February 21, 2020

Happy birthday!

Labour ward here I come! I may have dragged my tired brain out of bed when my alarm went off at 5 so I could grab the first bus off campus but it was so so worth it.

On my first shift, I was assigned to the Lucina ward where low risk births happen. The rooms were beautiful with huge birthing pools, lots of beanbags, and fairy lights in the ceiling giving the impression we were under the nights sky. Unfortunately, we had no patients (which I think is a first for the NHS) and the Lucina ward was shut down. I ended up shadowing the midwife who was originally on Lucina with me. I went into the room of a mother who was having contractions and I ended up chatting to the student midwife there. We don’t get an awful lot of interaction with other healthcare students as student nurses are so busy, you feel bad for disturbing them. She taught me about interpreting the CTG (the machine producing the wiggly line you see on one born every minute) and I began to see the wood for the trees with interpreting the lines.

As the pregnancy progressed, I saw how midwifes cope with the transition to the final part of labour and before I knew it, I was watching a beautiful baby boy being born. Mum was exhausted and it struck me just how misshapen babies heads are when they are first born. I was so happy for the rest of the day and I got to do some minor tasks around the ward such as taking blood and doing general obs. It felt amazing to be included in the team and I went home a happy student, if slightly tired.

My next shift, however, was one I will never forget. The first part of the day was quiet, and we were waiting around for something to happen. This is the norm on labour ward. When we turned up the midwives were joking around saying we should have turned up 12 hours earlier as they had birthed 14 babies overnight. I got to experience the delights of the labour ward toast (a legend passed down in the medical school) and attempted to draw blood. I decided to make it a mini-cex so I had a ST4 anaesthetist shadowing me which was terrifying. I was struggling to get the blood so eventually, he had to step in to help, which was slightly annoying as I couldn’t use it as a sign off but hey ho!

In the afternoon I ended up in a room with a lovely couple who were roughly my age. Being in that room was brilliant as everyone was joking around and we were chatting about everything from English lessons at school to favourite Disney movies. At one point I forgot I was on labour ward!

Eventually, the contractions got more frequent and before I knew it I was helping set up the labour equipment and the midwife was putting out sterile gloves for me and I was fully involved in the labour process. I could see the baby’s head appearing and before I knew it the midwife grabbed my hands and I helped the rest of the body to be born and passed baby up to mum with the midwife guiding my hands. I had just helped deliver a baby. I had the biggest grin on my face and I am not sure who was happier, the parents or I! I helped the midwife birth the placenta meaning I got to examine the placenta with the amniotic sac attached. It was incredible to remember that the placenta and the baby had all originated from two half cells. I wanted to stay to find out how much the baby weighed and its measurements as the parents had predicted and I wanted to see if they were right or not. When I looked at the clock after we had cleaned up I realised, I had done 14 hours on labour ward! However, I didn’t care. I had just helped a baby come into the world and no feeling could beat that.

I have two teddy cut outs on my wall now (pink and blue) to remind me of the two births I had seen. It will be an experience I will carry through me for the rest of this year and although I don’t think obs and gyne was for me, I enjoyed every second there.

February 10, 2020

Next Please!

This week we got to have our first taste at being a GP. I have to admit , it’s not a career that I have ever seen myself going into. I thought it was all going to be colds and coughs but, I was proved wrong!

Our GP is the Gabels Medi Centre so, it isn’t too far to get to and when they said our first week started at 10am, my tired brain celebrated! I could get up after 7am! We were welcomed and made to feel part of the team immediately and it felt amazing to be there. I was initially out in to observe a nurse and I got to see 12 month vaccinations. It sparked a conversation about the anti-vax movement which is increasing in the UK and the mum herself knew of someone who was anti-vax but had managed to be persuaded to give her child the vaccinations. It was interesting and gave me a bit of food for thought for the day.

