Organ Donation

 

This week, an uplifting story on the news regarding organ donation caught my eye. A young 13 year old girl’s organs have been transplanted into eight different people, 5 of which were children.

As an organ donor myself, I understand the importance of the process and how many lives can be saved via donation, however the UK still has an ‘opt-in’ system. Thus, unless you register, your organs will not be donated after your death. 24 other European countries have an ‘opt-out’ system, [2] meaning everyone is on the organ donor register unless they choose to remove themselves from this list. In our modern day healthcare system I think this is a much more beneficial scheme, due to organ demand and the sheer number of people who are indifferent to the process.

Jemima Layzell died suddenly due to a brain aneurysm, and after her death donated her heart, small bowel, pancreas, kidneys, liver and lungs [1]. 8 is a remarkable number of organs for one person to donate, with the average only being around 2/3. Something many people don’t realise is how many people die waiting for a transplant, last year a staggering 457, as families said no to organ donation.

So why this blog post? Not only is Jemima Layzell’s story an incredible one, it also brings with it a few key messages. The first, opt in. The UK does not automatically register everyone on the organ donor register, so please take the time to. For me, it came through when I applied for my provisional driving licence. The second, inform your family. If you want to be a donor, tell them. Let them know of your wishes as they have the opportunity to dispute them after your death. It is an incredibly important process which can save thousands of lives each year.

 

[1] http://www.bbc.co.uk/news/health-41187008

[2] https://en.wikipedia.org/wiki/Organ_donation

Work Experience – Day 5

 

Friday was the final day of my work experience at the QEH, and its safe to day that despite my hectic and busy week I definitely didn’t want to leave.

Again, I spent the morning doing the TSS ward round, but this time with a consultant, two F1 students and two ‘soon to be’ F1 students. There were a few patients I had seen every day of the week, showing that despite the aim for patients to leave TSS after 72 hours in the current situation of the NHS and QEH, this just wasn’t possible as beds, clinics and homes were not available for them to go to. The consultant had a very busy day, so the ward round was completed quickly, with lists and lists of jobs for the F1’s to do before they went home. After discharge letters, taking bloods, requesting scans and looking at X-rays, I spent the afternoon in a gastroenterology clinic.

The clinic was a different environment to that of the ward, and reminded me much more of a GP surgery. There were a variety of patients with different symptoms and illnesses, some losing weight unexpectedly, some gluten intolerant, some with IBS. In the same way as symptoms and illnesses varied, there were patients form all walks of life, elderly, a young mum with her 3 year old, a teenage girl, an alcoholic who appeared to have been drinking already. Again, each was spoken to differently despite the same questions being asked, depending on if they were nervous, experienced in controlling illness, alone or with family. There were two cases which stood out for me, the first a young anorexic girl, who was being investigated as the cause for her anaemia was unknown. The consultant realised when she was alone, that this would be a difficult consultation as she had nobody to support her – calling in a nurse to ‘chaperone’ eased and relaxed the environment, meaning there was comfort for her when she broke down in tears. This was a difficult conversation as she was worried the consultant would tell her GP her weight, missing her parents (who were on holiday) and worried about her future. The consultant was reassuring, never rushing or pushing her and making time for all their patients, something which is easily lost in a busy afternoon.

Breaking bad news is, I’m sure, something every doctor dreads. Unfortunately, the end to my work experience placement was not a happy one. The consultant I had been shadowing had to break the diagnosis of lung cancer to a patient. During an ultrasound of her liver, shadows had been found, and later scans showed that these were also found into her lung. While it seemed the patient was almost expecting this diagnosis, it was still an incredibly difficult conversation, again with a nurse present . The doctor was very clear that he wanted to keep the patient in the loop, as many decisions and discussions were taking place behind their back. The important aspect of this conversation was making the patient aware of the support network available for them, the opportunity to ask any questions and to write any down when she thought of them to ask later.

I had an incredible, eye opening week during my work experience. I would recommend it to anyone considering medicine, as it has shown me both the highs and the lows of life in  a hospital. I have realised the sometimes mundane tasks of an F1 doctor (sometimes they felt like secretaries) and how doctors are seemingly always rushing from one place, clinic or ward to another. Most importantly, it has shown to me that its a tough career, busy, with a lot of responsibility and hard work, but if you truly enjoy and love what you do (as everyone I met did) it is definitely worth it.

