Medlink

Last Sunday, I went up to Nottingham University to spend 4 days at Medlink, a medical conference. After finding my halls of residence (which was amazingly close to where most of the lectures were), I went to the sports hall for our first lecture. After a brief introduction on how to make the most of Medlink, we had our first talk on Paediatrics then General Medicine. Both were very interesting but were mainly talks encouraging us to join that particular specialty. We then had a talk from a man in the air ambulance, who told us some fascinating stories from his time on the air ambulance after showing us a video of people breaking bones (and often subsequently standing on the bone). It was a really interesting talk, and everyone seemed to leave the talk wanting to either hear more or join the air ambulance immediately. 

The next day, the morning involved more talks on specialties (Surgery, General Practice and A&E) and a talk on “What kind of a Doctor would I make?”. I enjoyed learning more about the particular specialties, and more about the history of surgery. Safe to say, I would not have liked to have needed surgery long ago, when sterile environments were unheard of and any old person could perform it. We then heard about the opportunities provided by studying medicine in Europe and did a casualty-alert simulation, in which we had to try and diagnose 2 people before they infected everyone else. Considering one of the people had a heart attack and the other had diabetes, we were all a bit confused by the spread of the disease. We also listened to “Life as a Junior Doctor” from a man who had worked in the Navy, which was very engaging. 

On Tuesday, we had another talk on studying abroad, this time in Grenada at St. George’s University. We also learned more about the different styles of teaching medicine, and had a lecture from a woman who specialised in geriatrics, which was particularly interesting considering my experiences at Rowden House. In the afternoon, we had a Q&A session with current med school students, and it was interesting listening to their answers and opinions on their med schools. We also spent some time doing clinical skills (‘patient’ diagnosis, using a stethoscope and using otoscopes and opthalmoscopes), which I enjoyed. Otoscopes were particularly interesting as I had never used one before. In the evening, I went to the optional ‘The EDGE’ session, which was fascinating as we learn different routes into both med school and medicine.

On Wednesday, we initially went to the Exhibition, where it was nice talking to different universities and looking at opportunities that you may not have previously considered. We also had a talk on the UKCAT and winning and keeping a place at med school (which was very similar to the EDGE). I also spent the afternoon at the optional Oxbridge session, where it was interesting to see how different the BMAT was to the UKCAT and listening to the talk on Oxbridge admissions.

In general, I had a great 4 days, as the talks were really interesting, I met a lot of new people and learnt a lot, but above all, I enjoyed feeling as if I were at university, as it felt like I had finally achieved my dream.

A Week in Cardiology

Monday

This week, I spent the week in Cardiology at Musgrove Park Hospital, mainly in the Cath Lab, seeing a variety of diagnostic procedures and treatments. On Monday, I spent some time with a technician and a nurse looking at treadmills and ECGs, where a patient with suspected angina would walk (unless they lasted for a very long time!) on the treadmill, with speed and gradient of the treadmill increasing every 3 minutes. The test would finish if a variety of things happened, for example the patient asking to stop, or experiencing their symptoms, a large change in blood pressure or heart rate exceeding the maximum value that it should be. In order to look at the heart, a 12-lead ECG was going on at the same time, except that the ‘limb leads’ were placed on the shoulders and hips respectively, so that the patient wouldn’t fall over them. I was also shown what a normal ECG should look like, and had some of it explained to me. We also had one patient who came for a stress ECG but couldn’t do it, due to him being on crutches, so he had to have a stress echo instead. In the afternoon, I looked at Echoes and Complex Echoes. The first complex echo involved putting some dye into the blood in the heart to get a more detailed and clearer view of it, as the first (normal) echo that the patient had had done was not clear enough to draw any valid conclusions. Seeing a heart pumping on the ultrasound machine was fascinating, even if I wasn’t always sure which part of the heart I was looking at, although the consultant doing the echo was very good at trying to point out what was what. I then saw a normal echo on an inpatient in the Cardiology ward, which was particularly interesting as he was quite young, so the scan was much more clear and detailed, even though his heart was absolutely massive (and shouldn’t have been!). After that was finished, the technician doing the echo explained everything that she had been doing and further explained what I had seen on the ultrasound scan, and the likely reasons that this patient was getting chest pain. The last echo I saw was another complex echo - a stress echo, where they give the patient a drug that causes the heart to replicate what it would be doing during exercise, so speeds it up. Although the scan wasn’t very detailed, it was very interesting to see the heart pumping so fast when the patient was resting. Overall, it was a great day and I learnt an awful lot about cardiac diagnostic procedures. It was also very exciting to be wearing scrubs, as I felt a lot more professional and more a part of a team.

