Getting Left Behind and Vanishing...

It's been a little over a month since I last blogged, and it's not been the best of months which is why I've not been blogging, although I'm still around on twitter. My grandad's been really ill and has been in and out of hospital and generally a big worry for me. My sisters got A level and GCSE results. No idea how my sister's A levels went and I don't dare ask but my baby sister did fantastically in her GCSEs so I'm really proud of her. I've come back to university for a couple of weeks because I've had some clinical placement hours to make up from when I was ill and things were strained at home because my mum's been so stressed.

It's generally been quite lonely because my friends I had at home have all moved on and the few friends I have at university have been home for the summer. I kind of feel like everyone is moving on and leaving me behind. I'm still the same shy, insecure person I was when I was at school. I'm still permanently doubting myself and my abilities, and it feels like life is passing me by and that I'm missing out on things that should be normal for someone my age, like going out with friends and just actually enjoying university life.

I also feel like i'm being left behind in terms of the blogging world too. I used to have a really fab blog but now, it seems like it's pointless. I have little motivation to write because I get little back from this blog now. The number of comments have dwindled and I just don't think it's worth the effort any more. It seems more successful and popular blogs have more popular people behind them and they're streaks ahead of me. Let's face it, who wants to read this when you can read blogs by people like Mark Glencorse and Stuart Gray? I guess I'm just going to have to decide whether I want to even blog any more, because quite frankly, it just doesn't seem worth it, and too many people keep trying to shoot me down and stop me blogging.

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.

An Invitation

As I'm really busy at the moment with possibly life changing decisions to make, revision to do, still feeling ill, and putting up with my family, I'd like to invite somebody else to write a post for me. Would like it to be about an experience as a patient, a medical student during your training or a paramedicine student during your training, or someone in a medical career coming across something particularly interesting.

Submissions to dysdiadochokinesia@hotmail.com by midnight (UK time) tonight preferably for the first post, and midnight Thursday for the second post of the week.

Look forward to reading them!

Thank You

I wanted to say thank you for all your thoughts, comments and prayers, and kind messages that you have sent me. They are all playing a part in my decision making, and I'd be grateful if you'd keep them coming and spread the word for me. I really appreciate your kind words, and they're all helping me on my way to reaching a decision. I think I'm nearly there, but I just need those last few bits of help and reassurance to keep me on the right track for me.


Thank you, all you kind people, and thank you social media.

Faye
xxx

Hardest Decision

So, I'm a week on, and nothing much has changed. I'm home for Easter and hating it. Family life is difficult and I don't fit back in anymore. To top it off, the boyfriend is in Australia so I can't even talk to him all that much because of the time difference (Time zones suck!!). I'm quite lonely here and all I want to do is sleep.


I'm having a real rethink about my life at the moment. I'm not really happy in medical school and I really don't know if it's the right thing for me. I always wanted to be a paramedic, but my school refused to send off the UCAS form with Paramedic Science on it, or write me a reference for a student paramedic position. My parents refused to support me in that career, and I knew that nursing and midwifery weren't for me, so I decided to just go for it and apply for medicine. I didn't think I'd get offers, let alone get the grades, but I did, even if it was by the skin of my teeth. 


Since then I've been struggling with everything at medical school, aside from the practical things. The science is way beyond what I can cope with without doing stupid amounts of work. I no longer have a social life and the stress is having an impact on my health. I love the practical stuff, and fast paced patient turnaround, but other than that, there is very little keeping me here. I haven't made many friends, I don't go out or even dance anymore (I used to be a dancer on the university Dancesport team) and I just don't see a reason why to carry on. I keep scraping through exams other than the practical ones and I'm just not enjoying much of it at all.


I'm thinking about leaving it all and going to be a paramedic. It's what I wanted to do in the first place and I think it's really where my heart's at but I just don't know. My parents would hate me for it, I don't think my boyfriend would really be all too happy about it and I just don't know. I can't decide. I've agonised over it, shed plenty of tears and lost a lot of sleep over it. It's a very difficult decision but one I will have to make soon enough.