One step at a time...

Amidst all the uncertainty and chaos, I woke up on Friday morning alert enough to realize that it was D-day.

To my relief, I passed everything, albeit horribly. None of the 'D's I got bothered me at first, it was a solid pass and loads of my colleagues were worse off.

As the day went on, I realized how low my standards have become. I've become accustomed to scoring above average in a majority of exams.

Then I chose medicine.

At least I passed..

Gone with the wind

It’s been a windy few days in Dublin. Reports were coming in of an elderly lady who died as the wind caused a tree branch to fall right on to her.

I even witnessed a guy getting blown off his bike while taking a corner.

Even though the weather was dark and gloomy, it was heartening to get smiles from quite a few patients while I walked along the halls of St Joseph’s Ward.

....

I was feeling pretty pleased with myself that morning. I had obtained an “outstanding “ grade for my case presentation on a patient with a perforated sigmoid diverticula.

I could tell that the consultant was impressed by the fact that I could answer all his questions. It actually came to a point where he admitted,

“Well, the more you answer, the more I’m going to ask. The way this goes is that I’ll keep on asking until you say, ‘I don’t know’,”

It was turning out to be a really good day for me.

As I made my way back home, I looked down and realized that my zipper had been open all the while.

No wonder I was getting smiles all round....

Tight Lipped

Dean the intern was really into teaching us the 'practical' bit of being a physician. He had us running around putting cannulas in and taking consents from patients undergoing minor procedures.

I was asked to obtain consent from Mr AR, who was due to have a left sided colonoscopy later in the evening.

He was sitting on a chair right beside the bed looking lucid and alert. I noticed that he had a really thick moustache which was covering his upper lip.

"Mr R, we're basically going to put a camera through your back passage to have a look at your bowels. You will be sedated for this procedure and will feel groggy. You will be concious enough so that you can adhere to our instructions as you will be lying on your side"

I asked if he understood what I had just explained.

"Hmmph," he mustered.

"As with all procedures there are some inherent risks associated with it. However I assure you that you are in good hands"

I raffled on about the potential complications of a colonoscopy.

Throughout the whole "consult", all he said was "hmmph".

At this point I was worried that I might've not explained the procedure well enough to warrant a signature of the consent form. Something was definitely off about the guy.

I asked for leave and went to seek Dean for help.

"Oh f*** it, I forgot to mention that AR had a squamous cell carcinoma removed from his upper lip. Yeah, he basically has no upper lip and can't really talk."

Ring Ring

Flashback : OSCE station number 4

The patient had an eye patch on her right eye. One thing came to mind.

Cranial nerve exam...

As she lifted off the patch, it was a spot diagnosis of lateral rectus palsy.

“So, what are the causes of a unilateral lateral rectus palsy?” asked Dr Marcus Butler, the respiratory consultant who had once given a lecture during which I didn’t pay attention to.

“Erm, a tumour?”

“Don’t say tumour, use the term neoplastic lesion,” he corrected. It's never a good sign when an examiner gives you lessons during exams.

“Oh sorry, a neoplastic lesion can be a cause of an isolated lateral rectus palsy,”

“Okay, could you be more specific in terms of location?”

“Errr, I’d expect that the tumour would be in...”

“NEOPLASTIC LESION!!” he raised his voice.

I looked to the heavens for guidance. This was not going well at all...

The Phone Call

“Any one of you who failed will be getting a call from me soon,” said the Bimbo.

“This is just to let you know that you need to work harder for the second part of your surgery module. It also means that I will be your personal tutor to guide you through any problems you might have,” she continued

I checked my phone for the tenth time in the space of an hour. I noticed that Adrienne did the same too. By the end of this week, those who had failed would’ve been contacted by phone.

A friend of mine had already burst into tears in the middle of a tutorial as an unknown number appeared on her mobile. It turned out to be an overseas call from her sister.

Tensions are running high as we go about our daily rotations in St Vincents. Everybody seems much more quiet than usual.

I'm also get visions of the Bimbo using the stethoscope to strangle me to death due to my incompetence.

