The power of

Perhaps a good way to finish off the year would be on a churchy note. A subject that infrequently comes up on this blog nowadays. I'm not sure why though, given that the world miracle is bandied about so often in medicine, or prayers for intervention in desperate situations are so frequently utterred.

Several days earlier at the christmas morning service the Rev was talking about the importance of family and had mentioned in passing that his aged father was quite unwell. Nothing more was said, but evidently a number of people had inquired after his fathers health over recent days.

This morning the Rev took a moment to briefly thank everyone who had inquired after his father and informed everyone that all medical treatments had ceased, and it was expected that his father would shortly be called home. For a man whose job description involves dealing with death on a routine basis, he managed to deliver this news with a heartfelt, yet matter of fact tone. Quite sombre, yet informative.

Just as he was about to change topic to other matters at hand one of the kindly older blokes jumped up and interrupted "Rev, can I  pray now for your parents?" And it was really wonderful. He spoke this extremely heartfelt prayer. It was so honest and so very genuine. A beautiful prayer of thanksgiving for a life fully lived. Incredibly moving.

I love when things like that happen. The capacity to vocalise the thoughts, feelings and yearnings that we all have within without fear or worry. It was beautiful. Not because it was fancy but because it was right.

It's a cause for some serious introspection.

Those crazy Yanks

Like a lot of people I have marveled at how the Americans treasure their guns so dearly. I remember once watching some sort of TV show of 'remarkable survival stories' where a man is trying to duck back and forth around a rather slender tree while a guy empties a clip from a 9mm handgun in to him. The guy got shot several times and was very fortunate to survive. Or so I thought.

Movies have trained us to expect people to die straight away when winged by a bullet from a handgun. In fact, 6/7 people in the states shot with a handgun don't die.

The physics of bullets hitting people (though extremely disturbing) is quite fascinating. Just recently I was talking to people about bullets hitting water, and how far you have to dive in order to be protected.

It turns out that the super fast bullets tend to destroy themselves, breaking in to shrapnel when they hit water, whereas the slower bullets will actually go a bit further. Interestingly, it seems the same seems to be true for people getting shot.

I recommend this Youtube video by an American anesthesiologist if you'd like to hear more about it. It's probably useful information if you plan on dealign with people who have been shot.

On a related note, I've been thinking about 4th year electives. I'd really like to go somewhere in Africa, but probably not South Africa (everybody goes there.) Might see some of this stuff, not that I see myself as a trauma junkie in any way at all.

Me Doctor. You patient.

So I should probably explain, or at least give a bit of context for those that don't understand medical school. I'm in a post-graduate course. It is four years long, the first two years you are left to study from books. Your occassional interactions with patients are awkward, but slowly you learn a few things:

1. All girls are pregnant till proven otherwise.

2. Blood loss without pain is always worrying.

Mostly though, you are left to feel stupid and realise that you know next to nothing.

I am about to enter the second half of the course, where the books are now secondary to constant interaction with patients. I anticipate the interaction will continue to be awkward, some girls will turn out to be pregnant, and I will be worried by any form of bloodloss (even when I'm taking it.)

Mostly though I expect to feel stupid and realise I know next to nothing.

I'm excited though, as I'm moving out to the country. My first time out of home, my first time seeing patients who are both real, undifferentiated and possibly sick. Annoyingly, the benevolent master that is Flinders University has decided to slug its students rent, where previously the trip to the country has been free. Thanks Flinders! At this stage the rent charged is only modest, but falls a literal couple dollars below the threshold for rent-assistance from the government, therby costing me more. Thanks Flinders! Ughhh. To think, at Adelaide Uni they have to pay the medical students to go to the country. At Flinders we pay... it's no wonder Flinders Uni has a complex about being the poor cousin. We are.

In preparation for this big adventure, I've decided to sell my beloved Jeep. It breaks my heart, but I need something economical and safe. So I've bought a lancer, that I'm hopeful will not kill me, unlike the Jeep which was always a little skittish. The proximity to death was just one of the reasons I felt so alive driving it though. In the same way that hanging around an old peoples home makes you fell alive. Wait... What?

Maybe cars are different.

I do like the new car, but I really am having troubles moving on. I guess one never forgets their first vehicular love. It's sad to have owned your dream car, only to then go back to 'the rest.' I foresee another Jeep in my future. Or at least something stupid.

So now we move on. Away from Flinders. For my group of friends this means disbanding. Three of my usual posse are rural bound. Cheers guys and gals. The sad reality though, is that things wont ever be the same. Realistically, the next time my cohort will all be in the same room again will be graduation in 2014.

Le posse: An academic tour de force, the likes of which will never be seen again.

Let's do this.

You're standing on my neck

Well officially we have all now passed (thanking the power of the rubber NGP stamp on my otherwise mediocre assessments.)

Went and spent a day in the ED for kicks. Apart from further appreciating my lack of knowledge, I had an interesting time. Got to watch my first proper resus. I was amazed and also strangely relieved at my emotional detachment. It was only a 20ish year old guy, who had managed to combine overdosing and drowning in to one serious misadventure. I watched them work on him for awhile, and as it was a slow day in the ED a plethora of doctors stood around and pointed things out to me with a vague disinterest.

An alarm went off, someone had collapsed in the waiting room, unconscious. They dragged her in to the room next door. A heroin overdose, nothing exciting. At least not to them. Once again the doctors stood around with vague interest that comes only through experience. A prolonged contemplation on whether to administer the antidote or just let her come good with time. She was still breathing, a fact that they made me make sure of. They asked me to reposition her head so her airway would be more open. I began tilting her head back only to have her eyes spring open and for her to begin grumbling.

