Survivor

Hi,

Back on vascular surgery, and back on the interesting cases. Unfortunately, with essays and the like to do (almost finished this essay), it is not possible to put as much time into going on the wards and into theatre as I would like. Still spending some time meeting patients and seeing interesting things, but passing assessments always has to come first.

This week I met up with the patient with cancer I mentioned some time before, I saw a patient presenting with an unusual swelling in her neck, baffling the doctors, and I found myself talking to a patient who had managed to survive a sequence of dangerous conditions.

The patient who had cancer, I mentioned some blogs ago and despite only mentioning her once here I had been following her through her whole treatment, visiting her once a week to see her radiotherapy and see how she was doing. The idea of this was to see how she coped with the increasing side effects radiotherapy causes on your life, and how she coped with the big life change that having to travel in ever single weekday for radiotherapy for 6 weeks could cause to her life. She finished the course a good month or two ago, and I hadn't seen her since, seeing as she has now gone of home. As I mentioned before, she is a wonderfully optimistic lady, who always has a nice thing to say about her position. I had managed to come upon (though somewhat sneaky means) the appointment time and place for her post-treatment appointment with the cancer specialists, so had decided to follow her here. While this sounds like (and definitely felt like) stalking her, I convinced myself that she would appreciate seeing me again, and anyway, its a valuable learning experience, seeing a follow up post-radiotherapy appointment, right? As is, I managed to persuade the nurses and doctors to let me see said appointment, though they were very confused as to why a 3rd year medical student wanted to be part of the morning, and for only one patient (at this medical school, oncology is not a 3rd year rotation). They were running about 2 hours behind, though, so I got plenty of time to sit and talk to this patient about how she had been keeping herself and how she was feeling. I was pleased to hear that she was feeling great, had no real abnormalities from the treatment other than a little hair loss around the site. She had more things going on in her life again, with someone in her family currently dying in hospital, but still maintained the same positive outlook and cheery demeanour that I remembered from before. Quite by accident I managed to get her appointment shifted forward so she was only waiting for about 30 minutes (I think the oncologists wanted to get rid of me). Not that that is right, as it just meant that others had to wait even longer, but it was unintentional, so I will not feel guilty. There are no signs whatsoever that there is any remnant of the cancer, so a cure is expected, though not guaranteed as who knows what remains in the microscopic level. Great news, and she was obviously very happy with this as well. After a touching farewell I left to return to a lecture. So I hope that I would get to see her again? If I am seeing her again, it will mean she is ill, either coming in with recurrence of her cancer or another medical condition. Its sad that you can see people leave and be unsure as to whether you want to see them again or not, but perhaps you can just hope for another setting, such as on a high street. Good luck to her, whenever I finished talking to her I would always leave with a smile, and I hope that other people who spend time with her give her the care that she is due.

I was spending some time in a clinic later on this week, and saw a good variety of patient presenting with problems with arteries and veins. Common things to see in this setting are problems with the venous or arterial circulation to the legs, stable aneurysms, and the like. One patient came in with a strange pulsatile mass in her neck. It pulsed with the heart beat, and overlay the carotid artery in the neck suggesting a carotid aneurysm (pretty rare). The patient had been referred via a duplex scan, which is an ultrasound scan which can create a picture of what is inside your body, and tell you where the blood is moving. The results from this showed a slightly swollen carotid artery, but nowhere near the size of an aneurysm, or the size needed to be clinically visible on the neck, which this lump was. The surgeons had plenty of questions for this lady, but none of her answers managed to give them an answer for this condition. What are they going to do about it? Are they going to prescribe her lots of invasive but clever tests? Will they admit her for careful monitoring and assess her as an in-patient? Nope. "Go home, and come back if you think its getting any bigger". Talking to one of the consultants after she had been discharged, he admits he has no idea what on earth it could be, but 'that's a bit boring anyway' and it didn't look life threatening. Fair enough, its like the GP option of see if it goes away, and come back if its worse, but that sounded like a bit of a cop out from a high level consultant. Where is the sense of curiosity? Do you not worry that it might be more dangerous than you think? I suppose he didn't want to put the patient though unnecessary, painful tests and waste her and his time. I'm only a medical student, I have no idea what's going on.
Clinics aren't all seriousness though. The surgeon had a good flirt off with a 97 year old woman who had come in with claudication. It started off with:

Doctor: "Don't worry, I will see to you right now"
Patient: :Ooh, I look forward to that, when can we get started? Do all these people have to be here"

And ended with information I don't feel happy about putting in a blog with unknown readership. Needless to say there are some very dirty minded older women out there! Its good to see this consultant not taking himself too seriously though. Makes you much more endearing to the patients.

