Foetal Alcohol syndrome (FAS)

Last term we learnt about a series of conditions with learning disabilities and brain maldevelopment. One condition we looked at was FAS, which is a spectrum disorder whereby babies acquire problems due to their mothers drinking during pregnancy. Common features include stunted growth, drug and alcohol problems, sexual deviancy, antisocial behaviour, ADHD-like symptoms, flat mid face, small head circumference, smooth upper lip, intellectual disability,

Within 2 weeks of finishing my neuroscience module I found myself working with a girl with this condition in the mental health rehabilitation hospital. She was 18 and was on a 6 month stay at the unit. She was aggressive and mentally unstable but she told me of her ambitions to learn psychology so she could help kids. She had been sexually abused twice and had previous drug habits. She also told me that she was always running away from her foster mum.

It's sad to think how different her life could have been if she hadn't been born with her condition. She seemed to follow the pattern that we were taught about at medical school. It is almost as if children born with FAS are predisposed to have difficult lives with significant statistics of suffers having drug problems and prison sentences. The patient I spoke to wasn't intellectually impaired but she did have most of the other features of the condition.

I wonder how hard it is knowing that problems could be prevented if your mother hadn't drank when pregnant. Obviously things are far more complicated than this; there are other environmental factors which contribute to a person and their mental health and it is difficult to know and understand the mothers' circumstances, but it does make you think.

Last night's dream

I've spent some time thinking about my recent shift at the mental health rehabilitation hospital and it seems to have crept into one of my dreams.

Last night I dreamt I lived within an institution because I had Scruft's syndrome (this isn't a real condition, merely a figure of my imagination). The main symptoms of Scruft's included problems with planning, intellectual disability and poor fine motor coordination but only at meal times (very odd but it is a dream after all!). I was lucky enough to not suffer from the intellectual symptoms, however because I was labelled with the condition I was forever being treated as if I had a lower IQ.

One of the activities we did was one where we had to pour soap mixture into different shaped moulds, using the colours indicated in the key given. I was chatting with the person next to me and accidentally poured blue into the orange mould. Before I had time to clean the mould and refill it, my support workers had already started marking down my mistakes on their clipboards which would 'confirm' that I had a learning disability.

This reminded me of the 1973 Rosenhan study where pseudo-patients we admitted to a psychiatric hospital after describing fake schizophrenic symptoms such as heading the sound 'hollow' and 'thud' in their heads. Once within the institution they were to act normally (rather than acting as if they had schizophrenia) however it took them many months before they were released. If people think you have a condition, they'll start treating you differently and wrongly interpret your behaviour to match the diagnostic manual. For example, if one of the pseudo-patients told a nurse that they didn't really have schizophrenia and they were playing an important part in a psychological study, this would probably be classified as a grandiose delusion (a symptom of schizophrenia).

For me, I felt this dream gave me insight into what stigma may feel like. I felt judged, frustrated and truly misunderstood. I had become Scruft's syndrome, I felt I was being treated as a condition rather than a person who needed help.

Thankfully this was only a dream and the rehab centre I've been working at is nothing like this. There are only 5 inpatients and the staff know them very well. They are very much treated as individuals; they all have their own stories, personalities  and many have complicated psychiatric backgrounds. I really enjoy working there and am touched that the manager offered me a full-time job after my performance on my first shift. Obviously I couldn't take it up as I'll be back to Brighton in January but I have been offered some extra shifts next week.

Losing someone special

Everyone will have that person they can go to at times of need. For me that was Sue, my academic tutor, who comforted me when I was flailing.

In my first term at med school, I found it hard to adapt to the workload after my year away. I tried to revise in the perfectionist style I used at A level; covering every detail and knowing the curriculum inside out. At Med school the shear content in the small time frame caused me to panic. Knowing that I would have to walking into an exam not knowing everything scared me, I was out of my comfort zone.

I had a timetabled meeting to get my portfolio signed off and I broke down. The thought of underachieving was too much. Sue was there for me, we talked about our home lives and I felt like she really cared. She was an interesting character with interests in art and literature. She was also an above the knee amputee from cancer. She emailed me over the holidays and invited me to meet her for coffee in town if I ever needed a chat. She was more than just a tutor.

