It's not about the money money money, we just wanna fix your nose bleeds, forget about the skiin tags...

Man it is seriously WINTER today. It's impressive that, just because the clocks went back a week ago, Jesus has somehow switched the weather around to make it all horrible-like. It's like it was all created by some kind of higher power and that our rotation around the sun & completely arbitrary creation of a 24hour clock has nothing to do with it whatsoever.

In the news this week: The prime minister of Greece is in trouble, I'm not exactly sure why but I imagine it's something to do with participating in some kind of summer-based lovin' and then finding out that the girl is a nerd. Prediction: She'll start smoking and become basically a whore and everyone will live happily ever after. Perhaps he'll drive his car into the SKY for some reason. Who knows.

Day 1:

06:00 The fact that it's now mildly light again in the morning is confusing me terribly and I spend the majority of the morning getting startled every time I see a clock.

07:45 It's basically daylight as I walk into work which provides me with an exciting insite into the lives of the people doing jobs in Medicine (which start at 9 rather than at 8). What a special existence they must lead.

07:50 There is no-one around on the ward. Zombie apocalypse? The rapture? Post-clock changing confusion syndrome (PCCCS)? Some tumbleweed rolls past and I can hear the sound of a swing door banging in the wind. Suddenly, accompanied by a high pitched violin screech, a blood splattered figure with red eyes darts across the doorway. Heart racing, I pick up a tendon hammer and flashlight and go in search of the creature, following the spots of blood on the floor until I come across a closed curtain around one of the beds.

I (close my eyes) draw back the curtain, to (see for certain) find the creature bent over some kind of dismembered corpse. "My god", I think "Is it... eating that poor man's face?"

"Oh morning Geoff", says Matt turning round from the patient, his eyes blood shot from the long long nightshift, "This guy's nose just wont stop bleeding, I'm going to have to put in a posterior pack"

Posterior packs are the deus ex machina of nose bleeding emergencies but are rarely done and none of us junior staff have much experience with them. Fortunately for Matt I've seen one done really badly before so can be an excellent back seat nose-packer.

08:00 "Tsk NO Matt you don't want to do it like THAT, you want to do it PROPERLY" I say, whilst getting in the way of the nurse who is trying to help out, "You need to SEE the catheter before you inflate it" "No don't pull it THAT way for god's sake man" "Now pull back with one hand, tighten the clasp with your other hand and then inject the saline with your third hand. No I've not got any gloves on so I can't do it"

08:10 Eventually the pack is in and he stops bleeding. "Well I think WE did a good job there, Matt. Good stuff"

08:15 Brodie has been sitting in the office during this time wondering why no-one from the entire ENT department has bothered to turn up. Most interestingly of all he is now sporting a cool new quiffy haircut that seems to shout "oo la la" or... whatever haircuts are supposed to shout. Unfortunately he has also invested in some kind of green puffy coat the likes of which require mandatory fox hunting trips and ownership of a landrover.

08:45 Some other staff have eventually arrived and we're ward rounding it up to the MAX (i.e. to the nearest significant figure). Unfortunately in my excitement at being back at work I manage to draw pen all over Steve-o's arm. I apologise in a jokey manner but he just stares at me with pure hatred in his eyes. I've always had the feeling that he thinks I'm an idiot and fear that this pen drawing incident may be the last straw, all of which is particularly upsetting as he's the last person I need to sign off my 360 degree appraisal.

09:30 Down in paeds and my bleep goes off. It's Alison the ward matron (although now known as a senior sister for some reason that doubtless cost the NHS billions of pounds to implement) asking if I might just come up and have a word with someone who needs to talk to me.

09:40 Apparently these guys are from an elite patient safety group equivalent in many ways to the FBI and whose powers include the ability to fire F1s with just a thought. They're questioning me, in the way that someone who is clearly just waiting for you to make a wrong move does, about a patient I saw at 5am about 2 months ago.

"So the drug cards, how many would you say there were?"
"Hmm I guess 2 or 3?"
"I see, I see. So was it 2 or was it 3?"
"Errr 3, I think"
"You think?"
"Definitely 3"
"Right Right. Oh that reminds me" she pulls out THE VERY DRUG CARDS SHE WAS JUST ASKING ABOUT "Why do you think you might have written this on here"
"Oh I think the information I was given was a bit unclear and so I corrected myself"
"When would that have been?"
"Well it would have been within a few minutes of initially writing it up, otherwise I'd have countersigned the change"
"I see. So when EXACTLY would it have been?"

