Monday, 23 October 2017

Could I be a neurologist?

For some really, really daft reason, we only spend 2 weeks doing Neurology in our fourth year. Despite the fact that there are very very few neurologists in the country per head meaning that most other doctors spend a significant amount of time doing lots of (less complicated) neuro stuff too, we get a grand total of a fortnight.

It was the best organised placement I think I've ever had. We had the best of the best teaching us. It was fun, I learnt a huge amount and now seriously consider doing it as a career. It's competitive, can be incredibly tricky and complex and there is still so far to go in this area of medicine, but it is fun. I said to one of the consultants I was clinic with this week, "I'd love to do it...but it's too competitive...I don't know whether I would be able to make enough sacrifices to do it. Did you have to sacrifice a lot?" I asked, wondering about how things were different when this middle-aged irish consultant trained in Neurology. Were they screaming out for more neurologists back then? Was it a speciality you walked into in comparison to others?

"Well," he began, already exacerbated by the question, "I mean, my marriage is in pieces, obviously. My wifes career is over, someone had to look after the kids, because I never see them. She hates me. We've had to move house more times than I'd care to mention, sometimes, I wonder if my kids know if they have a dad let alone who it is... I'm constantly exhausted, I haven't seen my friends or my parents for years, I have no time or anything like that, but absolutely do Neurology. Do I regret it? Yes. But if Neurology is what you want to do, then you absolutely should do it."

I still, don't know if he's kidding.

Next: A week on ophthalmology. A week! For the whole of ophthalmology.

Saturday, 30 September 2017

Psychiatry

A very different specialty to anything i've ever known and yes, I mean different, not, a crock of shit. I was actually very prepared to hate it, the "wishy-washy" (cue every psych consultant rolling their eyes) parts of it but actually for the most part it's an area of medicine that is unfairly ignored for the "sexier" specialties. 

It is hard work too. Gone, are the images of sitting in a 3 grand arm chair listening to a patient talk about how being an only child ruined him. Instead, think of a cramped board room filled with more MDT members i've ever seen in general medicine, pacing patients, talking fast and loud,  illogical delusions, not stopping for breath for 8-9 minutes, answers to simple questions taking 24 different tangent. Think, vacant stares, auditory hallucinations, messages of suicide, completely mute patients, patients that require restraining in a 5:1 ratio - it's very hard work. 

It's interesting because you get so many patients with a similar diagnosis that present in so many different ways. I wanted to become a doctor because I love meeting different people and I love making a difference to people. Psychiatry encompasses probably the most different people you'll ever come across  and in terms of making a difference? Well, there's no health without mental health.

So, aside from the ways real psychiatry is different from TV-psychiatry, what else is different?

Ward rounds take forever and the patients come to you. There's no physical disability preventing these patients from coming to you in the ward round room so they do that.

There is always input from a lot of other people - the main difference to other wards being Mental Health Advocates, Social Workers, Clinical Psychologists etc.

There's so much more to it then medication. I know technically that actually that's the case for all specialties, but it's so much less hands on and so much more about getting people to actually engage with services. So much about it is about managing people's relationships.

People are around a long time. Think at least 3 months in most scenarios. 

You are dealing with sometimes, the most ignored and vulnerable people in society. If your 65+, acutely psychotic, homeless and drawn into a world of substance misuse, well fuck. 


Saturday, 26 August 2017

Well this is intense

Another very busy week for me. I am scheduling private study very intensely around university commitments. Rheumatology is freakin nuts, there are so many possible diagnosis' all with overlapping symptoms and signs that actually nailing a diagnosis is fucking hard!

It's also come to my attention that as I failed the last progress test, if I fail the next one, I will be kicked out of medical school. So if I wasn't stressed, under pressure, or seriously fucking worried before, I am now.

Found the day case centre for Rheumatology this week where patients with chronic conditions perhaps having a flare up or whatever come in and have some treatment. It's really really good for getting histories and I so wish I had found it sooner. Also met the rheum reg's who are really keen on teaching - it's always that as you just begin to find your feet you know you'll have to up and leave again which is so annoying!!

