chemicallvs

8th June 2007

I've managed to completely screw up my body clock - I don't think it knows what time it is, what day it is, and it keeps wanting to party like it's 1999.  You know who I blame?  My stupid surgery work-book, which was due this week, that's who!  Oh and myself, because I compete at a world level in procrastination.  I'm really not too sure how much sleep I've had this week but I know right now that I've only had 3hrs in the last 2 days and, surprisingly, I don't feel too bad.  Just don't jump in front of my car....I may not react till next week.

Every time I start a new rotation I promise myself that I'll start assignments early and keep up to date with lectures so that I don't end up in a major panic in the last week of term.  But it never happens - especially when I've missed half my rotation due to being sick.  So yay for WMHL keeping me awake in the wee hours of the morning that my work-book was due so I could finally get it finished.

So what have I learnt in the last week or so of surgery?

Well today I watched a septoplasty being performed.  Basically it's a procedure used to reconstruct/re-build the nasal septum (that bit that divides your nose into two holes).  The patient had damaged hers during a motorcycle accident, which resulted in her left nostril becoming entirely occluded (blocked).  I also spent the morning at the local children's hospital in the Ear, Nose and Throat (ENT) clinic, coming to the realisation that tonsillectomy (removal of the tonsils) isn't such an easy and relatively safe procedure as I'd once thought. 

My tonsils have been giving me hell my entire life and I'm always pushing my Doctor to let me get them taken out (thinking that the operation is so common and not much of a big deal).  But now I know otherwise.  This poor little 6 year old boy had his tonsils taken out at another hospital and was referred to this children's hospital because he had developed an infection at the wound site in his throat.  It turned out that he hadn't been given any antibiotics prophylactically (before the surgery) to decrease the risk of infection.  But when he was sent home with antibiotics to combat the infection he'd developed, the infective 'slough' that was covering the wound came off and he started bleeding.  He arrested on the way to the children's hospital and although they revived him, he'd lost so much blood by the time they got there that he's now in a vegetative state (brain dead).  I guess that it's important to realise that even common surgeries carry significant risk and even though you might be keen to get out of the hospital after an operation as quickly as possible, if your Doctor wants you to stay longer, there is generally a very good and important reason why.

I'll end off with a few lighter stories that should be labelled under the WTF?! category.

I was observing an emergency repair of a perforated small bowel.  All of a sudden I could smell popcorn and I kept turning around trying to find who the hell was eating popcorn around the operating theatre.  Then I realised that the 'popcorn' smell was actually the odour given off by burning human tissue - the surgeon was using an instrument called a diathermy to cut through the abdominal layers and it 'burns' as it goes to cauterise (close off) bloods vessels to minimise bleeding.  I swear, I'll never walk into a cinema thinking the same thing about the smell of popcorn again.

'Scrubbing in' isn't as simple as washing to make sure your hands are clean.  It's this entire process of washing that needs to be learned, and once you've washed certain parts of your hands/arms you can only rinse in a certain direction and you can't come into contact with anything that isn't sterile (you end up turning taps on and off and squirting soap with your elbows/upper arms) and the process needs to last for a certain amoutn of time and then you repeat.  One of the guys in my team ended up having to restart scrubbing 6 times because he just kept forgetting and he'd accidently touch something that wasn't sterile - you felt sorry for him at the time but it's pretty funny when you think back on it.

I have come to realise that the male gender have a strange fascination with sticking things into their anus.  Unfortunately, many of them don't realise what a powerful muscle the anal canal is and that, in its case, what goes in must come out, isn't as easy as it sounds.  We had one young man who used a deodorant can, but when he pulled the deodorant can out, the lid came off and got stuck, so it had to be 'retrieved' at the hospital. 

