This bus smells like the dead...

I think I've finally got used to dissection. Ive stopped noticing that its weird to be stood, scalpel in hand, in a room full of the living slowly stripping down cadavers to their very core. Its not strange that some of the bodies are hemi-faced, or mono-legged. Our demonstrator took us through the basics of an abdominal exam on Thursday and said 'What is the first thing you would notice if this lady (gestures to our cadaver) came in for a check up?' and someone answered 'We'll i think the abdominal exam would be the least of her worries, she's quite clearly got no lungs...'- The first years have started their semester on Cardiorespiratory fitness you see...

Our demonstrator is very softly spoken and sweet natured. She is training for her exams to become a surgeon and is a proverbial font of knowledge. She finds us very funny, our morbid humour is not above her although never in a million years would she make a lighthearted remark about the dead...
She asked me to find the transversus abdomonis muscle and when i say 'find it', literally, dig away with a knife until it is discovered.
'Dig' perhaps is not the appropriate word because it is actually an incredibly delicate task navigating your way through the skin, fatty tissue layer and fibrous layer to reveal the different muscles of the abdominal region. My friend Sam said he felt physically inferior to the 90 year old man he dissected who could only be described as 'Tonk' or 'Ripped'- a 6 pack to rival the best apparently!
Anyway, the most important thing about me completing this task was not that I found the muscle, but was that I could do it. Slicing an ex-human no longer bothers me!
In fact its got to the point where I need to remember that discussing this weeks anatomy session is not appropriate in a restaurant that sells slow-braised pork resembling human flesh long retired. People LOVE hearing about it, i often get asked 'have you cut up dead people recently?' and its funny to see the response when you reply 'why yes, i spent Thursday morning knee deep in gangrenous intestines'...people have a morbid fascination for these things, but providing a little too much detail is an easy thing to achieve.
I went to the doctors today and was sat in the waiting room reading a book my uncle got me for Christmas-Was this too far too? Its brilliant, and it was in my bag and my iPod was out of battery. But i did get plenty of funny looks, especially from those closer to the grave than me...(can i say that?!)

I was on the bus with my friend Kyle the other day, she was telling me that she had had to iron her lab coat for her exams as it had been shoved in a drawer for Christmas, having been newly washed, and then crumpled. The hot iron brought out the fatty, phenol-y, formaldehyde-y smell and filled her living room with 'essence of Dissection Room'..Gross....
It truly is an original smell, it gets into your hair and wafts around you for many hours. On my way back from the doctors i kept getting drifting whiffs of the exact scent as i was sat on the bus...i couldn't see a medic (post-d.r the buses, filled with anatomically accurate medical students often smell...interesting) or an abandoned lab coat.....







Must have been my mind playing tricks on me.....

Long time coming.....

Sorry fans, i know its been ages, I've been pretty busy, what with reading ENTIRE neuroscience textbooks over my Christmas holidays and the likes....Here's an UPDATERRRRRR on my life since i wrote about never being able to understand the brain-

APPARENTLY i was meant to have some holidays- they seem to have not materialised between finishing on the 19th of December and the commencement of my DEATH EXAMS almost exactly one month later. Seriously its the most stressed i have ever been, we finished them a week ago and it seems like a lifetime already. I am sleep deprived and utterly exhausted, how am i ever going to cope with night shifts? I clockwatch from about 6pm until it gets to an 'acceptable' time to go to bed! We have gone from exams straight into 4th semester, which is all about the digestive system...which is not gripping, i no lie when i tell you today i had an HOUR lecture on mucus. yes folks, snot.
The exams were hardd but i think the work i did paid off, i put everything into them, i think i have been running on caffeine, adrenaline and sugar....not a health combination, you don't have to be a health care professional to tell me that (at least i gave up alcohol though hey?!?!) and now i am seriously crashing and burning.
I went to see hol in mac after my first two just for a break and could not put a coherent sentence together, i had nothing interesting to talk about and found it nigh impossible to make a decision about dinner, let alone about what i wanted to do for the day....So we went on a crazyfun road trip to a place called Wizard's Walk and ran around the forest with her housemate Malcolm duelling with giant staffs made from sticks and played 'Guess Who in 20 Questions' and i came home feeling slightly more normal...

