Happy days indeed

What a good day!  I don't even know where to start.  I read all sorts of interesting things in the paper, such as this by Julie Bindel in the Guardian.  And I loved shadowing in the hospital.

The day actually started in a muddle.  I took my train ticket from home to DGH out of my bag, then left it behind.  I cycled all the way to the station before I realised, speeded back and started again.  Luckily, even after getting changed I was only a couple of minutes late for my teaching on prescribing drugs at 8am this morning.  The format was good and the presentations well done.  I also got a very sweet text from a young man I rather have my eye on, which made the morning look brighter.  

By 10am I was on what will next week be my ward.  It's one I know from a student placement, but the firm is different.  Looks like I shall be working for Rheumatology for my first 5 weeks of house jobs.  This particular firm has coffee and biscuits on consultant ward rounds and seems generally friendly and kind to baby doctors.  

Having visited occupational health and medical staffing and been fully kitted out with computer id and passwords I returned to hunt the house officer I was shadowing for the day.   No sooner had I written a discharge summary for her, but I was phoned by another house officer.  This one works for surgeons, but I won't be doing that job for 6 months.  Still, he knew me as a keen theatre-goer from my student placement and thought of me when summoned to theatres to assist my previous consultant during a bowel resection.  Now, for me, assisting in theatre is the best thing I did at medical school, and I won't get to do it for my first 6 months of work, so I raced off to theatre like a 6 year old at Christmas.  Miss X the consultant was pleased enough to see me volunteering to let me mostly close up the abdomen after the operation.  

To compensate for abandoning medicine, I offered to show up for the post-take ward round tomorrow, where the consultant who's been on call the night before goes round all the people admitted by their team.  This is sort of optional for me on shadowing week, but I think I should show willing.  Better go to bed soon as it will start at 0755 tomorrow.  

I sometimes feel I ought to make more reflection on things, like the Fortunate Man and other medical authors.  I hope to do so in the future, but since this is all pretty new and I am still quite excited I will stick to informing you for the moment of my activities and I will reflect a bit when I calm down.

First day

My first day was uneventful.  The security people had my room key, but not my i.d. request from personnel, which felt inauspicious.  However, the first doctor I saw was a lovely surgeon, my favourite in fact, who had told me in my finals OSCE that I should come and be her house officer!  That felt a bit more auspicious and I cheered up.  The rest of the day was spent doing administrative things.  The talk was good, the medical staffing team organised, efficient and excellent (I know, I was shocked too!), but the IT training was incredibly slow, in a hot room, after lunch.  I am still impressed that I stayed awake through the whole hour and a half.  The only other bonus was finding another silly creature who likes spending their weekends cycling around big hills looking for good views, tired legs and pubs.  She and I will no doubt be off on bikes in the near future.  No medicine today, but shadowing my predecessor tomorrow, so no doubt I will have some more to report anon.

My first day at DGH

Well, blogspotters, if anyone is still reading this after another week of silence, you will be glad to know I am about to stop swanning about the place and start working.  Any minute now I will set off to the DGH and start being administrated, photographed and lectured to within an inch of my sanity.  And then at some point let loose on unsuspecting patients.  I'll keep you posted.

Not long now!

Good morning campers, less than a week to go before I head off into the wilds of suburbia to my new district general hospital and start being inducted into doctor-hood.  I am starting to get nervous, but I am tackling it by making this week excessively busy.  I have taken on the writing of an audit based on data I collected in Tanzania, I have arranged a trip to a friend this evening, he's already a doctor in a nearby hospital.  Tomorrow I head into London to see old flatmates and drink sangria and Thursday there is a picnic planned.  I am also dating again.  Boyfriend of 4 years broke up with just after finals, but it seemed a natural end to things.  Someone new is working very hard at chatting me up and I am deciding what I think about it.  There will be dancing with the girls on Friday night and cinema with this boy on Saturday.  By the time it gets to Sunday I plan to be asleep all day, so I won't have a chance to worry about Monday until it's too late and I am already there, signing contracts.  How exciting!

Duke Elder

Way back in September, I was told to take the Duke Elder prize exam for CV building purposes.  It's set by the Royal College of Ophthalmology and is worth money if you win and kudos if you do well.  So in January I got an email from the medical school with dates and I applied.  