Tuesday

On Tuesday, I had another great day. In the morning, I was very excited to see pacemaker implants, as I enjoy watching surgery take place, as it’s not exactly the kind of thing you see everyday! I was very impressed by their infection control, which was unsurprising as they have recently won an award for it! After ensuring that we were all sterile, and that I wasn’t going to touch anything blue, the surgery started. The technician in the theatre, who was watching the patients 3-lead ECG to ensure that the patient wasn’t crashing, was very good in explaining to me what was going on, and showing me the different types of leads (in their boxes!) and the pacemaker itself. I learnt how the leads have 2 tines on the end to ensure that they stay in place, unless the person is particularly active, in which case there is an active ‘screw’ end on a different lead as it is more secure than the tines. It was also very interesting to see the ‘pocket’ made for the pacemaker, as I had always presumed that it went a lot closer to the heart, although retrospectively this would make the batteries a lot harder to change and would be a lot more dangerous. I was also told about using different numbers of leads depending on what the problem is, although using 2 is by far the most common. I was also surprised by the patients being awake through the procedure, with only a local anesthetic, although the procedure was not what I had expected, so it was slightly less surprising. In the afternoon, I spent some time in a pacemaker clinic, with most people coming for their check ups - after 1 month, 3 months after that and then every year. There was also a man who had developed severe bruising around the pacemaker which was getting worse, so he was scheduled for a repositioning of the pacemaker. It was fascinating to see the technicians work out the threshold energy needed to make the heart pump to determine the minimum voltage and time that the pacemaker needed to work for, in order to save battery life (as replacing a battery and thus the entire pacemaker requires surgery), although the standard voltage, unless the threshold is higher than it, is 2.5V. It was interesting to see them control the pacemaker and input details into the memory of the pacemaker using a magnet placed on the patient’s chest. I also enjoyed looking at the ECGs, and developed a better understanding for what each part meant and what a normal ECG should look like. It was another fascinating day, and I greatly expanded my knowledge of pacemakers - not that I knew much about them before! I also loved being in surgery and seeing and learning things that I would never have otherwise been able to do.

Wednesday

On Wednesday, I spent the morning looking at angiograms. It fascinated me to see the arteries around the heart shown on the X-Ray in the technician room I was sitting in, as I was too young to be in the room with the patient. It was also very interesting to see how the only way of controlling where the dye goes is through the seemingly rather uncontrollable catheter in the arteries, which seemed like an inefficient way of doing it, and it struck me how technology may have come a long way in medicine, but there is still a lot more than can be done to further improve procedures like these, for example better control over the catheter. The fact that you can only control it by pushing, pulling and turning the catheter (and the use of guide wires, which have their limits) later proved a problem when an attempt at angioplasty eventually proved too difficult to do, as the stent needed positioning after a sharp S-bend with many branches coming off, including one going straight on. The patient and the team attempting the procedure were very disappointed, but they knew that it was always going to be a long shot. Still, I found watching the angiograms very interesting and enjoyed learning more about the main arteries around the heart. In one of the angiograms, they also used a ‘pig-tail’ catheter to dye the blood within the heart to make it show up on the X-Ray, which looked amazing, and it was captivating to see the heart pumping using a different method than I had seen on Tuesday. It was unfortunate (for me, not the patients) that I didn’t get to see any angioplasty, as I would have loved to have seen some, however I did manage to, by coincidence, later that day, when a primary came in. It was remarkable to see how quickly the patient was prepped and bought in for a much needed angiogram after arriving in an ambulance, although the patient, as we later found out, had been having severe chest pain for over 12 hours, and really should have phoned someone sooner. Even so, a femoral catheter was put in and positioned to deposit the dye, and a normal angiogram took place. However, when we first found some narrowing, it was clear that this wasn’t the cause of the chest pain as it was not severe enough and, as it was a primary, they left it to be dealt with at a later date and kept looking for the source of the chest pain. Eventually, they found the source to be a massive narrowing of an artery, and quickly positioned 3 stents to deal with the problem. It was fascinating to see how quickly and efficiently they dealt with the problem, but equally as fascinating to see balloons being blown up in the arteries and the stents being used to keep the narrowing open. It was another great day where I really learnt a lot more about the arteries around the heart, and was really excited to see yet more that I wouldn’t have otherwise seen. It also showed me a lot about dealing with patients in critical care and how  efficiency and keeping calm is of the utmost importancy.

