10 07 2011

I am such a crap blogger. Still, it has been a very busy three months. I have a degree and all sorts now.

In a week or so, I’m going to be moving to a whole new city and starting my first job. I am, obviously, bloody terrified.

I start with two nights AMU, which is not the idea start, sort of like thinking you were going to dip a toe into the swimming pool and then getting scooped up by a helicopter and dropped into the middle of the Atlantic. Still, it’ll either go okay or I’ll fuck up completely, chuck in the medicine and go and live in a cave on an island. There’s always that.

Who’s with me?

22 03 2011

Yesterday morning, in our introductory Preparation for Practice lecture, our head of year was explaining why we were doing what we were about to do. He went through a number of reasons. The main one was that there were certain things med students were known to feel unprepared for when approaching the start of FY1. These included prescribing, ethics and law, and a number of other perfectly sensible things. He went through all of these and explained what we were going to do. Last on the list was something like ‘understanding Complementary and Alternative Medicine’. His comment? (I wrote it down at the time so I could quote it)

“We’re not going to do anything about [CAM] at all, and we make no apology for that.”

Glasgow, I’m proud of you.

1 03 2011

So I’m sitting here in a kind of dozy half panic waiting for it to be time to go to my first OSCE. I can’t decide what to take with me. Stethoscope, obviously. Pin for testing visual fields? There’s theoretically no ophtho on this one and you can do it just as well with a finger, so probably not. It’d just be something to lose somewhere. Torch? Probably a good idea. There’s lots of things you can do with a pen torch. Tourniquet? No. I’d never be without one on the wards (particularly since I have a good one) but I won’t need it for this.

It feels jarringly unfamiliar. I will dress the same as I normally do for ward time, except no necklace in case my stethoscope gets caught in it (this happened when I was practicing last night. Total facepalm) and I will behave in the same way, except instead of a series of interesting people I have a series of tests and examiners.

Anyway, I’m not going to talk about that cause I’m scared. I’m going to talk about Guides instead.

I’ve been a Girl Guide since I was five. I was a Rainbow, a Brownie, a Guide, a Young Leader, I did DofE with Guides, I did some International Guiding, I’ve been a Unit Helper for ages and I’m currently doing my Adult Leadership Qualification. By this point, Guiding is almost written into my genes. (Almost literally – my grandmother was in the Trefoil Guild until she was 75.) I like Guides, I think it’s a fundamentally good thing for girls to have a space of their own where they are encouraged to do everything. I think boys, particularly teenage boys, can sometimes be a bit overpowering and take the lead in things, and it’s good for girls of that age to learn that they can do stuff too, that there are ways of building self esteem that don’t relate to boys, I think it teaches practical skills and people skills and helps you relate to other girls. I don’t believe in single sex schooling, but for a couple of hours a week, I think it’s a good thing. I learned a lot from guiding, I gained a lot, and I want to be a part of it, I want to make it possible for other girls.

The problem I currently have is with the promise. I have taken a variation on the promise five times. In the fullest form it goes as follows:

I promise that I will do my best to love my God, to serve the Queen and my country, to help other people and to keep the Guide law, and to be of service in the community.

Guess which bit of that I have a problem with?

I don’t like promising to love a god I don’t believe in. I really really don’t believe. Not even a bit. The promise is worded to deliberately include any and all interpretations of god, whether that be a religious interpretation (God, Allah, Yahweh, Buddha, whatever) or a spiritual interpretation of a ‘higher power’. I don’t believe in any of those things, in anything that could be called a god, and certainly not in anything I could profess to love. There is no way around this. If I won’t promise to love my god, I can’t take the promise, and incidentally if I do take it and I become a Leader I am obliged to teach the kids about loving a god I don’t believe exists.

If I had not wanted to take the promise for this reason I could still have been a Rainbow, a Brownie, a Guide, a Unit Helper,  a Young Leader, whatever. What I can’t be is an Adult Leader. To be a Leader you have to take the promise.

I am deeply uncomfortable about taking it and lying every single time, but if I want to be an Adult Leader I have no choice, and I do want to. So I said the words and I hate that I did, and I wish there was a choice.

Girl Guiding is actively excluding atheists and I don’t like it. There’s no reason and no sense to it and it needs to change. In Canada it already has changed, their promise is now: “I Promise to do my best, To be true to myself, my beliefs and Canada, I will take action for a better world And respect the Guiding Law”. That may have gone a little far – the ideas of service and helping others are important ones, I think. But it’s an interesting step and I think we need to look at something similar here, to open Guiding to those of us who don’t believe.