Even I, a humble second year knows that a talking patient isn't having difficulty breathing. And that was the extent of my good deeds. I left the ED, walking past a tearful family, waiting for news on their son. Weird, but distant.

I could work in the ED I think. People are only your problems transiently, none of this forming a relationship business.

An interesting thought indeed.

Half-doc

Some times after the power goes out temporarily, and if I know I have no responsibilities. I like to leave my radio-clock unset. Just let it flash grumpily, the time incorrect. It sounds weird, and I really don't do it all that often.

Just some times though, it's nice to see what my body is really telling me in regards to sleep. If I have no idea what the time is, I can't feel guilt for staying in bed too long. Nor angst about getting out of bed so early that I'm missing the opportunity for more Z's.

Inevitably tough it winds up with a third situation where I start stressing myself out about the possibility that I've slept through lunch, and am forced to check the time on a second device.

I suppose this is really just a long-winded way of announcing that I passed my exams and have a bit of free time on my hands. I'm all set to enter third year. A year that is penultimate in number, but for all intents and purposes*, academically ultimate.

This time next year, I'll be a most-doc.

Stay tuned for updates about my upcoming year in the "country" :) I'm thinking of renaming the blog;

 "We're not in Netherby anymore."

*It may also be ultimate for intensive academic purposes.

After the facts

One thing you don't normally hear about in the study-exam-holiday cycle is the waiting. Waiting for the results of the exam whilst holidays trundle onward. Mmm it's bad. That's really all I have to say on the issue, which I guess is why you don't hear much about it, hey?

The other bad thing about having a lot of medical friends is that they all go back to where they came from over the break. Now I'm forced to write my thesis with very little in the way of distraction (except the internet.)

Knowing your anatomy is the key to success...

A song about exams

Tomorrow! Tomorrow!
You'll love me tomorrow?
It's only 13 hours away.

And then, it's time to get real life done.

Half-time show

Well, I'm but four days away from being a half-doc.

I have forgotten everything I wanted to tell you.

But I did get to watch a tumour being removed from somebodies caratoid artery the other day. It was exciting, seeing as you are only ever millimeters away from shooting blood across the room. There was a communal "Yay!" when the surgeon got the mass free.

So strange.

^date

So I spent a couple weeks on the cardiology medical unit. It was really interesting and I did learn a lot. I also ended up successfuly taking a few bloods and doing cannulas (my future bread and butter.) Amazingly, I feel heaps more confident in my ability to diagnose things from an ECG. Well, seriously obvious things. But having had some good teaching and cast my eyes over tens of ECGs. It has become aparrant that ECG interpretation is less crystal ball gazing and more a science than I thought. I could totally be a cardiologist.

Now I'm on ENT surgery. It's great! Watching the surgeries is really good. It really helps with the anatomy. And the surgeons have been really generous with their teaching time.  I got to watch (amongst other things) a doctors first solo tonsillectomy, which took many times longer than a veterans efforts. But it allowed me to see heaps of the basic anatomy and to get softly pimped. Fortunately as a second year im not expected to know anything, so I'm taking it all with great humour.

Really enjoying medicine at the minute, just wish the final set of exams would get out of the way.

2 weeks.

Surgery is surpringsly violent. Apparently jaw dislocation during the operation is not uncommon. Now say "ahhh!"

The perfect doctor

Prior to today I was the perfect medical student. 100% of my cannulations, blood draws and intubations had been on song. Alas, my first real patient and I missed the target. Naturally I blamed the tools - it was my first time using a butterfly and didnt go deep enough. But still, I concede my record is now shot.

Like most of the things I just assume I'm good at. I really should have retired before I started.

In other news, I'm making a living following doctors around. It has been interesting. Also tiring. Two years of being a student and you forget what a full day of work looks like. But the team has been nice to me. I happened to kick off on New RMO Day. Which was great, because they were also finding their feet and the consultant spent extra time explaining things. Unfortunately my first ever ward round went for five hours, and I was extremely glad to go skive off and have lunch at the end of it.

Sure I sucked at interpreting ECGs. But on the plus side, I knew that a tumour in the left lung can give you a horse voice (but forgot the more likely cause of hypothyroidism, who knew!)

Also, I actually properly hear my first ever murmur (and not just nodding when a doctor asks me if I can hear that?) It must have been super loud.

I'm learnding.

All I see is vampires

I stole a mans blood today. Right from out of his elbow! I suspect it wont be the only time I'll have to do that. But it was the first, and very exciting. Regrettably the same person got me back when my head was turned.

And then for the sake of education we learned about ambulances int he afternoon. It was quite amusing, as it strarted off with a rather cheerful fellow asking us about what sort of things you might find in an aambulance. He let the group meander blindly before calling us all to get up and leave the lecture theatre. Walking us outside to a waiting he ambulance, we were instructed to strip its contents bare and bring it inside to see just how many fun bits of equipment there are.

It was actually quite amusing.

All in all a good day. Back to the wards for the weekend though. Pretending to be a nurse again.

Eric the half an eel

I was talking to a friend today about going swimming in the dead sea. I learnt some interesting things

1. If you feel inclined to pee in the dead sea - it is a bad idea due to the extremely high tonicity.
2. Fat people can die when they become trapped face down in the super-buoyant water

This latter point reminded me of an incident a few nights ago, where upon I awoke face down in my bed with two dead arms. oh my! Try figuring out how to rollover without your arms... Awkward.

Out of curiosity, what do you call a man with no arms and legs going swimming?

