Last Saturday was a very tiring day. I worked from 0700-2230. Did home care. It was my first time actually, but did not feel too nervous because I've had a bit of experience in care already. Must admit that although I don't mind doing it again, I don't particularly enjoy it. I like nursing heavily confused people in hospital because they are hilarious!
Finished my attachment with the renal firm and started the surgical firm. Again, must admit that although I've had a great time there, I don't particularly miss it as eight weeks of clerking patients presenting with rather similar symptoms can be a little boring, although having said that I haven't learn everything that I think I should know about renal.
I've been a little naughty today going back to renal outpatient to practise taking blood. (No where else to go - got kicked out from the undergraduate building because of the fourth year exams, not even allowed to get my book from the locker) I'm improving - took blood from 3 patients and all was successful! (Current venupuncture stat: 6 successes 3 failures; Current cannulation stat: 1 success). And now that I'm in the renal firm I'm aiming to be doing at least 1 cannulation, 1 catheterisation and 1 assisting in theatre - don't know how, I need to find out soon.
The surgical firm is definitely a refreshing change. The firm seems better organised in terms of teaching and the wards are more spacious and felt more relaxed. I've not figured out how the medical staff organise themselves in managing the patients hence felt a little lost for the past two days (but this is acceptable since today was only my second day).
I thought I wouldn't enjoy surgery but surprisingly I found it ok. Went to observe a paraumbilical hernia repair this morning. Quite straight forward I suppose but I think I learn better from simple things like this for a start. There was a nice friendly registrar who talked me through what they were doing, taught me a bit on hernia and examined a lady's hernia with me. The consultant was nice as well, although she was in such a moany mood that she kept on talking about how the clinical staff are being undervalued by unintelligent NHS managers. I had to stay until about five yesterday to clerk one of the patient for the operation but it was all worth it. I listened to the anaesthetist taking history and discussing the anaesthesia, pain relief with the patient, then listened to the registrar consenting the patient. Those were well useful because I swear I was probably more clueless about the operation than the patient. Also the anaesthetist was really nice so I've learnt a little bit. It was my first time watching induction for general anaesthetic. Intubation looked scary. And I was quite shocked to see that the patient actually stopped breathing when the muscle relaxant was injected... after which only I remember that I've actually know this for ages from books already. It's just hard to believe. I mean in BLS, when a person is not breathing, you are suppose to give chest compression straight away, implying how close 'not breathing' is to 'death'. Was this what happened to me as well 5 years ago when I had to be given general anaesthetic to remove a lump on my tongue? But don't be put off by my silly thoughts. Obviously not breathing for a few seconds isn't harmful. I just need sometime to get used to this idea.
You guys at home, if you've received my post can you send me a text message just so that I know please? Thanks. I miss all of you and I love you!
Tuesday, November 27
Sunday, November 18
What have I learnt?
I am on a 4-weeks integrated block, meaning that we spend Monday and Friday in the hospital (renal firm) and Tuesday to Thursday in the community (in a GP surgery or the community). I've found out that: Doctors walk fast, read fast and work long hours; and that men cannot multitask.
I've been really lucky to be allocated to this GP. Not only do we get free sandwiches every Thursday, he gets us as involve as possible in whatever he does. Home visits are really interesting. And the relationship between him and his patients is just amazing, he's such an excellent doctor, all his patients say that.
Dealt with death (or rather dying). Our GP when to a nursing home, said that an end-stage dementia patient might have just had a stroke - no point sending her to hospital as she will only die of horrible bed sores, and started her on the care for the dying pathway. A nurse who had cared for her and seen her suffered cried. He also then showed us the all the death certificates he signed for the past 10 years or so. We went to a one day placement on a hospice, observe a doctor managing symptom relief. Talking to patients there were alright actually, doesn't seem as if they were going to die very soon. I just felt that the atmosphere is deliberately made so beautiful and serene that it constantly reminds everyone present of what the patients are there for. On the ward some patients were not getting better despite dialysis and the doctors has decided to just stop treatment. Very harsh when I first thought about it. I mean, a patient has known renal failure, and you are just going to let his creatinine climb, and literally watch him get uraemic and die? But on second thought I figured if I were in that state, I wouldn't want to die while people are inserting and removing lines into and from my body all the time and forcing medications down my throats that is going to make me feel sick and unwell.
On the other hand, I've also learnt about intervention that offers hope. I sat in a renal post-transplant annual review clinic and saw same liver post-transplant patients in a liver clinic. Transplant is not as bad as I thought. I previously thought quality of life post-transplant would not be good because of various medication to take, but patients normally only take 2/3 immunosuppressants - that can't be too bad. And patients are no longer hooked on to dialysis, restricted diet and various existing medications. Things are even better for the liver patients since transplanted liver could potentially last for a life time. The transplant nurse told me that once the blood vessel of the donated kidney is joined to the patient, you can very obviously see the colour of life coming back on the patient's face. Such an amazing description, isn't it? It's not likely that I'll be seeing a transplant surgery but I think I'm going to ask tomorrow.
