*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...

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!

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!!

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.

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....

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.

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]