Holly and her housemates are only here until September, and my housemates are all graduating in June and its slowly sinking in. I'm pretty sad about it all to be honest, were just in the process of getting tickets for their Graduation Ball, which i am apparently allowed to go to, and i cant stop thinking about how much these last 3 years have been excellent and how much i am going to miss them all This is us at the festival at our student union last Saturday, with an assortment of friends, relatives, girlfriends and boyfriends....It was an 'Out of this World' theme....dunno really what half of them are wearing!

But i am very excited for all of them and very proud of how hard they work and i know we will be in contact for years to come and they will probably come to me for medical advice and i can go to them when i need to be made sane again by normality. I'm grateful at the moment i have 24/7 access and will be making the most of it....expect better costumes in the summer!

Theory of Mind or Luck and Magic?

You'd think that doing medicine would be about learning HARD FACTS and FIGURES and the likes, so you could regurgitate them and pass exams and save people and whatnot. It kind of has been like that up until semester three- heres a heart, this is what it does, heres how it does it, answer questions about it and come across it next in a hospital, thank you very much.
Surprisingly, this semester we are encountering 'this mechanism is not fully understood', which is almost disgruntling if youre trying to bash out your case for the week. WE.WANT.THE.TRUTH.
But then, have you ever thought about the brain? Like, properly? I have only just really started to, and seriously, its MIND BLOWING. excuse the pun.
Your skull is like a helmet protecting you, but not just 'you', actually 'you'. Everything you are as a person, apart from what you look like, is in your brain. We started off with the basics and i got that, spinal cord and impulses from your periphery and how they get to the brain, and which direction they take out of the brain back to the periphery (out of the Foramen Magnum, first turning on the left...), we did a bit of embryology, so how you go from looking like a tiny, ugly dinosaur to being born and having a giant head in comparison to your body, and a squidgy bit in your skull where you can poke your brain (DONT do this please)..and then we did some of the bits they know about, that you can see on a dissected brain, like the cerebellum which is the bit at the back that looks like a leaf when cut in half. thats alright, its easy to remember what it does cos if it goes wrong you act kinda drunk and everyone knows what thats like.
Last week we started on the Limbic System, and seriously i cant even start to explain that its just mental....It almost makes me want to cry its so complicated (even thats bloody controlled by the limbic system, so in two senses it makes me want to cry...AARGHHH!!!)
It controls reward and punishment, and anger and pleasure through some feedback mechanism that im not going to attempt to understand at this moment in time, it makes you comfort eat when youre sad, or cold.. HOW DOES THAT WORK???
One of my homegirls is having a pretty rough time at the moment and ive been chatting to her loads, its nice to have someone validate your sadness, i remember that, but it seems crazy to go from seeing chronic emotional pain, to a textbook that will put it down to X or Y neural pathway, via the activation of Z ganglion, through the ABC nucleus. I mean, really?
Are all my neurotic tics explainable by this sort of jargon? i dont really want them to be, i want my personality to be separate i guess. I eat pudding only from a teaspoon...what pathways that then Titus? hey? ( Titus is the author of what is the equivalent of 'Neuro for Dummies') I can watch scary films as long as i cant hear them, i was literally sat in the cinema watching Harry Potter (ashamedly) with my fingers in my ears as he duelled with a giant snake...that surely cant be explainable by the level of activation of some gyrus somewhere.

I was bitching with my friend El about the brain and this was the conclusion i made:

Basically everything is impossible and the human body is run mainly on magic and luck.

I quite like it. They should put that instead of 'this is an Unknown Mechanism'....basically means the same anyway, how can a mushy grey and pink thing decide what i fancy for tea? OBVIOUSLY MY STOMACH DOES THAT.

Cynical, but NOT a cynic.

