Some Advice

This is a question I was asked a few weeks ago, via my formspring page. I thought it might help those students starting 6th Form, or about to start thinking about the dreaded UCAS (University and College Application System).

As a second year student, what advice would you give to anyone considering the same career path that you have chosen?

Think VERY carefully about whether this is REALLY what you want to do - you will be devoting your entire life to this degree for 5 years. You will lose your social life, and it will be hard to make and keep friends. Discuss it with your adults, your tutors, your friends, your family, ask questions to people like me who have already been through this (I'm happy to answer emails from anyone about this - dysdiadochokinesia@hotmail.com). It is hard, physically, emotionally and mentally.

It's a rewarding career but if it's not right for you, it will wear you down. Also - pick the right type of degree for you. PBL doesn't suit everyone, nor does a traditional course, nor a course with clinical placements from the word go.

Get lots of experience - being a doctor isn't glamorous like on Casualty or ER, it's hard graft and very demanding, and can often be very unglamorous - particularly when you're examining stool samples or putting maggots into leg ulcers! It's incredibly demanding, tiring and stressful. It can be upsetting, it can make you angry, get you frustrated. You'll experience more emotions in your first few weeks of clinical placements than you ever thought possible. It's a lot of hard work, and won't be much like you expected it to be. Do some work as a healthcare assistant or something in a hospital, do lots of shadowing.

If you're serious about it, go on lots of open days, ask current students about the courses and what they think about them, work hard at your A levels and GCSEs, and pick the right subjects for the courses you have in mind - DO your research. If you don't think you're going to get the grades, look at Access to Medicine courses, or Medical Schools that offer lower grades depending on what school you're at, or Medical Degrees with a Foundation Year.

Do lots of practice interviews, find out what they're like at the universities you've applied to - they vary a lot. For example, UEA is an OSCE style interview, whereas St George's University in London is a traditional interview with 3 consultants and a medical student firing questions at you.

But ultimately, do what YOU want, and what you think is going to make YOU happiest.

Good Luck

Future HEMS Doctor?

When I joined Twitter, I started out as MedStudentFaye. That's me, that's who I am and what I am. Plain and simple. I soon realised thought, that I wasn't happy just being me. I wanted to aim higher. I wasn't happy just being mediocre or average. So, I became FutureHEMSDoc, in order to give myself something to aim for. However, this year, I've been doubting myself. A LOT. I haven't been at all happy at UEA, that's no secret. The course isn't really right for me and I haven't made many real friends at all on my course, or even at UEA in general. I feel isolated and alone a lot of the time, despite having a wonderful boyfriend (NorfolkDocToBe) but he's usually up in Manchester, but at the moment he's the other side of the world. I love him to pieces but him being so far away is currently very unhelpful! I don't at all begrudge him the opportunity he has in Australia, and am really pleased he's enjoying himself and travelling and learning a bit more about himself and what he wants to do as he advances in his medical career. He's made for medicine. I'm not so sure that I am.

I've had several lengthy discussions with many of my good friends on twitter about all of this - mostly Mark Glencorse and his lovely wife Sandra, as well as iMedicFF (who has put up with me crying far too much!) who have been fantastic in helping me decide what is best for me, and what I should do. (Thank you guys! Really appreciate all the lengthy conversations - I know I'm a pain in the butt, but you've helped me out a hell of a lot). But in the end, no matter how much I discuss this with people, it is MY decision. I changed my twitter name so there was no pressure on myself to be FutureHEMSDoc, but at the end of the day, I wouldn't be me if I didn't push myself. For now, I'm going to work as hard as I can at this medical degree, because I'm not one for giving up. If I pass the year, I'll carry on and work until I get to where I want to be. I'm not particularly bright, and I'm not popular or happy on this degree, but once I'm qualified, I can do so much with it, and I just can't waste that opportunity. I've got this far, and I couldn't forgive myself if I threw that away. If I fail the year, at least I gave it a go and did my best, but I'll then go and be a paramedic. I'd be happy in that job, I know I would. I love every single aspect of it, even the paperwork and the picking up drunks on a Saturday night, but I think I'd always feel like I lost the opportunity to do more. I'm not at all putting down paramedics and what they do - the VAST majority of those that I've met have been fantastic people, highly skilled and far better than I would ever be at that job, but as a doctor, I could do many more different things, and maybe even change the way a few things work for the better.

As I said in my first post, I'm stubborn, opinionated and I care a hell of a lot. Because of that I'm going to do my best whatever I do. I'm going to keep going out observing with paramedics as much as possible (if you're a paramedic or tech who wants an observer, give me a shout!! I'd love to go out with as many different people as possible). I'm going to keep working as an HCA in my hospital, and I'm going to speak to ambulance services about student paramedic jobs, and look into paramedic science degrees, because I'm still a little unsure.

