Medicine "oop North"

[M Clayton]

I have returned from a thoroughly enjoyable fortnight doing little of any real consequence in Florida.

I am relaxed.

I have something of a sun tan to take away the harsh whiteness of my pale and pasty English flesh.

I have finally gotten round to reading all of Dan Brown's books and discovered that the hype is, well, hype.

I am just about ready to start the first term of year 4 on Monday.

[M Clayton]

Day 2 of year 4.

Registration went as well as could be expected yesterday. I have finally gotten a smart card with a picture that doesn't make me look like a hapless retard - even better, this one isn't tinged with green!

Ah, must go - work to be done. More later.

[M Clayton]

Blood is just.... well, blood

Profound.

I love cells!!

(Slightly insane grin)

Worrying...

People or cells; it's the choice you must make.

Words of wisdom from our lecturer in cytology yesterday afternoon.

Oh what fun that lecture was.

This morning was the first proper small group session and we had the task of discussing a case of Ulcerative Colitis and Colonic Carcinoma. All told, things went well. My group are a really decent bunch and, between us, we managed to get the vast majority of stuff down. Today was also my turn to chair the "Peer Led Case Discussion" and, I have to say, I felt like House MD!

Whoops - the Telewest man is coming in half an hour and I've got to get back to Low Fell now. More later (with a bit of luck!).

[M Clayton]

This week has been a real eye opener in a number of ways. For the first time in a long time (maybe the first time) I actually feel like a proper student. Not bad after four years of medicine eh?

I've been reminded of what it feels like to be a fresher; not being wholly sure what's going on, feeling like I hardly know anybody (which is nonsense, because I know at least 90 of the 340 people in the lecture theatre), not really knowing where any of the mysteriously labelled rooms on my timetable are and so on. It's all very odd, I have to say.

Living in the big city is pretty great, however. My home for the next twelve weeks or so is far enough away from uni that each morning commute is an adventure (just how cool are journeys on the metro?!) but not so far away that I can't justifiably claim to live in Newcastle which, as many of you are aware, is a fantastic place.

Since I'm in that sort of mood today, here is a bad phone camera piccie of my house.



Look - we have steps up to our open front door! I've spent a lot of time sitting on those steps looking out across the valley. When the sun shines (which has been rather a lot, surprisingly) it's such a nice place to sit with a good book and glass of pop. They also bring to mind episodes of that "ever so funny" Northern gem, The Last of the Summer Wine. It may please you to know that I don't have a penchant for beating dirty old men with a broom whilst wearing loose stockings...

On the other hand, it may come as something of a disappointment to you. There's no accounting for taste these days after all.

We also have a rather sorry looking Christmas Tree which could do with some of my patented plant reviving care. Whether I can be bothered to look after a Christmas Tree remains to be seen - after all, at times I can barely look after myself.

Hmm. Another poster seems to have spontaneously decided to part company with the wall. I wonder why they do that at such inopportune moments...

No matter.

This weekend, I have been left all alone to my own devices since my sole flatmate had to go home and discuss urgent matters of state (alternatively, she may have gone home to see her other half, I forget which). Like a big boy, I managed to wash, dress and feed myself and I even managed to leave the house for a few minutes of fresh air.

Well, I say a few minutes, it was more like a few hours. I went to soak up some culture but when I realised that I'm an uncultured swine I decided to pay a visit to the Angel of the North instead. It'd be hard to justify not going to see it when it's all of 15 minutes from my house.

So I went.



Phwoar! Look at those...

Wings.

Apparently, the wings are swept forward slightly as in an embrace to those coming into the area from the South. How do I know this? Perhaps I was able to glean this information from the massive, air conditioned visitor's centre (with cafe, licenced bar, ample parking and gift shop selling AotN novelties) Or perhaps it was the numerous, well proportioned information boards and audiotape walking tour.

Alas, none of these things exist. The Angel sits atop its hill in glorious solitude and it really is so much better for it.

Oh, in the event that my meandering hasn't put you off, I learned about the winged embrace from the ice cream man in his van on the A1.



Just to prove I was there in person and didn't just steal the poor quality image from the internet in order to impress you all. I crave your acceptance...

And finally, on a totally unrelated tangent;

Summer's here... it's time for mayonnaise.