Today has been a b.a.d. day. just one of those 'wrong side of the bed' ones, yknow, gets worse as it progresses until every non-withered living thing has curled up and died at your icy stare.
Manchester is colddd at the moment, and i have to say that i am starting to not mind the cold sooo much. i mean i live in the NORTH now...but today i was not pleased it was cold so i could wear my nice Tailored in Vietnam jacket, or pleased it was brisk so i could look forward to a warm pub and a nice lunch post-invigorating walk. Its not like i can wrap up and whack on my skiis or anything, it was just 8am trying-not-to-take-a-dive-before-getting-on-the-bus cold.
So that wasnt a great start and i have managed to have such a nice weekend that i didnt do any work- which is fine. honestly. maybe. no, it is. but its just an anticlimax to have to go back to academia, which is, i promise you mostly impossible. And to add to this we have the head of medicine taking our casegroup this week as our normal tutor has jetted off to San Diego for a conference. Seriously he best be bringing us back some exceptional presents to make up for this.
Its no biggie, like, he cant throw us off the course or anything, but he called us lazy and to be honest i think thats one thing we actually aren't. In context he said we werent working out our 'intended learning outcomes' out properly, we were merely guessing them, but really i thought thats what we were meant to be doing...i thought that quite a lot of the stuff were going to be doing for the next 2 years at least was executive guesswork?!
Take anatomy, par example, Anil, our demonstrator will say something like 'Lucy, tell me which lymph nodes drain the scalp' and i will go 'errrrrrr, the scalp nodes?' ( i wouldnt, cos they dont exist, but along those lines..you get me) and theres actually normally a good chance youre right, and if youre not, youve answered in a way which means youve asked him, so then he has to answer. Clever hey? they dont let just anyone into med school.......maybe.
ANyway, this week were doing about Parkinson's and i think its reasonable to say that there isnt a generalised public knowledge about this disease, except that Mohammed Ali had it....so for us to be able to theorise rather than guess about what were meant to learn about is almost not realistic....
Anyway so i havent done much work so i have to do it all now which hasnt helped my day.
And my weekend was spent pissing around with my homegirl and we went to a ball and drank cava like we used to and went to a really good gig and then i get woken up at some early a.m o'clock by my drunk housemate and his girlfriend crashing around coming in from a night out. its FINE FOR HIM. he finished lectures at the end of oct and doesnt have to be in uni until post-january exams. WORK THAT ONE OUT. Hence wrong side of bed several hours later.... but i think the thing that PISSED me off the most was the fact it dawned on me that i have gone from being know as 'cynical' to being a 'cynic' which is apparently either
a)

a person who believes that only selfishness motivates human actions and who disbelieves in or minimizes selfless acts or disinterested points of view.
or
b)

a person who shows or expresses a bitterly or sneeringly cynical attitude.
(dictionary.com)

EXCELLENT. just what i want to be seen as. SOmeone told me today that i was a cynic and i would agree that i am DUBIOUS about a lot of things, but to be written off as being bitter or a non-believer in selfless acts is just not true.
Firstly, i actually have a lot of faith in (select) people and generally i would rather be disappointed again and again than ever write off anyone that i ever considered a friend.
I would happily put myself on the line for something i believed in, however i do also think that its a protection mechanism, if you think the worst about something it only leaves you pleasantly surprised, or right, and its sometimes better to be right and a bit cynical than it is to be sat fat, dumb and happy and surprised that your were ever wrong.
Also, sometimes we cant help but being cynical, if we have even just 2 brain cells to rub together. Things dont just happen for the greater good- generally. In society if something brilliant happens the chances are theres some massive financial gain there for someone, its just obvious. If youre clever enough to get into medical school you should realise that we dont live in a world where the economy runs on hugs and kisses, most people have motives for doing things- they dont have to be ulterior motives, for self gain, but equally i dont just share my milk with my house mates because im nice. I do it because when i run out, ill use theirs.
Im not bitter about the world, i have NOTHING to be bitter about, there is no chip on my shoulder, and ask me most of the time i am incredibly happy (i can see how this looks, considering how this piece started...)
I just think its important to think about why things are happening, and not wander blindly through life without questioning anything, making the assumption that everything is fine.

