The Leodisian Life...

[yeliab_cram]

Some mornings you wake up and you just know its going to be one of those days dont you. Today was always going to be unfortunate, as it was my wonderful GU clinic day in Bradford. Unfortunately the precise location of the GU clinic in question remained elusive as i set off with my right honorable colleague Ronnie at 8 this morning. Well it was more like ten past - i overslept, which set the tone for the day really. It was freeeezing cold this morning, and due to the lateness of my waking i had to go out without that most essential of meals - breakfast. The finesse bar i stole from my housemate's cupboard on the way out of the door was hardly fullfilling.

Anyway, we knew it was going to be bad when at 8:49 we had progressed less than a mile, and we still stranded in Leeds. We arrived nearly an hour late, and i had the pleasure of starting the day on the male side of proceedings, where i was privalaged to spend the morning looking at many different peni (peni, penuses, hmm) with varying degrees of warts, rashes, discharge and perhaps worst, herpes ulcers. It was all most lovely i can tell you. The afternoon was far more traumatic. After discussing in great detail the precise order of the anal, vaginal and oral sex the lady gave, and received it was time to watch the swab taking. What a wonderfully pleasant experience for all concerned. Perhaps topped off by the fishy odour given off by the creamy exudate. It was all just too much for me really. I NEVER want to work in GU!!!

I think the day was perhaps epitomised by our lunch. As we were stuck in Bradford, in a GU clinic with no food in site, and being male had not bothered to bring lunch, we set out en voiture to find some form of nourishment in the local vacinity. However all we could find was, quite possibly the rankest chip shop ever to grace gods green earth. We decided to be brave and take the plunge with some £2 chicken burgers and chips. It was so bad that i feared i was going to spend the afternoon session in the infectios diseases unit at St James.

Having had such a fulfilling day, we journeyed home. Ronnie had a wonderful idea to take the M62. And it really was excellent, we were back in Leeds in 30mins. However despite this initial optimism, we landed at around 5pm and as a result Leeds was gridlocked. I didnt get home until 6:20.

So having spent the best part of 4 hours in my car to cover the gand old distance of 16miles, and having learnt a rather uncomfortably large ammount about the sexual habits of the general public in Bradford (in case u are interested i discovered that nobody uses a condom and everybody sticks everyting in almost every hole!!) I am going to go to bed in an (probably unsucessful) attempt to drown the images of today from my brain forever!

[yeliab_cram]

Do you ever get that feeling of horrific inevitability, like a long express train relentelessly chugging towards you? That feeling you get before your driving test, those big important exams, and also the feeling you get before presenting your research to a room full of vascular surgeons.

As i sat listening to an SpR in vascular surgery explain the merits of primary care monitoring of AAAs and subsequently be ripped apart by the waiting pack of consultants, i had to wonder what was in store for me. I sat there wondering precisely why i insist on putting myself through these things completely voluntarily. However, it does seem that with every stressfull experience you learn to manage the adrenaline and accept that what is coming, is inevitably going to arrive. In fact that is what i was thinking about as the presentation before mine finished... how you just have to embrace the inevitability of it.

So the Yorkshire Vascular Forum is perhaps not the most presitgous of events at which to be presenting however it is a significant regional meeting, and there were surgeons from as far and wide as Sheffiled and Doncaster along with the usual suspects from Leeds, Bradford and the local trusts. I was glad to be with one other medical student who was also presenting in a sea of Registrars and Consultants, of whom i recognised few and knew even less.

So as i set off to walk to the front of the firing squad - and they were in a harsh mood - i thought, at the end of the day, it doesnt matter if i crash and burn, there is nobody here to see this who i need to see again. However as i began to discuss my topic, i couldnt help but notice that far from the eyes of a completely uninterested audience, those consultants at the front at least seemed genuinely interested in what i was saying. And whilst their questions to almost all the other presenters were focused on ripping their methodology and statistical analysis to shreds, they instead asked genuine questions, which i was able to deal with, and was hit by how much they had obviously understood from my brief presentation. Anyway as we finished off, the chairman praised a good presentation, and another consultant chipped in "its nice to hear someone talking anatomy for a change" which i thought was nice.

