Hospital Work Experience

I was lucky enough to get 8 days of work experience at my local hospital on 31st July – 9th August.  I was allocated 3 different areas: The trauma orthopaedic fracture clinic (3 days), respiratory ward (2 days) and the acute medical unit (3 days).

On all of the areas I learnt a lot about how important it is for everyone to work as a team and how invaluable the nurses really were for the patients and for the doctors, they kept everything organised and made sure the doctor’s had all the notes they needed and of course carrying out  procedures such as taking blood pressure, collecting blood for a blood transfusion, giving blood transfusions and most importantly giving the patients the drugs the doctors have prescribed (as well as many other things).  They obviously spent more time with the patients and got to know them so much better, whereas the doctor’s weren’t able to get to know them as well as they would only see them once a day on ward rounds (and each doctor was given 2 bays, so they wouldn’t be on the same bay every day).  Therefore, the doctor’s had to work off the nurses notes and previous doctors notes, the ob’s charts and what the patient was telling them and whether everything was okay with the heart, chest and lungs using the stethoscope.

In each area I worked in, the doctors and nurses would give me the hard truth about being a doctor and would try their best to get me to falter in me wanting to do medicine…but it didn’t work!  I know the hours will be tough and so will the shift work, it will be challenging and difficult at times…but I learnt you can’t get disheartened and you can’t want to go into medicine thinking that you will get immediate gratification from patients if you help them, because most of the time you don’t.  You need to be satisfied and happy about knowing you have helped someone and you shouldn’t expect a thank you from anyone. Becoming a doctor is something that definitely shouldn’t be taken lightly, because once you step through those doors of the medical school and start studying medicine, you have to remember, you will be doing this for the rest of your life and it’s not a job that you can just drop and move on from.  In fact it’s not a job it’s a vocation and you have to really want to do medicine to take on the challenge of becoming a doctor and then being the best doctor you can be.

I met one doctor who didn’t get into medicine the first time round and he said to me to not give up and to keep trying because if this is something you really want to do you’ll get there.  Just put the hard work in, get the experience and keep applying!  And that’s what I am doing.  If I don’t get into medicine for 2014 then that’s fine, I’ll apply for a job as a healthcare assistant and then reapply the following year.  If I don’t get in again i’ll apply to university to study becoming a physician assistant or nursing.  Then I’ll do a few years in one of those jobs and then reapply again.  Since this work experience at the hospital it has given me so much insight into so many different jobs in the NHS (as I spent time with the nurses, doctors, orthopaedic practitioners and occupation therapists) and it has shown me that there are so many options I can take if I don’t get into medicine (which I really hope I do!) the first time round or even the second time! And that I shouldn’t give up because if I try hard enough I will get there eventually.

I was also lucky enough to be doing my work experience when the FY1 medical students started at the hospital, so I got to see the type of work they undertake  and how much support the really got from all of the staff there! At the same time I could see how stressful and busy it is and how good you need to be with thinking on your feet and taking responsibility and working efficiently so you can get done the majority of the numerous number of jobs you have been given.

I haven’t written anything on my blog for a while as I have been doing my AS exams, but now that they are all out the way, and my gold DofE expedition that I did all last week is finished, (which really did teach me what teamwork really was as we had never worked together before and we weren’t friends before we were put together, it also taught me that at times you just have to let your pride go and when someone does something to annoy you, you just have to brush it off, smile and accept it, just for the better of the team!  And in the end when we all worked together, it all paid off, we did well and I certainly learnt a lot!) , I can start blogging again this week.

However, it won’t be for long as on Saturday 6th-8th July I am doing Medsim then on the 11th July I go away to Tanzania for 18 days, which will give me plenty to talk about!  Even though these activities might not seem relevant to medicine they are teaching me many of the skills I will need such as teamwork, patience, good communication and listening skills, courage to be strong willed in some decisions and being more understanding whatever the circumstances.

 

Types of Strokes

Recently a family member has suffered from two strokes in a 5 day period.  I was able to travel in the ambulance up to St George’s hospital as it has a specialised stroke clinic.  When I asked the paramedics about the stroke they said that it was a TIA not a CVA and they went on to quickly explain what both were which I didn’t fully understand so I decided to look it up!

