War and Peace on D Level

I was pottering around on the wards today, trying to find a patient to chat to who wasn't a) asleep, b) confused, c) uncompliant or d) dead. As I shuffled along to the third ward in vain, I absent-mindedly looked up and I found that I'd wandered into a group of pensive looking nurses, who were staring defensively down the corridor, and backing off fairly sharpish. I didn't have time to fully get my bearings before I heard somebody say "careful, he's got a glass as well", and then caught sight of the tumbler hurtling towards our general direction. As the shards of glass cascaded around my shoes I finally got a good look at the barefoot, unkempt elderly gentleman from whom they had originated. He was sporting a rather nifty clashing pair of NHS pajamas, two sizes too big, and was ducking and diving around outside his sideroom, bright eyed and ready to go. Obviously something had set him off, in most cases it's fear stemming from confusion about where they are or what we're doing with their arm and needles. The sister ordered that all the bay doors be closed, and all the petite little nurses and physios retreated to a safe distance. She asked someone to bleep the junior doctor, so he could "see that he really is this bad". Blatantly we'd been ignoring him in the past, as I mentioned in an earlier entry, doctors hate everyone and deliberately treat them badly, just read the Sun. Only a porter held the elderly patient at bay with a transporting cage, much like a gladiator would hold back a lion with a trident. Whenever the patient tried to get around the cage one way, the porter would roll it around and cut him off. I felt obliged to ask the sister if there was anything I could help with, but I'm sure my honest offer was misconstrued as a macho dig, that I assume that in my capacity as a man I have a sworn right and duty to protect all women. But, thank the lord, the porter kept the old guy at bay until security arrived and cracked open their extra large bag of bravado. They opened with the line "oh, it's you mate, we had a chat on G level a few weeks ago. Come on then, pipe down." They don't have to crawl through a mountain of red tape to talk honestly to a rowdy patient like we do, and they do it well. I didn't want to get in the way any further, so I lurked off for my fifth coffee.
In retrospect, when I offered to help restrain him, could I really have won that battle? On one hand, if I wasn't forceful enough, and a nurse had gotten punched or something, I would've had some apologies to make, let alone a feeling of incapability. On the other hand, if I appeared too forceful, I'm suddenly abusing a confused old dear who just got angry because he forgot where he was for a second. No matter how much "conflict resolution" I do, no matter how good at karate I get, I couldn't have done much good. Either way somebody is getting hurt, or at least getting a big kick to the ego. Just another one of the semi-reflective situations I find myself in from day to day, struggling to learn lessons from them, although their poignancy suggest they should teach me something about life. I guess we don't have time; we brush up the broken glass, calm him down, and hope it doesn't happen again for a while.

The Hunter becomes the Hunted

In the giant metaphorical food chain of hospital life, we medical students are somewhere pretty damn close to the bottom. Like gazelle on the savannah we tiptoe around in sensible, safe packs, making it much more difficult for any one animal to get picked off by a predatory lion (consultant, sister, hell, even the bloody librarian). Woe betide the straggler, the weak, lame beast that falls behind, because they are lost to the wilderness of trying to get a straight answer out of anybody, trying to find that one convenient second in which to ask someone what there is to do.
When face to face with a more superior mammal, the survival techniques are learnt quickly. Avoiding eye contact when posed with a difficult question. Walking at the back of the pack during rounds, anticipating the obvious thunderbolt of cringing embarrassment when the consultant actually tries to be friendly with the patient.
Camouflage is by no means useless either- carefully positioned stethoscopes and ID badges, plus an air of confident business can easily lead to us being mistaken for junior doctors, an infinitely more respected bunch. As long as you say that the patient in question is not under your care then you'll be untouchable as far as abuse goes.
But maybe the gazelle is not such an appropriate simile- we do have some aggressive characteristics. I admit, it takes a large herd of us, and a fair bit of irritation, but we can bite back. Take today for instance, when a group of 12 of us were being taught by an SpR about the intricacies of the clotting cascade, in which approximately 15 factors get activated, inhibited and promoted by eachother. After ten minutes the diagram had more arrows in it than Robin Hood's practice tree. Not the simplest topic to teach, but when you stumble over your own diagram, lose the thread of the questions and then respond to a perfectly reasonable question about physiology with "that's just nature's way of doing it", then you're dangling a very bitter carrot that might just get bitten off. The poor SpR didn't stand a chance. Bless him, but he didn't quite have the intense theoretical knowledge you need to hold off the barrage of endless curious questions we ask, and the chinks in his armour cracked wider and wider as we rephrased the same questions over and over, finally giving up, stating that "it would be too boring" to keep asking the same unanswered question. We laughed when he couldn't find the relevant section on the picture he'd drawn two minutes ago. We sighed audibly when he couldn't tell us precisely which factors inhibited precisely which other factors in every possible scenario of disease. We closed in for the kill and shared the flesh out in gruesome chunks. All the pent up stress of being preyed upon day after day comes pouring out, and whether you think it's caused by deeply laid cynicism, bruised egos or a desire for mutual respect, sometimes these gazelle grow some claws. We know we're pretty average as status goes, but we're snapping at heels, and we like the thrill of the chase.

