Learning :)

General medicine is exhausting! If it wasn't so interesting and exciting we all would have crashed by last week. I had my phlebotomy session in Monday and felt so relieved afterwards! I was in the out patient pathology clinic from 8am to 12pm with Lali from RPH, it was nice to have a familiar face there as we were both a little nervous! The man in charge (Vishnue) was really helpful with a sense of humour which eased our nerves a little and he took us through a few of his patients as we watched his technique and listened to his tips. Then it was our turn to try out on a fake arm first.... then real patients!! I felt confident enough but was still trying not to shake, these patients aren't necessarily the healthiest and some had come from upstairs where nurses could not take the blood because they had tricky veins. I did 8 bleeds in total and got a vein each time!!! I had a little trouble switching tubes as i would draw the needle out ever so slightly which caused a little superficial bleed but only enough to be mopped up by a cotton wool ball. I will remember that if no blood comes out at first, withdraw ever so slightly in case you are on the wall of the vein (i did that once) then pull/anchor the vein inferiorly with your other hand. If blood does not still come out, pull out and try again. One man was worried i would miss but the staff member watching me said 'if she misses you can punch me'... no pressure there!! But i told him i would get it and thankfully i did! It was a good experience i hope i can practice again soon while it is all fresh enough in my mind :)

Tuesday 4 of us had a really good morning following an endocrinologist in the outpatient clinic called Dr Walsh. He specialised in thyroid disease and first took us through the thyroid examination, i learnt about Pemberton's sign, how to assess the eyes for thyroid related pathology and also about squatting to test for myopathy - a few additions from last years thyroid examination. I was amazed at how common Grave's disease is in the population, we were able to palpate some goitres too and see what they feel like.

That afternoon I also had a good chat to a really nice older man and his wife and got a history from them. They were both in their 80's but so lovely and positive, i hope i can be like them when i am older, apart from a minor problem bringing Mr into the hospital they were quite fit and healthy :)

Today we had a trip to the ICU... first impressions made me feel uneasy it is such a scary place seeing the patients so out of it with tubes coming from every direction with nurses just watching them in case anything changed. We met a man who was alert and looking quite well compared to the others, you could tell he wanted to get out of there and was feeling uneasy and thankfully he was moved down to the wards where he came under our doctor teams' care, i look forward to chatting to him he had a nice sense of humour.

Unfortunately we faced a sad moment when we met a patient we have been seeing for the past week with aggressive cancer. We have watched him deteriorate quite fast and seeing him today was quite a shock, i don't know how long he will last.

We met a nice man this afternoon who was really nice to us med students and let our consultant take a tutorial using his case for us. The man had the first case of jaundice i have seen, he was literally yellow!! We took turns doing part of the history and i

started the physical examination, i am always uneasy doing it in front of people watching me let alone doctors but did OK. It was also the first time i had palpated an enlarged liver so now i finally know what it feels like and what to look out for. The man had Crohn's disease which was related to his symptoms now causing an autoimmune primary sclerosing cholangitis where the biliary tree becomes inflamed and scarred blocking the bile duct and causing obstructive jaundice. The man is on the waiting list for a liver transplant, i hope to follow him up and see how he is going! It is quite rare though as only 4% of people with inflammatory bowel disease develop this condition.

I have managed to fit in some exercise in the afternoons as we are starting too early to fit in in the morning. Today we started at 7.30 and finished at 4 so i went for a run but felt lethargic! We are starting to get a little ill from being exposed to all the bugs in the hospital as well as running around tiring ourselves but hopefully we will pull through :) I better get back to some study all the same!