Return

Today seems like a good day to write a catch up post, with A level results released. Firstly, I hope people got what they wanted. If you did, congrats! You have so much to look forward to. Secondly, I apologise for the amount of time between posts. I will now have to change the title of my blog though!

I have been intercalating this year, as I said before, and have finished a degree in Immunology with a first. Better than I thought I would do, but no complaints! I didn't think that this year was going to be interesting for most people, so didn't write about it. I had several terms of lectures on the immune system / autoimmunity and infective agents, and a lab based research project from which to write my dissertation. The lectures were standard learning-by-rote that I am more than used to from medicine now, and unfortunately boring compared to the fun I was having clinically last year. The best parts was cutting-edge information, such as using a Rituxilup regime for Lupus, based around Rituximab but without the use of steroids, and the possible benefits. Very interesting seeing information being researched, and how it might affect what doctors (or I!) prescribe in the future.

The lab based project was the exciting part, working on Streptococcus, and the feeling before getting the result to an experiment that no-one knows the answer to is very exciting. If I am kicked out of medicine due to malpractice (fingers crossed not), then I definitely wouldn't shy away from a career in research. The idea of working in clinical research for my future career though, probably not. I found the pure clinical side even more exciting than being in a lab, and more rewarding!

Having finished the entire year intercalating (summed up in a very short time) I now move onto my 5th year, which is my 4th year back at my old medical school, as it offers a 5 year programme as standard. Looking forward to getting back into the clinical side, in my old hospital, with all my old friends. Before that, though, I have something much more exciting to look forward to:

My Elective

This is something I have been looking forward to since the start of medical school, and is when I get to practice medicine in a different setting. most people go abroad for this, and it practically means you can do anything medical, anywhere in the world. As I may have mentioned before, I had been toying with many ideas, such as

• A river trip down the Amazon, serving the tribes living there (But I speak no Spanish); 
• Flying doctors in Africa, where they run clinics under the wings of their aircraft, after rural villages clear landing strips for them in the forest ( They would rather take 60kg of drugs than 60kg of medical student)
• Trauma hospital in South Africa, where I could get hands on experience with stabbings and shootings (But I felt that this was something I could get in England anyway)
• Somewhere very rural with little staff and little resources (Who am I, Ray Mears?)

I finally decided on the last bullet point (after much deliberation, after all, when you can choose anywhere in the world, just choosing one seems very wasteful). Some were not possible, such as working with the flying doctors in Africa - but once I am qualified I will actually be of use to these organisations and I have many plans! While all of my choices were a little 'out there' this does not have to be the case. Many of my friends went for options in the Bahamas, or in Australia. Probably much less demanding, and it does take place over part of your summer holiday, but I wanted an experience of a life time. Perhaps, in a few months time, I will regret my choice, but I doubt it.

The hospital I contacted, and will be working at, is in Tanzania. In case you do not know where Tanzania is, here is a wonderful map:

The hospital has no running water, no grid electricity and few drugs and diagnostic tests. I have been told they have electricity for an hour a day, for operations, from an expensive generator. This should provide the different experience I have been looking for! I have organised to take over £3000 worth of drugs with a charity called IHPUK, and should this be successful (I hope so, have them sitting in my room at the moment in two massive boxes) then the hospital will have lots of drugs to play with.

The bonus of going somewhere so simple is that there are few staff, so I will actually be useful, and the lack of treatments and diagnostic tests means that it is (possibly) harder to go wrong. I can imagine the downside is that a lot more will rely on diagnosis from examination and history, and there will be deaths.

I am not sure how I will cope with either of these, but am leaving in a few weeks. I will write a daily blog over there and will upload them day by day on my return. Without grid electricity, I will obviously not be able to upload blogs there, so I have taken a solar charger so I can write, which should stop me from forgetting things!

In summary: Sorry for being away for so long, but its better than I bore you all to death with lectures. Now comes the exciting part, the elective, which I am really looking forward to. Hopefully it will make a good read as well...

