Surgery

Today will be my first ever day in Surgery....... and I am very very very nervous.

• Will I manage to put gowns on ok?
• Will i be able to scrub / be sterile
• Will I touch the wrong things?
• Can I stand for 3 hours?
• What if I faint?
• Will I be able to see?
• Will the surgeon explain it all?

Oh well, only 8hrs til I find out!

Elective update

I have a meeting with my Elective supervisor on Friday at 9am to discus my project and confirm dates, objectives etc. This means i should make the faculty deadline of Monday - phew!

Domestic Bliss

On Monday night, just as I was getting everything ready for Uni on Tuesday, I remembered that I am in hospital on 4 days this week, and thus need a clean smart shirt on 4 days.
I knew I needed to Iron my two shirts, so got the ironing board out during scrubs, and plugged th iron in. It was dead - no light!!!!

I changed the fuse, I tried another socket, but no, it was dead.

So I put the shower on full hot, and hung both shirts in there for 20 minutes and let the steam do its work.

Then on Tuesday I bought myself a new Iron at Comet. You can spend up to £149 on an Iron, or as little as £7.99, but that one looked a bit plastic so I paid £19.99 for a Philips "steam, shot iron with vertical steam to refresh hanging garment" Iron. It has a 300ml tank, can be filled from the tap directly and generates 80grams/second steam. I have no idea if that is good, bu it ironed my shirts!

Since I was in work that night, I went to see Little Miss P who seemed less impressed with my new Iron that I might expect, but since she had been prodeed and poked and injected by the NHS that day, maybe she just didn't want to see another NHS person?

SSM Week 2 (1)

Tuesday
We spent the day with a Speech and Language Therapist, who was telling us about deaf children, and deafness in childhood.

Neonatal screening
One of the interesting bits was the new "Neonatal hearing test" which measures the brainstem response to sound. It does this using small electrodes stuck onto the baby, and by playing a sound into the ear. this basically tells you if the pathway from the ear to the brain is working. If the child does not pass the test, they do not 'FAIL' but the test is repeated, and if the same result appears, they are referred to the audiometrists who assess them further.

Multidisciplinary team
This seems to be an MDT that works, involving, SLT, audiometry, teachers, social workers, psychologists and Doctors. It is quite a community based specialty, and a lot of the consultations and work goes on in the child's home or school environment.

We also got to see some videos of deaf children and noticed that the ones who had had their hearing aids for the longest had the better spoken language skills. In the afternoon, we had a visit to a grou for parents and their deaf babies which was being addressed by a health visitor about baby behaviour and their developmental milestones. The babies were lots of fun, although one toddler did whack me in the face with a toy. I think it was an accident.

Wednesday
We were away at the Cochlear Implant centre getting an introduction to cochlear implants from a medical physicist, then watching the programming of a cochlear implant and finally the ENT Surgeon explained the surgery to us and explained what we would be seeing at the Implant operation on Thursday.

Random customers

At work, customers buy teh strangest selection of items - I haven't even thought what my own shopping would look like to others here - but you get strange combinations like:

• dog food, a pint of milk and 10 packs of condoms;
  
• dog food and bisto (worrying);
  
• and the ever amusing 4 bottles of vodka and a pack of anadin...

they're gonna need them!

SSM Week 1 (2)

Ear volume and pressure chart

Yesterday we visited the Hearing Aid clinic and sat in on a session with the Audiologist. Since he had two Audiometry students in, who have clinical exams coming up, he let them practice their examination techniques on us to give us an idea of the procedures and how they feel for a patient.

Audiogram of Right ear

Shown here are my charts for my right ear audiometry, both ear volumes and pressures (indicating that my hearing is normal and that I have un-perforated ear drums). They also took a mould from which a hearing aid ear mould could be made. This is done by injecting blue silicon into the ear canal them leaving it to harden. The picture does not do this wonderful toy any justice.

Mould of the inside of my right ear.

As we left, the Audiologist told me I looked too happy to have these exciting toys and souvenirs of my visit, but did tell me that the world needed people who got excited that easily. We are back next week, when we get to sit in on a session on programming a new type of hearing aid. I think I;m starting to like Medicine again.

