Halfway There

Halfway to Doctor Motorway Sign

Just passed this roadsign on my journey…

Halfway through another rotation and it all seems to be going well. We are now actually halfway through medical school  – at least from a time point of view and I’m surprised to feel that it’s gone so fast, although there is still a ton of continued learning for years to come. I certainly don’t feel as if I’ve travelled far enough along this journey or know enough to have reached the destination of half a foundation (F1) doctor. According to good old Wikipedia, I’m currently at the stage of “consciously incompetent“.

Although I’m confident using my stethoscope, it may be some time before I wield it with the same precision as Jedi consultants and can detach it from my neck without tangling it up in my ID badge neckstrap. It doesn’t inspire confidence in patients when your ID badge somehow ends up in their mashed potatoes.

I’ve met all kinds of patients with interesting jobs including a footballer, an athlete, an actor, an airline pilot, several doctors and even a professional clown. It has been pretty awesome.

Perhaps, my classmates and I are stressing too much about not knowing enough to be helpful and should just enjoy this stage where we can absorb and see a massive variety of specialties without being tied down to any of them – or be expected to carry out jobs or endure any huge responsibilities yet.

The “Medical Student” ID badge (when freed of potato) grants us “Access to All Areas” in the hospital and observe pretty much anything we’re interested in. Clinics and operating theatres may need prior arrangement but by asking nicely, I’ve often been able to show up ad-hoc even to these and watch procedures, get a bit of teaching and see conditions that we’d only previously read about in textbooks.

So we are not VIPs, but we do have backstage passes. Roll on the next 2.5 years – if all goes well.

Learning from Doctors & Patients

Amount-Learned-blackboard

Starting clinical rotations has been a really satisfying experience so far and I’m learning a lot. However, I think I could be learning more and this is mainly due to i) different kinds of doctors and ii) opportunities to see patients.

i) Types of Doctors:
We rely a lot on feedback and teaching from the doctors but there seems to be two categories of doctors on the wards.

The first are always: “busy and have no time to teach at the moment.” I never bother doctors who look stressed or busy but some consistently have no time to teach or completely ignore students during ward rounds – so I no longer feel comfortable asking. They are great doctors apparently and I’d learn a lot from them – but not being able to engage them, I won’t know.

Luckily, most doctors are in a second category; a different class who are really cooperative, sometimes actively seeking out students and recommending interesting patients for us to take histories from and perform examinations on – in addition to letting us present our findings back to them. Sometimes, we’re given the chance to be the first in the team to see the patient, write up the notes and present to the consultant. A small step but it’s a massive boost and a great feeling to be useful!

If you’re a doctor in this second category, I’m grateful and will try to follow in your footsteps!

“Want to see a patient with: a pan-systolic murmur / suspected appendicitis / a replacement mitral valve / Dupuytren’s contracture……?

Yes please.

ii) Seeing Patients:
The second factor that determines how much we learn is the amount of patients we see. This unfortunately involves good timing, luck and being in the right place at the right time. I have to add that patients are amazing, even though the majority of them are really sick, they still give us consent to practice on and learn from them.

Unless our team is on call, the earliest we can usually see patients is after the morning wash and breakfast. The race to examine and take histories begins – until the air fills with the unmistakable aroma of overcooked food and boiled to death vegetables signifying the imminent lunch trolley and protected mealtime when patients have to be left alone.

Other things to factor in are doctors on ward rounds, nurses, physiotherapists, pharmacists and phlebotomists who obviously get priority. Then of course there are fellow students who might reach the patient beforehand. So, an interesting patient who we can actually see is like gold dust!

After lunch – we squeeze in a few more hours seeing patients before visiting time when friends and relatives appear in the corridors, troop into the wards and fill patient bays, huddling around each bed.

The end result is that although we spend all day in a hospital jammed full of patients, there are only a few opportunities to actually see them!