Bob.

In a lecture today..

Esteemed clinical educators: "You know, you're going to become a doctor. It's a powerful position. I'm a doctor, and I can practically talk anybody in to anything, and I have!"  
Eager student: "In medicine?" *Class erupts in laughter*
 Esteemed clinical educator: "Bahahaha. Yes, no, well... It's important to stick boundaries around these things! We'll just stick with medicine today."

Ah chronic block, you have yielded some fun memories. But todays chat on end-of-life decisions and palliative care was surprisingly amusing given the material. In conclusion, although you are never meant to tell a patient what to do, some will ask you what you would do. And you are meant to tell them it's their choice. But. And somewhere in there, there is a line where you don't get sued if things go wrong whilst at the same time giving advice. It's all a little mysterious to me yet!

Too long for a facebook quip...

After driving home in the rain, I feel that there needs to be a word to describe the frustrating inability to get the windscreen wipers at just the right frequency to not be annoying. Ahhh, first world problems.

What a month!

Oh man, it was everything I forecast it would be, but actually fun! Coming soon: Actual content! But TCP so far has been the amazing holiday i was promised. And I'm LOVING IT! Also I passed my exams, and got full marks for musculoskeletal. Orthopod is on the table...

Oh wow

This is perhaps the best show I've seen produced solely for the internet (Yes, even better than Pure Pwnage). It's definitely for you intellectual types. But Caution, addictive...

A little sea-bathing please

Exam tomorrow. I wish I had a pre-exam ritual. Alas I don't, I just get SNS excitability. Also I wander around sighing, which is apparently a symptom of someone with anxiety. Who'd a thunk it! Anxiety about exams...

Sigh.

I'm trying to decide whether I think I'm going to pass or not. I'm stressed, but should I be stressed if I'm confident in passing? Which makes me wonder whether I'm confident in passing. I've never failed an exam so presumably I should be confident.

I don't know why blogging is cathartic. But it does help a little.

Meanwhile, I'm super-excited about TCP (playing doctor) and the whole of next year. It's gonna be so fun!

GABA GABA GABA

Ugh, exams Monday, Tuesday Wednesday. Have to go to Murrary Bridge on wednesday night for an interview regarding where I want to be next year. Fly out for Thailand Sunday, get back the next Sunday morning and have to be in Mount Gambier that night.

I'm exhausted just writing that. I hate exams. I hateee exams.

I
Am
Wigging
Out.

Screw you sympathetic nervous system.

It's genius!

Okay, here's a plan to get rid of the common cold forever (plus a whole bunch of other nasties).

It's pretty simple. Everybody stay where you are. For a month. Don't go out. Don't go to work. Don't do aything but stay at your place of residence. If everybody stays home, then nobody can pass on the infection. Once the last of the people sitting at home have burnt out their colds and become immune, we should all now be disease free.

Too easy...

 (Except from the chaos that results in the mean time - but then we'll all have something serious to complain about rather than a case of the sniffles. Everyone needs to make sacrifices for the greater good.)

It just surprises me that nobody has tried this earlier.

Clinical Vignette

A 26 year old medical student is forced to get a Hepititis A vaccine by his medical school. As he is also planning a trip to Thailand, he desires  a vaccination for Typhoid. He presents to his general practitioner and complains of feeling fiscally drained. As part of a mini-mental state exam, she consults the chart on the wall she asks him
"What price do you put on pain?"

Demonstrating his seventh and second, third, fourth and sixth cranial nerves to be functional, he squints at the numbers as well. The patient does not display any signs of acalculia or dysphasia.

"You see, there is a combined vaccine. It's one hundred and ten dollars. But we buy in bulk here and the two vaccines  given separately are only ninety two." She continued.

"I'm tight!" He declares. And a consensus is reached. Two shots it will be so he can lay on a beach.

12 hours later the patients presents to his couch. Symmetrical deltoid pain, malaise and mild wallet lightning persist.

Quick update. Not entertaining in any way

Can't decide what's worse. Being such a poor time manager that may blog updates are reduced to complaints about how busy and doomed I am. Or not blagging. It's hard to choose. So I've chosen both.

Devo about Cadel though. Still respect the man for not giving up! Such a phenomenal athlete.

I'm ready for a holiday.

The wrist bone's connected to the... err

I'm out of my depth.


Wait there's not even a wrist bone! Why!

Quit recycling anatomical names! Pffft.

We're on to the musculoskeletal block now. That's all very exciting, because I was sooo sick of neuro. Ironically neuro is probably the thing I'll use most in my future. But it's nice to deal with a subject that has facts again!

You always know that when your topic for the week is called 'multiple facial fractures.' You're going to find it entertaining.

It's kind of crazy really. With only six weeks left of traditional book learning, I'm starting to realise that the only thing I haven't really looked at are the knees and feet. And that's coming up soon. Eeeep! Now to spend the next couple years piecing it all together in the real world!

I'm getting more and more excited about moving to the sticks. I don't know where yet, but I'm really curious to find out more about the options. Happy happy joy joy!

The other good thing about this week has been the number of times where I've been able to hold up a skull and pretend I have a role in Hamlet.

Trust me, that was my first and most likely last reference to Shakespeare.

Rehab.

Hi!
Welcome to my blog. It's much the same as it usually is, but now with more drug trips!

I've been sick. For a month now. I was sick, resorted to a course of Augmentin, got better for a week (kinda) and now I'm sick again. And now I'm best friends with Doxycycline. I am so sick of being sick. It's ironic. But my lymph nodes and my head don't usually compete for space at the top of my neck.

