Tuesday:
Clinic in the morning - it's chilly when it's early! Had to wear my hoodie to work. It's the clear skies, apparently, which means it also warms up quickly in the sun. Not that there was much of that today. Rain and wind a plenty though!
Clinic was excellent, as always, and I got to teach a doctor how to use a lit lamp, because I'm apparently "very good" with them. Ha! He was probably just being nice, but teaching it makes you quickly realise your own limitations, so I ended up learning more stuff about them.
Cases seen: a chemical burn to the eye (and teaching on how to manage chemical burns should I ever see one), a 1 day post-op corneal graft, post-trabeculectomy scleral thinning, blocked meibomian ducts, an entropion and the unexpected highlight of a referral to RPH of "viral keratoconjunctivitis".
Normally, when you hear that as a case description you sort of switch off, because it's, well, just viral conjunctivits with some corneal involvement. It's not a big deal. I learnt a few things then:
1) Royal Perth Hospital is a specialist ("tertiary") ophthal centre that takes cases from all over Western Australia. People fly to get to hospital appointments there, routinely.
2) Cases sent to RPH are therefore normally like Ron Burgundy, "kind of a big deal"
3) Severe keratoconjunctivits is icky.
It was bacterial, not viral, so it hadn't spread to this guy's family/kids, which was good. However, severe keratoconjunctivits has a nasty 'special ability' if you will - it forms a membrane over the conjunctiva on the inside of one's lids. This can lead to bands of goop sticking the two conjunctival surfaces together (eyeball and inside of the lid stick together). This chap didn't have any bands, thankfully.
That didn't make his "membrane" better though. Under normal light, it just looks like a pale layer on the inner lid surface. With fluorescent staining and blue light, it glows like one of those stars you used to stick onto your bedroom ceiling. The problem with a membrane is that they are what's known as a reservoir for the invading organism. So they need removing, to try and prevent ongoing infection. With forceps. It peels off like a layer of dead skin, but bleeds profusely because it attaches itself if left for too long. Ouch. They can regenerate in days, at which point they need peeling off again. Ouch. Messy.
Afternoon was spent back in my room, wrapped up in layers of clothing and writing more of my project.
Wednesday
Research all day - it's almost done. I was told that the 1st draft I'd emailed originally was enough to grant me authorship of the paper, so was to finish off the bits I wanted to do today and tomorrow, but email it on Thursday and leave it. The team will sort the rest out, and will organise a mock OSCE 2 exam for me next week if I bring them the info on the stations after the Easter weekend. Awesome.
Thursday
Theatre in the morning - orbitotomy and orbital tumour biopsy (this thing was deep in the infero-nasal orbit and very difficult to tell apart from surrounding fat). Was cool to watch though - I now have a better idea as to how they access the orbit and get around the eyeball in the way - they push it. With a metal paddle/spoon. Saw another blepharoplasty - this one was for an anatomical defect on a young chap, basically meaning he didn't have an upper lid crease on the right side, so looking up caused his eyelid (and lashes) to fold inwards, which as you can imagine, would be pretty annoying.
Japanese lunch with the consultant and reg again - chicken katsu with a rice box and veg. Pretty good - especially when bought for you.
Afternoon research - finished the last bits I wanted to do, and emailed it off. Done. Huzzah!
Easter weekend plans: Beach, King's Park, OSCE 2 revision and collecting information bits for the team (to use against me), shopping, my brother's best man speech, and planning how I'm going to get to the airport in time for my Sydney flight the next Saturday. So it's not like I'm busy or anything...
No time for Rottnest Island the whole time I've been here. A little disappointing, but I'm not too worried - definitely coming back to Oz at some point for a (English) Winter holiday!
Thursday 28 March 2013
Monday 25 March 2013
Week 5
Sunday:
Hot! Better than Saturday, unfortunately, as I wasn't at the beach today. Stuff to do.
Lots of errand jobs - bought a souvenir, more postcards, food, etc.
Sat in the park writing this - they have free wifi here. Awesome. Going to move indoors again now so I don't get burnt.
I have to try and finish my project 1st draft. Can't stay outside and play. Sad times.
Did some OSCE 2 revision by going through appropriate history points for acute care and surgery. I'm optimistic about the retake - this stuff isn't difficult to revise since I did most of it right the first time around and knew most of it already. Just hoping they don't bell curve the retakes quite so much!
Monday:
Crap weather - it's grey, muggy, aaaaand just started raining. Still warm though, so I guess it's still beating the UK's never-ending Game of Thrones-style Winter that may last for years. Winter Is Coming, and all that.
Got some good work done, thumbs up from supervisor to keep going as I am. Also can hand it over to him again "when I've had enough" and would like him to take over. That kind of spurred me to to work harder, if anything. I'm not bloody giving up on it! Had enough? I don't know what that means.
Maybe next week. We'll see. There's lots I want to do with it still.
Thursday, Friday, Saturday Week 4
Thursday
Morning theatre - saw a bilateral blepharoplasty, and an ectropion repair with a lateral tarsal strip. In other words, eyelid surgery. The first one is for too much eyelid skin starting roll over the lid margins and impede vision, so we cut it away.
An ectropion means your lid is folding outwards, usually due to age and fat pad shifting. Basically, a slack lower lid at one attachment, and too tight on the outer surface. To correct it, you use physics. You cut the outer skin, slackening off tightness that was pulling the lid outwards. A skin graft covers the wound to remove further tension and prevent recurrence. Then you tighten the lower lid back up against the eyeball (where it should be) with a lateral tarsal strip - essentially attaching the lower lid to the bony orbital rim you can feel on yourself right next to the outermost part of your eye. Sorted.
Had lunch with the Consultant and Reg, which they bought for me. We ate at this Japanese place - I had teriyaki chicken and rice and japanese veg, was all very nice. Extra nice on account of it being free.
Afternoon research.