As we students are the ones hanging around looking the least busy, we’re usually the ones who get asked the questions:

“Can I talk to you about my Mum/Dad/Husband/Wife……? How is he/she doing then Doc?”

“Erm… I’ll ask one of the doctors as they know more than me about your Mum/Dad/Husband/Wife

Cue, friend/relatives’ downward glance at my name badge. “Oh you’re only a student?”

Scrub Nurse Angel

Surgical_gloves_19Observed a prostate biopsy today. After the patient was wheeled in from anaesthesia, the consultant told his surgical registrars to do a digital rectal examination on the patient to feel the prostate’s size and its nodules.

An orderly queue formed at the foot of the table, index fingers held up as though testing wind direction. He then motioned to me that I should also become familiar with what a prostate with pathology felt like.

Accepting the fate of my finger, I donned the gloves and joined the line. I shuffled forward to take my turn and just as I reached the patient, someone shouted that the patient had not yet been ‘taped’. I stepped aside to avoid the scrub nurse as she sprang into action, taping certain appendages out of the way and then immediately afterwards the surgeon moved in to start the procedure. I was saved – thank you scrub nurse!

Clinical Week 1

Beilinson_Hospital_ward_1950I’ve survived the first clinical week. After two years incarceration in mostly lectures and the recent week of back to back induction talks, my patient hungry classmates and I were released into hospital wards.

However, the new found freedom we’ve been craving has sometimes left many of us feeling like spare parts, trailing behind junior (F1) doctors and not knowing enough to help properly yet. We’re dressed as doctors, reinforced by shiny new stethoscopes around our necks but with little experience of using them.

I’m not beating myself up as it’s only the first week and we’re still discovering hospital protocols but so far a good recipe has been to i) find a cooperative doctor ii) be nice to nurses and iii) find friendly looking patients who will consent to histories and examinations.

Me: “Hello Mr X, my name is MSL and I’m a medical student. Could I talk to you about why you’re in hospital?”
Patient: “Sure doctor”
Me: “I’m actually still a medical student”
Patient: “Oh, OK”
Me: “So Mr X, why are you here today”
Patient: “Well I’ve had this pain for 3 days now doctor”
Me: “I’m a medical student
Patient: “OK doctor”

My initial concern about being mistaken for a qualified doctor is semi valid for some patients but is wasted on staff who look me up and down and spot my “Medical Student” ID badge, Oxford Handbook of Clinical Medicine (aka cheese and onion) or notice me waiting around awkwardly. Actual doctors have a pager clipped to their belt/handbag and hurry around efficiently with patient lists in their hands. The pager is like a little time bomb except nobody knows when it is going to go off. Consultants walk around in expensive shoes and suits – no pager.

So far so good, not many pointy questions and no humiliation in front of patients yet but I did hear a rumour that a consultant made one of the doctors cry.

Clinicals Here I Come

In years 1 – 2 we achieved most of our learning through lectures with regular but occasional placements in hospitals plus sessions with GPs (family doctors). 3rd year means starting the clinical part of our medical education where we’ll be members of a “firm” in teaching hospitals and seeing patients full time. I love patient interaction so this is an exciting transition and is the stage of medical school that I’ve been really looking forward to. I still have to kind of pinch myself to prove that it’s happening!

Part of me is guarded about what being in a clinical firm will be like as an extra mature student. Traditionally, age correlates with seniority and students are the youngest in the firm but in my case, there’s a good chance I’ll be older than even the consultant. Until now it hasn’t been an issue and In a lecture hall I’m just another face (albeit a wrinkly one) in a large crowd. A clinical firm is a small team so I’ll stick out. How will I be perceived? Could I be mistaken for a qualified doctor or even as an old fraudster impersonating a medical student?