Bears Shit in the Woods

And NHS staff get abused at a ridiculous rate. Welcome to the wonderful world of obvious statements, although recent "research" enblazed across the tabloids would suggest that this abuse is a secret, new issue. The fact is, NHS staff work under pretty unique conditions. They work crazy hours, in the absence of an adequate number of colleagues, without great equipment, with patients and relatives who believe, unfortunately incorrectly, that because they pay their taxes that they should be entitled to the best health care physically possible. In reality, they get what the NHS can afford. And blame the staff when the "miracle drug" is in fact a cramped bed on a noisy, indignant ward crammed the seams with MRSA and "psycho nurses". Well, that's what the media would have you believe.
I hear so many stories that cast the NHS in a bad light that I've started telling people that doctors actually hate people and want to see them suffer. We get up every morning, dole out the illegal overdoses of morphine, spray MRSA from little cans, fill the beds and waiting lists up with unnecessary cases and then start mentally abusing whoever is left alive.
So just for a change, when a news story actually takes our side, it treats a long standing issue like it's just started. Notices against abusing staff have been on ward walls for at least a decade. Paramedics have been wearing stab vests and asking for police escorts for ages. Nurses are treated like crap, doctors like malpracticing idiots. My point? I'm not really sure, but maybe it has something to do with sympathy for medical professionals, I don't know. The patients may be ill, but when they get better, they can go home. We will still be there, every day, with more ill people. So although we care, we are still human, and not bottomless pits of love and affection. Treat us with respect in your time of need, and we won't half mind.

Endless Education

One of the things about medicine is, for every one subject that you read about, you find three more that you need to revise. I thought I needed to know a bit more about renal failure, so I cracked open the textbooks and had a look. Everything was peachy until I came to the "causes" section and noticed that I knew nothing about prostatic hypertrophy, and then the "treatment" section where antibiotic subdivisions popped up again. I flipped to the corresponding chapters, but lo and behold, these contained more new questions than old answers. I could have spent all day traipsing from page to page, making the previous section make sense by filling in the gaps with info from the new one.
This phenomenon leads to the misconception of thinking that you know less than you do. I continuously find whole fields of knowledge that I know nothing about, but that doesn't mean that I don't know anything about medicine. I know a hell of a lot more about most things than I did when I started, when I couldn't point to a spleen if it put on some shoes and tapdanced on my tits. But there will always be three things to learn for every one thing I already know, that's life. Medicine is massive. The secret is learning enough to pass exams, keep your superiors happy, and most importantly to keep yourself content in the knowledge that you are a competent, respected doctor.
That in mind, I've had my relaxing weekend at home and now I'm back to get stuck into the schedule again. You can't keep going indefinitely working 9 hours a day, 5 days a week, sometimes you need to come up for air. Now I've had a break I can fully reabsorb myself in the devilishly complex and addictive world of medicine, and see how much I info I can soak up before I need another breather.