In other news, I went through the system of applying for third year placements. It was exciting to plan for the future, but annoying that the computer didn't necessarily agree with my intentions. I volunteered for a pilot group, but got denied. My second preference in the sticks was also passed over. In the end I was assigned a spot right here in at FMC. I was a bit annoyed by that, getting my 4th preference, which I didn't really want. Whilst another person got the place I wanted on their fourth preference. Whatever the algorithm is, it doesn't love me! I'm not going to complain though, it works to satisfy the greatest number of people and that's how it all pans out.

Fortunately another person also got their 4th preference, in the Hills /Mallee /Fleurieu region. So we've arranged to swap and I'll hopefully be heading South for a year. Though not that far South I guess! I'll end up somewhere between Port Elliott and Mannum if all goes to plan.

I'll have more to say on the issue in the future I guess, but in the end a good educational opportunity should come forth.

So that's my update. Short and sweet. I'll resume more regular blogging now that I'm back from a short week off.

Bye now!

This man is beyond help

I cant decide. I can't decide!

 I thought I wanted to head to the mount and see the "world." But now they are running a pilot program for 8 students at Flinders.  Essentially you stalk patients from the moment they arrive to see if they are clinically interesting. But it would be heaps more contact, heaps more acute medicine and possibly heaps more my style. But there are so many details that arent sorted out, and it could go gluteus superiorly.

Ungh. I thought I knew what I wanted, but the last minute has rocked up as usual and screwed it all up. The last minute is a rebel thought in a black jacket made of uncertainty and it wants to corrupt you and your naive friends.

What a jerk.

An elevated eyebrow

I don't get tumblr. I mean... what is it for?

Getting to know you!

I was asked to write another space filling article for another thing. Struggling to come up with an idea, I consulted another classmate. We had a laugh and managed to punch out something that we thought was witty. Unfortunately, our most innuendo laden pun failed to hit the mark so was cut. Probably because we were entering that unfortunate stage of delirium one enters with too much time on one task when we wrote it. So I present to you some of the surviving bits. A big thankyou to my esteemed colleague (to borrow a phrase) who co-wrote and co-procrastinated it to pseudo-success.

Facts about the body: how well do you know yourself?

Being in med school, you're in a prime position.  But which human cell is most numerous in your composition?

A) Neuron

            B) RBC

            C) Skeletal muscle

            D) Neutrophil

The most common cell type in your body is actually bacterial. So what percentage of your cells is human material?

            A) 50%

            B) 30%

            C) 10%

            D) 5%

As a medical student you should understand the feeling of being broke. But which is the bone that gets broke the most?

A)   Clavicle

B)   Radius

C)   Mandible

D)   Scaphoid

At long last, we move along from the long bones to the longest muscle of the body. Which has it been all along?

            A) Trapezius

            B) Sartorius

            C) Latissimus dorsi

            D) Gastrocnemius

Weighed down by knowledge is how you will be, when reaching the end of your medical degree. To fill up your brain will have taken much time, but the weight of your brain and which book, most closely align?

A)   Boron & Boulpaep, Medical Physiology

B)   Moore & Dalley, Clinically Oriented Anatomy

C)   Talley & O’Connor, Clinical Examination

D)   Longmore et al. The Oxford Handbook of Clinical Medicine

And yes, for the record I actually weighed the text books to see which weighed closest to the average brain weight of 1.4Kg. 

If you want the answers you'll have to earn them.

A Bi-polar expedition

Someone sent this around recently. It's a fascinating documentary about a guy with Bi-polar disorder (manic-depression). It's just amazing. This guy loves his mania so much, but what happens is just nuts.

Here's the blurb:
The extraordinary true story of millionaire businessman Paul Downes who hires a Jamaican castle and invites 12 models to join him to become his wives. What at first appeared to be an innocent fantasy rapidly becomes bewildering as Paul suffered a massive bipolar episode. He quickly loses interest in the women and what at first looked like a distorted reality show transforms into a bizarre spin on James Bond as Paul plots to take over the world. A full-blown mania has rarely been filmed and A Bipolar Expedition comes face to face with the extremes of his condition as events in Jamaica reach a crescendo.

Watch it!

For those of you interested, here is a checklist of symptoms that categorise mania. Yes, he has most of them.

Common behaviour associated with mania includes:

 increased energy
 irritability
 overactivity 
 being reckless or taking unnecessary risks (e.g. driving fast or dangerously)
 increased spending
 increased sex drive
 racing thoughts
 rapid speech 
 decreased sleep
 grandiose ideas
 hallucinations and/or delusions

Let there be small amounts of light!

Apparently dilated pupils are attractive. If you want to be more attractive - try rubbing cocaine in your eyes!

I once read a life hack advice column, with stupid suggestions on how to be more efficient at life. Some of them of course were really good, the others were trash. One of the best suggestions was to keep one eye closed when you wake up at night, so that after you've flicked the light on then off again your night vision will be retained in the closed eye. Brilliant! No more walking in to furniture on the way back from the bathroom right?

I always thought this was because the pupil of the closed eye would remain dilated, allowing more light in when the darkness returns. It turns out that's not the case. As neurology has taught me, in a normal person shining a light in one eye causes the pupils of both eyes to constrict (The consensual response.) If that's not happening, you should get yourself to a doctor because you've probably got some sort of brain lesion.

With regard to the night vision it actually turns out it's the cells at the back of your eye that make the detector for light. In the absence of light they become more sensitive to smaller and smaller amounts of light. By covering your eye in the light, the sensitivity is retained*.


And now you know another useless fact.

