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The Storytellers

Last week, I had dinner with a group of acute care physicians.

We are all storytellers. I tell the funny stories, the moving stories, the profound stories, and the ordinary stories. Sometimes, I tell stories that have been told to me by other people. I’m a blogger because there are stories I want to tell. I think we all do it, we all have a wee stash of good stories that we like telling and that we know get a good reaction from our audience. Of course, there are some that always get a good reaction no matter how they’re told or who they’re told to — I have a friend who likes to tell people about when he met the Queen and started talking about tampons — but, more often, stories are better when they’re told to people who have had common experiences. This is why you put seventeen Anglicans in a room and aren’t surprised when they start telling stories about funny things that have happened at funerals.

It’s no different with medics. If we end up around a table together, we will pull out all our best bits. We share stories about ridiculous things that have been done in the name of infection control (getting intercepted on your way out of theatre by an HEI inspector who wants to know when you last did handwashing training), least likely investigation results (a troponin level of 3.28 on a man who hadn’t thought himself unwell enough to come to A&E), most surprising greetings from patients (“um, can I have a cup of tea, please, doctor?” shouted from the room of a woman who had been GCS 3 every time we’d checked for the last week), and craziest experiences with patient transport (calling in a helicopter from the Ministry of Defence during the volcanic ash cloud). The fact that these are our best bits may explain why we make awkward dinner party guests.

In the middle of dessert, the conversation turned to funny stories about life support training.

I was the only person at the table who wasn’t an ALS trainer, so that was fairly predictable.

The only good story I have about life support training comes from my most recent OSCE. It all started well enough. I got the sticky pads attached and the monitor switched on, and I had identified VT and debfibrillated properly. I’d done all the things that we’re supposed to learn how to do in third year life support skills. The last part of the assessment is to demonstrate that you’ve not forgotten how to do all the rest of it. I tried to dash around to the other side so that I could take over from my “assistant”. I tripped over the Ambubag cable and took a nosedive onto the mannekin and expressed myself using words that my grandmother doesn’t know that I know. So, when third year OSCEs were mentioned, off I went into this story.

And you can meet someone and spend the entire day with them and know that there’s something familiar about them, something that’s tugging at the corners of your memory, something that you just can’t quite place…

I came to the end of my story and there was laughter, and the consultant who was sitting next to me put down his fork and said, “Oh, gosh. I remember that! I was your examiner!”

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Now playing: Barry Manilow – Somewhere Down the Road

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Posted by on October 14, 2010 in Blog, Medicine

 

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On The Move

I can’t believe it’s October, but time does indeed fly when you’re having fun.

My first real rotation has come to an end, and my next rotation starts at 9am on Tuesday.

In Glasgow, our fourth and fifth year rotations are punctuated by a weekend and an academic day. I’m going from a peripheral hospital with a killer commute to a peripheral hospital that I can’t commute to and I’m almost stupidly grateful for the extra day in the city to sort out my life, but 72 hours is still not a big amount of time. I have classes in the morning. In addition to the academic part of my academic day, I need to go to the university in order to beg a copy of my vaccinations record from them and to convince them that I didn’t fail my last rotation (which I really didn’t, but there seems to have been some kind of IT error…), and all of that is before going home to pack and get myself onto a train to the Borders by late afternoon. I’d planned to do tuition fees and visit the bank tomorrow, too, but I’m beginning to think that that will more realistically get done by phone and email and the Royal Mail.

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Now playing: Lauridsen – O Magnum Mysterium
via FoxyTunes

 
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Posted by on October 3, 2010 in Blog, Medicine

 

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Well. Obviously.

You know, we don’t mean what we think we do when we ask about past medical history. First, there’s a handful of common conditions that almost nobody lists as part of their medical history, like hypertension and hypercholesterolaemia. Those are at least sort of understandable. But people don’t think that arthritis is a medical condition, especially if they’re quite stoical west of Scotland types like my patients tend to be. They never think that an ‘operation’ is a ‘medical condition’, even if it was a CABG. They often forget about their diabetes, and, unlike hypertension, that doesn’t naturally reveal itself from the drug history because insulin isn’t a tablet, so, in their heads, it might not necessarily count as a medication. My jaw nearly hit the deck the first time someone made it clear that they didn’t think of their COPD as an actual disease, but it turns out that that’s not so unusual. And on and on and on.