I didn't see this case but one of the senior Doctors was telling us about another young man who came into the ER, visibly distressed and sporting an erection.  Taking his history, it was discovered he'd been playing with a vibrator and it had gotten stuck.  When he tried to get it out, it just kept getting pushed further and further inside.  Unfortunately for him there is a phenomenon called 'reverse peristalsis' whereby things get to a certain point in the large intestine and get 'sucked' backwards (small intestine direction).  Furthermore the poor guy had left the vibrator on.  So when the doctor listened to his abdomen to check for bowel sounds, he could hear this 'buzzzzzzzz'ing noise.  The Doctor telling us this story said it was the most awkward phone conversation he's ever had with his consultant surgeon as to why they needed an operating theatre - they ended up having to surgically remove the vibrator from his small intestine.  The lesson?  Hold on tight or have some sort of handle if your gonna play with toys.

Ahh so surgery wasn't too bad.  I think the whole experience was ruined by my illness.  But I have talked to my team's consultant surgeon and he's said I can come back at the end of the year and hang out in the OR with him, which I'm really looking forward to (surgery is amazing to be a part of).  But yeah, I don't think I would have gotten through this rotation without my friends pulling me out of the hole I'd ended up in, so thanks guys/girls! I owe you my life

One week of holidays, exams and then I start my psychiatry rotation!  Should be fun!

My way home is through you xx

28th May 2007

I am so amazingly tired that I may even fall asleep before I finish this post!  But I promised someone special that I'd write something new and I like to keep my word hehe.

Right, well I made it to the hospital this morning for 8am ward rounds...luckily.  I was sort of asking for trouble by continuing to drive my car with the fuel light on but it didn't break down so I was happy.  I can't remember if I explained about ward rounds, but basically the medical team (consultant, residents, registrar, interns, med students, nurses, physiotherapist) walk around and visit the patients under their care.  We check how the patient is doing, make sure all the vital signs are stable (blood pressure, pulse rate, oxygen saturation) and that the patient is afebrile (not spiking a fever).  It's also a time for making changes to drug regimens, ordering further investigatory tests and creating a management plan to ensure the patient dosn't spend longer than necessary in hospital (if you've ever stayed in a hospital, the desire to get out quickly, which is often brought on by the food, is pretty strong).  Ward rounds can take up to 3hrs, depending on how many patients are under your teams care, so always eat breakfast and wear compfy shoes, because it is a lot of walking around, climbing stairs and standing.

Anyways, ward rounds went smoothly and we finished in 2hrs.  We were sent off with the new intern to take some blood samples from a lady with a central-venous-line.  A central line is basically a tube that enters the right side of the neck (can go into the left side, but you risk damaging something called the thoracic duct) and goes into either the subclavian or the internal jugular vein.  It acts like a blood tap when you need to take blood quickly from a patient.  You just insert a syringe without a needle and draw the blood back into the syringe.  The blood can then be put into vials and sent to the pathology department for investigations.  I felt so sorry for the poor intern who was showing us how to do this procedure.  She kept saying how important it was to make sure the lids were on the vials really tight otherwise they have a tendency to come off and spill blood everywhere.  Well...one of her lids wasn't on tight enough and we ended up having to mop a decent blood trail from the patient's bed to the mailing room (room where specimens/other stuff you want to send in the hospital is sent via little cylinders that travel in a chute to different levels of the hospital - pretty cool to watch).

Just as we finished sending the bloods off, one of the nurses came to get us because one of the patients was having difficulty breathing and complaining of chest pain.  Luckily when we got there one of the senior registrars was already dealing with the situation.  I was amazed at just how calm the registrar was, despite the fact that the patient was screaming.  As there was a chance that the patient had possibly thrown a blood clot resulting in a pulmonary embolism (the patient was bed-bound which increases the likelihood of blood clots forming in the legs - these clots can then break apart, becoming emboli, which then travel through the blood vessels until they lodge in a smaller vessel, such as the ones in the pulmonary[lungs] system), or she was having a myocardial infarction (heart-attack), the registrar decided to give the patient oxygen and call the MET team.
A MET (Medical Emergency Team) is made up of senior doctors from ICU (intensive care unit), general medicine, anaesthesiology, respiratory, cardiac and vascular medicine.  They respond to medical emergencies (Duh!) and are there to help and offer more bodies (sometimes more capable bodies - especially when you're the only intern covering the wards and someone arrests) to assist with everything that goes into saving someones life (if it becomes necessary).  I mean, it doesn't matter how good a doctor you are, it gets pretty hard to ventilate, perform chest compressions, administer drugs, get the crash cart etc. and work out what's going on, all on your own.  So yeah, the room filled up pretty damn quickly!  Luckily the patient survived, and we later found out that she'd had a minor infarct.  
Spilling blood everywhere and a MET call all in the first few hours of the day - a nice 'welcome to vascular surgery' for the new intern!