I am definitely excited for the future, and everything it may bring.

Work Experience – Day 4

 

Thursday was a very exciting day at the QEH, as it was the day the new F1 students began shadowing for their placements which began last week. Therefore, after the TSS ward round in the morning, I joined in learning about the computer systems, request forms and how the ward generally runs. the security of the NHS became apparent when I was told every website/system had to have a different password, and each be changed every month.

The systems for looking at blood results, X-rays, booking scans and researching patient histories were all shown to me, alongside the referral forms and blood book. After this, I enjoyed speaking to the two new F1 students on TSS, one of which trained in Malta and the other in Plymouth. It was interesting to hear their views on gap years, reapplying and their own university experiences, as well as the challenges they have faced along the way. I was particularly impressed by one of the students, who I couldn’t help but think I would love to be my own doctor. She always had her eyes on the patients, walking them back to their beds when they got confused and speaking to them when they were obviously bored or distressed. A particular moment was occurred when watching a lumbar puncture, where a (scarily) large needle is inserted between the vertebrae to remove fluid. This fluid also circulated the brain and so can be used to detect small bleeds. The patient was a young woman who was obviously distressed during the procedure. The F1 student brought her tissues and water, reassured her and told her to squeeze her hand through the pain. For me, this was the best and most impressive piece of practice I saw all week – all be it the most simple.

I spent the final part of the afternoon back in endoscopy, watching procedures and learning again about how the equipment (air and water) worked. Seeing how different patients were spoken to and experienced the procedures was interesting, as it was an unpleasant experience for everyone. It was a really interesting and insightful day, surrounded by the excitement of the new F1 students and it definitely confirmed that medicine is the only career I want to undergo!

Work Experience – Day 3

 

Continuing the reflection of  my work experience at my local hospital, the end of the week was just as exciting as the start. Wednesday began with the TSS ward round again, where I continued to learn how to interpret chest x-rays, and followed the treatment of many patients I had seen before. The lady with jaundice due to her liver failure was still smiling despite her deterioration, however the ward was also filled with new patients we had not seen before. A particularly memorable case was a drug overdose, a young woman with a suspected tear in her oesophagus who was reluctant to undergo any treatment, but after speaking to a doctor relaxed into the hospital environment and was much more willing to cooperate. Perhaps the highlight of my day were an elderly couple who warmed everyone’s hearts – she was desperate to have him home. After speaking to them for a while, ‘just a touch of heart failure and pneumonia’ wasn’t going to worry them, and in her words was nothing they couldn’t handle. Her positivity and supportiveness of her husband was endearing, and I couldn’t help but smile at her excitement towards his discharge.

I spent the afternoon at the endoscopy unit with a consultant, watching and learning about the  procedures he undertook. The first of which  was a colonoscopy of a young and cheerful (slightly drowsy due to the medication!) male. It was particularly interesting to see the tiny ulcers in his colon, and how small biopsies and photographs could be taken using the equipment. As he was an outpatient, he was given steroids to take home to and reduce the inflammation. The second procedure I witnessed was a stark contrast to the first, a frail, elderly man who was an inpatient. He had a gastroscopy, which was used as a diagnostic procedure, hoping to find the source of a bleed. By this point the blues had stopped, but the end of the oesophagus was inflamed with ulcers. However, this was a particularly interesting case as the consultant made me consider whether this invasive procedure was a good thing for patient, who was so frail and elderly. The possibility of over investigating was an interesting and complex one, and led me to believe that if it was my grandparent, I wouldn’t want the procedure done unless they were in serious pain, or it was urgently life threatening. These procedures are simple with relatively few risks, but they are also unpleasant and undignified.

Wednesday definitely opened up my eyes to the harsh realities of medicine and the unpleasantries of certain procedures. I really enjoyed learning and speaking to patients on ward rounds and finding out about their own hospital experiences.

