UK CAT Test

Yesterday I took my UKCAT test, and was very pleased with my result, which was better than I had expected. These are some of the books I used to practice with. 

image from http://media.johnwiley.com.au/product_data/coverImage/45/11199658/1119965845.jpg

This book was useful for practice mock tests, but I used it less than the others.

image from http://ecx.images-amazon.com/images/I/41hJjKtD7rL._SY300_.jpg

This book was probably the most useful with very similar questions to the real test.

Now I just have to decide where to apply….

Kidney checks could save lives

I was really interested in the news here  and here about kidney checks saving around 12,000 lives a year, as I just spent a week at Southampton and Portsmouth hospitals shadowing consultant nephrologist, Kirsty Armstrong. Lydia Spilner’s life could have been saved if her acute kidney injury (AKI) had been prevented through the provision of basic clinical care, such as hydration. You can read more about her case here.

image from http://www.channel4.com/media/images/Channel4/c4-news/2013/Aug/28/28_kidney_g_w_SML.jpg

Work experience in Nephrology and Anaesthetics

This morning I was back at Y Hospital in a living donor clinic with a specialist nurse who was talking to a lady who wanted to donate a kidney to her son. It was really interesting to learn about how the mother and son’s care has to be completely separate and they have different doctors to ensure confidentiality and the best care for both patients. The nurse had to first make sure that the lady wanted to donate her kidney for the right reasons and that she wasn’t being pressured into it by her son or anyone else. She explained how everything had to be done legally in the UK because in some countries people are paid to donate their organs and there have even been some cases where people have been divorced and demanded their organ back from their partner. The nurse also assured the lady that she could change her mind at any point if she decided she no longer wanted to donate her kidney, and the doctors could always find a medical reason for her not to go ahead if she didn’t want to tell her son that she had opted out. The lady had to answer lots of questions about her health and previous operations or illnesses, which could affect whether or not she was able to donate her kidney. The nurse explained what would happen and all the different types of tests that she would have before the operation. She also explained how the operation would be carried out and all of the risks. She would also have a separate team of surgeons to her son so they were focused completely on her. I found it really fascinating to listen to especially when the nurse asked what the lady would like to do with the kidney if it was not able to be implanted into her son; she could have it put back inside her, donate it to a different patient on the national donor list, she could donate it for medical research or have it disposed of. I learnt how important living donors are; they help to save so many lives and improve people’s health as well as saving the NHS money, because patients with successful transplants no longer have to be treated with dialysis.

After the clinic I went over to the gastrointestinal department to shadow an anaesthetist, which I really enjoyed. I had to change into scrubs and put on an x-ray clip to measure the amount of radiation I was exposed to and a protective apron, which was very heavy. Before going into theatre, I went with the anaesthetist to talk to the next patient. I realised that you have to have really good communication skills as an anaesthetist, because you have only a short amount of time before the procedure to get information from the patient and also gain their confidence and trust. It was interesting to see how all of the nurses, surgeons and anaesthetists prepared for the operation by cleaning, opening new equipment and measuring out drugs. When the patient came in the anaesthetist reassured them and checked that he had the patient’s consent before injecting a general anaesthetic, which put them to sleep. He had to put a tube down into the patient’s throat to control their breathing, and the patient was given extra oxygen because the anaesthetic had slowed down the their heart rate. It was fascinating to watch and I was able to look right down inside their throat at their epiglottis. The surgeon was then able to start operating and although he was using an endoscope which wasn’t too invasive, the patient was elderly and there could have been complications so a general anaesthetic was used. The doctors and nurses explained to me a bit about the anatomy of the intestines and I could watch on the screen as the endoscope reached the bile duct. The path became a lot narrower, so the camera couldn’t get through and instead a needle was used to inject dye and it showed that there were some cysts blocking the duct. The surgeon removed the cysts using the endoscope and the bile came out. Fortunately the operation went very well and the anaesthetist was able to give the patient a drug which woke them up again after about ten minutes. Another anaesthetist was in the recovery ward to look after the patients who’d just come out of the theatres, explain how the operation went and make sure that there were no complications. I really enjoyed shadowing the anaesthetist, I thought that it was really fascinating and varied, because they see so many different patients of different ages and with different illnesses, and they have to work out how best to treat them individually. They have a position of responsibility, because they are in charge of monitoring and looking after the patient during the operation.

DFID investment to save millions of lives from malaria and other diseases

Today the UK Government announced an investment into pioneering partnerships to save millions of lives from the world’s most deadly but preventable diseases including malaria.

The Department for International Development (DFID) is investing £138 million over the next five years into nine public-private partnerships to support the development of new drugs, vaccines, insecticides and diagnostic tools to prevent, diagnose and treat malaria, HIV, TB, diarrhoea and other neglected tropical diseases.

image from https://www.concern.net/sites/www.concern.net/files/media/event/dfid-logo.jpg

You can read more about it in a DFID press release here and in Malaria No More’s policy section here. I think it’s really important to continue to develop new technologies to fight these deadly but avoidable diseases. You can support my fundraising for Malaria No More at my Just Giving page here.