TIA stands for Transient Ischaemic Attack.  It is usually called a mini stroke and the symptoms disappear after 24 hours.  It is caused by a section of a thrombus or atheroma/plague breaking off from the carotid arteries (there are 4) that supply the brain with blood or from a thrombus from the heart.  The arteries that become more narrow as they they move further towards the brain, this makes it easier for the blood clot carried in the blood (now called a embolus) to become stuck.  However, because the blood clot is small it easily breaks up so no permanent damage is caused to the brain tissue.  However, TIA should be treated like a stroke as it’s a sign of a stroke occurring.

carotid_arteries_pic

CVA stands for Cerebral Vascular Accident.  This is when the brain has been starved of oxygen and permanent damage has been caused resulting in a loss of brain functions.  This can be caused by ischemia (embolic) or a haemorrhage.  An ischemic stroke is where a blood clot blocks an artery in the/supplying the brain which doesn’t break down like in a TIA and starves an area of brain tissue of oxygen resulting in the brain tissue becoming damaged/dying.  There are two main types of haemorrhagic strokes:

  1. Intracerebral haemorrhage
  2. Subarachnoid haemorrhage

An intracerebral heamorrhage is where there has been a bleed in the brain which could be caused by aneurysms and/or arteriovenous malformations (AVMs)- this is where blood vessels in the brain (on on the surface) become tangled and bypass an area of brain tissue and the blood go straight from the arteries to the veins missing out capillaries.

AVMs

normal blood vessels

 

 

 

 

 

A subarachnoid stroke is where a blood vessel has burst or ruptured usually due to an aneurysm and blood has collected beneath the arachnoid membrane which lines the brain.

stroke types[1]subarachnoid_intercerebral

 

The Royal College of Anaesthetists

On Friday 1st February along with some other people from my school we were lucky enough to do an afternoon of workshops on anaesthetics at The Royal College of Anaesthetists, we learnt about the anaesthetics machine, resuscitation, ICU and airway management.

For the airway management we were allowed to try and do an endotracheal intubation on a dummy.  An endotracheal intubation is where a tube (ET tube) is placed into your trachea, this is achieved by using a laryngoscope:

The reason a laryngoscope is used is so that you are able to see the vocal cords in a persons throat which allows you to place the ET tube down the trachea instead of down the oesophegus more easily.  The ET tube needs to be placed 2cm in so that both the lungs can be inflated not only one.  Endotracheal Intubation looks like this:

The reason it is usually performed is because:

  1. It opens the airway so oxygen can be delivered as well as medication and anaesthesia
  2. It can protect the lungs in certain patients
  3. Helps to remove blockages from the airway

 

Research into Alzeimer’s Disease

Research so far has shown brain abnormalities to do with Alzheimers these include:

  1. Plaques- These are microscopic deposits (clumps) of beta-amyloid peptide (a protein).  The clumps can block cells signalling to each other through synapses they also cause immune cells to be activated leading to inflammation.
  2. Tangles- These are coiled strands of the protein Tau.
  3. Loss of connections between brain cells.
  4. Inflammation- A result of the brain trying to defend itself against the other changes happening.
  5. The death of brain cells (and severe shrinkage of the brain tissue).

Treatment at the moment is aiming at:

  • Producing a drug that prevents the formation of beta-amyloid.  Beta-amyloid breaks off from the larger protein called amyloid precursor protein (APP), and this is caused by 2 enzymes called beta-secretase and gamma-secretase.  Drugs are trying to be created the prevent beta-amyloid clumping together, to stop the enzymes from breaking it off and even trying to use antibodies against beta-amyloid so it can be cleared from the brain when people start developing the clumps
  • Producing a drug that prevents Tau molecules from collasping and twsting into tangles as it destroys a very important cell transport system.
  • Also looking at insulin resistance and seeing how the brain cells use insulin and to see if it would be possible to prevent insulin from feeding changes related to alzheimer’s.

Many studies are also being done on blood testing or testing spinal fluid as well as brain imaging, to try and develop a brain scan that could detect the onset of alzeimer’s earlier.

 

 

Dementia and Alzheimer’s Disease- Can you tell the difference?