I'm crying as I write this, not because I think I'm making the wrong decision, but because I think, for now, I'm making the right one for me, even if the world seems to be passing me by because of it, and because I've put a lot of people through my crying and worrying and stressing over all of this.

To everyone who has helped me with this decision, including those who I haven't mentioned by name: Thank You. You don't know how much help and support you've been. Honestly, you don't.

To everyone who has put me down and told me I can't do this, and told me to quit and that I'm useless and  a waste of space, and that I'll be a rubbish doctor: I'm going to prove you wrong. You may put me down, and say awful things to me, but it's just making me stronger. I'm going to FIGHT until I have nothing left.And I'm going to do what's right for ME.

Guest Post - I Can Still Hear the Crying

Still have a lot on my plate at the moment, so this is here courtesy of Will (@bungeechump on Twitter). Having not long seen my first in hospital death, this was something that was something that I could really relate to. It's a well written piece and something that I wanted to share.

As graduation races towards me, the knowledge that I will be a "real doctor" in a few short months has made me pause for reflection on my time in medical school. Death is something that medical students are expected to deal with easily. Often this isn't the case. They say you never forget your first cardiac arrest as a medical student, but in practice I found this not to be true – I will never forget my second.

The first cardiac arrest I participated in was fairly uneventful and as morbid as it sounds, unremarkable. An eighty-two year old gentleman who has suffered an out of hospital unwitnessed VF cardiac arrest. He was not a well man to start with, his swollen legs indicative of heart failure and the mere fact that he was over eighty put him at a disadvantage. I stood in the resuscitation bay with one of the SHOs and the registrar. The ambulance was about five minutes out. I noticed the two doctors were wearing gloves and had donned aprons so I followed suit. I knew that statistically the chances of surviving to discharge following an unwitnessed out of hospital cardiac arrest were less than five percent, so I wasn’t expecting miracles. I wasn’t sure what to expect.

A slam on the double doors and in rolls the patient, the paramedics pushing and a nurse pumping on his chest as they wheeled him into the bay. He was already intubated and had good IV access, so that was one less concern. I took over the chest compressions. The sensation of ribs cracking beneath your hands and vibrating up into your shoulders is horrible. It sounds like somebody breaking a large wooden branch in the next room. After each crack, the chest becomes easier to compress until eventually it is soft like an old chain link fence.

The defibrillator was attached. A familiar broad complex, irregular waveform tachycardia emerged – ventricular fibrillation. Stand clear, oxygen away, shocking! The man’s entire body tenses up, his arms come up in the air – but then instantly flop back down as the electricity subsides. Continue chest compressions. This cycle continued for about ten minutes with adrenaline injections interspersed. The man’s Grandson arrived and said an emotional goodbye and we stopped resuscitation. I calmly left the room and went back to trying to insert a cannula into a little old ladies forearm.

I was remarkably unbothered by what had just happened. I was suddenly dubious of what they say about your first arrest and how it always sticks in your mind. That was until my second arrest, several days later.

The man had walked into the department. He was a hospital porter and felt unwell and so had wandered down to A&E. He was in his mid-fourties. He looked awful and was complaining of a several day history of headache, breathlessness and general malaise. It was quickly decided that this guy was far too sick to just be sat in majors, and he was transferred to resus.

His level of consciousness was falling and he became unresponsive. His respiratory rate shot up and he was gasping for air. This patient was very unwell, and the anaesthetist was paged so we could get a definitive airway. All of a sudden, he doesn’t have a pulse. Chest compressions begin, and the anaesthetist is here – but the intubation is proving difficult. His oxygen saturations are falling and all the machines are beeping. Finally the tube is in, and compressions can resume.

His chest was very hairy - far too hairy to get a good contact for the defibrillator pads. One of the nurses scurried off to find a razor while somebody else had the bright idea to try and wax his chest with one of the sticky defib pads. This didn’t work. The razor turned up and the pads were on with good contact. The heart trace showed sinus rhythm. Oh shit. Pulseless electrical activity – a bad thing to have if there is no obvious reversible cause, because it is an unshockable rhythm and you just have to keep pushing adrenaline and hoping for the best.

Time flashes by and we still don’t know what has caused the arrest. The most likely culprit was a massive heart attack, or a pulmonary embolus. However we can’t give clot busting drugs because of his history of a headache – if he has a subarachnoid haemorrhage the thrombolytics will turn his brain to mush, but his pupils can’t be assessed because he has had so much adrenaline and atropine so it’s impossible to rule anything out and therefore impossible to really treat anything. Vigorous CPR was attempted to try and bust up a clot mechanically if one was present (cue more ribs cracking, and my arms aching the next day).

