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.