*Yes this has something to do with carrots, as carrots contain carotine, which is converted to Rhodopsin, which is used to signal to the brain when light hits the back of the eye. In the dark you get more Rhodopsin building up, so the cells are more likely to signal in lower light. So eat your veggies!

I want to get out of Kansas

There comes a time in medical school, when you cease to have any idea what is going on. That time is now! It's not that I'm stupid, it's just that the brain doesn't have one function. Nor one part. In fact it's just silly how much we don't know about the brain.

It's just silly how much I don't know about the brain.

It's funny isn't it. You'd think your own brain would have no trouble understanding itself.

Bah!

Ugh, speaking of an epic lack of understanding. I'm trying to figure out what I want to do with myself next year. We had the crash course introduction yesterday. Glamorous women strolled forth, flipping their signage over whilst music played and exotic locations were unfurled before us.

"Who wants to go to Noarlunga!?" They exclaimed, whilst throngs of young adults lunged forward, desperate for a piece of the South-side action.

"What about Mount Gambier? The riverland? The Fleurieu? Darwin, Katherine, Alive Springs? Perhaps you would like to go to the exotic, yet conveniently located FMC, about 3cm from here?"

They all seemed so good, except one place where you live with the Doctor who likes to run, and makes you run with him. Yuck.

Honestly I can't decide. I'm torn between staying here, because it would be easy and regimented (which I'm good at.) Or getting out, seeing the world, developing my life skills and getting stacks more hands on experience... In some place like the Mount.

I am also realising that that this undergrad holiday will come to an end. It has been a fun couple years in med school. Much hilarity and education. But things tend to change, and pulling up stumps for a year may not be such a bad thing.

Maybe it is time to grow up. Sigh. Part of me looks forward to a challenge, the other part fears failing it. The solutions seems pretty obvious.

Anyway, there's a poll up. Tell me what I should do if you feel inclined. Or comment even, my blog does have that functionality if you would like to use it...

I am learning a lot. Seriously.

For the first time ever in anatomy. I was actually challenged by something I saw this week. Naturally it didn't stop me from watching it, actually seeing it twice. But it's the first time I've ever gone home and still had it playing on mind that night. Usually I walk out of anatomy and don't think about it. I especially don't make any correlation between the cadaver and a cadaver having been a human.

That may sound strange, but I think that's the normal coping mechanism. Anyway, there was something that really sticks in your mind... I'm not going in to details. But it was interesting to watch the professional anatomists just take it all in their stride, while the young medical students either watched on in horror* or looked away.

Sigh, I hope I'm cut out for this.

In a way it reminds me of work in the lab. Sometimes you'd get the cream of the crop come to the lab. Although they had thrived within the boundaries of rigid assessment. As soon as they were let free to be bound by their own creativity - they sank, not swam.

I guess third year will decide that for me then! Speaking of third year related decisions. I have to choose what to do with my time. To stay at FMC, or head off to the sticks. Hmmm, so much to weigh up on that front. I need to seriously contemplate the merits of a year in the country.

*I should probably clarify that nothing dodgy was going on! It's just that anatomy classes have a lot of things happening that don't normally happen in the real world! You just don't normally look at peoples insides and occasionally it all becomes very 'whoa'. It's just different... Still respectful, and still educational.

P.S I promise I'll write a funny post soon. Amusing stuff does happen to me still! I'm just trying to write a medical themed blog.

Two things - A Biopic?

Had a few lectures on the eye today. I'll be honest - I find looking at inflamed eyes confronting. But the more I gazed upon them, the less gross they became. I like eyes normally, but weird eyes are weird.

Look out below?

Having said that, I'm sure I will handle them like a professional when the day comes. Eye injuries are quite common.

And now for something completely different: I'm fairly confident Berocca has close to zero medicinal value, especially in people with a decent diet. But I do enjoy monitoring my kidney function.

Complementary medicine

I had my SP assessment this morning. As I've recalled before, an SP is a standardised patient. A person who acts out a certain medical history in a reproducible manner so that all students can be assessed fairly and reproducibly. And I'm against that.

This is an actor playing a doctor. In many ways this is like me. Also the creepy patient in the background staring at you while you pose... also happens to me.

No, not the use of SP's. But the fact that it is fair. So I've ingeniously discovered a way to win the SP over and give myself the edge:

To prep you for the scenario, you are told to expect a patient of a certain stereotype, every student gets the same scenario more or less. Today I was told to expect an old looking man in his 50's. As there are numerous SPs, hardly any of them fit the stereotype. I've found the best way to begin an interview with a faux patient is to say that they look a lot younger than you were expecting. Seems to win them over from the start. They pretty much give up their history after that. Or maybe it's that they are trained to do that and I'm okay at talking to people. Whatever!

Regardless, it all went okay. Managed to speed through the history, GIT, cardio and resp exam in about 1 hour and ten minutes. I thought I was doing okay, with most people taking a bit longer. But one chap, who is a nurse by trade blitzed the whole thing in 45 minutes, without missing anything. Dang!

Room for improvement? I guess so!

Clear!

I'm not a joiner, a keener, or one of those peeps who aims to make medical school in to an episode of scrubs. On occasion though, I do like to challenge myself a little, and get involved with some of the activities that go on around med school.

Yesterday for shirts and giggles, my study group (well, more or less) responded to the desperate plea of one of our fellow second years to field a team for an emergency medicine challenge. The theme of which was "explosion." I'll be honest, I only got involved because one of my colleagues is a practicing paramedic. Who else would you want to leave a team of novices who have about as little emergency medical training as one can get?

