Wednesday, 16 August 2017

Start of Final Year!

“Hi, my name is….., I’m a final year medical student”

I haven’t achieved this by passing any exams, but since coming back to university from our summer break I am now technically a final year! This feels weird to say and I haven’t quite got used to it yet. What feels even weirder to say though is my new surname, because just over 2 weeks ago I got married! It was a crazy and wonderful day and it all still feels a bit surreal.

I timed getting married with the first weekend of our summer “break” so that I could go away on honeymoon straight away afterwards. I say summer “break” in inverted commas, because having been on clinical placement everyday (and yes, most days that is 9-5pm (or longer if doing an on call). Long gone are the frequent early finishes and “study days” of second year) since January, only 2 weeks off doesn’t feel much of a break! We got the bank holiday days off, but we didn’t even get given an Easter break *tear*. My partner husband and I went away to Italy for my 2 weeks off after the wedding. We had an amazing time, but the time just flew and now I’m back to clinical placement, and it still feel as though I’m in need of another few weeks off! The most upsetting thing is that we don’t get another holiday until Christmas, but given that our first finals exam is on January 8th I don’t think I’ll be having much time off over Christmas!

Last time I updated I’d just finished my paediatrics block. Since then I’ve done 3 more blocks in O&G, Medicine and Surgery. They all went well, and overall I mainly enjoyed them. During the surgery block I was assigned to 2 awesome female consultant surgeons who were really nice and got me involved as much as possible. A lot of my previous surgical experience has just been stood in the corner of theatres, being ignored and standing on my toes to try and see anything at all. In this block the surgeons all made an effort to involve us, meaning that I got to scrub up and assist in a lot of the surgeries so that I could actually see what was happening! I still don’t want to do surgery, but I did really enjoy my time in surgery.

Now that I'm starting my final year of medical school, I feel as though I'm slightly more useful/less of an inconvenience than previously, where we just trailed around after the doctors and got in the way. The most useful thing I used to be able to do was pull the curtains round the cubicle during ward round, but now I'm able to do things which actually feel slightly doctor-y and useful. For example; clerking in new patients for the doctor when on-call, seeing patients by myself during clinic so that the consultant only has to review my history/examination quickly before determining a management plan and assisting in surgeries as the 2nd surgeon when no juniors are available to assist the consultant. This is slightly stressful at times but definitely more interesting, and I feel that I'm learning more by actually being involved.

I’ve just started my Acute Medicine block. I’m looking forwards to it but it looks pretty intense. We’ve been assigned shifts to do and already I’ve done a 12.5 hour ITU shift yesterday and today I’ve got a 12 hour night shift in A&E.

During my ITU shift yesterday there was a patient who needed RSI (rapid sequence induction to put the patient to sleep quickly) and intubation. They also needed an arterial line fitting and a central line. The intubation and ventilation was fine initially but then the patient had several episodes where they just suddenly started desaturating fairly quickly and quite badly, until the anaesthetist bagged them and readjusted the tube. This happened quite a few times. During one of these incidents I noticed that the patient’s chest expansion looked really unequal. I pointed this out to the junior doctor, who mentioned it to the anaesthetist, but they were struggling to get in the arterial line and the nurses were all around doing things and no-one really paid attention to this. Later on the patient’s saturations had dropped to 50% and the consultant anaesthetist came in and took over. He realised that the patient had no air entry over one lung on auscultation and a deviated trachea (hallmark signs of a pneumothorax) and immediately performed a needle compression to release the air. The patient had a chest drain placed and was fine, but it made me think that maybe I should have spoken up more about the unequal chest expansion (another sign of a possible pneuothorax)? The weird thing was though that in-between these episodes of desaturations, the patient was fine and the anaesthetist said that they could hear air entry on auscultation so it was a bit strange. It made me realise though that I should have more confidence in my abilities in detecting clinical signs. Whenever I’m doing a clinical examination, for example for my end of block test or during bedside teaching, I often think that I detect something but I’m never 100% confident and say it in terms of “I think that there’s this” in a timid voice. Recently though, most of what I’ve been saying the doctor has agreed with, so maybe I need to try and be more confident in my abilities. I think a lot of doing well in OSCE exams is appearing confident in what you’re doing so I’m going to try and work on this!

1 comment:

  1. Congratulations on geting married!!! Fifth year is a step up and I definitely felt more useful. You did well to even mention it to the junior doctor about the unequal chest expansion. Seriously. In those situations, it takes a lot to even speak up especially when it's all getting a bit frantic. I'm an F2, and sometimes I'm still unsure of some of the things I hear or feel. But it's all perspective. I say 'slight' if I hear something but it's quiet, you can only say what you hear. And you're right, a lot of OSCE is appearing confident. Best of luck with exams!!