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

Ian Patterson – playing God?

 

As an aspiring medic, it has been impossible to ignore the news this week. In fact, I was trying to drag my way through an uninspiring gym session having forgotten my headphones when this news story caught my eye. Ian Patterson was a name I hadn’t heard of before last week, yet he is now a person I just cannot seem to fathom.

Ian Patterson is a breast cancer surgeon, meeting people, often young women, when they are scared and vulnerable. He has carried out unnecessary operations on 10 known patients [1] however the exact number of his victims could be in the thousands, leaving them feeling both mutilated and violated. The crown court stated that he carried out ‘extensive, life-changing operations for no medically justifiable reason” [1].

As despicable as this is, the real question I cannot be alone in asking is how did this go on for so long? The first of these ten patients was operated on in 1997 [1] and concerns have been raised since. Ian Patterson worked in the private healthcare system, and if any positives can come from this hugely negative situation it is that issues which need to be address have become evident. Restrictions and regulations must now come as a result of this medical crisis, helping to protect those across the healthcare system – including the private sector.

A doctor has a huge amount of responsibility, and a worried or anxious patient can easily believe everything that comes out of a healthcare professional’s mouth. I hope that this incident does not prevent patients trusting their doctors and nurses, but that it does stimulate the necessary questions to be asked. I hope the NHS and other organisations act quickly to help improve protocol, as a situation like this can never happen again.

[1] https://www.theguardian.com/uk-news/2017/apr/28/ian-paterson-the-likable-breast-surgeon-who-wounded-his-patients

[2] http://www.telegraph.co.uk/news/2017/04/28/ian-paterson-charmed-patients-scrimping-treatments-funding-luxury/

PrEP – preventing HIV?

 

A couple of weeks ago, I read an interesting, if not startling, BBC article surrounding the Scottish NHS. This lead me to research more into the treatment which the NHS in Scotland has recently approved to fund and routinely offer to its people. This treatment is known as ‘PrEP’, and it has been proven that a daily dose can protect those at risk of contracting the virus [1].

How does PrEP work?

PrEP is an anti-retroviral drug, fitting with the nature of HIV as a retrovirus. This means that HIV is composed on RNA, and contain reverse transcriptase, which is an enzyme. This allows the viral RNA to be transcribed into DBA after entering a host cell. This DNA can consequently be integrated into the DNA of the host cell and expressed – one of the key problems with treating HIV is that it is a retrovirus. [2]

PrEP therefore, prevents the virus from multiplying if it enters the body [1] without major side affects [4] . Therefore, it is a preventative treatment as opposed to a ‘cure’ for HIV. Taking the pill consistently each day has been shown to reduced the risk of HIV infection by 86% alone [4] – a staggering number, however with other preventative methods such as the use of condoms, this number increases [3].

What are the benefits?

What is remarkable about this drug however, is that it is estimated 1900 Scottish people could benefit from the drug, and the huge amount of money (around £450 a month per person) which the Scottish NHS is investing, [1], but also saving. For each person who does not become HIV positive due to the use of PrEP, the NHS in Scotland with save £360,000 in lifetime treatment costs [1] – prevention is better than cure, they say.

I think this is huge step in the right direction, when fighting an incredibly stigmatised disease. The treatment has the potential to help improve quality of life, save money and to reduce the numbers of those suffering with HIV in the future. I can only help that our NHS follows in the steps of NHS Scotland

[1] http://www.bbc.co.uk/news/uk-scotland-39552641

[2] http://www.medicinenet.com/script/main/art.asp?articlekey=5344

[3] https://www.cdc.gov/hiv/basics/prep.html

[4] http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

Book Review: When Breath Becomes Air – Paul Kalanithi

 

This book is undeniably honest, highlighting the realities of being a doctor, a patient, and dying. I am not embarrassed to say that I ended this book in tears, not only is it impeccably written but one of the most unique and useful books I have ever read.

“As a resident, my highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness.”
― Paul KalanithiWhen Breath Becomes Air

Becoming a doctor should not be viewed through rose tinted glasses, something I know I have previously written about (a phrase which has certainly stuck with me). The stresses, long hours and innumerable tasks which are encumbered within medicine are written about in ‘When Breath Becomes Air’, and most importantly the realisms of just wanting to get work done. Through reading this book, I learnt how easy it is to slip into monotony, to just ticking patients off a list, however, that is not what being a surgeon, let alone a doctor, is all about.

