Tuesday, 7 February 2012

“Doc, I Think I’ve Got the Clap”

Last year was my first time in a sexual health clinic. As a student these are very hit or miss - you can see loads, or every patient can refuse you. Being female definitely helps in this context, and I was having a very busy afternoon.

A doctor called me into his consultation as he walked past me in the hall. The patient was a young, scruffy looking, ex-heroin addict. He sits down, his pinpoint pupils staring at us as he thinks what to say.

“Doc, I think I’ve got the clap”.

“Can you tell me what you mean by the clap?” asks the doctor.

“You know , the clap. Gorhoea or summin’ ?”.

“Gonorrhea? What makes you think you have it?”

A full history is performed. After the examination we hand him a urine pot.

“Please fill this with urine then bring it back to us”.

“Now?” asks the patient.

“Yes please”.

The doctor and I turn and walk towards the door, to show the patient to the toilet. As we turn back, to direct him, we see the patient whipping his trousers down and picking up the pot. This was one of those moments in life where everything is in slow motion.

“Noooooooooooooooooo…. Not here, we think you will be much more comfortable in the toilet”, we say as we guide him to the door. As the door shuts the doctor and I make eye contact - both crying with laughter.

Patients- please don’t take things so literally.

Monday, 6 February 2012

Monkey See, Monkey Do.

People think medicine is difficult to learn. You blag your way through anatomy for the first few years, learning just enough to scrape through exams- safe in the knowledge that you will never use most of it again.
Once you hit clinical placements it comes down to the age old teaching of; monkey see, monkey do.  Monkey sees it enough times, and monkey remembers it.  Simple.

A few weeks ago, 3 weeks into my 6 week neurology placement I was in a TIA (mini stroke) clinic. It was with a particularly boring doctor, who didn’t feel much like teaching. Giving monkey plenty of time to observe.  

An ambulance patient was bought to the clinic, before we went to see the patient we checked the bloods which had been taken on the ward earlier. The patients troponin was raised (indicating they’d had a heart attack).

After taking a brief history it was time to examine the patients  cranial nerves (the nerves to the face and neck). Part of this is examining the patients eye movements.
“Mrs X, look at my finger”, the patient doesn’t look, “I said LOOK AT MY FINGER”.
“Doctor, I’m registered blind”.
“Well can you see light?” huffs the doctor.
“No, I can’t see a thing”.
“Great, well I’m going to shine this pen torch into your eye and I want you to follow the light”.
“I can’t see it, I’m blind!”.

The doctor looks frustrated and gives up on the examination. He decides to move onto her arms instead.
“Mrs X, can you put your arms like this”, says the doctor as he strikes a chicken like pose.
“No, I can’t see what you’re doing- I’m registered blind”.
Finally the doctor has heard that she’s blind enough times to give up on examination all together, rather than adapt it- like he probably should have done.

Suddenly the patient started experiencing chest pains, “they’re like the ones the other day” (i.e. the heart attack). The doctor looks flustered, grabs his notes and leaves. He asks the nurse to fetch some GTN spray to ease the pain, on his way out. Instead of going to the cardiology clinic (which is next door) where every man and his dog will own some…. They spend 10 minutes looking through their drug cupboards.

During this time me and one other medical student were left alone in the room with a blind woman having a heart attack. I shout the nurse as she is about to be sick, it’s a little blood stained so I go to find the doctor.  I peer round his office door to see him finishing off the dictation of his notes. He THEN (20 minutes later) picks up the phone to call the A &E chest pain clinic. Then he calls a porter, which takes a further 10 minutes to arrive- so all in al,l it is 30 minutes after the patients symptoms began.  Is this professional behavior? Is this in the patient’s best interest?

Monkey has seen, monkey has learnt what not to do.

Nasty Nurses.

Five of us walk onto the neurology day unit for a scheduled teaching session. A nurse walks past us whilst giving us such an icy cold stare it sends chills down your spine.

She stops and turns around.

Flashes the most insincere smile with an evil glint in her eye. I have seen this look before by many other nurses, it's the look a cat has in its eye as it plays with a half dead mouse. It's the world renowned look of how rude can I be to these medical students?