Fast forward to May and I was up to my eyeballs in finals revision and stress.  I had forgotten all about Duke Elder until I received the examination details about 2 weeks before it was due to take place.  Obviously I attempted some revision, and I have to say it is my special interest area.  Still, I walked in on the day with trepidation and no great hopes. 

Finals came and went.  Results, graduation and holidays have all intervened and I had sort of forgotten all about it until today.  I discovered by email that I had come 19th out of 319 candidates.  Now, although I didn't win, I never expected to.  And I have heard on the grapevine that coming in the top 20 is considered pretty good.  Good enough, in fact, to be worth putting on the CV when it comes to applying for specialty training in 18 months time.  

Needless to say, I am a very happy bunny.

Micro-surgical techniques

I haven't yet heard what happened to the girl with air in her CSF, but if I do I'll let you know. 

Today I practised micro-surgical techniques.  Well, I practised creating and cutting and sticking very small things.  It's my great aunt's birthday party on Sunday, so a mass family gathering with cake and champagne has been organised.  My grandmother (great aunt's sister) always used to make sugar flowers, very tiny and detailed, for such occasions.  My mother decided that in her memory, we should make some.  She said to me yesterday to get the kit together and start the flowers to help her.  What I didn't realise is that she actually meant would I please make them.  So off I went. 

I have Grandma's instruction books, and between her and Mum they have all the tools.  I have certainly attempted this before.  Still, it was incredibly tricky.  The flower paste needs to be rolled out really fine, and stuck to the wire stem.  Then each layer of petals is stuck to the one before with egg white.  They tear, they get caught up, they stick wrong.  It takes forever!  But I'm pretty happy with the results.  The tiny manipulation required was fun, maybe it's a good omen for my surgical career.

Sweden

Oooh strange!

I have just got back from Sweden, where I went to visit a girl I made friends with on elective.  We shared a room and a group of friends and some ridiculous experiences for 7 weeks, at the end of which we felt pretty close.  Then we both went back to our medical schools for finals, so we haven't seen each other since.

When we last saw each other we were medical students in Tanzania, but when I climbed off the coach on Friday to see her again we were doctors in Sweden!  It was odd.  Luckily, as soon as we started talking and walking (activities we both particularly like), it was as if 6 months had not in fact passed since our last decent gossip.  We went all over the place, onto the lake near her little town, 20km round trip to a viking burial mound on single-speed, clapped-out bikes, into Stockholm, to a party.  We ate fike (coffee and cake), korv (hot-dogs) and lax (salmon).  Then today she went to work.

She's working in the infectious diseases ward of a district general hospital, just outside the town centre.  So, I stole her bike and spent the day exploring the woods and islands around Lake Malaren, made some stew for dinner and went to collect her.  The ward is a separate block, with 12 rooms on each side around a central 'island' containing the kitchen, nurses station etc.  It was pretty similar to home, except all infection patients have one of these isolation rooms.  From the inside is a sort of air-lock, containing a sink and aprons.  Then the actual room opens onto a veranda, so that patients can go outside from their own room.  I thought it was all rather swish.  

Today my friend had a new patient with a complicated problem.  The patient was a child with otitis media and possibly externa, and suspected mastoiditis.  They were worried and got an ENT review and a CT.  The ENT review said it wasn't convincing for otitis media or externa, and the CT didn't show a collection.  However, it did show an air-bubble in the CSF!  Now, I've never heard of this before, but that doesn't mean much!  The radiologist said it must be from the L.P., but this was done after the CT, so that's impossible.  Clinically, this kid isn't too bad, and certainly isn't meningitic.  Any thoughts team?

Oh my. The bicycle fitting was an amazing experience. It took hours, and involved cycling on a stationary, highly adjustable test bike. My riding was video-taped, and the pressure differentials between my 2 feet were measured. My femur and leg lengths were measured, my range of motion was measured. Little wedges were placed under the cleats on my bicycle shoes. The difference was incredible. Just slight adjustments made it much easier to achieve the same wattage. I loved it.

