Originally published in the November issue of Medical Student Newspaper.
IT’S HALLOWE’EN in A&E. I start my shift at
Two out of six. As I can’t really take any credit for being male, I better try to enjoy my last month ‘working in emergency medicine’, which won’t be easy.
My first patient is what we politely refer to as a complete loon. I’ll call her Agnes and she’s visiting us from the local psychiatric hospital. Agnes has been sectioned for some time (don’t ask me what number) and hates the psychiatric ward she is on. It quickly becomes clear she is fabricating a story to get out of her ward. The psychiatrist must have seen her, realised he knows nothing about medicine and sent her to A&E.
It is, however, a little difficult to understand her as she has two Nicorette inhalers in her mouth. Not to mention the five Nicorette patches on her abdomen, her brown sunglasses, orange hair, five overcoats and two scarves.
Her sense of humour seems to be intact though:
“Doc, I’m telling you now, if you send me back there I will kill myself.”
“Well that’s convenient,” I replied, “because when people want to kill themselves we send them to psychiatric hospital.”
“In that case I don’t want to kill myself, I want to live!”
I’m rather in the mood for seeing some ghouls and ghosties tonight, and head to Minors in the hope of stitching up a pitchfork-laceration or vampire bite. I’m collared on the way by sister saying two are waiting in Resus.
I generally like working in Resus. You see, the overriding gripe I have about A&E is time-wasters. I have to resist slapping jackasses with nothing better to do with their time than ignore the sign saying “Accident and Emergency” and waltz in with problems they’ve had for years. But Resus patients (normally) aren’t faking it.
We’re short-staffed and I end up seeing two patients simultaneously. This is not only dangerous, it’s confusing. Luckily (for me, not them) they had almost identical problems (chest infections and fast AF) and pretty similar names, so I just said everything twice.
There’s no chance of me getting to Minors to see any pumpkin-heads after I’m finished with the two old boys in Resus, as “people are breaching in Majors.” Nurses always shout this at me under the impression I’m going to care.
A guy who felt his throat was closed for a minute, but is fine now. A girl who had chest pain but thinks it was wind. Then a bad-tempered Francophone jobseeker who broke his foot and was put in a cast two days ago, has a fracture clinic appointment in the morning and saw his GP two hours before coming to A&E. I explained broken feet do normally hurt, but he wasn’t satisfied.
In fact he turned out to be a real prick and I had to threaten to call security, in French, before he left. Not before shouting in Franglais:
“Where you from? How old you? You’re too yang bro! Je veut un autre médecin. Na, na, you got a long way to go.”
Whilst he was undeniably a tosser, he was probably right.
Where are those damn vampires? A frikking zombie at least, please Satan brighten my evening with something macabre.
The three others doctors on duty and myself wade through nursing home specials, neurotic parents, drunkards, asthmatics and more chest and abdo pains than you can shake a steth at.
2+ protein, 1+ blood, 1+ ketones. Ketones? I wonder what my blood glucose is? 2.9! Sweet, a new record. I mean, I think I’m going to faint. I rush dinner having wasted half my break investigating myself.
Back on the shop floor and I pick up the next card. “Limb problems” is the non-specific triage category and at last it’s a bunch of piss-artists in fancy dress. w00t!
My patient is not only dressed as an axe-wielding blood-soaked doctor, she’s an absolute hottie (I only mean that in a purely Hippocratical way).
Good-natured drunks are always fun so I act the part. Whilst taking a history I point to her friend in vampire garb and ask, “he with you?” and then examine her neck.
"What are you doing?" asks the friend.
"I need to know if she’s turned."
So she clearly has a thing for doctors and I will be spending the next half hour with her in a small room sewing up her elbow. I silently offer thanks to the Prince of Darkness as my mind turns back to that Lancet article.
However as she’s face-down for the stitching, I (tragically) spend most of the time talking to her friend, who wants to become a doctor. I give him half-mumbled answers as I get so engrossed in trying a fancy mattress-running suture combination on this hapless girl’s elbow.
When I’m done she bounds off without so much as a “thank you doctor, you saved my life” and an unexpected kiss on the lips, or a “how can I ever repay you?” and a lingering kiss on the cheek or even a “call me!” and an airkiss. In fact there was a distinct lack of kissing.
Somewhat confused as to how I could POSSIBLY have been turned down, I remembered I was lacking in brilliance, height, muscles and chiselled features. Soon I would lose my job title of emergency doctor as well. I mulled it over and decided I would rather undergo extensive leg-lengthening surgery than take another A&E job.