I've been really lucky to be allocated to this GP. Not only do we get free sandwiches every Thursday, he gets us as involve as possible in whatever he does. Home visits are really interesting. And the relationship between him and his patients is just amazing, he's such an excellent doctor, all his patients say that.
Dealt with death (or rather dying). Our GP when to a nursing home, said that an end-stage dementia patient might have just had a stroke - no point sending her to hospital as she will only die of horrible bed sores, and started her on the care for the dying pathway. A nurse who had cared for her and seen her suffered cried. He also then showed us the all the death certificates he signed for the past 10 years or so. We went to a one day placement on a hospice, observe a doctor managing symptom relief. Talking to patients there were alright actually, doesn't seem as if they were going to die very soon. I just felt that the atmosphere is deliberately made so beautiful and serene that it constantly reminds everyone present of what the patients are there for. On the ward some patients were not getting better despite dialysis and the doctors has decided to just stop treatment. Very harsh when I first thought about it. I mean, a patient has known renal failure, and you are just going to let his creatinine climb, and literally watch him get uraemic and die? But on second thought I figured if I were in that state, I wouldn't want to die while people are inserting and removing lines into and from my body all the time and forcing medications down my throats that is going to make me feel sick and unwell.
On the other hand, I've also learnt about intervention that offers hope. I sat in a renal post-transplant annual review clinic and saw same liver post-transplant patients in a liver clinic. Transplant is not as bad as I thought. I previously thought quality of life post-transplant would not be good because of various medication to take, but patients normally only take 2/3 immunosuppressants - that can't be too bad. And patients are no longer hooked on to dialysis, restricted diet and various existing medications. Things are even better for the liver patients since transplanted liver could potentially last for a life time. The transplant nurse told me that once the blood vessel of the donated kidney is joined to the patient, you can very obviously see the colour of life coming back on the patient's face. Such an amazing description, isn't it? It's not likely that I'll be seeing a transplant surgery but I think I'm going to ask tomorrow.
Friday, November 9
Balance
I feel that I need to get my balance back again. I felt that I haven't learnt much this week. But there's really nothing much to be learnt this week. Patients just happens to have boring, unchanging old problems. Staff in my ward were bit stress due to a C. diff outbreak in the ward. Hence I have made the decision regarding learning - I would keep enthusiasted but I won't hang around earlier than 0900 or later than 1700.
Short term solution to treat my burnt out feeling - Weekend plan: Ride bicycle, Play piano, Shop for winter clothes, Jogging at Platt Field and Watch movie.
I have lost 8-9kg since I came back from summer holiday. All my pants and skirts are annoyingly loose now. (Annoying because my fob watch and name badge shake vigorously when I walk around the hospital).
I miss mummy, papa and all my sisters.
Wednesday, November 7
Bitching
This post is a waste of time. Unless you have too much time to kill, don't bother reading.
Basically I just want to rant about my PBL group. They are alright generally. Just one or two people whom I wonder from time to time why the hell are they doing medicine. One of them is my clinical partner. She is lovely but she is simply not keen to learn medicine. She doesn't bother remembering patients' names and clerk patients only because Dr New said 'we must have 8 clerkings by the end of the firm' - and as soon as Dr new said it's ok to only have 2 or 3 clerkings, she went straight back home for a lay in. She doesn't want to learn anything else other than what we are suppose to know at this point. And she's often with the attitude - we've got to let our tutor see that we are doing work so we don't get marked down, then we'll be ok. Our group sort of got told off yesterday that our PBL discussion isn't up to scratch, and today in the GP surgery, she was actually reading her PBL notes rather than learning from the consultations, seeing interesting signs and symptoms from the patients and paying attention to the doctor's excellent communication skills. I mean, if you are still not mature enough to get out of this schoolchildren attitude towards learning (put on the hardworking act when the teacher sees you, and when the teacher leaves just throw away the mask), then I'm afraid medicine, especially in such self directed learning environment, isn't for you.
I always get very excited after clerking a patient, especially whose diagnosis is yet unknown, reading a lot and trying to work out if I could out what the problem is. My clinical partner and many of my groupmates just never showed any interest to discuss these queries. My clinical partner would rather discuss her cat, her boyfriend, her going home every weekend or her car insurance with our GP than asking him any medical questions. Maybe it's just me the boring medical student with nothing else to talk about other than medical topics. And none of my groupmates wants to hang around the ward to learn stuff no matter how many times I've asked them to join me. Maybe I am just too keen, bit overenthusiastic for them to cope with. I have to say, nevertheless, that having a group with this low level of motivation does hold me back a bit. I actually feel more accepted by the doctors in the ward than my group. I'm constantly reconsidering should I actually be less enthusiast.