Life of Brian

Sorry to return to a theme again, but my favourite political commentator, Brian Taylor of BBC Scotland has a fantastic piece on his blog about NHS Auditing (financial, not medical) - see Blether with Brian.

My favourite section has to be where he says

Howat agrees with Audit Scotland that “it remains difficult to assess whether the NHS in Scotland is delivering value for money”. Is it perhaps beyond difficult? Is it philosophically impossible?

Further, is it possible that improving the audit capacity may actually hinder or distort the small matter of catering for patients? Has this already happened through the obsession with targets? Did this oblige clinicians to pursue objectives which departed from medical decisions they would otherwise have taken?

Selling my body

I am selling my body, well technically I am renting it out, to the Medical School. Having last year volunteered to be a Guinea Pig in a research trial, my altruistic action this year is to be a model for the second year OSCE (in second year, all the patients are 'normal' and the OSCE assesses examination technique). I have been assigned to a DGH about 25 miles from home which means leaving the house at 6.55 to get there by 8.30am.

I get paid £30 for the day, thus valuing my time at a little over £3 an hour!!!!

Being male, I will be doing any of the examinations:-

• Cardiovascular
• Respiratory (front & back)
• Abdominal
• GALS / Musculoskeletal
• Blood Pressure

Extra work

I have done 2 extra shifts at work so far this week, and have another two to go. They are easy shifts on checkouts - very little cleaning, not much stress and work at your own pace - bliss. Well certainly a nice change from the dirty hot frenetic, understaffed life that is my own department at the moment.

The main reason i am doing the extra is MONEY! With an elective coming up, and no additional student support to cover it, things could get a little tight in July & August, so I am trying to plan ahead.

On Tuesday night, while working a normal shift, one of the guys smashed a fire alarm point with a cage of frozen food. How, we don't know. What we do know is that the alarm sounded for about 20 minutes on and off until we found a way to silence it overnight until the engineer came out about 10am today. It did mean I was on a checkout with the 'fault' buzzer down my ear - nice, not!!

Still, only another 13 hours work to go this week. Little Miss P has persuaded me into doing an extra cashier shift next week, on her backshift night. She's a menace that girl.

Glasses

My glasses snapped on wednesday night. Not just a loose lens either, but the bridge snapped so they are un-wearable. Handily, the new frames i ordered came in today (Thursday) and will be glazed by Friday. Given that i got them and my contact lenses today, i have to decide whether to have the old glasses (frameless) repaired at a cost of £80...

Decisions, decisions..

Resuscitation

Oh well, I failed this station in the OSCE ( a stand alone station0 and thus have a retraining and re-assessment day in mid June.

SSM Week 1

The SSM on Hearing disability & its Management is interesting - like most SSMs it is quite light - about 10 clinical sessions, an essay, and presentation over 5 weeks. As one Doctor put it "SSM's are how the medical school fits 30 weeks of funding into a 5 week year". Basically, a lot of teh work is self directed. There are only3 of us on the SSM, so i think we may hav to meet up through the block even when not timetabled, in order to keep a sense of Uni about the process.

This week I made use of teh opportunity to catch on some jobs - Contents insurance quote anyone....shopping...extra shifts on checkouts at work, hair cut, opticians etc.

The chaos continues

With work, Uni (SSM) and other stuff this week, I may not be back blogging until this weekend, but I hope to be back sooner.

Something for the weekend?

It appear I am either a success or a failure....either way, I am not borderline in my OSCE. Obviously I hope it is a pass - even a C would be nice.

You might think that since my SSm starts on Mionday I might have a relaxing weekend to eat and sleep, but no.........................................I have a manic weekend with lots of to-ing and fro-ing.

So I might not be back til Monday

O S C E (to the tune of YMCA)

Exams are over!

Well for the moment, I might have a recall exam for my OSCE, if I was in the gap between PASS and (PASS + 5%). Hopefully I am not. I would like to think that the OSCE went well

1. Ethics station - a man with a sickline which says Alcohol (10 min)
2. Blood Pressure measurement
3. History of a jaundiced patient
4. History of a suicidal patient
   
5. Peripheral vascular examination of lower limbs
6. Respiratory examination of the back
7. GI examination of a jaundiced patient with hepatomegaly
8. History of a rheumatoid patient
9. Difficult circumstances with pregnant woman drinking alcohol
10. Comms Skills station - woman with a cough - followed by information giving for bronchoscopy. (10 min)
    
11. Neurological examination of upper limb
12. History of a woman presenting with headache
13. Resus with a Defibrillator
14. History of a woman with weight loss.
15. Breast examination of a manekin.
    

