In 2010 I shared this picture via Youth Journalism International of a skeleton in our faculty dressed up for the Fifa World Cup. (Click the link and scroll down to the middle-left.)
Today we had a rather long clinical skills session for our anaesthesiology block.
This little guy met us there. I laughed:
Radiology tutorials make me sleepy. I don’t find them boring, strangely… they just send me straight into narcoleptic episodes. But this one was fun:
Basically, neonatal X-rays (yes, they do periodically expose those little things to X-rays) can be divided into different presentations.
Grainy, Streaky, Blacky, Fluffy, Hazy, Bubbly and Dotty. And of course, Snow White.
Grainy and Hazy chest X-rays are characteristic of Hyaline Membrane Disease, which is caused by surfactant deficiency in the newborn. This leads to low lung volume and is quite common in premature infants. It’s often described as a ground-glass picture.
The consultant didn’t really elaborate on Fluffy and Dotty, so if you know them be sure to introduce me.
Streaky chest X-rays are associated with Transient Tachypnoea of the Newborn. Unlike HMD, TTN is more common in term infants without labour complications. The disease is said to be mostly self-limiting. These X-rays are said to resemble “streaks”, usually with a very prominent illustration of the transverse fissure of the right lung. TTN is also sometimes referred to as a “wet lung”.
Blacky is just that: a very black lung, indicative of a pneumothorax.
Bubbly is my favourite because he displays exactly like you would expect: bubbly. Unlike Grainy and Streaky and Hazy which really might as well be the same damn thing. Bubbly is caused by a diaphragmatic hernia – not fun, but easy to recognize.
And Snow White? Generally an under-exposed X-ray, that looks snowed-under and all white.
Obviously I can’t walk into an exam and say, oh this is Bubbly and blah-blah. One must actually be able to know the clinical relevance. But that’s not asking too much for a doctor and this remains a fun way of making the learning process easier.
This past week, Stellenbosch University has been celebrating the successes of the Hope Project (about which I have written before).
In two years, the SU has made leaps and bounds of improvements in the fields of healthcare, legal aid, agriculture and science. For more on all that, you can check out these two sites or read the virtual paper here.
I’m particularly enamoured by the story of Hillary Lane, who was born with Cerebral Palsy and had significant gait disturbances and pain such that she preferred not to walk.
The SU Faculty of Health Sciences has a Motion Analysis Centre, and a lot of their upgrades have been made by means of the HOPE Project. Using the technology at this centre, Lane’s gait could be improved in such a way that she completed the NYC Marathon in 2011. 42 Kilometres. Something I, fully able-bodied, am not sure I want to attempt.
I like this. I think it’s great for the Allied Health Sciences (who are often scorned by old-school doctors) and I think it is great for the CP-community.
But, this is not my story to tell. Watch the clip below to hear more about it first-hand.
Last week, the fifth years had their last ever day of class. For the next eighteen months, until they graduate, they will only be doing clinical rotations.
It is a longstanding tradition here for fifth years to dress up on their last day of class and ambush all the other classes. The general theme is “What would you have been if you weren’t studying medicine?”
I’ve seen a lot of things, from hobos to blue-skinned Avatars.
These are two of my friends who dressed up:
It’s weird to think that in a year’s time, that will be me. I don’t even know what I’ll dress up as. There were many alternatives, to be honest…
On Friday, members of the Student Government (including myself!) were invited to attend Semester at Sea‘s Open Ship at Cape Town Harbour.
This is us being all touristy-like:
This is the ship:
Semester at Sea is just that: it allows students the opportunity of a semester abroad… abroad in various places. It is affiliated with the University of Virginia, and has excellent courses available.
And I want to go. Next year, 9 January to 25 April.
The itinerary includes San Diago, Hawaii, Japan, China, Vietnam, Singapore, Malaysia, India, Mauritius, South Africa (!!!), Ghana, Morocco and Spain. The great thing about SAS is that they take “service learning” very seriously. So you don’t just visit these places for the fun of it; you also visit them to learn.
