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!!

What am I doing?!?!?!?!?

SO, the summer has been and gone and it is well and truly SEMESTER 3. Notoriously the most difficult term of the course. This is because it is mainly orientated around Neurology and Neuroanatomy. Sigh. Who even cares about the brain??
As a bit of light relief I hung out with my housemate last night, because we have become a house mainly of hermits who have no ambition to embark on 'wild' nights out anymore. Paul and I turned out all the lights and snuggled up to watch 'Marley and Me'. Before I tell you the result of the film i will tell you that after we watched 'In pursuit of happyness' which left me with a dull and depressed ache in my stomach about the hardship of life and how some people work so so so so hard to provide for themselves and their family. Bear in mind this sadness, when the bloody Labrador died Paul and i were absolutely bawling, sobbing and steaming up our glasses. Paul was trying to laugh it off because the last time he cried at a film he was about 8 and it was when some dragon rider had to kill his dragon to save something or other and his mother had to remove him from the cinema because he was making such a fuss! I was genuinely annoyed at myself that what is, yes, a sad event had got me worse than basic human suffering.

Yesterday wasn't really the best day anyway-the head of our year gave us a preparatory lecture for our next 2 cases. I quote, 'Year 2, i know the last week has been hellish for you and that a lot of people are struggling with the workload. Well good news- you're all going to have to rearrange your priorities because these next cases are worse. good luck'. THANKS FOR THAT.

NOTTTTTTTTTTTTTTTTTTTT.


So like most of my contemporaries i have been thinking about why i am putting myself through this. After our case, after that lecture i met up with 'the good medics' (see previous notes on my general opinion of medical students: these are the exception) and we went to the pub. it was HALF 3 and no one cared. We came to no conclusion but it was nice to be in the same boat as a friendly few. This year is hard.

This morning, post 'Marley and me' I opened my door to find an envelope addressed to me and it was with joy that i opened it to realise that it was from Mr Witherow. Mr Witherow was the orthopedic consultant who in no uncertain terms, rebuilt my foot. I wrote to him this summer thanking him for doing a brilliant job and he wrote back.
It was quite a long letter, I'm not going to go into it, but i did find it somewhat a boost to my motivation. Not that i ever consider sacking it all in but sometimes wise words from someone who knows what its like is nice. He told me to always remember to eat lunch...and on that note, I'm hungry.....

braaaainnnn draaaiiinnn....

''The brain makes up 2% of a person's weight. Despite this, even at rest, the brain consumes 20% of the body's energy. The brain consumes energy at 10 times the rate of the rest of the body per gram of tissue. The average power consumption of a typical adult is 100 Watts and the brain consumes 20% of this making the power of the brain 20 W''

My brain has become an ABSOLUTE MACHINE. Its actually kind of annoying. When i was revising it would decide when it would work...
9am-
Me-come on brain, we've had coffee, now lets start thinking..
Brain-no
Me- right, well we will have a shower and maybe the caffeine will have kicked in by then.
Brain- Try me.

and it goes on. It tells me its stopped listening by making my eyes ache at the back and going a bit fuzzy around the temporal region, then i try and remember what I've just read and it cackles at me.
This is when i know i need a break.
But still, I've trained it to know it needs to intake information at every moment of the day. During revision i would work solidly post shower, stop for half an hour lunch, an hour for dinner and then work until when Brain then did the Windows Shutdown procedure at which point i had approximately ten minutes on 'power save' mode to get into bed before i collapsed into a deep sleep.
Undoubtedly in the morning i would wake up having dreamt about whatever i had been cramming into every nook and cranny in my mind and have ONE WORD just there. going round and round.
'vasopressin', 'vasopressin', 'vasopressin' etc etc etc etc until i found a medical dictionary and looked up the word and placed in on the right brain shelf. and then the cycle of the day continued.

The thing is, i have honestly never been so stressed about an exam in my life. towards the end of the revision period I'm talking absolute exhaustion but a complete inability to sleep. the shakes. headaches. weight loss. the works.

The night before the exam I did the mock paper online, one question was:
The psychosocial model of stress indicates that stress
A. can be interpreted as the objective response to excessive stimuli
B. is a specific response of the body to a specific demand
C. is caused by over-exposure to life events
D. is unaffected by daily life
E. occurs when perceived demands outweigh personal resources

The answer is E.
My brain had given up listening to me and gone into hibernation.
And then i sat the exam and my brain went 'nah nah nah nah nah nahhhhhhhhhhhhhhh...i was listening even when you thought i wasn't'. i dumped all my knowledge onto the paper and it seemed to fit the questions.