After the excitement, us med students snuck off down stairs to the common room for 'free muffin day'.  We were met by our old intern (after several attempts at trying to remember the code to the door lock), at which point we knew that all the tops off of the chocolate muffins were now gone, but it was good to catch up.  My friend and I shared an apple muffin - although now I know to stock up on food when you get the chance because it was the last thing I had time to eat until I got home at 6:30pm (my stomach was desperately trying to digest itself).  I then went back up to the wards to speak to one of the patients I was writing a case-study on.

The afternoon was interesting but tiresome.  I ended up going into theatre to watch an endo-luminal graft (ELG) being inserted.  An ELG, when fixed in place, looks like a pair of paper pants with hooks at the waist band that attach themselves to the inside lining of the abdominal aorta.  It is acts as an artificial artery wall when the original wall has become damaged and in danger of rupturing (mostly in the case of an aneurysm - dilatation [ballooning] inside the structure of the artery wall which weakens the wall).  The patient we were inserting one in today had 3 anuerysms - one each in his left and right common iliac arteries and one in his abdominal aorta below where the renal arteries branch off to go to the kidneys.  To picture this simply, look at your tummy.  This isn't completely accurate but, imagine a cross (+) just above your bellybutton - the vertical part of the cross is your abdominal aorta, whilst the horizontal part represents your left and right renal arteries that supply the kidneys (of which you have two).  Continue the bottom of the cross down past your bellybutton and imagine it forming into an upside down 'Y'.  The branching bits angle each towards one leg and are known as your common iliac arteries.  These in turn branch again (upside down 'Y') to form the internal and external iliac arteries in each leg.  Finally the last branch to know for this operation is the superficial femoral artery which comes off the external iliac artery.  If you press down into the middle of your groin area, you should be able to feel this artery pulsing (femoral pulse).

To insert the graft, cuts are made in the groin area on the right and left side and the femoral artery in each leg located (the operation is done under a general anaesthetic so the patient is asleep the whole time).  The artery is then opened up (and blood pisses out everywhere until effective compression is possible) and a wire (catheter) is inserted into the femoral artery and threaded back up until it reaches the abdominal aorta.  A lot of tricky manouvering is done to position the wires and get the inside of the arteries (the lumen) ready for the graft.  The graft is rolled up in another fine tube like instrument - the right leg pant + top and 1/3 of left leg pant in one tube and the other 2/3 of the left leg pant is in another.  The right section is inserted into the right femoral artery and threaded up to a place that has been marked, below the branching of the renal arteries.  It is then 'deployed' and the 'hooks' at the top of the pants attach themselves to the inside of the artery wall.  The left part of the graft is inserted into the left femoral artery and into the missing 1/3 of the pant leg.  It too is deployed creating a set of 'pants' or a new upside down 'Y' shaped artificial artery wall, helping to restore blood flow to the lower legs and decrease the chance of the patient requiring emergency surgery due to a ruptured anuerysm.  The wires and tubes are then removed, the femoral arteries repaired and the incisions closed.  Of course this whole thing is a lot more complicated than that, but hopefully you get the idea.

The operation lasted 3 hours.  3 hours of standing up on a stomach fuelled by half an apple muffin (breakfast was used up on ward rounds lol).  To make matters worse, it's really important that the surgeons can 'see' where the wires and graft are being placed.  For example, if they go too high and block off the renal arteries than the kidneys won't recieve a blood supply and will become ischaemic (oxygen starved) and die - which is not a good thing because your kidneys are extremely important.  So therefore there is an x-ray machine constantly in use taking 'pictures' of what's going on.  Now because someday we might need our ovaries/testicles and cancer is a bitch, we have to protect ourselves from the radiation being produced by the machine.  Insert lead gowns that go from shoulders to mid-calf, plus a lead neck tie to protect the thyroid glands in your neck.  All I can say is heavy....VERY heavy.  And standing up in these for 3hours is not much fun at all.  Walking up 4 flights of stairs carrying them to see the display model of the graft is also not much fun.  So yeah, I'm kinda weary and my shoulders hurt.  But the surgery was interesting and I learnt a lot which is the whole point (at least it wasn't a ruptured abdominal aortic aneurysm cause those surgeries can last up to 9hrs!)  