I was relieved to be done, and shortly after finishing it was time for lunch (luke warm baked potatoes, coslaw and fresh fruit and veg - very healthy!!) and i was astonished to find that many of the regs and cons came up to talk to me following my presentation. I had taken some of my DVDs with, and they were all gone within 5 minutes. A couple of people told me they thought i would win the Registrars Prize, i told them i was only a wee medical student and was mainly here for the free food - which i was finding to be largely dissapointing. On the flip side, one SHO picked me up for spelling Siena wrong in a slide (sorry to all the Italians out there - i love Siena really, i do!)

I have never been so aware of such a sudden change in attitude. Before my presentation, many of the doctors were looking at me (i was obviously NOT a reg) wondering what i was doing there, and why i was drinking all their free tea and coffee. However after my presentation, they were actually giving both us medics a little (very mild form of) respect.

Anyway, after lunch they announced the winner of the Registrars Prize from the mornings presentations. It was me. Talk about dark horse! I was totally shocked, but im not going to turn down 50 quid and the fact that my abstract will now be published is fantastic. So my trip to Garforth was not a bad mornings work really.

[yeliab_cram]

So i guess this is as good a time as any to use that wonderful gift of hindisght to talk once again about my intercalated BSc, but perhaps in a more positive light than when i was actually sat about doing it.

Whilst it was rediculously hard work, it has equipped me with some very useful skills which i guess i just didnt really realise i was picking up as i went along last year. For example i can now rattle off really quite good essays in a weekend - which is quite quick! I have better critical analysis skills, and the formating of my work is a different league to how it was before i intercalated. I have managed to accumulate a number of good Vascular Surgery contacts in the UK and in Europe. So there you have it you just have to take the shit to get the gain.

For me, the best part of the year was graduating. I know thats a bit sad, but it was lovely to spend some time with you old and new friends alike and not have to worry or feel guilty about working, or more accurately for not doing so. And best of all you get to walz around in a gown which makes you feel (in the words of another anatomy intercaltor who shalt remain nameless) "regal." As we sat in the Great Hall in our suits and flowing robes, i had almost forgotten all that stress, worry, and panic. In fact i started to realise that, as with most things i was just becoming used to life as a BSC student, and things were about to change all over again, and i wondered then if i was actually going to miss it!! However im still undecided on that!

Whilst it does have its uses, it has already got me some extra stick this year. Especially in A&E and whilst doing orthopaedics. For some reason everyone seems to know i intercalated in anatomy, and it comes out sooner or later in front of the docs. Who then also seem to remember. Then when an xray of the foot goes up, one will chirp "ah, Marc. You intercalated in anatomy. Why dont you tell me about the bones of the foot / route of the common pernoeal nerve" or whatever. Unfortunately my BSc doesnt come with user instructions - ie ONLY for head and neck anatomy!

[yeliab_cram]

I dont know if you watch Scrubs - i do, and i find, increasingly, that it really does nail certain issues right on the head. Turk likes Turk-Time, when he can spend some time with himself doing absolutely nothing. Some of my friends hate being alone with the company only of themselves, and quickly get bored and edgy. Im not like that though. Its not that im a recluse, its just that every once in a while i really quite like having the house to myself and doing nothing, absolutely nothing.

For a start it means i can wander round all day in my boxers and a dressing gown, but it also means i can just do nothing without feeling bad for doing nothing. Its very refreshing, you should definately try it.

Anyway, thats what i did yesturday, i slept a lot, ete good food and watched a lot of TV and generally filled the day with meaningless shit. some people would say its a wasted day, but i really think that mental health days are absolutely essential once in a while. Its all very well to have lots of hobbies and interests, and i do, but every so often you just have to stop, and say **** it, im doing NOTHING instead thanks! And its the same with work, when it lets up for just one second you have to grab the opportunity to do nothing with both hands or it will be lost forever and who knows when the next chance to spend the day productively and meaningfully doing sweet FA.

[yeliab_cram]

How come this thing will let you say shit but wont let you say ****. how is **** more offensive than shit - id always thought they were on a par as the kahuna swear words of modern life.

I wonder if it lets you say ****?

[yeliab_cram]

Originally Posted by yeliab_cram

I wonder if it lets you say ****?

Seemingly not then!!

[yeliab_cram]

I must admit, after spending the first 3 days of my "Trauma" SSC week on an ATLS course, and the next day at a spinal injuries unit, i had forgotten quite what it is like in A&E as a medical student during the day. After two days of it i can re-confirm that it mostly consists of sitting around waiting for something interesting to happen with varying degrees of getting in the way, seeing patients who have esentially very little wrong with them and generally getting in the way some more.