I’m also wondering whether I’ll be able to answer the questions that consultants and registrars will throw at me. Do they really humiliate their students and juniors? I’ve learned an amazing amount since starting medical school but I feel that I’ve forgotten a lot too. My classmates have voiced similar concerns and we’ve been told: “It’s in there somewhere and comes rushing back when you need it” – Well I hope so as I’m going to need it all very soon and I don’t feel anything rushing about up there.

Is He Dead?

1024px-Russell_Square_Tube_PlatformHe was completely motionless.  Balanced on the edge of the steel bench he was sitting on. Bent over, his head to one side and hanging down so far it was between his legs.

Busy commuters blurred past, ignoring him and choosing to keep their distance. I also walked by but in the few seconds before I turned back to look again, I thought: “What kind of doctor will I become if I walk past people who may need help?” My next thought was: “Never mind that, what kind of person would I be….?” I tried to see if there were any movements to suggest he was breathing but he looked so still – and peaceful. Like dead peaceful.

So I walked back. “Are you alright?”

No answer. Thoughts about CPR, whether they kept AEDs (defibrillators) on station platforms and the location of the platform emergency phone flashed in my mind. My train pulled in and others turned to look. (Why do others only stop when someone else is already there?)

A little louder: “Hey, are you alright?”

Again, no answer. There was a possibility that he really was dead.

This time I also gave him a gentle shove. The body slumped away with my push and just before it hit the bench, the head tilted up. One bloodshot bleary eye opened to look at me, slurred words, alcoholic breath: “What?! Yeah I’m OK”

2nd Year Exams

quiet-trying-to-get-into-3rd-yearIt’s been ages but for good reason – 2nd year was pretty tough and if I’m honest, much more stressful than the 1st year.

Added pressure came from our first ever OSCEs scheduled just before the written exams. Apparently, the key to success was to get into the lab and practice procedures and practice and practice some more. So we did. Again and again we took medical histories from each other using actual patient scenarios, timing ourselves and giving each other feedback. We watched each other repeatedly talk to and inject a rubber arm. We measured each others’ blood pressures countless times and sutured bits of foam together until we thought we could do it in our sleep. With all this practice, I was quietly confident about the OSCEs.

In the actual exam, we moved between “stations”  that consisted of a screened off cubicle inside of which was an examiner squeezed in with a “patient” and an empty chair for candidates. Knee touching cosiness. Sometimes, there was just an examiner with a mannequin or a rubber arm. Sometimes there was nobody, just a bone or a microscope or a set of photos to keep an answer sheet company. When a bell rang we moved to the next station.

Despite the practice, I still made many silly mistakes, such as: forgetting patients’ names straight after they’d told me – at which point they soon become sirs and madams. I also failed to anticipate a very large patient with very big (and hairy) arms with which I had to try to get a blood pressure, thinking the cuff was big enough but hearing the velcro undoing itself, ripping open with every squeeze of the sphyg. I’m sure the patient was chosen by the school due to their pulse – or lack of it.

Afterwards I replayed things I should/shouldn’t have said and done but it was too late. Written exams were just around the corner and needed attention.

So exams came and went. I told myself I didn’t care about the mark, I’d be grateful just to pass. Hope for the best and prepare for the worst. Failing one exam would mean summer revision preparing for a re-sit but would at least be recoverable. Resitting two exams was still manageable although stressful but three or more fails didn’t bear thinking about.

Even classmates who normally shrug exams off with confidence were worried that they might have failed at least one. Perhaps there was more to lose – at least that’s how I felt.

Friends and family all thought I was worrying too much. “Oh, you’ll be fine” they said “You always say you might have failed and yet you always do well” but they didn’t seem to understand -  these might really be the exams I fail and they thought it was a case of me crying wolf again.

When the results were released my eyes couldn’t scan the row on the page quickly enough. Ignoring the scores, I just concentrated on whether each column said pass or fail: “Pass” “Pass” “Pass” “Pass”…. each time I reached the next column the intensity grew – until I’d got to the end where the words read:

“Proceed to 3rd year”