Thursday

On Thursday, I arrived at the hospital with the knowledge that I was going to be looking at DCC, but without the knowledge of what it actually was. When I later found out that this mean that I would be looking at Electrical Cardioversion - defibrillation. Having often seen defibrillation on the TV in medical documentaries, but never having seen it in real life, I was very excited to finally be getting to see it. Before the cardioversion took place, I went round with a junior sister to talk to the patients who would be receiving the treatment to ensure that they were still alright to undergo this risky procedure, though luckily, they all were! I also watched as she placed canulas in their hands as this was where the general anesthetic would be delivered. We then started the cardioversion. With the exception of using electrode pads instead of paddles, it was remarkably similar to how I imagined it. Luckily, none of the patients flatlined, and all only required 1 shock using the smallest amount of energy to revert their heart back to the pattern it should be taking. This meant that the general risks of the procedure were greatly reduced. Apparently, whilst it is quite an exciting and fun procedure, it has about a 50% chance of lasting over 2 years, so a lot of people have to have it redone later in life. However, whilst it is a risky treatment, it has it’s merits, especially in not being invasive, making infection a lot less likely. In the afternoon, I spent time in a stent clinic, when people were having their 6 month check up, the only check up for stents, although patients are supposed to go to cardiac rehab 6 weeks after the angioplasty, where they can talk to nurses who can keep an eye on them. After the check up, if they are doing well then they are discharged from clinic and then only need to go to their GP to ensure that their blood pressure among other things, remains safe and to ensure that their symptoms are not returning and that they don’t gain any more. At the clinic, the nurse who does it has to assess any pain and breathlessness they are having now and, if they came in as a primary, what they were like just before their episode to assess any changes (hopefully improvements) that have occurred due to the angioplasty. They also are very keen that their patients stop smoking, as it is the one thing that can reblock the stent. Whilst one of the patients had not smoked at all since his primary, another was struggling more, so the clinic nurse advised him to try the NHS smoke free programme. It was interesting to see how 2 different people had tried the same thing with such different outcomes. Overall, it was an excellent and captivating day, and I particularly enjoyed seeing something move in my mind from TV documentaries to real life.