This went on in a similar way for around 45 minutes and by the end I felt pretty certain that I was going  to go to prison and that, when in prison, I was going to be ritualistically raped. But at least then I'd be getting SOME action I suppose.

11:00 In order to try to get Steve to hate me less I've gone to see one of his patients at the treatment room. She is another person who's eaten food to quickly and it's got stuck so I endoscope her to see whats going down (her oesphagus). There is nothing to see but she isn't even able to keep her own saliva down so we put her on some IV drugs that fix this kind of problem and admit her with a view to taking her to theatre later on.

As I'm dealing with all the associated paperwork a variety of medical studentey looking people meander onto the ward chuckling and saying "muahaha this is the Head & Neck ward right, and no-one is assigned to head and neck so all these patients are OURS".

For some reason I instantly dislike these guys but offer to give them some teaching anyway. I also task them with challenging puzzles while they're waiting for me to become free like "What is buscopan?" "Write this lady up for buscopan" and "When else might you use buscopan?". They fail on all these tasks so I explain to them what the stuff is however as I'm talking Steve-o chimes in that, really, buscopan never works and that I'm probably an idiot.

Ahhh the hatred. How I love it.

13:00 Just as the previous students leave another student bleeps me. This student is actually my OWN student, so fair game to her. I take her through a head and neck examination using Brodie as a model as we have no interesting/sane patients. She then complains that there isn't really much teaching as they've tried bleeping me several times and got no answer and now they only have 4 weeks left (during which I'm off for 2 weeks). This is interesting, because I've never had a bleep from them and, furthermore, neither have most of the other F1 teachers. There are several possible explanations.

1: They never actually bothered and are trying to squirm their way out (thats what I'd have done)
2: They don't understand how to bleep people (a distinct possibility)
3: They have all been given the wrong bleep numbers in some kind of NHS conspiracy to make all the final years fail and therefore reduce the burden of F1 salaries on the stretched budget. Sure all the patients will die but who cares about THEM? (Daily Mail ftw)

14:30 One of my colleagues eventually turns up for me to check her ears. I feel a bit sorry for her as she's clearly got a horrible cold and is also all on her own this week dealing with all 2 of her rheumatology patients (which is more patients than we could ever DREAM of). Her ears look pretty good to me but I get Kishan to have a look too as he's a super ENT pro.

"So what's the problem she's been having?", he asks
"Ear pain"
"Well her drums look fine, has she been on holiday anywhere lately?"
"Nope"
"Hmm, well I dunno then. You're sure she's not just had a cold recently?
"Oh yea, she's definitely had a cold"
"...", he looks at me wearily "Well that'll be the problem then won't it"

Ah yes. Humiliation. Again.

17:00 I go to Matt's for a cuddle/lamb themed horror evening. It is good fun except that I drink too much wine and so probably act like a douche. Matt amuses us all with his interaction with the little Trick And/Or Treat Kiddies. More amusing still is how the enthusiasm dwindles over the course of the evening from "AAAAGHHH I'm so scaaaared" and "I love your costumes" to "Hi, sweets? Here."

Tuesday:

09:00 I'm well hungover innit from my 2 glasses of wine and ward round has been dragging on seemingly forever. Furthermore it's one of the scary registrars who demands that we do lots of things, things that I generally disagree with but do out of fear none the less.

09:30 Eventually I manage to get down to clinic to schmooze with my consultant. I feel bad about leaving the Brodenator with all the work to do but then his consultant doesn't care if he turns up to HOSPITAL never mind clinic so tough potatoes.

The clinic is the same as ever, particularly featuring the special needs nurse who writes down all his thoughts about diagnoses on a piece of paper, presumably in the hope that one day someone will say "Hey dude, I can't be bothered with this clinic. Do you want to do it instead?" and then everyone will DIE when he treats every one of them for postural hypotension.

Also featuring in this clinic is a student clutching an iPad. This initally gains him points but later I learn that a) It's actually my consultants iPad and b) he asks ALL THE QUESTIONS IN THE WORLD.

10:15 "Sorry, Mr Archer" he pipes up, AGAIN "but can you explain the difference between labrynthitis and vestibular neuronitis?"
"No problem, bru" responds Mr Archer, before giving us a twenty minute talk on the fact that the two things are actually THE SAME. This would be painful enough if I DIDN'T ALREADY KNOW THAT and HE DIDN'T ASSUME THAT I'M AS RETARDED AS THE STUDENT.

10:30 The student is trying to access some information on Mr Archer's iPad but it's locked out.

"That'll be NHS mail forcing you to password the thing" I suggest
"Actually no, I just have a code on there because I have some important files." replies the consultant "Like my porn"

Nice. Who knew consultants had a sense of humour. They probably dont. It probably is his porn.