Bit behind on my learning of examinations if we are to follow the schedule I posted last... also seriously just want a list from my medical school of the examinations that we need to know because right now everything is a bit wishy-washy. AKA - do i need to know an elbow examination YAY OR NAY.


Flatmate: are you ok
Me pouring gasoline on myself: yea y

Tuesday, 22 August 2017

Revision Plan Year 4


  • Weeks 1-3 = learn 4 examinations / week 
    • Review previous examinations every week
    • Review all 12 during week 4
  • Schedule 30mins - 1 hour / week for Year 3 review
  • Complete all cases every week
  • Review previous week cases (1hour)
  • Review previous fortnight cases (1hour)
  • Review previous month cases (1hour)

Friday, 18 August 2017

Year 4 Week 1

I can't remember the last time I felt this shattered.

I get up at 6am, I train (75 minutes weight training), I walk to placement to get there for 9am (40 minutes), I walk back (40 minutes), I eat, I study, I sleep. Rinse and repeat. There's not enough hours in the day. I've had my tired eye twitch all week.

I'm finding it more difficult than I thought having an additional friend stay with us. I'm going to bed later, I'm having to be switched "on" a lot more... she works full time, she doesn't get my whole training and diet or I-really-just-need-to-study-thing. I'm really, really looking forward to being on my own this evening. I really, really value my peace and quiet and at the moment, i'm not getting any. Not before i go to bed, not when I walk through the door, not all day when i'm a headless chicken on placement....so i'm quite excited how i've got my evening all planned out.

Today, as I had such an early start, I didn't have time to train before clinic. I was planning on doing it at some point today, but actually as i'm typing this, I think I might leave it till tomorrow morning. I'll keep in my routine of 6am starts, get an early night post-long-bath-soak, may be watch Trust Me in the bath too (oh my god, i've not watched television since Love Island). I need to laundry, clean the flat, have an admin morning when I arrange my whole week ahead. I know, I know, I KNOW, everyone always hammers on about this and every year I'm like, fuck, YES, FUCK WE GET IT. And that's the constant drilling of 'time management' into us, but I swear to God, the only way I can actually get through the week at this rate is if I have every hour of my life scheduled into my diary. I feel like this sounds really fucking boring and I suppose it is, but I am happy. I am busy. I am doing things I love. I don't care if it sounds boring.

I have started on Rheumatology and Orthopaedics for 4 weeks. Basically, I'm sitting in a lot of clinics wondering what in gods name the disease they are talking about is, or watching hip and knee replacements. So far, so fun.

Sunday, 16 July 2017

Reflecting on my SSCP

At the end of third year, your final placement is a 4 week Student-Selected block. You rank your 7 most preferred along with every body else and you are matched to the highest one, depending on how many others have ranked them in a similar fashion. I really, really wanted neonatal HDU, but ended up getting Paediatric Anaesthesia.

Unbeknown to me at the time, I would be spending a fair amount of time with neonates anyway! Anaesthesia appealed to me for lots of different reasons; it's very hands on, lots of one-to-one teaching, it can be quite varied. Saying that, working with young children rather than neonates didn't really appeal to me, spending a humongous amount of time in theatre also didn't particularly lavish me with enthusiasm and so I was fairly apprehensive about this placement.

I needn't worry. I've had an absolute ball. I learnt how to bag and mask tiny tiny babies, attempted (unsuccessfully) cannulation, spent time with some of the most fantastic consultants i've had the pleasure of spending time with and was given loads of advice. It was apparent how hugely varied different doctors career pathway had been to get to become a paediatric anaesthetics. The downside to this placement was being in the middle of the NHS inefficiencies. Surgeries that could have, should have, would have gone ahead are cancelled last minute because of bed shortages; this translated into a lot of time in the coffee room for me. Other than that, I cannot complain. Everyone I worked with went above and beyond to teach me and by the end of the four weeks I had come to get real comfortable with the idea that anaesthetics is something I really want to do.

