Internal Optimist

[InternalOptimist]

An anonymous 3rd year medical student's weekly blog


OK, I have already just started a blog, so I will not be using this weblogs section as a post for this, instead I would love to link you to my blog (link below).
I will be updating it every week with what I have been up to - if you are interested please follow along, if not then don't!
you can always follow it with the tab on the side / favourite it or anything. Sorry not to post on here as well, 3rd year is really hectic and posting in several sites (especially with the large volume I sometimes write) would be quite a lot of work

I just know that I always wanted to read about what they got up to in clinical years when I was applying to be a medical student, and when i was pre-clinical - so here it is! If you are a clinical student I wonder how the experiences differ. I try to keep a friendly, optimistic slant on things.

Link below!
A weekly blog from a 3rd year UK medical student

[InternalOptimist]

[Intro to this weeks blog. Full blog at blogger]

Alcohol

Hi,

Alcohol abuse, confused patients, growing up, shocking patients and a rectal exam this week!

'How much do normally drink in a week.' 'How many cigarettes do you normally smoke in a day.' The questions we have to ask patients to assess how much they are harming their bodies. And these things do hurt people. Patients coughing up blood and in pain from lung cancer, or patients with the apparent cognitive function of a 4 year old from decades of heavy drinking. I'm not saying I don't have my vices, but the harm people can inflict on themselves with these everyday substances is shocking. I saw an elderly man throughout this week who has destroyed most of his brain with alcohol. He never knows where he is and is always wandering off around the ward to go to 'an anniversary' or 'a christening' or some other event he seems to have imagined.

[InternalOptimist]

Hi,

I play nurse, get chatted up by an 84 year old, talk with an overdose patient and have an elderly lady drink a bottle of alcohol gel this week!

A busy week, and my last week on the elderly rotation, a real shame I think. I have enjoyed spending time with the old patients, with all their oddnesses, quirks and wonderful stories, but I am moving off to psych next week, where I am sure I will see many more oddnesses. Anyway - I saw many patients who should be on my next rotation this week so perhaps I am well prepared.

Towards the start of the week I was on a ward round with a consultant and another medical student when we came to a ward with a patient who had fallen out of bed and onto the floor. He was an elderly gent, and could not get up. We helped him into a sitting position and called the nurses to hoist his sizeable mass back into the bed. He was very confused and kept trying to crawl out of bed. There were only 2 nurses on shift to cover the entire ward (15-20 beds) and one of these was a ward sister, who was meant to be filling in paperwork and ensuring the smooth running of the ward from an office. The other nurses were on their lunch break. Seeing as this gent needed constant watching this meant that the ward sister had to stand by his bed for the next 45 minutes keeping him from getting out again, and she wasn't able to get any work done. At the end of my ward round I went over to this bed and offered to give her some time to do her paperwork. I was done for the day anyway, and would only be relaxing at home. This gent turned out to be a real handful, unfortunately. He was exceedingly confused and tried to get out of his bed every minute or so. He ignored me if I asked him to stay there, and if I gently guided him back down the the mattress he would scratch and hit at me. This man had caught MRSA and was producing a lot of sputum which he managed to throw at, and smear all over me. Not nice. In conjunction to hitting me, scratching me and covering me in super-bug ridden bodily secretions this man managed to wet the bed 3 times whilst I was there, needing many bed changes. This wasn't such a problem, and seeing as he had been given a diuretic earlier it could be expected, it was just a shame he wouldn't give any warning. To top it all off, the poor man really didn't seem to enjoy wearing clothes and kept taking off his clothing and giving it to me. Throwing off his covers to reveal his naked glory to the whole ward, and complaining whenever the curtains were closed, it was a fight to maintain his dignity, let alone keep myself safe. Unfortunately I got left looking after this man for 3 hours until I managed to get relief, a little more time in hell than the 20 minutes I was promised. The main thing I learnt from this exercise is that nurses have a VERY hard job. I don't envy them at all. Patients can be hard work.

[ Blog continues at A weekly blog from a 3rd year UK medical student ]

[Yixian]

Hey dude!

I was reading your blog, it's great! I would wondering if you could tell me what it was like going from pre-clinical years to work on the wards? How did they prepare you at the end of y2, start of y3?

[MonkeywithaMachete]

Awesome stuff, keep them coming!

[InternalOptimist]

Hi,

Hi,

This week is very laid back, but the thee patients I do manage to meet are poles apart, one being an alcohol and heroin addict, one being depressed and anxious and one being the 'stereotypical' mentally ill patient that the public seem to imagine. Rapid mood swings, shouting and delusions, this sort of patient is a rarity nowadays due to all of the medication passed around.

