Sunday, 15 December 2013

Books from an ex-medical student...

With no medics in my family, I had been searching for a mentor that could give me advice on the entire process of becoming a doctor. Thankfully, I came into communication with a student that had dropped out of medical school a year ago; this was after realising that her parents wanted her to follow that career, but it was not something that she wanted to pursue. I became increasingly aware of what a major commitment studying medicine is, and that you need to make sure that your decision is thoroughly thought through.
I was delighted to be given many of her books from the period she was studying medicine. Anatomy has fascinated me since childhood, and now I had detailed textbooks of human anatomy! In my spare time I use these books for pleasure reading, but also helping my A level subjects by providing a deeper knowledge base for subjects like biology. The books included: Vanders Human Physiology, Human Anatomy, One stop doc- Cell and Molecular Biology and Clinically Orientated Anatomy. I have now grown to realise the sheer academic rigour required for studying the subject, and this continues to inspire me.

Monday, 19 August 2013

Photos from my trip to India






 I was invited to give a speech at a local school, talking about exercise's beneficial effects on the body. As I've played regionally, the students were very interested in my hockey playing. I was, however, surprised to hear that there was no female hockey team there (only male). After my speech, one of the school's governors announced that 'a female hockey team would be set up in my honour. Interacting in lessons and talking to teachers gave me insight into Indian culture a lot further.





 There were obvious differences between the hospital in Jodhpur and NHS hospitals in the UK.













 Me and a few of the doctors from the accident and emergency equivalent.


Sunday, 18 August 2013

Adventure To India

I was on the train- destination Heathrow- and it finally dawned on me: I was going to India alone. The previous year I had researched medical intern-ships abroad, I was desperate to see healthcare in a developing country after completing some experience in the UK. I found a place for this; based in Jodhpur in the Royal state of Rajasthan, and I was not hesitant to book a month there (the chance to observe live surgeries was just to tempting!).

Upon my arrival, in contrast to the culture shock I was warned of, I fell in love with India. I was, however, dubious about the hospital I was staying and working in as the tuk tuk pulled up. It looked nothing like the generic western hospitals I was used to, it looked more like housing! But as I walked in with my supervisor, I was reassured by the friendly doctors and familiar equipment that, I would not feel entirely alien here. My room was at the top of Raj Hospital (A/C, thankfully); I was told about the outline of my work days here and soon felt quite at home. Shortly after my orientation around the town, I collapsed to sleep; the time, travelling, and especially the long changeover in Delhi,  had got to me.

My first day was the most difficult. It was frustrating not being able to understand Hindi (the language spoken in Jodhpur) although the staff did exercise their varying levels of English gladly on me. As I spent an hour or two on the wards, I couldn't help but compare the practice of medicine to that of London. The standards of hygiene were the most shocking; a very lax attitude relative to what I was made accustom to at home. However, the quality of the practice seemed equal- minus the fancy equipment and strict regulations- patient records format was very similar. Raj was a private hospital, as all but one government hospital in Jodhpur were; you had to pay for your own treatment etc, but had a lot more power over when you wanted to receive it. You could chose when you wanted your surgery, it was not dictated and with a sometimes horrendously long waiting time as in the NHS system. I was eager to make it into theatre that day, to see my first ever live surgery. This happened to be a hysterectomy, which turned out to be the most common one performed in my time at the hospital. (I will complete further posts giving detail of the surgeries).

I think that the greatest culture shock I experienced was the relaxed attitude of the staff. Team surgery only got going once a patient arrived after their game of cards was complete. Mobile phones were never turned off; in fact, they answer them during the surgery. By the end of my time I was fully trained at answering surgeons' mobiles and holding it to their ear as an unconscious body lay before them. Saying this, I must reiterate the shear skill of the people in theatre in that hospital. I adored surgery as a speciality-the results before you were shown, hence making the job very satisfying.

My time there was somewhat disrupted by illness. I ended up being treated in the the same hospital that I was working in, by the same staff that I was shadowing. Although only semi-conscious at the time, I remember being put on drips on three different occasions; but thankfully my new friends were on hand to take photos so I can look back now at myself on hospital beds there! I now have experience of healthcare in India from both sides, this can only be taken as benefit in my mind...

The experience I gained was near incomprehensible. I saw 24 surgeries all-in-all, including 2 impressively quick cataract surgeries and one electric burn case. The breadth of my observations highlighted the awe- inducing skill of the individual surgeons, as well as giving me insight into different procedures. Living in India for a month taught me some valuable life skills; I was in an alien country, with an alien language, working and exploring an alien area. I picked up very strongly the 'I know a man' attitude, with people going to specific doctors as well as other things; but also the strong business mindset of practically everyone there. Poverty was prominent, with many people living on the street and begging as well as the need for more orphanages.