It's gonna be a helluva week

Hand's ON

In surgery, a medical student is expected to observe the ‘real’ surgeons do their jobs. The highest acclaim a student can ever achieve in an operating theatre is to be asked to scrub in. This entails passing on equipment to the surgeon, holding the suction device, or if one is very lucky, to complete the suturing.

While this may not sound so exciting, the rare chance to stand right next to the surgeon cutting open a person is a really profound learning experience. One can never read enough textbooks to describe the various methods of performing a CABG (google it), yet watching it ‘live’ suddenly makes all the words read come together, being imprinted permanently in one’s brain. It’s amazing how easy it is remembering a procedure seen compared to memorizing the steps off a book.

A real ‘hands-on’ experience

I was asked to scrub in for a pneumonectomy, an operation to remove one half of the lung. In that case, the patient had lung cancer which had spread thoughout his left (maybe it was right?) lung.

There were four people at the operating table. Two doctors, a nurse, and ME.

When I had finished scrubbing in, I was asked to stand right beside Mr Bartosik, the Polish cardiothoracic consultant, who was the boss doing most of the work. In order to remain sterile, it is general practice for student to put their hands on the patient’s gown to avoid unconsciously touching any unsterile surfaces.

I arrived at the table, feeling very excited, immediately resting my hands on the patient. I knew that it had to remain there for the next four hours.

Bartosik was an expert at what he did. He seamlessly exposed the lung with minimal bleeding. The heart was also exposed. Watching the human heart beat was riveting. It moved with extreme precision. Lub-dub, Lub-dub…

Suddenly my hands felt something move. I didn’t want to alarm Bartosik as his hands were deep into the patient’s chest. I shifted my attention to the patient. That’s when I realized what moved.

My hands were on his penis. Suddenly, four hours seemed like an eternity.

Frozen Brain Syndrome

“The patient presented with a central abdominal pain ra-..”

“Are you sure it is central?” asked the surgical tutor.

Twelve pairs of eyes were staring straight at me. I was put on the spot.

“Urm, it’s just above the umbilicus I guess,” I answered unsurely.

“Okay, what is ‘just above the umbilicus’ called in medical terms?” he asked, sensing that I was just waiting to be torn at.

“Erm, the right iliac fossa?”

“Release the hounds,” cried the Montgomery Burns residing in my head.

“First and foremost, she’s pointing to her left side,”

I heard a snicker in the background.

“Oh,” was all I could muster.

“SO, name me the nine quadrants of the abdomen,” he probed further.

It was as if the prior twelve intensive weeks of attachments counted for nothing. I was totally blank.

I couldn’t answer it even if my life had depended on it.

“Errrm” was fast becoming my trademark.

I was telepathically transmitting emergency SOS signals to my team-mates. Keith finally ended the fiasco.

“The nine quadrants are, ......” he uttered without even stuttering.

Bring out the anti-depressants

"It’s gonna be an easy week, make the most of it," was the first sentence I heard from the Plastics and Reconstruction team intern on my first day back after a relatively long hiatus from hospital work.

It was a surreal experience walking through the halls of St Vincents’, which was still looking merry with plenty of festive decorations hanging from the ceiling. Everyone seemed to be moving in slow motion, probably still hungover from celebrating New Year’s Day.

In a country that is already suffering economically with banks folding left and right, the recent weather disaster brought even more gloom to the people of Ireland. I can’t begin to describe the nightmare of spending the festive period in the hospital caring for a loved one who slipped on the icy roads and is now in a coma due to a brain injury. Those were just some of the depressing scenarios that were echoing throughout the wards in St Vincents. The emergency room casualty turnover was at its peak, as the aftermath of the lovely white snow bore its untold dangers. How’s that for drama?

Who the heck studies on the first day of term anyway.

Prof O Connor at the introductory lecture was at his threatening best.

"The results this year weren't even nearly as good as last. I’d have to say it was mediocre at best. Some of you didn't even make it. Therefore most of you will have to put in more work than you probably bargained for"

The room fell silent.

As we walked out of the lecture hall, Steven muttered to me,

"Time to bring out the anti depressants, it's gonna be a long 18 weeks"

Enough said