In the afternoon we attended the sister practise up the road and met our mentor who was to oversee us through the next 7 weeks. We also run our own consultations in GP but I didn’t expect to be running them on the first day. I did feel a little out of my depth but I soon began to enjoy it. It’s nice having the GP there in the back of the room to glance to for help. In fact, on my first case I virtually ran to her in my mind as my patient had a rash from a suspected diabetic foot complication. They were a lovely patient but unbeknownst to me, I had severely over run my appointment! Must.Get.Better.At.Directing.Consultations......

However, my other patients were also lovely and the most surprising thing to me was the variety. I honestly did not expect to be jumping around each system between appointments, especially at this time of the year when colds and coughs are rife. It was also nice to get feedback from both my CP and GP and also give the same to my CP. I think we are both wobbly on histories and we both need to work on getting our consultations quicker but we came out of that day beaming.

It felt like we had made a difference to patient care, especially when the GP was going off our suggestions! I had my foot patient coming back for the next week so I need to read up on diabetic treatment. It felt amazing to be put on the spot but also to drag information from the depths of your brain and put it into practical use out in healthcare. I think we both went home thinking a lot more about GP as a potential career but I know that paediatrics is still my forward choice at the moment.

We’ve also had our first community midwife shifts and again, I loved every second. I met a two day year old baby and I had to control every fibre of me that just wanted to pick her up and have a cuddle. The visit was to check in on both mum and baby and to answer any questions mum and dad have. It was clear the little one was a tad early but apparently that’s all babies, appear when you’re not quite ready ! I also got to see a heal prick test carried out on a 5 day old which was nice to see as we were taught about these in Block 5 last year.

In the afternoon I got to sit in on some check up visits with mums still pregnant and help the midwife with urine dipsticks and got the chance to feel the bumps for babies' head and bum. It felt amazing to be allowed into such an important part of the couples lives and I was allowed to take a maternity information pack away with me to look at in my own time.

Im finding that I love the clinical side of the medical degree. It’s making me think of other career options and being able to put into place all the theory I learnt last year, put all that work last year into context. We’ve got labour ward shifts coming up which I am really looking forward to… well, apart from the early starts! 'Til next time – Abbie.

Introduction to Prescribing

It has been another busy week for my clinical partner and I. Up until now most of our experiences with psychiatry have been in an outpatient and community settings, so we were both looking forward to seeing how acute psychiatric issues are dealt with. This week, we have been placed on an acute psychiatric ward this week, in a Psychiatric hospital. It was interesting being able to sit in on the ward rounds and see the various conditions the team must deal with on a day to day basis. These conditions are amongst some of the hardest to treat medical conditions and include; severe depression, anxiety, mania and personality disorders.

Our consultant was keen that we get involved and gave us the opportunity to practice our history taking with patients where we could get consent, although admittedly it was a whole new experience when compared to your standard history taking scenario. Some of the conversations we had and listened to this week were very emotionally difficult for all involved, and I have huge admiration for the staff and indeed the patients who have to work to improve often difficult situations.

This week we also had an academic day where we were given an introduction to prescribing. I had been looking forward to this for some time, as prior to starting medical school I worked in Pharmacy as a dispenser, so I was waiting for an opportunity for my pharmacy knowledge to become useful! We had lectures which focused on the basics of pharmacology relevant to prescribing, a lot of which was revision from our first-year studies (which feels like a long time ago!) We also had a lecture on some of the pitfalls of prescribing, for example, making sure that you write units in full to avoid confusion and also about some of the common errors junior doctors make. It turns out that junior doctors make 90% of prescribing errors, which I suppose demonstrates both how junior they are and also the fact that most hospital prescribing is done by the juniors. It was all slightly terrifying to think about how much responsibility we will have in just over a year’s time. I know first-hand from my previous work experience how crucial it is to get things right and minimise mistakes to make sure the patient gets the correct treatment.