Having said that, we were all qualified in basic life support... we also had an ex-military nurse, two life-guards, a pharmacist who could draw up drugs and a couple newbs. Keen, but still newbs (especially me.) Other than that, we had had no preparation for the coming disaster.

A few different explosion themed medical scenarios were set up, and we got to compete with a couple teams from Radelaide and another Flinders team, who were equally unprepared. To save the suspense - we either came first or third (due to some confusion over which flinders team was team 1 or team 2.) The important thing being that we didn't come last and beat out a team of clinical students.

The scenarios were a mix of cannulating an arm and suturing an open wound. Single patient with blunt chest trauma and a tension pneumothorax. Single patient thrown by an explosion in to a car, with a broken pelvis and internal haemorrhage. And then a multiple casualty scenario, where you had triage three different casualties, get them on backboards and carry them off to an aid station.

It was all good fun, though my contribution was nothing particularly life saving, just jumping up and down a bit on a dummy chest etc. It was a valuable lesson in how to handle the excitement and pressure of trauma.

So apart from that, I passed my exams and did as well as I'd hoped in anatomy. I'm struggling to get motivated for brain and behaviour though. It's... uninspiring maybe? I'll put my head down soon. Once I pass GIT/Cardio/Resp exam on Monday...

The pace of things this year is a lot more intense than last year. I will say that.

Plexus schmexus

I went to the repat today, for the first time ever. Fascinating little place. As I wandered in I couldn't help but feel that I had time warped back to the 1940s. For those of you who aren't locals, imagine a single story hospital, with numerous different buildings connected by courtyards. And then superimpose band of brothers on top of it, except that the war has ended and the cast got old.

 I wandered slightly aimlessly through the grounds, trying to find the ward where I was to meet the tutor. It was a fascinating little detour through history. I don't mind a bit of history, as the bulk of the hospital was built during WW2. Very quaint. One of the lesser known things about the repat, and I have done some extensive googling on this. Is that there is a secret underground hospital on its grounds. Back in the 40's, in fear of Japanese aerial attack, somebody decided it would be a good idea to build an underground hospital. The world moved on, the hospital was bricked up and forgotten about and is now the stuff of legend. I think it would be fascinating to find out more about that... One day!

At the end of the day though, it's just a rickety old hospital. But I always enjoy seeing new places. And I got checked out by a tutor who declared my reflexes to be excellent. I'm thinking of getting a job as a standardised patient...

Apart from that life is good. I'm a little under-excited by the neuro block. There is a bit too much unknown about a lot of the mechanisms. I like to deal with certainties some times in life! But I'm sure it will turn out fine :)

 Lumpage, out.

Like sands through the hour glass

Exams are over! I survived. It was an interesting experience as usual though. I felt well prepared. So I wasn't as stressed as usual, perhaps because the family are away! (Hi Dad!) But the highly strung people around me were still quite content to wig-out. I'm sure everyone did fine. I wish I had more exciting stories to tell, but I'm just trying to regain the energy for the next semester... which starts tomorrow.

I've been so conditioned to expect a break after exams. It's a bit disappointing to only have one day off. Especially since I spent the whole Easter weekend tether to my text books (except for a brief escape to see James Morrison, who was pretty good.)

In the end I enjoyed GIT and Endocrinology. Fascinating things happen when hormones go wrong. And GIT stuff seems pretty straightforward too.

Such fun!

More exams, already?

I feel like I just had exams a few weeks ago, so it's very concerning that there are more exams in two weeks. Sigh. Once again, I feel as though I know nothing. But this is the story of medical school isn't it. Drinking from a firehose, whilst eating a mountain of pancakes. Or something.

Let us have some musings then:

I bought a pneumatic differential locker for the Jeep. Should be good as it will cut back on the wheel spin. I can't wait to go try out it out after exams. The best part is that it also comes with a compressor, so now I can let my tires down and then fill them back up again. Something I really needed to do on my last beach trip, when getting stuck in the sand was a serious issue.

I'm continuing to enjoy study. Learning about the endocrine and reproductive systems has been... interesting. It's always amazing how much you don't know about stuff. It's been good though, because all these hormones have important yet magical functions. So it has been nice to learn about their function. I've also learnt a lot more pathology, which scarily I still seem to be enjoying. I don't know where this medical degree is going to take me, but I feel as though surgery is definitely not it.

On the same line, I had a review with my PBL tutor this week. Basically you size yourself up over how you perform, and the tutor weighs in. Fortunately I have a tutor that cares this time, because the exercise can be quite pointless when the PBL tutor just sits with glassy eyes the whole time. Apparently I give the impression of a humorous person, who is also a deep thinker. A valuable contributor to the group dynamic, or something. In short, I have painted myself as a normal human being. Success!

As the tutor and I both came from Immuno research backgrounds, we had a bit of a chat about med and science stuff. But somehow I spun it around in to a "So what kind of a doctor do you see me as?" It turns out, I'm not seen as a GP and probably not a surgeon. I appear to enjoy thinking about things too much. Hmmm. This tutor has me figured out. It doesn't help that my PhD supervisor had told her to look out for me.

Another aspect of med school I am also enjoying is dissection. I have reached that level of detachment with our cadaver that only hours and hours of poking and prodding can achieve. My partner and I explore our way through the human body, with a poorly written handbook as our guide. Constantly wondering "what was that we just cut through? or "Is that normal anatomy, I swear the book didn't have one of those." Of course, when we're not hopelessly lost in the guts of an issue, we do enjoy a good deep and meaningful and a laugh about life and medicine. It's good times! However you still get those moments periodically, where you pause to be thankful for the opportunity to be doing this.