I finally allowed the chatter of friend-who-wants-to-be-doctor through and in an unusual display of paternalism, I put a hand on his shoulder and said “son, don’t do it.”
My shift would be up soon and I could grab a Rosie Lee’s Full English on my way home. Working nights eliminates your ability to do anything, so I’ll get back to working on my serum and saving the world from vampires next week. Right now, I’m just the daysleeper.
Labels: A+E, junior doctors, medical students, Rohinplasty articles
Originally published in the April issue of Medical Student Newspaper.
F2 JOBS are out, huzzah! With nothing more than an arbitrary survey of me asking my friends, it seems as though most of my fellow F1s are happy with what they'll be hating next year.
Contrary to the February issue's prediction of becoming a McGP in Slough, I managed to land A&E, renal medicine and ITU at St. George's. I could not be more pleased. However there is one problem - I will have no one to boss around. I don't think I'll have an F1 for any of these firms.
My one consolation is that I might be lucky enough to have some hapless medical students to do my bidding. Although they must be the right type of medical students. The right type of medical student is one that loves bleeding people, sticking in venflons, writing TTOs and getting me food. It's the kind of student I was not. In fact, now that I find myself in the bizarre position of imparting knowledge (ha) onto students, I realise I would have hated to have someone as work-shy as me for a shadow.
I have a long and distinguished history of hypocrisy and you will be pleased to know I have continued it into my working life. Despite being a lazy and ignorant medstudent, I have no qualms violently demanding nothing less than complete dedication from my assistant house officers. Other people's students, however, I send home as early as I can.
"Finished lunch? Yeah why don't you head off? Your team doesn't need you this afternoon. Just tell them Rohin said you could go home."
The teams in question always seem 'annoyed' with me; I know they're just showing their affection in a male-acceptable way. When my students ask for the same courtesy, I have to work very hard not to throttle them with their new tourniquet.
"Have you checked the bloods, done a PR on the fat guy and got me a bacon sandwich? Nooooo? Chop chop then, get to it woman!"
Nowadays I stop short of physical contact, after the nasty business that occurred when I tried to encourage Valerie with a firm slap on the arse. The less said about that, the better.
The simple fact is that house officers are far more willing to help keen students as opposed to layabouts. I have discovered this too late. I cringe when I think what my house officers must've thought of me. Except for my firm at Medway. You'd be surprised how a hot SHO can motivate a young man to put in the hours.
Willingness to get involved with the firm isn't the only criterion upon which we rank students. During my first firm I had twelve students at one time. Twelve. At St. Peter's we open our doors to third, fourth and fifth years from both Imperial and St. George's. Thus I find myself in a prime position to make sweeping generalisations and unfair comparisons between the two medical schools.
Third years are uniformly a nuisance, whether they come from Gimperial or George's. They buzz around and get under foot like insects. Bad insects. Insects that carry some sort of disease. But not mosquitoes because they don't crunch when you kill them. Maybe cockroaches. But not that big. Like some disease-carrying medium-sized hard-shelled scuttling insect. Yeah.
I do feel sorry for the ICSM little ones though - they're abandoned on the wards for up to ten weeks with almost no instruction. They wander around like lost puppies and have to rely on the good nature of the junior doctors to teach them clinical skills and create educational tasks for them to do. So if they're with me, they're screwed.
Fourth years are, without doubt, the most accomplished skivers. I feel barely qualified to comment on their characteristics as students as I have seen so little of them. I prided myself on my unparalleled bunkalicious skivism, but some of these guys make me look like an amateur.
It is the final years with whom F1s have most contact. I have now had seventeen shadows and they break down nicely into three sub-categories. George's five years, George's four-years (GEPs) and Imperial (sixth years). Each group has their own idiosyncrasies and foibles.
The conventional five year St. George's final year is thoroughly competent, relaxed around patients and ready to get stuck in. I, of course, feel more than a little kinship with them as I was one just ten months ago. They're keen to absorb knowledge, which is just as well as most of them have plenty to learn. The best Venflonners by a country mile.
Imperial final years – though it pains me to say it - seem to be more book-smart. There are few experiences more humiliating than being shown up by a smartarse student, but it happens so frequently I have grown to expect it. And there are myriad ways for me to exact a horrible catheterising revenge. In contrast to their admirable knowledge, some Imperial medics can be deficient in patient skills.
Lastly, by far the most interesting category is the GEPs. While they are exceptional players of blood bottle bowls, they are either doddery to the point of comedy or utterly set in their ways. One of my recent students, a German chap in his mid-30s and post PhD, lacked any logical thought whatsoever.