"Why are you here?"....

Silence... I guess I will have to be the one to answer then...

"For teaching with Doctor X", I say....

"NO TEACHING, NO MORE TEACHING" She huffs loudly... "Please God NO more teaching".

She then walks off sighing, huffing and crashing around the place in anger.

Once the coast is clear us medics begin talking.

"Would she rather us turn up as an FY1 with no experience? I'm sure she would be moaning then".

"Because student nurses never learn anything" another says sarcastically "they just magically know everything... it's not like they are STUDENT nurses".

Our consultant for teaching turns up and we quickly hush. The nurse then comes back, big warm grin on her face, happy as Larry.

"Dr X, the patient wants to know if you want him sitting or standing?"


"Can he have his medication at the same time?".


She swoons on his every word, and politely asks if he needs anything else. Inside us students are bitter, we did nothing to her, and she is rude to us.

Compared to many of the encounters with nurses we have had in the past this nurse was a delight. Most nurses are lovely- it's just a few that ruin it for the rest of them.

It begs the question, why do Doctors have a reputation for speaking harshly to nurses? I have not seen it yet in my four years, but I've seen much of it the other way around. I also wonder how we as medical students can cause so much bitterness and anger without doing a thing or saying a word?

Twenty-One and Terrified.

Let me start by telling you a little about myself. I am a fourth year medical student in Northern England, I am 21 years old- and I am TERRIFIED that I graduate in just over one year!

I’ll start from the beginning shall I?

I am not posh, I never will be posh and I am proud of this. Everything that I have gotten in life I have got for myself- and I like it that way. My mum works in an office. My dad trained as an engineer when I was a toddler, and my step mum works as a teacher. I have had your average upbringing; going to a school which failed many an OFSTED report, where you were lucky if you passed your A levels. And I have worked damn hard for myself. But as a medic I am far from average. Mummy and Daddy aren’t doctors; I don’t own a pony, BMW, or a hefty trust fund - like many medics. Medicine is still elite and pretentious, the med students are judgmental. Commoners like me have to regularly remind ourselves that we are the normal ones- not them.

What now seems like an eternity ago I made the decision that I wanted to become a doctor. Partly due to an infatuation with the series Scrubs, and partly because I wanted to get as far away as possible from my disgusting, alcoholic stepfather. I liked the idea that every day would be a different exciting adventure (a delusion from watching Casualty for many years), but most importantly I simply thought I would be good at it! I decided this during my final year of GCSE’s, never believing for a second that I would actually get to medical school.

In the summer following my GCSE’s I went on a summer school to Cambridge university, which further fed my passion for medicine. I desperately wanted to go to Cambridge University, but when I got an interview there I realised that I could not have hated it more. I got an offer from another very good medical school, and accepted it- and have never looked back.

The first two years of med school were in lectures, we were mostly in a zombie like daze throughout- jotting down the odd word, and complaining like hell about the lecturers who didn’t make handouts. I have very little medical notes from these years (but many pictures of animals, cakes and notes discussions of lunch).

Third year was hospital based teaching. I was based at a brilliant hospital, where the teaching and organization ran as smoothly as a well-oiled machine. At the beginning of this year we were told “this will be the most you ever learn, the steepest learning curve you ever take”- no one believed it but it was true.

When you hit fourth year the doctor ambition becomes more real. Now your grades count towards your foundation jobs. Now you can’t play dumb to consultants. Now you’re just over a year from being a doctor. All you think about is “this would look good on my CV”. Now medicine is becoming a career, not just a hobby you like to learn about. And let me tell you, aged 21 when your whole life is planned out so much it is truly terrifying.

I know at my age my mother had already been married for 2 years, and was considering having me- but I still feel like a child! I don’t even know how to pay a bill, I just give the money to my flat mate.

Don’t get me wrong, I cannot imagine myself doing any other career. I do want to be a doctor. I do love medicine, but I do still get scared. Every day I wonder “have I made the right choice?” and every day I realise I have.

Still, every day I dread qualifying more and more….