I don't generally bitch about people. Since a few years ago when I discovered my tendency to prejudice, I take extra effort all the time to make sure I keep an open mind about people. But this is just too frustrating.
Basically I just want to rant about my PBL group. They are alright generally. Just one or two people whom I wonder from time to time why the hell are they doing medicine. One of them is my clinical partner. She is lovely but she is simply not keen to learn medicine. She doesn't bother remembering patients' names and clerk patients only because Dr New said 'we must have 8 clerkings by the end of the firm' - and as soon as Dr new said it's ok to only have 2 or 3 clerkings, she went straight back home for a lay in. She doesn't want to learn anything else other than what we are suppose to know at this point. And she's often with the attitude - we've got to let our tutor see that we are doing work so we don't get marked down, then we'll be ok. Our group sort of got told off yesterday that our PBL discussion isn't up to scratch, and today in the GP surgery, she was actually reading her PBL notes rather than learning from the consultations, seeing interesting signs and symptoms from the patients and paying attention to the doctor's excellent communication skills. I mean, if you are still not mature enough to get out of this schoolchildren attitude towards learning (put on the hardworking act when the teacher sees you, and when the teacher leaves just throw away the mask), then I'm afraid medicine, especially in such self directed learning environment, isn't for you.
I always get very excited after clerking a patient, especially whose diagnosis is yet unknown, reading a lot and trying to work out if I could out what the problem is. My clinical partner and many of my groupmates just never showed any interest to discuss these queries. My clinical partner would rather discuss her cat, her boyfriend, her going home every weekend or her car insurance with our GP than asking him any medical questions. Maybe it's just me the boring medical student with nothing else to talk about other than medical topics. And none of my groupmates wants to hang around the ward to learn stuff no matter how many times I've asked them to join me. Maybe I am just too keen, bit overenthusiastic for them to cope with. I have to say, nevertheless, that having a group with this low level of motivation does hold me back a bit. I actually feel more accepted by the doctors in the ward than my group. I'm constantly reconsidering should I actually be less enthusiast.
I don't generally bitch about people. Since a few years ago when I discovered my tendency to prejudice, I take extra effort all the time to make sure I keep an open mind about people. But this is just too frustrating.
Monday, November 5
Disorientation
I'm always disorientated in the ward, but today was particularly bad. After PBL at 4:30pm, I thought I would go on to the ward and practise examining some patients. I examine my first patient's abdomen. After the examination, I thank him and said 'have a nice weekend'.
Then went on to the next patient. This is a chap whom I already know (I've taken a history from him last Friday). He said 'what are you doing here on a sunday?', and I naturally went 'it's not sunday today, it's friday'... 'patient looking confused' ... I added 'no, I'm not trying to wind you up, it's definitely friday today'. So we went to arguing for a while, I even asked somebody else to come and clarify to the patient that today is indeed Friday!
Then, I made my way to the bus to go home. On the bus, I thought about the Crossing Borders meeting which I would be going to, which reminded me that today is a monday, not a friday! Aaaaaaaghhhhhhh!!! So I'm as confused as some of the patients in the ward..
Apart from the disorientation I had a great day. The first patient I examined has spider naevi and probable hepatomegaly, and the second chap has a clear basal crepitation. Ward round was enjoyable. I always feel like part of the team in Janet's ward round. I'm really grateful to be included in the team. I think when I become a consultant I want to be like her. And it's very nice to finally have a role model to look up to after 6 weeks in hospital.
Then went on to the next patient. This is a chap whom I already know (I've taken a history from him last Friday). He said 'what are you doing here on a sunday?', and I naturally went 'it's not sunday today, it's friday'... 'patient looking confused' ... I added 'no, I'm not trying to wind you up, it's definitely friday today'. So we went to arguing for a while, I even asked somebody else to come and clarify to the patient that today is indeed Friday!
Then, I made my way to the bus to go home. On the bus, I thought about the Crossing Borders meeting which I would be going to, which reminded me that today is a monday, not a friday! Aaaaaaaghhhhhhh!!! So I'm as confused as some of the patients in the ward..
Apart from the disorientation I had a great day. The first patient I examined has spider naevi and probable hepatomegaly, and the second chap has a clear basal crepitation. Ward round was enjoyable. I always feel like part of the team in Janet's ward round. I'm really grateful to be included in the team. I think when I become a consultant I want to be like her. And it's very nice to finally have a role model to look up to after 6 weeks in hospital.
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