Its not that i dont like A&E i do, kind of. Its just that when it comes down to it, as a medical student, you are pretty useless. Either you can see patients in minors - which is great practice but quickly mindnumbing (oh good another sprained ankle whoopee) or you can sit around in majors hoping something exciting will happen or the great red bat phone will ring signalling something exciting being rushed in. Essentially it never seems to ring when there are medical students present, it has a detector or something.

I have noticed that i get most out of A&E when im not actually based there. For example two of the three cool things i have ever seen in A&E have occured when i was based with a Medical SpR on call and the Anaesthetists (those guys do everything!). Unfortunately when you are actually in A&E people often forget to tell you there is something exciting going on. However when you are following the on call medic around you get to run accross the hospital with them when they get bleeped by resus and look all ER and wot not.

You see my problem is this: i can cope with the boring sprained ankles and stuff and thats great. But it really does become a little dull very quickly. However when something completely random comes in, it often falls slightly out of my zone of comfort. Eg the girl who had immense pain in shoulder after doing, well nothing at all. It seemed all good until she decided her mum and dad heard a bump in the night, so maybe she fell out of bed, and oh actually she did have a history of sleep walking and, oh actually, and oh actually, and o yes i remember and... yes its all just very very very RANDOM! it is these things that tend to throw me. So its back to the sprained ankles but they are BOOORING. Jeez im like a 7 year old! But i am doing peads next, so i should fit right in!

[yeliab_cram]

The other day i was driving home from some far flung and highly exotic location in Yorkshire listening to Radio 1, when i heard the Alanis Morisette song "ironic." Not heard it in ages, and whilst listening, it reminded me of a General Studies lession we had in 6th form when we were talking about irony and our unwitting teacher asked us to name some ironic situations. Im sure you can see where this is going, and yes, indeed we did just do lines from the song. However, our teacher (not really being with the whole Alanis Morisette thing, and not really sure why we were all finding this so funny) pointed out that none of the examples we gave were really ironic. And this made me think as i was driving along - is Alanis Morisette therefore a complete idiot, or an absolute genius. You see, if she meant none of the lines in the song to be ironic, then that in itself is ironic, which is REALLY ironic!

Anyway, why all this talk of irony? Well today was the last day of my "Trauma" SSC. I say trauma in inverted commas because it has been more my oh-shit-my-hand-hurts-why-have-i-been-waiting-for-seven-hours SSC. For the three clinical weeks of this SSC, which have been spread over the last 14 weeks i have suceeded in seeing absolutely no major trauma. Not even on the night shift i did the other day. So we can conclude that i am either unlucky, or that absolutely nothing ever happens in Halifax - the jury is still out methinks.

So today, all i needed to do was to go to Calderdale and hand in my SSC and come home to revise for the resus OSCE i have tomorrow - simple? of course not. As i tried to get onto the only major road to Halifax from the mororway, i found, to my surprise, that it was closed by Police due to a rather major trauma. At first i found this merely annoying and attempted to find another way to the hospital.

It was only when i had failed in my guesswork navigation and ended up heading past the accident on the opposite carriageway stuck in the longest, slowest moving que ever, that I was able to watch all the ambulances pull away and rush, blue lights and sirens blaring towards the Calderdale A&E department. Unbelievable - there is finally some major trauma at a sensible hour in Halifax, and rather than standing around bored in A&E i am sitting around in my car, bored on the way to A&E. Luckily however, the irony of the situation was not lost on me. Sometimes, things are just so silly that you can only laugh.

As i arrived in A&E an hour and a half later, i found that the trauma case had already gone to theatre and my SSC supervisor was in Huddersfiled. Mother****ers.

[yeliab_cram]

MMC, modernising medical careers. What a wonderful and fantastic idea! I mean, how excellent, to improve doctor training and produce the best docs in the known universe, ever. Excellent. Well done Mr Blair - a stupendous idea.

The only problem is that, like many New Labour initiatives, it is all spin and no substance. And every so often, it dawns on me that MMC could seriously **** with my career plan, my life and quite frankly may cause my employer to cease to exist.

What i do not understand is this: MMC has been on the cards for as long as i have known anything significant about medicine. It rears its ugly head in the changes to medical education - all that lovely reflection and lack of actual medicine. But nonetheless when i started medical school, life as a doctor seemed hard, but it was most definately certain and secure. Things have noticibly been going down hill throughout my time at medical school. However it was only after returning from a year out of the system whilst intercalating that i realised things truly were at breaking point. How did such massive overhauls to medical training just appear overnight?