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This has helped me realise that every patient who walks into a hospital is different, and that as a doctor you frequently meet people at their most vulnerable, most scared or most weak. How you approach a situation or initiate a conversation can impact hugely on how someone remembers their hospital experience or views hospitals for the rest of their life, and what can easily become just another patient in your day is a huge moment in a persons life. The humanity of being a doctor is truly emphasised within ‘When Breath Becomes Air’, with the personal stresses, commitment needed and responsibility felt being accentuated.

“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.” 
― Paul KalanithiWhen Breath Becomes Air

Besides this, the second chapter of the book is as close to an account of death as possible. Dr Paul Kalanithi himself realised how as a doctor you deal with patients every day, but rarely do you experience what it is like, or the close proximity of death. I have not dealt with many loses in my life, and I think reading this book I got as close as possible to experiencing just a tiny part of what dealing with cancer can be like.

For me, being a doctor is a commitment to putting your patients first, and I believe that in many cases this is about making them feel comfortable, aware of what is happening but also recognising when not to bombard a patient with information. ‘When Breath Becomes Air’ is both phenomenally written and a just balance between science, patient care and first hand experience. I would recommend it to anyone, as it is a huge insight into what life is like as a neurosurgeon, but also death and how hospitals can influence lives.

‘People often ask if it is a calling, and my answer is yes. You can’t see it as a job, because if it’s a job, its the worst one there is’
― Paul KalanithiWhen Breath Becomes Air

Here is the amazon link for ‘When Breath Becomes AIr’

https://www.amazon.co.uk/When-Breath-Becomes-Paul-Kalanithi/dp/1847923674

 

RSM Medical Careers Day

 

Last week, I alongside many other aspiring medics spent the day at Oakham School, for a ‘medicine day’ offered by the Royal Society of Medicine. It was an incredibly interesting day, and shed light on the application process and specialisms. Being a doctor is an incredibly varied role, and I love the potential that there is to choose a career which definitely suits you. However, it is easy for anyone to find out about the application process, course structures and entry grades, so I wanted to take some time to reflect on the medical professionals who gave their time to speak to us about their careers during the day. Two of which were presentations which particularly stuck with me, and another a comforting realisation.

The Trainee Years – Dr Brinda Christopher 

Dr Brinda Christopher is the president of the Sports and Exercise Medicine section of the RSM, and currently works for Tottenham football club. Admittedly, I have never particularly considered the role of doctors in this environment – thinking that the players would always turn to a physiotherapist. However, I found it explained to be an interesting field of medicine – and an uplifting one. Dr Christopher mentioned that a part of her choice of specialism was due to the unlikelihood of encountering death, as she herself finds it difficult to deal with. This has opened up my eyes to other aspects of medicine, where I have previously thought that dealing with death is something with is inevitably common as a Doctor. This shows that medicine can really be chosen to suit you, and hugely warped around your personality and what you want to do.

The road to being a doctor, is undoubtedly a long and winding long. Five or six years at med school, two foundation years, specialist training and a LOT of exams. However, I have no concern about whether or not it is worth it – it is an incredibly interesting, rewarding and important career, and the process is fitting considering as a doctor, you never stop learning. I learnt a lot from this talk about the stresses associated with being a Doctor, that many of these come from dealing with a huge system and not particularly the patients themselves. There are always quotas and deadlines to meet, making a hospital environment a fast moving one. It was emphasised during this talk, that being a doctor is not a career, but a lifestyle choice. While this is something I have witnessed first hand, it was not something which, before now, I had considered. Perhaps because I have taken it in my stride as an expected part of the job, but something I thought well worth mentioning.

Dr Christopher’s talk opened my eyes up to a field of medicine I was not previously aware of, and has encouraged me to take a look into what other specialisms which I am unaware of, are available. However, it was also an honest talk, the pros of being a doctor were equally weighted with the cons – moving around a lot, dealing with death, bullying in medicine and the stresses of the job. This appealed to be as I did not feel like I was looking onto the profession through rose-tinted glasses, and that some of the realities of being a doctor were brought to my attention.