Bed would be nice, and a decent massage haha!

Just Sleep xx

20th May 2007

It's often said that Doctors (and in this case, medical students) make the worst patients.  Well it's true, at least in respect to me.

I'm sick a lot, and it doesn't help that I spend most of my time working in a hospital around sick people.  I got so run-down that I managed to come down with an infection caused by bacteria that normally live peacefully in your body (commensal flora) - yep, they saw my immune system was down and took their chance to jump it in a dark alley haha!  Needless to say I ended up on antibiotics in an effort to get better and make it through the last few weeks of my surgery rotation.

The thing with antibiotics is that you really need to remember to take them when you're supposed to.  This allows for the drug to build up in your system and fight the good fight.  However, if you forget to take them, the concentration of the drug falls and this can give the bacteria a chance to evolve and develop resistance to the antibiotic, effectively making it useless.  Yes, so it's important to remember to take your antibiotics, and because I'm an idiot and forever losing track of time, it's also important to do as I say and not as I do lol!  But I'm getting better so I must not have screwed up too badly.

Remembering to take your prescription drugs is just as important.  Their effects depend on the maintenance of effective concentration levels of the drug.  When you take your medicine, the drug concentration degrades over a period of time based on that drug's specific 'half-life' - time taken to degrade to half the effective concentration of the drug.  The longer the half-life, the longer the drug stays in your system.  Each time you take the drug, it adds to the development of steady-state concentration levels in your body (so one dose may be nearly degraded, the other half degraded and the new dose propping up the levels).  With drugs that have shorter half-lives it becomes very important to remember to take them as they can leave your system quickly and stop doing their job if effective concentration levels aren't being maintained.  Some drugs, such as anti-depressants, can put you into a withdrawal state if you deplete their concentration levels too much, because the body becomes dependent on the drugs effects. 

Which brings me to another reason why I suck as a patient.  I've managed to put myself into withdrawal from anti-depressants three times in the last month and a half.  Whether it be because I ran out and didn't have time/forgot to get my script filled or because I left them at home when I went on camp, I ended up being stupid and miserably ill.  It's not fun - the headaches, nausea, tremor, tachycardia (fast heart-rate), fever, nightmares and total out of body experience was something I swore I wouldn't repeat when I recognised it the first time.  But there I was today, in withdrawal, scoffing down some pharmacy jelly beans just so I could take my tablets and start feeling better (need to take them with food to aid absorption).  Yes....I suck at being a patient.

On a good note though, I did get the new Used CD!  Plus the Taste of Chaos Tour is coming to Perth (for once we are not forgotten) so that makes me feel better (even though it's happening during the exam period...nooooo!).

Assignments to do...people to bleed hehe,

Into your icey blues....xoxo

18th May 2007

I'm half way through my surgery rotation and it's been tough.  Partly due to the hours (14 hour shifts some days and we're not even getting paid) and partly because of how sick I've been.  That's one of the biggest problems with working in the hospital environment - if you haven't been looking after yourself and you get run-down, you'll get picked on by anything that can tackle your immune system to the ground (and my immune system wears glasses and is always being shoved in lockers).  But it's been interesting so far and I've had plenty of clinical exposure.

At the moment I'm attached to the vascular ward, so I see a lot of patients recovering from bypasses, aneurysm repair and amputations - a lot of amputations, many of them due to the progression of Diabetes. 

