Jakub and I started taking pictures with handed down Zenits and here is a sample of Jakub's work from his trip to Switzerland in 2006. As you can see the scanner and Zenit added a bit of charm to the photos. None of the pictures were edited.
8 March 2014
On Thursday I started my ophthalmology placement. I am based in a rather small district hospital and my placement mostly involves sitting in eye clinics and learning about eye examinations and diseases.
I will also have to go to theatre 3 times during the next two weeks to observe eye surgery (which I'm dreading, it gives me chills to even think about someone poking an eye with a knife). Patients are usually awake for this as it's sufficient to anaesthetise the eye and eye muscles to operate. I'm also going to observe cataract surgery and lacrimal duct surgery (tear duct leading from eye to nose ) for which I need to revise some anatomy.
Surgical placements follow a certain pattern. Knowledge is your currency. If you come in to hospital early you have a chance to talk to the patient before the surgeons do. You know the patient's case and can present on the ward round if your patient is an in-patient, i.e. stays in hospital before the operation. If it's just a day case surgery you still want to know the patient as it looks good when you can say that to the surgeon (S: have you met this patient before? M: oh yes, I've spoken to him this morning (*in a casual tone*). *impressed eyebrow raise from the surgeon*.)
Usually before surgery surgeons review scans and lab results. If you're there as a student you can expect to be quizzed on the anatomy, on pathophysiology of the disease and if you show enthusiasm and interest even on the surgical approach to the problem. Gaining brownie points in those exercises usually will lead to the surgeon saying : "Do you want to scrub in?" and then " have you scrubbed in before or do you want one of the nurses to help you?". If your answer is a confident yes to both, you make the surgeon happy. But this only happens once you've traded in your knowledge earlier on.
Unfortunately my med school is not the best at teaching anatomy. We did quite a lot of dissection of the chest and abdomen (yes it means what you think it does. small group work. I still have my dissection kit in a cupboard) but strangely we never did the head or limbs. So tomorrow I'll be trying to make sense of the eye anatomy using the Internet.
I've been thinking a lot about the qualities that one needs to have to be a good doctor. This is one of the most commonly asked questions at medical school interviews. Usually my answer involved qualities such as being knowledgeable and competent, being dedicated, a good communicator and a people's person, being decisive, compassionate, interested in patients and caring. Ability to synthesize information from the available sources and making sense of it is important too as well as being able to cope with uncertainty and take responsibility for one's actions. What has never occurred to me before is that confidence is an important quality too, and one I will have to work on probably the most in the next year before I qualify. Patients are scared when they're feeling unwell. They want their doctor to come across as confident, to perform the examination in a confident manner, to speak with confidence about the next steps that are going to be taken to make them feel better.
All of the doctors I'm learning from are great at that and I, as a student. am struggling. I am good at examining patients, I've practised with my friends and with J, rehearsed every step, passed my OSCEs* but I still think it's a nuisance to patients because I'm just a student. On top of that confidence doesn't come to me naturally. I'm usually happier as a follower not a leader. But I know it's yet another skill I have to practise to be a good doctor. And yet another thing I wish I knew was expected of me before I applied to medical school.
What do you expect your doctor to be like? Any tips on how to be more confident but not overconfident?
*OSCEs stand for Objective Standardized Clinical Examinations i.e. practical exams which medical students have to pass each year. They usually last between 5-10 min per station with about 5-20 stations per exam, with a scenario and a patient to take a history from and examine at each station. The aim of the exam is to make sure that students are competent at clinical skills under time constraints. You have 1 minute to read the instructions before entering the examination room, 5-10 min to perform the exam, give a diagnosis and management plan, answer exterminator's questions. Then the whistle goes off and you move on to another station.
7 March 2014
This is what I googled last Saturday afternoon and that's how we made a decision to drive up to visit Anstruther Fish Bar in the Kingdom of Fife across the Forth Bridge. Anstruther won the independent fish and chips award in 2008 and 2009 and according to the website this where you will find finest raw ingredients, cooked with skill and expertise to produce the tastiest fish and chips - all served with a smile and a dash of salt and vinegar (no vinegar for me though).
It was a beautiful drive via the Fife scenic route, about 45 miles from Edinburgh, up and down the hills with a frequent glimpse of the sea (as in pictures above). At first, we got a little lost in Anstruther and ended up in a small harbour just in time for the sunset (coincidence? doubt it).