My problem is now post-exam my super efficient brain is............SOOOOOOOO BORED!!!!!

I cant win.

'You might want to turn that lancet round.....'

This, is a 'SAFETY' lancet. Millions of diabetics use them every day to check their blood glucose daily. The reason Ive whacked this in here is because today i had 6/10th of my OSCE. (Oh look, another medical school acronym)... OSCE stands for Observed Structured Clinical Examination and it means you get to don your white coat (not actually allowed in hospitals anymore...) and show the skills you have learned throughout the year/crammed the night before.
We got a brilliant set, no bloody spirometry (technically no blood should be involved...), Lung and heart auscultation(listening)...showing someone how to use a metered dose inhaler, ECG and pulses, CPR, blood pressure and blood sample taking and the handling of blood products...

Mine went OK, its one of the pluses of being a 'Williams', i was at then end of the day which means i get almost an extra day to prepare than your average Anderson or Andrews...(this makes up for the years of going last for EVERYTHING at school...).
The thing with these is that your potential for being able to competently complete the task is 100%, they are simple and we've done them a million times, but you lose marks for small things- e.g. not washing your hands at all, not introducing yourself, moaning that you cant count the ribs of the patient because he/she is too fat, not washing your hands after taking one persons dorsalis pedis pulse (foot) before you take the examiners temporal pulse. you get MINUS points for not putting gloves on before handling blood. I know someone who crashed the ECG machine. don't know how that one works.
Here's MY big mistake.....i almost lanceted myself! what a foooooooooooooooooooool!
The thing with the blood taking station is that you have to talk to a plastic hand. What i mean is that you approach and go 'Here Mr. Hand, let me shake you (joking...), My name is Lucy Williams, I am a first year medical student and Ive been asked to take a small blood sample today. This will be from your thumb, it will hardly hurt, is this Ok?' The hand says yes and then you pick up the lancet, twist that pink bit off and as you can QUITE CLEARLY see in the photo there is an ARROW which indicated where the stabby bit comes out..... I was steaming along until the examiner (who seemed to be quite jolly and up for a bit of banter...) said 'You might want to turn that around, or you might get blood everywhere...then i might pass out and that would be embarrassing wouldn't it'.
So I turned it around and stabbed the plastic hand with it, apologised to it and continued....

Lets be honest, It could have been worse.


At least I put it in the sharps bin once I'd finished....

5 stitches down and call me a doctor....

It is soooo hot in Manchester. As in its only bearable to wear running shorts and a tiny vest top and all the windows in the house that cant be accessed by some scally are wide open. Its summer in the North and I have 2 WEEKS of exams to go. I know, I just know that as soon as I'm free of academia for the summer it'll undoubtedly rain.
I ran the Great Manchester Run last Sunday... 10km for this charity called Depaul UK. Ive never heard of them before but they help out homeless teenagers. since then all I've wanted to do is run. For the first few days my Rectus Femoris' were pretty sore and i couldn't walk downstairs without considerable amounts of shuffling and groaning. Sucks to be me considering I'm in the attic room. It felt really amazing to run with 36000 people though, definitely something Id do again.
However, I haven't been running all week because I've been working. the fear has not appeared but i have got my proverbial finger out now. We have physiology practicals on Tuesday and anatomy and communications on Thursday and then a portfolio review on Friday, then the following Thursday is our SEMESTER EXAM OH GOLLY.
Now physiology involves CPR and taking blood pressure and handling blood products and heart and lung auscultation and that sort of thing. We have 6 stations of that, then on the Thursday we have 2 simulated patients and 2 prosections to work. all of this is the sort of stuff that you can justify as being useful for budding young doctors.
Portfolio is literally the bane of my life. apart from brussel sprouts. Its so EMBARRASSING, one big 'Dear Diary' session for the next 4 years... we have to write reflective pieces on 'probity' and on 'patient interactions'. one massive pile of barf. My piece on probity makes me nauseous.

What makes me feel more competent than working for any of these exams is that t-Ed actually let me take out all 5 of his stitches. He didn't even squeak. He then offered anyone in the room a fiver to eat them. boys are so gross.