Onwards and upwards!

I have been sticking very strictly to our proposed update schedule, as advertised in the top right-hand corner, i.e. infrequent and irregular. So much so that I'd forgotten I'd meant to update at all. Here comes a potentially long, definitely rambling blog post with little structure or purpose.

I'm amused to be able to tell you all that the reason I could hear nothing through my stethoscope originally was because I hadn't realised you had to rotate the end-that-goes-on-the-patient so that you're listening to the noises coming FROM THE PATIENT. Let me try to explain: at one end of your stethoscope are the ear pieces. You put these in your ears; even I'd figured that one out. At the other end is the round bit that you put on whatever you're trying to listen to. My stethoscope features two sides to this: one with a bit of plastic on it, and one without. You can only listen to noises from ONE of these two sides at a time; you have to twist it so you're listening to the right one. It was probably about three weeks before anyone realised I wasn't doing this. Turns out, those noises are way more obvious when you're using the stethoscope right.

Related note: I'm pretty sure people don't realise that you can just buy stethoscopes. Like, online. For money. In case you are ever in a hospital, ever: they do not check you have a medical degree before they sell you a stethoscope. Owning a stethoscope does not guarantee any medical knowledge whatsoever. Please do not let someone put needles in you just because they have a stethoscope and ask. They need an ID badge before they get to steal your bodily fluids. Remember this.

Also useful to remember: if your doctor seems like they aren't listening to you, it's probably because they're not. Unfortunately, if they are a doctor (as opposed to a medical student, say) there is almost nothing you can do about this except develop a more interesting problem.

Final point: from teaching on Wednesday, I now know that injecting yourself with laboratory substrates is not a good way to try to kill yourself, especially if you pick two chemicals with opposing actions. While each of them may have killed you on its own, if you give yourself a drug and something that is effectively the antidote to that drug at the same time, you will probably not die. This is why the French put the antidote to paracetamol in their paracetamol tablets.

The things we learn from our patients

If you're going through family stress, cocaine's probably not a great way to help you cope.

If you've been detained under the mental health act, your best course of action is probably not grabbing the nearest medical student and asking them to let you leave, while claiming your nursing staff are 'deranged'.

Signs that I'm going to die

Waking up at 2a.m. with the smoke alarm going off is never ideal. While in halls, it usually means someone's cooking toast or the test is being particularly malicious. When in a private flat, it probably means you're going to die. However, this was my train of thought:

'It's warm, I'm not getting up. Wait, that's the smoke alarm. I should probably check that out. I smell bacon, it's probably just that. Time to sleep. Oh, my flatmates are up. If I'm going to die, they'll probably wake me up first. Sleepy time now. Bacon smell makes me hungry, harder to sleep. Shame.'

For the record, my flat was actually filled with smoke at the time I was thinking all of this. Good to know.

CTs are not always all that useful.

'OK, so we have...trachea...trachea...trachea...weird thing...bigger weird thing...what even is that?'

Ladies and gentlemen, today's doctors!

Clinical School: hurry up and wait

Being a clinical med student is a lot like being a duckling. You spend a lot of time following someone bigger than you, hoping they'll teach you things like eating bread or whether all those numbers mean a patient's dying or not. Sometimes they do lead you to good things, but they're nearly as likely to lead you to certain doom. Also, like ducks, you know nothing about medicine. And you're cute and fluffy and bad at metaphors.

Clinical School

Those of us still in Cambridge have just finished our second week of clinical school (I was going to update at the end of the first week, but then the weekend was as hectic as the week, so go figure). Distressingly, after three whole years of introducing ourselves with a variation upon "Hi, I'm Felicity, I'm a medic", the gap between us (bottom of the food chain) and the all-knowing consultants and GPs we see seems just as huge as ever. More distressingly still, the gap between us now and the FY1s, who are brand new doctors fresh out of clinical school, seems almost equally gigantic: they know things, like how to diagnose and what drugs to give people and what they're listening for when they play with their stethoscopes and so on; and yet even they are often seen as ignorant little pawns in the grand scheme of the NHS.

The thing is, despite three years of what was ostensibly 'medicine' at the best university in the world, I am still pretty sure that I could not diagnose anything from a list of symptoms above 0·1% of the time. That tiny percentage where I might hit upon a diagnosis is when the symptoms happen to match something that I, a close friend, or a family member has had. None of it is the result of any of the knowledge I've clung to from my actual degree. I'm terrified by the sheer volume of knowledge I'm apparently expected to just pick up over the course of three years in an institution which we are constantly reminded is 'chaotic' and does not have our education as its main purpose (obviously - there are patients to care for, primarily).

So, at the end of our second week, what have we learnt? We have been taught how to introduce ourselves to a patient. We have been given a framework for collecting information about what is wrong with a patient - both 'biomedically' (i.e. in terms of symptoms and diseases) and 'from the patient's perspective' (which reduces down to 'how are these symptoms affecting the patient's life, in their own opinion'). We have been taught to stick needles into people (so far only each other) in a safe, hygienic, aseptic way, and hopefully achieve a bottle of blood at the end of it. In the last three days, we have been taught how to examine a patient's cardiovascular (heart and junk) and respiratory (lungs) systems, and their abdomen.

Unfortunately, we can't actually do much with most of this. I can get a full history of what is wrong with a patient, including what they think about it (if the patient is nice and co-operative); I can possibly work out which bit of them is going wrong and check for other symptoms that might be associated with what they've already told me. If they have something wrong with one of three bits of them, I can examine them to find out other stuff. I've been told that I am so far incapable of presenting any of this information to anyone more senior than my friends, so I can't pass it on. I don't know any diseases, so I can't decide what is actually wrong myself, and even if I could, I can't decide what to do about it. Worst of all, if I examine a patient, I'm so busy trying to remember what comes next and not miss anything out that I more than likely have forgotten what I worked out by the time I'm finished.

Finally, a secret: I suspect stethoscopes are mostly a fashion accessory. So far, I have yet to hear anything other than a vague rushing noise through the earpieces of that symbolic bit of kit - even when assured that the patient has the most obvious *insert medical term here* that whoever's watching me has ever heard. I'm pretty sure it's all made up.

Scientific papers are not happy things

If you write a paper, how do you get people to read it? Surprisingly few take the sensible approach, a variation on something you were probably told as a child: 'If you don't have something awesome to say (about cancer/ion channels/dinosaurs), say nothing at all.' Fewer take my favourite approach: have an amusing name. Even something childish that I'd normally take perfectly seriously will make me far liklier to want to cite you in an essay. Wang, for example. Or something with unusual characters, like an o with a line through it. If I can't pronounce it, I want to write it lots. Maybe I should write a paper on that, once I've changed my name to the result of mashing my hand into my keyboard. Or Dong.

Of course, there are plenty of people who just try to make bad jokes in their titles. As a general rule, scientists trying to be funny are more or less ultimately pathetic. I have begrudgingly read 'Keeping abreast of the mammary epithelial hierarchy and breast tumorigenesis'. A lot of scientists, either intentionally or as a result of their own strange minds, just give their papers really odd titles. 'Evolution of the human X--a smart and sexy chromosome that controls speciation and development' contained an anthropomorphised 'sexy' X chromosome brandishing a whip. The fact that three whole people were involved in creating this paper and not one of them thought that this was a bad idea should make you scared for all humanity: these are people with access to lasers.

But then, there are papers that are unredeemably awful: 'Vulvodynia and chronic pelvic and perineal pain' springs to mind. Gragh.