I have not met one consultant, registrar, SHO, PRHO or medical student that thinks MMC is going to improve healthcare one bit. And it comes at a time when the NHS is undergoing massive restructuring in terms of managers, targets new nurse specialists and above all the EWTD. So why steam ahead and restructure medical training simply for the purpose of restructuring training????

The only reason i can see is the promise that Mr Blair made all those years ago to make more consultants. It seems someone pointed out to good old Tony that he was not going to make any more consultants in 10 years as they take quite a bit of training. So essentially MMC is just a massive rebranding excercise. SHOs shall be discarded and shall instead function as (somewhat useless) SpRs. SpRs are then free to function as baby consultants to make it look like Mr Blair has upped the numbers - fantastic, lets do it.

Problem is that this mass restructuring to fix some figures will destroy the training scheme. Not only will junior docs have to choose their specialty within two years of qualification, but for the next few years the huge number of SHOs will not fit into the ammount of ST places. So dispite Labour recruiting so many more med students and making so many more junior doctors, it is going to make them all redundent again before they become consultants anyway!! And at the same time, medical schools are still letting in double the ammount of students they were 4 or 5 years ago. It is complete and utter madness.

I've got to admit, i have far less faith than some - i really think MMC marks the end of the NHS. I dont think it is in any way sustainable and coupled with poor management and cost cutting measures will lead to the emergence of private medicine in competition with the NHS and ultimately the demise of what really is a most excellent system. We really are not going to realise what we had until it is gone. Its something we should all stand up and fight for.

The best thing of all is that the Government spin machine is just sweeping the isseus under the carpet: problem, what problem? I really dont know why anyone would choose to embark on a career in medicine right now, hats off to anyone who is willing to apply to med school today, with the system collapsing all around, i shall be seeing you in the dole que.

[yeliab_cram]

Medical Student life is rather like a roller coaster. But not a cool roller-coaster like the Big One, more like a shitty big dipper. Essentially it has its ups and downs. Many days you are treated like crap, grilled on subjects of which you know nothing and pissed on as you walk home.

However every so often you are put in a really nice group of students. Your teachings happen, and they are by really nice doctors. And the really nice doctors decide to grill you on subjects that you just so happen to know quite a lot about. When this happens, medicine is great. It really is. It only takes a few keen, enthusiastic teachers to fill you with confidence, and then it is almost self perpetuating.

However, it helps to be in a group with someone "good." I dont just mean someone clever who knows all the answers, but someone who is intelligent and just generally nice. Because it means that you drive each other forward. Its how i work best. Its not so much competitiveness more like a pub quiz team. It fills you and everyone else with that bit of confidence to say what they are thinking with some conviction. And if nobody knows, you can work productively together to get to an answer.

You see, being on paediatrics - where everyone is helpful and generally lovely, and being on a placement with another student who i actually do find genuinely inspiring (and really, thats never happened before) just makes life so much more enjoyable. If the docs are keen, and the students are knowledgeable and talkative, a seminar, or some ward teaching stops being a chore and just becomes, well, fun.

And when the joy is put back into what you do, it is amazing what you can achieve without even realising. For example, we were on PICU today. The SpR slapped an xray in front of us, and said he's be back in 2mins for one of us to present it. It was one of those xrays that once upon a time would have stumped me completely. It was a little kiddy with tubes coming out of everywhere, and there was some form of pathology everywhere too. However between the two of us we managed to pick up on just about everything. I had to present. I thought there was dextrocardia and dextrogastria. However, lets be honest, thats some pretty severe abnormalities going on, so to say that with confidence is difficult as if you are wrong you look oh so silly. But because i trusted the other person, it gave me confidence in what i already knew. And we were absolutely correct.

Why am i going on so randomly? well i realised something today. As you look around your medical school, or the wards in which you work, you see all these doctors who know so much (often with big egos in tow, but thats not the point). And you feel intimidated by their superior knowledge. To be honest, you often feel a little intimidated by anyone with superior knowledge. Often as students there is a power struggle within a small group to try and prove you know more than someone else (i think its a hang over from school where it was every man for himslef). However today that wasnt the case at all. We worked together, played off each other, and were better because of it. I honestly cant remember the last time i met a fellow student and thought - if im ill, i really really hope you are my doctor!