However, I will freely accept that me repeatedly shouting "I’m a cybernetic organism", “you’re a CHOIRBOY compared to me, a CHOIRBOY”!” and "who is your daddy and what does he do?" in an Arnie voice cannot have helped. Austria, Germany...same thing, right?
The transition from student to competent doctor is a gradual one and it comes as something of a shock to find yourself suddenly obligated to teach mates you've been getting pissed with for the last five years. In between emptying alcogel dispensers on each other, stealing drug rep goodies and flicking elastic bands at nurses, teaching students is one of the highlights of being a junior doctor, for as one teaches, one learns. I feel like I should dematerialise on Dagobah after that line. Lastly, a special thanks to Davina Hensman and Matt Roe, the best students I've had!
Labels: medical students, Rohinplasty articles
I THOUGHT I'd copy what other journalists do (did I just refer to myself as a journalist? Sorry about that) and post up random articles they've written elsewhere on their own blog, where far less people will read them. Ah well, it saves having to spend time thinking about an original blog post.
HARK! Is that the songbird of revision I hear chirping? No of course it isn't, revision has no sound; how foolish. Understand this - revision is taciturn; it silently pulls your heart out through your feet and methodically beats all the life out of it with the stump of your spinal column. Yes, revision kills. All over London, medical students are slowly dying - all secondary to revision, which has replaced Tetris as the UK's third highest cause of death, after myocardial infarction and radish.
This should come as no surprise to anyone abreast of the latest evidence-based medicine, which is why you are undoubtedly surprised. As proof, I could now quote some general medical shit at you, but you don't want that. You want to understand why and how revision kills and what you can do to stop it. Revision, contrary to popular belief, rots the mind.
Is this what you want? Revision will make it happen
The brain is a complex, and by that I mean remarkably simple, semi-cybernetic device. With every useless factoid about 'medicine' or 'surgery', more valuable knowledge is pushed out of your brain. Most areas of the brain are devoted to goat's cheese, Simpsons quotes and stethoscope-swinging murder techniques.
A tiny proportion, maybe a part of the brain the size of a sugar cube is devoted to all conscious functioning. Although we're talking about a sugar cube that is one quarter the size of a conventional sugar cube. Revision doesn't belong there, because 1 - it smells and 2 - it's a form of mind control which will end your life.
A. IT EATS YOU
Revision wields its evil power thanks to the phenomenon of "exams", which provoke otherwise reasonable humans to engage in what is clearly a hazardous pursuit. Most post-mortem specimens whose demise was due to revision-related injuries are so hideously disfigured by the time they reached the morgue that little research has been possible.
However the poor souls who died in their own medical school's library (this will probably be you, soon) have occasionally been carted down to the coroner in time. What they discovered will chill you to the bone and you will probably never be able to sleep peacefully again.
Revision turns out to be a vector-borne disease, like malaria - but more "fucked up". These are the words of Professor Hurley "von" von Tempest (pictured below), the leading expert on revision. He has documented evidence of flesh-eating parasites that enter the body via the eyes, causing unimaginable pain. It seems that whichever bright spark named eyes the "window to the soul" has turned out to be some morbid dick.
Professor Hurley "von" von Tempest demonstrating the dangers of revision: OBVIOUS
Hungry revision parasites quickly track up the optic nerve and flood the brain. Within days the entire cortex has been devoured and blood streams forth from all orifices. ALL orifices. Yet there remains a darker, more disturbing aspect to the global, and bizarrely underestimated, threat of human-eating revision. What is yet to happen.
Found buried in a Pastest book, between the misspellings and poor grammar, Zachariah "Chewable" Heshapsut stumbled upon The Prophecy.
They came long before us. Their sovereignty over this mortal realm was supreme, but in their opulence they grew complacent and power was soon ceded to us. For them, beings that had enjoyed free reign for millions of years, our ascent was rapid. From rudimentary gatherings of ape-like apes, huddled beneath black monoliths, we became hairless hominids almost overnight.
Their reaction was slow at first, we consumed their resources and they became weak. But then they drew plans to enslave us all. They created revision. The Prophecy foretells of the day that enough of us are doing filthy revision upon ourselves, the so-called 'critical math'. When sufficient numbers of people are revising, they will rise and we will all be eaten.
The concentrated evil has been sleeping for aeons, but slumbers only to awaken once more and rid the earth of humans. No one will live.
