Weirdest moment: The patient who lied. This patient in his 30s came in with acute cerebellar ataxia. He told us that he'd had brain surgery as a child, but didn't remember what for. CT and MRI showed the craniotomy scar and some calcification where the surgery was done, and also showed severe cerebellar atrophy. The registrar examined the patient and asked him to get out of bed so we could check his gait. As he did this, a red and white capsule rolled out of his bed. He told us it was a vitamin pill that his friend gave him. It sounded very odd, but wasn't pursued at that time. About half an hour later, the patient asked to see the doctor again because he'd lied about the tablet and felt guilty. He told us that it was Dilantin (phenytoin), an anticonvulsant, and that he doesn't take it very often. However his phenytoin level was VERY high, and the docs concluded that it was causing his cerebellar signs. He improved off the Dilantin, but will have permanent damage to his cerebellum. (He also lied about the brain surgery - it was done about 10 years ago to remove a cavernoma, and he was taking the Dilantin to prevent seizures caused by the scarring.) I still don't understand why he lied - I guess he was scared. Read this interesting post by Edwin Leap about patients who lie and deceive.
Worst moment: The patient who died. This university professor was in his 70s, but still lecturing occasionally. Then one day he suddenly lost his speech and collapsed. He had all manner of neurological investigations, but imaging and other investigations were inconclusive. It didn't look like a stroke, or epilepsy, or a hypo, or syncope. However a suspicious lesion on the chest X-ray was explored further (with a CT), showing advanced small-cell lung cancer. There were no metastases, but it was decided that his neurological signs were explained by a paraneoplastic syndrome. The prognosis was poor. He was on the ward for the first 3 weeks I was there. In week 1 he was able to talk and follow commands. In week 2 he deteriorated, and by week 3 he was moribund. He passed away in the middle of week 3. It was very sad.
My next placement was supposed to be at a rural location, but it was cancelled. It's kind of a long story, so I'll save it for another post. I'm doing Immunology and Infectious Diseases instead, which so far is very interesting.
Oh, and my long case exam (described at the end of this post) went well, I think. We get the results next week. My patient had lot of things wrong with him, and I spent too long taking his history, but my presentation was good and I think I answered (most) questions intelligently. My two examiners were very nice - not at all scary.
Now I'm having a week off from study and focusing on:
My sister's wedding this Friday - will be fantastic, as long as family dramas are avoided (is it possible for me to get a divorce from my father?)
My netball grand final on Saturday - I hope my hangover is not too bad (luckily the game's in the afternoon)!
I've liked The Polyphonic Spree* for ages - beautiful, fun, uplifting music, full of energy. But for some reason I've never gotten around to buying any of their albums.
Anyway, I really should get to the point of this post. Yesterday, while listening to their music and procrastinating online, I thought it'd be good to find out when they're touring Australia. Based on their clips, this is a band that can be best appreciated live. So I explored their website, and to my dismay I found that they're currently in Australia, and they played the Metro in Sydney on the Tuesday night just gone! Aaaaaagh!! I'm SPEWING.
Can't believe how bad my timing is. I'm usually very much in the know about which bands are touring, etc. I get various email updates from places like The Vanguard. Now I'll have to get on the mailing lists for the Metro and the Enmore Theatre to ensure I don't miss any other brilliant bands.
In the meantime, I'll keep listening to The Polyphonic Spree, whose songs have the power to turn my frown upside down! (Heh.)
*The Polyphonic Spree is a 23-member "choral symphonic rock" group. They started out wearing white robes, then coloured robes, and have recently changed their look to black army outfits.
Earlier this week I had to chance to scrub in and assist* on brain surgery. Very, very cool.
This article describes the way it's done at the hospital where I'm based. I assisted the neurosurgeon featured in the article - he's a great teacher and very nice.
This MRI-guided surgery is interesting, but it takes a long time. It took over an hour for the patient to be prepped and anaesthetised. Then the initial scans and planning took over an hour. After all that waiting, it was a relief to finally scrub and get started. I ended up leaving after 5.5 hours, when the operation halted for more scanning. The scan showed a lot of tumour still to be removed, so the operation would have continued for several more hours.
More on neuro at the end of the rotation. I need to get back to preparing for the long case, which is in 2 weeks. Eeek!
* There's not much a medical student can offer when it comes to assisting on brain surgery! I was in charge of irrigation during drilling, and suction. I was pleased to discover that watching the surgeon drill through the surprisingly thick skull didn't bother me at all.
I typed "heart" into the Search field in my iTunes and lo! What a collection of wonderful/scary/strange songs appeared. It was hard to select just one to use for the title of this post, but in the end, how could I go past Jason Donovan?
(Why do I have a Jason Donovan song in my collection? It's part of a compilation of other [better] music, though I must confess I do love this song...)
Well that was a lightbeat start to a post that's anything but lightbeat.
Last week I finished my 6th rotation for the year - Cardiology. As you can see in my last post, I was excited about this rotation and generally a happy little camper about everything. One month later - not so much.
Cardiology is a very busy department - at my hospital, there are 3 teams of registrar/resident combinations, with 5 or 6 consultants attached to each team. The team I was on had anything from 15-25 patients to see each day, which meant that ward rounds took a very long time. On my first day, the registrar basically told me not to expect much teaching from him, because he simply has no time.
That was OK - I expected it. It was clear that this rotation would require me to be proactive if I wanted to get anything out of it. So it's a shame that this rotation coincided with my development of Killer Fatigue (a phenomenon often seen on The Amazing Race).
It's been a long year, with only 1 week off during 8 months. And I reached a point in the second week of my Cardiology rotation where I just couldn't get out of bed. I ended up taking 2 days off in week 2, and I slept, got some uni work done, and tried to summon up some motivation.