Now it's a matter of waiting to see whether the man in the shop can fit my measurements to a suitable frame or not. If not, I might get one custom-made in pink-coated steel. And then insure it heavily.

In fact, yesterday was altogether a wonderful day. I saw an old friend for the first time in a year and spent the afternoon catching up on his travel adventures. In the evening I met a new friend, with whom I clicked instantly. We talked non-stop for 4 1/2 hours and only stopped when the restaurant kicked us out. Although the interaction with old and new friends is very different, both were wonderful in their way. It strange to see someone I had known so well and not seen for ages. The conversation just fell into place as if it had never stopped. With the new friend, it was strange that the conversation picked up as if we were old friends, as we found more and more attitudes, strengths and vices in common. I think it will be an interesting summer all round, what with being newly single, new friends being made, old ones rediscovered, a new job on the way and no more revision to do.

Off to Sweden tomorrow, to catch up with a friend I met in Tanzania on elective back in November, when this blog fizzled out. I will let you know how that goes when I get back on Monday.

Spending my inheritance

I am about to go into London to spend a great chunk of my inheritance.

My very elderly grandmother died around Easter this year, freeing her from immobility and vascular dementia, but depriving me of my visits to her for still very entertaining chats. In her will, she left money to me and my cousins, which she wanted us to enjoy. My investment (I will insist on calling it an investment, as well as an indulgence!) is to be a new bicycle, fitted to me so that my myriad injuries are accommodated as well as can be. The fitting alone will cost over £150, which is more than I have spent in one go (except on flights) for a couple of years. I'm very excited about it, and will post again later on how it goes.

It does seem a little over-board, as I am starting work in a district general hospital in August. I will be living in, so I won't need the bike to commute as I did in London. Still, next year I hope to be back in London as a cycle-commuter again, and this year I shall use the bike for adventures in the countryside around my new hospital. Today is a bit of bleak day for a cycle ride, but I refuse to let the English weather dampen my enthusiasm.

Super Duper Doctor Holidays

Finals really takes it out of you! For days after exams I awoke early, full of nervous energy. For a few brief and awful moments I would worry about all the work I'd have to do in the day ahead. Then realisation would dawn that I was finished. No more exams, no more revision, no more stressing out. Once results came out I didn't even have to worry about that! Yet, it was still only 2 weeks after the last exam, when we graduated, that it felt real. I am in fact a doctor. Wow!

In celebration, I went away on a super-duper doctor holiday to Greece with 7 other newly minted baby doctors, a med student and a lawyer. The busy days were filled with swimming in the sea, lying on the beach or the terrace reading novels (novels, I tell you, novels! Not a text-book to be seen!), eating souvlaki, ice-cream or fish and drinking ouzo or beer. I had afternoon naps, lie-ins, pointless wanders round shops and games of pictionary all with no guilt and no need to rush off to study. The sheer bliss of this can be best understood by everyone who ever did medical finals, or perhaps a big dissertation. When your life has been occupied by constant, all-consuming study for literally years on end, nothing is quite so disconcerting and yet rewarding as knowing it's all over!

Ms Medic is a DOCTOR!

I passed! I passed finals! It's all over. I have a hell of a headache from the celebratory drinking already, but I think well earned. More news later, I think I'm going to curl up in a ball now.

Sobering up

Well, I have sobered up. The Boxwood Cafe is really really good, not that I ever like plugging things much. We had a really good meal, went out for drinks in our dresses and stayed up, 8 of us, drinking rum and gossiping til 4am on Saturday morning, when the sun came up and scared us all into bed.

Saturday I wandered round Oxford Street and nursed my hangover. I remembered why I didn't like going to Oxford Street, especially on a Saturday, since it took me about an hour to make it about 400yards down the road. People are bonkers. I never seem to get road-rage in a car, and I only get bike-rage if someone came really really close to killing me. But somehow, I am very prone to pedestrian-rage. There is something in me that snaps when the umpteenth group of selfish dopes decide to stop in the narrowest part of a crowded street, spread out and have a think about what to do next. They seem to pick areas like beside a bus-stop, or by the traffic lights. If you try to squeeze through the middle, all 'excuse me' and 'pardon' they look insulted that you interrupted the conversation. Well, dearest tourists and assembled self-absorbed idiots. you interrupted my wander! How dare you look at me like I'm in the way when you're the one blocking one of the world's busiest footpaths!