Then, you get the huge glaring gaps in medical histories that nobody could possibly have anticipated.

I was sent with the rest of my clinical practice group to speak with a gentleman who had been admitted to the stroke ward a few days earlier. There are few things more awkward than four people trying to take a medical history all at the same time, and so it was decided that one person would take the history and that the rest of us would observe. The gentleman told us that he had been feeling well throughout the day and had been watching television when he became aware of blurry vision and a heaviness in his right arm, and, thinking that he was having a stroke, had gone and knocked on his neighbour’s window. He had realised then that he couldn’t speak, but the neighbour had called an ambulance and he had been brought to A&E. The guy who had volunteered for the firing line asked about the specifics of his inability to speak, and then asked if there had been any symptoms in his right leg, if he had had a headache, if he had blacked out, if anything like this had ever happened before. It all seemed to be going well. He moved on, asked about any other medical conditions and any past medical history — it was after this that I started asking, “has your doctor ever told you that you have high blood pressure or high cholesterol?”, because we do need ways of getting around the obstacles in the first paragraph and I liked that question and it works. He asked about family history, about medications and social circumstances and smoking and alcohol intake and recreational drugs.

Finally, he asked, “Sir, can you take me through exactly what happened on the day you were brought into hospital just once more?”

“Well, I got home from my radiotherapy at about lunchtime…”

Collectively, we wondered if we had misheard that.

“Right,” he said. “Okay. Um. If you don’t mind me asking, what is it that you’re having the radiotherapy for?”

The patient looked at him as if he might have a screw loose. “Well, for my lung cancer.”

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Now playing: Leona Lewis – Run
via FoxyTunes

 
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Posted by on September 12, 2010 in Blog, Medicine

 

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My Slice of Paradise

Dalbeg, Eileanan Siar

See, who needs tropical beaches?

I had an incredible time on elective. I came because I wanted to experience rural and remote medicine in my own country. It’s completely different to anything I’ve ever done or expect to do on the mainland — it’s not much bigger than a medium-sized cottage hospital, everyone knows everyone else, you can’t get labs after 5.30pm or a CXR on the weekend,  and there are no registrars at all. Besides, there aren’t many hospitals in the UK where you hear stories about patients being flown off the island by the MOD during the volcanic ash.

I’ve lived and worked with some terrific people. I’ve picked up a few words of Gaelic. I’ve been to the very edge of Scotland and watched waves come in from the Atlantic Ocean. I’ve got caught in island storms while running along the banks of some stunning lochs. I’ve had a barbecue on a beach. I’ve avoided being eaten by midges. I’ve learned where to buy emergency rations on a Sunday. I think that maybe I’ve even learned a bit of medicine.

Honestly, this isn’t where I see myself working (mind you, MTAS could feel differently). I have many reasons, which all boil down to the fact that I’m a city girl and I’d like my civilisation to be more accessible than a 4+ hour expedition by bus and ferry. But for a month, this has been absolutely perfect.

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Now playing: Mozart – Horn Concerto No.4 in E Flat Major
via FoxyTunes

 
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Posted by on August 17, 2010 in Blog, Medicine

 

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Trial By Fire

My hospital is a remote DGH with a tiny staff. This is a good thing. The compensation for going to the arse end of nowhere is that this is where you’ll find hospitals with fewer students, better teaching, and much more opportunity for getting stuck into things. I was told before I came that at this hospital, I would be able to do practical stuff and improve my clinical skills.

I clerked in my first patients. I learned how to scrub in. I relearned how to take bloods. I stopped trembling when I had to sign patients’ notes, and pretended I wasn’t when I had to hold down a toddler for a blood draw.