Work Experience – Day 2

 

Continuing my work experience placement at the QEH, I had another really interesting and insightful day. I began my day following the consultant on the TSS/MAU ward round, what I found particularly interesting was looking at chest x-rays, and listening to the sounds of patients’ lungs. For those with crepalations (crackling noises), looking at the X-ray reinforced the probability of infection, due to the amount of ‘white space’ seen. One particular patient with heart failure and pneumonia had an especially fascinating X-ray, with white areas appearing in lines – as if down each bronchiole. The consultant explained to me that because of the heart failure, not enough blood and thus oxygen was reaching the span of the lungs, causing the infection to occur in this manner.

I saw a variety of patients, from the elderly with infections and some heart failure, to a young man who had overdosed on drugs, a woman with seizures and another with jaundice, explained to be due to her liver failure. The young man who had overdosed, was my first experience of a rude and unpleasant patient, who could not understand how the doctors could not spend their entire day with him. However, he was dealt with calmly by an F1 doctor, who explained that his requests were underway and some pain relief would be along shortly. I was however, occasionally disappointed at how doctors would sometimes walk away from patients when they were speaking to them, and in one case, left a frail elderly lady confused about the future of her treatment.

In the afternoon, I sat in a diabetes clinic, listening to consultations with a diabetes nurse, nutritionist and endocrinologist. Here, I was surprised at how well the nurses knew their patients, but also how medicines were not relied upon. While diabetes is managed by insulin, I also learnt that diet (carb counting) and exercise where really important in managing diabetes. Encouraging their patients to learn about how their diabetes and insulin works, and it being explained on a one to one basis seemed really effective, in giving patients the tools they needed to control their diabetes with less (expensive) medication. As the diabetes nurses had a very niche area of work, it meant that they could see their patients frequently, and give them small ‘snippets’ of information to take away at once. Not overwhelming them, I was told that this made large changes to occur in small intervals.

I have really enjoyed my time at the QEH so far, gaining an insight into both the positives and negatives of working as a doctor, and the hospital environment as a whole. I am certainly looking forward to what the rest of the week will bring.

Work Experience – Day 1

 

This week, I am lucky enough to have a placement at my local hospital, on the MAU and TSS wards. The MAU ward is the medical assessment unit, where patients are examined and then referred to specialisms, sent home, or moved to other wards. The TSS unit stands for the Terrington Short Stay Unit, and was where I was placed today. Here, many patients are admitted due to a fall, problems with diabetes or problems which come through A&E which aren’t life threatening. The aim for a maximum stay at the TSS unit is 72 hours, however today I have seen the stresses and strains of the unit, and how this is not always possible.

Surprisingly, while not one of my first experiences in a healthcare setting, today was one of only a couple of times I have been on a hospital ward. My family and I are lucky enough not to fall ill very often, so it was a hugely eye opening experience. It is a tough environment, bright lights, loud noises and machines, ill patients and lots of people who need help, however I found I quickly found my feet and the ward became much less daunting.

I began my day following two F1 students and a consultant doing the ward round, seeing just under 30 different patients. I saw a number of fascinating conditions, including sepsis, jaundice and been able to listen to an abnormal respiratory sound –  ‘crackling’ and compare it to a healthy lung. From looking at the scans of the patient, I then saw that what was supposed to be a black area (lung) was patched with abnormal white areas, causing the crackling. This was explained to me to be fluid, which needed to be monitored incase it worsened. I learnt a lot medically, from simple abbreviations, to little pieces of knowledge about diseases and illnesses, however a key part of this for me was patient interaction. The consultant led the ward round, asking the F1 students questions and for their opinions, however, he spoke differently to each patient, both making himself easy to understand and the patients as comfortable as possible. Nobody wants to be in hospital and I’ve seen today how a friendly doctor, who listens to the stories a patient has to tell, can really improve a patients’ experience.