Anyway, rant over. I abandoned Oxford Street and went home to get ready for our finalists ball. The tickets cost a fortune, so I was a bit skeptical about the the whole thing, feeling like it might be a bit of a rip-off. Then I got there to find it was far more exciting than I had expected! The venue was beautiful and it turns out the medics scrub up pretty well when you take the grey mask of revision away and put them in full finery. I was pleasantly surprised by the whole event. Even the food was pretty good. Still, another 4am bedtime nearly killed me. I'm not that old to need a respectable bedtime, but I think I'm out of practice. I spent yesterday and this morning recovering at home with the kitten, who helpfully bit me a few times and then curled up exhausted on my knee. It really does seem tiring to be a kitten, all that running about to do, sofas to claw, curtains to climb and people to shout at. I'm feeling pretty tired just watching him. Or maybe that is the cumulative effect of finals. I am certainly enjoying the recovery period, but I wonder if I am alone in finding it hard to shake a lingering guilt at doing nothing? It's been so long since I last slugged about on a sofa with a novel and a cup of tea that I feel like I should be busy working on something. I hope I will get better at lazing about with practice, so I shall be taking my cup of tea back to the cat, the sofa and the tv!

Over and out

Finals are over.

My short case OSCE was on Wednesday and now I have nothing to do! I felt at a very loose end, but filled it with moving out of halls. I am now at home surrounded by boxes and bags and not sure what to do with myself now I don't have to revise! It's exciting, but none of us seem to know what to think. It's not exactly an anti-climax, but we've been so busy for so long now I think we're a bit lost without revision! No-one has done anything exciting lately and we haven't had any normal conversation for a while, so I think everyone is stuck.

I hope it will get fixed with a posh dinner tomorrow and the ball on Saturday! I'll report again when I sober up.

3 down, 2 to go

Written finals, I never want to see you again!

On Wednesday I had my pathology and data-interpretation paper for 3 hours, followed by my clinical single best answer paper, for another 3 hours. The path paper was off the map, I have never seen an exam like it, and we have been examined at least twice a year for the last 6. The paper bore no resemblance at all to the pre-exam lectures. None. We were told to look at some pictures of histology, but not to worry too much, because we'd get a history with the picture in the exam, and that's what we were really expected to interpret, with the picture for added clues. Well, there were at least 3 pictures with no history at all and one that said "this patient has a cough". Well, that narrows it down! For Heaven's sake, if you want us to learn histopath, fine, we're trained to learn what's required. But why tell us outright not to do so?! Nutters. I was not a happy bunny.

Then in the afternoon, shattered, we went back for the clinical questions. Ok, clinical is easier for final year medics than path, because it relates much more closely to what we do and see on the wards. Still, there were some startlingly ambiguous questions. One started with a patient who had sensory loss in the feet, then went on to say they had no sensory loss. Helpful. Did they or didn't they? I was now not happy and disgruntled, and exhausted!

Luckily, the paper on Thursday morning was so incredibly straightforward that I worried I might have been given the 3rd year's paper instead. Baffling. All that stress on Wednesday and a perfectly reasonable Thursday morning. So on Friday my body gave up and got my usual post-exam cold. I have been so sleepy ever since, you'd think I was gearing up for summer holidays. This might prove to be a mistake as I have my long cases exam on Tuesday and a short case OSCE ('objective structured clinical exam', which is a pretty biased and chaotic exam for medical students) on Wednesday. Let's hope I start getting the fear back or I risk falling asleep in the middle of the exam...

Poisonous witches and nonsense journalism

I was directed by a post on Doctors.net to a blog on the News of The World posted on the 1st of June. Now, I know that the rag in question is not famed for it's quality investigative journalism, but the sheer screaming vitriol of this article, it's absence of factual accuracy, made me want to throttle the writer. Her name is Carole Malone and she basically blames doctors for all that's wrong with world.

Very sadly, her father died of colon cancer. She feels this is the fault of his GP for referring him too late. However, rather than complaining to the GP or through appropriate channels, she has written a spiteful rant about how all GPs do is cadge money from the government for doing less and less work, in fact, it's their fault the NHS is short of cash and they get paid a quarter of a million pounds each.

