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Because I'm a lazy shit
2008-05-26 20:40:00
A 75 year old man was admitted to hospital with SOB, severe fatigue, muscle weakness and swollen ankles. At night he says he requires four pillows and often wakes due to shortness of breath. His history revealed that for several years he has experienced episodes of chest pain and shortness of breath on exertion. On examination he was noted to have slight cyanosis, distension of neck veins, tachypnoea (20/min), tachycardia (110BPM), ankle oedema and rales at the lung bases bilaterally. His BP was 115/80. The chest x-ray examination showed an enlarged heart and diffuse density at both lung bases. An ECG showed normal sinus rhythm. Treatment included bed rest and administration of digitoxin and a diuretic.******************Once again, if anyone can help explain this scenario it would be of great help. I think I understand it on the most part, being that it's heart failure. We've done right-heart failure before, so am I right in assuming this is left-sided?
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Retrosexual
2008-05-20 23:09:00
Human development wasn’t as interesting as I’d hoped. Perhaps that is just the typical male medical student attitude, maybe things are different on the wards. I for one will be glad to see the back of anything remotely menstrual. That’s not to say it was all that bad, I learnt a few things, things I perhaps would rather not know in hindsight (– YouTube ‘episiotomy’ at your own risk).Quote of the week: “Using the femidom was like making love to a packet of crisps” From one of the last lectures of the year – contraception. Slightly odd, knowing what sex with a crisp packet is like. Stranger still is that these things are not effective in preventing the spread of STDs despite the masses of latex they’re made from, but perhaps that’s not a real problem as no one seems to use femidoms anymore. More concerning still, is that one student seemed to think ‘double Dutch’ involved swallowing both the pill and the condom.I did receive a text from my friend sat on anoth...

Calling all haematologists...
2008-05-18 19:47:00
Mr Ali, a 59yr old Bengali man, presented to his GP with a 1 week history of cough productive of green sputum. He had a pain in the right side of his chest whenever he coughed. He had been feeling unwell for some time, with aches and pains all over. The GP sent off the sputum for culture, and in the meantime prescribed amoxicillin 250mg three times a day for 5 days.A week later he returned, feeling worse. He still had the cough productive of green sputum, now sometimes flecked with blood. He still had the pain in his chest, and his left thigh was becoming more painful making walking hard. The report from the laboratory was back, showing prolific growth of Haemophilus influenzae, resistant to amoxicillin and to cephalosporins, but sensitive to azithromycin and ciprofloxacin. Mr Ali confessed to not remembering to take 3 tablets a day, so the GP prescribed azithromycin 500mg once daily; its pharmacokinetics allowed a single daily dose. She also requested an X-ray, a full blood count, ...
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Gone drummin'
2008-05-15 20:04:00
In 2 hours I shall be drumming away at the union for RAG band night. We've only had a day and a half to put together our bit.Wish me luck!!

Because histology sucks
2008-05-13 00:38:00
LAMECan you guess what it actually is?
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FYI
2008-05-12 00:06:00
Things learnt this past week:1. The GPs reception area probably isn’t the ideal place to conduct an interview with a patient.2. Need to push on pregnant lady’s belly a little harder if you want to feel that uterus.3. If you are planning to get pregnant, don’t get a massive dolphin tattooed on your tummy, because it will get skewed.4. Not all parents find their child’s immunisation that funny.