In week 3, I had to deliver 3 separate presentations at uni. They all went very well, but I was absent from the ward a lot, finishing them off.
All of this added up to not much time for me in the Cardiology department. I tended to be there for ward rounds in the morning, have lunch, then either do a long case or go home (the latter more than the former).
Of course it didn't really matter in the end - the registrar signed my form at the end of the rotation and wrote in the comments, "Good attendance". What a joke.
So I didn't really love this rotation, but it's not Cardiology's fault - I blame the Faculty for their poor planning. For the third years next year it looks like there's a week of holidays after the first 16 weeks, and then a week off after each subsequent 8-week block, which is much more sensible (but still not ideal).
Anyhoo, let's do this again, just for consistency...
Best moment: A patient had a planned cardioversion for atrial fibrillation. This means I saw the patient receive an electric shock to her heart. It was the first time I've seen this in real life. Being a planned procedure, the patient was anaesthetised, and shouldn't have felt much/any pain. It was interesting to see how the patient's body responded to receiving the shock - she jumped, and raised her arm so that it looked like she was warding off an attacker.
Weirdest moment: I did a long case on a male patient, and he gave me a "true blue" recipe for scones! Apparently the secret is flat lemonade...
Worst moment: A male patient had just been flown in from the country after having a heart attack. It was late afternoon, so he was being rushed into the cath lab for angiography +/- stent. It was busy - doctors and nurses everywhere, people talking over people - chaos. While this was happening, the registrar from the cath lab had a brief chat to the patient to explain the procedure and get consent. One of the questions the registrar asked was "Do you smoke?" - a standard (and very important) question, which the patient answered in the affirmative. So the registrar thought this was the perfect time to lecture the patient (very loudly, having to yell over the noise everyone else was making) about the fact that if he wasn't a smoker, he wouldn't have had a heart attack and wouldn't be in the hospital today. Ooooh it made my blood boil! Did she seriously think that was going to have an impact at that moment? It just made her sound like a pompous holier-than-thou asshole. (I felt sorry for this patient during the procedure too - his IV tube got caught on the X-ray machine and ripped the cannula out of his arm - not a pleasant experience.)
So it was really bad timing for Killer Fatigue to hit this month. I've got the long case coming up in less than a month, and I need to be doing (and presenting) several long cases each week.
And it's hit me in the non-uni parts of my life too. For example, I'm very unmotivated to exercise - and far too motivated to eat bad food - so I've put on some weight. Not unusual for winter of course, but I need to do something about it.
Oh - and just to keep you completely updated on my life: the guy I was dating (who I met online) seems to have disappeared without explanation. If he's the type of guy who thinks "incommunicado" is appropriate, then I'm well shot of him. But definitely not a happy camper.
Despite all of the above, I'm feeling a lot better this week, and hopefully I'll be more motivated for my next rotation - Neurology and Neurosurgery, which started today. A good rotation to be on in the lead-up to the long case. This week: finish my ethics essay (hopefully today), do lots of long cases, go to the gym at least 4 times, go for a run, cook good food, and stop eating bad food.
And I think my love life (such as it is) needs to be placed on hold until third year finishes in September.
I just finished my 4-week placement in Gastroenterology. Loved it!
Apart from finding it very interesting, it was a great placement because of the doctors on the service. The registrars were so willing to teach - it was really refreshing. Even more refreshing was that the consultants were the same (we just didn't see them as often as the registrars). Each week we (myself and the other 2 students on the placement) were required to present at least one long case to one of the consultants, which was extremely valuable.
And yes, there was a lot of poo. I even saw melaena for the first time. But the weird thing is, I didn't smell it! In fact, although I saw a shitload of poo (hahaha), I don't recall smelling it once. Perhaps I trained my nose somehow? I dunno.
Best moment: Every morning, the registrar gave us each a new patient to clerk. We had to take a history and do an examination, and then do a short case presentation to the registrar. It was good to get practice doing short cases, because you have to pick the key information to present, leaving out the extraneous stuff that would come up in a long case. It's similar to how we'll need to present cases when we're working as interns. The other good experience was the outpatient clinic, where we saw new patients who'd been referred to the Gastro team. Again, we took a history and did an examination (and wrote in the patient's notes), and then presented to the registrar or consultant on duty.
Weirdest moment: A patient came into the outpatient clinic after some rectal bleeding. I'd finished the history and was about to start the examination, when she said, "I took a photo of it - do you want to see?" How could I say no? She then whipped out a camera phone to show me several photos of a blood-filled toilet bowl.
Worst moment: The patient with a blocked biliary tree due to pancreatic cancer, with only weeks to live. However, he didn't know this because his family didn't want to tell him, and he didn't speak English. Big ethical dilemma! The registrar didn't approve, but had respected the family's wishes so far. One of the family members had been doing the translating - the registrar told them that if he felt his words were being mistranslated at all, he'd arrange for an independent translator. Also, he told them that if the patient asked specifically about whether he had cancer, then he would tell him. A very tough situation indeed...
I started my 6th placement today - Cardiology. It's a lot busier than Gastro, but so far very good. I'm going to get a lot of practice taking blood, reading ECGs, and doing long cases.
And how nice is this: the Gastro registrar found out that I was doing Cardiology next, and offered to give me a tutorial on the Cardio examination. Those sorts of offers don't come along very often, so of course I took full advantage of his kindness.
Hit 30 and decided to change careers, so now I'm a doctor. It's good, bad, fascinating, mind-numbing, but ultimately wonderful. I think I've found the thing that I should be doing. I hope.