The difficulty for me lies within teasing out whether its paediatric anaesthesia, paediatrics, or anaesthesia that is providing the attraction. For sure, paediatric anaesthetists as people seem to be my kinda people. It's so nice when you think you find "your people". There are stereotypes of people within every specialty and while I can't put my finger on what it is about paediatric anaesthetists, I think that they are great.

This 4 week block simply set a new standard of what it means to enjoy placement. Are you reading a blog from a future anaesthetist? May be.

Saturday, 15 July 2017

Reflection on juggling a job and third year

Recently, i've been going round and round in circles, trying to figure out whether it is worth keeping this job throughout fourth year. I have just finished third year and as the intensity of fourth year dawns upon me, I am weighing it all up.

When I first started working at Waitrose in November 2015, I don't think I envisaged keeping the job throughout my third year. Knowing full well, I would be on placement and unsure of how structured the timetable would be (but imagining 0800-2000 shifts ha ha!), I blindly just thought i'll see how it goes.

When I first received my timetable, it was clear that I couldn't work 1200-2000 every Wednesday like I had been before. I needed to reduce my hours.

For the first two months, I only worked on Sundays. This was not strictly allowed - the rules were, you had to work at least 2 days a week. So eventually they put my Wednesday shift back in, but halved the hours so it was now just from 1600-2000. I managed to keep this up all year. I rang in sick a few times after some big party weekends, but for the most part, I just kept pulling through it.

 I would always leave early on a Wednesday, i'd drive to placement so that I could drive straight to work from there, making my excuses about "doctors appointments" or whatever. Tutors and doctors never really raised an eyebrow; colleagues knew the score. I got sufficient study leave when I asked for it, even if it was a bit stressful to arrange and so I just managed. Can I continue to "just manage" throughout fourth year? Is it worth it?

I got the job initially because financially, I was struggling. My parents were in the middle of an expensive divorce and paying extortionate lawyer fees, so weren't able to support me as much as they had been. It was incredibly stressful managing being so broke and in fact I distinctly remember it was when I broke down in tears after my card was declined for a £3 purchase in Sainsburys, I knew I had to do something. Being broke was becoming detrimental to my mental health. I got a job fairly quickly and enjoyed the luxury of being financially liberated again. I never worried about my finances again.

Since then, things are very different. The divorce is officially over. I am a year closer to graduating and my mum can financially support me better. It no longer feels like I need this job to survive financially. Fourth year is notorious for being the most difficult year of the whole degree. It will involve longer hours, double the exams, travelling further and wider, it's going to be fast and fucking furious. Should I continue to juggle a job I know I don't need?

1. Would it be possible in terms of time management?
Probably. Waitrose have always been very accommodating, particularly around exam time and i'm sure I could manage. I could get trained doing other things, have my shifts at other time. It might be a bit stressful arranging around two osce seasons, a 4-week GP placement away from manchester and the progress tests though.

2. Do I even enjoy work?
Yes, I do. I love the girls, I love working behind the bakery counter. That being said, I do feel like things are going downhill there and i'm not sure for how much longer i will enjoy it. People are leaving left right and centre.

3. Is it worth the pay?
I am the last cohort to get paid time-and-a-half on Sunday and as I work every Sunday, that is the main reason it is worth it.

I just got off the the phone to my mum and she said something which probably cleared the decision for me. The question needs to change from being "Could I manage" to, "Is it worth managing". Say yes, I could probably manage to keep juggling my part time job with everything else. Is it worth it though? Is it worth the stress? Is it worth missing out on being an actual student and having a student lifestyle? (No-one ever looks back on their deathbed, and says they wish they worked for longer hours). Is it worth jeopardising my degree? Is it worth the energy it takes? And finally, there you have it. No, during fourth year, it wouldn't. It would stop being worth it, but heck, I really will miss it.

Could I be a neurologist?

For some really, really daft reason, we only spend 2 weeks doing Neurology in our fourth year. Despite the fact that there are very very few...