Diabetes Mellitus refers to a lack of/reduced effectiveness of insulin.  Insulin is a hormone secreted by the pancreas, which helps regulate the body's glucose levels (eg. storage of glucose in the liver).  Diabetes comes in two forms.  Type 1 diabetes (or insulin dependent DM) usually appears in childhood and results in a dependency on insulin injections because the insulin secreting  beta-cells in the pancreas have been destroyed.  Type 2 diabetes (non-insulin dependent DM), however, occurs due to a decrease in the secretion of insulin or the development of insulin resistance in the body.  This form is associated with obesity, lack of exercise and calorie excess - therefore, there are things you can do to prevent it or at least lessen your risk of developing it later in life!  And seeing the devastating effects of diabetes would definately scare me into trying to be healthy.  It often results (especially if poorly controlled) in micro- and macrovascular damage, which eventually may result in you needing an amputation.  Not fun.

I watched my first below knee amputation on Tuesday.  I think brutal is the only word to describe it.  You really appreciate the force needed to actually break a bone as you watch the surgeon struggling to snap the fibula in half.  The patient was only under a spinal block because he was allergic to the general anaesthetic.  He wanted to watch the procedure but the surgeon didn't think it was such a good idea, although it was pretty cool to watch (granted I am a medical student and used to seeing 'blood and guts').  They used this really awesome surgical cutting wire to 'saw' the tibia in half - it pretty much slid through the bone like it was butter.  I also got to feel the artery that was cut away.  Arteries usually feel a little like cooked spaghetti, but this one was so full of atherosclerotic crap it felt as if the spaghetti was half-cooked (hard in the middle,squishy on the outside).  It was pretty surreal watching the lower part of the man's leg being put into a biohazard bag...zombie movie images kept flashing through my brain lol!  The whole operation took about an hour.  It was pretty funny at the start because 'Welcome to the Black Parade' started playing on the radio and I just thought "yep, appropriate" considering the patient lieing on the table in front of me.

Oh and surgical scrubs are not sexy....I don't care how they look on Grey's Anatomy.  The hair nets and booties are pretty cool though... I might steal some to wear for fancy dress hehe

Other interesting events...umm... well we had a patient walk out of the hospital with one of our $30,000 vacuum dressing machines....been checking ebay for it...

On a sad note, one of our patients tried to commit suicide by strangling himself with the cord to his oxygen mask.  He was suffering so much from phantom limb pain (perceived pain in the limb even though it has been removed).  He's on constant monitoring now.

Another of the common cases we see on the vascular ward are patients recovering from surgery to repair abdominal aortic aneurysms (AAA).  An aneurysm is a dilatation (like a ballooning) of an artery (in this case the abdominal aorta) due to widening and expansion of the lumen. They are rare under the age of 60, most are asymptomatic (don't cause noticeable problems) and, if detected, are surgically treated when greater than 5.5cm (risk of rupture is fairly low under this size).  However, sometimes they aren't detected and can rupture (dissection) - which is a medical emergency!  50% of patients don't make it to hospital (100% mortality if you don't get medical assistance).  50% of those who do, die on the operating table.  50% of the patients who survive the operation will then die from further complications post-operatively.  In other words, if you survive and go home, you're pretty damn lucky (if you consider it to be luck).  One of the patients under our team's care had a nasty dissected AAA.  The operation took 9hrs to repair the aorta and the patient has subsequently suffered from many complications.  He ended up throwing blood clots into his peripheral vessels and devloped compartment syndrome in both his legs.  Compartment syndrome results in increased pressure in the limb - with the first sign of it being excruciating pain.  He required bilateral fasciotomy (cutting a layer called 'fascia' in the limb to relieve the pressure) medially and laterally in his legs.  His kidneys have been damaged due to the lack of blood flow to them when the aorta ruptured and when the surgeons clamped the aorta to stop the haemorrhage - he now has to have dialysis (a machine performs the function of the kidneys).  Now he's suffering gastrointestinal problems which we are still investigating.  The complications of a ruptured AAA are numerous and everyday I hope I'll still see him on ward rounds.

Our intern is fantastic - plus he introduced us to free muffin day.  Although he did find it hilarious sending us to put a cannula into a lady he knew full well had terrible veins and we'd never be able to get it in (oh haha - just you wait...).  I feel really awful about turning some of my patients into pin-cushions whilst trying to draw blood - but I guess you gotta start somewhere.