I Fought the Law, and they sent me an Apology

Well well, the weight of bureaucracy crumbles under the sustained pressure of a single pissed off medical student. Agreed, when they gave me a parking ticket for parking right outside my own house whilst displaying the correct permit, they might have been entering into indefensible territory, but still, I made them pay. The semi-apologetic letter written and signed by a low-grade Parking Services pen-pusher really put the case to rest. Power to the people.
Back to mundane reality, I handed in my second and final essay of the year on Thursday, so now all that stands between me and 9 weeks in India this summer are 3 small, perfectly failable exams. Just scanning through the past papers makes me realise how shite at medicine I am. What antibiotic do you give for peptic ulcer disease? How you feel is how I feel (unless you're qualified, you lucky bastard). What ECG changes occur in hyperkalaemia? I'm only relieved of sheer terror when confronted with a sociology (aka common sense) question like what should Mr Smith do personally to reduce the risk of a second heart attack? Hmmmm...stop smoking? Get off his fat arse? Take the Chinese off speed dial?
Randomly skipping from subject to subject, we had a tutorial with a doctor who famously suffers from Prosopagnosia, he cannot recognise familiar faces. His own daughter could pass him in the street and he wouldn't know her from Eve. Interestingly, he only realised that something was wrong when in his mid thirties he heard of a criminal who had escaped and was disguising himself. To the doctor, the idea of disguising oneself seemed totally pointless, why would anyone bother when you are unrecognisable if you simply changes your clothes? Anyway, he has lived with the condition his entire life, and being a consultant, it hasn't caused him too much of a hindrance, although I'm sure he'd fix it if he could. When he meets you, you can see him visibly recording your features, effects and build; with the girls he jokily asks them to wear the same earrings every day. His condition aside, he is an excellent teacher whose clear articulation is a large benefit to him.
The mind is a strange thing, I heard of a man once who was blind, but when you showed him a card with a basic shape on it, he would "see" the card and tell you which shape it was, 100% of the time. He could see the card, and everything else, but his brain wouldn't let him view what his eyes received. All very complex, but enthralling.
First things first for me though- which antibiotic for peptic ulcer disease?

Under my Care

He was 53, and had been a lifelong asthmatic. Earlier this morning, he suffered from a severe asthma attack and an ambulance was called, which took him straight the Southampton General, by which time his airway had deteriorated considerably. All he had to count on for survival was me, and another third year medic. We tried our best, tried to remember which procedures to do and which regimes of drugs to give, and via which route. He didn't improve with nebulisers, and as we were getting an IV line in and bleeping the registrar, I noticed his BP had dropped. As I struggled to think of a way to improve matters, his heart rate dropped from 180 to 40, then to 30, 20 and then, finally zero. We started resuscitation, but after 2 cycles we had to stop. He was dead.


Thank fuck he was made from plastic. The Simulation Suite is a great learning tool.

It was a rather too realistic experience with the life-size doll that can talk, breathe, get injected, crash, recover and die, but it was a very useful hour. If there's one way to remember the pathway for treatment for a certain disease, it's to learn it after you've panicked over a dying "patient" wishing you'd learnt it already. It's crazy-we learn the basics over and over and OVER again in lectures, seminars, and during bedside teaching. But today when the guy crashed we didn't even ring 2222 for the cardiac arrest team, probably the most essential rule on the list.

On a lighter note, I handed in my long-suffering essay over the net today. To make things "easier" the School of Medicine makes us hand it in twice, so I'll have to hand some paper copies in tomorrow, but I can't change it now. My "grade sense" is fairly good, and I'm sensing a B.

Normal Service Resumed

The results are in, and surprise surprise, I'm not medically ill. The GP seemed more taken aback than me, I think I knew what he was going to say. Even so, it's very strange to see your hormone and enzyme levels written on a screen-you don't associate yourself with your insides. I have 14.0 units of T3 in my blood. Cool. I have 180g/l of haemoglobin. Kushdy. I won't get overly dramatic but it's like meeting a person who you've been talking to over the phone for years, but have never seen.
He suggested some multivitamins but frankly just knowing that I'm not officially ill makes me feel a bit better. My essay is due in on Thursday too so after that I'll be heading off home for a long weekend to catch up on some lazing.

"The longer I run, the smaller my problems become." That seems to be the new slogan for pushing jogging on the masses, and with plenty of problems to make smaller, I was easily enticed. I'm not a total beginner, I did a few months of running about 4 or 5 miles every day at 6th Form, but the trouble is, your body doesn't remember all the exercise you did in 2003. Thankfully I have a bit of humility so I quickly planned a short route of about one and a half miles (if that sounds like a piece of piss, try it). Drizzle is always good during a run, you get warm whatever the weather so it's good to have something to cool you down. At least for the first half I was enjoying it, but towards to end I was just a bit too achy and let's be honest, unfit to think about much else than the mild pain in my legs and throat. It'll get easier if I do it consistently, but I have a nasty habit of "running before I can walk" and planning a marathon training schedule after a mile jog.