Firstly, to clarify any confusion, dementia and Alzheimer’s disease aren’t the same, even though they are used interchangeably.  Alzheimer’s is a disease that causes dementia.

What is dementia?

  • It’s an impairement of a persons memory and thinking
  • It can stop them carrying out things they used to be able to do
  • It is a symptom
  • It’s caused by something like Alzheimer’s for example
  • “Dementia simply means the symptom of a deterioration of intellectual abilities resulting from an unspecified disease or disorder of the brain.”

What is Alzheimer’s?

  • It’s one of the diseases that causes dementia,
  • It’s the most common form of dementia
  • It’s a disease that affects the brain (brain disease) and it is progressive
  • It affects thinking, memory and behaviours become so severe that work life and social life is affected
  • Alzheimer’s damages the brain cells and eventually brain cells are destroyed
  • It gets worse over time
  • It is fatal
  • There is no cure yet
  • Common in older people

Alzheimer’s is a disease and dementia is a symptom of Alzheimer’s

 

Voluntary Work at a Care Home

On 4th January 2013 I started volunteering at a care home. I go every Tuesday after school for about 1 and a half- 2 hours.  I have been given 3 residents that I am allowed one-to-one with, which involves just talking to them or doing an activity if they wanted to.  Many of the residents suffer from dementia so patience is one of the key skills you need, especially if you are working with them every day.  The phrases that you here most of the time is ‘Can I go home yet?’ or ‘I think it’s time for me to leave’.  With this you need to try and settle them back down and get them doing something else (preferably something they enjoy such as embroidery).

What I also found was that many of the residents go back to behaving as if they were a child again and some become very upset as they start remembering their parents and grandparents.  At this point to be able to deal with this you need to know the person pretty well on a personal level as some prefer to be left alone, some want to talk about it and others the best thing to do is again taking their mind off of it.

Some of you may be wondering so how does this help with medicine?  Firstly,  volunteering in a care home gives you that one-to-one patient contact that you will need to be able to do for the rest of your career in medicine.  It doesn’t matter what area you end up specialising in you will need to have patient contact at some point.  Some areas require more patient contact than others.  In the UK especially we have an ageing population and  so you are more likely to come into contact with elderly patients so being able to deal with different age related illnesses they may have is essential.  Talking to a patient with dementia you will have to have the patience to be able to deal with getting the same answer as you have been getting for the last 5 minutes and trying to find a way in getting the information you need out of them which may mean phrasing your question differently.  Also in the care home a few residents suffer from hallucinations, sometimes this can be a symptom of an underlying health problem/disease/illness, but for some it’s just something they have developed.  The worst thing to do is be stubborn and say ‘No that’s not true, you are being silly’ because firstly that is rude and you shouldn’t talk to patients like that and secondly, some may become hurt by it, then you have an even bigger problem on your hands in having to make them happier again.  So either just partly agree with them and try and move onto a different subject or just try and carry on with the conversation you were having before.

The experience I have gained so far at the care home has been brilliant, being able to see how the same illness can affect different people very differently is fascinating, especially with dementia.  It has made me want to study medicine even more because it has shown me how varied patients are, how you have to be the detective in figuring things out and knowing they won’t make it easy for you! But that’s the interesting part! However, it has also made me understand that at this stage of life making sure the patient is as comfortable and as happy as possible is very important, and you will never believe how happy the residents are when the doctor of the home walks in, it’s as if all their troubles and problems have been lifted from them.  Most of the time there is nothing you can do, but it seems just the simple trick of actually listening to their problems and taking a real interest in them makes most of the things go away, and this is because they have lifted it off their chest and are they are so much happier for it.  I want to be that Doctor that could make one very unhappy resident smile just because I have made them feel I was doing something and really cared about their problem, even if I couldn’t cure them of a a disease like dementia, they would know I was their and would always do the best I could for them.

 

 

Optical Coherence Tomography (OCT)

I was looking on the bbc website and I found a report on how OCT has been found to be useful in finding out how far along MS (multiple sclerosis)  has developed caught my eye as one of my family members has  MS.