Make of that what you will.

[M Clayton]

Oh good lord, I appear to have agreed to a "beard growing contest" with Steven.

[M Clayton]

Yesterday I was forced to begin a presentation with the words;

"I just wanted to say I do have some friends"

This wouldn't have been a major problem accept it was in response to a consultant radiologist telling me I had none. Oh, and it was in front of 320 of my colleagues.

Perhaps some explanation might be required here.

As part of the course, 3 of the 32 small groups are tasked to make a presentation on some aspect of the week's case. Our group was asked to talk for 10 minutes on the role of imaging in painful jaundice - easy enough, no?

We'd done our research and the three of us that had agreed to make the presentation were confident we could put the material across in an appropriate style. All good. Our turn came to present and the radiologist called us down.

Now, I moved a bit faster than the other two so was at the lecturn for a little while waiting for them to join me. At this point the radiologist piped up with;

"You're a small group! Aww, he doesn't have any friends"

So that was a little off putting.

[M Clayton]

Does anybody know what the point of carb free chocolate is? Does it, in fact, even have a reason to exist?

I ask because I've just eaten a "carb free double chocolate" chocolate bar made by the good folk at Nestle and, quite frankly, don't see the point. Yes, it tasted almost like real chocolate (aside from the grittiness) and yes, you might like to eat chocolate if you're on the Atkins Diet (why are you even on the Atkins diet, you're not fat) but, if you're going to cheat, just eat the full carb, full fat, sugary stuff and be done with it!

Oh, a point. Yes, there was a point to this. I remember now - The Great North Run. (The chocolate bar was in my bag of GNR goodies)

The Great North Run is a big fat road race along 13.1 miles of the hilliest bits of Tyneside. That much is, I hope, obvious. What may be less obvious is the fact that I spent all of yesterday working in the field hospital at the finish line. Now it should be obvious since I just told you.

This was my first duty as a member of Newcastle LINKS and, aside from Royal Ascot at York, is probably the largest single event I've ever been part of. I have to admit to being a little bit worried that, with a long gap since my last duty (Augustish), I might have forgotten some of the more basic stuff, but I had a feeling it'd come back to me in the heat of the moment.

My day started at half six because I had to meet my lift at half 7 in order to make it to the finish line for an 8 o'clock briefing. Not being hugely familiar with the area, I'd arranged to skag a lift from one of the St. John nurses covering the field hospital with me. We took the route of the run to the finish line so that I could see the conditions we were expecting 50000 people to tramp along before the day was out.

Hills!

Bloody hell, there are a lot of fairly steep hills to run up and down on the way from Newcastle to South Shields. Andrew (for that was his name) explained that we could expect a lot of minor stuff to come through the field hospital - cuts, bruises, dehydration, cramp and the like and that, based on previous years, up to 200 casualties across the course of the day wouldn't be unreasonable. Fair enough, I thought.

Our arrival at the finish area was less smooth than I'd imagined - after all, we had the correct colour permit to enter the area and were fairly conspicuously dressed in St. John uniform. Yet, the steward had his orders and wasn't prepared to budge or use free, rational thought. Never mind, Andrew's car was, cunningly, a four wheel drive Jeep thingy so we drove over the field to get to where we wanted to be. Always handy.

Walking into the field hospital felt rather like walking into a funeral and urinating on the coffin (not that I've ever actually done such a thing). There were about a million members from the Red Cross (I exagerate, but there were a lot) and, as far as I could tell, just one other member of St. John.

Now, at this stage I should say that I hold no store by the petty rivalries that some members of the Voluntary Aid Societies seem to hold. We're all working towards the same goal and I have a lot of respect for my colleagues in the Red Cross. That said, I did feel very much like an outsider.

In the end, it really didn't matter because the team I worked with in the hospital was a very decent bunch. Of course, being paired with the only other member of St. John (aside from the two nurses) was helpful. As was the fact that he was a third year student from Newcastle and a little bit naive when it came to vomit....

I love a good vomit based anecdote and I think this one's going to have a lot of mileage - I wonder if James is as willing to tell this story as I am...