I saw two caesarean sections! Births right before my eyes. And it was truly awe- inspiring...if a bit too similar to the 'Alien' films...Now I was never warned of what specific operation would be carried out whilst I was there; so, as you can probably imagine, seeing a woman being cut and ripped open and baby roughly pulled out came as a bit of a shock after witnessing numerous commonplace hysterectomies. I have to say, that the usual vague romance to what childbirth may seem, was completely unfounded in my personal experience. But nonetheless, I felt very privileged to be present as a proud woman entered into the role of mother.

The electric burn case: a boy aged 8 with burns on his head, abdomen and left leg. This was the only surgery I saw where the anaesthesia suppressed respiration, so intubation was needed to pump air into the patient's lungs manually. In preparation for operating, the staff- as usual- covered the body to expose only the areas needed; but by the time this was completed, I must say that the entire operating theatre looked like a scene from 'Saw'...very cool but odd. I noticed the head injury which left the skull exposed, as well as the right thigh also left exposed- I guessed that a skin graft was going to be performed. And I was correct, after wounds were cleaned a split thickness skin graft took place; this involved shaving a thin layer of skin from the thigh to use on the skull. I was shocked by the use of hammer and chisel on the skull before this happened...and I still have no idea why that was necessary. I was particularly inspired by this surgery as there was such a large team involved in this one patient- everyone had their own roles to ensure the best care.

I managed to get in contact with the most well- known eye surgeons in the area, and went to shadow him whenever I could. I saw cataract operations, using microscopes the surgeon himself was using to operate. These surgeries could be done under only local anaesthetic, and no stitches were needed. This was precise surgery on a minute scale. Lignocaine was used as local anaesthetic injection and once in theatre, the cataract was broken up and removed before a new lens replaced the old. What was even more impressive, was the time in which these were performed- always under 10 minutes. This type of operation is particularly important in third world countries, where cataracts are common- but the poverty means that many can't afford treatment. Luckily, I discovered that there are charities to help with those problems and that the surgeon I was with  worked with them to provide care.

When my position of regional hockey player became known, I was invited to a local school to give a speech on sports and exercise. I was greeted traditional, by the end of the welcoming ceremony I was fashioning a bindi and feeling sufficiently special. As an experienced public speaker, I don't usually get too nervous in that kind of situation, but the fact that I needed a translator meant that I was unaware of what was actually being communicated to the students. For some reason, I think my explanation of exercise's effect on the brain involving nurerogenesis and BDMF was missed out. The hall was decorated with welcome greetings to a 'Miss Catriona Ailsa Osborn Moar', with photographers and various important people (the chairman for Mayo etc). Flowers and a trophy were presented to me after I was shown around the school, oh and of course after being near force fed various goodies as with anywhere I went. Autographs were wanted by the students, which was challenging in itself! After I left, I was informed that an all girls' hockey team was to be set up in my honour, and that I would be welcomed back to the  school any time.

I managed to fit in some travelling and site seeing, too, but this is a little irrelevant to this blog...although amazing too!



Monday, 22 July 2013

Work Experience, QE Hospital

I have grown up with many joint problems, encountering numerous rheumatologists and physiotherapists. It was natural, therefore, to be curious about rheumatology as a subject area. I managed to secure a week of work experience with my grandmother's rheumatologist (I am a carer for her) at Queen Elizabeth hospital. I was fortunate enough to be in contact with the doctor in question via email beforehand, so that I could arrange to visit other departments, too.

Rheumatology
It did not take me long to realise the systematic approach to clinics run there. I was struck at how repetitive the work seemed at times, but also at how grateful patients were to receive this kind of specialist help. The patients' desires were fully taken into account: if treatment was uncomfortable, it would be changed; if they suspected a problem, tests would be done. Trust is key from both sides. After every consultation a voice recording was made about it, verifying information and suggesting treatments- this would then by typed up and sent to those concerned (namely the patients, GPs, etc). After only about half an hour on my first day, I was made aware on the hierarchy at the hospital. Every senior member of staff was also overseeing juniors, providing advice and support. I like the learning-teaching aspect.
I found out about the intertwining of social services; most common was the unemployed that were 'looking for a reason not to get back to work by coming here', wanting to be deemed not capable- even though they may well be. I found this very interesting, my mother being a social worker herself, I have an interest in this mixing with medicine. 'Saying work is harmful has no evidence, but unemployment is bad for your health...you can see that' I was told. I was made to reflect on a wider societal contact with medicine.
Most commonly occurring cases I saw, were: vitamin D deficiency (I have this, too- supplements are prescribed) and osteoporosis- I was given information handouts that patients were also given, which proved to be very insightful. I knew that I wanted to pursue medicine as a career.

Ultrasound
I was lucky enough to be taught how to use an ultrasound machine, as well as shadowing a specialist in radiology. I was enthralled by the application of physics in this specialism; able to use my A level knowledge to explain the image produced. Depo- Mendrone was used- this injection contains methylprednisolone as the active ingredient, and is a corticosteroid; it was a number of uses. Upon arrival here, I was told the reasons for using ultrasound- it is: cheap, dynamic, and live. It was also emphasised to me the importance of sharing knowledge and understanding in a hospital setting; there is a 'complex multidisciplinary team' and  many junior doctors were about and senior staff helping where possible.
Using a small (transportable) ultrasound machine was great fun; I was able to look at my own joints and was taught how to look for inflammation as a marker of rheumatoid arthritis. Fortunately, no arthritis for me!