At least twice a day, someone asked, “Are you a medical student? Do you put venflons in?” I always told them that I was a medical student but that I’d only ever done a venflon on a plastic arm (and that in my OSCE, I had failed to do even that — but I didn’t say that part), and they always balked and went to find someone else. Eventually, my FY2 found a man with excellent veins and herded me in to his room… and I gave up after the fourth attempt. It happened again on the next three patients. The patient who ended up being my first successful venflon got me because it was the middle of the night and the ward nurse thought that my burgundy scrubs indicated some sort of competence.

The patient didn’t ask if I’d done this before, and thank God for that. I’d not slept. I might have blurted out the thing about the plastic arm.

Although if someone’s putting in a venflon and they can’t work out the venflon dressing, it’s a pretty good indicator that they’ve never done this before.

I cleaned up the blood that I’d got all over her and apologised profusely to the nurses for the blood that I’d got all over her sheets, and I scuttled back to the doctors’ room with my heart still doing triple time. They beamed at me. “Oh, we knew you could do it. You just needed to be left alone to get on with it!” Well, I suppose. Yes. I feel better about them now — getting one in in the mostly dark at five o’clock in the morning does wonders for confidence, even if it doesn’t do much for actual technique. Still, I’d not have wanted to be that patient.

I’ve still not worked out how to get them in without spurting blood absolutely everywhere.

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Now playing: Woldemar Bargiel – Adagio for Cello and Orchestra
via FoxyTunes

 
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Posted by on August 10, 2010 in Blog, Medicine

 

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Babies!

For my junior elective, I’ve come to a remote hospital in the Highlands and Islands. I’d originally planned to do four weeks of general medicine, but, after a collective realisation by the medical students and the junior doctors that there were four students assigned to general medicine and none to anywhere else, we quietly decided to rotate ourselves around the hospital.

I’ve been temporarily adopted by the FY2 in obs and gynae.

Yesterday, I spent the whole morning in theatre. I was allowed to retract things (my arms still don’t quite feel like they belong to me), and later to hold clamps and cut sutures. I think that watching a Caesarean is pretty much the coolest thing I’ve ever seen in my whole life.

Or, as I put it to my mum via email: “I held stuff and felt things, and then he cut other things, and then there was a baby!”

Yes, I sometimes revert to being an eight-year-old.

This week, we’ve got a locum gynaecologist who seems to be a very enthusiastic teacher. So, although it would have been a really cool experience on its own merits, the FY2 and I were effectively getting a five hour gynae tutorial as well. He explained everything that he was doing and why it was important. He made sure that we knew what we were seeing, and, when we were inhaling coffee between operations, he drew out the reproductive anatomy and showed us how the pathologies we’d just seen were different from the normal. I was able to spend a few hours last night with the gynae chapter of the Oxford Handbook of Clinical Specialties, which is one of the two books that I bothered to pack — he’d made me want to go away and read about the anatomy of the female reproductive system. And I loathe reproductive medicine, so that’s an achievement by anybody’s standards.

I think the other important thing that I learned yesterday was that theatre is exhausting. In the afternoon, I went to the maternity ward to check on the C-section baby and was overwhelmed by the urge to sit down on the floor just because it was the closest thing.

 
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Posted by on July 7, 2010 in Blog, Medicine

 

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Requiescat

I flicked to the most recent entry in her notes.

It had been written by the on-call SHO, in the early hours of the same morning.

“I was called to confirm death,” it said. “Apnoea. No palpable pulse. No heart sounds. No pupillary reaction to light. Death confirmed at 0510.”

And underneath: “Rest in peace.”

She had been a young woman with a several year history of endometrial cancer. She had had bone mets and brain mets and a long line of infections, and she had been admitted to acute receiving. We had never met. I was only reading her notes because she had been flagged up as a patient who might be relevant to my audit.

I hadn’t known her in life, but her death was the first time I’ve touched death.

She was a mother, a sister, a daughter, a friend.

Just for a moment, I stopped reading and I ran my fingers across that last line. Rest in peace. And I prayed that I might always have the humanity to remember these things — perhaps especially at five o’clock in the morning.

Rest in peace.

 
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Posted by on June 10, 2010 in Blog, Medicine

 

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