The only frustrating thing is that our guy has been under the knife a lot. The cadaver is missing a lot of different things, and there are a few mechanical things added as well. In terms of learning about surgery, it's fascinating. Unfortunately, for learning about things like normal anatomy, it can be very annoying. Structures that were meant to be at the back are floating free at the front. And the whole left side of the colon, appendix and more were missing. Which is a little sad, as it would have been good to see them in situ. Oh well, I'm sure I'll see my share of them in the future :) Apparently you have a 5% chance of needing your appendix out.

So, having talked about the deceased. I'll finish on a positive note. I now have a cute little nephew, James. Good job TnR! Such a cute little family :)

Justweighing in before the big event...

I'm predicting it will be a girl!



:)

Couch to five Yays

Well, I'm not normally one to gloat. But I finally completed that couch to 5k program I've been doing for a little while. I cranked out my 5km in 30 minutes, at an unsurprising average speed of 10 km/h. I was pretty happy with that, because awhile ago on my last blog I set some goals about being able to run, and putting on some weight. And you know what! I've achieved them both!

It may have taken me 18 months, but I have managed to put back on all the weight I lost over my PhD and some muscle too. I've finally cracked 80kg! I'm probably the fittest I've ever been. Which is good, because apparently 25 years of age is my biological peak anyway. So woo yeah! Bring on my epic fat man, beer gut, back hair body odour decline!

For now though, I'm going to the gym with people from Uni. I'm enjoying the weights, but I'm really enjoying the spin classes. Mr Shouty man makes me drip sweat like never before. So fun! I love his slogans though. They are ridiculous until you find yourself believing them.
Internal monologue: "Maybe it is all in my mind, maybe I am the only thing holding me back. Maybe I am here for the pain..."

Ah shouty man, why can't my own motivation be more like you!?

Trust me, I'm pretending to be a doctor.

There comes a time in every medical students life, where they have to suck it up and put a finger in another mans bottom. This was my week. Odd experience. You sit down, explain to them why you need to do it, and what is involved. And then... yeah. It wasn't a bad or traumatic experience, in fact I would describe it as extremely educational. But exceptionally out of the norm.

The strange thing is, the kindly male volunteer has done this many times before. But sits there pretending he has never heard or experienced what you are telling him. Meanwhile, you're sitting there pretending to be an expert in the technique, telling them what to expect, when in reality... You've never done this before and have no idea what to expect! It's a very odd scenario!

Anyway, it turns out the rectal exam is extremely useful, not just for checking peoples prostates. It seems to be a good way to yield a lot of clinically useful information, especially with regard to unexplained blood loss and cancer. Even though both parties are less than inclined to go there most of the time. To paraphrase Talley "the only reason you shouldn't be doing a DRE, is if the doctor has no fingers, or the patient has no rectum."

So there you go, as you get older, it's just another one of those things you have to look forward to. But much like christmas, probably better to be the giver rather than receiver... Maybe. It's just generally weird.

And thus my 4 week intensive of the GIT system concludes. Now on to endocrine and reproductive, where more educational experiences no doubt await. Ummm Wooo?

Reporting in

Had a really long week at medical school. I'm not sure why, but somehow it got big on me. Consequently I feel very very tired. But, I guess compared to others I have nothing to complain about!

Still, there are a few reasons people often list for not wanting to go to medical school. One of them is working with dead people in order to learn anatomy. It's a confronting thing to do in many ways.

I remember this time last year, just wigging out at the notion of having to see a dead person. I was really nervous about it. I'm not sure why, but I'd never seen a body devoid of the essence that made it human before. But I sucked it up, and it was all fine.

So far in medical school the pracs with cadavers in are generally prosected already, and all you have to do is take a peek, see where that organ lies, or where that vessel goes. It's really helpful in that sense, but still similar to looking in a text book.

Alas though, recent evidence has shown that the best way to teach students is to actually have them perform dissection themselves. And what was once an elective has become mandatory. Without going in to too many details, my partner and I found ourselves face to face with a cadavar today. It was a strange experience.

One thinks one would feel rude about it, exploring somebodies body without them consenting to you personally. But you know they made a choice to be there... And then sooner or later you find yourself trying to tease two bits of body apart and you forget they used to be people. So many strange feelings!

But it was fascinating, and I've learnt so much. As we were working, the topic came up of what a privilege it is to be able to do this. Not many people in the world get to see the wonder of the body in all its magnificent glory like this. Our guy also has benefited greatly from medciine. He has a pacemaker still in him, his chest still had old staples holding his sternum together, and evidence of a central venous line.

So I can't help but wonder if that was anything to do with his compulsion to donate his body to science. I know I don't have a strong compulsion to do it, at least not now!

Incredible really. Incredible.

Reminders

It's funny. Sometimes I see things, hear things or read things that remind me that I am at such an early stage in my medical training. I've read some good blogs from doctors and students alike, that serve to freak me the hell out sufficiently to want to know more, and make me wonder if I'm cut out for it. And then there are other events... I saw a fellow student, looking mildly shell shocked after performing his first DRE. Groan... enough said. I hope I'm an alright doctor...

Meanwhile, I have some fun. The editor of Placebo was sufficiently desperate, that I was asked to submit something. So here you are, feel free to have an advanced copy.

How to be a stand out performer in PBL.
So you’ve made it to medical school! You’ve got the stethoscope your family gave you as a congratulatory present draped comfortably around your neck, and you’re ready to get down and do some pseudo-doctoring!

