Some of my favourite quotes so far

"I used to use StopandGrow to stop me biting my fingers. You know what works better? Rectals. I just don't want to put it in my mouth any more."
-one of the other new F1s

"You want some Glicazide to go with that?"
- my SHO to my Registrar when he cut himself a hunk of chocolate cake (do I need to say I'm doing an Endocrinology rotation!)

I've finished my rotation in the Medical Admissions Unit and I'm starting with my Endocrinology. I've learned more in three weeks than in six years of medical school. I am terribly afraid pretty much all the time. The smalles victories take on epic proportions, like when I examine someone and find the same things as the seniors. Like when the nurses ask me to do something - prescribe something, speak to the family of a patient, whatever - and I can actually do it.

I seem to have developed an invisible wall around me that stops me getting upset as I was. I can almost feel things bouncing off. I am aware of things that would have floored me before I started medical school. I have seen people ill and in pain and I am so calm. I saw someone go into cardiac arrest and die five minutes into my first shift and I was fine, I just got on with my work afterwards. I started to get terrified that I was completely emotionally numb, really genuinely worry I had lost all compassion! Then it happened - 21 years old. Feverish. And ravaged by tumours. I felt them under my hands. His white, white skin was clammy. I did every test I could think of. I spoke to his Mum about everything I was doing. I asked the seniors if I was doing things right. They suggested a few more things. So after only a day of treatment for his infection, he went back home. To be treated palliatively. He kissed me on the cheek as he walked off the ward. I cried all the way home.

Number of fingers in a rectum: 1
Number of catheters in a penis: 2
Number of needles stuck in veins: more than I can count

So with my favourite stethoscope, my favourite pen, and a bucketload of fear, I have tramped the wards for the first time as a real true doctor. I was unlucky with the rota and have started off on nights on "medical take" - I have to help look after the problems that aren't for the surgeons, like babies, broken bones and appendicitis. It means suicidal people, heart attacks, and chest infections - translated into para od, MI, and LRTI. I have been prescribing medications for real. I have been writing in notes and signing my name doctor, and answering my bleep and saying I'm a doctor. It's like I've been looking down on someone else doing all this, it feels surreal and very strange! That could be the sleep deprivation, or as it's referred to, "the jet lag". I feel I have learned more about real medicine than medical school ever taught me. Two things: firstly, the days of spending as much time as I felt like with patients are over. I hate to have to feel like I am limited in time when I'm talking to people. Secondly, the nurses know more than me about everything.

We have a few hours of teaching every week.The first week was death. We had the coroner talk to us about death certificates, the head of palliative care talk to us about the Liverpool Care Pathway (the principles of looking after people who are dying) and finally the chaplain. He's quite young, and hilarious, and completely adorable. Not in a horrid happy-clappy way. In a genuine way. "The chapel is on the seventh floor," he says. "It's non-clinical. It's dark, There are pillars to hide behind. And I promise, if I see any of you sitting there in a huddled lump, I won't come up to you and say "hello my daughter, what can I do for you?" I may arrange a flower or two, just so you know I'm there." Isn't that wonderful?
I have the day off tomorrow. I'm doing nights for the rest of the week. Hopefully it will go as well as this week has gone.

Signing

A General Surgery clinic, years ago right at the beginning of my clinical training. I had been assigned the Professor of Surgery at the large teaching hospital that I had been placed. He was a formidible man - an obviously talented surgeon - the go-to guy that everyone relied on to rescue the sickest patients from their bleeds and cancers and perforations. I respected him so so much for his dedication and exacting standards, even if it meant feeling very very stupid for a lot of the time! I still am glad it was my first rotation, as he drummed into me what high standards I should keep for myself.

However, he was in medicine for the excitement of his surgery and his research. He didn't really like patients, and was interested in them only as a potential cut. So when a deaf man came into the clinic, I grimaced inside. I knew exactly how this was going to turn out.

"God, deaf! You take a history, I don't have time for this."

I dutifully go. Begin by calling out his name in the waiting room - mentally slap myself. Go up to him and touch his arm to get his attention, then say hello. He smiles and comes with me to the room. I say hello again, trying to be as friendly as I can. I ask "do you lip read?" whilst pointing at my lips. He understands, but shakes his head, and gestures with his hands that he just signs. I get out my notebook and we do the whole history by paper.

I find the surgeon again and present the history of the man's problems. He listens, comes in, and speaks loudly to the man - "Where is your pain?" The man makes the gesture that I am sure he has made every day of his life - hand to ear, shaking his head. As Prof asks each question, I show the man where I wrote the question in my notebook. Prof carries on examining the man. Explains what he thinks may be wrong in the same load slow voice, finishing with "So go for an ultrasound now, I'll see you again." The man looks at me, a little confused by now as to why this man keeps on talking to him. Prof leaves. I look at the man, trying not to mirror his amusement and rolling of eyes. I get out my notebook again.

So, this is why I am doing sign language classes! I have had very very little success with remembering anything at all so far, but I have read it takes years. Also, to actually do any good and to be able to take a history, I would need to get really quite fluent. Maybe one day.

I got a crush on Obama

http://www.youtube.com/watch?v=phBBnxXJdoM

This is like a joke to me! Is this really going to make anyone think any better of McCain? Is anone that stupid?