I had a good mid-semester review so that made me feel better.  I need to speak up more and become more confident though...something to work on.

Otherwise...dog is good...she's asleep right now.  I've written a few songs but I still need to get the music going for them.  The guitar is still awesome.  I'm pretty tired.

So Long and Goodnight xx

Today was good, freezing cold to the point of blue fingers, but good.  I spent the afternoon in the musculoskeletal clinic with the specialist, listening to patients, performing exams, looking at x-rays etc. etc.  It was different.  I think I saw more patients in half an hour than I'd ever seen when I sat in with my allocated GP.  They just came in, were examined/diagnosed/followed up/referred and then out they went.  When I'm with the GP, it might take over half-an-hour just to see one patient! 

I felt good about studying medicine today, which is something I haven't felt very often this year!  I think it's got a bit to do with the fact that many of my friends are finishing uni now and I'm only halfway.  I'm a bit tired of studying, but the course is long enough without taking a break in the middle, so it's not something I'd put much thought into doing.  But I had been thinking a lot about whether I was still doing something that made me happy.  Although being depressed at the same time doesn't help with trying to think happy thoughts.

Last year I got dumped by my boyfriend, whom I'd been with for the last 6 years (living with for 3).  He cheated on me and decided the best time to tell me was in the middle of my fucking end of year exams which was absolutely awesome. Yes I know we met young and the chances of us getting married and living happily ever after were slim but I was happy (although looking back I wasn't) and I thought I had my entire life worked out and planned (ie. graduate, get married, have kids blah blah blah all that crap).  And now I'm on my own and I'm not sure what I really want anymore.  I feel like I have to start my life over again (oh yes I know that's very melodramatic, but when you put so much energy stupidly into one person and one goal it does feel that way when it all ends). 

The only thing that makes me happy, that I really look forward to doing at the moment is music.  I'd always wanted to sing in a band and learn guitar but because I was so focused on medicine I'd sort of put those thoughts aside.  But I started thinking about it more after the break-up and I just thought 'fuck it! I'm young, why not? Why not do something you want to do for a change?' - so I bought an electric guitar (I've been singing competitively for years so that's covered) and organised lessons (going well, picking things up quickly).  I guess I just wanted to feel alive and all I wanted was to have fun, play in a band and tour in a smelly bus with good mates - not having to stress so much.  And I know the chances of that happening are slim but I don't care right now. 

But yeah...I'd lost that drive that you really need for medicine.  I mean 'Grey's Anatomy' has it right, it is a game and you've got to be focused or you'll get left behind, and at the moment I'm drowning.  But I felt good today, there was a spark.

We had a lecture today from a paediatric oncologist, who came to discuss with us end of life care.  She told us a story about a 15 year old girl who had been under her care for a number of years.  She was suffering from an extremely rare form of cancer which had metastasised (spread to) her ovaries.  This form of cancer was not treatable.  The girl had been coping well until last weekend when she presented to the ER with shortness of breath and was found to have fluid on her lungs.  She was dying.  When the oncologist visited the family at home, the family didn't want to talk about death, but it was up to her to tell them that their daughter would die very soon.  The lecturer blinked back tears whilst she spoke.

It was a hard lecture to sit through. I wanted to cry.  I wanted to find that girl and hold her, just do something to make her feel better.  I wanted to save her life.  That's why you go into medicine, to cure people.  But we have to learn that you can't save everyone and the idea of helplessly watching someone die scares me.  My grandad is very sick and not expected to last the year.  I don't want to think about losing him but it's going to happen one day, and I need to make peace with that.  The fact is people are going to die throughout my career.  The only certainties in life are being born and dying - doctors just happen to get in the way. 