So You Want to Be a GP – Dr Mohammed Saqib Anwar 

I had never even considered a career as a GP before this talk, I was convinced there would be little variety and an extortionate amount of time-wasting patients. However, this talk proved to me how a GP is often the first point of contact of the NHS. The first time a patient brings their potential illness to the attention of a medical professional, and that it is not only physical illnesses GP’s have to worry about it. Any doctor has a duty of care, and this extends far beyond diagnosis – it is incredibly hard for a patient to confide in you, if you are not approachable or have not build a rapport with them. Working in the medical profession is not about preventing death, it is about improving quality of life and providing standardised care to everyone. Those who repeatedly ‘waste time’ through appointments are not actually wasting time, as they are concerned about their health – the one time you turn them away, they may actually have fallen ill.

Being a General Practitioner is not a boring job, variety is encountered through clinics everyday. Although, the opportunity for other roles was highlighted to me throughout this day. Dr Saqib Anwar has a huge roles in media management, is faculty chair at the Royal College of General Practitioners and a primary care adviser for Care Quality Commission. When giving us a run through of his last two days, it included press releases, meetings and clinics – showing the life of a GP to be much more interesting than I initially thought. These two speakers were incredible, and gave a thoughtful insight into life as a doctor is two very different roles. My eyes have certainly been opened up to the prospect of different specialisms – even though it is years away.

The last speaker I would like to mention however, is a F2 student. Medicine is competitive, and not everyone gets in first time around, however this speech demonstrated to me that if it is truly what you want to do, there is more than one pathway into life as a doctor. This junior doctor was one of those people, and went on to do a biomedical sciences degree. After these three years, he gained a place on a graduates course – and from what I could see, hasn’t looked back since. So as a final message, don’t give up. Getting into med school is tough and challenging and just because you don’t achieve it first time around, doesn’t mean that you won’t make an excellent doctor.

This was only a small aspect of the day, but these talks definitely opened my eyes up to the endless possibilities within medicine. The day itself, was another affirmation that this is what I want to do, and worth the hard work. I learnt not only about the variety of life as a doctor, but left with some negatives to consider and a yearning for the next eighteen months to hurry up, so hopefully I can start med school!

Sources: RSM Medical Careers Day [23.03.17]

Rat Dissection

 

This week, as part of our biology AS I dissected a rat. As someone who is vegan, this was morally quite difficult for me, however once I had overcome my initial emotions, I learnt a lot from the practical – both about anatomy and ethics.

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I found it incredibly interesting to look at the ratio of the length of the rat and its small intestine, which was easily 2 if not 3 times longer than the rat itself. We focused initially on the digestive system, locating the stomach, ileum and large intestine. This was incredibly useful in realising what we have learnt about the surface area and ‘coiling’ of the small intestine, and how this helps absorption. What was also particularly apparent was how large the liver of a rat is, while not surprising due to its vast number of functions such as deamination, it was by far the largest organ inside the rat.

I then went on to dissect the chest cavity of the rat, removing its ribs using sharp scissors and a blunt nosed seeker. I was surprised with the positioning of the lobed lungs, as I found a particularly large right lung but a  considerably smaller left lung. However, this makes a lot of sense as the heart is slightly angled towards the left hand side of the rat, and the left side of the heart is larger than the right – therefore a smaller lung compensates for the larger side of the heart.

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I drew a scientific drawing of the chest cavity of my rat (left), representing what I could see in the clearest way possible. This was a good opportunity to practice this skill, however the dissection skills I learnt were of much more importance. The significance of making a clean incision and angling your scissors up, to keep the insides intact, but as I progressed through the dissection I also found I was picking up the right tools more frequently – those which would do the least damage to the organs.

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While I can’t say I’m an aspiring surgeon, this was an incredibly interesting experience and a huge personal achievement. I do believe that I would find operating on a human, who could consent, much less morally conflicting, than on an animal bred for dissection. Although, this experience has allowed me to partake in something I may find hard to agree with, it has taught me to put my feelings aside to do what is important (in this case, for my learning). This is something which applies easily to a medical professional, and a realisation I will take with me into my future career.

(I hope no-one is offended by these photos, and if you’d rather me take them down please don’t hesitate to leave a comment)