Worst Weekend EVER

Generally the worst thing you expect to have happen to you on a hockey tour is that you might have too many beers the night before the coach trip home and feel quite fragile for a few hours. Oh no, not me.
I actually did get at least 3 beers down me before the headache kicked in. Bit early for a hangover, I thought. Then I got dizzy. Very dizzy. All of a sudden I couldn't stand lights, or noise. I started to sweat. Not nice to picture, I know, so at least picturing the raging fever I got may be less disturbing. Enough, you think? Not a chance. I got an instant blocked nose, and sore throat. When my mouth was open long enough to take respite from breathing, I coughed. I lost a lot of my bottom lip from unwillingly biting it in fits of nausea. I had muscle pain. Everywhere. My abdomen hurt, occasionally searingly in localised areas.
When I finally got to the hostel bed (nylon sheets, top bunk without a ladder, room next to the front door) I curled up in a ball and prayed for sleep. Hell no, life isn't that easy. A sodding rugby tour decided to sing in chorus right outside my door until 5am, about the same time that my teammates came back in themselves.
In the morning, no better. I asked for a few bottles of water, but when they were gone I took about an hour (seriously) to get some jeans on and stumble out to the reception and ask for change to get some more. I looked like hell, and by the receptionist's comments, which I don't entirely remember but contained some references to smoking, I also looked very stoned. Unfortunately not.
I returned to my sweat-pit with a half litre of Evian and a packet of M&Ms. I later realised that I'd lost about 3 or 4 pounds.
Finally, on the third day, I woke up and felt confident enough on my feet to have a wander around the immediate vicinity of the hostel. I got about 50 metres before I got the last and not the most attractive symptom. Back to the room, and to the loo. Just to further the illustrative point, my piss looked like I'd been addicted to radioactive Tango since the 60's.
So in my honest medical opinion, what was this life-threatening affliction? Meningitis? No, the absence of a textbook rash or neck stiffness, plus the fact that I'm still alive don't fit the bill. What about appendicitis? Again, much better symptoms, but just like the previous guess, I'm still alive. I'll tell you quietly what I really think it was. An horrendous case of the bloody flu. How manly.
At last, on Saturday evening, me and my friend wandered down to the red light district (surprisingly well kept, full of tourists, actually very acceptable). We were having a nice chat about something or other when in broad daylight, on a street by the river, surrounded by at least 10 people within earshot, we were mugged at knifepoint. I couldn't fucking believe it. I had next to nothing on me, and still felt like shit, and some arrogant black asshole starts jogging up behind me, muttering rubbish and showing me the blade of his knife under his hoody. Looking back on it, if I'd have been feeling totally well, and in a bad mood, I might well have slung him a quick right hook and legged it. But it's easy to say that now, and for the pittance I had on me, he can have it just for being such a total wanker. I hope he uses my money to buy a prostitute with rampant AIDS. Quote me.
We reported it at the local police station, and the officer was excessively nice, despite the fact that everyone in the room knew that the chances of them "solving the case" were next to none.
At last, I got on the coach to go home and was blissfully happy in the knowledge of facing a mere 13 hours between the worst weekend ever, and my quiet, private, coked-up-prick-free bedroom in Southampton.

