Early mornings

Hi,


It seems the higher up the medical school-ladder you move, the further away you need to travel for your placements. While this seemed fair in previous years (letting those who know the least stay close to home and all that) I am starting to change my mind. It is so tiring! For example, this rotation has 8.30 starts at a distant district hospital. The buses here run one an hour, getting in at 45 minutes past the hour. This means I have to arrive at 7.45 in order to be on time. Seeing as the journey on the bus is an hour, and getting myself to the bus takes time, I am getting up before 6AM. Ungodly... This would be (just about) acceptable if it was worth it, but it seems as though these sessions keep starting 20-30 minutes late, meaning I could have gotten up an hour later if I had known. Getting up at 5.45 is a lot earlier than getting up at 6.45! Anyway, rant over...


Because of these stupid early morning starts, impending exams-and-presentations-of-doom and the fact I am currently trying to move out of my house while still in this extended term-time, I am not being too successful with this blog, for which I apologise. Clinics have been very interesting however. Rheumatology seems a very complicated subject, that collects lots of the parts of medicine that other specialities seem to 'mysticize' or don't really understand, including the House favourite Lupus, and the poorly understood disease fibromyalgia. All of these confusing connective tissues disorders, along with the multitude of types of arthritis, which all seem to cross and overlap with one another is very confusing for a poor little medical student! Fortunately, it was highlighted to us how out of our depth we were in this field in one clinic, the favourite quote I take away with me being "Don't feel for heat with your knuckles, you're not a gypo"...


Other than our somewhat outspoken un-PC consultant (or perhaps because of it) this clinic was very interesting. We saw a boy who had had severe burns to his face, which he had received plastic surgery for, but had (somehow, inexplicably) lead to him developing some kind of juvenile arthritis. There was an elderly gentleman with psoriatic arthritis who had been referred by his GP for better treatment as he was still in pain. For some reason the GP had prescribed him diamorphine (Heroin) to help with his pain. This is normally reserved for the worst kind of pain, as people are dying. I am sure he was really enjoying its pain-killing properties! There was a 40 year old woman who had been put on a biologic anti-TNF agent to help treat her rheumatoid arthritis. This had changed her life, allowing her to dress herself, change her grand kids nappies and hold a pen. The side effect was she was losing all of her hair, including her eyelashes. Despite this, she was adamant that she didn't want to stop taking this wonder-drug (which costs about £20,000 a year). I was really moved by this, an attractive 40 year old is willing to lose all her hair in order to get rid of this disease - I suppose this really highlights how debilitating these diseases can be. She was willing to give her 'right arm' to return to normal, and saw having to wear a hat as a small price to pay. These sort of patients, whose lives are turned around by successful treatment, are what really makes clinics and being a doctor. If I have a few people, every once in a while, who I can feel that I help half as much as this lady, all these early mornings will be worth it.

Its not laughter, its not paracetamol, its not even talking and understanding. Some doctor  decided that the best medicine to cheer up his unhappy patients would be heroin... Brilliant!




Now you will have to excuse me - I have to go to bed, in order to be up before 6 again...