24 01 2011

I am doing obstetrics and gynaecology right now, and it is very strange. I’m avoiding gyn as much as humanly possible because it is basically kind of icky and I have no desire to spend my time looking at infected/cancerous/prolapsed/otherwise nasty vaginas, usually attached to old ladies. The exception to this being the wonderfully euphemistic “social gynaecology clinic” which is a nice way of saying termination assessments. Social gyn is interesting and almost entirely free of ick, which is why I think it should be classified under obstetrics.

The interesting part of that is that obstetrics is of course fairly heavy on the ick also, and it doesn’t seem to bother me. I was watching C sections the other day, and believe me those are bloody and brutal and involve random fluid gushing everywhere and are generally quite icky. I think the essential difference is that I am crazy broody at the moment, and at the end of a C section, if all goes to plan, they hand you a baby! A tiny, unique little person. It’s possibly the coolest thing I’ve ever seen. I was stood in theatre muttering “holy shit” under my breath for about ten minutes. One of the student midwives laughed at me, which is fair enough I suppose. I really want one of those. Everyone tells me I’m not allowed yet though :( I suppose they’ve got a point. When I do get round to it, though, I’m definitely going to give my firstborn son the middle name “Firefly”.

So obstetrics has been fun, ick notwithstanding. I’m enjoying antenatal assessment and ultrasound and all that stuff. Unfortunately I should probably do some gynae at some point too. Meh. Maybe next week. Actually, I think there’s a clinic on Friday, with a bonkers lady also known as my gynae supervisor. Hopefully it will be interesting and I will not be obliged to touch anyone’s hooha. I don’t mind that sort of thing when there’s a purpose to it, but at the moment I sort of feel bad for them, as the doctor is obliged to repeat any important examinations which I perform, particularly as I haven’t done much gyn. That sort of thing is unpleasant anyway without having to have a medical student do it a second time.

Ah, we’ll see. Perhaps it won’t be too bad. I’m feeling optimistic today.

1 01 2011

India is a strange place. Some disorganised reflections –

Mumbai is hot and the traffic is as insane as it ever was, all the drivers just drive where they feel like and sound the horn a lot and expect everyone else to deal with it. Moves that would take me five minutes and about a mile (e.g. cutting across three lanes of traffic to exit the A road) take three seconds and happen at the last possible moment. I did genuinely think I was going to die several times on the way home from the airport but accidents are usually not serious because no one can drive fast anyway. It’s hectic and busy and on the way home from the shops we saw some goats perched on a tin roof eating a tree.

Getting around takes forever because of the bonkers traffic. If there are three lanes marked on the roads, there are four or five lanes of cars weaving in and out of each other, three or four rickshaws, and any number of cyclists, motorcycles, pedestrians, people trying to sell things, dogs and the odd cow. You can’t walk by yourself and you can’t walk far at all. Rickshaws are kind of fun in a novel sort of way but not all that useful. We’ve been lucky to have a car service while we’ve been here but they’re not terribly organised and a lot of the time they don’t know where we’re going, and frankly there’s nothing they can do about the traffic.

It’s a strange city. There’s so much contrast here. Some people are very wealthy and have every luxury, with staff and swimming pools and all that, and some people are desperately poor. It’s not like at home, where mostly the poverty is caused by drugs or social problems (I know there’s endemic poverty but it’s low level compared to here), and to be honest we have a completely different idea of poor. Here, there are so so many people who are born with *nothing* and then spend their whole lives scratching out the barest living on the absolute edge of life, one step away from disaster the whole time. There are drugs, of course there are, but they’re not the cause of this. It’s just how it is, how it’s always been.

My uncle suggested today that I should come and work here for a few months after I qualify, at one of the big fancy hospitals, and the idea makes me sick. I always wanted to go out with Medicins Sans Frontieres for a while, which I still do want to do one day and I could work here in that capacity or a similar charity capacity, but I don’t want to work in the big private posh hospitals, not at all.

I don’t know. It’s hard to come to terms with this place.

30 11 2010

So. Driving in the snow. I’ve never done it before, funnily enough, given that I passed my test in June.