Hockey Tour

Tomorrow I'm up at 6am to don my mechanic's outfit and get on a coach to Amsterdam. Such is the schedule for the annual Medic's Hockey Club tour. Fancy dress is compulsory and mechanics are easy and cheap to arrange, I got my overalls from eBay two weeks ago for a fiver. Then it's just 10 or so hours until we hit the hash cafes of liberal little Holland, who mind their own business when you're behind closed doors. There's a faint possibility of us bumping into the Van Gogh museum or Anne Frank's annex but I sincerely doubt that we'll do more than drink, sleep, and cause general irritation. There's an even fainter chance or us playing hockey, although we have games booked for both Friday night and Saturday afternoon - last time we toured, only 4 people volunteered to run around on a crisp February morning on the outskirts of Edinburgh. We still won.
I'm glad I've long since finished my stint as a fresher, so I won't have to suffer the indignity of being tied to another fresher for 24 hours, being thrown out of 2 clubs, being forced to drink inordinate amounts of booze and sleep in a bunkbed with approximately 20 other people. I don't think those are compulsory, it just happened to me.
Buzzed the car up to Winchester on Monday night with the Uni chess team. Admittedly, not the most scintillating conversation ever, but with Pete Tong turned up to the max I won't pretend that I had conversation in mind. I drew against a good player on board 2 (each player plays their equivalent on the other team) and it was looking like everyone else was going to lose, until in the space of 5 minutes, 3 of Winchester's players ran out of time. I've not seen that happen to anyone at all for years, let alone 3 people in the same match. Apparently the result relegated them. Typical!

Medical Dramas

The wards are quiet, the corridors empty. The floors are clean, on which only essential staff tread, with measured purpose. The pictures on the walls are tasteful, and the nurse's stations are tidy. In fact, the whole building seems to be as good as new. The patients are always fully conscious, except when they're in peaceful, well monitored comas. They discuss their conditions, which are never visible, in a calm and considered manner with the doctors who are courteous, well dressed and clean shaven. Everyone, absolutely everyone, seems to have constant visitors with mild to moderate personal issues that seem to resolve, either in a genuinely happy outcome or at the least in a peaceful conclusion. All the menial jobs seem to be accomplished by a five second phone call, or by delegating to a colleague who reappears within a minute.
There is no smell of disinfectant or bodily fluids. The floors are not comprised of decade old dusty vinyl, and the walls aren't coated in cheap matt and adorned with tacky, dated "artwork" with grime infested frames. There are no porters, HCAs, cleaners, physios, pharmacists, podiatrists, social workers, nurses, sisters, junior doctors or medical students lurking aimlessly on the ward fiddling with mountains of notes. There is no constant murmur of phones, chatter, renovation or ventilation. There is definitely no pain induced groaning, and never any frail weeping or sobbing. Nobody mutters for a nurse because they need the loo, or can't remember where they are. There have never been any patients that die in a bed in the corner without being noticed for 20 minutes, and hospital acquired infections only cause the odd bout of "feeling a bit dizzy". There has never been a single patient with a personal issue that the doctors don't try to fix.
If you honestly believe the NHS you pay your taxes for is like this, you watch too much TV.

Palliative Care

I got a letter from the doctor's today, requesting my presence at the surgery on Friday. Of course, it's only an automatic letter because my blood test results are back, and even if they come back indicating something that could cause my tiredness then it will most likely be innocuous, but I'll tell you what...it's scary! The mind immediately jumps to conclusions. They must've sent the letter because it's serious....it's leukaemia....shit. Being the patient for just a second reminds me just how different the situations are for them than doctors.
On that note, the work we did today on breaking bad news was quite interesting. No matter what you do it'll still be bad news, but there's plenty you can do not to screw it up even more, like fire a "warning shot" to suggest something nasty is coming. We watched a video (yes, a thoroughly modern medical education) about how not to do it. It was totally hilarious how the actor/patient got angry when the actor/consultant told him that "that's how it goes". And of course, we couldn't get away without doing a roleplay, which was actually pretty helpful. You really got to see how speechless and dumbfounded some people get when they search for a better word than "terminal" or "cancer".
It was part of the first day of my Palliative Care week, which has already cast away some of my assumptions. The unit is modern and run by skilled professionals, and has more than adequate facilities to deal with it's patients, who are often not visibly ill at all. The 72 year old lady I saw today was alert and orientated, and talked fluently and at length about her situation. And quite against my preconceptions, she, like 50% of hospice patients, will go home. The services are used for exacerbations of terminal illnesses, but not exclusively at the very end of life.
Unfortunatley I won't be around for the last day of the week, because I'll be on hockey tour in Amsterdam, possibly trying out painkilling medication in totally different circumstances.
Ironic, I can't help thinking.

