Sunday, 7 October 2012

Bursting bladders


A very busy week this week, and another short post. It seems the busier I am, the shorter the post as there is then more to do at the weekend. This week I see some strange things on call, I practice (and mess up) some procedures and I have a fantastic teaching success. 

While on call with my F1, I am asked to carry out a lumbar puncture by one of the doctors, as it will be a good 'learning experience' for me. I decline the offer, I don't think it is a good idea at all to have me sticking needles into people's spinal canals. I do watch it though, and the man it is being performed on has a snake tattooed up his back, the exact point where the needle needs to be put corresponding with the eye. It was strange, watching this needle be pushed into this tattoo's eye, as it looked on fearfully, and ended up with the snake 'crying' blood after the procedure. Very creepy... The on call was also full of other 'fun' experiences, such the man who was in urinary retention with a three way catheter in situ. Usually these catheters can be 'flushed'  to unblock them, but this catheter had been flushed multiple times by the nursing staff with nothing coming out, filling his bladder up ever more with the fluid.  His was well over a 1 1/2 litres on an ultrasound scan - a lot more than normal!!I wonder if its possible to burst from a huge bladder? [according to the guardian and BMJ, perhaps it is: Article here)

A strange, unrelated, bladder related advert

I have also been having a busy time on the ward, practising a lot of the minor procedures I will need to do as an F1. I have been doing a lot of ABGs, and inserting a lot of cannulas, and am now getting pretty good at putting cannulas in (I was pretty terrible last week) I managed to get an ABG on a woman with Parkinson's disease this week, which was a real challenge as her wrist was shaking all over the place. It wasn't all success, though, as later that day I tried inserting a cannula into a woman who had an INR of 8 (a measurement of blood clotting, and normally 1) which ended up with her bleeding all over her pillow and the bed. I did manage to get the cannula in, but had to ask the ward staff to change all the bed clothes as they were soaked. Very embarrassing, though fortunately she was very understanding and kind about it. When taking some of my blood results to the lab to be analysed, I have to wait outside in the public blood-testing area for my results. While waiting there, I decided to be a helpful little medical-student and asked a man, about my age, if I could help him - he looked a little lost... I got the po-faced reply "I am here to give a sperm sample, I'm not sure if I want your help"... Awkward times! I had to go and hide around the corner until he left...

A lovely patient was admitted to our ward this week, a man who was described by his son as 'normally really grumpy and cantankerous' but over the last few months had become increasingly more jovial and 'giggly'. He wasn't admitted to the ward for this, but for breathing difficulties. While it sounds lovely, someone enjoying their old age, this change of mood set alarm bells ringing in the consultant's head, and a CT scan of their brain showed a large number of brain metastases from a tumour elsewhere in the body. Getting cancer is a terrible thing, though if it makes you cheery and less bothered about it, I suppose it could be worse. It brings to mind the stories about people who almost die from drowning, who say in the last moments you lose all the worry and panic about it, and just relax and accept it. (for you medicine lovers out there, this is probably due to the hypoxia in the brain shutting down the areas which deal with this fear).

To finish of this week, I was at a bedside teaching session which was being run by one of the junior doctors. Here, they take a group of 2 or 3 students around 'interesting' patients in the hospital, where we perform an examination similar to how we would in our final exams, and present the findings. The idea is to improve our examination techniques, and to practice recognising common conditions. I was told to do a cardiovascular examination on my patient this week, the most important part being listening to the heart. I floundered a little, confused over why I couldn't really hear anything, but then remembered about the medical school myths of patients who have their hearts on the wrong sides of their bodies being bought in to flummox medical students in exams. I listened to the other side, and lo-and-behold, there was a nice beating heart sound! I didn't say anything, but let the other 2 in the group have a listen and went back to present it to the doctor. I presented it as a case of dextrocardia with a heart murmur  and was correct! Definitely a good feel-good factor to boost confidence! Hopefully that one won't mess with me if it comes up in the exams!
*geek out*

The heart in its normal postiion, and switched around in the inherited condition known as dextrocardia. I was so pleased I spotted this!


  1. Great spot on working out the heart position, will make sure to share this on out Google+ group.

  2. Hmmm I've been told by a doctor before that you should never do a lumbar puncture through a tattoo (and that this causes problems with the popular "tramp stamps") That must be a myth I guess!

  3. ps totally met the patient with dextracardia before you if its the same one, been here several weeks!

  4. What's with all the sudden spam? Anyway I think you should have tried the lumbar puncture, one of my mates got it in 3rd year (when the rest of us were bunking).

    An F2 told me a funny story about when he was on his own in A&E (well, with an F1 who had similar lack of experience) and needed to do a chest drain with nothing but his C&O to guide him.

  5. Yeah, loads of spam. All gone now, though...

    It takes me ages to work out a captcha normally - poor guys...

    @Half a doc - they definitely went in right through the tattoo, so I suppose it must be a myth. Either that or they hadn't heard about this problem, leading to the seeding of tattoo into the spinal canal and a really cool spinal chord!

    @Anonymous2, sounds pretty petrifying! I did an ABG in my 3rd year (seems pretty tame now) because I had read the page about it on wiki, though I think if you are the only one available, its probably pretty ethical (and a pretty cool pub story)!

    1. Sorry, it wasn't spam at all. I just shot you an email....