We also had a lecture on the UK foundation programme, the two-year programme that all UK graduates must complete immediately after graduation. Up until this lecture I had happily forgotten how soon this process kicks off – by the end of this year we will have applied for our first jobs as doctors and ranked the areas we would like to work. Currently I want to stay in the West Midlands after graduation as I have had experience of many of the hospitals in the area, and I feel this will make the transition from student to junior doctor smoother. Allocation is completely points based, with 50% of your mark coming from your achievements at medical school and the other 50% coming from a test called the Situational Judgement Test. This test is sort of a test of reasoning. For example, the questions will be something along the lines of “This thing has happened. What is the most appropriate thing to do?”. We get lots of practice questions and cases in CBL, lectures and other aspects of the teaching so I hope that I will pick up the knack to it.

Next week is last week of our psychiatry placement, which means that we have to finish our sign-offs and say goodbye to our faculty team before moving on to our Acute placement block. Looking ahead at our timetable for Acute it looks to be a busy block, with lots of long days and night shifts. Some of these are in A+E, and others on acute medical wards. After Psychiatry, which is a very separate field to “physical” medicine, I have to admit that I am excited to get stuck in and have some exciting experiences on the very front-line of Medicine. However, it will be stressful – here’s hoping that my knowledge from exams comes rushing back….

January 27, 2020

Getting into the swing of clinical life

Term didn’t exactly start out how I wanted it to. I pictured jumping into clinical life, getting to know my consultant and getting to grips with managing hospital life with solo learning. My immune system, however, had different ideas. So, instead of getting sign offs done and (more importantly) enjoying paediatric week, I was at home with a mammoth ear infection (think IV morphine) thoroughly researching the patient journey. However, I eventually got back, managed to set off my hall’s fire alarm cooking biscuits (and suffered the mocking of 90X 18 year olds) and started my clinical life in care of the elderly.

I hadn’t thought much about this speciality to be honest. I was so driven on surgery and neuro that the idea of being on the ward caring for elderly hadn’t taken any of my interest but,now I’m drifting away from the idea of surgery, I found that I loved being on the ward and getting to know the patients there. We arrived at 9am on Monday morning and I felt immediately included into the team which was amazing. You always hear of these horror stories of being left out in the cold as such but it was like we were important to the doctors there. We sat in on the board round which involved a lot of medical abbreviations but thankfully I was able to keep up as I’ve decided to use a tablet to take notes, which means I can quickly google things I don’t understand. The team even stopped at one point to explain lasting power of attorney and what they can do if they feel the appointed person isn’t acting in the patients best interests. We were also alerted to a flu diagnosis on the ward meaning everyone was told to get their flu jab (my clinical partner was virtually dragged by a nurse to get his!). I had mine earlier as I wanted the free pen and sticker to go with it. Even at 23 years old I can’t resist a sticker…..

We were assigned to a consultant and as a group of three took a history, general and focused exam on a patient who had been admitted with shortness of breath. She was lovely and had so much to say so we were struggling to steer the conversation in the direction we needed to. I think it’s being British, we never want to be rude! My history taking has definitely taken a turn for the worse since OSCE’s last year (sorry, Prof Patel!) so I need to review my structure. We were then taken aside and given some tips on OSCE skills and common mistakes to avoid. I had some slight tachycardia during this point as I’m 60% sure the consultant was examining me in my exam last year when I completely forgot to ask patient details!

The rest of the week flew by and I got two sign off’s done. There was a potential third sign off but if I have learnt anything this week, it’s that elderly veins are hard to draw blood from. You can hit the vein and they will not bleed, yet when you remove the needle they bleed everywhere and you panic inside to stop the bleed and not look completely incompetent (totally didn’t happen to me this week).

We have also been in the presence of an amazing F1 who was chasing us around the ward telling us to go and see patients, recommending certain exams to do on them and offering us procedures at every stage. He was lovely and a Warwick grad! It does make you feel like there is a light at the end of this tunnel when you see someone who was once in your boat out there and doing well. He was also teaching us at every stage he could (even getting dragged away by the consultant because they had to get work done). I hope to be like that as an F1 one day. I know I am going home for F1 now just to save costs and be near family so, I will have Kings College and the new Kent and Medway Medical School students to teach so, I am hoping to pass down Warwick Wisdom. If I get there!