Friday

On Friday, I spent the morning doing a Ward Round in Fielding ward, one of the Cardiology Wards and then shadowing a CT1 and an F1. As the consultant had done a big ward round yesterday and spoken to all of his patients, he only spoke to those who were being discharged or who nurses or other doctors flagged up as being people that he needed to see. Whilst on the ward round, I learnt about Left Atrial Appendage Occlusion, using a Watchman device to block of the appendage so that any clots formed there would be trapped there and couldn’t be thrown up, which could cause a stroke amongst other things. It is a relatively new treatment, and it was interesting seeing how he explained it to the patient, showing the importance of clear communication. It was also nice to see that he ensured that the patient knew what was happening, rather than using complicated words that might confuse the patient. After the ward round, I followed the CT1 to the Coronary Care Unit, as the F1 who was supposed to be covering it was ill. Luckily, a consultant on the CCU was already part way through a ward round, so we then left back for Fielding Ward so that the CT1 and the F1 who wasn’t ill could do their respective ward rounds, as each had half the ward to look after. 2 of the patients we visited had a lot of fluid around their heart amongst other places, for example both, at some point, had so much fluid in their abdomen that they looked pregnant, and had heavily swollen legs. The F1 showed me how you could gently squeeze the leg using 2 fingers and how an imprint would be left. After they had seen all their patients, they both had discharge summaries to do, so I went back to the Cath Lab. After lunch, my timetable said that I was to have a personal feedback and review section, however, as this was not for school and I didn’t have to do a report on it, I was allowed to spend some more time in my place of fancy, although hardly anything was going on that afternoon. As a stress echo was going on, I planned on seeing that, however the woman running it wasn’t there, so I waited for her. However, in the corridor where I was waiting, 2 of the staff were filing all of the patients’ files, as they were moving from a numbered to an alphabetical system. Whilst waiting, I decided to help, as I thought that I might as well use my time for filing rather than theirs when they could later be performing tests, diagnosing people and helping to treat people. This required a surprising amount of concentration and it was only when we realised it was time for me to leave that I stopped. However, I did enjoy the feeling that I was helping, alongside the jokes of “What are you doing next week?”. Overall, I had a fantastic week where I learnt a great deal about cardiology as well as the work of medical technicians and what happens when patients are in a critical situation. I also found that I much prefered spending a week in one place rather than doing days in lots of places as you feel as if you are more of a part of a team, as if you can help more and you learn everything in a much greater detail. Strangely, I found that, whilst I greatly enjoyed learning everything about cardiology and watching the diagnostic procedures and treatments, the thing that I enjoyed the most was feeling like a part of the team, making me feel as if I had suddenly become a lot closer to the end in my journey to become a doctor.

Scrubs

Last Tuesday, I spent the day in Musgrove Park Hospital, mainly with the neurology team in Triscombe Ward. I started off with consultant ward round with Dr. Fathers and his team. I saw a variety of rare neurological conditions, varying from informing a patient that he had motor neurone disease to finally speaking to a woman who had been dumb for 2 months following a neurological problem. I also saw the value of MRI scans to review inflammation, among other problems, in patients, which can damage nerves and nerve transmission. Next in the plan for the day was viewing neurological tests. However, upon arrival, I was told that there were no tests that afternoon, but one of the testing team would be monitoring a patient’s neurological observations during a spinal operation. Was I interested in watching? Of course! So, for the first (and hopefully not the last!) time in my life, I got scrubbed up, complete with pyjama-like clothes, hideous shoes, a face mask and a very attractive hat. I also donned a lead apron (which was surprisingly heavy!) and then, fully dressed, I was allowed to go into the Operating Theatre (upon my promise that I didn’t faint at the sight of blood). I was in Theatre for 90 minutes, watching rods being inserted into the patient’s back as some of the vertebrae plates had fused. This had to be done with constant checks, both radiology checks to assess position, and nerve transmission checks to ensure that no lasting damage was being done. It was epic. After the operation (and lunch) I went to watch a lumbar puncture, where I saw the time taken to perform the procedure, due to the small size of the gaps and the precision needed to avoid nerve damage. Overall, I left feeling really excited and even more committed to my dream of being a doctor.

The Beacon Centre - Oncology

Yesterday, I spend the day at the Beacon Centre at Musgrove Park Hospital, which specialises in Oncology. As they recently won the International Quality Improvement Award in May 2012, I felt very privileged to be spending a day there. I started my day in a gynae-oncology MDT where I saw a variety of care teams discuss the latest changes to the patients’ conditions. This was supported by CT scans (which I really enjoyed looking at) showing progression of tumours and cysts etc. It was interesting to see the number of different specialties in the MDT, including a radiologist, a pathologist, a gynaecologist and both a medical and a clinical oncologist, which showed the importance of teamwork. I then spent the rest of the morning on the ward, shadowing 2 junior doctors. The patients, whilst it was an oncology ward, were mainly all suffering from other diseases as well as cancer, and many had palliative care programmes. This taught me the importance of reducing adverse symptoms to make patients more comfortable, rather than always trying to cure diseases. After this, I went to radiology where I saw the in depth planning systems required for radiotherapy, including CT scans and the colourful mapping of them. This, along with specifically angling the rays and being able to shape them using lead ‘fingers’ helped to reduce irradiating healthy tissue that could lead to unwanted side-effects. I also learnt how they use small tattoos on the patient to ensure that their numerous radiotherapy treatments (5 a week for 7.5 weeks in some cases) all go in the same place, and how increasing the number of rays used decreased side-effects by reducing dose except to where the rays met. I then went into the room where the radiotherapy occurs (luckily no-one was in there!) and saw the machine used to create the high-energy beams of photons or electrons used for the radiotherapy, and numerous safety devices to ensure that no-one but the patient receives doses of radiation that, if repeatedly received, could cause damage. In addition, I saw the bench for patients to lie on whilst they receive radiotherapy and it felt very uncomfortable but needed to be hard so that patients could always lie in exactly the same position.  Overall, I felt I learnt a lot and it was a worthwhile and interesting day.