Here’s the other awesome thing: The Academic Dean for the specific voyage is Dr Sharon Hostler. She is a professor in pediatrics, and one of her niches is outreach to rural underserved children.
This Friday, I am going to meet with my faculty’s assistant registrar. Our school doesn’t readily allow students to just leave for three months… BUT, I have a plan! It is quite a complex plan, but it will work, and it will make me a better student and a better doctor and this the only thing I want to think of right now.
Which is making studying extremely difficult.
They supposedly do this thing at the beginning of medical school:
Look to your left, look to your right. Only one of you will graduate in the allotted time.
I don’t remember them doing it for our class, three years ago. I used to think it was because they were committed to getting us all to the end of med school in one piece.
Nowadays, I think I may just have bunked that lecture. Or fallen asleep during it.
Of my original clinical group, only two of us remain. One person may not even be in my year anymore, soon.
I have seen brilliant medical students not only fail, but get excluded from their course. These are students whose notes I have used to study for exams. These are people who taught me to draw blood or put up an IV or resuscitate a patient.
I understand that medicine is a tough field. I understand that doctors hold the lives (and livelihoods) of their patients in their hands. But I have to wonder if we are assessing whether one is a “good doctor” correctly – if people like me get to stay, and people like them have to leave.
This is South Africa. We cannot afford rotten doctors. But nor can we afford to produce so terribly few doctors.
I am seeing some of the best doctors being removed from this profession before they are even part of it. And there is nothing I can do about it.
Today, hordes of brand new First Years arrive on our campus. Wild-eyed and bushy-tailed, I wonder if they hear the seniors murmuring, “Run now, while you still can.”
It was not too long ago that I was there… three years ago, I was a scared little kid, stepping into a world where the maturing process would be escalated far beyond my then-eighteen years.
Tomorrow, I will be giving the newbies and their parents a speech. I’m still trying to polish it, but I know that it must be short: I remember close to nothing of the Chairperson’s speech in my first year.
So I’ve been thinking a lot about what I would have liked to hear as a vulnerable (and gullible) little first year.
There are many things… but one thing sticks out:
Medicine will take so much from you. It makes you study longer and later than most of your friends. It works your fingers to the bone, literally. It places you at physical and psychological risk. It shows you things that the human psyche is not equipped to understand.
Medicine will take so much from you: cling to your little bits of individuality.
I have a bright pink stethoscope – and who’s business is that? I like the colour and it makes me happy. It appears to make my patients happy too.
You want a neon stethoscope? Get one – make the decisions that remain fully yours.
The inspiration for this document came during my second year while studying for an end-of-block test. At the same time, the then-first years were studying for Pathology, aided by “Le Document”. Somewhere in this time period I looked at a fellow second year, threw my hands in the air rather dramatically and exclaimed,
Le Document pour MB.ChB.II can be found here. It focussed mostly on holistic wellness during a tough theoretical year. Third year is a whole new ballgame, with students finally set wild in the clinical environment. Theory modules are unfortunately still a reality and at my school, third years are haunted by Neurosciences and Musculoskeletal System.
I throughly enjoyed this year and fortunately I had some older friends who had some handy tips. Thus, some advise for new third years:
Do not freak out if you struggle to draw blood. Practice will make perfect. Accept any challenge, but look out for patients with good veins – they will boost your confidence.
Do not freak out if nurses know more than you do – chances are they have been practicing longer than you have been alive. Respect them: they can either help you a lot, or make life extremely difficult for you.
ARVs are not a joke. Stressing for an HIV-test isn’t either Never fool around with a contanimated needle or specimen.
OBSTETRICS: wear a mask when delivering a baby, amniotic fluid does not taste very nice. Always remember tbe infection risk. Wear goggles or a visor and an apron too. Note that if a lady comes in crowning it is not always possible. Remember that the mothers do all the work, it is your job to help them. Remember you are working with lives, always. If told to deliver a multipara, check twice with a doctor or matron.
