recycle all recycleable rubbish.
53. Ride a roller-coaster. A real one. At Alton Towers.
54. Swim in the sea at night.
55. Steal a road sign (preferably 'man putting up umbrella').
56. Attend an Aberdeen FC Vs Celtic game at Pittodrie
57. Ask a stranger where they bought their shoes.
58. Get a credit card, and use it responsibly.
59. Have a joint bank account.
60. Make friends with my neighbours.
61. Be in two countries at once.
62. Go to a Ceilidh.
63. Own a pet.
64. Declutter my wardrobe.
65. Attend a uni ball.
66. Tend a garden.
67. Find the study style that suits me.
68. Get a 20 at least once a semester.
69. Have sex outdoors.
70. Stop buying greetings cards - make my own.
71. Make up with Hannah.
72. Visit Sweden.
73. Climb a munro.
74. Come off Prozac.
75. Meet a giraffe.
76. Ride in an ambulance.
77. Witness trauma treatment on-scene.
78. Ride in a helicopter.
79. Work at the London Olympics.
80. Have a job in uni town.
81. Make a curry from scratch.
82. Have a professional bra-fitting.
83. Wear heels to uni.
84. Talk to my lil bro at least once a week - and not just to say 'is mum/dad in?'
85. Find a new favourite author (sorry, Ms Picoult...)
86. Work as a barmaid /waitress.
87. Work as a check-out girl.
88. Work as a secretary.
89. Work as a manual labourer.
90. Buy new heels without feeling guilty.
91. Replace the lop-sided ponytail with a new look.
92. Celebrate New Year in a different country.
93. Save a life.
94. Write a will.
95. Study first, procrastinate later.
96. Have a FaceBook free fortnight.
97. Go to the cinema alone.
98. Buy/sell on eBay.
99. Shop vintage.
100. Love, don't begrudge.
101. Write a new 101/1001 list...
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