Dermatology
The morning I spent in a children's allergy clinic here, showed me quite a different practise of medicine. I was made aware of the pressures of managerial and administrative responsibilities of senior members of staff; sitting in on a meeting about funding opened my eyes to the NHS as a business as well as a service.
On thing that particularly concerned me, was the use of paper work instead of using computer systems...'it's 2013, why can't we use computers like everywhere else?' one of the doctors remarked; I agree entirely, but this just showed me that there is always room for change. I did, also, find the constant referrals quite frustrating, as you would never see one patient though the entire process- however I realised that it was this teamwork that lead to effective management and treatment for the patients.
Witnessing consultations with children present was interesting, to say the least. It was a more complex procedure due to the number of people responsible for making decisions about the child... as well as the noise levels of certain individuals in the room. But it was obvious how much the doctors enjoyed working in paediatrics. I was left alone on a mnuber of occassions to speak to the famiies, getting to know personal stories and accounts of allergies and their lives; this was very enjoyable.
Ordering tests was a major component in this clinic. HISS (hospital information support system) and WinPath (laboratory information management system) were used frequently. But these old computer systems seemed to me, over-complicated when one universal system could be used for the entire NHS... But funding, of course, is an issue.

Fracture Clinic
My time spent here, was my favourite of the entire work experience.This was probably thanks to the incredibly enthusiastic senior orthopaedic surgeon that I was shadowing. He taught me so much anatomy and background information of patient's conditions in between consultations- I spent the whole day frantically making notes on everything I could. The passion shown was truly inspirational to me. I was shown how to interpret basic x-rays and spoke to patients about their various conditions. He was giving me a day in the life of a medical student- lectures and shadowing and tutorials all in one. This day alone assured me that studying medicine would be the best choice of my life.
Here, I was also displayed the gratitude of the doctors toward the nurses; they seem to be an irreplaceable part of the team, doing so much of the groundwork.  It was highlighted to me, the new pressures that an ageing population is putting on the NHS- would more doctors need to go into fields such as geriatrics and in the future? There is a 25% chance of me living to 100. And 20 000 neurones are lost per day after the age of 25!

My time at the hospital did nothing but confirm my passion for medicine as a vocation. I gained so much knowledge of day-to-day life as a doctor and met real patients to discover their own stories. I am just so looking forward to studying at university! (Hopefully).

Saturday, 13 July 2013

The Rise and Fall of Modern Medicine

The Rise and Fall of Modern Medicine
This book really set-in-stone my desire to study medicine. Providing much information on the major surge in medical achievement in the post-war years, it provided a perspective to view the practice of medicine today. Not only the achievements themselves, but also how they came about, such as by chance or drug screening. The latter part of the book focused on the possible limitations of medicine in modern society, and that it's future cannot be certain. And that the perpetual advance of medicine, that many believed would continue in the 'age of optimism', has come to barriers more recently. Resulting in a changing subject of both social and intellectual integrity.

Saturday, 8 June 2013

Playing Hide and Seek with Tumour Cells

Immunotherapies in cancer treatment attempt to stimulate the body's own immune system to reject and destroy tumours.

Tumours in some people with advanced melanoma have disappeared after treatment with drugs that force the cells out of hiding. With this done, the patient's immune system can act to destroy the tumour, as it can now recognise the cancer.
Tumour cells tend to outfox the immune system as they find ways to camouflage themselves; they grow a ligand- a surface molecule that activates the PD-1 receptor on the T-cell, this fools the immune system to think that tumours are normal tissue.
The drugs used were one of three types of antibodies.T-cells (playing a key role in the immune response, matured in the thymus) should be able to spot these cancer cells as foreign and therefore destroy them. They act by blocking the interaction between the PD-1 receptor and the ligand.; thus allowing the immune system to recognise the tumour as cancer cells.
Another immunotherapy is to genetically engineer a patient's T-cells to recognise and destroy cancer cells. These engineered cells attack any cell with a CD19, which is a unique surface molecule to cancer cells.

Sunday, 12 May 2013

Epilepsy's Unpredictability End?

This story now has a personal interest to me- I have recently been suffering from seizures and have now been referred to a neurologist to investigate the possibility of having epilepsy.

A new implant in the brain can warn of seizures minutes before they occur. Without this, epilepsy is incredibly unpredictable- putting people with the condition at risk, it is hazardous and disruptive. The warning of an imminent seizure helps sufferers stay safe.
Seizures can be described like earthquakes: you can't prevent them from happening, but if you predict them you can prepare to mitigate the effects. The implant is a patch of electrodes that measure brainwaves- it learns patterns of activity that indicate a seizure is about to happen. As this happens, the implant signals to a receiver implanted under the collarbone; alerting the person activating a handheld device with warning lights.
This means an enormous change in the independence and confidence of sufferers.