Sunday, 23 February 2014

Chorea

Block: Community medicine, week 2

"Chorea, or St Vitus' Dance, is the occurrence of short, purposeless, involuntary movements of the face, heads, hands and feet. Movements are sudden, but the affected person may hold the new posture for several seconds..." - Black's Medical Dictionary, 42nd edition

So last week I was based at a stroke unit in a hospital for the first week of our community medicine block. Each week I move to a different location and setting so for my second week (of three), I was sent to a centre for adults with neurological disabilities to observe the care provided.

I have to be perfectly honest here, this week was not much fun. It was tiring, both emotionally and physically. The latter is something I am familiar with...the former is something I have been fortunate enough to have never really encountered before in my personal life.

I have worked with adults with acquired brain injuries before, back when I was applying to medical school and I wanted to do some volunteering. The centre which I volunteered at back then was rather different to the one I was based at this week however in that the adults I met on volunteering, whilst disabled, still maintained a large degree of independence. This was in complete contrast to the residents I met this week, nearly all of whom depended on the carers to assist them with every aspect of their personal care.

This alone was fairly eye-opening. I had never really given much deep thought to the work which carers do. I was aware that it's an invaluable and demanding job which isn't well paid at all, but I suppose until I actually saw the nature of the work first hand, I didn't really and truly understand just how very personal it is and what a difference it makes to the lives of the patients, most of whom (due to the nature of their conditions) are also completely unaware of the care which they are receiving.

Observing the work of the carers was physically tiring as it meant long hours and early starts, but it was nothing compared to the emotional impact of seeing the effects of long term neurological disability. What had the most significant impact on me was seeing a patient with Huntington's disease on the second day of the placement. Huntington's disease is something which is taught to any GCSE biology student as a prime example of an autosomal dominant condition. Back then, all I remember was constructing Punnett squares and learning that because its signs and symptoms manifest later on in life, many of the sufferers have already gone on to have children who will also be affected before they themselves realise they have the condition.

At medical school this basic understanding was slightly expanded upon with the inclusion of some facts about CAG repeats, PolyQ tracts, and mutant Huntingtin protein. I dutifully memorised the definition at the beginning of this post in case an exam question came up asking me to define the main symptom, chorea (no such luck). By this point, I felt I had a pretty good understanding of this condition.

All of the above however, as scientifically fascinating as they may be, are completely useless at actually getting across the severity of the condition or indeed, for preparing you for the physical reality which the patient faces on a daily basis. Based on the dry definition from Black's, I had somehow assumed that chorea was basically like a more severe form of twitch...but not something which would make the patient look like they were receiving an electric shock to their entire body. None of my notes on the genetics of Huntington's disease prepared me for the sight of the patient lying in a bed with raised, padded sides, with weakened, wasted limbs, unable to understand what's going on in the room around them - the carers preparing the liquid breakfast...the shouts coming from another patient's room down the corridor...the medical student standing in the room trying to connect the dry textbook definition which was rote memorised months before and the three-dimensional evidence of a condition which someone else has to live with everyday for the rest of their (shortened) life...

It was a steep learning curve to say the least. By the end of that second day, I was feeling pretty down indeed. I suppose I should mention at this point that I don't normally get very emotional; usually I'm quite composed and in control of my emotions. That's not to say that I don't care or I don't have human empathy...but in my personal life I'm not very prone to shouting, crying, etc. It's just not me. But by the end of that second day, and for the first time in nearly 6 years, I felt the full force of my emotions.

Things improved slightly after that. Once I got my initial emotional reaction out of the way, I gradually got more used to the nature of the centre and began to accept that it was what it was. So the third and fourth days of the placement were a bit easier to deal with. At the end of the week, I went out and got extremely drunk (I think I spent about £30 on Jagerbombs alone)...that too also helped, though admittedly, the following morning wasn't much fun.

Before starting medical school, I knew that before long I would encounter emotionally demanding situations...I didn't get into the profession with false impressions or delusions, but I suppose actually being faced with the situation for the first time was bound to be tough to deal with, no matter how prepared I felt for it in my mind. I guess like the long hours, endless exams, increased student debt, etc it'll be something which I'll get more "used to" as time goes on, as callous as that sounds.

Finally, here's a nice song from the legendary Woody Guthrie, who also had Huntington's disease:

Friday, 14 February 2014

The start of something new

Block: Community medicine, week 1

So yeah, further to my last post I'm going to be trying a new way of doing things on here...there'll be less focus on academic worries and exams, and I'll try to concentrate more on reflecting on what I've seen on placement about the nature of being a medic itself. Ultimately being a medic is more about being able to understand and work well with the job on a day to day basis rather than simply passing exams, so I think it'll be useful to reflect more on my experiences rather than just posting a list of grades every few weeks.

I'm not exactly sure how this will work just yet, but for this week at any rate I have tried to organise my thoughts into subheadings and I'll just try and write a bit on each...here goes...

Finally growing up?

I'm in my 6th year of higher education. For the past six years or so, life has been pretty much exactly the same. I've gotten up in the mornings, gone to lectures/group work (if I've felt like it and if they weren't too early), panicked over exams, gotten results and moved onto the next stage of the degree. Lather, rinse, repeat, term after term, year after year, as I finished my teens and meandered my way through my twenties. The university and location has changed, but the actual routine has been pretty much the same since 2008.

Things are different now...I've finished pre-clinical medicine and what I will be doing from now until 2016 is completing a variety of different placements in medical and surgical specialties. I have no Easter holiday and a two week summer holiday in the middle of August. I have to get up each morning, make sure I'm shaved and presentable, put on some smart clothes and go to placement.

