Death in the family

What else to say

Evidence based medicine ( try not yawn)

This whole week we have been through practical/statistical way to appraise any given research paper. Say, your patient came asking about the risk of drinking coffee and developing high blood pressure or wearing white clothes and getting hit by a lightening or even using aspirin to reduce heart attack risks. It turn out you don't accept any research paper. Even if it was a review comparing many published papers and drawing conclusion from them (meta analysis). You first appraise that paper, to check its quality and validity and obviously applicability to your particular patient. There are many formulas and such. My point: Evidence based medicine is intended to tailor each patient clinical encounter.

If you still awake, I felt a shamed that after all these year in college I still have no published research. I don't know if that even matters to me. But I feel sad and old. And like a spoiled babe, I need a research right now. But I am not good in working with ..um doctors!

End of year exam is nearby, maybe I want an excuse to not study, Hey, and so is my elective. Hooray!

Oh and I can use some friends, with chocolate and aerobic exercise. Yah, didn't make sense to me either. I need to sleep. But first aerobics, appraise a study with a colleague for tomorrow's presentation and then ... study some more! College life rocks!

 

 

 

 

Lectures

In high school I learnt a funny trick to avoid literally falling a sleep in a boring lecture. It consist of raising your hand and coming up with a question related to the topic title. Piece of cake with whiteboards. Not so easy in a  series of  powerpoint lectures. Let's say I made the whole class confused today. I am pretty sure the tutor thought me asking him was part of day dreaming. Hey even maybe a stroke. He asked me to read the next slide, maybe to assess my mental state.
I have no idea what I said. But from my classmates reaction, it sounded genius.

Good news, I stayed awake for the rest of day.

Missing my friends

I wish I can cry when I want and be able to hold my tears when I wish too. 

How can one stop blaming oneself  for something that already happened. How to stop being so sensitive and so naïve.

One day folks, one day

Here and there ( as opposed to "And Now and Here")

Today I met a very inspiring spine surgeon. His attitude to life, the way he communicated with patients and how he treated us, medical student...if only we can capture great moment and  re live them again.

Ortho last day tomorrow. I feel guilty for not reading the way I wanted. There are many topics and branches; it is crazy. At least I know the basics. I hope.

Evidence based medicine next week. Beside a presentation we are expected to analyze a study. I really pray that no more brain numbing presentations. Some people just ignore the fact thier colleagues may have  a soul. Why I am with the nerdest group. Oh yes because I maybe one!

In completely unrelated subject, I just ate a maltesers icecream for the first time ever. Did not know it is so yummy. Glad I am not to icecreams other wise I will be addicted.
O and I feel  I could use some shoping, just not in the mood.
Flatmate goodbye dinner tonight. She is paying. She is going abroad for a 2 month elective. The other flatmate which is in the same year as I am, and a distinction student by the way, is busy preparing for our end of year exam, helping preclerk students out and other stuff. How can someone be so active! I think I'll befriend the gym again!
Enjoy life people!

P.S.
"And Now and Here" is a lovely collection of Osho talks. Any one interested email me I'll send a copy.

Pyrrhic victory

That is a new phrase added to my glossary thanks to the BBC. Yesterday I was super productive and indeed finished my presentation ( it was awesome; that feelings when you make your classmate awake and interested), mini assessment and a bedside discussion went smooth. I also did my first ortho on call. Simply amazing. I truly enjoyed it. We got to see loads of traumas and different fractures. Enough bragging. The price was me surrendering to my sinusitis induced headache ( sleeping when I was supposed to study). O and I should add I barely read/ prepare! The consultant said we don't need too. I swear.

I'm currently in my third week in ortho. And seriously considering it as a future specialty. My consultant also said it would suite me:) Well at least that is what he thought before I missed a basic question. (bye bye dear "remnant" ego. I am considering total face reconstruction once I graduate from medical school. Man, I need to shut my mouth and pretend I am thinking quite often).



Diabetes affect blood supply to nerves leading poor sensation and injury going unnoticed

In the ward I saw a lovely lady with Charcot foot (common in poorly controlled diabetes) who slipped in the bathroom and broke her ankle (grade C in Weber ankle classification.. umm..yes I know what that is). Because of her poorly controlled diabetes her wound got infected and the healing was delayed ( 2 months and the wound still swollen and not fused). Her motion at ankle was restricted in all directions. Sensation was almost normal. Joint position sense was not there! First time I test someone and they test positive! Needless to say her ankle was deformed. Much like the picture. There were many fracture cases with different correcting implants. And we got to know the name of different plates and screws used. We saw two cases of implant failure, one due to a combination of wearing off of the implants (estimated age of an implant is 15-20 years) and an advance osteoporosis. The other was due to infection. And after spending 2 hours teaching us about these stuff, the doctor conclude by saying that it is beyond what is expected from us! Hooray! Additionally we got to spent one day in the physiotherapy department!



In fractures (compared to joint replacement) implants is removed after one year, sometimes sooner!

Clinic wise; I saw many interesting cases in the wrist clinic ( I told you it is a highly specialized center). One was of an army fellow who managed to tear his TFCC ( help in forearm supination and pronation which were limited in our patient.) I also saw the classic scaphoid fracture. The patient main complain was pain in the anatomical snuff box ( yes, the area people used to put heroin to sniff it). I spent most of the time in the knee and spine clinic.

We learn loads of examinations to detect ligaments tears and impingementation and were introduced to different fracture classification system. I guess we are not expected to know them by heart ( or are we?) there is a classification system for almost each joint/bone. I guess I will learn the Ottawa one, because ankle injury is the commonest ( yeah, not because its super usefull and copys of it hanging from A & E walls).

In aside note, do students from other specialty share their experience over meal time or in trips? Because when I told my brother, who is a honor student , he said that is what nerds do!

Ok, I have boooooooooks to read. Wish me luck.