If only! I don't understand why people are allowed to write journalistic articles containing such wild inaccuracies. Firstly, GPs don't really earn anything like that much. The income to their practice (as a partner) has to pay for the whole practice for heavens sake. And just because they had horrendous hours in the the past, for which they were not renumerated, doesn't mean they should be treated even worse now. And whatever the GPs salary, she's not publishing her own in the national press, is she?

I just don't know why people have it in for doctors at the moment, I really don't. 2 days before my finals is not a good time to be thinking this is really not a promising profession.

My black eye

I have had dark circles under my eyes for weeks now. There's something about the quality of revision sleep that means it isn't refreshing, no matter how many or few hours you get. I'm constantly sleepy, possibly because I have been constantly bored by revision. Pathology and surgery and now done I think, and just haematology and oncology to go before I give up on medicine as well and move on to practise questions. The dark circles I think will stay until after the post-exam drinking.

Now, though, I have one eye with an extra-dark circle. And a small claw mark. My parent's new kitten thought surgery revision looked boring too, and decided to help cheer me up by playing with my ponytail. When he fell over my shoulder and onto my lap he looked up into my glassy eyes and I was cheered up. So far, so good Mr Kitten. But then he saw some escaped hair hanging over my eyes. He sized it up and jumped, perfectly swiping the hair in mid-flight. And catching me square in the eye on the follow-through. Oh well, it was worth it since he's so cute.

7 days to go

The clock is ticking away, the days disappear underneath me and the exams loom large on the horizon. And am I panicking? Am I finally getting my arse in gear and becoming more productive? Am I confident and collected?

Well, no.

In fact, I am so de-motivated I can barely work up the energy to worry about it, let alone work effectively. Oh dear. Let's just hope my consultants told the truth when they said what counts is to be on the wards every day and get involved in managing patients. I think it'll come good in the OSCE and the long cases, but I fear for the pathology written paper, I really do. My knowledge is patchy, so I pop with things like BCR-ABL and can't work out which antibiotics work on gram negative bacteria. Let's hope it's enough!

Charlie Brooker and the pathology of heart disease

Yesterday I abandoned ship. There's only so much time you can spend in your room with a laptop and a pathology revision guide without very bad things happening to your will to live. I ran away to my parent's house and spent the day there, with the laptop and the pathology, but most importantly, a kitten. I felt much better reading with a kitten on my knee.

This morning I was back in my flat, with (you guessed it) the laptop and the pathology. No kittens available here, so instead I have the Guardian online and the joys of Charlie Brooker. He is the perfect expression of how I feel about the world at the moment, that is, not friendly toward it. Not only is it raining, Boris is Mayor of London, people are dying in China and Burma, not to mention Iraq, Sudan and Afghanistan, AND I have to revise. Oh what a joy to be alive. So, now I am still avoiding work, but with a warm love for grumpy Charlie B in my heart and a cup of tea.

If I pass these exams, I shall have write him a thank you note.

PS

And thank you for the encouragement Little Medic, every little helps at the moment.

Pathology

So today I have been trying to read pathology for surgery, and I was so bored I could have eaten my own brain with a spoon. Luckily, I decided watching "Mean Girls' on tv was a better plan. And drinking Pimms. Oh dear. I have to say, it's a good thing for patients everywhere that I want to be a surgeon and not a histopath or they would be in real trouble. So far, I have worked out what red blood cells look like under the microscope and then I gave up. I can just about manage to pay attention enough to have learned the acid-base stuff and calcium metabolism. But that felt like such an achievement that I got nothing else much done after it.

Oh dear. I know that revision always makes every subject feel awful and dull, but I do hope that I get my joy back before I start FY1 in August. I really have lost interest at the moment.

Finals are approaching...

So this blog dropped off the map a bit when I went to Tanzania. I have been back about 6 months now, dragging myself through final year and towards exams. Being in a different place for clinics every single month is tiring and unsettling, so I have got to this point (10 days from finals) with an underlying sense of grump and the overwhelming desire to be on holiday already. Oh well, not long to go now and I start working as a junior doctor...