Friday
Research all day.
Watched Django Unchained in the evening. It's still good. I still like it a lot. It is still pretty long.
Saturday
Job rankings finished finished finished. Submitted! Exciting. Hoping I pass the Finals retake so it means something.
Cottesloe beach for most of the day - windy! Made it a bit chilly towards 4 pm. Had to put a t-shirt on. Terrible form.
Deep fried mars bar and chips for lunch. Amazing. I could actually feel my arteries clogging, and it felt good.
Morning theatre - saw a bilateral blepharoplasty, and an ectropion repair with a lateral tarsal strip. In other words, eyelid surgery. The first one is for too much eyelid skin starting roll over the lid margins and impede vision, so we cut it away.
An ectropion means your lid is folding outwards, usually due to age and fat pad shifting. Basically, a slack lower lid at one attachment, and too tight on the outer surface. To correct it, you use physics. You cut the outer skin, slackening off tightness that was pulling the lid outwards. A skin graft covers the wound to remove further tension and prevent recurrence. Then you tighten the lower lid back up against the eyeball (where it should be) with a lateral tarsal strip - essentially attaching the lower lid to the bony orbital rim you can feel on yourself right next to the outermost part of your eye. Sorted.
Had lunch with the Consultant and Reg, which they bought for me. We ate at this Japanese place - I had teriyaki chicken and rice and japanese veg, was all very nice. Extra nice on account of it being free.
Afternoon research.
Friday
Research all day.
Watched Django Unchained in the evening. It's still good. I still like it a lot. It is still pretty long.
Saturday
Job rankings finished finished finished. Submitted! Exciting. Hoping I pass the Finals retake so it means something.
Cottesloe beach for most of the day - windy! Made it a bit chilly towards 4 pm. Had to put a t-shirt on. Terrible form.
Deep fried mars bar and chips for lunch. Amazing. I could actually feel my arteries clogging, and it felt good.
Wednesday 20 March 2013
Wednesday: 1st table tennis win!
21-15
Boom. My returns got better, I was more relaxed, and I was away. Also did a lot more controlling of the play - getting the ball off to one side or another to get the opponent running around a bit. Next things to work on: spinning and distance control. Would love to drop a nasty short backspin *just* into the opponent's half.
Research continues as normal. Waiting for them to approve giving me microsoft office so I can sort out references with endnote web that much easier, so just focusing on writing the main text at the mo, and putting in references manually with a view to updating them once this is sorted.
It does start to drag a bit, which is why the clinical days are nice. Reading, re-reading and slightly tweaking the same page over and over before the 1st draft is done is frustrating, but that's how I do it. That's how bad it gets - I frustrate myself that I'm such a perfectionist about these things. The problem is partly in the name. 1st draft implies a rough selection of ideas splurged onto paper. Researchers don't see it that way though - a 1st draft to them is a fully completed and written paper that just hasn't been submitted to a supervisor for 'professional' reading and input yet. To me, this is currently more like a third draft, as I've shaped it from being a selection of titles across several pages into a justified aligned introduction and methods with yellow highlighted sentences that may belong elsewhere in the document or may need re-wording. But the fact that I'm still working on the 1st draft sounds like a lot less of an accomplishment than what I've actually done. The results are essentially just a table, which is easy enough, and the analysis points are fairly self-explanatory/obvious. As usual, it's the introduction and discussion that take most of the work, as they're the bits that need thinking about, careful wording, and lots of references.
Oh, and there's a 2000 word limit. Great.
At some point, probably this weekend, I'm hoping to be able to say "1st draft done". That gives me 2 weeks to edit it. Do-able.
Boom. My returns got better, I was more relaxed, and I was away. Also did a lot more controlling of the play - getting the ball off to one side or another to get the opponent running around a bit. Next things to work on: spinning and distance control. Would love to drop a nasty short backspin *just* into the opponent's half.
Research continues as normal. Waiting for them to approve giving me microsoft office so I can sort out references with endnote web that much easier, so just focusing on writing the main text at the mo, and putting in references manually with a view to updating them once this is sorted.
It does start to drag a bit, which is why the clinical days are nice. Reading, re-reading and slightly tweaking the same page over and over before the 1st draft is done is frustrating, but that's how I do it. That's how bad it gets - I frustrate myself that I'm such a perfectionist about these things. The problem is partly in the name. 1st draft implies a rough selection of ideas splurged onto paper. Researchers don't see it that way though - a 1st draft to them is a fully completed and written paper that just hasn't been submitted to a supervisor for 'professional' reading and input yet. To me, this is currently more like a third draft, as I've shaped it from being a selection of titles across several pages into a justified aligned introduction and methods with yellow highlighted sentences that may belong elsewhere in the document or may need re-wording. But the fact that I'm still working on the 1st draft sounds like a lot less of an accomplishment than what I've actually done. The results are essentially just a table, which is easy enough, and the analysis points are fairly self-explanatory/obvious. As usual, it's the introduction and discussion that take most of the work, as they're the bits that need thinking about, careful wording, and lots of references.
Oh, and there's a 2000 word limit. Great.
At some point, probably this weekend, I'm hoping to be able to say "1st draft done". That gives me 2 weeks to edit it. Do-able.
Tuesday 19 March 2013
Sunday, Monday and Tuesday, Week 4
Sunday:
Caversham Wildlife Park! Amazing. Pics are on FB, will put some on here soon. Australian fauna is cute, and I want a small marsupial as a house pet. Kangaroos all have different coats of fur, so some of them are fluffier/cuddlier than others. All of them, however, can be cute, when holding your hand and giving you the 'feed me more food pls' look.
They can also be threatening. Having fed a particular kangaroo (kangaroo A), one of us decided to feed the lonely-looking one next to it (kangaroo B). This resulted in the original kangaroo (A) in hopping over to B, pinching the food, growling, and suddenly landing a nasty left hook across B's face with an audible thump that made everyone present stand up and move quickly away.