Yep, I'm mature
2008-05-07 21:43:00
Microanatomy session this morning, checking out the slides.Following on from a long spiel on various tissue samples, the tutor declares:"I know there's a lot to take in, but I hope by now you've managed to get a feel for the prostate"And I was the only one who seemed to find that funny...
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Big mouth strikes again
2008-05-06 23:20:00
The final module is upon us, as is the countdown to end of year exams and summer. For the next three weeks we shall be slogging our way through the ins and outs of the pelvis, the highs and lows of the sex hormones and finishing with the triumphant climax of birth – all to come in human development.But, back to last week…The dreaded brain and behaviour and locomotor exam. Yes, it was hard, somewhat sly and at times seemingly unfair (name four bursae of the knee joint and precisely where they are located – WHY?!).Yet, it was nothing compared to the moment of blinding stupidity I had today:“It must be pretty bad for those people who’ve failed the other exams so far, because they’ll be facing getting kicked out if they fail this one too, I wouldn’t want to be one of them right now.”I think you can guess who I unwittingly said that to.Some days are better spent in silence.
More About: Big Mouth , Mouth

Unprotected Text and the City
2008-04-30 15:46:00
I temporarily made a transition to city-boy status this morning, donning my smart clothes and making my way to an agency to register for summer work. I hadn’t however, anticipated the two hour slog of paper work and menial computerised tests. As I sat down in this open plan office at a computer terminal, to log on and grind down, I felt a sudden sense of chilling perspective.MeThe candidate - Ferocious in the boardroomand packing some serious toner cartridgeOffice jobs suck. They suck in themselves and they suck the life out of you. Everyday I spend battling the crowd of suits coming out of the underground station as they make their way to their offices to push paper, answer phones and send e-mails, day in day out. Thank fuck I’m not stuck in the rat race. The Agency Hired or fired?And so, like a less than alluring episode of The Apprentice I typed away having my spelling and typing speed assessed. Sixty words per minute, disappointing really as I thought I could do better. Whil...
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Diff'rent Strokes
2008-04-28 22:50:00
Lock-down mode once again at the halls for this Friday brings the dreaded, hastily anticipated, and supposedly most difficult of all first year exams – the brain and behaviour (and locomotor) exam.Cranial nerves, spinal tracts, brain anatomy and infinite fact have been crammed into our cortexes over the past eight weeks. I for one am running out of gray matter, which isn’t so much of a problem as I’m also running out of time. B+B isn’t easy, but the general consensus seems to be it was actually a really enjoyable module.As for highlights, well, part way through the course I found out exactly ‘What Willis was talk’n about.’Yes, that’s right he was talking about ‘the Circle of Willis’, or rather the blood supply to the brain.Ironically, the Circle of Willis can also be used to explain the ‘Diff’rent Strokes’ that an individual may suffer from.For example, a CVA involving the middle cerebral artery will affect the entire lateral aspect of the cerebral hemisphe...

Suture Self?
2008-04-20 18:04:00
Hospitals are a foreign place, especially for us first year medical students. On the rare occasion the university will let us set foot on a ward to have a supervised interview with a patient, one that tends to be on the road to recovery with full mental faculties. In short, we all seem to have a naïve, romanticised idea of what goes on in these places.The other week a friend and I ventured into the basement of the Royal London for a guest lecture. It would seem that the silent corridors and rooms of the hospital basement are for three things; the MRI, the morgue, and the medical students. Sat in the dingy and dated lecture theatre, most likely surrounded by radioactive dyes in storage through one wall and cold dead bodies through another, we ponder as to what dramas are playing up on the floors above.The lecture was put on by the surgical society, and featured a retired emeritus professor in surgery who was delivering a lecture that he’s been giving to students for years; in fact...

Nuclear warheads
2008-04-18 19:01:00
There are some weird and wonderful disorders in neurology. From the man who could only say ‘tan’, to patients who cannot differentiate between background and objects, and, famously to Phineus Gauge, the first accidental frontal lobotomy. All of which suffer from unusual, bizarre consequences.And then there is my uncle, who has been diagnosed with ‘Exploding Head Syndrome’. Now, at first when my mother told me about this I was sceptical, but to my astonishment it was actually listed in my Oxford Medical Dictionary. As he describes it, he hears an enormous crash that wakes him up in a sudden jolt sending his pulse racing.Last night I swear I heard a massive bang, but couldn’t really tell where it came from. The next morning no-one else seemed to have been woken by any noise.Here’s hoping it’s not hereditary…Of course, I could just be suffering from medical student syndrome.
More About: Nuclear , Nuclear warheads , Warheads