What I didn’t like about the TSS ward, was the emphasis on discharge. There seemed to be rush to get people out as someone was always waiting for a bed, and the F1 students were being pushed to discharge patients quickly by the nurses. It is a ward with an incredibly quick turnaround, and on speaking to one of the F1 students I shadowed for the rest of the day, she told me that she wished she had more time to follow her patients’ stories and really get to know them, rather than just treat them and send them on their way. This has really made me consider which aspects of medicine I might like to pursue, as I feel that this following of a patient and their story – both medical and personal, is an aspect of medicine really important to me, and one that you might not get in a ward such as TSS or A&E.

Having said this, I really enjoyed my insight into medicine today, as packed full of paperwork and stress as it may be. I saw both what I consider to be good and bad practice, and both upbeat and unhappy patients – a reality of medicine. Perhaps one of the loveliest and most heartwarming aspects of today was husband and wife, on adjacent wards just the other side of the wall from each other. The husband of the couple just wanted to sit and hold his wife’s hand, and this was facilitated for as much as possible by the TSS team, as they obviously appreciated just how much it improved their stay.

Grenfell

 

It has been a tragic couple of months for London, Manchester and Britain as a whole. The terror attacks and the fire in the Grenfell Tower block are deeply saddening, and have really emphasised my appreciation for and the importance of not only our emergency services, but also the accepting and tolerant communities we have established.

I’m sure many of you, if not most, have seen images of these attacks. For me, a particular twitter post brought down the earth the realities of being a member of the emergency services. The sacrifices which these people are willing to make to help others, and the bravery of each and every one of them. I never thought a name on the back of a helmet could signify so much, but I believe it is a reflection of how we can be so willing to help others, regardless of race, religion, age, sexuality, and any other factor.

 

Following the Grenfell Fire, I read a really interesting article entitled, ‘Ahmed Kazmi: A GP’s experience of the Grenfell Tower fire’. http://blogs.bmj.com/bmj/2017/06/16/ahmed-kazmi-a-gps-experiences-of-the-grenfell-tower-fire/

Yet again, this made me step back and think of what the role of a doctor really is. The article reinforced to me that as a doctor you are not always curing people, saving lives or treating illnesses, and often this is just a small part of the day. One of the most important aspects of being a doctor is undoubtedly, dealing with people and Ahmed Kazmi proves that, as by comforting and playing with children, he was still acting as a doctor. I can see how it could have been very easy for him to leave the centre, seeing they didn’t need his medical knowledge. However, this has emphasised to me that help comes in so many forms, treatment, operations, a shoulder to cry on, a helping hand.

This makes me think again of the BBC documentary ‘Hospital’ in which a young junior doctor sat with the wife of a patient, after telling her that his chances were slim. Despite her stressful and busy day, finding the time to help and care for each patient and their family is essential, and in that situation it seemed to make even the silence much more comfortable.

I just thought I’d write a short article as I believe that this is something every aspiring medic should understand and consider – help and care come in a number of ways, and it is incredibly important to give every patient the time and support they both need and deserve.

Aspirin and Cancer

 

When talking to a friend today, she mentioned her idea for an EPQ – investigating the link between aspirin and cancer. Aspirin is taken by many to reduce the risk of heart attack and stroke [1], although I had not heard of its link to cancer before. I thought this was a really interesting topic, and have heard many stories of doctors themselves taking aspirin daily to improve their health. Therefore I would like to share the research I have done into possible uses for aspirin.

In doing this, I found that the most potential has been found regarding colorectal cancer. A hereditary condition called Lynch increases the risk of the development of cancers such as bowel cancer, womb cancer and colorectal cancer [2]. As it causes no symptoms itself, many with the condition often do not know they have the faulty gene which causes it [2]. In a trial of those with Lynch syndrome, those given aspirin had a 63% less chance (relatively) of developing colorectal cancer, in comparison to those who didn’t take aspirin and merely had a placebo [1]. I’m sure you’ll agree this is a huge decrease, and could potentially save lives and money for the NHS. While the cost of prescribing a daily dose of aspirin for a vast amount of the population would be high, the true question is whether this outweighs the cost of treating patients with colorectal cancer. Most importantly however, doing this is likely to save lives and provide a much better quality of life (cancer free).