Spread the word, revision is merely malevolent mind control, wool that's been pulled over our eyes to once again make the oceans run red with our blood. Do whatever you can not to revise. House, Scrubs, Lost, The Apprentice - these have been created by underground rebels to help you in your quest to avoid revising.
However, despite appeals from myself, the President "of" Angola and Brent "Data" Spiner, it seems the end is inevitable. When the day of reckoning comes, all I can hope for is that I am eaten first. If you have sense, you'll pray for the same, to whatever ultimately ineffectual god you believe in.If you are unlucky enough to still be alive as they wreak havoc upon our world, your mind will simply implode with the utter depravity. BREAK THIS CYCLE OF HORROR AND VIOLATION: DO NOT REVISE.
I'm doing my bit. Are you? Help others go mad with the knowledge of their impending doom, tell them they will all be eaten.
Originally published in the May issue of Medical Student Newspaper. I was revising for finals, my mind was hurting.
Taggart: medicine, medical, medical students, medical school, humour
Labels: death, idiocy, medical students, Rohinplasty articles
GS is a 24 year-old female beach volleyball player who is referred to you, the on-call F1 in the Surgical Admissions Unit. She has been sent in by her GP, who writes “Dear Doctor, thank you for seeing this young lady.” Unfortunately, that’s all his letter says. He’s a pretty shit GP if one is to be honest. So, none the wiser, you go to see her and can immediately see she is hot, indeed the nurse tells you her temperature is ‘up’. She’s a pretty shit nurse if one is to be honest.
From her brief history, you learn that she recently had a belly-button piercing performed, after which her symptoms began. She has a chronic history of injuries sustained whilst playing beach volleyball, such as getting tanned and developing a toned body. She has no other significant medical history.
On examination, GS is a young lady wearing a bikini and is comfortable at rest. Cardiovascular and neurological exam are unremarkable, although you do notice she has a good pair of lungs on her. The abdomen is soft and non-tender and is Stefani’s sign positive. She’s is in no pain, but as her abdomen is so unlike any you ever saw whilst practicing with friends in medical school, you realise something is definitely amiss. Your doctey sense is tingling.
You recall the influx of acute pancake-itis that came in soon after Shrove Tuesday…but it doesn’t seem like that. As usual, you’re completely flummoxed. But just then, yes just then, Christopher Lloyd tells you the diagnosis. You’re about to ask him if the flux capacitor is real, when you realise that he’s right.
What’s the diagnosis?
A Cute Abdomen.
That’s right, GS has a cute abdomen. Be sure to remember this case as you will encounter it incredibly rarely if you practice medicine in Britain. The classic triad of a cute abdomen is a lack of distension, a waist:hip ratio of less than 0.7 and very often a cute pairitonice-tits. Management for this condition is very, very close observation, with conservative treatment. You know the Daily Rhino loves steroids, but this is probably one instance that you definitely, positively should NOT give them.
Previous teaching sessions:
Medical Student Teaching #1
Medical Student Teaching #2
Medical Student Teaching #3
Originally published in Medical Student Newspaper.
Technorati tags: Medicine medical school medical students medical student
Labels: Medical Student Teaching, medical students
Presenting Complaint - Paediatric Fever
THIS teaching session concerns a three year old Japanese boy whom you see in A&E. His mother informs you that he has had a fever for seven days, which began soon after a ride on his father’s motorcycle. He has been crying excessively, more so over the last 48 hours. He has vomited and had an episode of diarrhoea. The toddler has been rather drowsy and occasionally makes a low-pitched humming noise and holds his hands out in front of him. His mother also reports that her son frequently places bowls on his head when he does this.
On examination the young boy is crying and has a fever of 38.9C. His heart rate is 120. You notice cracked and red lips, a blotchy rash and peeling hands. On auscultation you notice that the child is Vrrroooooom test positive. You order some investigations:
ECG – prolonged PR interval
ESR – 88mm/hr
Echo – ?Mild ectasia.
You are not entirely sure until a passing mime artist gestures that you should check the blood film, shown below.
What's the diagnosis?
That's right, it's Kawasaki’s Disease. The presence of minute Japanese motorbikes in the blood is pathognomonic for Kawasaki’s. One must remember to use the maximum possible magnification, as very small motorbikes can often be mistaken for endoplasmic reticula. One must be mindful to distinguish between the harmless Suzuki vasculitis and the rapidly fatal Yamaha fever – make a Kwik-Fit referral.