Stroke Folk
2008-04-14 02:14:00
I spent some time last week at the hospital, on the stroke rehabilitation ward. Upon arrival we were greeted by various members of the team, later we would be introduced to a man who’d recently suffered a cerebellar stroke. This is where the medicine learnt in a lecture theatre translates into something completely different. No longer is it as clear cut as ‘a cerebrovascular occlusion of the posterior inferior cerebellar artery resulting in localised ischemia.’ It is instead, a man who has difficulties walking, standing, co-ordinating his hand. I watch for a moment as he tries to place a red counter into a connect-four grid.The occupational health therapist tells me how he presented, and how his rehabilitation has gone so far. I observe the man, as he cunningly dupes a nurse into losing, a move that I myself had not foreseen. If anything, it provides a poignant demonstration of his full mental faculties despite the damage caused by a stroke.Later in the day we go on to visit a...
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Clinical (s)-Kills
2008-04-09 21:09:00
There’s nothing like a long clinical skills session to demonstrate how much you’ve forgotten when it comes to cardiovascular, respiratory and abdominal exams. Fundamental, keystones of good clinical practice these theatrical displays of competence are right now, at best shabby. I can’t for the life of me remember the order, and signs we’re instructed to look out for. Come the summer OSCEs we will be given perfectly healthy patients with none of these pathological features, yet we will need to say what we’re checking for and remark on their absence.A respiratory exam should start something like this:“Hello, I’m Harry and I’m a first year medical student. Would it be alright if I can quickly look at your chest and listen to your breathing?” Said as I wash my hands and stand near at the end of the bed.“No, go right ahead.”“Patient seems well, good symmetrical breathing no use of accessory muscles, steady breathing rate, seems well perfused, no scars on chest, no...

Blind Man's Bluff
2008-04-04 00:56:00
‘Blind people don’t see blackness’A provocative afternoon at the hospital as we’re given an awareness workshop by the Royal National Institute for the Blind. Later on we’re to discover that a person born totally blind sees with their other senses. For those who lost their sight in later life, they may see different patterns or the same one permanently. When they dream, they can see – all in the eye of the mind.It’s a philosophical question, and something that is not fully comprehensible to someone who is able to read this blog. Of course, they are not ‘seeing’ in the sense you and I can as there is no visual input into the visual cortex. Occasionally when some people lose sight, they experience hallucinations – a condition known as Charles Bonnet syndrome. We’re told that these hallucinations are involuntary, and a small proportion of CBS sufferers are tormented with terrifying image which may be fixed there permanently. Tragically, some of these people commit ...
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Apologies for the late running of this service.
2008-03-30 17:30:00
Once again I find myself neglecting this little patch of cyberspace in favour of less pressing matters and general idleness. March has been a fairly dry month, with little of interest to report. Saying that, I have spent the past two weeks arsing about as it was the Easter holidays.A brief visit home and a slightly overbearing mother pushing me to spend more quality time with my brother is more than enough ‘family time’. It ain’t gonna get fixed that easily. I still haven’t managed to find any form of housing for next year, or job for the summer. Instead I received two rejections for some summer research applications as I’m still a first year medical student, despite the fact I have a fucking degree in Biomedical Sciences. Looks like a few dreaded months of agency work is on the horizon.But with the glass half-full, I did get the chance to relieve some stress and damage my hearing with an old friend: The simple pleasures in life, but by god is it ever satisfying!We’re en...
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Cranial Nerves
2008-03-20 17:43:00
Easter has taken a rather rostral turn from the spine to the twelve cranial nerves. It would seem this is a part of medicine where a mnemonic will come in useful. So far I’ve heard two good ones.(Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal)Only One Object Transcends Time And Foams Vivaciously: Glorious Vagina! All Hail!Ohh, Ohh, Oh, To Touch And Feel Virgin Girls' Vaginas And HymensIt always seems much easier to remember with the added charm of smut. Well, I suppose it beats the more conservative mnemonic:On Old Olympus Towering Tops A Finn And German Vending At HopsDoes anyone even understand what this means??!Once I’ve finally managed to remember the names and spellings of the nerves let alone their initial, the next step is to actually place them on the brain stem. Of course, what I see is actually this:Oh dear, I think this could take a while…