Finally, on the wards I was talking to a gentleman who had been in hospital for 3 months or so. This is a long LONG time for an NHS hospital, which turfs people out as soon as possible. And understandably so - with bed prices for a night in hospital estimated at £800-£1000 A NIGHT, it is expensive to keep people in hospital longer than needed. That patient had been kept in for so long because he had had a series of problems befall him. he had come in with a AAA rupture (a different man to the one we saw come in with the same condition a few weeks ago), which has a chance of death or around 80% before you get to hospital. This had been operated on and repaired, the operation carrying about a 40% mortality rate (please note, these are very rough figures). In recovering from this, due to the immobility in the beds, he had developed compartment syndrome in his leg, infected with MRSA after an operation, which then progressed with deterioration in his health leading to multi-organ failure, which can give 80-90% chance of dying, with the number of organs he had involved. In and out of intensive care, this patient was still alive, chatty and happy with pictures of his extended family up around his bedside. All of these chances added together give the patient less than a 1-2% chance of survival. That is exceptionally small, especially given that the these figures account for a person who was healthy before, and didn't suffer from the previous insults to his system. All in all, a very impressive feat, and made you feel all warm and fuzzy inside when you saw all the smiling faces of his family on the walls, looking down at him as though they wanted him back home. He would make a lovely grandad, very cheerful and fun to be around, and I hope that he managed to make it out of hospital without encountering any more problems or infections. Surely he has used up all of his bad luck by now!

Relativity short blog today, as I spent the weekend at my grandmother's 95th birthday party. Lovely to see family I had never met before, but means this has been knocked out in under an hour... Have a great week!

TurpTurpTurp

Hi,

A very different week compared to last week's excitement, but at least I now know that I don't want to be a urologist! Seeing as we get to see a bit of everything on the rotation, I suppose a lot of time is spent working out what you don't want to do. If you wanted to do everything, well, you couldn't.

As the first paragraph suggests, this week was spent doing urology surgery. Perhaps it is a little premature for me to say this so prematurely, but if I ended up having to go into urology surgery, I would probably leave medicine and go into something different. Perhaps I could joint he police force, being a detective looks exciting from TV.

Not that my experience this week was a bad one. The teachers had plenty of time for us, and in theatre we were walked through what was going on in a friendly manner. The low point here was that we didn't get to assist or scrub in at all this week, but that's just because of the procedure that was being carried out.

Yes, that's right - a whole week of surgery and I only saw one procedure. No - it wasn't just one chance in the theatre, had plenty of those opportunity - it was just the same procedure again and again. While surgeons in urology do carry out a range of operations, from surgical treatment of bladder cancer to operations on the kidneys, there is one operation they do far more than any other. This is called the TURP, which stands for Transurethral Resection of Prostate. Sounds pretty fancy, doesn't it!

Enlarged prostates are very common (in men, obviously) and cause a range of problems with urination by putting pressure on the urethra. The prostate is basically like a ring doughnut, the middle of which the urethra passes through. As the prostate grows, this puts pressure on the urethra, making it harder to urinate. Prostates can enlarge by themselves, for no obvious reason, or they can be cancerous. Whatever the reason for their enlargement, if the patient wants to be able to go to the toilet normally this is the operation for them.

We saw one on Monday and it looked pretty exciting. A tube is passed up the urethra via the end of the penis, up into the bladder, as though the patient was being catheterised. This tube is larger than a catheter, though, and the doctor passes an instrument similar to an endoscope up through the tube with a camera on it in order to visualise the bladder and urethra. With this camera another instrument can be passed up, which looks like a loop of wire, and used to cut away at the prostate encroaching on the urethra - see below.

Here you can see the insertion of the tube down to the level of the prostate, which can be operated on (see small organ above and below the tip of the tube)

This is the image the surgeon can see. The operation from this point on is carried out by feel and what can be seen in the camera. The wire loop can be seen, and is linked up to a diathermy, using electricity to cut through the prostate and seal the blood vessels after the cut is made.


The tube also has to pump water continuously into the urethra and bladder in order to make the tube as open as possible, to make the operation easy.

Now you can see why it was not possible for us to assist - this is carried out by one surgeon with anaesthetist(s), assistant theatre technicians and nurses there to help with the procedure. It still sounds like a lot, but the operating theatre would have been pretty empty, comparative to normal, if it weren't for all of the medical students standing in the corner peering at the screen.

