Going back

My 2 week mid-year break is over, and Melbourne is the last place I want to be. I feel like this must be how dumbledore felt as Harry forced the potion down his throat. This must be done, but just at what cost.

Mid Air Emergency

(now, I don't know why but I'm going to try to build up the situation as though you don't know what this post is going to be about from looking at the title)

So, the other day I was on a plane back home because I finally finished exams and I was free (FREE!). I'm pretty used to being on planes so nothing was out of the ordinary. They'd served our dinner, and everything was peachy. I was watching Avatar, and I think they were only just past the part where Aywa (or whatever her name is) just decided to take a side in the battle in the skies, when, all of a sudden...the screen cut and a message was displayed saying there was a cabin announcement. In short order, my worst nightmare came true...

"If there are any medically trained passengers, please immediately make yourself known to staff by pressing your call bell".

The blood I felt immediately drain from my face, and my heart stopped. I wasn't ready for this! In a split second my mind had a furious battle where numerous arguments fought: first and foremost, I was afraid that I would be the only medically trained person on the plane, and that if I made myself known I would suddenly have a life on my hands. Within that though, I knew that despite being just a first year medical student I still perhaps knew more than the average joe blog and so I knew I should take the call. Still, I was afraid of having the life on my hands. Secondly, to be honest I wanted to be a part of it. Not because I was nosy, but because it was exciting and perhaps a chance to use some of the knowledge I've gained so far.  Thirdly, as I saw another person press their call bell I had to think about whether my limited knowledge would be of any assistance at all, and whether I would just be in the way. Fourthly, I did consciously put my stethoscope in my carry on luggage just in the remote chance that something happened in the air because I've heard horror stories of airline medical kits not even having stethoscopes and I want to be prepared. So, all of this went through my mind in about a split second. I wasn't ready, but my mind went blank and I just knew what I should do: I pressed the call bell.

Within less than a second a hostess came to me but I was already getting out of my seat -- I didn't know what the issue was and if it was serious then time may have been against any attempt to save the person. Once I decided to help, I was committed. I felt sheepish being escorted to the rear of the plane, feeling way out of my depth and wondering just what the hell I'd just gotten myself into. If I couldn't help this passenger, what would I do? The people around might be looking to me as the person to save the passenger, and if I didn't know what was happening to them or if I didn't know what to do, what would I do?? I was freaking out, but trying to stay calm at least to assess the situation.

Making my way to the rear of the plane, I noticed that there were barely any passengers around and I wasn't sure if they'd cleared the area but it was really good. When I arrived there was already a guy in a tshirt talking to the man who had an oxygen mask on, and there were probably 5 or 6 air hosts/esses around. The guy in the tshirt I quickly realised was an experienced medical person, which made me instantly relieved -- I felt like he had saved me, as much as he was saving the passenger. I soon learnt he was a trainee surgeon from a victorian hospital. He was doing a history of the guy, while the air hostesses got out what seemed like every piece of medical equipment and materials the plane had. The guy was diaphoretic, tachypnoeic, had rigors, tremors, fever, headache, had vomited profusely and had a large quantity of diarrhoea over the whole duration of the flight, had chest pain, numbness around the mouth (we decided probably from hypocapnia secondary to the tachypnoea), and he felt very nauseous. He had lost consciousness while trying to tell a hostess that he was feeling ill, and he convulsed while unconscious. While the nausea, diaphoresis and chest pain initially had me wanting to rule out MI, the surgeon said quite rightly that at the patient's age it was highly unlikely, and so with the fever he was more inclined to go straight to a bacterial cause -- sepsis, secondary to a gastroenteritis.

Basically, we found that almost everything the aeroplane had was for acute life threatening non infectious conditions like an MI. In the absence of IV antibiotics (or even oral antibiotics), our options were severely limited. Basically, we could only give symptomatic treatment and hope that the diarrhoea and vomiting had reduced the infectious load enough that he would make it to our destination. We gave him an aspirin for the chest pain, and we were going to give him some fluids that they had (hartmann's solution) but the cannula didn't connect with the tube from the IV bag for some reason, so we just had to be content that we had secured a peripheral line for the ambulances who were going to meet us when we touched down.

The man's condition was pretty serious. His temperature was very high, but he perceived his temperature to be varying wildly -- one minute he would be sweating profusely, the next he would be shaking with extreme shivers. The sepsis appeared to be quite bad. We had him on 4L O2 and he said that was the only thing stopping him from vomiting. His condition become the worst we saw just before we landed, but he still didn't vomit again after we saw to him.

As for what I did myself, it wasn't all that much. I of course offered my stethoscope and it was gratefully received so the surgeon could listen to the breath sounds. I also liaised a lot with the aeroplane staff, telling them what we needed and what was happening now. I also talked a lot with the surgeon, giving him equipment and talking to him about what he was doing and thinking, what I was thinking, etc. I really wanted to get in there and have a listen to his chest as well, but there wasn't enough space and I didn't want to speak up because I was just a medical student after all...

Anyway, when it was apparent to us that he was perhaps at least stable, I talked more casually with the surgeon. We got friendly, and he said that he'd give me his number and when I'm back in melbourne I should give him a call and maybe he could give me some experience in his hospital -- including theatre! I'm sure he didn't mean that though so I'm staying realistic, but I'd still love to even just get to be friends with him.

The staff of the plane thanked us so much after the paramedics came on board and we started packing up. They were thrilled with us, even the captain came down and shook our hands. One of the main staff people gave us each a bottle of wine, and they took our details and the captain said he'd see what he could do...he meant about getting free tickets I think!! Incredible.

All in all, that was an incredible experience and I am very glad that I decided to stand up and offer what little I could. I couldn't believe that it was actually happening and I still can't in a way, but it taught me several things but most importantly, it gave me my first taste of a situation where not only are tensions running high, but I am also required to be able to think critically and draw upon my knowledge. So exciting.

Until the next time,

Circle

Stories

I want to maybe start posting tiny stories on this blog, as a way of staying sane and as a way of widening the variety of things I post about. You always hear people say that practice makes perfect, and so my stories would be crap to start with but hey maybe by the end of the year they'd get better.

Catchas!
Circle

Exam prep

Heading up to exams next week -- WOOHOO! Wait a minute, I'm not excited about that...take that woohoo back!

I have two exams next week, and one of them I'm either going to ace or miserably fail utterly and wholeheartedly. That is, of course, the main FBS (foundations of biomedical science) test. Basically, it's all of gastro and renal block, plus all the labs from the whole semester. That's all the immunology labs, all the cardio labs, all the resp labs, all the gastro labs, all the renal labs, all the anatomy labs, all the microbiology labs, and there's one other set of labs that I've forgotten too. Oh, histology. Oh and the pathology labs for all those organ systems too. Sooo...since I'm really only just starting revising the lectures for gastro and renal, what do you think my chances are?

Well, that's actually an interesting question. See, everyone right now is stressing out about anatomy. BUT, I've already done heaps of anatomy! So if anatomy forms a large amount of the test, then I'll almost be able to wing the rest of it...don't you just hate it when you get to the point where you're thinking about how to minimise the amount of work you have to do simply because you're in a position where you can't possibly hope to do it all. Ahhh well.

After next week I'm heading back home for our two week mid-semester break (yeah we only get a 2 week break), and after that we have neuroscience which is universally stated as being the absolute hardest block of the whole year. It's six weeks long!! So I'm hoping to bring some of my pathology books home and study up some neuroscience over my break so that it doesn't hit me too hard .Knowing me though, I'll be posting here probably at the end of the first week of neuro that I wish I'd actually done that study over the break.

We talked to a vascular surgeon trainee yesterday, and he said that while he's training now to be a surgeon he actually knows that there aren't any jobs available for him. And that kicked off a massive discussion about our job prospects in medicine...basically, they suck. And the prevailing opinion is that some day technology will basically replace doctors. If not doctors, then certainly surgeons. For example, cardiothoracic surgeons -- drugs to treat heart conditions are getting pretty darn good now, and lots of people are saying that they're heading the way of the dodo. Hopefully neurosurg doesn't become obsolete for, hmm, at least 60 years :P

Anyway so that's me for the moment. This weekend's going to be a mad struggle to get enough sleep and cram a whole pile of stuff into my memory circuits (yes robotic overlords of the future, I am a robot and you should keep me alive). And when I say a whole pile I mean it: I exported my onenote notebook to word so I could see the wordcount. Here it is:

Like...what. Halfway through the year, people, and I'm almost up to 100000 words. Imagine being told to write 100000 words. I would laugh in your face and then do a little poo in my pants when I realised you're serious. Thank god I moved to dvorak, or I bet I would have been veeery familiar with the effects of carpal tunnel syndrome. Actually come to think of it...damn, knowing those effects would have been handy for this test (get it, handy. My mum thinks I'm funny ok).

Wish me luck!

Circle

Hospital Allocation

Today we received our allocations to the hospital that we'll be learning at for the rest of our courses after this year. I wanted to be at a major metropolitan hospital but before even entering the course I didn't get that luxury. I was down to a choice between two hospitals, and I preferenced one over the other because I really only liked one of them, the other one seemed like a bit of a dump...anyway, so of course I've been allocated to the hospital that I didn't really want. Hooray, right? Ah, me. I just can't shake the idea that not being at a major hospital is going to affect my internship chances somehow, and by extension my ability to get into whatever training course I want later (I say that rather than 'my ability to get into neurosurgery', as a hat tip to the fact that I will probably change my mind in the future -- everyone does, multiple times). If I'm going back to Perth after my MD course then I guess it doesn't matter as much...but what if I don't go back to Perth? There's actually a lot of unknown in my future at the moment.

They only let you change clinical schools in very specific circumstances, and I don't meet any of those circumstances, but just in case I sent them an email tonight saying that if anyone happens to want to move out of the school that I wanted, and has to move to the one I'm to go to at the moment, then I really wouldn't mind being someone they think of to swap with that person. I guess that's the best I can do!

Having said all of this, I know that I am still going to get a good education. I'm still going to go to my hospital and get as involved as I can without annoying everyone. I guess I was just hoping to get involved in that 'big hospital' feel, with all the important consultants and surgeons (I'm thinking neurosurgeons of course) around. Not that they'd have any time for me, but still. Also, the facilities at the metro hospitals are a bit nicer.

Adios,

Circle

GP Visit!

I've got my first ever visit to a GP tomorrow, and it's 1am and I should really get to sleep because it's at 9am tomorrow (today?). I'm super excited! A lot of my friends have already been on their GP visit and they report various amounts of involvement -- some have just been sat in the corner, but some have been able to even take blood! I hope my GP is really willing to let me get involved, because I will absolutely do anything he's comfortable with me doing. I'd be a bit stressed out about doing an interview, but like last time I'm sure that once I'm doing the interview I'd be ok. I mean I've practiced on people before, so it shouldn't be too bad to take that and do it with a real patient.

Next year I'm going to actually go to a GP every friday I think, which I wasn't so sure about initially but now that I think about it I think it's going to be really good. It will not only let me get integrated with a community, and see patients come back time and time again, but it'll give me really practical skills and great patient contact. In some way though...I have a small voice at the back of my head that's saying that I hope it doesn't convince me to be a GP. I will keep an open mind though, because if seeing a GP work really gets me excited, then why not be a GP.

Exciting times in my world! Wish me luck!

-Circle

Contracts For Difference

Hola!

A long time ago I used to not be into medicine at all, and was in fact well and truly obsessed with contracts for difference (CFDs). Why were you so obsessed with them, I hear you ask? Well, it's pretty simple. Basically, trading a CFD is the same as trading a share, except for the same change in price in the underlying security you make either a much greater loss or a much higher profit. For example, the other day I was trading USD/AUD with a leverage of about 99.75%. Normal share trading you can think of, for the purposes of comparison, as a CFD with a leverage of 0%. What you get is what you can pay for. With the CFD I was trading the other day, I was only having to come up with 0.25% of the total value of the goods I was trading. Now when something increases in price by $2, if you buy at the bottom price and sell at the top price you only get $2 for every share you were able to buy. If I was to buy that without using CFDs, I might only be able to buy a few hundred of those shares because my money isn't being leveraged. However, if I was to buy with a CFD I could leverage my money and have the buying power of say $10000, without actually having anywhere near that amount. Now I can buy many more than a few hundred of those shares, and so even though the price difference is still just $2 I am now making a much grander profit. 

The downside to this of course is that if it had gone down $2, I could have just put my family into bankruptcy (quite literally -- leverage can be extremely powerful in CFDs, such as my 99.75% example above). At the moment I use extremely tight stop losses (automatic levels that you set where, if the share trades at that value, it automatically sells them for you, to 'stop' your 'loss' hence the name) and I only trade in small amounts. However, it's still easy to see how powerful these things are: I think I traded 2 units of gold, which I needed to put I think $6 on the line for (that's instead of having to put out about $3000 to have 2 ounces of gold...). The share price went the way I thought it would, and I took a profit pretty quickly, and the profit ended up being $10. That's $10 above my $6, so by the end I had $16 on top of my reserve cash. Now, you're probably thinking 'so what, that's $10, who cares!' but think about this: that ends up being a 167% profit. Now, change my $6 into $6000, and all of a sudden out of that small price movement I've made a clear $10000. $6000 usually would only have bought me about 4 ounces of gold if I had no leverage, so my profit would have only been about $20 ($5 per ounce, because before I owned 2 ounces and made $10). You can clearly see that a $20 profit after putting $6000 on the line is not quite as good as a $10000 profit for putting the same amount of money on the line.

So, if there's so much profit to be made out there by the calm and logical investor, why didn't I go into it! Well, I read a very wise share trader once say that to be a day trader you can't do it on the side -- it has to replace a job. It takes a lot of time to watch the markets, and be in a position of knowledge about the share price, rather than guessing where you think it's going to go. At the time when I was thinking about going into CFDs in a big way, I just couldn't see myself sitting at a computer all day as being much fun. And if it really did happen in a big way for me, if I retired in a couple of years with a billion dollars in my pocket (my dreams were big, ok) then what? There's only so much you can sit on a beach sipping cocktails! At that time as well I was getting veeeery interested in medicine, so I decided that I would give medicine a go and see where it takes me. Of course my attitude to medicine is now very different -- even if I could be guaranteed of billions in CFDs I wouldn't stop pursuing medicine -- and I'm very glad that I decided to not go into CFDs.

As mentioned though, I have been doing the odd trade here and there recently, and as long as I don't put much money into it it could be just a nice distraction. I intend to set up a trade in the morning, and not touching it again until the evening, seeing what happened with it and learning about what went wrong for about 5 minutes. If it could be a nice little earner on the side as I go through these next years then that would be pretty nice!

Regards,

Circle