Yeovil District Hospital

Last week, I spent 4 days in Yeovil District Hospital as part of a work experience programme. This gave me some insight into some departments in the hospital that I hadn’t seen before. This ranged from time with the porters and in the linen room to the Academy to the Day Hospital and the Cardiac Rehabilitation Unit. Whilst all were interesting and, as I learnt, important to the smooth running of the hospital, the areas I enjoyed the most were the Cardiac Rehab Unit and the Day Hospital. In Cardiac Rehab, I saw the importance of exercising after a heart operation for both physiological and psychological reasons – whilst rebuilding heart muscles is important, it is equally important that people doesn’t feel alone and realise that they can still do the things that they want to do. There was a great atmosphere, and the volunteers (who took me round pretending that I had had a heart operation) told me that the thing they strive for is for you to have fun. In the Day Hospital, I saw 3 blood transfusions being prepared and taking place. I was surprised how long the transfusion took and saw how the nurses constantly checked for adverse reactions to the blood.

Islip Medical Practice

Last Monday, I went to Oxford to spend a day with Dr. Lisa Ibbs in the Islip Medical Practice. I started off by visiting the local nursing home, The Manor, which cared for elderly patients, mostly with severe dementia. The Islip Medical Practice provides regular medical support to The Manor and its residents. Having regularly visited Rowden House, a residential home, I could very easily notice the difference in the severity of the condition of the residents, most of whom were bedridden. Next, I sat in with the Practice Nurse, where I learnt the general role of the Practice Nurse and a lot about childhood immunisations. This showed me how much doctors rely on the nurses for a wide range of tasks, such as tests, vaccinations and chronic condition check-ups, e.g. diabetes. After lunch, I went to the dispensary where I helped find drugs for peoples’ prescriptions. After being repeatedly instructed to check the type of drug (e.g. capsules vs tablets) as well as the dosage, I further appreciated the importance of getting the medication right. I was also told that morphine was kept in a locked opaque cabinet, and had to be signed out by doctors due to its controlled drug status and addictive properties. I spent the rest of the day with Dr. Ibbs, mainly in her surgery. Firstly I watched Dr. Ibbs change a catheter which demonstrated a common complaint with an ageing population. Next, I saw the other end of the age spectrum – a baby’s 6-week check-up, where Dr. Ibbs checked the baby’s measurements, hips, skull and breathing. It was adorable! I then saw a large range of patients with conditions from conjunctivitis to ankle injuries to stomach pain. This taught me the large variety of illnesses that GPs have to know about, and that GPs have a very different relationship with the patient than most hospital doctors. Dr. Ibbs also told me that, whilst you do get a lot of people coming to their GPs for common ailments like coughs and colds, you also get a lot coming for chronic disease check-ups. Finally, I accompanied Dr. Ibbs (as duty doctor) on a home visit to an elderly patient with a suspected infection. Whilst I only had a day, it did give me a real snapshot of life as a GP. 