The first casualty of the 350 or so to come through the doors of the 70 bed hospital didn't make it to me - he was passed on to someone else. However, the initial disappointment of that gave way quickly as it became clear that we weren't going to stop once the main bulk of runners made it as far as the end. My first casualty arrived approximately ten minutes after the first and was a young man looking a tad worse for wear. That said, he was still "with it" and indicated that he needed to lie down before he fell down. James, the third year, offered to help by filling in the paperwork - a task I readily agreed to let him perform since paperwork is so dull.

It became clear that our patient had taken a turn for the worse when he lay flat and I could see that he was on the verge of losing his breakfast. Being a clever - if not somewhat evil - person, I had James help me turn him onto his side. Crucially, this placed me out of the line of fire.

"James, would you be kind enough to get a vomit bowl please"

Hesitation.

"Why?"

Projectile vomiting which covers James nicely in watery, chicken soupy vomit. I have to say, this was the most impressive example of projectile vomiting that I've ever seen. There was an obvious pressure behind it and the volume wasn't half bad either. It lost marks on consistency, but you can't have it all now can you?

Hats off to James though; he was the consummate professional. Whilst it was all I could do to coo soothingly and not piss myself laughing, James managed to look as though he'd not noticed the vomit slowly soaking into his shirt and trousers and carried on filling in the paperwork.

The day continued in much the same vein with a little less vomit but no end to the steady flow of bodies coming through the door. Ambulances moved back and forth transferring patients from the field hospital to South Tyneside Hospital and from the race to the field hospital. Internal transfers were made of patients from the High and Medium Dependency Units to the recovery area and back again. To a casual observer, it was chaos without the good grace to even be organised chaos.

I have to share with you my second favourite anecdote from the day.

I'd decided that a patient needed to be moved from recovery back to the medium dependency unit because he'd taken a turn for the worse. Getting him from the cot to the trolley was easy enough - he simply slid himself across. Getting him off the trolley at the other end was a bit more difficult since he'd slipped down the conscious scale.

Nurse 1: "Ok, let's get this fella onto the cot. Everyone grab some blanket... ah, he's no blanket."

Nurse 2: "So it's the old fashioned way then?"

Nurse 1: "You mean the way we've been forbidden from moving people?"

Nurse 2: "That's it. Everyone grab some flesh and well get him onto this bed. On three..."

But, on the whole, it worked. The whole team (including the raceside teams) managed to process a huge number of casualties in an efficient manner. I think it's important to focus on the positives, so I don't feel it's appropriate to talk about the fatalities here.

With the day finally over with by 6, we formally closed down the field hospital and retired to a local (well, Newcastle Quayside) hostelry for some well earned LINKS drinks.

Flaming heck though, my shoulder muscles ache today.

[M Clayton]

Today I have managed to eat all of the 5 bagels that I bought to enliven my breakfasts. I bought them yesterday night, fully intending to only eat 1 this morning but they're so ridiculously tasty that I felt the need to eat the rest with my dinner and thereafter as snacks. I may invest in a bagel cutter in order to avoid the frankly unnecessary squashing hazard that comes when you cut them in two by hand...

In the event that the above doesn't make it abundantly clear, the past few days have been "slow blog days". I'm wracking my brain in a vain attempt to recall exciting or, at the very least, noteworthy occurences from my daily life but keep coming up blank.

This week's group case has focussed on Non Alcoholic Fatty Liver Disease (NAFLD) and has entailed a fairly pleasant reminder of liver physiology. It's not been too taxing but has provided a few gems in terms of lecturer quotation;

"Jack Spratt ate lots of fat
His Wife ate lots of sweeties
Now Jack has Non Alcoholic Fatty Liver Disease
And his wife has diabetes"

No? Not amused? How about this one;

"Radiology: sitting in dark rooms looking at dodgy films and worrying about exposing yourself"

Still not finding it funny? Then how about this - it made me laugh anyway;

"We used to give them lots of IV fluid and diuretics... but they got pulmonary oedema and died. Generally, this is a bad thing"

Still nothing? Sod it. You may well be a prime candidate for a sense of humour transplant. I suggest you get in touch with Bupa for more info.

[M Clayton]

I am dying.

Or, more accurately, I am a man with flu which is, essentially, the same thing.

Bleurgh

[M Clayton]

I spoke a little bit too soon when I posted on Friday - I hadn't envisioned that things could get any worse over the weekend. Oh how very wrong I was.