The surgeon works the loop around the urethra, making the hole bigger by cutting away bits of prostate from the inside. This damages the urethra as well, but like when you graze your knee, the surface will just grow back again, so that is no worry. With bloody water being pumped out of the patient's penis, and the surgeon working away, as I said before, this seems like quite an interesting surgery. But then it just goes on and on. And on. The surgeon is working away, shaving little bits of prostate away for some time, and then another patient comes in, and exactly the same thing is carried out. Starting to get a little boring. Then another. You get the picture.

That was only the first day - the rest of the week consisted of seeing more and more TURPs, there were some performed by LASERS! Again, sounds exciting in principal, but just involves a slightly different instrument being used, a small spark on the screen, and the instrument being moved around for some time within the vision, slowly singeing back the prostate to allow the passage of urine. Not thrilling.

The rest of the week, when we were not in these theatre sessions, involved talking to patients (again, always the positive of the weeks) and being taught by the interested doctors.

Now, I am not saying that this is all urologists do - I am assured there are other operations, but I personally wouldn't want to do more than one or two of these operations a week, it just seems so mundane. It is not even like being a physician and treating pneumonia after pneumonia. At least there patients are able to chat with you, you have plenty of confounding factors to take into account and a thousand and one other interesting sidelines possible. Here a patient comes in, is treated, leaves and repeated. You may as well be assembling things on a factory production line. A very necessary job, and I am glad that someone does it, but not for me, thanks!

With that, I will have to depart. Had a lovely BBQ in the sun today, and got some work done, which is nice - hoping to keep it rolling. Next week will be more interesting, I can smell it!

Emergency

Hi,

Very exciting and eventful week this week. Lots going on each day, and I feel as though I am 'properly' back into the rotations. Most exciting event this week was getting to scrub in and assist in an emergency ruptured Abdominal Aortic Aneurysm (AAA), which can be beautifully compared to having hours of chat with a particular very sad patient, when I was just meant to be clerking them in. All of this is set on the background of the absolutely abysmal bedside manner the surgeons tend to display, making this one very interesting week!

On with business anyway. Monday was the day, as I mentioned before, that I had been offered the chance to assist during an emergency surgery list. These lists usually involve a lot of diagnostic laparotomies, emergency appendectomies and the such. I was looking forward to this, as after our session on Friday, I was confident suturing and such, so happy I could assist and be helpful. Unfortunately, when myself and my partner got there, there were already 2 medical students in the theatre, meaning we would just crowd the place, or sit at the back and watch. Not much fun. They got their first, they go in - fair enough - so we were planning on going off to a surgical clinic or something, and phoning around using the theatre reception phones to try and find somewhere to go. One of the theatre nurses was helping us for a while, disappeared for a few minutes, then came back just as we were about to leave with the news that a suspected ruptured AAA was on the way in an ambulance, and they were just preparing a theatre to use. Did we want to join in?

Hell yes we did!

Just a side note to explain what this AAA is, for anyone who doesn't know. The Aorta is the main artery in the body. It starts from the heart and travels down to the legs, where it splits in two (one to supply each leg, of course). On its course, it supplies pretty much every organ in the body apart from the lungs, and as such, it is a pretty important vessel. An aneurysm is where it swells up to larger than it should be, due to general rubbish being deposited on the walls (or "A load of shit", as the surgeons call it). This rubbish causes the vessel to get bigger, as it still needs to get the blood through. Picture on the left below (a), seeing the big bulge on the normal aorta!

This aneurysm builds up over years, and is often asymptomatic (people do not know they have one) which is often not too much of a problem. However, in this case the aneurysm had build up and the wall had become weakened, meaning it had torn. This is, as you can imagine, very bad. Suddenly all of this blood which was flowing nicely to your body starts pouring out of the aorta and into the spaces in your body. The AAA is in your abdomen (its in the name) so this blood comes pouring out into this area. This causes plenty of pain, and a massive drop in blood pressure (its not in your vessels any more, its in your belly!). This is bad, and has a mortality (chance of dying) of over 80%. The good news for this patient was that if he got into hospital, the mortality is reduced to 40% - still pretty high though.

We wait around for what seems like ages for the patient to come in and have an emergency CT scan. This is because if the aneurysm is above the level of the renal arteries (the little things which look like arms on the diagram above) the operation is far far harder, and he would usually just be given palliative care because he wouldn't survive the operation. Fortunately, this patient had a suitably placed aneurysm, so was taken through to the theatre. No history had come with the patient other than he had been found collapsed. Does he take any drugs? Does he have any medical conditions? Who knows!