Right. I'm done here. Whatever.

My (medical) Family

These are my babies. At Manchester medical school there is a mentoring programme where second year medics mentor first years as they make their transition into the big wide university world. Mixed in with them are my housemates and my medical wife, Jess.
This was taken on my birthday in fresher's week, in the foyer of the medical school at about half 8 at night...yes we are wearing lingerie pyjamas, yes tom on the end does look quite comfortable with this fact! This was for the annual PJ pub crawl, none of us really knew each other then but we had a really good night. Except it ended at a foam party where i got a viral chest infection and Jess got a strep tonsillar abscess from the gross things that are put in the foam!

As you all know i have been somewhat of a cynic with regards to (most things really) but medicine in general. But this year has undoubtedly been my favourite of the 3 and yes we are only 2 months in as my mother pointed out. Work-wise it is an absolute joke. no joke. almost impossible on every level. but i don't really care about this because all of a sudden i feel like lots of people i actually like are in the same boat.


Jess was saying the other day that everything we do together ends in absolute carnage..this is true, we have just been on the Halloween night out where we inevitably managed to lose all our children in the club, one of which has a broken ankle and physically cant move, Jess went for a curry on the curry mile at 3am dressed like a car crash victim and i ended up doing the macarena with a smurf, a member of kiss and PAC man. Bearing in mind these are the responsible second years, not the babies. I'm pretty sure they were all sat in a corner somewhere behaving themselves!
I used to scorn the 'work hard, play harder' philosophy to which most medics subscribe, seeing it as an excuse to behave badly and blame the 'stress of the job'..
There was recently an article in the 'MancUnion', our student paper, about the medical rugby team: -
(okay i cant work out how to rotate it...) but it absolutely slated medical students, mainly the sports teams who do have a horrific reputation, for being cliquey, arrogant and a general disgrace. I was talking to one of the rugby team who said they had written back in retaliation, but in my opinion it would have been best just leaving it. Medics are cliquey- we are either inclusive- of each other, or exclusive, i cant work out which. Were all in it for the long haul,( i could have 2 normal undergraduate degrees, or one and at least a masters in the time its taking me to get a medical degree) and we understand that. We get registered for EVERYTHING. less than 80% attendance = automatic failure of the year as the GMC (general medical council) says you physically wont have attended enough academic sessions to be a competent doctor. We have weekly deadlines. And yet by the very nature of PBL we are teaching ourselves most things. Stressssful. so the clique thing is internally, probably seen as a mode for supporting each other and being in the same boat. but from the outside, in our lingerie or our smurf outfits, seen as a load of idiots getting hammered and doing daft things. i can definitely see it from the outside p.o.v, but maybe with this semester, i can see it a bit from the inside too....I'm not defending the arrogance or the general disgrace, or in fact the cliquishness, but sometimes it feels nice to be united in the carnage of medical stress-relief!

Problems with the NHS

I'm not going to harp on about the coalition government and the management structures, funding problems, patient waiting times and the likes, this is a personal, insider's view of what the bloody hell goes on on wards in our hospitals.