11:45 We've been talking for about 45 minutes about the way that Foundation Trainee posts are funded and how completely shize the QMC is in every way when eventually a patient arrives. It's a guy who broke his nose last week so Mr Archer sends Alan the registrar (who, I should note, would prefer I referred to him as Fernando) and I off to see him.

Alan has been on all night and so drapes himself across several chairs, head in hands as I chat to the patient. It's pretty simple stuff and his presence here is largely unnecessary but to make it worth his while we decide to have a look in his nose. This would normally be a quick procedure but this clinic room lacks the futuristic fibreoptic headset we normally use and has instead a lamp and head worn mirror. The kind that crazy doctors from horror films wear.

Me In Crazy Mirror

Not only does this make me look like a psychotic killer it also makes me look like a FOOL because I haven't used one since the beginning of the course and even then it was for about 30 seconds. I apologise to the patient, who is losing faith in me by the second, as I desperately try to line up the hole in the middle with my eye whilst keeping the light reflecting onto his face. Just as I achieve this, Alan manages to muster up a fibreoptic headset making the whole thing a big waste of time.

Me In Awesome Fibreoptic Headset

In the end the nose is totally fine and I'm left to dictate a letter to the GP. This takes me 30 minutes as I falteringly try to construct sentences that make me sound like a real doctor. In the end I give up and just dictate "Guy. Nose. Fine."in the hope that the secretary can fill in the blanks. That's what we pay her for... right?

13:00 Teaching today is in the form of a PBL (Problem Based Learning) case. The mere though of such a thing fills all of us GEM students (Graduate Entry Medicine) with dread as that is the method by which we were all taught medicine. I say it fills us all with dread but I really mean it fills everyone but me with dread because I really liked PBL, it was essentially 5.5 hours of enforced chatting every week.

Either way we weren't looking forward to doing it again over lunch and our dismay was heightened further by the fact it was a Pharmacy: Safe Prescribing event. Now I KNOW drugs are tricksy and I KNOW that most people are idiots and prescribe Benzene to people with acute Benzene allergy because they didn't understand the drug card or whatever but SERIOUSLY, ENOUGH of the safe prescribing events.

13:10 We're given a handout with an ECG on it. "That has digoxin toxicity written all over it" I say to the girl sitting next to me.
"Nuh-uh", she says "There's no peaked T-waves"
Now I don't want to seem like a dick (although I realise that I invariably DO) but this answer is so wrong I don't even deem it worthy of a RESPONSE.

13:25 "So as you can see from the ECG" says the lecturer "There is evidence of digoxin toxicity".
I can hear a chorus of "oh yeaaaa" from the populous of the room. Usually in this situation I'd be tempted to jump up onto my chair and yell "YES! IN YOUR FACE!" at the girl next to me but I decide against it because I'd just eaten my lunch and it might give me gas.

13:45 "Right, so what do you think has caused all these problems. Decreased renal function, dehydration in a 92 year old" asks the lecturer.
"Given the White Cell Count of 18 (x10^9/l) I'd wager it's infection" I reply, becoming further hated by the entirety of the room
"Exactly, can you guess what kind of infection?"

You will need 2 pieces of information for my reply to make sense. 1: Trimethoprim is exclusively given to people with Urinary Tract Infections. 2: I was being funny
"Well, as she was just put on trimethoprim 3 days ago, I think it's pretty obvious that its... a CHEST INFECTION"

The entire room stares at me shaking their heads. It would be OK if they were shaking them in a "God Geoff, you're so not funny" way but I worry that they really thought I didn't know what trimethoprim was for.

(Actually Trimethoprim isn't really for ANYTHING anymore as all the bacteria are resistant to it but that's another story).

15:00 On-call. I've already had to suck out the ears of an old demented lady while she screamed out for her long dead husband "Bill" the whole time. On the plus side if it hadn't been for the fact she'd mistaken me as her son I doubt she have let me do the procedure so maybe old age isn't so bad.

Subnote: It really is.

16:00 The Staff Grade comes to tell me that there's a kid down in A&E with a bead up it's nose. I throw a bit of a hissy fit at this because children with stuff in their nose invariably need to come in for theatre and there's no real point in me even trying to pull it out because the little bastard will only scream and scream until their weak willed parent who, despite being too busy with the milkman to prevent the object+nose interaction from taking place, is defiantly protective of the child and doesn't want to see them hurt.

If you didn't want to see them hurt you shouldn't have squeezed them out of your vagina because life is pain. Trust me.