And another 1 I have forgotten since this afternoon, and 2 5-minute rest stations.

Scrubs

Tonight E4 was showing the end of Series 3 of Scrubs (for those of you not paying attention, this is the episode where Turk and Carla are supposed to be getting married). JD has persuaded Elliot to leave Sean and go out with him, and then told her that he didn't love her.

Elliot was doing the whole jilted-girl-at-a-wedding thing or appeared to catch JD's attention then storm off, anyway, it all went from looking all positive and hopeful of maybe two romances, to 2 singletons and a marriage in a side-ward the day after the wedding. reception.

That hopefully means that E4 will be showing the first 2 episodes of series 4 tomorrow night. This should be good. I was very pleased with tonights timings - 2340-0040. Towards the end of last month, the scrubs double bill was slipping towards not starting til 0030, which is a touch late to watch if you are in Uni at 9 next day. Anyway it helped postpone the exam stress a little.

One down

First exam was today - this one had:

• 60 EMQs - like a long MCQ - 5 clinical scenarios on one topic and then 15 possible answers at the bottom - match them up. Seemed to go ok, but there were some nasty results interpretation questions.
• 3 Short notes questions - Rheumatoid/Osteoarthritis comparison; Alcohol misuse - communication issues, treatment and chronic effects; Breast Cancer screening & pathology
  
• 2 Modified Essay Questions - the ones which are a bit like a PBL Scenario - Coeliac disease and osteomalacia; Asthma and COPD.

So it looks like tomorrow will focus on Cariology, Renal, Neurology, Psychiatry...or maybe not.

Write Short Notes

Write Short Notes on "Why I know so little about Medicine 8 hours before my exam starts". (20 marks)

If I was going to revise for the exam, I wouldn't start here

Hmm with less than 48hrs to Exam 1, I started makinga list of teh areas I was worried about

• Bones (Always hated bones)
• Haematology
• ECG
  
• Cariology
• Renal
• GI / Liver
• Respiratory
• Psychiatry
• Neurology
• Ethics
• Antibiotics
• Infectious diseases
• Ethics

So basically the whole curriculum.

Argh!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

If the wiggly line is flat, it's bad.........

9 stickies = 12 leads......
Number one difficulty is learning where all 9 leads go - for a 12 lead ECG. 3 are easy - the limbs (well, except for th Right Leg) - no-one mentioned how you do an ECG on an amputee though...... The other 6 go on the chest - in an inverted tick formation from just in from the right armpit to just in from the left armpit. Arghhhh!!!

Why are they so difficult to understand?

I think it is because we get taught it as one nice line which has all the waves at the correct timings, amplitudes and orientations. Then in the assessments they give us all 12 leads, with a pathology and my mind goes to grey jelly. It all makes sense when I read it in the textbooks, but come the real deal and it's back to grey goo.

Oh well I have some nice sBMJ printouts and some lecture notes, and an online game - I might understand this soon, then we move onto Bones........

Medical Colouring books

Why is the body not colour coded?
When I use my Anatomy/Physiology colouring book, it makes life so much simpler - everything is a nice vibrant colour, and no two adjacent structures are the same colour - muscles of inspiration are a different colour to expiration etc. However, come to histology, dissection or the exam and everything is the same colour:

• pinky white in dissesction,
  
• pinky purple in histology,
• grey in the exam as yet again we have a black and white photocopy to label.

Where do they think I get my coloured pencils?
My colouring book expects no less than 26 different colours - some I achieve using shading techniques - the only thing I learned in 3 years of high school art and 8 years of primary school art lessons. When do I find even 15 different colours?

PS. The answer to where do I get my colouring pencils was ASDA - 10 Jumbo pencils for 29p.

Getting Old

Just remembered to given my Grandad a call as today is his birthday - his 94th (I for some reason thought it was his 95th but was corrected by my Mum). He is off to the casino for dinner with friends tonight, having been out for a meal with my uncle yesterday.