The Cheese and Onion Bible

I have procured a copy of the Bible of medical students, the Koran of junior doctors. Yes, it is the holy text of the inexperienced medical world. With the Oxford Handbook of Clinical Medicine by my side I am instantly transformed from a stuttering amateur to a seasoned professional. The priceless publication is in the possession of the majority of my colleagues and it is by far and away the most valuable 850 pages I'll ever need. It has chapters on everything from asthma to AIDS, paracetamol to paralysis. Due to it's lovely green and yellow cover it is frequently referred to as "the cheese and onion". Bleep your consultant and confess to not knowing if you can give steroids to your patient? Screw that. Ask the physio if your patient can get out of bed before 2010? Hell no. Check the cheese and onion. Patient crashes in the corridor and you can't remember what traces are shockable? Run for a cleaner's closet and check the Bible. Basically, I can stop working, spend 4 months chilling out in the Hospital cafe or playing Stick Cricket on the net and then breeze my exams, because as long as the blessed book in within 5 metres of my person, I am a invincible medicine machine.

Being the Patient for a Change

Sorry about the lack of frequent posts, I've had things to deal with! Right then, today I missed the morning lectures (thank God, apparently they were shockingly boring, all about pain management), to go to the GP surgery and discuss my recent lack of energy. Not a big concern, but worth checking out seeing as it's been going on for a few weeks and it came on quite suddenly. He did the usual, listening to my lungs and heart (slightly clueless as to why, but hey, he's the doctor), and then a blood pressure(110/76, lower margins of normal), and my pulse (72, normal). Finally he ordered some blood tests........

1. FBCs (full blood count, checking the amount of my red and white blood cells)
2. ESR (erythrocyte sedimentation rate, how quickly the red blood cells fall to the bottom of the tube)
3. LFTs (liver function tests,to check that my liver isn't falling apart. It isn't, trust me.)
4. U+Es (urea and creatinine levels, to check that my kidneys are filtering properly. Tell your mates what it stands for during Holby City)
5. TFTs (Ahah! Thyroid function tests, actually something that might be useful!)

.............and told me to bugger off to the nurse and get stuck (a term used by doctors, meaning to have blood taken, and yes, sometimes meaning to well, you get the picture). She reminded me of how utterly shite I am at taking blood by glancing at my vein-deserted arm for approximately half a second before conjouring blood up from the middle of nowhere, and filling two sodding tubes. I'd be lucky if I could extract that much blood from a patient using a chainsaw and a bucket.

The GP said he was highly suspicious that the TFTs might come back with some diagnostic results but I'm not holding my breath, it's just an off-chance that I want to remove from the back of my mind, so I can get off my clinically healthy arse and get some work done.

In the afternoon I had my weekly Global Health session, HIV and TB this week, lots of statistics. Why is the morbidity rate for HIV falling in some sub-Saharan countries? Yes, well done, it's because everyone that had it before is now dead. And we still do bugger all about it apart from send Bob Geldof to sing a supposedly curative rendition of "I don't like Mondays". The 21st century, ladies and gents.

By the way, which one of these 3 is least likely to happen-

1. I co-pilot my spaceship with Elvis, and we hit the Loch Ness Monster
2. I win the lottery on two consecutive weeks with the numbers 1, 2, 3, 4, 5 and 6
3. I actually get allocated one of the two places on next term's A+E optional unit

No clues, answers on a postcard (and it's not 1 or 2)...

Random Revision

I managed to get into the hospital for 11am today, and did a short session on assessing consciousness. The two different systems used are the AVPU system (alert, voice, pain, unresponsive) and the Glasgow Coma Scale (GCS, often heard on Casualty). GCS is measured out of 15, but don't worry, you can't score less than 3, not even Jade Goody could do that.
After that, I filled an hour with some random revision, a technique I'm developing, where I pick a random topic and take notes on it and related topics. Since we're being given no revision list (apparently it was ill advised after last year's exams didn't relate to it very well), it seems to be the only way to go. Plus, unlike other courses, I'll probably end up using the info anyway, even if it doesn't come up it exams. Today I worked over diverticulitis, Crohn's disease and ulcerative colitis, three common and nasty bowel diseases. I also gave the surrounding blood supply a quick look.
After that I nipped back to the main campus to do my "mentor training". I've been assigned 3 sixth form students from nearby colleges to mentor over the internet in the coming year, I'm getting paid but it'll look good on the CV as well. Plus, I suppose, maybe I'll get something out of it too, come up with your own vague adjective like "rewarding" or "fulfilling". Anyway, the training was partly group work (bloody hell) and partly getting to know the software.
Noticed that my poker earning were beginning to slip down so I stopped the rot and cashed out, approximately a hundred quid better off for 6 day's play. I didn't need as much money as I first thought, and I don't need an excuse to stay up late when I'm so tired.
On that note, doctor's appointment is for Friday, on the off chance my prolonged tiredness is based on anything easily remedied.