But easy there Tiger. Before you get down to saving some lives, you’ve got to go through this PBL lark. The rite of passage for all Flinders Medical Students. The mandatory mode of learning you waxed lyrically about in your interview. Remember, PBL is a fun educational tool, that will serve you well. And if you don’t like it, than at least attend to demonstrate that you know the significant difference between palpating the perineum and the peritoneum*. Or that Military tuberculosis is actually spelled and pronounced, Miliary Tuberculosis*

So having surveyed a few comrades, we’ve compiled a list of seven sterling tips, that will help you stand out in your PBL like the flower in a pot of dirt you’ve always known you are.

1. Always be condescending. Remember, dismissing other peoples ideas out of hand is a good way to educate others, whilst showing how smart you are!
2. Begin all anecdotes with “In my experience.” This will add weight to your absence of experience and knowledge.
3. Arrive late. Whilst the rest of the suckers might get there early and draw diagrams, your vast experience and laissez-faire attitude will allow you to arrive fashionably late. Twenty minutes is optimal, as your group will politely wait the first ten, allowing you to skip the recap and proceed straight to teaching your group new things.
4. Forget PBL food. Remember, a hungry PBL group is a focused PBL group. Time spent munching can better be spent on the Kreb’s cycle.
5. Use permanent marker. White board markers are for wusses. What you put on the board is gold, and should be remembered for the ages.
6. Claim other groups’ work. Did the previous group forgot to wipe the whiteboard? No problem! You were only going to put the same Guyton diagram up as the previous group anyway, right?
7. Pick a fight with the tutor. Just because they have a medical degree or a Ph.D in the area, doesn’t make that story you read in Woman’s Weekly while you were getting your hair done completely wrong.

By never doing any of these things you’ll be greatly loved by classmates and tutors alike. In fact, recent research has shown that the only thing that can make you more popular is hooking up with your classmates and tutors alike! But if you don’t like to defecate where you masticate relationship-wise, listening, discussing and being a constructive part of your PBL group will see you become an outstanding medical student.

* True stories!

I also hope to be a better doctor than author...

And we're back for another year!

School went back this week, and it was with much joy and happiness that we found ourselves sitting in PBL first thing monday morning. Once again, I'm happy with my group, which means I've been very fortunate in my group allocations for the entirety of medical school. Though only 5 of the 7 group members have turned up yet. Still, there's hope!

I always enjoy the start of a new block. The first session is usually quick as nobody knows anything, and then the first week is painful, as you sort through numerous books deciding what's helpful and what should never have been written in the first place. It all works out in the end, and we all have a bit of fun getting there.

In a way I'm kind of excited about this year. It marks the end of solid book based learning, and transition to pseudo-doctoring. Or as I like to think of it, I'll be a half-doc come year end.

I'll be honest though, going back to educating myself these past few days has been hard. I've really enjoyed the holiday period. The jeep is filled with sand. At times you would have found golf clubs, tennis rackets, fishing gear and bathers stashed in the back. I have had a great break, and it was the first real holiday I've had in quite some time. It was great to feel relaxed for weeks on end. I'm already looking forward to the end of the year so I can do it all again!

Unfortunately though, there are a few obstacles to be overcome yet. GIT, Endocrine and reproductive, Brain and behavior and the intimidating musculo-skeletal blocks must be conquered. And that unfortunately will require some mental effort. Oh well, I always have my mantra to chant:

"It beats getting a real job!"

Arrrr me mateys! What? Too soon?

Recently, for those of you lucky enough to have seen any piece of news material, a large cruise liner went Titanic. But instead of sinking it rolled over on its side a few hundred metres from an island, and 99% of the people on board escaped unharmed. Half the boat however remains under water.

In the news reports that followed, the pushing and shoving etc was widely described as pandemonium, chaos and other similar, yet disastrous adjectives. But due to the proximity to land and sufficient numbers of life boats, few lives were lost.

But I had to have a bit of a chuckle to myself though. There was an interesting tid bit article on one of the trash web sites (news.com.au), about whether 'women and children first' should still apply in this day and age. In a society where it's deemed to be every man for himself (so to speak) wouldn't we then just end up with life boats full of muscly guys who have fought valiantly for their own survival?

Hmmm, I'm all for equality between the sexes. But that one's a thorny issue! Enough said really... But not really.

A few "Lol" worthy points were raised in the comments section.
The ironic observation was made, that on average women are more chubbed up. Therefore, if anyone should have to go in the drink, it should be the girls as they will survive longer in cold water. Guys, with more muscle and higher metabolisms will quickly freeze (a la Leonardo DiCaprio V. Kate Winslett). It made me "lol."

Some optimist also had the cahones to suggest that proportional representation should occur. I'd like to see that get sorted out on a sinking ship though!

Anyway, I'd be interested to hear your thoughts. I'm going to assume we're all modest enough to say that the kids can go first. But does gender equality demand men and women die in equal numbers these days!?

Consider this link maybe

gtg save a life bbl

On occasion I have been known to chat to friends on the internet, or over the telephone in a textual based manner. Having grown up in the PC generation, this occurrence is quite the norm. But in recent years, as my friends have grown up and changed, got jobs etc. I've found that the conversation tends to end slightly differently than it used to. in previous years it would dwindle to nothing, or a pleasant 'gnite' was dropped.

Nowadays though, it just seems to end with "MET call, adios" or "gtg, cat 1" as my friends dash off to save a life. Interesting times. Funny to think that I might get to say that one day...

Anyway, somebody posted the link to this video on the forum for my cohort of med students. I found it interesting, and confronting. But fascinating to see what its like to try save people in a war zone.

War is silly.