 In theatre, I didn't really know what to do with myself, there were people rushing everywhere, and still no sign of any surgeons. It was the anaesthetist's job first. They had to get some blood to cross match in order to get enough to replace the blood he lost (bags and bags went in through the operation), and they had to put in some cannulas in order to be able to give this blood and monitor his blood pressure properly. Once all this was done, they could give him the general anaesthetic and let the surgeons start the operation. This proved to be a lot harder than I had thought - I saw consultant anaesthetists trying again and again to put a cannula into the patient in the arms, but failing because he had lost so much blood they couldn't get into a vein. Next they tried the arteries. Again, failing on the arms, they had to move up and insert a line into the neck. The more central the vessels, the more likely they are to have blood in them - and the body prioritises the brain over everything, so it will get the best blood flow. All the time this was going on, I had been instructed to talk to the patient, keep him from flinching away from the pain of the repeated needles he was being jabbed with, and keep the anaesthetist informed about his concious level. If he stopped talking, then things were getting worse. He was absolutely out of it - no recordable blood pressure, in hypovolemic shock and in agony, He didn't want to talk, and when I tried to engage him he would mutter something about his walking stick, or about a budgie. All this time, I was aware that, if he died before waking - I would have been the last one to talk to him. What do you say? I didn't know.

Once the patient was anaesthetised, I was given another astonishingly important job. Hold his arm. Wonderful - this operating table only comes with one arm rest now (who knows where the other is) so you need to hold his arm out, full of lines now, whilst holding up the "blood brain barrier" (the shield that separates the the anaesthetists at the head end from the blood and sterile conditions down the other end) and making sure I didn't touch anyone who was scrubbed up. Arms can get pretty heavy after a while, but that's just me being weak. Better that holding up a leg. Finally someone got an arm board from another theatre, and I could set the arm down. At this time, they were just putting in the graft to make the aorta a closed tube again, rather than a torn hose. Similar to the diagram above (c) this is just a section of tube that is put inside the aorta to let the blood flow through that instead, and stitched on at either end. The surgery isn't done like it is in (c) though,  that is a non-emergency aneurysm repair (EVAR) This surgery involved putting a couple of beefy clamps on the aorta either end of the aneurysm and cutting it open to scoop out all that rubbish inside, and put this tube in. obviously whilst doing this you have to avoid all the blood that is already around the aorta from where it is been bleeding from the tear. When I say avoid it, I mean just stick a suction nozzle in it and try and suck it all out of your way so you can get to the aorta.

Once I had put down this arm, I got to scrub in. Excellent - seeing as they had done the hardest part, putting the graft in, the consultant didn't need another highly experienced assistant any more. He could get away with anyone. I went and scrubbed up (basically just washing your hands for ages, and then dressing in a certain way so what you put on is still sterile) and got to get my hands (or should I say gloves) dirty. We just tried to stop any visible vessels bleeding (the incision and surgery is done in a real hurry in order to get to the rupture, that these cannot be sealed as they are cut through) and put the gut back into the body in pretty much the correct order. At the start, all of the gut had been heaved out of the cavity and just put in a plastic bag to keep it wet and warm 'til now. You would then sew the patient up, but there was a substantial delay to this because he wouldn't stop bleeding. This was due to an effect known as consumptive coagulopathy, where the body had used up all of its clotting proteins in trying to stop the ruptured AAA bleeding into the abdomen. Now that that had stopped, the body could no longer clot the blood, and every single capillary that had been cut through was leaking watery red blood. Normally the clotting would shut them off in an instant, but without these fancy factors, the patient would just keep bleeding. Fortunately, the anaesthetists are equipped to deal with this, and after several bags of platelets didn't slow him down, they gave some fancy proteins and drugs which did. About time as well, all this lack of clotting had not just affected the incision in the abdomen. All of the previous attempts at inserting a line in his arms to his neck had started bleeding, and his lips had swollen and bled over his mouth and face, from the pressure that was exerted during intubation. Quite a lot of blood, everywhere. The abdomen was closed and we were free to go off home.

How long did this operation last do you think? About 5 1/2 hours would be a pretty accurate answer. That's a long time with your arms inside someone's belly, but its major surgery. Most patients survive the surgery if they get to hospital, it is the days/weeks later in ITU that pose a problem. It is a lot for your body to recover from. Hoping that the patient would be fine (obviously, no point in wanting anything but that, is there) I went home for a nice shower. You will be pleased to know that he is still alive in ITU!

