Almost the end of paeds

Wow paeds is hectic! It's generally said about paeds that it's not just adult medicine on little people, it's a whole other kind of medicine!

They're right.

I spent the first few weeks trying to survive on my meagre adult medicine knowledge (largely meagre since it was acquired in Bedford). After about 2 weeks when it was clear this tactic was leading to me being labelled as an idiot by the ward staff (even some of the kids). So I decided to do some reading. Then I got a bit scared as I realised how much there was to learn. So I stopped reading.

Luckily for me I discovered a series of textbooks called 'at a glance'. Somehow they manage to crush down horrible long complicated topics into a double page spread, which is much easier to learn. So Paediatrics at a Glance is now my new best friend. If I ever hear about a condition or disease i've never heard of before (this happens on a fairly frequent basis) I turn to my trusty book and quickly scan 2 pages of A4 to get up to speed! Pretty handy!

Paeds itself is fun. The babies are lots of fun. When a baby is first born before it can leave hospital it must be examined by a paediatrician to make sure it's working properly. You very broadly take a look at how the baby looks, check its lungs and heart and intestines are working ok, and check that its brain is working fine. It's quite fun, and they're very cute. Especially when they put their hands in their mouth and think its a dummy to start sucking on their own hands. Poor little guys. Less fun when they wee on you.

An important aspect of paeds is how quickly seemingly well kids can become very unwell. If a child comes in with what seems to be a meningitic rash you have never seen so many doctors and nurses move so fast in your life. Before you know it the kid will be pumped full of antibiotics and have all kinds of blood tests done! Speed is of the essence in paeds emergencies. Children it seems have a lower coping ability when it comes to illness. That said, they do bounce back very quickly once you get on top of the problem and treat them right.

Only a few weeks left of it now......and then summer hols YEAH BABY!

Paediatrics!

Finally my special study module is over, and after 5 weeks hard slog I am looking forward to playing with kiddies for the next 8 weeks. Paediatrics is the branch of medicine that deals with child health. Anything from 4 weeks to about 18 years old can come under paeds, so it's a wide and varied specialty.

Today we had our first day of a 2 day induction course. We learnt about basic life support for young kids and babies (so, what to do if you see a collapsed or choking child etc) and then we got to try out our new knowledge on some dummies! Then we had a lecture on how to talk to kids in a medical environment, especially when trying to find out the info about why they're ill or why they feel unwell. We saw some very funny videos with toddlers being incredibly difficult to examine. Because kids are so unpredictable paeds has a much more flexible feel to it that adult medicine. It's perfectly acceptable to not wear a tie (largely since most kids and some babies will grab and wee on them!).

Tomorow we have some more lectures about how to recognise a critically ill child (which is very important since kids fluctuate in the seriousness of their condition at a greater rate than adults, so if the warning signs are present one must pick them up efficiently and speedily!). Then happily, on Thursday we head off onto the wards to save lives and play with babies.

I hope none of them scream or cry at me...........and that I don't have to change any nappies!

Special Study Module

Exams are all over - and happily I passed them all so now I can relax and forget about stuff like that for a while! After my 2 weeks of easter hols I have returned to Cambridge to do a 5 week special study module. Special study modules are designed to allow students to choose a topic in medcine or surgery that they want to pursue for 5 weeks. Usually people choose something they're interested in, or something that just sounds really cool. Most medical schools will offer you the chance to do special study modules at various points in your course.

At Cambridge there was a choice of about 60 different special study options to choose from. They ranged from hardcore action packed stuff like 'pre hospital trauma' and 'critical care' to the less adrenaline fueled titles such as 'world public health' and 'forensic osteology'. Needless to say, there is usually at least one module that is of interest to you, so you'll find something you want to do.

I choose to do a module in acute leukaemia. Leukaemia is a cancerous disease of a patient's blood cells. The type of doctor that treats these patients is called a Haematologist. My special study module involves spending lots of time with patients who have a condition called 'acute leukaemia'. I'm spending time sitting in clinics with the consultants seeing patients, talking to patients on the wards and assisting with their care. One of the things that attracted me to this module is the opportunity to get to grips with stem cells and the really interesting genetic basis of haematological (blood) malignancy (cancer). As part of my module i'll be looking at some of the data the department has collected on its leukaemic patients over the past few years to see if the treatment they are getting is as good as it should be (when compared to national guidelines). It should be really interesting!

Gastroenterology medicine

I'm all done with surgery for my 4th year! Won't be going back to it for a while now as my next 2 five week attachments are in medicine and my special study module respectively.

My medicine attachment is in gastroenterology. Basically peoples gastrointestinal tracts. Loads of people with diarrhoea, things like Crohns disease, ulcerative colitis etc. It's quite nice to be with medics again rather than surgeons. I love surgeons, but they can be a bit brutal and efficient with the patients. Medics on the other hand love to waft around the hospital from ward to ward taking their time. Surgeons think medics mince around doing very little, medics think surgeons burst into patients cubicles in a whirlwind and are gone before the patient can work out what the hell is going on.