24 Hour Lie-In

Today I couldn't get out of bed. I've been feeling a bit lethargic recently, downright faigued sometimes, but this was a new one altogether. I just couldn't get my feet out from under the bloody covers. I wanted to. I had things to do and lots of other things to find to do. But I couldn't budge. Heavy eyes, non-complaint body. I don't want to jazz up good old student laziness, but it's gotten to the point where it's affecting my work. So I'm going to book an appointment with the GP and see what he says. If it turns out I'm just lacking motivation then that'll be alright but there's no point in struggling on when I could have hypothyroidism or something. However, knowing my GP, an aging asian man who has the uncanny ability to conduct a consultation speaking only three words and making no eye contact, I am struggling to predict how it will go. He'll probably do one of a few things-

1. Misdiagnose it as depression, give me an SSRI and tell me to fuck off.
2. Misdiagnose it as chronic fatigue syndrome and tell me to fuck off.
3. Tell me I'm lazy, and that I should fuck off.
4. Stare at me inquisitively for two minutes, wondering why I thought this was his problem.
5. Tell me to eat healthier, stop drinking and find a relaxing hobby. And fuck off.

Still, there are no end of perfectly productive things that you can do in bed (calm down), so I researched a few pages about stroke and the Circle of Willis (blood vessels at the base of the brain). I could draw the structure off-hand now, but come exam time doubtless the info will have been replaced with the names of all the wars that France have lost or some other useless but highly interesting fact. I saw a few of the past papers for the summer exams this week, initially I almost fainted from shock but now I've come to terms with the fact that you have to give everything a good guess, and get 50% to pass. Last year's average was 55%....

The ABC of taking blood

For all you puzzled people out there who are wondering just how an experienced medical student carefully extracts blood from a patient, I have prepared the following learning aid. It's foolproof. Don't try it at home though, it's for trained healthcare professionals only.

Copyright-The Rising Medic 2007

Ray Mears - Legend or Fraud?

I've just seen some of Ray Mears on TV, chatting about how the forests of Britain can sustain anyone indefinitely. Pretty cool, I thought, as Ray goes on to explain the characteristics of the most common edible mushrooms. He says "oh, those will be excellent", and the scene cuts to Ray sitting in a clearing with a fire going and the mushrooms nicely sliced. Hang on...a fire? How did he do that? Never mind, I'm sure it's possible by rubbing sticks together or something. And I'm sure he sliced the mushrooms with a sharp rock.
Then things get a bit less realistic. He whips out a wok and fries the mushrooms with butter and tomatoes. Come on Ray, did you fashion that pan from twigs and berries? Did you breed cattle and churn the milk into butter? But in the end I excuse him the discrepancy and put it down to convenience.
But then, inexplicably, he quips "much better with a dressing and bread" and magically materialises some ciabatta bread and balsamic vinegar. Come on Ray, there's ease of filming and then there's just cheating mate. We could all live in the forest indefinitely if Domino's know which tree to deliver your fucking pizza to.
In a different scene, he explains the nutritional virtues of chequer berries, or something like that. "Lovely, I could eat them all day, but they've been forgotten by rural society" he gleefully states. It's only at the last second when he quickly mutters the probable reason for their banishment from the menu- "best not to eat the stones in them though, they contain cyanide".
Oh, and right now, he's glazing a pig on a spit with a brush he made from a branch. You tell me-genius or cheat?

We Wuz Robbed...