I love being able to teach myself the topics we need to know and I am finding it easier to retain information. I just have to get used to being tired after hospital as at the moment all I want to do is go to sleep! I'm looking forward to the rest of the block as I am on O&G, finally going to GP placement and going back into theatre with anaesthetics, a speciality of which is now growing on me. I guess that’s it for me now, good luck to all our amazing final years with their finals! You will all SMASH it!

The Power of Positivity

How is my Psychiatry block treating me? Well, I’m enjoying it more than I thought I would! I mentioned in my last blog about the clinical skills lab; well now I can report back as to what it was like. The skills lab is basically a simulated practice of how we would manage a psychiatric patient. The Medical School get professional actors to act out a “character” and we get a chance to practice taking a history from them as if they were a real patient. The “character” I got to talk to was a patient who had MUS (Medically unexplained symptoms). This is an interesting condition as the character was convinced they had stomach cancer and were experiencing symptoms. However, they had been investigated by specialists and there was no sign of cancer, so the symptoms were suspected to be psychiatric in nature. This doesn’t mean that the patient is making it up at all – in this condition, the patient experiences these symptoms as if they were real. However, they were not due to cancer, and could be eased by psychological talking therapies and psychiatric treatment. It was a difficult one to do as you have to be very careful to listen carefully and acknowledge that the patient IS experiencing these symptoms but also have in the back of your mind that the patient doesn’t have cancer. I wasn’t sure how to do this, but went for something reassuring such as “I can see that the symptoms you are experiencing are distressing for you”. Overall it was a very useful learning experience as psychiatric histories can be difficult.

This week I also had some stressful news – I’ve been hacked! Someone was trying to log into my personal email addresses and social media accounts. Luckily, they didn’t access anything, but it still scared me into changing all my passwords and wiping my laptop and phone etc in case they were bugged. I always think you can’t be too paranoid about these things so I changed everything. I think my paranoia about being hacked in that week probably met the diagnostic criteria for Paranoid Personality Disorder, but hopefully everything is okay now I’ve changed my passwords!

Every Tuesday we have small group teaching on psychiatric topics to help pad out and support the clinical experiences we are getting. This week it was on the topic of psychopharmacology (drugs used in mental health). It was exciting as a lot of the teaching was on how to use these drugs and side effects, considerations etc, which makes it very clear that we need to be stepping up our knowledge into actually managing patients ourselves. It is slightly scary that in a year’s time exactly we will be sitting our final exams and soon after be qualified doctors…yikes! The safety blanket of being a student, where it is perfectly acceptable to say “I don’t know” will be replaced by actually having to look after patients (albeit with support).

On Wednesday of this week we also had a CAMHS clinic (Child and Adolescent Mental Health), where we sat in with a consultant who was seeing children and teenagers. I enjoyed this as the child side of mental health focuses around development and family issues which means that you are not only dealing with the patient, but often parents, school, social services. I really enjoyed this clinic and our consultant was fantastic and very good at explaining what was going on. I think we must have done okay as the consultant then contacted the Psychiatry coordinator and gave some lovely positive feedback about us. Often a lot of feedback in medicine is negative or neutral and rarely given at all, so it really does mean a lot to get some positive feedback. It reassures us that we are doing everything right and gives us a morale boost. At a time of generally low morale in the NHS, positive feedback can be a very powerful tool to tell us when something goes right. One consultant who I worked with in my gap year between my first degree and medicine pioneered “Learning from Excellence” which formalises positive feedback in the same way that incident reporting is formalised. Positivity can be a powerful tool against burn-out and understaffing. Google “Learning from Excellence” to learn more about the philosophy – it may change your perspective and encourage you to offer positive feedback for a good experience. That’s all for this week – remember to say so if you have a good experience!

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About our student blogs

Our Med Life blogs are all written by current WMS MB ChB students. Although these students are paid to blog, we don’t tell our bloggers what to say. All these posts are their thoughts, opinions and insights. We hope these posts help you discover a little more about what life as a med student at Warwick is really like.

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