Ok massive stereotypes perhaps, and many medics and surgeons are nothing like what I said above. But there are a few!

After my medicine attachment is over Ihave the dubious fun of exams! Essentially end of 4th year exams, they will be on medicine and surgery and comprise a 1 hour written multiple choice exam, and a long long long practical exam where I have to do things like take blood, do abdominal examinations and demonstrate my 'communication skills'. Fun!

After my little tests, and my easter hols, I get to do my special study module. Becoming more and more common in all medical schools, the special study module is a time that you can choose what you would like to spend more time on for 5 weeks. So you can choose an area you're weak at, something your interested in, or something very dossy (like clinical hypnosis) if you just want a holiday for 5 weeks. I went for a clinical haematology option about acute leukaemia. I'm not especially interested in leukaemia, but I didn't feel like I knew enough about it, and it sounded more interesting that 'a history of anatomy' or 'forensic osteology (bones)' which were some of the other choices. And, happily, the module is based in Cambridge, which is very good for me. The last thing I want is to be dashing around the villages of east anglia in May, when I could be punting on the river Cam instead eating strawberries and sipping champagne. Or, as is more likely in this country, running from the rain.

My time in Bedford is coming to an end. I've been here for almost 10 weeks now on attachment (5 weeks of medicine, and 5 weeks of surgery). At first it was a bit of a pain not being in Cambridge where my nice warm bed and other modern conveniences are - but after a while Bedford does sort of grow on you (not like a fungus as someone remarked to me earlier).

I'm finishing off my vascular surgery attachment this week. I've quite enjoyed it so far, although as i've said earlier it's about the most minging thing i've ever seen. People literally have huge ulcers centimetres deep on their legs filled with pus and other oozing stuff! But it's really satisfying being able to treat them at the end of the day, and slowly but surely you can see that even these quite painful and miserable looking ulcers can end up healing (even if you do it by chucking a tea bag of maggots into the wound!).

The other side of vascular surgery is a bit more acute and sudden. An aneurysm is when an artery gets really dilated. You can feel them pulsating, and they can rupture causing big problems for the patients (perhaps not quite akin to something out of the Alien films. but close enough). If somones aneurysm bursts sometimes you have to rush them to the operating theatre straight away. That kind of excitement and rapid fixing of problems really appeals to me. Plus I bet you feel pretty cool as the surgeon doing all the chopping - saving someones life in real time, rather than over the course of a long period of time!

Anyway, next week I shall be back in Cambridge at Addenbrooke's ready for a week of lectures before I start my next attachment!

Vascular Surgery

I've finished my colo-rectal surgery attachement now. Aside from smelling rather bad, it was by and large a fun experience. I suppose the only negative point was headbutting the consultant by accident in the operating theatre as we both bent down to look into the abdomen. I think he came off worse though, but the patient was fine so all was well!

I've now swapped over onto vascular surgery, which is in a word, minging. The big problem people with vascular problems seem to suffer is their limbs not getting a good enough blood supply, and so they go black and necrotic and horrible. They look horrific and smell even worse! And so, how does one treat a necrotic foot? Well, rather obviously you fill it with maggots! Yes, the doctors on the wards put a bunch of maggots (in what looks like a tea bag) into the wounds of some patients! The logic is, the maggots will eat all the dead material leaving the wound clean and happy. To me, it sounds quite a distressing experience - but it does actually seem to work. If maggots don't float your boat, other proven options include dressings made of honey or silver. Odd!

General Surgery

Leaving old people far behind, I have now moved onto my general surgery attachment. Which is actually a bit of a misnomer. General surgery is sort of dying out a bit - people are specialising more and more. Gone are the days when you were a general surgeon and dealt with anything that came through the door. Now you are a general surgeon with an interest in Upper gastrointestinal tract disease, or colo-rectal disease or vascular disease.

I am currently attached to a colorectal surgeon. Why one would wan't to revolve ones career around other people's bottoms is a bit beyond me, but everyone seems pretty excited and enthused about their chosen career. Colorectal disease incorporates many important conditions, with perhaps colon cancer springing to mind first. I've seen a lot of patients this week with colon cancer, some of whom will probably be ok, and some of whom really only have a few months to live. I've come across cancer a few times over the past year, but i've never really been around when the bad news about a diagnosis of cancer is given to a patient. This week i've seen it 3 times. It's a horrible feeling to go into a room knowing you have to tell someone they have cancer - even when you're just watching someone else do it!

Aside from academic things, my group out on attachment have decided we need to bond a bit more, so next week we're going to go out into the local town near where we are dressed as chavs. But i'm not really sure how a chav dresses, so it's going to take a bit of researching.

This week i've also been trying to decide what I want to do for my special study module in may. There are loads of choices, and the module is 5 weeks, so if you choose something good you can have a really awesome month. The choices ranged from projects on the history of anatomy to working in a heart transplant unit. Something for everything, but there are about 80 possibles and I have to choose 5! argh!