Basically...it feels like I'm finally a less of a conventional uni student and more of a grown up being trained for a real job. Of course...I don't get paid and I'm still not qualified, and even though it's only been a week, already it feels like the endless sequences of lectures-group work-revision-exams was a million years ago and this new way of doing things is going to be more similar to what the rest of my life will be like.

Despite feeling pretty tired this week (there have been early starts each day and a fair amount of traveling around), I feel happy with finally being able to do something a bit different and more grown up-ish. Being a clinical student feels a lot more like what I want and need at my current stage in life, although I can hear the cynics out there saying that this optimism is merely the honeymoon period. They may be right...but I very much doubt I'll ever really start yearning to return to group work.

The difference between this term and last term

Put simply...this time 3 months ago I was panicking about trying to remember exactly what the Loop of Henle does and earlier this week I was taking breakfast orders from patients and helping an elderly gentleman with his washing and dressing. 'Nuff said.

Ward rounds

So this week I've been based on a stroke unit...the hospital is small and friendly...there's a consultant and a registrar based on the ward and one morning I found myself joining them and a few nurses on the ward round as they went from bed to bed checking up on the patients and reviewing their medication, listening to their concerns etc.

This definitely felt like what being a medical student should be like...though it became slightly more demanding when the consultant asked me some questions and I got a few of them wrong. This was especially annoying since they were questions which I'm sure I knew the answer to deep down...perhaps it was a case of nerves and being felt like I was being put on the spot? At any rate, I feel that clinical medicine will involve a lot of instances of getting things wrong in front of my seniors and having to go away and make sure I learn it properly for future reference. Unlike before, there's no immediate exam pressure, only the desire to not appear lazy and/or incompetent in front of doctors and patients...which in some ways is more motivating than the threat of failing exams.

The bigger picture

Last week my (fairly new) phone broke. I was a bit gutted about this since it was my first smartphone (yes, I know I'm late to the game) and I'd barely had it a few weeks and it was already being sent off to repair at god knows what cost. I'd been enjoying using Snapchat and WhatsApp (it's like free text messaging, don't cha know)...and now I was phoneless for no good reason.

Then I turned up to the ward over the next few days and saw some of the pressures patients and their family members were under. Things rather more difficult and trying than a new phone breaking e.g. uncertainties over the future, housing, money, and so on. And that's not even considering the very obvious and serious medical issues which each of the patients and their families are facing as they attempt to adapt to life following a stroke.

I know that as a future doctor I can't negate all the annoying things in my life simply by remembering that the patients may have it worse. If I did that, I'd never be able to complain about anything ever again and it would probably lead to a lot of unconscious pent-up frustration...but at any rate, on this occasion, considering the bigger picture did bring me back down to earth slightly. I got myself a £10 phone to use in the meantime until my current phone gets repaired...I just hope the warranty covers whatever's gone wrong with it as I really don't want to end up spending loads on it.

Conclusion

I've been blogging for over four years now and this feels like a very different way of writing about things...but it's been good to get these things off my chest. Until next time then...

Monday, 3 February 2014

Future directions

Okay so it's been a while since I last updated this thing. This is for several reasons. Firstly...not much has really been happening lately: I got my exam results towards the end of December, had my Christmas holiday then came back for a week long introduction to clinical medicine and our first community placement block. I've since had three weeks off, which will be coming to an end shortly.

The three week community medicine placement seems fairly laid back - the purpose of it is to become better acquainted with how disability and impairment can affect patients in their daily lives and to understand the ways in which our health and social care system can help them (or in some cases...what could be done better). I think we have to do a report and then we begin our first "proper" hospital based placements at the beginning of March, something I am obviously very excited about!

But yeah...there hasn't been much to think about lately...or at least...not much in the way of the typical things I normally think and write about. This kind of makes me wonder about the future direction of this blog. For the past four years, my blogging activities have mostly been a way for me to do deal with my own personal uncertainties and mostly academic neuroses; my struggle to do well in my BSc, my anxieties over getting med school interviews/offers, and more recently, my attempts to try and handle the pressure of accelerated pre-clinical medicine and to get through to the bit of the course I've been looking most forward to.

But these things are now largely in the past - I won't have any other major exams until March 2015, things should start becoming slightly less pressurised during this phase of the course, and I can't even moan about how useless I find things like lectures and group work...because that's all over now.

However...that said, I don't think that means that it'll be plain sailing for me from now on. Based on the knowledge I have of myself, my personality and my way of dealing with things, I still think I should blog as a method of stress relief and to make sense of things (even non-exam related things). Clinical medicine might be slightly less intense compared to the basic science onslaught which is years 1 and 2 of a medical degree, but I have no doubt that there will still be long hours, deadlines and (potential) emotional and personal uncertainties which might crop up as I finally ditch the lecture theatre and begin to learn how best to get to grips with the most fundamental and human aspect of the job: understanding and treating patients.

I think, therefore, I need to start becoming more comfortable with reflecting about non-academic matters on here. Up until now, I've talked about standard studenty things like exam pressure, results etc, and whilst I'm sure I'll still do this throughout the next 2.5 years, I think it would also be good if I attempted to think and reflect a bit more on here about the day-to-day aspects of being a medic, as opposed to being a student.

At the moment, I know I can talk to my friends, parents, etc about what goes on...so it's not like there isn't anyone who'd listen, but at the same time, there's nothing quite like sitting down, considering my thoughts and feelings over the course of an hour by myself, and then getting it all down in print. And then looking back on it weeks and months later to see how far I've come along. Spoken conversations just don't allow for that...so I suppose that's the reason why I'm keen to carry on writing, in one form or another.