Although, aspirin has not only been found to affect those with increased risk of colorectal cancer. In a similar study published in 2016, the long term use of aspirin was investigated. After 6 years of taking aspirin, there was a reduction of 19% in the risk of colorectal cancer, and 15% reduction in the risk of nay type of gastrointestinal cancer [1]. Colorectal cancer however, is not the only cancer that aspirin can effect. A systematic review also found an 11% decrease in the risk of death from prostate cancer [3]. This shows taking one small tablet each day could have huge benefits on health, especially when coupled with the reduction of heart attacks and strokes.

Undoubtedly, aspirin in low doses benefits human health. However, before everyone starts popping aspirin pills, the long term effects of the drug need to be investigated and known, alongside costs being totalled up. Aspirin may have negative effects on other areas of the body yet the evidence for the apparent use of aspirin in preventing cancer, heart attacks and strokes is abundant.

[1] https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk

[2] http://www.macmillan.org.uk/information-and-support/diagnosing/causes-and-risk-factors/genetic-testing-and-counselling/lynch-syndrome.html

[3] http://www.nhs.uk/news/2016/04April/Pages/Daily-low-dose-aspirin-may-help-combat-cancer.aspx

Exams and Revision

 

After months of preparation, my AS exams finally finished yesterday and it’s safe to say a feel a little more free! In light of this, I thought I’d share some of the resources I made when revising, as they could be of use for others! For guidance I am studying OCR A chemistry and AQA biology, so any notes are based on the textbook and specification for these courses, though I’m sure much of it applies to others too.

Chemistry Summary sheets:

Atoms:ions PDF

Halogens and G2 Metals PDF

PHYSICAL CHEM NOTES PDF

quantitative analysis PDF

Reactions 1 PDF

Reactions 2 PDF

Biology Summary Sheets 

Cell structure summary PDF I

MMUNITY SUMMARY PDF

PLANT TRANSPORT PDF

Exam season is a long and stressful one, but I am glad that I kept up my volunteering right up until we went on study leave (3 days before my first exam) as this gave me a good break, doing something I really enjoy. I know many people are not sitting AS exams this year, so this is a tip I would take forward onto next year – having some time away from revision is (in small doses) a good idea – for me it was my volunteering, and then once on study leave going to the gym. While I didn’t feel any of my exams went overly well, I know that I worked hard for them and so the grades I get will be the best I can, and if I’m honest I’m excited to forget about them until August!

While this post didn’t have much purpose, I just wanted to keep you in the loop with what I’m doing, as throughout the year priorities definitely change. Good luck to anyone still sitting exams! You’ll do great 🙂

Book Review – Madness and Memory

 

On the eve of AS exams, I have just finished reading ‘Madness and Memory’ by Stanley B. Prisoner, M.D. It is a book I found when researching for my EPQ and bought back in February, however because of its scientific content, it has taken me a while to get my head around and work through.

Despite this however, I have found it an incredibly interesting book, which appealed to both my love of science and medicine. It is written almost like a diary, a documentation of the events which led to the discovery of prions but explained for those without a science degree (definitely aiding my understanding a huge amount!) making it much more of an easy read.

To me this book highlighted the sheer amount of dedication which goes into research, not something I aspire to do but definitely something I respect. It reflects the skepticisms of new ideas and the rivalries between scientists in bucketloads – a perfect balance of drama and science. The transformation of an unconventional hypothesis – that of protein only (prion) diseases – into what I think is one of the greatest discoveries since the DNA double helix.

I would recommend this book to any budding medical professional or scientist not only because of the way it is written but largely down to its content. Prions are incredibly interesting diseases, and further discoveries could help unravel the unknown about brain diseases – mad cow, Alzheimers, Parkinson’s and Lou Gehrig’s. The debate about the origins of such diseases is what I intend to focus my EPQ on, are they due to cannibalism, food supplements or BSE infected beef? This book has certainly succeeded in piquing my interest in the topic further, and I can’t wait to pick my research up again in a months time, after my exams.

The amazon link to ‘Madness and Memory’ is: https://www.amazon.co.uk/d/Books/Madness-Memory-Discovery-Prions-Biological-Principle-Disease/0300216904/ref=sr_1_1?ie=UTF8&qid=1494614063&sr=8-1&keywords=madness+and+memory