Thursday, 7 January 2010

Catchup



Hi,

Ok, there is some need for some serious catchup, just for the purpose of continuity, before I promise to start my weekly blogging routine this weekend. Bear with me, so I can get into this.
Over the few months up to Christmas I have been on a reproductive rotation and a paediatric rotation. These were the first full time rotations I have been on in my medical training, and as such it would be best to start from these.

On the Reproductive rotation, I spent time doing Gynaecology and Obstetrics. This is quite a specialised subject, and this can be seen as a good or bad thing for one to start on. For one thing, it means there are (relativity) few complaints that a patient can have, meaning forming diagnoses and knowledge is less of an issue at a medical student level. When there are around 5 common Gynae diagnoses, it means you will know something about each one, and can take a good guess at which a patient is presenting with. There are obviously a lot more, much rarer, conditions, but as a 3rd year medical student these are less important. On a down side, if you are not considering Gynae as a career then perhaps the Gynae rotation is of less interest and use. I suppose its always useful being able to diagnose conditions and be aware of the Gynae differentials.
Anyway - In my time in Gynae I learnt to perform basic examinations, take a smear, take a Gynae centred history, learnt about the common Gynae complaints and got to assist in my first surgeries. The first surgery I assisted in was a hysterectomy for a large fibroid growth. This is basically a benign tumour in the uterus, and the patient was happy for the whole uterus to be removed so that it wouldn't grow back. The patient was friendly, easy to talk to and personable. I scrubbed in and got to assist in the operation, and then even more so when the assisting doctor got bleeped away. While it felt like a lot to me, I suppose I wasn't really doing much: Holding things, cutting thread with scissors, passing things to the surgeon and such. The surgery team works beautifully. Like a well oiled machine. There is often little talk in the theatre (other than occasional banter or music playing in the background) with the assisting doctor or theatre nurses passing things to the surgeon or assisting when they see that they are needed. While surgery does not appeal to me as a career (lacks a large element of the 'puzzle solving') this must be something fantastic to be the centre of. Anyway, the patient got better fast, and I saw her improve quickly in a few visits over the couple of days before she was discharged. Success! At least I didn't kill her.
Well I suppose I cannot talk about loads of cases in this 'summery' but needless to say the Gynae team were really nice and friendly, and provided the patients with first rate care. The only problem I saw was when I went to work with a surgeon, but the surgery list had been cancelled for the day. The patients and surgeon had not been told and all were very annoyed. Unfortunately the operations could not happen as there were not spare theatres, and they could not be carried out in the afternoon as the surgeon had a clinic of about 30 people to see then. The patients had been starved, bought into hospital and worried for no reason and the surgeon had wasted his time. Annoyance at the management came from this - an error in communication was the diagnosis.
We were taught to carry out intimate examinations by professionals trained to act as patients and teach us to perform them on themselves. An odd experience, but much much better than the fabled olden days of students practising such things on unconsented patients under anaesthesia!

The obstetrics rotation was very hands on. I got to assist in births and saw births from normal deliveries to water births to forceps aided deliveries to a C-section of twins.
I cannot say how amazing seeing a birth was, or how privileged I felt being accepted by all of the mums-to-be. Childbirth can be a scary time, and having them allow me to help out, under experienced supervision of course, was very generous. Fortunately all of the babies I saw were completely 'normal' and while some of the mums had problems with the delivery none of the babies were adversely affected. I saw one mum suffer from a Postpartum haemorrhage (PPH) which is where the uterus does not contract properly after the birth and all of the blood which would normally be supplying the baby (a lot) is not cut off as it should be and so pours out. A very scary time for me (and much more so for the mum and dad) as everyone was running around sorting things out and treating. I didn't know what to do with myself, so hid in a corner and noted down everything that happened for the notes. An important job, honest! Fortunately this, while not common, is a side effect that is well expected and drugs exist to make the uterus contract. Everything turned out fine!
I saw another very touching case, but it was somewhat unique, so I will not put it on here in case it in any way breaks confidentiality. Perhaps I can combine it with another some time later. Who knows.
In the obstetrics rotation, time was also spent in other smaller units, such as the Early Pregnancy Clinic, where women with problems during the pregnancy, such as bleeding, came to have a scan and bloods taken to see if they have miscarried or if their babies are fine. Very sad.

On the paediatric rotation I spent time trailing after doctors in hospitals, sitting in outpatient clinics and I also spent some time in the community, seeing children in nurseries and the such.

When in the hospital much of my time was spent observing. This was a shame, as I enjoy being hands on, but I suppose that children need the highest level of care and don't want to be scared by me. I heard that there was a clown that went around the hospital keeping the children amused. Unfortunatly I never got so see this, but wonder as to how much of a good idea this is - I am sure that if you have coulrophobia and are in a hospital this would be the last thing you would want to see. I did get to take a lot of histories from children in the assessment unit, while the doctors were busy elsewhere and present the patients back to the doctors. Hopefully saving the doctors time and getting the patients treated faster. Hopefully. When I was with a registrar we also got bleeped down to A&E for a child who was having real trouble breathing. Follow the ABC's and the child was put on oxygen. A suspected diagnosis of croup later and some inhaled steroids and the child was playing around on the floor. That's one good thing about children's hospitals, full of bright colours and toys!
Anyway - this sort of quick recovery really pulls me towards wanting to work in A&E. Making that sort of difference so quickly is really appealing, feeling like you are changing peoples lives every day is amazing. Well - keeping my options open but I will keep my eye on emergency medicine!
Time spent in outpatients involved seeing patients either before admission, or who needed to be seen by a specialist and had been referred by another professional, such as a GP. I did least here, mainly watching consultations. With a high volume of patients and little time common it meant there wasn't time for me to take a history and report it to the Dr, but I still got to learn about plenty of things from 'observing'. Saw some sad cases of abuse or suspected abuse, though, which I suppose is just something you have to get used to. Sitting in on clinics from general surgery to a clinic for premature babies who have lung problems due to being on a ventilator for so long gave a good variety and depth to the learning. Paeds is far broader than Gynae- and I think it is breadth that I am looking for in a medical career. Variety is the spice of life, after all! Who knows - early days, and I am not sure I have the patience to deal with children day in day out - too much bribery. I have a lot of respect for the patience needed to be a paediatrician!
In the community we saw children in clinic-like settings and visited nurseries. In the nursery I spent time with children with disabilities such as aspergers. What can I say? My course requires me to go and play games with children as a way to learn. I love my course.

Anyway, This post is very long, and pretty basic missing out a lot of the learning and interesting things that happened over those months, but its only a basic catch up. Sorry for the poor blogging style - it can only get better (though don't expect much any time soon - time limitations)!

I will be back at the weekend to talk about this last week.

Don't forget to smile.

1 comment:

  1. Your style is so sweet, that I prefered 20 minutes of reading your blog rather than lying in bed after a long day,(a waiting the bus at 6.30 am, back home at 4 pm) . Pediatric is a nice rotation indeed. It is a shame only 2 weeks left. Time to go study. Thank you:)

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