Work experience in Nephrology

I spent two days of my work experience in nephrology at X, which I found fascinating because I was able to compare the department to the one at Y. Although X is a large teaching hospital, there is not an adult dialysis unit so very ill patients who need dialysis are sent to the intensive care unit for blood filtration, or transported to Y.

Both mornings I spent at X started off with long ward rounds and many of the patients we saw were the same, so it was interesting to see the continuity of patient care.

One of the patients we saw was in a side room, because they’d had an infection, which had affected their kidneys. Although the patient’s kidneys had recovered they had picked up a hospital-acquired infection and it had made them very confused causing them to attack one of the doctors. I saw the patient a couple of days later and they were much better and they apologised to the doctor. This made me realise some of the difficulties of a career in medicine and highlighted the importance of keeping everything clean to prevent hospital-acquired infections.

One of the patients we saw needed to have a catheter put in to their kidneys for the doctor to measure how much water they passed, however they had refused. The doctor couldn’t go against the patient’s wishes because everyone has a right to autonomy so the doctor had to do their best for the patient with the information they had, even though it wasn’t entirely accurate. It was interesting to watch how the doctor interacted with the patient, explaining to them why having a catheter would be beneficial and asking them again if they would consider having one put in, after explaining that they couldn’t work out exactly what to do with recordings that weren’t accurate. The doctor explained later that the patient would probably be in hospital for a while because they wouldn’t get out of bed and move around, which was essential for their recovery, so they would need rehab.

Another patient was memorable, because they were quite elderly and had kidney problems as well as bladder cancer, which couldn’t be treated. The doctor had to have a difficult conversation with them about the likelihood of their heart stopping in hospital and whether they would want resuscitation. It’s a sensitive topic and the doctor was really empathetic. The patient hadn’t ever thought about what they would want so they were going to think about it and talk to their family. The doctor explained that if they were resuscitated they could survive, or they could end up on a ventilator with a poor quality of life. This made me think about ethical issues and what to do when a patient is dying. If the patient hadn’t expressed clear wishes then the doctors would act in their best interests and follow the correct path.

There was one patient who had become blind almost overnight after a kidney infection and dehydration. Many of the doctors were surprised because the patient had completely lost their vision and they hadn’t seen a case like it before. Although the patient had recovered from their infection, they would have to remain in hospital for a while longer until they had the right support and rehabilitation to adjust and return home. They were being cared for not only by the doctors and nurses but also occupational therapists, who had to assess their flat and make sure it was safe. This made me realise that while many patients in hospital have recovered from their illness, many require rehabilitation and after-care before they are able to leave.

Another patient we saw on the ward round had just come into hospital and when the doctor tried to ask them questions they seemed confused and didn’t reply. When a medical student spent some more time talking to them she found that the patient was more responsive if she talked loudly and they thought the patient could be a bit deaf. The doctors found it hard to get a history from the patient who still didn’t move or talk much at all so they tried to contact a relative who’d brought in the patient. The relative was able to give a history to one of the junior doctors, describing how the patient was an alcoholic and visited the pub everyday. 

I really enjoyed going on the ward rounds and seeing lots of patients who were so different and who each had individual needs. 

Work Experience in Nephrology

This morning I started my week of work experience in Nephrology at Y. When I arrived at about 9:00, I went to a multidisciplinary team meeting where doctors, surgeons and nurses were discussing some of their patients and planning their care. It was interesting to see how they worked together to organise treatments. I went on a ward round with a consultant nephrologist, registrar, junior doctor and a medical student from X. It was really interesting to see all the different patients and to learn that most of them had other illnesses as well as renal problems, such as diabetes. The first patient was friendly and I went back in the afternoon to chat with them. They were diabetic and had just had their leg amputated, but they said that it was a relief because they felt a lot better immediately after the amputation. I felt their arm, and I could feel where they’d had a fistula put in and they explained more about preparing for dialysis. After lunch I went to the dialysis unit where there were lots of patients who all had dialysis treatment for about 4 hours 3 days a week. I talked to a lot of the patients who were really friendly and eager to chat – they told me that dialysis took up so much of their time and energy. Some were waiting for a transplant, but others had already had transplants, which had been rejected. The patients had to limit their fluid intake, but one patient hadn’t and so they felt really unwell and breathless. Earlier I had seen a patient who needed to start dialysis and had got quite upset because it’s such a big change and it really affects your lifestyle. Later I went to the outpatient’s clinic and saw different types of patients. One patient had previously had cancer treatment, which had caused the ureters to become blocked so they needed stents put in to the ureters and medication. Some patients had chronic kidney disease and had to think about going on dialysis in the future. One patient wasn’t English and needed some tests but it was difficult for them to understand what to do because of the language barrier. The doctor had very effective communication skills and used actions to help the patient to understand.