As a medical student i am acutely aware of the idea that doctors treat everyone who is not a doctor atrociously. This summer i trained as a health care assistant at my local hospital in Bristol. I worked on the bank, which is a big pool of trained staff who get shipped to random wards that are understaffed. This is probably the most valuable thing i could ever have done- i learnt more in the 4 weeks that i could actually get shifts than i have in the year of communications training and the 2 years of academic training i have under my belt.
Not in terms of disease pathways, physiology and anatomy, but i can navigate my way around any ward now, chaperone intimate exams, clear up any type of body fluid, make 10 beds in half an hour, wipe innumerable amounts of bottoms, bed bath, assist with shower, spoon feed, remove venflons and help change dressings.
I was wary of telling people that i was studying medicine but my inquisitiveness gave me away most of the time when i would ask if i could accompany a patient to surgery or if i could watch cannula insertion or whatever. Every nurse i encountered, every HCA was more than willing to feed my hunger for knowledge. They all said that they thought every medical student should have to do the basics so they learned to respect all members of the Multi-Disciplinary team. I wholeheartedly agree.
Something i noticed on the ward was the distinct lack of communication between the doctors in charge of the care of the patients, and the people, the nurses and HCAs who were doing the 'care'. We are the people who notice the minute by minute, hour by hour changes in the patients, who do the 'care-plans', who note the shape and amounts of the stools produced etcetc. Never did a doctor ask me how the patient seemed, in fact never did a doctor meet my eye as i staggered past with 10 beds-worth of blankets or a bucket of vomit or whatever.


However, later on in the summer my grandma had a fall and broke her hip. My dad and i went to visit her in hospital and i honestly have never been so frustrated in my whole life at the lack of knowledge about what is going on. NO ONE KNEW ANYTHING!!! And what was worse i could peruse her obs sheets as i had spend my working summer doing, and i could see her b.p was high or whatever but no one ever came to speak to us about the surgery, the physio, how she was getting on daily. Visitors are just there to perk up the patients, they are ignorant to the daily goings on, and when they want to know about anything they are brushed off. We arrived on the Thursday and they told us they suspected a UTI. On the Sunday dad and i came in to see grandma after a trip to the zoo and she was honestly raving mad. She was convinced that there was a terror plot involving snakes that had occurred on the ward the night before- but don't worry, she had informed security and it had all been dealt with and hushed up by the morn.

WHAT!?!?!? the staff hadn't even noticed this. i know i know i know there are 3 shifts a day and you don't necessarily return to the same patients, but for someone who had gone from being totally lucid to a complete loon overnight i would have hoped this was noticed. even just little star on the handover sheet that says 'suddenly gone mental' would have been better than the surprise as my father explained to the ward staff that his mother did not usually talk about covert terror operations.

'we'll order a uti test, they often cause acute confusion'

'well there was actually one ordered on Thursday'

'ah yes well the results aren't back yet, so we'll try and get another one'

'what about a urine dip? that ought show white blood cells or blood or something shouldn't it?'

'well we have tried but she isn't passing much water'

'her fluid chart says she is......'

'.........................................ill just go and check her results, see if they've miraculously come through in the last 3 minutes of this awkward conversation demonstrating my incompetence'

..................

'oh yes so she doesn't have a UTI don't worry.'

'well shes still being quite mental and has in fact just referred to me as her 70 year old neighbour'

'probs the codeine innit.'

and that was it. So to some extent i understand what i thought was the arrogance of doctors, which i now see as thoroughness. The idea that at the end of the day the patients well-being is the responsibility of the doctor and so they must check everything themselves and not rely on other people's opinions. This is not an excuse for the obvious elitism that still occurs on the wards, and this is one case and it is very personal to me which is why i care so much about it.

At the end of the day it is not the doctors role to comfort and explain every minute detail of treatment to the family. But from the other side it is difficult to see that your relative is getting the best possible care when no one seems to know what care they are even receiving.

When i worked as a HCA i resented been overlooked by other staff, i felt that my role was one of the most valuable on the team, that it was me that was making the difference in the patients daily lives, but as a medical student i understand that when the shit hits the fan it will be my fault and i cant take any word for gospel, i must be able to justify all my own actions based on my own investigations and not because someone told me that it was like this or that.

confused.com

Old Friends

What is one of the best things this year is that a key member of the A-Team has moved up to Macclesfield to work for a drugs company. That means that instead of the 4 hour train journey to visit her in Kent, i can see her in 20 mins flat! It would take that to walk from mine to hers in Bristol.

There are a few photos like this one of us walking in various areas of England spanning our 14 year friendship.Welcome to the Peaks Ford!! WOOO!!