That is how I can see the appeal in surgery. That was very exciting, and exactly the sort of environment that I would enjoy working in later. I would love to do something that acute and that exciting, where people come in with such extreme problems, and you have to do that work to save them. Awesome.

Over the next week, more things happened, nothing as exciting as Monday, though. On one of the days, I was clerking in a woman who had been admitted from a clinic because of limb ischemia. One of her legs had developed a problem in the artery, and it wasn't getting the blood it needed any more. A simple operation sticking a balloon down the artery and expanding it again, would put her back to normal, otherwise the leg would die and start rotting. Not really a competition. This lady was very unhappy to be in hospital, though, and I started talking about some of her worries whilst examining her. She had lost a number of family members in hospital, including children, one an adolescent. I was just chit chatting with her, really, until I came to feeling her pulse. You should feel both sides, looking for any delay, and as I was feeling on the other arm, it felt all bumpy under my fingers, I turned over her hand, to see what it was, and saw dozens of white scars across her wrist. I didn't change the topic of conversation, I didn't even let on I had noticed, continuing the examination - and I think she bought it, being distracted at the time talking about her pets at the home she lived in by herself. My attitude towards her changed completely, though. I felt I was no longer just clerking in someone who didn't want to be in hospital. I felt I was looking after someone who had been more upset that I could imagine at times in her life. I felt sorry for her. I wanted to help her. But I didn't want to act strangely suddenly. I decided that the best way to do this would be to just talk to her about her worries, her troubles, her past and what she saw in her future. I was there 'til around 8 in the evening (though I hadn't gotten there to clerk her early by any means) and then I visited her the next day, and the day afterwards. There was always a medical reason to lead the visit with. I could be checking on her blood results in order to build a case to present, I could be interested in what the results of the scan were, but I would just end up talking with her. It is sad that, when I am a doctor (sooner rather than later, please), I will not be able to justify doing anything like that. At the moment, it is my time, to spend how I want to learn. If I am being paid to be in the hospital, I will have mounds of work to do, and won't be able to talk to any patients like that. A real shame.

As the week went on, I decided that perhaps I don't want to be a surgeon. Monday was really exciting, but most of their time is spent doing mundane operations again and again. This isn't the main reason, though. Surgeons really do not have any bedside manner at all. Spending time with consultants and registrars in clinics, they would just wander into an examination room, instruct a patient to take off whatever item of clothing was required, wander back in a few minutes later and tell the patient what they were going to do. Then leave.

Surgeon - "I am going to scan your leg"
Patient - "Err, ok - what does that involve?"
"Sit on the couch please" (bear in mind, patient has already taken off trousers from previous 'visit')
"Mmm... ok"
*Surgeon uses duplex scan (ultrasound like device) to assess arterial insufficiency in leg*
Surgeon - "Thank you"- and leaves room
Surgeon - returns 5 minutes later, patient still sitting on couch without trousers on - "You can leave now, we have patient's waiting you know. Your AT has a triphasic response by the way"
Patient - "Psyphasic?"
Surgeon - "We will send you a letter about it in the post, don't worry"

This wasn't just one patient. It happened again and again. Don't get me wrong, surgeons are great fun to hang around, and can be really nice to the patients. It just seems that some of them (don't let me generalise here) don't realise that you should try all the time.

In case you are wondering, a triphasic vascular response is a good thing, and indicates normality. Hopefully the patient will be pleased to find that out!

Have a good week, next week I am doing urology - perhaps not going to be as exciting as this week, but perhaps that is a good thing - I have far too much work I need to be doing!

Surgery

Hi,

I'm back after a nice holiday, and back on the working train. As the first week of a rotation, it wasn't typical, and we started off the week with 'introduction' lectures. These involved learning the history about the area we practice medicine in, the history of surgery, and the history of medicine within the area we practice medicine in. If this wasn't going to be too much fun for our poor bored minds after the holidays, we also managed to get a lecture from an NHS manager on the management of the NHS, the structure of the NHS system, and what managers do. Unfortunately this only served to reinforce the feeling that if anything in the NHS needs to get cut back, this would be a good place to start.