Pathway to Medicine

Back from another 2 days at Musgrove Park Hospital where I have spent the time on the Pathway to Medicine programme. This involved a general introduction to the NHS and a talk on infection control, which taught me what I needed to do to minimise the risk of spreading infections. Then came the fun bit! I met up with an F1 doctor who was working in the respiratory ward and who I would be shadowing for the next day and a half. It was really exciting to get closer to patients and the different types of treatment. Some of the things I enjoyed seeing were chest X-Rays, blood tests and a diagnostic lung tap, to see if any fluid in the lung was infected. I was also lucky enough to accompany a long consultant ward round and it was interesting to see how the consultant talked to both the patients and the other doctors who were in training. It also showed me that being a junior doctor involved moments that may not have been exciting (i.e. paperwork) but that they were still really important to patient care. These two days have made me even keener (if that's possible) on becoming a doctor.

The endocrinology clinic

So today was the day I learnt more about diabetes! I was invited to accompany Dr. Close (Medical Director) at Musgrove Park Hospital during his outpatient's endocrinology clinic. A number of these patients have had diabetes for many years and were suffering the side-effects such as kidney failure, circulation problems and eye problems. This taught me that for some conditions, treating the side-effects can be as difficult and as important as treating the main condition. What I found really interesting was how Dr. Close's communication style changed with each patient so that he and the patient got the most out of every consultation. It also further proved to me that not all patients can follow instructions and take their medication, even when they know there are significant risks.

Shadowing a matron

Monday 2^nd April started early for me! Leaving home before 6:30 to get to Musgrove Park Hospital in Taunton by 8 am proved ... a bit of a challenge, but by the end of the day, it was well worth while! I was lucky enough to be shadowing a matron (Sally Maltravers) who looks after Endocrinology amongst other wards. First of all, I toured the Endocrinology ward with the other nurses who were discussing changes that would be made to allow for two single sex recovery rooms. I was then given the opportunity to accompany a consultant ward round in the Neurology Unit which focused on rehabilitation. This was great, as this is an area that really interests me, and taught me that whilst doctors generally know what’s best for the patient, the patient isn’t always co-operative, so listening skills, having patience and staying calm are all very important. After that, I went to SAU, where I learnt the role of the ward sister and the need to balance time spent with patients and time managing staff. Towards the end of the day, I headed to a meeting to discuss the changes to the Endocrinology ward, which involved people from different functions in the hospital to talk about practicalities of the changes and to suggest alternative options. This showed to me the planning side of medicine and the number of things that nurses and doctors get involved in.

Battling Infections

2 weekends ago, I tried to visit Rowden House as normal. When I arrived there, there was a sign on the door informing visitors that they had had an outbreak of Norovirus in the home, and no visitors were allowed. The following weekend, all was back to normal, but some of my favourite residents were still suffering the after effects of this infection. I’m aware that Norovirus is common in the community but younger people usually recover quickly. At Rowden House, many of the residents are over 90 and it took them a long time to recover. This showed me how important it was to control any infections, especially in very communal areas. The residents were very pleased to see me, and enjoyed their sing-a-long to my saxophone playing even more than normal.

Over £5,000 for CHSW!

It’s been almost 5 years since I started fundraising for Children’s Hospice South West, and have just reached my £5,000 milestone (most recent total is £5,528.44)! As you can see from the photo, I was quite young (that explains the silly look!) when I started. I have visited one of the hospices – the one near Bristol – twice and it has never failed to impress me. It’s amazing how such a fundamentally sad place is kept very cheerful and homely, despite all of the specialised equipment. Just before Christmas I did another collection outside the local farm shop and raised £245.20, bringing my total for 2011 to over £1,000. Now I need to start planning my fundraising for 2012!

Visiting a Pathology Department

Over the Christmas holidays, I spent some time in the Pathology Department at Musgrove Park Hospital in Taunton. This is often an area of medicine that is forgotten, but most hospital patients and many who visit their GP will have tests done that find their way to a Path Lab. Getting quick and accurate results from these tests is a key part of quick and effective diagnosis. The team I met were very proud of some recent work they had done to dramatically speed up the cytology process. They had done a step-by-step assessment of their process and removed bottle-necks and delays, so that now, patients and their doctors can get their test results much faster. I was also given the opportunity to look down a microscope at some disease cells and compare them to healthy ones. The differences were often obvious, but some weren’t, showing the skill required to interpret the results. I’m looking forward to going back for a longer visit soon!