This week was very quiet due to having our consultant and his PA both on holiday (not sure if they were off together, but that could be the ingredients for a soap...) Unfortunatly this meant that we only saw 3 patients over the entire week. We had times we went to the hospital for ward rounds which we couldn't participate in, and we have had teaching as well - so the week was not empty, but it was by no means as busy as the elderly weeks. So far I think psych is a lot more laid back compared to everything else I have seen. We got refused consent to sit in on consultations as well, but I can only assume that this will be a lot more common in psych than in other specialities due to the stigma some people still associate with mental illness.

Anyway - On the first day myself and my partner spent some time talking with a 28 year old lady who had admitted herself to the hospital to help her detox from her addicts life. Talking to her, it sounds like she has had a very hard life. Currently addicted to alcohol (drinking 8 litres of 7% cider) and heroin (still using despite being on methadone) she wants to come off of alcohol completely and move back to just being on methadone. She started off with cannabis at 12, moved onto cocaine when 14 because she was a model and it was part of the job and then she has been on heroin since 15 and an alcoholic since 16. Because she has been using heroin for so long, the normal injection sites have become unusable and she has had to start using other access points such as her breast or neck. Despite being on methadone for 10 years she has never really come off of heroin. She first got into heroin in quite a forced way, being invited back to a strangers flat after drinks (age 15 remember) and being persuaded to shoot up there because it was 'fun'

[ Blog continues at http://internal-optimist.blogspot.com/ ]

Hi Yixian and MWaM, I will keep up blogging as long as people are interested, thanks for the positive feedback - and I have PM'd you Yixian.

[Yixian]

Wow.. starting heroin at 15 Not good..

[InternalOptimist]

Hi,

A shorter blog this week, partly because of all the work that is going on a the moment limiting time, and partly because not as much seems to be going on in psych meaning I have less to write about. Law plays an large role this week, I meet a psychiatric prisoner and someone under the witness protection programme. I also meet an androgynous feeling male.


Psych seems to be a very laid back speciality, with outpatient doctors having about 5 consultations per day, compared to the 30+ that GPs seem to have to deal with. Despite these consultations needing to be substantially longer, due to the complex needs of the patients, many of the patients do not turn up. Of those that do turn up, unfortunately only about half of them consent to have medical students sit in. This means we can go through an afternoon seeing no patients, just sitting and chatting with the psychiatrist. While good for learning, as we are being taught pretty much on a 1:1 basis, this is a real shame as we see less patients. So far, my impression is that psychiatrists have it very easy, but perhaps that is an incorrect initial feeling. Anyway, we saw 3 patients this week, but all interesting so I shall continue.

[ Blog continued at A weekly blog from a 3rd year UK medical student ]

[InternalOptimist]

Hi,

Ok, A better week than last, saw a student who seemed to be trying to persuade the doctor to prescribe him some Ritalin to help him study, a very activly suicidal patient, a 25 year old with aspergers and an actor with grandiose delusions who was bought in after going to a nursary and threatening to kill himself violently in front of the children.

While from that list above it looks like I was kept busy last week I can assure you that this is not the case. Hours and hours were spent sitting around waiting for patients to turn up. I am sure I said before how patients often don't turn up for apointments and all of that. Perhaps one of the key things about psychiatry is that patients tend to be very interesting when we actually get to meet them. Unlike in the hospital where one patient with pneumonia is very similar in presentation to another patient with pneumonia, psych has a huge range of presentations and stories behind each illness. Perhaps the fact that you spend so much of your time just finding out a patient's story as part of the history taking makes this appealing, but this week was definitely more enjoyable than the last.

One of the first patients we saw in the week was of a similar age to myself and my partner, and was complaining of poor concentration and irritability. With a history that he gave almost perfectly fitting ADHD the consultant evidently became quickly suspicious.

[ Blog continued at A weekly blog from a 3rd year UK medical student ]

[InternalOptimist]

Hi,

It was a very short week last week because being the last week of the rotation there were exams instead of ward rounds. That said, there was a single day in the psych hospital, which I really enjoyed. It is a shame that at the end of the entire psych rotation it starts getting good. A good combination between a proactive and interested consultant and seeing about 4 (yes four!) patients in a day showed me what psychiatry can be like.

Two of the patients we saw were in because of violent tendencies. One of the patients was in the manic phase of bipolar affective disorder and had been bought in because of their strange behaviour, and the other one was a possible sufferer of antisocial personality disorder (AKA psychopathy). Talking to both of them, they seemed relatively normal likeable people, though the latter did seem very manipulative. This was obviously not enough for the consultant psychiatrist, who decided it would be a good idea to test whether they were ready for release. He slowly started winding the patient up and saying things to aggravate and annoy them.

[Blog continued at A weekly blog from a 3rd year UK medical student ]