A day to remember
2008-03-13 22:03:00
We met in a church hall, after the briefest of introductions I sat in the spare chair next to her. She seemed delighted, as the other lady’s gently teased “Oh look after that one, you’ve got a looker there, Emily!” She would then reply, “None of your business!” laughing and flirting harmlessly as older ladies do and I would sit smiling bashfully, as young men do.Emily has Alzheimer’s, quite how advanced I am still unsure. I was handed a children’s puzzle to go through with her. At first I felt awkward, trying to treat her like an adult whilst piecing together a cartoon farm. To make it worse, she was unimpressed and reluctant to take part. “Shut up, not interested” she would keep telling me. At this point the carer would explain that she is a particularly hard client to motivate.She would laugh at anything, in exactly the same manner every time. I would smile and laugh back like a moron, there was no joke, no conversation, nothing. After a while we gave up on the...

A little out of hand
2008-03-09 13:14:00
I’m loving the new PBL, especially the way it’s tailored to make it relevant to us.“Bartek is a 23 year old Polish labourer working on the Olympic site at Stratford. He is involved in an accident with a band saw which results in his right hand being completely severed 4cm proximal to the wrist.”Dare I say it; this one is actually quite interesting to read up on. Lots of journal articles with gory pictures:The new PBL tutor isn’t bad either, a seemingly nice lady and generous with the group mark - unlike our last tutor, though even they made sure we did the work. The past week has consisted of locomotor lectures, and for the most part dissection of the upper limb has proved extremely useful.Trying to remember the different nerve roots and palsies is giving me grief. What with the roots being just overlapping numbers e.g. C5-C7, besides it took me nearly a year to memorise my mobile number!This next week is the last week of term, edging us closer to the end of year one. I ha...
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What not to do...in your first year
2008-03-04 22:02:00
Telling everyone you’re a medical studentAs a first year, you are bottom of the pile. You’re not special like those finalists and you know fuck all medicine. If you try using it as a chat up line, you can bet the locals will have heard it before.Telling everyone you’re going to be a surgeonOr obstetrician, or cardiologist, or gastroenterologist, or whatever. You can’t possibly know at this stage, and naming some glamorous-sounding specialty does not give you credibility. By all means start thinking of possible career choices, but keep it to yourself for the next five years.Buying a stethoscopeIt depends on your school, but by and large there is little need for a stethoscope in the first year. Certainly, if you do decide to buy a stethoscope then don’t be that guy with the obscenely expensive ‘Littman Cardiology Consultant VIII Mumurtastic Special Edition” you will look like a penis when you can’t even locate the apex beat.Relationships with classmatesChances are it w...
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Goin' loco
2008-03-02 17:57:00
Tomorrow marks the start of two new modules, one of which is supposedly the hardest element of the first year. Welcome to ‘brain and behaviour’ and ‘locomotion’. I’ve heard dreadful, awful things about B+B, alas, I am actually looking forwards to it. In biomed, neuroscience was one of my favourite topics we covered. As for locomotor, the dissection SSM I’ve just done should prove extremely useful. Of course, returning to the usual daily grind makes for an unwelcome return of PBL.I went to one of the best union nights so far last Friday – live bands night. Both cheap and relaxed, I really enjoyed watching students putting on a good show, the appreciation and unity of the crowd was electric. I’m definitely going to guitar soc this week, I’ve been meaning to for a long while but kept putting it off for various reasons.Last night I went to central London for an awesome meal in a Lebanese restaurant. It was of course, hideously expensive – the only thing that put a do...
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Dissection Recollection
2008-02-28 19:47:00
The final day of cutting is over. We spent it looking at the hip, knee and ankle joints. I eagerly jumped in at the start, keen to find and remove the head of the femur from its socket. With what seemed to me like a rather careless approach I managed to do so in ‘record time’ according to the instructor, and apparently not a bad job either. Synovial fluid spat out as I tried to sever the ligaments, and as the head rolled out of the socket I smiled coyly at the smooth white contours of the joint. I was a little disappointed there wasn’t an artificial hip joint, as there occasionally can be. As in the nature of medicine, there’s always far more information than anyone could possibly remember, and the torrent of fact from the instructor’s explanation went way over our heads.With the end of dissection comes a relief. We must have dissected and identified over 150 muscles along with numerous bones, arteries, veins and nerves. It was a fairly heavy SSM to take, a demanding timet...
More About: Dissection