We also met a wombat (Neil), who was fat and lazy and slept on the park staff's lap with his nuts on full frontal display. You then get a photo with Neil while touching his lower legs (only, please, no stroking anything higher like his back, or somewhere, for example, further away from his nuts). He was bristly.
Monday:
Research all day. Lost table tennis 18-21 again. Getting better still, but returns are still my downfall!
Tuesday:
Clinic in the morning - very cool and a nice break from research. Lots of varied and interesting cases, including a lady who'd managed to use superglue instead of eye drops. We had to cut her eyelids open as a minor op.
Just...wow. Not impressive as an op (pair of scissors and patience did the trick) but scary for her, and had me wondering - HOW exactly, does one confuse the two? WHY would you keep them anywhere near one another?
Surely, when seeing a superglue bottle, you think, hey, this kind of looks like an eye drops bottle. Better be careful not to get them mixed up with my eye drops!
But we don't. Because most people don't keep a SUPERGLUE bottle anywhere near the same place as a similar-looking-but-entirely-different-function bottle of MEDICATION eye drops that GO IN THE FRIDGE.
Honestly, some people.
I do feel for her though - I've been through enough painful superglue experiences of sticking my fingers together to know that getting them cut apart hurts like hell - can't imagine what eyelids are like!
Thankfully no eye damage - glue won't stick to wet surfaces, so the conjunctiva and cornea were ok, if a bit raw.
Other cases included post-op corneal transplants, a facial nerve palsy and associated exposure keratitis (despite the ptosis-inducing gold weight implant), blocked lacrimal systems causing watery eyes, blocked pores causing dry eyes...all sorts. Learnt a lot. More fun than UK clinics, as it wasn't a "diabetic retinopathy" clinic, seeing the same thing over and over again. Included ED referrals (as per superglued eyelids lady) in the clinic too.
Dream job.
Speaking of which, I "finished" job ranking today. Probably won't submit them for a few days to do any last minute tweaks and changing my mind.
Will add photos tomorrow.
Caversham Wildlife Park! Amazing. Pics are on FB, will put some on here soon. Australian fauna is cute, and I want a small marsupial as a house pet. Kangaroos all have different coats of fur, so some of them are fluffier/cuddlier than others. All of them, however, can be cute, when holding your hand and giving you the 'feed me more food pls' look.
 |
| Moar food pls? |
They can also be threatening. Having fed a particular kangaroo (kangaroo A), one of us decided to feed the lonely-looking one next to it (kangaroo B). This resulted in the original kangaroo (A) in hopping over to B, pinching the food, growling, and suddenly landing a nasty left hook across B's face with an audible thump that made everyone present stand up and move quickly away.
 |
| Another sleeping koala we met. What a surprise. |
 |
| An awake koala! Moving! Aaaah! |
We also met a wombat (Neil), who was fat and lazy and slept on the park staff's lap with his nuts on full frontal display. You then get a photo with Neil while touching his lower legs (only, please, no stroking anything higher like his back, or somewhere, for example, further away from his nuts). He was bristly.
 |
| This is Neil and his staff couch. |
 |
| Us, awkwardly touching Neil's legs for the photo. |
Monday:
Research all day. Lost table tennis 18-21 again. Getting better still, but returns are still my downfall!
Tuesday:
Clinic in the morning - very cool and a nice break from research. Lots of varied and interesting cases, including a lady who'd managed to use superglue instead of eye drops. We had to cut her eyelids open as a minor op.
Just...wow. Not impressive as an op (pair of scissors and patience did the trick) but scary for her, and had me wondering - HOW exactly, does one confuse the two? WHY would you keep them anywhere near one another?
Surely, when seeing a superglue bottle, you think, hey, this kind of looks like an eye drops bottle. Better be careful not to get them mixed up with my eye drops!
But we don't. Because most people don't keep a SUPERGLUE bottle anywhere near the same place as a similar-looking-but-entirely-different-function bottle of MEDICATION eye drops that GO IN THE FRIDGE.
Honestly, some people.
I do feel for her though - I've been through enough painful superglue experiences of sticking my fingers together to know that getting them cut apart hurts like hell - can't imagine what eyelids are like!
Thankfully no eye damage - glue won't stick to wet surfaces, so the conjunctiva and cornea were ok, if a bit raw.
Other cases included post-op corneal transplants, a facial nerve palsy and associated exposure keratitis (despite the ptosis-inducing gold weight implant), blocked lacrimal systems causing watery eyes, blocked pores causing dry eyes...all sorts. Learnt a lot. More fun than UK clinics, as it wasn't a "diabetic retinopathy" clinic, seeing the same thing over and over again. Included ED referrals (as per superglued eyelids lady) in the clinic too.
Dream job.
Speaking of which, I "finished" job ranking today. Probably won't submit them for a few days to do any last minute tweaks and changing my mind.
Will add photos tomorrow.
Saturday 16 March 2013
Week 3
Was busy this week! Not much time for the blog, so here's a rundown of the week...
Monday: Project all day, quiet night in.
Tuesday: Royal Perth Hospital in the
morning, sorted ID and another blood test(!), was still able to go to clinic. I learnt lots, and even got to assist with a chalazion steroid injection minor op. Went home in the afternoon and met some new friends over dinner - 3 girls doing teaching work out here for a few weeks.
Wednesday: Project all
day, table tennis loss (damn), OCT scan - all normal, but fun to play with the kit!
Went out with the girls in the evening. We had originally said that since we were all up at 6
am the next day, we'd keep it as an early night. Oops.
We ended up going with
2 random older aussies who definitely weren't quite right but knew
the town. Went to a couple of bars, mostly staying in the
hipster/indie/chillout bar which was nice and had decent sized drinks
for only $8. I wasn't drinking much (pacing myself anyway) on account
of having my guard up around these two tag-alongs and looking out for
the girls.