Yesterday started well enough - I managed to finish watching the Return of the King Extended Edition and was quite pleased with myself for having managed to tidy my room and get my washing done at the same time. I'd even gotten my pharmacology work out of the way. Not to blow my own trumpet, but I was cooking on gas!

And then, in my flu addled state, I made a stupid mistake involving concrete stairs and a total lack of attention. At that point, things ceased to go well.

I had managed to misjudge the position of the bottom two steps and twisted my left ankle sufficiently to cause incredible pain. I really can't think of a time when I've been in such a lot of pain - I recognise now that I was suffering from shock because my vision became tunnelled, my hearing became echoey and I felt nauseous. All I really remember after that point is lying on the ground and trying to decide what the best course of action would be. After much agonising, I decided that I might as well try and get back upstairs into the house and see what damage I'd done.

This, of course, was easier said than done and involved a rather undignified crawl up the stairs, all the while cursing the person that decided 7 stairs were a good way into a house. On examination, the left ankle was clearly not at its best - it had swollen pretty rapidly and had turned a rather fetching shade that I shall hereafter refer to as "plum". It was fairly obvious that I should probably get it checked out at some point but, at that moment, I felt that "RICE" treatment was the way forward and I settled down to watch some episodes of Scrubs whilst the swelling subsided.

It didn't subside.

Admitting defeat after a couple of hours, I reckoned that having a professional opinion might be the way forward so I hopped on a bus to A&E at the QE - well, I say hopped; what I mean is that I hobbled for 20 minutes to get to the bus stop that is about 200m from my front door. All the while, totally unable to get my shoe on or bear any weight on that left leg.

The bus driver laughed at me - obviously he's not had any teaching on biopsychosocial approaches to illness and injury.

Luckily for me, A&E was still in that "calm before the storm" mode as it was still only half 8 but I felt like a real idiot being there. I hate wasting people's time (which is why I got the bus rather than phone a mate for a lift) and felt that I was probably overreacting. I was assessed pretty quickly and the doctor decided that it was probably soft tissue related rather than anything more sinister. Just to be sure, he sent me through to get it x-rayed.

I thought I'd been in pain before that point but when the x-ray technician manipulated my foot to get the best view, I could have leapt through the ceiling. I know I sound like a bit of a wimp, but I don't care. All I know is that it bloody hurt!

At this juncture, I thought it would probably be worth phoning my parents to let them know what had happened. Primarily, I was after a bit of sympathy but I also knew I'd get a rollocking if I didn't tell them.

"Mum, don't worry I'm in A&E"

<Phone cuts out>

Don't you just love the timing? Tell them you're in A&E and then hang up - that won't make them worry at all.

I decided that I'd probably rather speak to my folks than watch Who Wants to be a Millionaire (which was on the wall mounted telly), so I phoned them back and explained the situation. For some reason, my mum kept asking if I'd done my ankle in at the football. I've no clue where she'd get such an idea from but she kept asking so she must have had some reason to! She also offered to come and pick me up from the hospital but seemed less committed when I informed her that'd it be a 2 hour drive to somewhere she'd never been before. Parents these days eh?

The x-ray came back clear and the pattern of tenderness and bruising indicated that the most likely cause for the pain was a rupture of some of the lateral ligaments of the ankle joint. Joyous. Good news on the lack of fracture, bad news on the treatment for sprains. RICE was all that the hospital could suggest (this despite the fact that the evidence doesn't support the claims made about this form of treatment) and I was duly fitted out with the ubiquitous tubigrip from knee to toe. I was also given advice on appropriate over the counter analgesia; "Do you have any painkillers at home?" Do I have any painkillers at home?!

Actually, as of today, I have 8 paracetamol and some aspirin which may or may not be out of date.

I somehow managed to get back home on another bus and I'm sure I woke up all the neighbours as I used their fences to help support myself on the way back up the street.

Try sleeping with your leg raised - go on, it's impossible.

Today, I have been tired and grumpy and still cannot weight bear. I have devised an ingenious hopping system to negotiate the house and can now even carry a cup of tea without spilling it... much.

I really hope this sorts itself out soon because I'm supposed to be going to Alton Towers on Wednesday and there's no way I'm missing that.

Beware deadly steps kids.