OCT is an eye scan which works similarly to an unltrasound, the main difference is that it uses infrared light waves instead of normal soundwaves.  The infrared light waves are used to find the distance of eye structures.  It has 25 times better resolution than other eye scans and machines and it allows you to see the retina in a large amount of detail as well as the layers of the retina.  This means that you are able to see if there is a thickening or thinning of the retina.  OCT also allows for the nerve fibres in the retina to be viewed and shows any damage to them.

MS is caused by recurrent immune reactions in the spinal cord and brain.  The myelin layer that covers the nerve fibres (axons) is damaged by these reactions which leaves the nerve fibres open to damage.  Due to the damage to the nerve fibres people with MS  experience problems with balance, vision and usually movements. MS can be diagnosed through MRI scans as these show up any scar tissue in the brain.  The scar tissue is caused by new layers of myelin forming over the nerve fibres, however these are usually thinner and weaker and so are more easily damaged.

However, the problem with MRI scans is that we aren’t quite sure at which stage of MS these scar tissues begin to appear visibly and OCT is thought to be able to detect one of the earlier signs of MS.  This is because the nerve fibres in the brain have the myelin layer over them but the nerve fibres in the retina don’t have this layer.  It has been suggested that therefore the nerve fibres in the retina will show damage first because there is nothing to protect them.  This could allow for an earlier diagnosis which would allow the person to undergo treatment to slow down the disease (unfortunately there is no cure for MS yet).

Nonetheless, this trial has only been done on 164 people which did show that the ones that had earlier and more active MS had thinning of the retina.  OCT could also be used to find out how fast the disease is progressing as well as helping to diagnose people with it, this could help improve the quality of life for some people as they could have the possibility of changing the treatment they are on to see if that will slow down the disease anymore.  However more trials need to be done on a larger number of people to find out whether OCT really does help show the extent of MS.

Flu is no ordinary virus!

I have been reading the New scientist magazine and I found an article on, “Diabetes link to flu in vulnerable people”.  It was found that flu could possibly lead to Type 1 diabetes.  I know you are all thinking, ‘but Type 1 diabetes is genetically inherited’, however, it can also be triggered by the environment, such as by the flu virus.  The article talks about how the flu virus can cause diabetes in vulnerable people which is through confusing the immune system so much that it turns on the pancreas, breaking down the pancreatic cells.  Without these pancreatic cells insulin is unable to be produced allowing a continuing rise in blood glucose concentration (type 1 diabetes).  This isn’t a recent suspicion it has been around since the 1970s.

It is thought that what happens is when the killer T-cells are shown a piece of infected tissue to learn how to recognise it they also recognise these pancreatic cells as well and so think they should destroy them along with the virus.  Sometimes our bodies are wonderful machines, but just like machines they can make a small mistake which leads to a huge consequence.  Now we need to try and stop this!

Research was done and two of the studies stood out.  One showed that when birds were infected with the virus they usually developed an inflamed pancreas.  Many of these turkey’s suffered from diabetes due to the damage to the pancreas from the virus.  This research was followed by one carried out on a human pancreas where they injected two common flu viruses into the tissues, both viruses multiplied and colonised the tissues really well, especially in the insulin-producing cells, said Ilaria Capua.

We know that usually the flu virus only stays within the lungs and gut, but sometimes it can seep into the blood stream and so has access to the rest of our body.  It has also been shown that there has been a rise in Type 1 diabetes from people who have been infected with the flu virus relatively recently as well as there being a recorded rise in Type 1 diabetes after the 2009 swine flu pandemic.

As we are aware of this possible trigger of Type 1 diabetes we are able to do something about it.  The people who have a genetic tendency to develop this type of diabetes can been given the flu vaccination to immunise themselves against it.  This could stop a small percentage of people developing Type 1 diabetes which would be a great achievement to say the least!

This was an article from the New Scientist magazine on 10th November 2012.

 

Hello! 🙂

On the 19th-22nd December I went to the medlink conference at Nottingham Univerisity.  It was certainly one experience I will never forget!  It was extremely helpful and I now feel more prepared  for the difficult but very interesting journey to medical school!

In my blog I will be posting about articles and news in the science and medical world that has interested me, as well as my thoughts and opinions on them.  I will blog for at least 20mins every week and will also talk about work experience and volunteering that I have had the chance to do.

I hope people enjoy the blog and possibly find the articles and news I am talking about interesting to them as well 🙂

Emmeline