This all happened at the weekend, so none of his relatives were in work and they all turned up rapidly until there was a gang of about eight of them in the resuscitation bay within twenty minutes. His wife and sister are holding his hand, sobbing into each other’s embrace, calling out to him and asking him to wake up. His son turns up and stands next to his head, intubated with eyes wide open and staring, flopping around lifelessly as we jump up and down on his chest, telling him to pull through so they can go to the match next week together. His elderly Father stands at the foot of the bed. He fights back the tears, occasionally slapping his son of the legs and telling him to ‘pull through’ and stop messing around.

A pause in the CPR and suddenly a familiar rhythm emerges on the screen. Pulseless ventricular tachycardia. One of the nurses pulls the family off him, and a shock is given. His wife nearly falls to the floor watching her husband convulse off the bed as 120J of electricity pass through his lifeless body. They huddle back round him. I am taking turns doing the chest compressions with one of the nurses, in short cycles so we don’t get tired and therefore not push hard enough. The A&E consultant is talking quietly to the anaesthetist at the head of the bed. CPR has been on-going for 45 minutes and there was been no real improvement. A pause in chest compressions to check the monitor reveals a very irregular agonal rhythm.

The consultant turns to the family and introduces himself. He tells them what we are all doing to try and save their beloved. He tells them we have done all we can but he’s not showing any sign of improvement. He tells them he doesn’t expect the patient to recover. His wife pleads with him, please, just keep going for a little bit longer, he’ll pull through - I know he will.

We all know he won’t pull through. We all know that he has been receiving CPR for so long that all the centres of his brain that make him the person his relatives know and love, are dead. Even if he did get back to sinus rhythm, he would be a vegetable and would end up in intensive care (also known as the cabbage patch) for several years, just waiting for the pneumonia that will kill him.

The consultant looks round at all of us involved in the resuscitation attempt. Then he turns back to the family. I’m sorry, there’s nothing more we can do, we have to stop. The monitors are turned off, the oxygen is disconnected and chest compressions cease. We all take a step back, the sound of multiple pairs of gloves snapping off spells defeat.

His family rush towards him and hold him, all of them sobbing. All we can do is stand and watch. I slip out the side of the room and walk back towards the main area of the department. I walk past an angry young woman shouting at one of the nurses about how she’s been waiting for four hours, and I feel angry. If only she had a clue as to why she’d been waiting for so long, I’d bet she’d go and sit down and shut right up.

I can still hear the crying in the background. I sit down in one of the cubicles and gather my thoughts. Now this was an arrest that I will never forget.

It's A Strange World

Those of you who follow me on Twitter will know that I've recently spent 9 days in hospital. It was an interesting experience to say the least. It was very up and down and incredibly emotional. I cried a lot, I got angry a lot, and I learned who my friends are really and truly. Being ill enough to be in hospital teaches you a lot.


It's a very strange experience being a patient in your own hospital. On the first two wards I was on, I knew the majority of the staff, and even managed to have a catch up with a few of them, but suffice to say, it was very odd not being in control of anything. Even through the pain, I wanted to answer ringing call bells.  I wanted to help the other patients who  looked more ill than me. I wanted to help everyone, and be the one to answer the call bells instead of being the one pressing my buzzer. I got a real taste of how horrible and scary and disorientating and confusing and just how strange it is being a patient. This is something I'm going to remember in future. I don't think I could ever fully appreciate what it was like in the hospital as a patient before now.


Throughout the whole time, my best friend and my boyfriend (The Manchester Medic) were both very supportive. They even made my birthday fun, despite me being in hospital and in pain, and feeling generally terrible. I felt like a fraud to begin with, because everyone else just looked so much more ill than I thought I did. It was only on the second night did I realise how ill I actually was. I'd fought this illness for a month before admitting defeat and letting myself be admitted to hospital. Medical Students are well known for the phenomenon that is "Medstudentitis". We all think we have every disease we study. Something that comes from having too much knowledge I guess. Except, I'd refused to admit that I really was ill. I kept saying I was fine until the point where I just had to give in.


I learned a lot from being a patient, and this is something I'm going to share over the next few days and weeks.


And for those of you wondering about my health - I'm still in pain, I'm still exhausted and I'm still ill. Nobody knows what's wrong but it's definitely not an infection or anything urological. If you want to play guess the diagnosis, email me and I'll give you a run down of my history and symptoms. Would be interesting to know what differentials people come up with!! Let me know by leaving your differential diagnoses in the comments of this post.

Little Blip and Nightmares

Apologies for my little blip last week. I still feel like crap, but normal blogging has now returned. (But related to that, I would love if you would let me know that you're reading, either via Twitter or a comment or email. Anything really! Would love feedback on the blog, and requests for things you want me to post about).