You get to your car and the first thing you do is thank your lucky stars that you park in a garage and you are not currently digging your car out of a tiny mountain of snow. The second thing you do is switch the heaters on and turn them up. As you leave the garage you cross your fingers and hope you don’t skid on the impacted ice/snow combination on the pavement that you know is slippy because you saw some hopeless ned shining it up last night. Once you get on the road, the first thing you notice is that you can’t see any road markings. You can’t see the lanes, you can’t see the edges of the pavements, all you can see is the parallel tracks where other peoples’ wheels have been with a six inch deep, foot wide track of snow in the middle. So you follow the tracks, and hope they’re going where you’re going. If you’re lucky, you’ve driven the route a few times and you know roughly where the lanes should be.

Your brakes squeal and make crunchy noises when the workmen at the building site down the road wave to stop you.  You realise that your car’s excellent brakes are not quite so excellent in this, and if you have to stop suddenly you’re screwed. So, same as everyone else, you drive slowly, and carefully. The A road is a blessing, because it’s clear and you can relax. You’re late for ward rounds already but that doesn’t matter because next up is the Clyde Tunnel. It only takes a moment before you realise you didn’t need to worry about that, though. The Tunnel is covered and it’s not yet cold enough to be icy. It’s just damp, that’s fine. On the other side, you realise that Govan is even less clear than home. Apparently, the very few gritters that were out last night didn’t come here. The roundabout is worrying, you can see where people have grazed the edges of it or driven right up onto it because they just couldn’t see it. By now though, you’re not noticing that because you’re busy hoping against all reason that they will have gritted the hospital.

They didn’t grit the hospital. You drive very, very slowly, knowing how prone people are to wandering about the grounds without looking. Lots of the cars in the 4-hour-only patient spaces have clear patches under them, reinforcing your suspicion that some bastards leave their cars there for days on end, which is why you can never park. Today though, you can park. You edge your car very very gently into what may or may not be a space, given that it’s so covered in ice you have no idea, and get out of it. Screw four hour parking, you’re not moving it again til it’s time to go home.

The funny thing is, if you forget the low level fear of fiery death, it’s actually pretty nice. No one’s hurrying. Everyone is late, and everyone has a good excuse, so no one cares. Everyone’s boss is probably late too. No one is hurrying, no one is beeping at you, no one is doing anything even slightly reckless or inconsiderate, cause no one wants to be the fireball on the side of the road. Everyone is relaxed, polite and calm. Why does it take six inches of snow before people behave nicely?

I want to write about the protests in London but I’m waiting to see what happens. I’ll write tomorrow, probably.

22 11 2010

Point the first: apparently there are people reading this blog 0_O hello people! *waves madly* You should say hi.

Point the second, which I actually meant to write about.

I have always thought of psychiatry as a very holistic specialty, in the sense of considering all the person’s different problems and how they contribute to their mental health. Sort of the opposite of ortho. Apparently, not so much.

Today we saw a patient who was in her 60s, and very very thin. (I won’t put numbers for all sorts of reasons.) We (or rather the consultant) had been asked by her CPN to assess her for a possible eating disorder. When we met her, she was indeed thin to the point of skeletal, and admitted to eating very little. However, she went on to explain that this was because she had no appetite, and had not had for ages. She tried to keep her weight up by drinking fortisips and gallons of irn bru (the sugary kind), and ate when she could. She’s clearly fighting a losing battle, but that’s not anorexia. The ICD10 criteria for anorexia nervosa states: Anorexia nervosa is a disorder characterized by deliberate weight loss, induced and/or sustained by the patient. So the patient was not anorexic, not bulimic because she doesn’t vomit, and frankly did not seem like someone with an eating disorder.

So. You’re presented with an old lady who smokes like a chimney, has no appetite whatsoever, has lost two stone in the past year and has frequent chest infections. What’s your first thought, guys?

The consultant ended up switching her medication from citalopram to mirtazapine, to aid her appetite and sleeping and hopefully the depression which she definitely does have, and encouraging her to eat food rather than fortisips. She also suggested reducing her diazepam. That’s all fair enough but I was sat there thinking “lung cancer!”  It’s probably the first thing I would have thought of and certainly the first thing I would have checked for, or at least checked to make sure someone else had done the appropriate tests.

So I am a touch confused. The lady in question had been in hospital recently for one of her chest infections, so I have to assume that someone did the necessary tests while she was in there. Regardless, I am definitely a bit surprised that no one considered a physical problem here. I guess it’s that old conundrum of making the diagnosis appropriate to the specialty.

Any thoughts?


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