Feet
2008-02-27 12:56:00
The lower limb is a little easier to dissect. For one, the face is out of view allowing for us to slip into a less personal sense of thought and just get on with the task in hand… or foot. Secondly, the muscles in the leg are much larger and easier to separate than those in the arm. Finally, there is no need for twisting the limbs into place, as they have been fixed in the anatomical position. Needless to say, the lower limb has proved a little easier to deal with.We started with the posterior - the gluts and hamstring muscles. Once again, we found ourselves with the rather unpleasant task of cutting out chunks of fatty tissue, but eventually the anatomy became clear. Following on from this came the femoral triangle. It’s odd poking around near the cadavers genitals, but as is the nature of dissection you forget about it soon enough.My once clean white lab coat is now lightly stained by preservative. I get the feeling that many of the students who stand back and watch use this a...
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Bad to the bone
2008-02-24 17:53:00
As the week drew on, the nature of dissection changed. In the beginning, after the initial shock was overcome the cutting process became fairly routine. By Thursday, things started to get a little messier. In order to fully dissect the joints, we ended up doing what can be described as effectively skinning the arms. Needless to say, the week ended on a fairly drained note, most of us glad for the weekend.I think the best part for me was dissecting the palm. The method itself was quite challenging, the skin and facia stuck on tight. It required a lot of patience and hands on precision to make a half decent job of it all. Eventually we penetrated the carpal tunnel, something that I’d put as a highlight of the week. The instructor explained to us how the anatomy related to carpal tunnel syndrome, and the usual obscured mishmash of tissue made a lot more sense – almost textbook stuff.At the end of the week, we were told to cut away at the muscles surrounding the shoulder joint and f...
More About: Bone

Dissection
2008-02-20 00:23:00
Just a quick request to start with, that is if you are planning on donating your body to medical science then it would help a great deal if you could end your days laying in the anatomical position, arms supine.One of the hardest things about dissection is trying to move a body into the necessary accessible positions. A fair deal of force is required that, for a first year medical student with limited exposure to death can prove exceptionally tough to overcome. It is undignified, especially when it comes to rolling the entire cadaver over onto its front to dissect the back, it is also messy at times, but still we persist.The general atmosphere is quite jovial. There is no need for it to be solemn and there are the usual light hearted jokes and comments needed to overcome the mental obstacles that arise from cutting into a dead human. I would not describe it as disrespectful and so far over the past two days there has been a general show of respect. However, there was one instance on...
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Feel lucky, punk?
2008-02-17 21:28:00
Friday’s exams proved on the whole to be much more challenging than the FunMed cohort, as you can see:FUNMEDWhat type of image is this? A. CTB. X-rayC. MRID. Contrast media X-rayE. Ultrasound(Website was left on the image)CARDIORESPIRATORYName A.A. Anterior papillary muscle of the right ventricleB. Septal papillary muscle of the right ventricleC. Posterior papillary muscle of the right ventricleD. Anterior papillary muscle of the left ventricleE. Posterior papillary muscle of the left ventricleAs you can imagine, this has a significant impact on results. In fact they went from this:FunMed Class Average: 60%To this:Cardiorespiratory and Metabolism Class Average: 49%Over half the class (~150 people) failed.Thankfully I did not, though I didn’t score as high as before which is a bit of a bitch. Still, that was only one of three parts we sat but the other exams were on the whole a lot kinder. Fingers crossed!Tomorrow marks the start of dissection, two solid gold weeks of anatomy…a...
More About: Punk , Lucky , Feel