I was there when my dog died.  It's not really the same as a human but they're still a big part of your family.  I was the only one home, I couldn't drive and my closest neighbours were km's away.  I noticed her walking funny and she collapsed on the ground.  I went outside and there were pieces of a very large snake all over the place.  Unfortunately she had been bitten.  I rang my mum and told her to come home, but she was 15 minutes away.  All I could do was hold her and try to clear her airway.  She choked and shivered and I screamed and cried and called for help.  She stopped breathing and I held her as she went cold.  My mum arrived a few seconds too late to say goodbye.  I just cried and kept saying 'she's so cold' over and over again.  I still cry now when I think about her and it really affected me.  I keep going back over it and thinking 'what if I'd made an airway for her? Helped her breathe? Performed CPR? Would it have made a difference?'.  God knows how I'll react when a patient I've cared for dies.  What more could I have done to save their life?

She told us that, from her experience, the worst deaths are when people feel that they haven't lived a good life.  It sort of makes you think about your own life and what you would think about it if you were told tomorrow that you were going to die.  I certainly haven't lived enough - I study too much, don't go out and get held back from doing what I'd love to do because of stupid insecurities.  I guess I need to think about what would be important to me if I was dying - worrying about looking fat in an outfit or missing out on the chance to have a good time with friends?

Letting go of a patient you've known for a long time will be hard, especially when you're not ready to stop looking for a cure.  She was treating a 14 year old boy who had a tumour in his shoulder blade region.  They'd had some success with surgery but on a check-up found that the tumour had progressed to multiple lung lesions and invaded the pancreas.  It was terminal.  The tumour wasn't chemo-sensitive, but the surgeons wouldn't operate unless the lung masses were shrunk by chemotherapy.  She wanted to give chemo a try (miracles can happen) and asked the family to consider it overnight.  When they came back the next day, all they wanted was the port removed from his body because it got in the way when they hugged him.  The boy had decided to not go ahead with treatment because they couldn't offer a cure and he hated how sick the chemo made him feel.  She was caught slightly off guard because she wasn't ready for the patient to make that decision, to die, but clearly the patient was.  She had to respect his wishes and let go.

Children shouldn't die before their parents, but it happens.  You hear a lot of people who want to get into medicine say how they'd love to become a paediatrician and work with kids all day.  But it's a hard speciality because they're sick kids - you can't have a romantic view of it.  She talked to us about how the kids prepare for death.  They write letters and draw pictures that they want to be given out to people after they die.  They plan their funerals and ask for memorial gardens with fairies.  They want to leave their mark on the world.  And they do.  She said that every child that she's lost leaves a piece of themselves with her - a lasting impression.

One day I'll walk with someone as they face death and I hope that I can be as strong as those kids so I can do everything I can and more to treat and provide support, but be brave enough when the time comes to let go and not be afraid.

I guess the question is, when the Black Parade comes for you, will it be a good death?  Will you be able to look back on your life and smile without regret?

Every year we have a ball where all the med students from each year get together and have some fun and generally get pretty wasted.  Each year group produces a 5 minute video that sort of sums up their year (they're usually pretty funny).  I think our video this year is going to be an episode of 'LOST'. 

I swear, most of us are wandering around aimlessly trying to find where we're supposed to be and what we're supposed to be doing.  I ended up being extremely late for a clinic this morning just because the map I had for the hospital grounds neglected to show dead ends.  But when I did get there I found the rest of my group sitting around not doing much (I was pretty relieved that my lateness wasn't noticed!).  Turns out that the guy that was supposed to be running our skeletal muscle clinic was in a meeting and nobody had any idea what we were doing there.  We ended up hanging around for another hour until his meeting ended, just for him to tell us he had no idea what was going on and that we should just go home.  Great! I've just wasted the entire morning hanging around.  But it's not his fault, just the faculty doing what it usually does to us.

Yesterday was awesome though.  Spent the whole day with patients and consultants going through musculoskeletal exams and diseases.  We got introduced to our first McDreamy, who unfortunately was just on loan for the day from another hospital to help out.  Although I don't think I made such a great impression considering I was the one he chose to demonstrate a foot exam on (I hate my feet...plus I still had black toenail polish on which raised a few eyebrows haha).  Hopefully we'll meet a lot more McDreamys, considering the Musculoskeletal speciality is usually a male-dominated speciality. 

