Hearts

Hi,

As far as interesting cases go, this week was dominated by meeting a man who had two functioning hearts. As well as meeting this very interesting case, I also got on with the normal life of a 3rd year medical student. I met someone who is a very famous musician, in a clinic for people suffering from syncope (faints) and I managed to get dragged into a cubicle half way through another medical student examining a patient, and thoroughly embarrassed on my lack of knowledge. I have also been enjoying the political atmosphere. I love a good debate, and it is always interesting seeing people who you know, but not enough to have had such discussions with before, reveal their political colours (such as all of your classmates). Its great seeing how peoples political views match up to what you might suspect of them. Do those who tend to wear Ralph Lauren polo shirts or YSL cuff links tend towards conservative? Its interesting to sit in a common room and listen to people discuss various aspects, and reactions to other's political views.
"Urgh, I cannot believe you are conservative, I always thought you were a nice person"
 or "Liberal Democrat? What are you doing in medschool, I thought there was an entrance requirement?"
Not always meant in jest, these 'debates' can get pretty ugly, but its a good opportunity to learn more about your friends and classmates.

I will go straight onto this patient who had two hearts, as I never knew this was possible until this week. This was not some form of congenital abnormality, meaning he was born with two hearts, rather he received a heart transplant about 20 years ago, but the old heart was not removed. The new heart was stuck into his chest on the right hand side, next to the old heart, and connected up so they could both function at once, giving him extra pumping volume. This kind of operation, known as a heterotopic heart transplant is rarely performed nowadays, with the main reasons for doing it being if the original heart is suspected to recover (foolish to remove a hear that will improve, just give it some time without the person dying); if the transplanted heart is too small to work properly in the transplantee (i.e. a small woman's heart transplanted into a large man); or if the transplantee's body is suffering from pulmonary hypertension, meaning the heart needs extra force to pump against the increased pressure. This sort of problem is usually surmounted by a heart and lungs transplant now, however, as this gets around the increased pressure int he lungs by giving a new set of lungs as well! I had a very informative talk with this interesting patient about how his life had been going and the problems he had had, but unfortunately I never got to examine him. Seeing him in a clinic, where he had come for a general check up, I felt it would be rude to ask him if I could auscultate or feel his chest to see what having two hearts sounded like. I think this was probably the right decision, as I am sure he gets a lot of attention from medics and students alike wherever he goes, but I regret it at the moment - I hope I see someone else with such a transplant to see! A very "Dr Who" like situation. The two hearts had a pace maker attached to both of them a little after inserting them to make sure that they beat at different times, to stop a large increase of pressure from a combined beat.
Next time I see a really interesting patient I will make sure that I say something and get a chance to examine!

I was wandering around in the A&E looking for some ambulance crew who didn't look too busy. I had heard that it was possible to go out in an ambulance for a day or two if you asked the right people, and this sounds really exciting, so I was trying to get a phone number off of someone who looked like they knew what they were doing. Whilst looking, I was suddenly approached by a small, hyperactive doctor who grabbed me by an arm, muttering something about an interesting case, and dragged me behind some curtains into a cubical where one of the other medical students was examining a patient. I was a bit lost and flustered, wondering what was going on, and then I was asked a series of rapid questions by the doctor about the patient, their condition, differentials, examination techniques and the such. This was a respiratory problem, and as of yet, i unfortunately do not know all that much respiratory medicine. Especially of this level, as I found out later that this patient had often been hired with his chronic condition for MRCP exams (very high level exams for 'proper' doctors). The other medical student there was on a respiratory rotation, compared to my gastro/cardiac experience thus far, and managed to get the majority of the questions right, whereas I fumbled almost all of them. It was pretty embarrassing, seeming so stupid in front of one of my fellow medical students, while he seemed to know so much more. It was especially unnerving to keep having to say "I don't know" to this excited doctor, who obviously loved teaching, who was pacing around telling me I would never pass my MRCP examination if I gave stupid answers like that! All in all a pretty embarrassing situation, but embarrassing enough to kick me into revision action. I will have to make sure I know more about the lungs then - I think I know plenty about guts and livers by now!

To finish off, I saw someone very famous this week in a syncope clinic. They had been fainting at inopportune times, and were afraid of it happening to them on stage. Another great thing about medicine. Everyone needs medical help, rich or poor, young or old (though mostly the old). Despite all of the lack of knowledge and embarrassment that seems to occur around me, this is a wonderful profession to get into - and I look forward to the day when I actually know something!