Yesterday I played for the Southampton medics against Sheffield in the national semi-final, and to cut a long story short we lost 4-2. It's the third consecutive time that we've lost to Sheffield in the semis and each time we seem to get progressively more unlucky. This time, we scored early, only for me to see a savable shot bounce nicely under my hand-pad during my dive. We scored another nicely worked goal but again, 5 minutes later, during a lengthy goal mouth scrap they squeezed the ball across the line after I couldn't get my feet in the way for a third time. We dominated and were unlucky not to score again, but then in the middle of the second half they whipped a ball upfield into the D and their striker caught it with a badly timed slice and sent it low towards my near post. I got fingers to it, but when it bounced, the backspin sent it in. I couldn't believe it, during training those things happen about once a week and I had 3 in half an hour. They scored again, our defence was tired and disheartened and the goal was well worked. At least one of their midfielders got yellow carded for appealing for decisions too much, every time we got the ball back he looked like a toddler who had just had his sweets nicked. Although the goals in my view weren't largely due to my errors, I think I'll give hockey a miss for a while now, goalkeeping at least. It's not the most rewarding position on the pitch and you never have a chance to redeem yourself if you mess things up. I might try outfield play for the 2nds or 3rds.
My dad came down and we had a curry, I deviated from my usual vindaloo, and it was a nice change to taste something other than searing pain.
And at karate, we got a chance to use some bows (six foot long wooden poles). Let me tell you, have a black belt swing a massive stick at your face for 2 hours will do your cortisol levels no good whatsoever.
As for today, I have a day off everything, for the first time in weeks. I'll lie around in bed for a bit, and play some more poker. I'm up to $240 as we speak, and I haven't even been especially fortunate. I might draw up the final appendix of my essay, but there's no rush, I have 3 weeks. What a boring, work-loving young man I am.

Back to the Tables

I made the schoolboy error of checking my bank balance today, and of course I regretted it. I'm not flirting with the overdraft limit but for this stage of the term I'm certainly running low. So, seeing as my essay is 90% done with three weeks until the deadline, and my hospital work is going well, I decided to see if I could make some cash back on the online poker tables. I won't bore you with the details (because to the layman it is boring), but I'll just say that my $50 is now $170, after fairly little effort. Ah, just $50, I remember the days when I was a highroller with $6,000 in an online account. I withdrew it all, for a good reason. No matter how much I improve at poker, no matter how good I get and how much money I win, it'll only ever be a stopgap job to top up my loans until I qualify. Keeping that much money online would've only served to trick me into taking it more seriously and hence getting more emotionally involved.
In fact, I had the opportunity to discuss my views on gambling on tape for a PhD student's study today. She interviewed me about my opinions on problem gambling, the opinions of my family and friends towards my gambling, and related topics.I made it clear than I regard poker as a game of skill (despite common thinking) and that I'm not naive about the perils and unavoidable losses involved in casino gambling. I hope I came off as genuine.
Teaching today was based on infection in the morning and I had my Global Health session in the afternoon, this week about poverty. I find contributing in these sessions easier than in other subjects, probably due to my personal interest. Just a quick fact, one in seven mothers will die during pregnancy in Niger. In Sweden, it's one in 29,300.
Tomorrow is the biggest hockey game of the season, Sheffield are coming down to play us in the national medical schools semi-final. I for one am sick of them beating us by the minutest of margins in the semis, and it's about time we changed the tune.

Dignity

Dignity is one of those things that you don't notice you have until you lose it. You don't realise that being able to speak without drooling, change the channel on the TV without pushing the remote off the bed, and take a piss without having to call a nurse to help is quite a privelige. But every day I see scores of people who have had this privelige removed. And I hear you say, "it'll never be me, those people are different". Whatever. I saw a stroke patient today in his forties who up until last week was a fully functional man, working 9 til 5, picking the kids up from footie, kissing his wife goodnight. Then during a phone call he collapsed and now he can't even think of the words to say, let alone say them. And the crime he commited for this punishment? He possibly had a few pies too many, smoked a few fags with the odd pint. That's it. Remind you of anyone?
Life isn't fair. Health isn't fairly distributed. Some people smoke 40 a day for life and then slide away peacefully in their sleep. Some people get up in the morning and die suddenly in the shower from an undiagnosed hole in the heart. We'd like to think that there's some invisible force, a God if you like, who will be there to give us a hug when things go a bit wrong, someone to give us a reason and a second chance when we get the rough end of the deal. As much as I'd love it to be true, with my experience it just ain't.
You get one shot, and you'd better use it, love it, and regret nothing, because before you know it I'll be standing over you with my consultant, pretending to understand you because you can't speak without drooling and need help going for a slash.