Exams

Hi,

Time for a quick update as to how things are going. I worked hard for my exams, and let me tell you, revising is nowhere near as fun as bouncing around the hospital. More tiring though. The problem with revision is that during those weeks when you are preparing for your exam, you have no time for yourself. Whenever you do anything fun, it feels as though you should be working, and you are procrastinating. You end up feeling guilty for enjoying yourself. Anyway, enough of that - exams seemed to go well, though I was least sure about the OSCE, which was the last exam, and least prepared for. Let me tell you about two of the stations, for lack of anything else to write about. Who wants to hear about written exams!

The OSCE station I had most problems with was that of a woman who had started bleeding vaginally early during her pregnancy. After asking about dates, pain and amount of blood I wasn't really sure where to go. I cannot really reassure her, as it sounded like an ectopic pregnancy, which would mean it wouldn't be viable. Not point telling someone "it's all going to be fine, don't worry' when its likely the baby cannot survive. I couldn't really tell her that either, as it would have to be diagnosed by blood tests and ultrasound scans. I told her about these, but I really don't think I covered enough in that OSCE to cover the 15-20 marking points. The other OSCE stations (20-30 of them) went with varying degrees of success, but there is one I was very pleased about.

The station I was most proud of came close to the end. This exam lasts for hours, and by the end you are starting to get pretty tired. This was a station where you needed to do a cardiac examination, which involves feeling pulses, looking for signs of cardiac disease in areas from the nails to the eyes, and the obvious listening to the heart. In a 3rd year OSCE there are a few likely problems, such as heart failure or valvular disease, which is probably going to be either aortic stenosis or mitral regurgitation. These are the two easiest-to-hear murmurs, created by problems with the valves in the heart, and among the most common, meaning it is easy to get patients for us to examine. The trick is distinguishing between the two, as they both cause a murmur in the same space of the "lub-dub" of the heart beat, as the heart contracts and with the pulse, they just sound a little different.

[If you are interested Here is Aortic Stenosis and Here is Mitral Regurgitation]


As well as the slight difference in the sound, there are a few other methods of distinguishing between the two. Aortic stenosis partially blocks the flow of blood from the right side of the heart, to the body. Mitral regurgitation causes back flow, so the right heart doesn't just pump blood forward, out of the aorta, but also backwards into the atrium, making it less efficient. Talking to friends in the days before the exam (a good way to revise) we talked about the difference that can be felt at the radial pulse. In particular that aortic stenosis causes a 'slow rising' pulse because of the hindrance the valve causes to the blood leaving the heart. I had never felt one of these before, but in the OSCE, I was sure that there was something odd with the pulse. I went out on a limb and said that the pulse felt like it was slow rising, because it did feel flatter and more delayed, as friends who had felt such a pulse had described it. This was confirmed when I came to listen to the heart with the stethoscope, and heard the ejection systolic murmur, radiating to the carotids. It felt great, having diagnosed someone with my first laying on of hands, and using a sign that I had never even felt before.

Enough self-indulgence. Waiting around and working over summer, exam results came quickly and it turned out I had done more than OK. With grade boundaries up near 90% for an A I had still managed to mission through with some great marks. I won't go into specifics, but I am more than pleased! The OSCE was fine as well, fortunately, though unfortunately we don't get a breakdown of that as it is merely pass/fail. I would like to have known how I did on that ?ectopic question!

The best part about passing all those exams is that I am now off to another university to do research for a year. Something that interests me, and a year where I will have free weekends again! I had to revise a lot of cellular level science for these end of year exams, so hopefully I will know some of it when I get there. I find out about halls on the second week of September, and with term later in September, and no guarantee I will get a halls place this could get quite interesting. I may be sleeping on some friend's sofas for a month or so...

I will keep you posted as to how it goes, but I have a feeling it won't be as exciting to write about as the last clinical year.