Kawasaki’s is often associated with Ruff Ryder’s Syndrome - treatment involves gradually starving the child of petrol, replacing this with diesel and playing DMX music on loop. Prescribe steroids, they never do any harm. Honestly, they're fucking awesome.
Medical Student Teaching #1
Medical Student Teaching #2
Originally published in Medical Student Newspaper.
Technorati tags: Medicine medical school medical medical students medical student
Labels: Medical Student Teaching, medical students
Presenting Complaint - Flank Pain
Mr JM presents to you in A&E with a four hour history of excruciating left flank pain. He introduces himself as a man of wealth and taste. It was first brought on in his bathroom (recently painted black) and is colicky in nature. He has experienced two episodes of vomiting associated with nausea. A slight fever is noted, otherwise examination is unremarkable. A urine dip showed the presence of Brown Sugar.
An X-ray is initially requested but confusingly returns negative, as does a renal ultrasound. The patient grows irritable, insisting that all he wants is some satisfaction by getting rid of his pain. For the sixth month in a row, you are stumped until a passing Brazilian model suggests a renal biopsy, where you see the film below:What's the diagnosis?
That's right, kidney stones.
This common affliction affects more men than women and incidence is reducing as Hip Hop grows in popularity. The presence of any of the Stones on biopsy is pathognomonic for this condition. Symptoms include sufferers not being able to get any satisfaction, despite them trying and trying and trying and trying. It should be noted that the finding of Mick Jagger or Charlie Watts in young girls is not uncommon and is associated with a poor prognosis.Management consists of smoking cessation, listening to the Beatles and prescribing shitloads of steroids - they're awesome. In uncomplicated cases, stones have been known to easily pass through the urinary tract, eased by their 'rolling' nature.
Medical Student Teaching #1
Medical Student Teaching #3
Originally published in Medical Student Newspaper.
Labels: Medical Student Teaching, medical students
ONE of the regular features I've put in the paper over the last year has been Education Corner. They're pretty geeky and not funny to anyone non-medics but I thought I'd put up a few from time to time for any budding doctors to groan at.
Presenting Complaint - Ankle Swelling
PQ is a 45 year old man who presents to you in clinic with a history of ankle swelling. He gives a gradual progression over several years. He has no specific complaints but you fear the oedema could be quite severe as he has also noticed abdominal and facial swelling.
He has no cardiac history, nor any symptoms of kidney or liver disease, but he has noticed that his appetite has been affected. He is currently not taking any medication. Family history is unremarkable, but in the social history you learn he has increased his trouser size recently and as such you begin to consider endocrine pathology.
Examination is unhelpful. Shifting dullness is negative. No organs are palpable, JVP is normal and no abnormalities are detected.
You run a battery of tests. Nothing is conclusive and you are stumped. You recall that malnutrition can cause abdominal swelling - but an inexplicable hunch tells you that his nutritional status seems intact. As usual, you have no clue as to the diagnosis and are about to run away crying. Luckily a band of wandering minstrels give you a clue. They sing a song suggesting you take a step back and observe the patient from the end of the bed. Suddenly it all becomes clear.
What's the diagnosis?
Your patient is fat.
Chubby fat fat fatboy porker's disease (or as it was previously known, obesity) is a remarkably under-diagnosed condition. This is normally explained by the subtlety of the clinical signs suggestive of fatness, but it is important to rule it out in every patient you see, so be sure to look for it. The pathognomonic finding is a big fat person on examination. If you are unsure as to the diagnosis, do not be afraid to ask "are you fat?"
Fatness afflicts many, spread across all age groups. Symptoms include inability to fit through doors, causing earthquakes, losing small objects between rolls of flab and chronic celibacy. Treatment for fatties (it is impolite to use any other terminology) is a controversial field. Those that insist it's their glands should be punched on sight. This is the cruel-to-be-kind approach which has produced superb results in America, where 1 in 1 people are fat. Others should be shunned and treated as social pariahs. A novel therapy from GlaxoSmithKlineBeechamWellcome is very encouraging. A wet towel is used to 'whip' the tubby wideload's rear-end, as he or she runs around and tries to escape, often shouting "I'm full of chocolate". This fascinating treatment's full name is Liquid-Activated Rear-Driven Ass-Snapping Sequence, abbreviated to LARDASS.
If all else fails, pump them full of steroids, they never do any harm.
Originally published in Medical Student Newspaper
Labels: Medical Student Teaching, medical students
Diversity Writer of the Year
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HERStory
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2. Rohinplasty (series)
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9. If it looks like a quack...
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They hate you
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The bastard son of MTAS
All Hallow's A&E
Quack
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