One of the aussies was
abandoned after this bar – shows how much his mate 'knew' him
and/or cared where he went. We have no idea.
We ended up at a
gay/lesbian club, after following this leading aussie, but there were
a lot of straight people too, and a lot of transvestites/ladyboys.
Odd experience. Got hit on by a couple of guys, had to politely
decline. Not sure whether that was a good thing? Shows I'm attractive to some people anyway!
There was lesbian mud
wrestling for volunteers. The winner got $100 (£70). These lesbians
were not attractive to guys, so the whole experience was rather
uncomfortable but funny to watch.
The other aussie then
tried to pull one of the girls – confirming my original suspicions
as to why he'd come with us – he was thankfully unsuccessful despite
her drunken state, as she was a) not single and b) not interested,
and c) managed to escape to the ladies. So we left him, and rescued her.
We got back at 3 am. There was a unanimous decision to not go in tomorrow, as they were in no state to
teach children after 3 hours sleep and still being drunk, and I
couldn't face a 7 am meeting and then theatre all morning whilst
smelling of booze, feeling grimy, and being absolutely knackered. I
hate late late nights.
Thursday:
Hungover. Did some job
ranking, chilled with friends. None of us went in. Oh well. Board
games in the evening, was nice.
Met some more friends. There are 7 of us as a group in total. 4 girls, 3 guys - 3 of us are at or have finished uni. The others are on a gap year.
Friday:
Hospital research all
day. Apologised for not being there on Thursday. Lost table-tennis
18-21. Getting there! So close. Service returns still need more work!
Evening – the girls
made lasagna for us! This was nice, as I got in late (8 pm) and could just sit down and tuck in. As a Friday night in, we watched The Woman in Black and How to Train Your Dragon (in that order). Wasn't too scary, since I was able to laugh at it all the way through - Harry Potter should know how to deal with old creepy houses by now!
Saturday:
The group went to Fremantle, then
to Cottesloe beach. Swam, sunbathed, saw actual wild dolphins at sunset. Awesomeness.
Plan is for Caversham
Wildlife Park tomorrow.
Not many photos this week - dolphins are incredibly tricky to get as they only appear above the water for a split second, which you usually need to actually see where they are before taking the photo.
Sunday 10 March 2013
Friday and the weekend (8-10th March)
Friday:
Morning research and procrastination, and found out I am clean of diseases from pathology results. I knew this already, but now it's on an official yellow sticky note with numbers.
Morning research and procrastination, and found out I am clean of diseases from pathology results. I knew this already, but now it's on an official yellow sticky note with numbers.
Friday evening: I found
out I'm in Trent again, with no change to score or placement –
excellent news!
3 hours later, found
out I'd failed a finals exam – OSCE 2 :(
Distress and emotional
responses followed.
I had to watched in
silent agony as friends happily asserted their new doctor-y-ness on
Facebook.
I was then waiting for info as to what happens next. Got an email with a lot of
information in it, so in my semi-delirious state had to read it about
3 times to figure out what exactly I needed to do now. It turned out
I needed to email just one person for all the different things. Did
so.
I will lose about 2
weeks of free time at the end of the elective to go to a feedback
appointment in mid April, then there is a revision week in what would
be my last week of elective on the Gold Coast...
At the time, it was
like my world was ending. I felt like this was the final stamp of
disapproval from the medschool that actually, no, I'm not good
enough, and shouldn't be a doctor, and there's a reason you've not
been able to get through a year at medschool (bar 3rd
year) without failing something. But apparently I know enough (passed
knowledge), and can jump through their hoops sufficiently to examine,
diagnose, and relay back some sort of spiel in 6 mins (passed OSCE
1).
What worried/upset me
most was that I felt like OSCE 2 was actual doctor stuff. You get 5
stations, 15 mins each, with a scenario – usually a prescribing,
communications skills and ethics, history +/- examination, history
alone, and another random station. The scenarios themselves can
literally be anything. Much like what you get in real life.
But I failed 3 out of
the 5 stations. I knew I'd fluffed up one – I had a complete
mind-blank and panicked, it was my first station of my first exam of
my Finals. Lots of pressure and my brain shut down about the scenario
until I walked out of the building – I then realised what I was
supposed to do. Bollocks.
Failed, but kind of
expected.
It turned out I scored
quite highly on it though, surprisingly, but everyone else must've
done better, to put me in the fail section of marks.
OSCEs are marked in a
complicated way. You get marked on a checklist of items – fair
enough. But that's compared with how everyone else taking that exam
on that day did. So even if you're a clear pass in the examiner's
mind, if everyone else scored better, you're failed.
This sucks.
This is why I failed
the one station in OSCE 2 that I was dead certain I was guaranteed to
pass. I nailed it. I got the diagnosis in 5 mins of questioning, and,
knowing the diagnosis from the history, performed all the appropriate
tests, and confidently/competently demonstrated that it had to be
this specific tendon in the shoulder that was inflamed because of
this test being positive and none of the others. Boom. Nailed it. In
real life, I would have the exact diagnosis and the patient would be
treated correctly, etc, etc.
Failed. Because
everyone else did the same thing. And I got one mark less than them.
That's silly. I'm clearly competent at the exam, why on earth would
you fail me for it just because my cohort/year are a bunch of clever
dicks and know-it-alls?
It works the other way,
too – if you screw up on a station because it's hard, not because
you personally are a screw up, you can still pass if everyone else
does badly. It all depends on how everyone else scores.
This is still not cool
– your exam results are out of your hands, because they're not so
much based on your performance, they're based on everyone else's.
The third failed
station was the ethics/comms station. I have no idea why. It may be
to do with me counselling for a more serious disease than was
actually present in the patient, but sometimes the medschool leans
towards safety as a top priority, and at others they lean towards
reality.