He was saying that he plans to mow the lawn and plant some fruit / veggies later in the week, and is thinking of getting someone to come and repaint bits of the house as he's not sure he is up to it. The lawn is 10m by 10m in his 100ft long garden, while managing with poor eyesight and type 2 diabetes. Not only does he seem to have more energy than me, he also has a better social life!

Sometimes I think old people fall into two groups - the ones we see in hospitals / at GPs who are old, sick and chronically ill, and the rest who get on with life but are rarely seen by doctors. This I think sometimes gives Medical Students a bizarre idea of the illness burden in the elderly population.

Being Cox.

At work tonight I felt like Dr Cox. I was on with two 17yo newbies. They were being semi efficient, but both seemed not to have the sense of urgency, of pride in cleaning etc that the old timers (or Safeway old school as we call ourselves) have. They seem to not be able to cope with more than one task at a time, or clean up after themselves, or clean everything. Alongside this I had to watch them make mistakes so i could point out why the way WE do things is better than the way there were doing them. I suddenly felt very old, especially as after 2 weeks, one of them seems to be making no progress and his cleaning was at best adequate. The other was doing better.

I felt like Cox in the sense of being the old cynical one, not in terms of my ex-wife being in work with me, and sadly we have no Kelso character.

Allergy rhinitis and house dust mite

I have a hayfever type thing - its since I moved all my furniture round at the weekend so it's probably an allergy to house dust mite in the dust I disturbed. So I have runny eyes, a runny nose, sore throat and gallons of mucus - all in all a pretty sight. I also have aching limbs. My GP tutor gave me a pack of free antihistamines the other week but they cause drowsiness, which since I can't waken up in the mornings at the moment may not be a good idea.

In the middle of this I am trying to revise, but the medical school library area is jammed with Years 1 & 2 and I can't be bothered to beat them with sticks to get a seat, and I don't actually need many books for revision, so I tried revising at home - the builders opposite, bagpipers, drummers, buses and drunk people screaming in the street seem adverse to that idea.

Also the presence of tea, coffee and the internet are a bad combination, such that I have taken to hiding my keyboard places between revision breaks so I am not tempted to play online.

Oh well, only a week to go!

Films

Last night, I was walking home about 9pm and noticed an ivy covered building with dark windows, covered in large cobwebs, misty clouds around it and a cold breeze. There was bright light shining through it as mist billowed around, and the rain started, only in one place though.

Nothing odd you might think, but the building in normally an Art Gallery.... All was made clear round the corner - half the city centre was blocked off to0 allow the filming of a new Hollywood blockbuster with Bob Hoskins and some others who I'd not heard of. They have been filming all over the city for the past week or so. The picture above may look like 'normal' life up here, but it's not - the streets are far to clean for starters.

The film is called Doomsday and is a horror film about a team of people sent to check on Scotland 30 years after a killer virus wiped out most of the population, and a huge wall was built to contain the infected area. They filmed in Greece, South Africa, oh and Scotland!

MTAS cloned? (aka Election Guddle)

Well I have finally caught up on my sleep having stayed up all Thursday night to watch the shambolic event that was the Scottish election count. The main points were.

1. This was a new untested system (untested on this scale).
2. The Government did not listen to experts in the field who told them not to run two elections using different systems on the same day
3. Computer / IT problems - the computers would count but not output the final vote
4. Government blamed the voters - some sheets were rejected (10% of total) as incorrectly filled in
5. Late running - the postal votes were not sent out until the Monday before polling day, when many people who wanted them were on holiday.
6. Making it up as we go along - if the X was not clear in a box, the returning officers could look at the appear to see if it was poor handwriting etc. Due to the huge number of such papers, some were being trained how to do this on the night - Training in a Live environment with little supervision.

Anyone spot any similarity to MTAS????

Unlike MTAS, the returning officers just ignored the rejected vote since the 100,000 discounted voters won't know that they have been disenfranchised.


See also the fantastic election blog by Brian Taylor, BBC Political guy with fancy braces and ties. I would like to just quote one post from Brian's blog.

Ah bourach

• Brian Taylor 4 May 07, 12:51 PM

Let's cut to the chase here re: this voting guddle. There was a big problem getting out the correct number of postal ballots. There was a huge challenge for voters in filling in the ballot forms. There was then a problem with e-counting.