The Staff Grade doesn't seem very impressed with this and insists I have a go anyway and if I really REALLY can't do it then she'll come along. To this end I go a-walking off down the corridor, headlamp in one hand, spiky implements of nose extraction in the other grumbling audibly about stupid children. It's lucky I want to be a paediatrician really :S

16:30 I succeed in removing the bead from the kids nose. This fills me with disconcerting levels of joy which are further backed up when Kishan makes a point of telling what a great job that was (Kishan is generally fairly encouraging) and that, despite it being all because of the child's stoic demeanour, it must have been at least part due to an improvement in my skills and interaction.

Cheers Kish.

Day 3:

09:30 We're in theatre with Mr Archer. He has already sent me across the hospital to get coffee (which he paid for) and muffins for the staff (which I paid for). Unfortunately there aren't enough goggles to protect everyone's eyes from the frikkin LASERBEAMS he's using to treat this lady's cancer. I see the medical students looking sad and, knowing the feeling all too well I go out of the theatre with them to help them find something else to do.

One of the students is horribly keen and talks his way into watching a Urology theatre but the other student just looks at the board in hopeless confusion. I'm tempted to bunk off the whole session myself and go and hang with Ms Tierney (who is the best thing that has ever happened, ever) but an overwhelming desire to get my log book signed off forces me to head back to ENT theatre to see if the light show is finished (it's been all of 3 minutes).

Fortunately my muffin buying skills have curried favour with the staff and they manage to find some extra goggles for me and the student. It also turns out that normal glasses do just the same job and so I could have given mine to the keen guy but he's probably knee deep in someone's penis around about now so I leave him be.

10:45: I'm holding 10 pairs of retractors across my various appendages. This is about as exciting as surgery gets until you're a senior registrar so all is going well. We all make idle chat about how medical school isn't what it used to be and how easy it is for complete losers to get through. Mr Archer makes a joke about my small hands having nothing to do with the size of anything else. Ho hoho. All is merry. I start to feel like my consultant might actually sign me off.

This is all suddenly ruined though, when one of the nurses mocks my consultant for eating one of the muffins I bought for them. He thought I bought it for him and doesn't appreciate being mocked in his theatre. Pretty sure he now hates me... and I was so CLOSE!

11:30 Alan lets me do a stitch in the woman's neck. It goes horribly wrong, of course, because everything always does when you have one chance to shine but seeing as I don't want to be a surgeon I don't really care (though I secretly do).

15:00 The blood results come back on a patient who suffered a bit of a cardiac episode earlier in the day. A whole new section has appeared on the results page which we've never seen before, the title of which is "Acute Renal Failure". Ominous. Underneath this header is a line that reads "This patient is in Acute Renal Failure (Creatinine 2.5x baseline)".

Acute Renal Failure (now known as Acute Kidney Injury) is generally bad times. Firstly because it's not so good for the patient. Secondly because it can be extremely complicated to manage and requires ordering all the tests in the world but mainly because it might involve talking to the ridiculously scary Renal team. I did my SSM in Renal Medicine and it was all very interesting but the main thing I learned was to avoid the renal department at all costs because they will Fuck. You. Up.

15:30 Having run around the room screaming in horror for a while we ring the Med Reg who is generally unexcited by the whole thing. He tells us just to give the dude some fluids and not worry about any of the other tests. This is a shame because we already ordered the tests before we asked him. No matter though.

Since I've started this job there have been several occasions when a blood test result has come back, causing me to get very excited and resulting in me writing page long sections in the patient's notes about the possible causes and necessary investigations. Every single time, however, it's turned out to be absolutely nothing and I'm beginning to worry that when something genuinely bad DOES come along I'll be far too apathetic to give it the same attention.

But probably not

17:30 Having handed the patient over to Kishan, Brodie and I both leave only to discover that a queue of traffic is not only backed up to the hospital but to the very car park barriers themselves. I decided it's not worth the aggravation and go back to the hospital to find something to do while Brodie braves the traffic.

17:45 I receive a text from Brodie: "This is fucking ridiculous".

18:00 The urine dip results come back on our patient with the broken kidneys showing that he has all sorts of crazy intra-renal pathology going on. This causes Kishan to have to do horrible amounts of work, including sending urine off for microscopy and all sorts of jazz. He has a minor argument with the reg who, being a surgeon, has forgotten all of medicine and so doesn't really understand the implications of these results about why he is doing so much writing and so little cutting.

I leave them squabbling and head home in the significantly (but not totally) reduced traffic.