Anyway, moving on from the tedium of the first few days, which did serve to remind me how much more I enjoy the clinical years compared to the first 2 years of lectures, we spent some time with surgeons doing everything they do apart from going into theatre. A bit of a shame we haven't had the opportunity to slip into theatre yet in the first week, but next week... Anyway - I can see why surgery might appeal to people, you seem to do everything an physician does, as well as operate. You see patients with symptoms to plan investigations to diagnose. You prescribe drugs, you run clinics (though they seem to be the bane of the surgeon) AND you operate in your spare time. Despite all of this 'work' surgery seems a lot more relaxed than the other departments I have done rotations in so far. We were taken to the common room a couple of times, and had tea and coffee, watched the election on the TV, and had the opportunity to play some pool or table football. It seems that medics seem to have a lot more work to do compared to surgeons, who can wait around much more waiting for surgery to start, and so on.

Another wonderful thing about surgery is the fun nature that a lot of surgeons seem to have. The typical opinion across hospitals of surgeons is pretty similar to 'Scrubs', arrogant, less intelligent and jocks. That's the usual response I tend to hear, if I tell people I am starting surgery, or going to have it as my next rotation. For some of the surgeons, this isn't an inaccurate description. There are some particularly scary surgeons who have reputations across the hospital as those not to cross or annoy, and unfortunately I have one of these in about a month. Despite all this negative press that surgeons tend to get, many of them are really fun to be around. Not always taking things too seriously, they are often jokey and interesting to be around. It seems that many surgeons place a lot of value on general knowledge, perhaps hence the history lessons at the start of the rotation, and like you to know a lot of non-medical things (verging into more academic areas such as physics). The sceptic in me says that this could be because they don't need to know as much medicine, instead concentrating on manual skill for operations, but that would just be harsh, right!

Learnt a few important facts this week, though. Certain surgeons lock the doors as they start the lectures, in order to stop people from coming in late. Sounds a good idea really, but will probably mean about half the rotation don't benefit from the lecture. Also learnt that surgeons expect you to learn a LOT of anatomy. I was embarrassed this week because I couldn't name all of the vascular branches from the start of the Aorta to when it passes under the inguinal ligament in the thigh after bifurcating. This includes all the branches in the pelvis, and is quite a lot (supplying all of your body but the legs) -  but have been told I should know them all by Monday. The plan is if I do know them, I can assist in the emergency surgery list on Monday, which would be exciting. I have some work to do!

On that note, I managed to embarrass myself further last week by missing a patients femoral pulse completely.  The lady had arterial insufficiency to her legs, meaning they were ulcerating, getting infected and starting to decay because the cells were dying as they were not getting enough oxygen/nutrients. Peripheral vascular problems are very common it turns out. Myself and another medical student were asked to feel for this lady's femoral pulse, to see if anything could be felt to work out where the blood supply was being occluded.  A little awkward, as this lady was in a hospital gown, so we had to lift it up to around her belly-button in a cubical with about 8 people in, including us. I couldn't feel anything, and neither could my medical-student college. We reported this to the surgeon who duly wrote it down in the notes. About 5 minutes later, as part of the examination of the abdomen, a senior doctor pointed out that there was most definitely a femoral pulse, and guided out hands to it. It was very obvious, and I have no idea how I had missed it. Perhaps on the frail skin of the old lady I had gotten my land marks confused? Perhaps I was just being dense. We were 'firmly advised' to practice feeling our own femoral pulses 'in bed at night' - with a wink, so we didn't miss it again. Not only did I manage to stop here, but I managed to answer the question as to which bone the femoral pulse was felt against as "the Fibia" I was duly ignored by the doctor, but yes, there is no such bone as "the fibia" and yes, the correct answer would be femur, pretty much the best known bone in the human body. I should have known that around GCSE level, let alone now I am a 3rd year medical student. Not good! Needless to say, this was a pretty embarrassing day, but sometimes days just go like that, the brain doesn't seem to engage.

Well, I will wander off now to learn the branches of the aorta and to do an essay, and won't waste my time or yours rambling on any more. Hopefully next week I will have done some exciting things to report back. While exams loom and work presses on, I still want to get the most out of surgery and get stuck in. We did a workshop on Friday where I learnt to suture pretty effectively, so hopefully I can put that into practice!

Holiday

Hi,

Nothing to say this week, so I will not waste your time gabbling on about something you don't want to hear about.

Just to tell you I had a wonderful holiday in Dublin, saw some friends around the country, and am going onto a surgery rotation next, so the next post will hopefully be a better read than this one.

Nice to have a break and get the chance to see some friends and go on holiday though.

Until next Sunday!