Ask to take a picture of your first baby, you will not regret the memory.
PAEDS: little humans are resilient, but not made of steel. Be sure you know how to do procedures on them – do not attempt to draw blood from a little human with a syringe. Do not perform a procedure in their cot – it is the only safe place they have. For your own emotional well-being, try not to get too attached. And beware the paediatrician - just because they love kids does not mean they love you.
INTERNAL MEDICINE: this rotation is competitive and exhausting. Try to be on your supervisor’s good side. Take initiative. Look interested. Go the extra mile. Wear comfortable shoes. Read up about all cases on your firm, not only those of your own patients. These are good principles anywhere, but especially important in Internal.
Never underestimate the importance of a good history and a basic physical. If you don’t know what to do, start there. Have a method to your investigation, and a structured presentation.
FAMILY MEDICINE: Do not scowl at this rotation, there is a remarkable load you can learn here , especially if you learn to respect the multidisciplinary approach. Be well prepared for site visits, take sturdy shoes and hand- sanitisers. Take the time to understand you patients’ psyche and sociology, there are not many blocks that cater for this.
SURGERY: not my favourite rotation. Apparently doctors fall into one of two groups: those who love surgery and those who despise it. Surgeons can be scary and temperamental, but try to learn as much as possible. Attend tutorials even if it is easy to slip out. Assist in surgeries even if other students are willing to relieve you of your duties. Do not stress about assisting, you will be told what to do. Most importantly, know how to scrub in and practise your suturing.
With so much practical, theory becomes mundane. Do not lose sight of your goal. Attend classes. If you get bored, look for blogs, student sites or books to pique your interest. For example, The Brain that Changes Itself promises to be a great addition to neurosciences. A Life in Pieces is exceptional for psychiatry. Three Letter Plague as well as Disease are gripping. Musculoskeletal system requires great effort. Colour in, draw, use your friends’ anatomy and don’t let the skeleton stay in the closet.
Third year is wonderful and can ignite your passion for medicine once more. However, you must take good care of yourself. Sleep often, eat well.
I suppose it is appropriate to share the good news on Thanksgiving, even though we do not really celebrate the holiday in South Africa: I passed my third year final examinations.
If you have been following this blog, you will know that I started the year with the will to be a “better student” and it did not always work out too well. Third year ended up being a little tougher than expected. Regardless, I am thankful that I get to enjoy my short summer holiday without studying for a rewrite, and I am thankful for the myriad of people who have supported me throughout this year.
When on holiday (or procrastinating), I like to pretend that med school hasn’t swallowed up all of my creativity. This was the product of my recent dip:
I am thankful for all those who stood by me and told me that no, I wasn’t an idiot.
And I am thankful that the first three years of med school are over.
Now, on to the next three.
The day you start Med School, everyone tells you that it is nothing like Grey’s Anatomy.
And when, two years later, you are finally unleashed upon the poor unsuspecting state patients, you realise: it’s exactly like Grey’s.
Except, funnily enough… in surgery.
I finally made it to my third year abdominal surgery rotation. It is not really fun.
I suppose it may just be the luck of the draw, but I find it boring… pancreatic debridement, sigmoidectomy, rectopexy, appendectomy by the thousands.
Here’s some gut, here’s some more gut, oh look! There’s an organ! Oh, it’s rotten. Let’s cut it out!
And there is lots of… excrement. Let us not forget that. Somehow, to me, it is worse than placenta.
And the surgeons? They are quite temperamental.
Like I said, maybe the timing is just all wrong, but so far… I am not enjoying surgery.
I admit, it makes me a little sad. I have never been particularly set on it as a specialisation, but the field is so glorified. I cannot help but fear that not enjoying it, might mean I am sub-par.