That means the authorities are saying:

1. we couldn't get all the ballot papers out
2. they were so complex, folk couldn't fill them in
3. when they finally filled them in, we couldn't count the blasted things!

There's a splendid Gaelic word, bourach. It means an utter, hideous mess. This is bourach, Mach Five.

Differences to MTAS
Everyone under the sun has promised investigations - judicial; public; independent; by the suppliers; by the civil service; by the press.

And the result.......

Well the SNP got the most seats, but until a coalition government is formed, we don;t yet know who is in charge, what comprises must be made, or what the Health policies will be.

Sorry!!

Apologies for my lack of posting last weekend and earlier this week, we had coursework due on Wednesday, and my USB key corrupted my essay on Monday night!

Comms Skills / OSCE

Today was our final year 3 Comms skills training - on ethics. With OSCE's 13 days away, we were all nervous, but everyone seemed to do quite well, even the one person who through nerves seems to do the opposite to what seems sensible. We discussed each scenario beforehand so we have notes in case we get that scenario in the OSCE.

My case was a woman whose mum was in a nursing home, aged 86, and had had a recent attack of pneumonia, and she wanted her mum to be allowed to die next time she was ill. The matron had refused to allow this. The mother was confused since her hospitalisation for pneumonia, and I as GP* had to explain about 'powers of attorney', 'legal duties to preserve life' and was supposed to check what other family there was (I forgot this one). I am convinced that in the OSCE I will probably wash my hands before and after the communication skills sessions as well as the examinations.

*(why do they spend years telling us we are not Doctors, only for them to make us pretend to be Junior GP's in OSCE's???????)

The rest of my group had interesting scenarios as well - a drunk wanting his medical records kept confidential from his boss; a mistake by a hospital outpatient clinic resulting in a woman having a 10 month delay before being told her cancer was inoperable; a worried parent whose child had an allergic reaction to a first dose of amoxycillin, wanting to complain; and a man who felt he was badly treated by a fellow GP.

Of these, the misdiagnosis was the one I thought was most difficult, but it was handled really well by one fo the blonde female mature students, who really does have a gift for communication skills - she's really good at it. In fact I think we mature students sometimes are better at Comms skills because we bring different and more life experiences. However the younger students generally get the facts correct!!!

Election Day

Well I voted.

Not going to say who for, but suffice to say it was a different party in each of the 3 ballots, and in one case I did base it on their NHS policies. I doubt my constituency one will win, but the regional stands a good chance and no idea about the council.
I did wonder why it needed 8 council staff to staff one polling station. 7 people (plus 2 police)
x 15 hours is a lot of money......still they have a computer or scanner to count the votes this time, so the results will be later than before (go figure). Ah well I have this afternoon off timetable, so back to my flat looking out the window at the half-dressed peely-wally ones getting their UV rays. I am actually very very very very very jealous - normally its raining!

Elective update (2)

At last, after firing off lots of emails, I have an offer of an elective, working with an anaesthesia team - it is nearby, and I have met the supervisor when he was a PBL facilitator, The one fly in the drink is that he is on holiday the first 3 weeks of the elective block, so my summer holiday will be split into 3 weeks between SSM and elective, and 2 weeks after, This also means that the Year 3 exam resits are in the last week of my elective!

Political balance.,....

And lest anyone thinks that my post the other day was designed to stop you voting SNP, look at this video. Its by the SNP but it neatly sums up why I would love to see either a rainbow coalition of smaller parties or, at least a definite change in the direction that the Scottish Executive pursues on health, social justice and community cohesion.



As one of the party politicians has said on TV this week, I have two slogans for the public:

"No Vote, no Voice"
"Vote. Vote for me, vote against me, just vote"

and in this, the 200th anniversary of the end of slavery, and the first steps to all people in the UK being treated equally, and allowed to vote, I'd like to add my voice - think about it, and whether your election is for a parish councilor, an elected mayor, an MSP or a Welsh Assembly Member, go and vote.

For Scotland or Wales, check out the party's health policies - what kind of NHS do you want, centralised, de-centralised, clinician led, management led, community hospitals, or specialist centres?

So come Friday, will I live in a Nationalist utopia, half way to Independence? I doubt it.