Thursday:

08:45 Brodie and I leave the ward round in order to go to a meeting with the deanery about how good a place Derby is for the F1s. This was going to be extremely satisfying as it was to leave no junior staff on the ward round and require the registrar to do all the grunt work like writing in the notes and clipping the patient's toenails. Unfortunately this backfired because they instead forced Kat, who had just been on nights, to hang around to fullfil our job but there was nothing that could be done as the meeting was compulsary.

08:46 As we arrive at the education centre it also transpires that the meeting is at 9:45 not 8:45.

"OK Brodie" I say conspiratorially "The story is that we got here and they were really apologetic but they were overrunning and needed to bump the meeting forward an hour. This way we and be we I mean I don't look like idiot(s)."
"Sure" He replies

09:00 We track down the ward round somewhere in paediatrics and usher Kat on her way home.

"Hey? What happened?" Asks Alan
"Oh, Geoff got the time wrong, it's at 09:45" Replies Brodie like a DOUCHE

10:00 In the actual meeting, I'm getting more and more edgy as the massses generally bitch and moan about pointless things. One person drones on for a good 20 minutes about a problem that has nothing to do with the hospital and everything to do with random chance.

"Hmmm. I see" says the head of the deanery, managing at last to get a word in edgeways "So is there anything that the hospital could have done to support you in this situation?"

"Well, it would have helped if I'd known more about the law and the procedure for psychiatric patients"  continues the F1, either failing to understand the question or choosing to ignore it. "It was really awful"


I'm sure it was awful, but seriously, this meeting is about whether we're getting a good level of support as F1s and whether the hospital aught to be shut down. It is not group therapy.


11:00 Brodie is trying to get Sri to sign off on a Case Based Discussion for him. We need two of them signed off per module and he hasn't got any (neither, for that matter have I) and there isn't much time left. Sri is generally not a fan of doing these things because he's spent the last 6 years being badgered for them and has, as far as I can tell, given up on life as a direct result. However because he is extremely nice he decides to help Brodie out.

The case Brodie is presenting is the quite interesting renal failure one from earlier in the week. Unfortunately that case has very little to do with ENT so Sri is trying to focus on the nose bleed that brought the guy in. Brodie, in the other camp, is trying to talk about renal failure. Neither of the two people involve know anything about the thing the other person wants them to talk about.

It is great.

Furthermore midway through the conversation about 5 ENT doctors arrive to but in occasionally with unhelpful information.

"So Brodie, what are the causes of nosebleeds", asks Sri
"Um well the risk factors are high blood pressure..."
"I think he means the surgical sieve" Kishan pipes in
"Oh right well then the causes can be either congenital or acquired", Brodie responds, digging himself an extremely large hole
"Congenital causes you say? OK well what's a congenital cause?"

Minutes pass. Stars are born and galaxies destroyed. I am growing agitated (I do that alot).

"Ummm"
"OH FOR GOD'S SAKE MAN" I explode, grabbing Brodie by the lapels and shaking him "JUST SAY GLANZMANN'S THROMBASTHENIA"

The reason for my problem here is that Brodie spends a lot of time trying to chat up med students by explaining what Glanzmann's Thrombasthenia is, he won't shut up about it, it is his favourite disease ever. This is fair enough because it is deliciously esoteric and one does sound pretty clever when explaining it but given that ONE OF OUR PATIENTS WHOSE NOSE BLEEDS AT LEAST THREE TIMES A DAY HAS THE DISEASE AND IS THE VERY REASON ANY OF US HAVE EVER HEARD OF IT MEANS THAT MAYBE IT SHOULD SPRING TO MIND AS A CAUSE OF EPISTAXIS.

*cough* yes.

14:45 After a delicious curry lunch to which Sri was lured under the misconception that it would be free, further denting his opinion of me and meaning I'm going to have to spend continued time sitting under a cold shower crying, I manage to invite myself along to a teaching session for the 5th years.

By far the most exciting thing about the teaching is that I rediscover the existence of Steve Day, the most handsome guy in all of GEM, who had disappeared for a while. Man that sentence was gay, but whatever.

15:15 Alan has to leave the teaching to do some work and tries to take me along too but Sri buts in

"Absolutely not, Geoff is staying here until the end, he's very very good at this and we need him"

AND THE CROWD GOES WILLDDD. *Chariots Of Fire Theme*. At last! AT LAST!

16:00 Still glowing with pride (such... a... strange... feeling...) I go and find Alan to help him with the data entry he's been working on. It is not so interesting.

Day 5:

Stuff happened today that I wrote loads of things about but then blogger deleted them and I really can't be bothered to write them again.

So there.