As those of you who have been reading the blog back will know, I have a really keen interest in Emergency Medicine. I love anything adrenaline fuelled and fast paced, and I even love treating the minor injuries and drunks etc in A&E (although I much prefer "real" medicine, I love it all!). This means that a lot of the cardiovascular medicine I'm studying at the moment is of great interest to me. I enjoyed my defibrillator training, teaching on arrhythmias and ECGs, teaching on MIs, teaching on AAAs. All of it I find really interesting, and geared towards the medicine I like and want as a future career. So, why am I having recurrent nightmares about being involved in my first cardiac arrest?


I've seen cardiac arrests before, but not been actively involved other than fetching and carrying. I've seen my first in hospital death, and yes it affected me, and I was upset by it, but it's the nature of this job that people will die sometimes. We all have to die eventually. What I don't understand is why I keep waking up from this nightmare panicking, and why throughout the dream I am absolutely petrified.


The nightmare starts with me following a consultant on a ward round. We go to a patient behind a curtain, and find them unconscious. Then begins the resuscitation protocol. I know exactly what happens, I've seen it before, I've been trained to deal with it. Yet, in the nightmare, when the consultant asks me to start compressions and to then start the defibrillation protocols, I freeze and panic, and see the patient slipping away before me. I get pushed out of the way, see a failing resuscitation attempt before me, hear in the distance the consultant ask if everyone agrees to stop and call the time of death. This is the point where I wake up. I wake up panicking and breathing far too quickly, and absolutely petrified.


I couldn't do anything, I couldn't move, I couldn't get myself to do what I've been trained to. I doubt in real life it'll be like this, because often, when I'm stressed then that intrinsic knowledge kicks in and I move and do what needs doing. I don't understand why I'm having these nightmares, because it shouldn't happen like that, and the likelihood is that, as a medical student,  probably won't be involved in an active resuscitation attempt for some time. But yet, that niggle is always at the back of my mind every time I'm in the hospital. I don't know why, and I hope this nightmare will go because I'm exhausted from waking up every night at least once. I guess I'll just have to beat this panic out of my subconscious.


As a weird aside, according to my housemate, I've been sleep talking. Mostly having conversations with my boyfriend apparently. Maybe this is all my stress? It's creepy, that's for sure!! Just hope I don't start sleepwalking!

Nerves

As I'm doing a cardiovascular placement in the hospital at the moment, part of this encompasses stroke medicine. In August my grandmother had a massive stroke, and as a result will be in a nursing home for the rest of her life. Because of this, I'm really nervous about this week's placement with the stroke team.


I worked on the stroke unit at the end of August once I'd come back to university. I thought I'd be fine and able to distance myself and to cope with it all. I was wrong, and I spent most of the day hiding my tears from the other members of staff. I was able to do my job, but I struggled to keep composed when I had a spare moment. I have a fair amount of free time this week. 2 hours a day is scheduled into our timetables. I'm worrying that I'll break down and be a mess. I'm hoping that I won't. In any case, this is the reason I'm still awake right now.


I guess I'll just have to take each day as it comes and keep on going.

Ill. Again.

For those of you who know me, I have the world's worst immune system. Not a quality you want in a possible future doctor, and in an auxiliary nurse I know. I've been ill on and off for the last week, until tonight when I felt absolutely horrific and was in huge amounts of pain. I'm not brilliant at looking after myself when I'm stressed and this time I'm no different, but this time, I've had a lot more to think about, and there are people I've needed and wanted to look out for, so in order to do that, I ignored my illness.


Turns out, I'm bloody unlucky anyway. I have a chest infection and a kidney infection. Double whammy. What joy!! Anywho..... bedtime. I feel like crap.

An Introduction

Hi. I'm Faye. I'm a second year student based in Norfolk, and am an Auxiliary Nurse/Healthcare Assistant in one of the hospitals I train in. My ambition is to become a consultant in Emergency Medicine, followed by becoming a Doctor on a HEMS aircraft. I'm stubborn and opinionated but I care a hell of a lot. I work hard (or at least, I like to think I do) and I am determined to achieve my ambition.


This blog is my third, having previously had 2 under pseudonyms. This time, I intend to be completely honest about everything I write. I will still change identities to protect the confidentiality of any patients I may mention, but other than that I intend to keep everything as near to the truth as possible.


This blog will be my place to rant and moan, discuss things, write down what I'm thinking and feeling, what I've done, what I'm doing and what I intend to do and am going to do. It's primarily for me, but feel free to read. I like sharing with people. I've seen first hand the power of the internet and what it can do for people, and believe it is a very powerful tool.


Feel free to join in with anything I discuss, and feel free to send me any requests for posts. I won't offer medical advice, I'm not trained to do that yet, but I am happy to offer advice on getting into Medical School. After all, I didn't go through it that long ago.


Anyway, enough of my rambling. Welcome, and I hope you enjoy what's to come.


Faye x