Easter Holidays

UK universities seem to have a rather unique term system. The 2nd semester is much long than the 1st (Jan to May, compared to Sep to Dec). Year 1 medical school is pretty generous with their breaks. I'm currently having 3 weeks easter holiday, a much needed break after continuous mugging. Thereafter, 3+ weeks of project work, without any other lessons. Then another 3+ weeks of study break before a barrage of exams...

So technically, year 1 cirriculum has finished. And it ended off on a good note.

My last lesson was a ward session. In pairs, we headed out to our assigned wards, to our allocated patients, to practice all the clinical skills we have learnt thus far.

It was my partner's turn to take the patients history, and it flows like this:
Presenting complaint
History of presenting complaint
Past medical history
Drugs & Allergies
Family History
Social History
Systematic enquiry
Ideas, concern, expectations

Our patient was so chatty that I didn't get a chance to do the 2nd part, physical examination. Unsatisfied, i headed back to the hospital after our debrief, while my classmates strided off into the early spring for their holidays.

B.S was sitting in the vascular wards, her left foot bounded up. A visible black marker drawn across her shin, though the ulceration and red tender skin was creeping superiorly. Her ulcers are progressing upwards. Now with all the time i had, i pulled a chair beside her bed, and started chatting with her. She shared the hardship and adventures of her life. And like a jigsaw puzzle, piecing the stories together in my mind, she felt like more than just a patient, and more like a friend.

We spoke till the sun was no longer shining through the windows, and the seagulls were back to their routine and irritating squawkings. It was time to go. So i wished her all the best; afterall, that's all i had to offer.

Medical school has loads to offer. But admist all the structured learning and clinical session, we need to know how to recognise and sieze an opportunity when it arises. B.S was my patient, but through the additional time i had with her, she unknowingly become my teacher. There is so much information u can gather from simply observing and listening, rather than diving straight into clearing the checklist for history taking, and the procedures of physical examination. For example:

When she shook my hand, her grip was loose and her fingers cringed - Osteoarthiritis
As she spoke, she occassional pause to catch her breath. The muscles in her neck and shoulder tensed, meaning she needed additional effort. - Chronic obstructive pulmonary disease
Swollen ankle - Heart failure? Vein blockage?
Large number of bruising - On steroid medication? blood-thinners?
Cloudy rim around the iris, and excess skin deposits around the eyes - Corneal arcus & Xanthelasma = High cholesterol

I'm grateful that Aberdeen medical school starts clinical from year 1. Clinical skills require time to develop. In the end, that's what makes us doctors.

Reflection Essay

So... We are made to do a reflection essay every once in a while. Just thought i share what i had written / typed. It felt more like a story though:

My first ward experience

I was fortunate to have a regent who was willing to have me shadow him on his ward rounds, even though it was only our first visit. At that point of time, I have yet to have the official ward opportunity, so that was my first contact with real patients. As I trailed behind my consultant, it was a mixture of both excitement and uncertainty. This was the reason why I came to medical school, and it was starting that very moment. Yet I was feeling inadequate as a 1^st year medical student, who had barely any clinical knowledge.

“Follow me, and do as I do,” the first advice the cardiothoracic surgeon gave me before he proceeded to apply the alcohol hand sanitiser. I jumped onto it instantly, proud and relief that I knew how to perform the first task. Hand-washing never felt that good before. By then, we were gathered before an elderly man, propped up comfortably on the bedside chair. My consultant began the conversation with an update on the patient’s upcoming surgery. Soon, I got lost in the many new jargons that were used. Keeping a straight-face, I attempted to keep up with the case summary of the elderly man. It was all panic from within. I constantly hoped that my regent would not throw a question at me and stun me. And thankfully, he did not.

My regent started with the auscultation of the heart, and had me follow-suit. I inched towards the patient, trying to look confident; in hope that it would compensate my incompetency. A smile, my first greeting, all seems well as the patient gave me consent to have me examine him. Still confused as to what the patient’s condition was, I mimicked my regent’s actions. And the moment the stethoscope was pressed against the patient’s chest, my eyes lit up. It was the sound of saw against wood, preceding the ‘lub’ heart sound. Containing my excitement, I calmly described what I had heard. Thereafter, my regent taught me how to use a stethoscope, such as how to amplify the sound or how to hold the bell.

As we took our leave, my regent began explaining the details to the patient’s condition – Aetiology, pathophysiology, clinical features, management and treatment. Everything felt much easier to understand as I mentally pieced together the information with my personal encounter.

In retrospect, I had a very eventful first ward experience. The patient was very cooperative, and it did not seem to bother him that a medical student was examining him. In fact, as I listened to his heart a couple of times thereafter, his assuring smile conveyed a form of satisfaction; that he as a patient may also be a teacher. Being able to put into practice clinical skills was satisfying. I can only imagine that without them, I would have been much more ill-prepared and nervous. Furthermore, a very patient regent who was keen to teach made the whole experience a very fruitful and memorable one.

Presently, we are on the topic of Cardio-vascular system. And the moment ‘Aortic Valve Stenosis’ appears on the slides, the distinctive sound of blood flow turbulence preceding S1, ringed in my mind. Moreover, I picked up on skills on how to use the stethoscope effectively, and I had been practicing and imparting them on to my fellow colleagues. In addition, I have decided to bring a little notebook for documenting new information whenever I visited the wards; for experience is the best teacher.