Ahh! Another epic event.  I went into the post office to get a 'working with children check' form and came out with BLUNT magazine containing an MCR poster (yay!).  One of my friends, who was waiting outside for me, saw the giggly girlish look on my face and just rolled his eyes saying 'If I look on that cover am I going to see you-know-who' haha.  Oh well, I'd rather be addicted to MCR than drugs or alcohol (although some people might disagree with me).  My mum is extremely scared considering I've pretty much gone from classical music to MCR since she last visited me (I think I'll try to find as many posters as possible just to see the look on her face again hehe).  She rang me the other day just to let me know how worried she was about the effect their music might have on me.  Apparently the daughter of a friend of hers had told her that they were some 'emo goth freaks' and she was all 'no wonder you're depressed when you listen to depressing music!'.  Oh no!  It couldn't be because of the serotonin imbalance in my brain, it's not anything to do with me - it's the band's fault!  I just told her that her source obviosuly has no idea and that if she really wants to know something about the band she should talk to me or listen to their music and decide for herself.

...phew!  Glad I got that off my chest. 

Oh dear...it's very late or early depending on how you look at it.  I better go and start preparing for the 5hrs straight of lectures tomorrow (yay for me).  Goodnight!

Today was the first day of my musculoskeletal rotation.  Got off to a great start by sleeping through my alarm and then consequently broke all landspeed records to get ready and make it to uni on time for the 8am start.  Was absolutely wreaked due to the minimal amount of sleep I'd actually managed to get last night, but everyone else looked like they were in the same boat and many people didn't even turn up.  Got my timetable, which was full of lots of lovely 7/8am starts and late finishes, and some thick workbooks to complete over the next four weeks.  Oh and highlighting once again the amazing organisational skills of the medical faculty, they've managed to schedule our clinical lectures at the same time as our medical lectures.  So I guess as usual, we'll all just have to go with the flow.

Then it was on to the dissecting room for anatomy revision.  I was met with something I hadn't missed from 1st and 2nd year - the smell of cadavers.  It hits you as you enter the room and you swear you can still smell it when you get home (although that could just be paranoia).  Plus it screws with my allergies and I spend the whole time with my nose dripping like a tap.  I was lucky enough to grab one of the lab coats, which not only keeps your clothes clean but also doubles as something to stop you freezing to death in the lab.  The surprise of the day was that we actually had a little mock test to go through - 14 stations with various limb parts and bones with pins/stickers on them showing something that we needed to identify.  I suddenly realised just how long ago it's been since I've done anatomy and was thankful that one of my friends was actually an anatomy tutor in a previous life and was willing to help me out.  Orientating is probably the most important thing (yes, that must be the lateral side of this leg because that thing usually hangs on the inside not the outside; is that really what I think it is?; and the kneebone is connected to the...umm) and nothing ever looks like it does in the textbook.  Plus there's a lot of individual variation between everybody, so things are not always as they seem.  Oh and arteries aren't red, veins aren't blue and nerves aren't yellow like in the textbook - everything is this brown colour and sometimes the only way to distinguish between them is by the differences in feel.  In the end we didn't do too bad, but I've still got a hell of a lot of study to do. 

We finished at 11 and I was starving due to the lack of time for breakfast (you feel a bit weird being hungry during an anatomy class haha).  Only had time for a fruit bar thingo and then we started on the afternoon sessions - clinical examination of the musculoskeletal system.  Basically take a history, look/feel/move the joints and muscles and make a diagnosis.  It doesn't sound that hard but when you have to actually do it on a real patient it's quite scary (especially cause you're usually the 50th medical student to examine that person in one day because the consultant said they were 'interesting' and they're sometimes not all that happy to see you).  Anyways, we just practiced on eachother today and tomorrow we'll be working on real patients at the various hospitals.

Got home at 5pm and ended up having a quick nanna nap.  Izzie (my dog) was happy to see me and was eager to show me the various things she had eaten today (my tv cabinet, the wall, the chair cushion, 3 pairs of underwear, one tree, but not her breakfast).  I swear, she vomited the other day and it was very interesting ('ahh so that's where that went').  I played guitar for a while and did some vocal work, had tea and caught up with the MCRmy and WMHC.  I might go for a run in a minute and try to head to bed early.  But yeah...fun day!