It's often difficult to
see and realise which one they want. I did what they would have
wanted if they wanted me to be extra safe.
The patient loses
consciousness after standing up from driving her bus. No fit, and
came around quickly according to a witness. It was classic benign
postural hypotension. I said as much, but better worded. I emphasised
that though this was most likely, to be safe we ought to rule out
epilepsy. And until I can rule out epilepsy, I kind of have to treat
you as though you've got it. This means no driving until the
diagnostic test comes back, which means no work, and so on for my
spiel under “epilepsy counselling”.
Presumably, they wanted
“reassurance and benign postural hypotension counselling”, but
could have been gunning for either, depending on the mark scheme. I
feel like you could argue that one either way, if this was the case.
If it was a form of seizure that wasn't a classical presentation, a
busload of people are in danger when she goes back to work the next
day. We'd be sued for so much money. So...a busload of people's
safety, or assume it's classical benign postural hypotension. Pick
one.
There is a medical
student curse: in a 50/50 choice, the medstudent will always pick the
wrong one.
If it's not this, then
I likely missed multiple very important somethings entirely to get a
low score of 10 out of 30ish, and I will have no idea what the
problem was until feedback in mid April.
Le sigh.
Sarturday:
Happiness and sunshine
and a perfect day out at the beach for only $3.20 for the whole day.
There was a free beach
art/sculpture display on today, that you could wander up to and have
a look at. It was all rather nice, and some bits were very cool. It was very busy so photos have random semi naked strangers in them.
 |
| To the Beach! |
 |
| Good job I didn't bring my spear then. |
 |
| Windmill chimes, made of bamboo. |
 |
| Twisty thing. |
 |
| Fishing rods |
 |
| That fish cray. |
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| "Portal" |
 |
| "Palm Tree" |
I made up for a lack of
spending during the daytime by treating myself to a steak and pint
for dinner at a pub near to my accommodation. This cost a lot, and I
learned that “fillet” here doesn't actually mean fillet
steak. It's more like a fillet of steak. I think it was
sirloin – so it wasn't bad. But it wasn't fillet. Cheapest
available pint - $10 = £6.80. Never mind. It's only once a week, for
one, and this was a commiseration dinner. I can spend a little bit
more if I'm in Aus for 2 weeks less, right?
Sunday:
Did this blog and boring jobs. Ranked my top 10 jobs in Trent (yes, still do all that, the offer is conditional on me passing before a certain deadline, which I should if the resit goes to plan).
Happy Mother's Day!
Sunday:
Did this blog and boring jobs. Ranked my top 10 jobs in Trent (yes, still do all that, the offer is conditional on me passing before a certain deadline, which I should if the resit goes to plan).
Happy Mother's Day!
Thursday 7 March 2013
Thursday
7 am meeting with the working ophthal people (as opposed to the researchers) was a joint meeting with radiology and pathology to discuss difficult to diagnose cases. Things that cropped up were an MS presentation, rare tumours, Wegener's granulomatosis, that sort of thing.
After that, it was off to observe an ectropion repair, and have it explained really well by the professor/consultant in a one to one setting for about an hour, while his reg's did the operation. It was actually really good and interesting teaching - lots of diagrams, and relating it to what was happening in the operation as and when. Although I imagine this only sounds interesting to medically oriented people, I can assure that this was very good. You don't get that kind of teaching opportunity very often in medschool - to be a professor's sole focus of teaching attention for an hour.
We then chatted about the different healthcare systems, because I was interested in how Australia's works. Basically, it's complicated, and I'm not sure I understood all of it correctly, so take the following with a pinch of salt.
At the State level, there's NHS-style public healthcare that's free and open to all, but massively under-funded and has long waiting lists (no surprises there). It was originally designed to treat those who couldn't afford private healthcare (they intended for a tier system of healthcare? I dunno), but naturally has taken all comers. This actually runs parallel to a private system that's backed by the Federal government, for which people pay for bits of, and then need health insurance to cover the bulk of the costs, but are treated by consultants and have basically zero waiting (again, similar to UK).
It might sound similar to the UK, because it is, in a way. We have the overworked, public hospital behemoth of bureaucracy that is the NHS dealing with most cases, and then we also have a small private sector and health insurance availability for those that want it. But in Australia the Federal gov't really backs the private system all the way, and you've got State governments trying to support their NHS equivalent without the funding that the Federal gov't can muster. In the UK it's traditionally the gov't supporting the NHS that gets them the votes (whether or not they live up to those promises of support).
Apparently the Federal gov't "incentivises" the wealthier population to get health insurance, by offering those earning above a certain amount per year a tax break if they have it (the idea being that at the other end of the scale, they aren't taxed as much and can't afford insurance?). This actually sounds rather good to me - incentivise the wealthy to stop getting freebies from an overworked public system that was originally designed to only treat those who couldn't afford to pay, and at the same time it makes the wealthy feel like they aren't paying for other people to mooch off their hard-earned dollars. It's like offering cheaper health insurance. I don't know how successful that ploy is.
I have a long ramble saved now, debating the ethics and my viewpoint behind this and the NHS and healthcare provision in general. I may publish it another day, when I have another think about it and edit it lots. I don't it to be inflammatory to people, and I know what I'm like when in the middle of a debate (even with myself) and things can get a bit exaggerated and extreme as arguments are followed to logical conclusions. I also tend to be quite tangential at times. It'll be more of an open question, as I feel like I'm missing a point somewhere in my feelings on the subject. I haven't done much in the way of journal or paper reading on the topic either, so it's likely 'uneducated' from that angle.
Anyway, that was interesting. Then it was wondering around the area outside of the hospital a bit to find some lunch - there's an entire high street nearby that seems to have sprung up purely to service hospital patients and staff during their breaks. It's all food places and same-day dry cleaning and opticians (and a pathology lab for some reason).