Introducing: The Medical Student
2008-02-12 17:49:00
As it has once again reached that time of year when an exam is looming, I felt it appropriate to compile a list of exam personalities that I have witnessed over the past few years. Please note, they are not a reflection of the students at my school (although some will invariably fit the description).The GunnerA classic personality. These high calibre front row revision jockeys are at the forefront of every year. They are walking textbooks that seem to run off self-satisfaction. To the Gunner, a pass is a fail unless they are right at the top of the year. They are ridiculed by the pack but always come off best.The SpongeSponges have a seemingly unnatural ability to turn up to lectures and remember volumes of information without effort. Revision time is brisk for a sponge as they are already saturated with the key concepts. They are seemingly normal on the outside, often shamefully coy about their superhuman memory and always do well when it comes to results.The AssassinThe knife in t...
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Withdrawal
2008-02-11 01:44:00
One of the best things about medicine is getting away from it all. Particularly the fascination and regard your non-medical friends have towards you. Friday night I ventured off to Carnaby Street in the heart of central London for drinks with some old friends. Every time I see them I get asked that same endearing question “how was school today?”And so would follow a short spiel of whatever amusing story I can think of that they’d appreciate. Many of them are still finding their feet and subsiding on the same disposable income they had when they were students. Though, with time modest salaries will increase, promotions will come and lives will move on. I am aware of this, a feeling which fills me slightly of dread. I will still be in school, living off my pocket money, revising for exams and hopefully still enjoying the subject. Five years (or four and a half) still seems a lifetime away.Next week marks the last week of our metabolism module and the dreaded in-course exam. As u...
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Hard to stomach
2008-02-07 20:21:00
When in the anatomy lab all notion of time fades away and hours can pass unnoticed. What does not fade away, is the smell of formalin. It seeps through the gloves and clings to your skin. No amount of washing is able to cleanse the scent, I am sitting in my room two hours after I’ve finished and can still smell it. This makes eating dinner a little unpleasant. Every forkful of food I put in my mouth brings with it a reminder of the days events.Lasagne was a bad idea.It is far too structured a meal, far too familiar. After a day spent pulling apart and prodding abdominal anatomy, the thin slightly tarnished and burnt-edge layers of pasta remind me of the layers of peritoneum and anterior abdominal wall. The béchamel white sauce browned by the oven, thick and gloppy from melted cheese is adipose fascia. Every forkful I detect the scent. It is all too recognizable.I am still perplexed as to why many students don’t turn up to these sessions. It is abundantly clear as their friends ...
More About: Stomach , Hard

No brainer
2008-02-06 01:00:00
I heard from a hall mate that during his PBL, two students turned up 20 minutes late and had to take the only spare seats left in the room – on either side of the tutor. Both then proceeded to take out their PBL notes, which happened to be the exact same printout of the relevant wikipedia page. Imagine the tutors delight!Still it begs the question, what kind of anencephalic bint would do that right next to their tutor??Surprisingly, my PBL session this morning went fairly smoothly and dare I say it? I actually enjoyed it, to a degree. Perhaps as I went in with absolutely no desire to be there or prospect of enjoying it. Expect the worse and never be disappointed, half empty and all that jazz. I’m not holding my breath for Friday’s session.Recently I have been trying to work out what to do about living arrangements for next year. It’s approaching a time where friends are raising the issue, and I am avoiding it like the plague. Med students vs. ex-students, that is my dilemma....