Cytokine Storm

I’d like to say a couple of things:

• - This has been a crazy year for me in more ways than one and I’m damn sorry that I’ve not been posting more.
• - This will be soon fixed, and am planning on getting a post up every couple of days, if not more frequently. 
• - Hello again to followers old and new, your attentions are always appreciated!
• - The message box is always open, and please feel free to fill it with anything from questions on medical school to even just wanting a chat!

Peace out!

lunarscope:

“Oh, there’s not many people here yet, we’ll give it another ten minutes in case people are getting coffee”.

“Now, most of this is going to be about my own research rather than examinable material…”

“Now, for the next hour we’ll be discussing the need to pass Cleanliness Champion before the end of fifth year…”

“In today’s Dermatology lecture…”

In terms of treating (usually Alzheimer’s) dementia, Acetylcholinesterase inhibitors are generally prescribed when the patients mini-mental state exam score is between 10 and 20. Guidelines say above and below this, they should be withheld (in the name of finances and QALY’s), however, many practitioners and textbooks err on the side of sentiment. Dementia is a very “family” disease, it affects the family and especially the spouse as much, if not more, than the patient. If the family and spouse notice a difference, even in general awareness and brightness in the patient, with the medication, that is not reflected in the MMSE or other mental state exams, it is usually seen that practitioners will continue the treatment.

I believe this is the right course of action, having had a family member suffering from severe dementia. 

“Using QALY’s (quality adjusted life years) can make us cruel, sentiment (as an alternative) may make us useless. However, it is better to be useless than cruel”.

Something that cheered me up today :) 

More to come from whitecoatandastethoscope later!

house-of-gnar:

untitled by adamheathRT on Flickr.

Pro-sections. That brings it all back!

The ask box on the blog is always open!

If you’re every curious, I’m more than happy to answer queries!

It’s that time of year again, I’ve seen young ‘uns in the medical school with their best clothes on to try and talk their way in to our lovely school!

Good luck everyone, no matter where you apply!

I usually love tackling medical ethics and the moral side of medicine. Thankfully this isn’t due for over a month, because today my brain is just saying:

Recently, I worked a short stint in Acute Receiving in the hospital I was placed at. It was great “fun”, in as much you can have fun on a ward, but hell, my joy is in my work or else I wouldn’t be working towards being a doctor. 

I got plenty experience doing bloods and venflons, and overall worked out just how things “work” on receiving, from clerk in to initial bloods to forward planning and consultant review etc. 

But I happened to clerk in a man in early middle age, experiencing chest pain. No history to speak of, previous hypertension controlled well on ACE inhibitors. 

I don’t want to speak too much about the details, the more anonymity for the poor gent the better. What I will say is for his symptoms and results of initial investigations, he was managed perfectly to guidelines, to the letter, by the entire team.

His chest pain cleared but he was kept in over the weekend just to keep an eye. He subsequently “crashed”, and despite the teams best efforts, he passed away. 

This isn’t the first time a patient that I’ve worked with has died, but it’s the most I’ve been “involved” in a patients care who has subsequently went on to die, especially such a young man, and, admittedly  despite only knowing him a few days, I had a good chat with him every morning whilst he was in. 

There’s not really a day in the last couple of weeks I’ve not thought about him, or what happened. 

The junior doctor who was seeing to his care, who I work with, found me as soon as she could to let me know what had happened, and I know I’m not the only one shaken up by the whole. Responses have varied from, “It’s awful but these things happen”, to “You can’t save them all…but this one’s certainly unusual”, to just general shock. 

And in general, my best friends, my friends I see the most, aren’t in the medical profession, and as much as I see this as a massive plus, normally, I feel like I bring down the mood when I need to talk these things.

It can’t be easy to relate, I guess. 

Moreover, I mentioned fun earlier. Because training as a Doctor, and getting to do all these things we’ve only trained on dummies on in previous years, is fun. You can get caught up in the learning experience and sometimes even forget that some of these people are horrendously ill. 

One of the worst moments is being sent to take bloods etc from a patient, chatting away to them and they’re absolutely lovely. Because then, out of curiosity, you ask the juniors what their diagnosis is, and the answer is usually something you really didn’t want to hear. 

And so it goes.

Sorry about the rant, friends. It’s just been on of those fortnights. Hope you all understand.