We continued to meet up and email throughout the academic year and I was looking forward to see her after the summer. Unfortunately, my academic tutor group was met by the school secretary who had some devastating news. Over the summer the cancer had returned. We were assured, that although Sue could no longer be our tutor she would be around and would still be lecturing ethics.

I was really saddened by the news, such a bombshell to be dropped on her life. I knew she was planning a holiday to Sardinia, I bet she hadn't been able to go. She was probably spending her time going back and forth to the hospital. I went out and bought her an arty card. There were lots of cards with 'get well soon' and 'thinking of you' but they just didn't seem right. I got my whole tutor group to sign the card and have it to school office to pass on to her.

That weekend was when the real shock was. I logged on to my uni account to find an announcement from the Medical school's Dean about Sue. I could only assume this would be about the cancer returning and about her relinquishing some of her teaching responsibilities. It was far worse that I ever imagined.
The cancer was terminal and it had taken her.

It was such a shock, how could it all happen so quickly? We were given the impression that she was relatively 'okay' seeing as she was still at work. I felt so stupid to be faffing about that card when Sue was dying. She was actually dying. I can't imagine her family looking at the frail version of Sue. Her teenage children watching her suffer. I was supposed be revising for tomorrow's exam but I found myself reading her blog. It filled me with pain and sadness to know that she will never see her daughter graduate and won't be around to support her son through his uni application.

I tried not let it bother me but it really did. I didn't know her incredibly well but she was someone special to me.
The following week we had seminars on death and dying, the day of Sue's funeral. Why is it that things always work out like that?
It was too much, I had to leave the group. I couldn't get her out of my mind. I didn't want to get her out of my mind, she deserved thinking about but now wasn't the time to mourn.

My seminar leader came out to me to make sure I was okay. I was, it was just a bit too soon to be openly discussing death. I would have probably been okay if I didn't contribute to the session but that's just not like me, I like to get involved. I was mortified that my seminar group had seen me in tears. I felt weak, like people would think I'm too sensitive.

She reassured me that I was doing okay, she said you can't teach empathy and sensitivity. After some time, this made me feel better; I shouldn't be embarrassed to be emotional. We all get caught off guard sometimes, it's what makes us responsive human beings.

Writing this has given me the opportunity to reflect on the whole experience. Sue really was a special lady. I'm very glad to have met her and send my condolences to those she was close to.

'A chronic patient' or 'A patient with a chronic disease'?

This year, alongside our primary care placements we have started our portfolio on the life of a patient with a chronic disease. In the first week our new GP tutor took us to the patient's house so we could take a detailed history and to try and build up a relationship. 

Our allocated patient 'Mr J' is a gentlemen in his 90's who claims he is 'just getting old'. He can tell us that he's been to hospital a few times and that he has angina. He is immobile and has daily carers to get him up in the morning. He lives with his French wife and dogs, spending most of his time on the sofa; thinking fondly of the times when he could go for walks and fix up his garden. We later found out from the GP that the patient also has chronic heart failure, AF and renal tubular disease. Mr J appeared to enjoy talking to us and telling us about his life and his family, however his wife was keen to stay out of the way.

I sensed from the moment we were invited that we weren't really 'invited'. The wife begrudgingly offered us a chair to talk to the patient and went outside to smoke and scowl at us. I must point out that patients are briefed by the GP beforehand so they know what to expect- it wasn't as if the visit was unplanned! Despite this, we felt we had made good progress with Mr J; that was until the wife came in to ask us not to come back! My GP partners and I left the house feeling frustrated, confused and a little embarrassed. We were all very friendly and polite and had never come across this before. What would our new GP think of us?

On our arrival back at the surgery, we swallowed our pride and gave the GP an honest account of what had just happened. Thankfully he was very understanding and offered us empathetic smiles. He apologised to us for not finding a suitable patient for us to study and said he would speak to the couple about them withdrawing from the scheme and potentially find us a new patient.

A week before our next primary care visit, we received an email from the GP informing us that Mr J was back on the programme. This made me feel uncomfortable; having to try and build up a rapport whilst knowing that we're not really welcome their home. 

When it came to the 2nd visit, it was a similar experience as before with the wife hiding in the garden. We had already come to terms with her unfriendly mannerisms so we tried not to read too much into it. Things went well with Mr J and we only had a few things to ask before returning back to the GP practice.

As we were about to make tracks we were confronted by the wife who asked us what we were actually doing with her husband. She couldn't understand what we could learn from talking to him, she kept saying 'he could just lie to you'. She interrogated us further asking why we hadn't examined him if we were learning to be doctors.

This got us thinking on our walk back from the house; there could have been a number of reasons for her questioning. Could it be due to cultural differences? A biomedical view that a doctors' perceived role is to treat only illness? Or was there something she didn't want him telling us? It could even be her way of making us aware that she still wasn't happy with us being around.

This has made me really grateful that our curriculum includes a biopsychosocial  approach. Treating patients as physical diseases is so old fashion, it's all the other stuff that makes us what we are. Of course it is important to address health issues, however we must have concerns and considerations for social and psychological contributions. 

Mental Health: Insight and experience

After a close friend "Mary" struggled through a depressive illness, I have always shown interest in mental health.

I recently watched Don't Call Me Crazy, a BBC 3 documentary about an institution for young people with mental illness. Over the three part series, the program followed the lives of patients with a range of condition from OCD to eating disorders. Several patients had been sectioned under the Mental Health Act and were being detained against their will. It was mostly how I had imagined; with many patients displaying what is  perceived as 'normal' teenage behaviour most of the times with some unstable outbursts. 

There was one particular female patient with depression, who had to spend time in the locked unit. This really made me think of "Mary". It made me remember what she had told me about the 24 hour surveillance- whether she was in the shower or on her period, there was always someone watching her. I fully understand that this was necessary as she was a risk to herself, but I still can't quite imagine living like that. In fact, it would be naive to think that I can understand what she was going through at all.

I've been to an adolescent mental health unit before, but it had been quite different from the one featured in the programme. Whilst "Mary" was in hospital, I had visited her. There were the same high staffing levels as shown on the TV but it looked nothing like a hospital. It was set in a manor house with huge grounds and lots of outside space. I distinctively remember the grand, sweeping staircase surrounded by big orange safely nets. That was what reminded me that it was a psychiatric hospital and not a hotel.

The thing is if we, as the general public, have had no experience then we will never know if the media is portraying the world correctly.

Having spent over six months of her life in two different institutions, I was really interested in what "Mary" thought of the programme. I was quite surprised that she had mainly positive things to say. She did however note that the programme hyped up the outbreaks; in reality it is far less eventful. Where she was staying there was a lot of sitting doing nothing, but I guess that doesn't make very interesting TV.

I'm going to conclude this blog post by sharing "Mary's" success story. I find it hard to express in words how proud I feel. After she was well enough to leave the hospital, "Mary" started at boarding school to complete her A levels. Despite her previous social anxiety, she made new friends and focused her attention toward to gym to lose the weight that she had retained through medication and being in the institution. Exercise and fitness became increasingly important to her and she has since ran in several marathons. She has secured her place at university to study sport science and has just completed her IronMan, coming in 1st place for her division and qualifying for the World Championships. 

Seeing what she has experienced makes me so glad I could be there for her through the harder times. She really is a true friend. It's onwards and upwards now.

My first HCA shift- An Outsider on the Inside

This morning I worked my first 6 hour shift. I was apprehensive because, not only had I not done this sort of work for 12 months, this care home had been in the media and was under close observation. 

When I turned up at 7.30, I was greeted by a frantic nurse who uttered the word 'CQC' to me- they had been inspecting the establishment since 4am. I instantly suspected that this wouldn't be a 'normal' shift. I spent the morning working in the dementia unit with a senior carer and 2 HCAs, similar ages to myself. After the initial routine of getting clients up, washed and fed breakfast, things started to change. 

I noticed an increase in the amount of people in the unit. It wasn't long before the home was full of social workers, inspectors, relatives, paramedics & the press: the home was shutting down. My duties shifted to packing suitcases and stripping beds, whilst trying to keep the frightened clients under control. 

I could tell that both the staff and the service users were having a difficult time. It was strange for me to be on the inside of the drama in  their personal stories. Although today I was working with them, I knew my day hadn't been the same as theirs. I wasn't being forced to leave the place I called home by men in ambulances nor was I about to lose my job as my workplace fell apart. 

Nobody likes to be moved against their will; we are creatures of comfort and we don't take kindly to change. Especially not those with dementia. For this confused and often aggressive group of people, routine is all they have to offer security. I wondered how the lady I had spent all morning with would cope in her new home, when she knew the layout of this one so well. She spends her days patrolling the corridors and lounges looking for 'Henry' which could mean anything from a blanket to glass of squash (she also called me and everyone else around us Henry). How well would she adapt when all her Henrys are suddenly different?

As for the carers, I really felt for them. The ladies I had been working with were good, honest and compassionate people who became overwhelmed when one by one the clients were taken away. What really stood out to me was how, despite the fact that they would be left without work, their real concerns sat with the clients. I busied myself clearing lunch plates and washing down tables as carers kissed and waved their clients goodbye, blubbing at the window. At my old care home, I had never seen anything of the sort, but then again i guess I'd never experienced a home being shut down by the authorities.

Seeing the film crew outside as I set off home, made me question the things that they  may be exposing in the media. Okay so I did notice that the carers didn't perhaps wash their hands a much as they should, but I did see real compassion from the few I was working alongside.

In a lot of ways it is a shame that the home had closed. However, without regulation where would we be? It's hard to make a proper judgement with such a narrow window, but we can only assume that the home was closed for good reasons. I really wish the people I met today all the best for the future, regardless of what happens.

StreetDoctors- Student BMJ May 2013

StreetDoctors is an organisation run by doctors and medical students to teach young offenders how to save a life. CPR tends to be the focal point of most first aid courses, however for this target audience, a bleed-focused itinerary is more appropriate. The sessions include discussions of personal experiences alongside formal teaching on how to deal with bleeds. With most of the pupils having witnessed a stabbing, the young people engaged well with the material and understood the importance of protecting the health of their friends and family.

StreetDoctors- established at Liverpool University 2008 

The main message appears to be emphasising the importance of preventing blood loss: if you lose blood your heart and brain stop working, the only place to get more blood is at the hospital. This simple concept is used to teach the children the importance of reducing bleeds and calling for an ambulance.

Personally, I think this is a great scheme. From my experience of teaching at local schools with the BrightWAMS society, young people really engage when provided with fun and relevant interactive sessions. Informing people, particularly those at risk,works to demonstrate that you don't need medical training to be able to save someone's life. Through basic procedures such as calling for an ambulance, raising a limb, applying pressure and bandaging, even young people can potentially make a difference.

The scheme is growing and is currently running at several UK locations. Hopefully it will continue to grow (and come to Brighton!)- I'd love the opportunity to get involved. For more information go to http://streetdoctors.org/

Image: http://www.lucianaberger.com/2012/10/meeting-liverpools-street-doctors/

Carter S.'StreetDoctors; teaching first aid to young offenders'. Student BMJ 2013;21:f2241. Available from URL: http://student.bmj.com/student/view-article.html?id=sbmj.f2241

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Care Assistant Work

Finally back home, after a very busy term!

This summer I will be working as a care assistant again. I have joined an agency where I will be allocated to local residential and nursing homes, as and when I am required. I am interested in how my experiences may differ now that I have had a year of medical training. I like the idea that I should now be able to understand the clients notes better. Hopefully I will be able to apply my pharmacological knowledge to make sense of the clients' side effects and predict what medication they may be on, based on their past and on-going medical history.

Right now I feel like a need a bit of a break from the whole world of medicine. However after I have recovered from my first year and got some more sleep I'm sure it will be a great opportunity to practice my knowledge, develop my bedside manner and earn a little money.

Recovering from a busy term.

An Amazing 1st Year at BSMS

So here we are, a year down the line. I've had some new experiences, made lots of great friends and even learnt how to use my stethoscope.

I don't think  I could have asked for a better start. The transition from my gap year, spent working full-time in care settings, could not have been smoother. Interestingly, most of my flat mates were in the same position as me. Having had a year out to re-apply and gain some life experience seemed to make everyone eager yet a little anxious about returning to an academic setting. It's amazing how little time in takes for you to become attached to people you have only just met. By the end of our first week, we were speaking to each other as if we'd known each other for years! 

The thing that really makes BSMS is the people. I honestly I could not have wished for a nicer year group! Everyone is so friendly which gives the whole medical school a great atmosphere. This is something I really noticed as being different to sixth form; all the students here seem to be passionate, out-going and hard working. On reflection, it wasn't until I started that I quite realised the value of medical school interviews. By looking at the type of students on my course, it seems quite obvious what BSMS were looking for in their candidates. Interview days seems like such a long time ago now!

Overall I feel that the work has been hard, but I've enjoyed the challenge. Plus it feels great to actually be able to recognise medical conditions and abnormalities, as well as understand how and why things work in our bodies. Dissection has been great, I have learnt so much anatomy and developed my cutting skills- I'm still far from a pro, but I'm getting much better at using the bone saw! Also I've become good friends with my dissection group-working as a team has brought a real mix of people together through the unique experience. 

In terms of social life, BSMS is simply amazing! From Freshers Week right through to the end of the year, MedSoc has organised an interesting array of nights out, most of which have included a hilarious fancy dress theme. I also love the Medic Parents scheme, which was introduced to us in our first week. My parents (2nd year students) have been great to me, they've cooked dinner for my Medic siblings and I and throughout the year they've  really looked out for us. I can't wait to be a parent in September, when I'll have my own Medic children to look after. Also, I hope I can keep in contact with my medic parents; this will be a little bit harder as they will be based at the hospital for their 3rd year of teaching. 

 It amazes me at how much I have learnt in just 30 weeks of term-time teaching. As well as learning about the thorax and abdomen, we have also been taught clinical skills. We have recently had our first OSCE which required us to examine the cardiovascular, respiratory and alimentary systems, take peak-flow & blood pressure readings and demonstrate our focused history taking skills. Through our clinical placements we have had the opportunity to practice these skills on real patients in the GP setting, which makes you feel like a real doctor (well sort of!). We also have been on secondary care visits to various hospitals to get an insight into some of the different specialities. In terms of patient contact, in addition to these visits, we have had the opportunity to follow the development of a new born child and the impact it has on their family. I really enjoyed talking to the mother about her experiences as well as having a few cuddles with her beautiful daughter.

Throughout the year I have got involved and joined new societies such as belly-dancing, Sexpression and paediatrics. I have been to local schools through the Teddy Bear Hospital scheme to help reduce reception children's fears of doctors, as well as taking part in dissection art classes and doing a naked calendar to raise money for our chosen charities. This year I have acted as the first year representative for BrightWAMS society, this included writing lesson plans and having meetings with older students to run sessions to teach primary school children about the human body and to inspire them to consider medicine as a career. 

Next year should be just as good, if not better! The work will be tougher, but with placements within A&E, psychiatry and paediatrics, there will be lots of exciting things going on. I will continue to work as a member of the BrightWAMS committee and have been elected the position of secretary. I'm excited to  be moving into a lovely student house in Brighton to live with my wonderful flat mates again. 

After making a silly campaign video, which we filmed in our flat, my best friend and I have been elected as Freshers Reps. This means over the summer we will be working hard to plan the most exciting week of social events in the Medsoc Calendar! We will need to design booklets, wristbands and choose some exciting themes, in addition to organising this year's Medic Parent scheme and communicating with club promoters to book venues. 

Roll on  September!