More project work in the afternoon. Had a desperate need for fruit today, so bought some bananas on the way home.
Results tomorrow. Terrifying prospect. It's constantly filling me with dread at one moment, with thoughts of failure, to elation the next moment with thoughts of "what if I pass?"
I will likely be a gibbering wreck in either scenario.
Wednesday 6 March 2013
Tuesday and Wednesday
Tuesday - getting into a pattern now, so feeling more comfortable about being here a while. As seems wont to happen around here though, it didn't go quite to the plan of "normal day, go home, bum around".
Remember all that paperwork I had to fill out last week? Naturally, it came round to bite me in the arse today. I say arse, I mean arm. Apparently, my safely being a medical student for 5 years, free of diseases and up to date with all appropriate jabs, doesn't count when it comes to Aussie hospital admin, because I couldn't remember dates of confirmation of various serology tests off the top of my head when I was filling out the forms. Nor could I quickly just check. I should have just guessed, in hindsight, and they wouldn't have been able to do a thing. But they were asking for some odd ones that I've definitely not been vaccinated against or had serology done, but I know I'm immune - varicella (chickenpox) for instance, I had when I was little. I'm immune. No, I haven't had serology to prove it, cos I don't need it!
However, as it was, they wanted proof of freedom from a remarkably long list of diseases, so the Occupational Health nurse sent me trotting off to the vampires (the blood takers).
It's worth noting that I'm not great at having blood taken. I don't like the idea of it much, nobody does I guess, but it's not like I'm scared or needle-phobic. I'm absolutely fine with injections and local anaesthetic to the face and being awake for a minor op (all past experiences). In my head, I'm even ok with blood being taken, really, as I know exactly how to do it myself and how it all works and how little is taken for these tests, and have done it to plenty of other people already.
My body disagrees. It thinks that anything in my veins is actually a secret signal to massively fire off a nerve called the vagus nerve, and dilate all my blood vessels. The vagus nerve is essentially a "brake" for your heart, and when triggered, slows your heart rate down. This is good for a lot of reasons in many situations. In this situation however, it causes something called "vasovagal syncope" which is a posh way of saying - a trigger can cause you to pass out. It causes you to pass out from a combination of two factors:
1) When your heart slows down, your blood pressure drops, and then you faint as your blood can't reach your head.
2) Your blood pressure also drops due to blood vessel dilation. We don't know why certain triggers cause the response - that's just 'odd wiring'.
I have a low blood pressure normally anyway, and sometimes get postural hypotension when I stand up too quickly from a funny position (I stand up, and feel faint because my blood pressure can't adapt to force the blood up to my head fast enough). So, it doesn't take very long with a needle in my arm before I start to feel myself go.
I only had my first (self-aware) blood test when I started medschool, so had no idea what to expect, but found out that I pass out. Which was fun. Anyway, I now know that it's worth pointing out to blood takers if you do have episodes like this. You get to have a lie down, for a start, and they do it all while you lie there. Helps the blood get to my head even when my pressure plummets. It's weird being awake for actually - I knew exactly what was going on, but my body responded against my control anyway, and I could feel my heart thumping - wasn't sure if slow, my body get sweaty, and my breaths get deeper as I unconsciously tried to compensate.
He needed a fair few vials, but once the needle was out of my vein, I was back to normal in seconds. I should add that he was very good - not a mark on me afterwards, and very little pain.
So results of those tests are on Friday morning - no clinical stuff until then, I've been warned. Finals and FPAS are Friday afternoon and evening. Fantastic day that's going to be :/
I went back to the office to do more Science. Played another table tennis match and lost again, 21-16, but was much improved this time! The score doesn't accurately reflect how close it was for most of the match, with each of us pulling ahead in turn. I just made a few mistakes that I know I can improve. Getting there. Got my serving eye back in though, which is good - nice to have their eyes widen a bit when it streaks off to one side. Lots of 'aces' had. My returns need more work!
Wednesday - Normal working day. More Science done. Introduced to a working ophthalmologist fellow who I'll be meeting with tomorrow morning at 7 am (what, an actual early morning start?!) for a team meeting and potentially some "off the books" theatre observation, although I can't condone that sort of behaviour and it's unlikely to happen, etc, etc.
Watched the Game of Thrones Season 3 trailer and contained a potentially embarrassing squeal of excitement that threatened to be let loose, by biting my fist in a manly fashion and clearing my throat. Watched the first of Tor's video blog. Skyped Tor before heading home, which was nice.
Friday looms. I can't shift it out of my head.
Remember all that paperwork I had to fill out last week? Naturally, it came round to bite me in the arse today. I say arse, I mean arm. Apparently, my safely being a medical student for 5 years, free of diseases and up to date with all appropriate jabs, doesn't count when it comes to Aussie hospital admin, because I couldn't remember dates of confirmation of various serology tests off the top of my head when I was filling out the forms. Nor could I quickly just check. I should have just guessed, in hindsight, and they wouldn't have been able to do a thing. But they were asking for some odd ones that I've definitely not been vaccinated against or had serology done, but I know I'm immune - varicella (chickenpox) for instance, I had when I was little. I'm immune. No, I haven't had serology to prove it, cos I don't need it!
However, as it was, they wanted proof of freedom from a remarkably long list of diseases, so the Occupational Health nurse sent me trotting off to the vampires (the blood takers).
It's worth noting that I'm not great at having blood taken. I don't like the idea of it much, nobody does I guess, but it's not like I'm scared or needle-phobic. I'm absolutely fine with injections and local anaesthetic to the face and being awake for a minor op (all past experiences). In my head, I'm even ok with blood being taken, really, as I know exactly how to do it myself and how it all works and how little is taken for these tests, and have done it to plenty of other people already.
My body disagrees. It thinks that anything in my veins is actually a secret signal to massively fire off a nerve called the vagus nerve, and dilate all my blood vessels. The vagus nerve is essentially a "brake" for your heart, and when triggered, slows your heart rate down. This is good for a lot of reasons in many situations. In this situation however, it causes something called "vasovagal syncope" which is a posh way of saying - a trigger can cause you to pass out. It causes you to pass out from a combination of two factors:
1) When your heart slows down, your blood pressure drops, and then you faint as your blood can't reach your head.
2) Your blood pressure also drops due to blood vessel dilation. We don't know why certain triggers cause the response - that's just 'odd wiring'.
I have a low blood pressure normally anyway, and sometimes get postural hypotension when I stand up too quickly from a funny position (I stand up, and feel faint because my blood pressure can't adapt to force the blood up to my head fast enough). So, it doesn't take very long with a needle in my arm before I start to feel myself go.
I only had my first (self-aware) blood test when I started medschool, so had no idea what to expect, but found out that I pass out. Which was fun. Anyway, I now know that it's worth pointing out to blood takers if you do have episodes like this. You get to have a lie down, for a start, and they do it all while you lie there. Helps the blood get to my head even when my pressure plummets. It's weird being awake for actually - I knew exactly what was going on, but my body responded against my control anyway, and I could feel my heart thumping - wasn't sure if slow, my body get sweaty, and my breaths get deeper as I unconsciously tried to compensate.
He needed a fair few vials, but once the needle was out of my vein, I was back to normal in seconds. I should add that he was very good - not a mark on me afterwards, and very little pain.
So results of those tests are on Friday morning - no clinical stuff until then, I've been warned. Finals and FPAS are Friday afternoon and evening. Fantastic day that's going to be :/
I went back to the office to do more Science. Played another table tennis match and lost again, 21-16, but was much improved this time! The score doesn't accurately reflect how close it was for most of the match, with each of us pulling ahead in turn. I just made a few mistakes that I know I can improve. Getting there. Got my serving eye back in though, which is good - nice to have their eyes widen a bit when it streaks off to one side. Lots of 'aces' had. My returns need more work!
Wednesday - Normal working day. More Science done. Introduced to a working ophthalmologist fellow who I'll be meeting with tomorrow morning at 7 am (what, an actual early morning start?!) for a team meeting and potentially some "off the books" theatre observation, although I can't condone that sort of behaviour and it's unlikely to happen, etc, etc.
Watched the Game of Thrones Season 3 trailer and contained a potentially embarrassing squeal of excitement that threatened to be let loose, by biting my fist in a manly fashion and clearing my throat. Watched the first of Tor's video blog. Skyped Tor before heading home, which was nice.
Friday looms. I can't shift it out of my head.
Monday 4 March 2013
Sunday and Monday
So, it's a long weekend here, and I do actually have some things to get done. Sunday was the day I Got Stuff Done. Laundry, work, emptying bin, paying rent, tidying room, etc. I started writing my best man speech(!) for my brother's wedding. Going well so far, but there's still a few bits that want tweaking.
Checked the weather for the rest of the week, and Monday was looking a bit cooler, with some clouds and potential rain, so the beach idea has been dropped for this weekend. That's ok. I'm here for a long time.
Went native, and had a wander around the nearby blocks at 7pm looking for places to eat - the Italian I'd planned on visiting was unexpectedly but very definitely shut, but the tables were all laid out and everything. It was weird. Instead, after not much searching, I found this cool little (posh) burger place, that felt like the equivalent of Gourmet Burger Kitchen in the UK. Open french doors onto a modern art-y stepped amphitheatre with water features and whatnot, and cheesy/cool chillout music playing (the Bodyguard song - "You can call me Al", Signed, sealed, delivered, and more)
It was really nice, and not badly priced at $17.50 for a (huge and very posh, with tomato relish etc.) burger and (amazing) chips. That's just under £12 in real money. Good for a very filling dinner.
I only make a point of this because of the cider, which I hadn't noticed because I was too busy focusing on the food and the name of the cider. Pipsqueak. My mum used to call me Pipsqueak. Must be destiny - but if destiny costs $11 for a pint (£7.40!) it can go to hell.
Monday - slept in till late, as I was up till the early hours writing bits for my book. Here's the thing, I'm not actually writing stories (yet), I'm just fleshing out ideas that I like in order to better set the world for the stories to happen in. I love world-building like that. It's all about the details - things that won't be noticed and will likely not even get mentioned in a story, but that doesn't matter, because as long as I know how x is supposed to look/work/etc. then I feel like I can give everything else better context for when I do get around to writing about a character's journey. Also if anything does get included, I have notes written down somewhere as to what I want it to look and feel like that I can reference without needing to remember stuff.
Also, I'm really picky over this particular world. I want everything to work. By which I mean, I want it to seem as realistic as possible, whilst still including the concept of magic. Which essentially just means that the laws of physics are exactly the same in this world as ours - but I've wedged magic in as an outside, restricted access power source from the 'closed system' of the universe. I like any setting that takes the original high fantasy approach to a magical setting and then goes "what happens when time and technology moves forward as it did with us?"
Anyway, I started actually writing about the characters last night, which is relatively new territory for me, but was rewarding in a different way. Nothing major, just fleshing out the concepts. Was fun.
Did some more work. Emailed a few companies, but not hopeful for replies. Doesn't matter particularly, but would be nice for completeness of the results.
Saturday 2 March 2013
Friday and Saturday - Lions and Tigers and more!
Work and not much else happened on Friday, considered going to a bar and having a few drinks, changed my mind several times, and came home on the basis that I actually still hadn't finished the work I wanted to do, so came home and did so. How very restrained of me.
So today (Saturday) was Perth zoo day, and I loved it. On initial gaze from the outside of the entrance, it looked pretty small, judging by how far I could see the walls go back. I mentally prepared myself for a few underwhelming marsupials on display.
This is not the case. Here is a map to prove it, and give some indication of size:
So, I started in the bottom left, and worked my way around anticlockwise, because I wanted to save the Australian animals till last and spend the most time with them. Again, this was not to be, but through my own choice.
It was really, really hot today. I had factor 50 on every bit of exposed skin - I think I got away with it. This did seem to affect the animals a fair bit too, as you will realise from the photos. Most of them were asleep. All day. In the shade/long grass/undergrowth/difficult to photograph bit. And there were very few that wanted to face in the correct direction. So I mostly have a collection of pictures of animals' backs. They are quite good photos of backs though, if there are any wealthy collectors out there. Very little 'face' in any of them, and good detail of the back fur/scales.
The zoo was also full of small children, making the whole process rather screechy, but at times hilarious as they attempted in a number of colourful ways to get themselves eaten/poisoned by the fauna. Alas, no such luck.
I think going through every animal I saw and my thoughts/experiences would be a rather long and dull process, as I did go and see everything in the zoo. Instead, I'll talk about a few of the cool ones.
1. Rhinos - cool. Just a pair of them, eating grass together, casual-like. I believe they were white rhinoceros. Kind of cute from this distance.
2. Lions. Just wow.
3. Meerkats - I have a long-standing affection/connection with meerkats that people who know me from uni will get. At any rate, these ones were cute, and you could get reeeally close, and they loved having photos taken. What's not to love?
4. Giraffes - only from a distance, as they weren't near any viewing spaces, and this one was determined not to turn around.
5. Cheetah - as per lions. Very cool to actually see one IRL.
6. Galapagos giant tortoises. Always awesome, all the time. I would like to use one as a slow-moving chair, one day.
7. Orangutans! A must-see for any Discworld fan, there were a lot of the Librarian's endangered ape cousins clambering about on specially-built equipment. It's designed to provide them with everything they get from trees in their natural habitat, but without being edible and quickly destroyed by them. They also put bits of 'litter' in with them (cardboard, old shirts, etc.) for nest material, as they like to build a nest for napping in the day, and one for sleeping at night.
8. Asian elephants - cute, and my mum's favourite critters on the planet. Here's one having a shower courtesy of the staff (the elephants are well trained).
The Tasmanian devil was the opposite, madly running around in a circle of foliage, proving impossible to photo. The wombats were fighting each other in their burrow, so didn't stay still for any decent photos. The dingos weren't visible at all. There was an emu sitting down, briefly. The kangaroos looked like this in the heat:
Zoo done. There were more, as I said, but not going to bother uploading all those photos on an expensive internet connection! Was a grand day out, and my legs are still knackered. Bought a Subway on the way home to make up for it.
So today (Saturday) was Perth zoo day, and I loved it. On initial gaze from the outside of the entrance, it looked pretty small, judging by how far I could see the walls go back. I mentally prepared myself for a few underwhelming marsupials on display.
This is not the case. Here is a map to prove it, and give some indication of size:
So, I started in the bottom left, and worked my way around anticlockwise, because I wanted to save the Australian animals till last and spend the most time with them. Again, this was not to be, but through my own choice.
It was really, really hot today. I had factor 50 on every bit of exposed skin - I think I got away with it. This did seem to affect the animals a fair bit too, as you will realise from the photos. Most of them were asleep. All day. In the shade/long grass/undergrowth/difficult to photograph bit. And there were very few that wanted to face in the correct direction. So I mostly have a collection of pictures of animals' backs. They are quite good photos of backs though, if there are any wealthy collectors out there. Very little 'face' in any of them, and good detail of the back fur/scales.
The zoo was also full of small children, making the whole process rather screechy, but at times hilarious as they attempted in a number of colourful ways to get themselves eaten/poisoned by the fauna. Alas, no such luck.
I think going through every animal I saw and my thoughts/experiences would be a rather long and dull process, as I did go and see everything in the zoo. Instead, I'll talk about a few of the cool ones.
1. Rhinos - cool. Just a pair of them, eating grass together, casual-like. I believe they were white rhinoceros. Kind of cute from this distance.
2. Lions. Just wow.
 |
| Let's play Sleeping Lions! |
3. Meerkats - I have a long-standing affection/connection with meerkats that people who know me from uni will get. At any rate, these ones were cute, and you could get reeeally close, and they loved having photos taken. What's not to love?
 |
| Personal favourite is the one 'Planking' on the right hand side |
 |
| This one heard my camera, so paused in his digging to let me get a shot. |
 |
| Note the derisive, tantalisingly slight turn of the head. One doesn't deign to look at you, pleb. |
6. Galapagos giant tortoises. Always awesome, all the time. I would like to use one as a slow-moving chair, one day.
7. Orangutans! A must-see for any Discworld fan, there were a lot of the Librarian's endangered ape cousins clambering about on specially-built equipment. It's designed to provide them with everything they get from trees in their natural habitat, but without being edible and quickly destroyed by them. They also put bits of 'litter' in with them (cardboard, old shirts, etc.) for nest material, as they like to build a nest for napping in the day, and one for sleeping at night.
8. Asian elephants - cute, and my mum's favourite critters on the planet. Here's one having a shower courtesy of the staff (the elephants are well trained).
9. Tigers! As per lions and cheetahs - they're big cats so I love them.
10. Australian animals various now. The koalas were all asleep whilst hugging their trees, so took photos and moved on.
 |
| They aint'nt dead. Promise. |
And the echidnas were all in their burrows together.
Last but not least, the estuarian croc! An absolute monster, looking a good 5 m long and proportionally wide, it's built to kill and has the armour plating of a tank. Seriously, this thing was BIG. And they really do look like they're from the dinosaur age. I only wish the photos gave a better sense of scale.
Zoo done. There were more, as I said, but not going to bother uploading all those photos on an expensive internet connection! Was a grand day out, and my legs are still knackered. Bought a Subway on the way home to make up for it.
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