You could see the Isle of May on the horizon, a small island at the entrance to the Firth of Forth which is a home to sea gulls, puffins and seals. It is thought that the island name comes from the Norsemen who called the island Maa Oy, which is norse for gull island. Unfortunately the sea was a bit rough that day and we later learnt that the ferries only operate from April to September (£24 for a return). We'll have to make sure to go back one day, the journey there and back takes about 5h, easily doable for a morning trip and then a lunch of the best fish and chips in the country.
After reaching the main harbour we ordered the takeaway of haddock with chips (£5.90 per portion). We then settled on one of the benches facing the boats with sea gulls jealously circling above our heads to enjoy our meals. And let me tell you, it was the best fish and chips I've eaten in my life (not that I'm such a connoisseur but it was truly delicious.) The batter was very thin and crispy and fish perfectly flaky and succulent.
The town of Anstruther is a lovely place to visit on its own too, a very worthy detour when visiting St Andrews as it's located only 9 miles south from there. It even has a small Scottish Fishery Museum and the Caves of Caiplie are accessible from there as well.
It started raining and was getting rather dark shortly after we finished eating and it was time to go home. I wish we started our trip earlier on in the day to explore Anstruther a bit more but it was one of the best weekends of February, that's for sure.
On our way back we stopped on a beach to take some more pictures of the rough sea.
Now we have to make plans to try some of the other Scottish classics.
Deep fried mars bars and pizza anyone?
Places mentioned in this post:
4 March 2014
* the price is a trip to New York for two people, including flights hotel and car hire (not sure about the last one...do people even drive in New York?). The last thing I won in my life was a disposable camera in a contest about alcohol and smoking awareness in primary school...
Yesterday was my last day in ENT theatre. It was one of my favourite placements so far, with lots of surgeries and also some time spent in the clinic. The majority of ENT I saw was concerned with hearing loss and surgery to treat that. There were operations treating glue ears in young children, eardrum reconstructions, lots of nose surgeries as well, tonsillectomies and some salivary gland tumours (not my favourite but I saw the branches of the facial nerve which was very cool).
I find that surgeons and scrub nurses have a much better sense of humour than medical physicians. I'm not sure where it comes from, perhaps it takes a certain personality to become a surgeon or a theatre nurse.In every placement I did so far patients, medical and nursing staff constantly say things that make me smile or even laugh. Some things that patients say make lives of medical students difficult. Other things will make you smile or laugh and you'd be glad that someone has just brightened your 8h day in hospital. Sometimes you just have to keep a poker face and be patient.
Here are some of my favourites from the past 4 years*
D:Any family history of hearing loss?
P: My mother lost her hearing as a punishment for not listening to anyone for 60 years
D: Can I ask who's at home with you?
P: Aye, it's just me and ma wee lassie *said in a Glaswegian accent*
D: Your GP said you had chest pain?
D: how long did you have it for?
P: a while
D: how long is a while?
P: a while
D: do you have any pain in your chest just now?
D: Do you hear any ringing or noises in your ears at nigh time?
P: Sometimes there is an owl or a dog barking across the street
nurse to the surgeon: you can see this wee boy now
S: He's 60, I wouldn't call him a boy
nurse: an older boy then
do they have saws in ortho theatre as well?
oh aye, saws, drills, screws...it's just like being in B&Q really...
nurse, aged above 60: Stop that, young ladies in this theatre are horrified. Including myself. As a young lady of course. I'm no horrified.
M: Do any diseases run in your family?
P: My second cousin has diabetes
M: No, I'm talking immediate family.
P: "Well, she lives next door."
M: Do you have any long term medical problems?
M: What do you see your doctor for?
P: Oh, just my diabetes, high blood pressure and prostate cancer
surgeon: Is that sore? Am I OK to continue?
Aye, carry on doc! I'll just look at this young lady's pretty face. *in my direction*
nurse: what's wrong with my face?
My next placement is ophtalmology. I have to say eyes gross me out a little bit. Just like bones. I'm defninitely not looking forward to eye surgery.
Do you have any funny stories from doctor's appointments? A&E maybe?
* All clinical encounters referred to have been invented or made anonymous.. If it sounds like something you said, be assured that it wasn't as lots of patients say the same things to medical students and doctors.
And a traditional selfie in scrubs: