So, it's been a while...

Well, I know it's been quite a while since my last post (which was featured in a Grand Rounds [only the second time I've submitted a post]). Things have been busy, I have been doing some steady 6-day weeks at the hospital and 5-6 day weeks at the gym. Am finishing up now, was in the ER today, have one more shift with the Hospitalists tomorrow as well as a night shift in the ER tomorrow and Saturday night. Then it's a few days of relaxation until my return to St. Andrews!

Couple interesting things I saw today:

86yo M on Coumadin bit his tongue 2 days ago, hasn't stopped bleeding since. Dr. M (female ER doc) puts a single 4-0 Vicryl (absorbable suture) in the hole, and applies some gauze. A little while later, patient has still not stopped bleeding, so we put some gel foam (little pieces soaked in thrombin/fibrin) to help the clotting...the bleeding slows, but the patient is poorly complaint (retired psychiatrist, Chinese - not much English) and it takes 3 things of gel foam and a small piece of surgicell to get it to stop. INR was only 2.0, btw.

64yo F originally from Northern Ireland on Vacation, forgot both her insulin refills and her glucometer. Felt horrible (very compliant in past, never forgot insulin shots ever); we thought it would be an easy script, but turns out her sugar is 501. We give her fluids and some insulin, but she doesn't understand what 501 is. Then I realize - in the UK we do blood sugars in mmol/L, while in the US its mg/dL. So, here is something for all you guys out there who encounter this problem: 1 mg/dL = 0.0555 mmol/L. So if you find her BS to be 501, tell her it's 27. If she tells you she's normally 5-8, that means she's normally 90-144. Hope that helps!

Today was also my last day shift in the ER...it always happens that I have to leave just when the nurses/techs/docs are getting used to me being around and are starting to feel more comfortable letting me talk to pt's, etc. Oh well, I've got years of that left.

-AMiB

Immunopatho-what?

Recently, I've been becoming more and more sceptical about the education I'm receiving here in the UK. The fact that the medical school starts straight out of high school (or sixth-form college) is an obvious major difference between the two systems of medical education. But I figured that in our first year, "Foundations of Medicine 1 & 2", they would teach us the "important" stuff from undergrad. Any biochemistry we would've missed, maybe a bit of important organic chemistry, but would leave out the less clinical parts, like "Origins of Civilization" and "Introduction to International Relations" (There are people who study those subject here, but as their major, not on their way to a science degree). However, I seem to be finding that we are generally taught things in a lesser detail schools back home would, with an attitude of "Oh, that's not important right now" or "You will have plenty of time to learn that in Manchester" (Manchester is where we go to complete our clinical training).

I recently obtained a copy of the infamous pathology notes by Dr. Goljan, and while browsing through it, was horrified at the amount of information I had never come across. Seeing as how this is one of the main books used by students preparing for the USMLE, it looks like I'll have quite a bit of work on my hands for my summer times…

While I did feel comfortable seeing some familiar terms ('calor, rubor, dolor…' – acute inflammation and the difference between the types of hypersensitivity reactions), these are just basic things that I would hope every medical school, no matter where it is, teaches. It's the more obscure things that scare me.

Until next time,

-AMiB