Medical Elective- Day 31

Feeling better today. Not one hundred percent but better. Got up and head to ward round for 8am no problems, was immediately plucked out of ward round by a consultant and followed him to theatre for a treat. Today was an interesting case, a ‘pioneering’ surgery. Basically they did a dynamic face lift with a twist. A patient with a facial hemiparesis can have a few things done- a static facelift, where the paralysed half of the face is lifted up so that it doesn’t look droopy, or a dynamic facelift with a view to restoring a bit of movement, also known as ‘facial reanimation’, which just made me think of zombies. In this particular case the temporalis muscle was mobilised and attached distally to the nasolabial fold (which in itself is pretty cool- with physiotherapy the patient can re-learn ‘chew’ as ‘smile’) with the added modification of a periosteal flap from the cranium to cover the whole thing to minimise the cavity defect of moving temporalis. It’s going to be written up as a paper by the consultants who invented it. Immensely cool. The un-cool part about it was that I got to see approximately zip. I was really hoping for a good opportunity to illustrate but what with the entire Maxfacs and Plastics departments along with the university film crew being there I was sort of confined to the edges. But still. Was very cool.

Things I have learnt: the scalp is ridiculously vascular. You can bleed out from a scalp wound and heard tale of a patient who died of hypovolaemia from as much. While the Reg was closing the scalp he popped the suture through, caught a vessel (of which there are many) and a puddle quickly formed by his feet. This is why, before any scalp incision, they infiltrate with a special mixture of saline, adrenaline, hydrocortisone and magic.

In my cunning schemey way I plan over the next day or two to try and turn the op into a series of technical illustrations. I know it’s hoping against hope (since there was a lot of photography) but if I present these to the consultant he may want to use them. But even if he doesn’t, it’ll still make for some cool illustrations. Sadly, in amongst all my being schemey and wiley, I have managed to leave my sketch book somewhere. If it’s in theatre I’m ok - I came in today, having not been in theatre for nearly a week, to find a library book I had borrowed, on the side exactly where I’d left it. I hadn’t even noticed it was missing. I need to start hanging on to things a bit better.

I abandoned ship after this op, at lunchtime, due to a combination of headache and needing milk. So I nipped to the supermarket, milk, bread and fruit, then home. Painted a bit, napped a bit, painted a bit. Then was invited out for a pint by some fellow flatmates. Trying not to nurture my antisocial tendencies I accepted and have just come back from a couple of pints at the local. It was really nice to spend a bit of time with other human beings. There are two guys and a girl from Austria and they are all really friendly. The girl’s English is fantastic (I was lamenting over our drink my inability to speak another language and admiring the fact that they are working in A&E in a second language). All in all a really nice bunch.  I also met another MaxFacs elective student today. He seems really nice and also expressed a penchant for scheming and projects. I think there’s a secret bunch of MaxFacs aficionados around the country who need a central organisation through which to scheme together- but that’s a scheme for another day.

Interestingly this evening’s portrait was done before I went out but looks strangely like me after two pints- sort of a bit sleepy. I must be drawing the future again.

Medical Elective- Day 30

 

Not much to report today. I had a sick day. The Man Flu finally got the better of me. Temperature and everything. I do not feel that it’s fair to be sitting still, minding your own business and to be feeling nauseous. So, after having gotten up at midday I went back to bed about an hour later to watch DVDs. I felt a bit better around 5pm. Sadly, I seem to have missed the warmest loveliest day of the year so far. I quite needed to head out too as I’m dangerously low on milk.

No matter. Tomorrow will be different. Today I at least tried to do something constructive and started a painting. Still panicking slightly about the lack of definition to The Project, but I reckon if I just start painting, something will happen.

Medical Elective- Day 29

After a rested weekend with The Mother, I’m feeling motivated. I have been filled with loverly Sunday Roast (both beef that wasn’t dry *miracle* and Mum’s special nutroast, which went wrong, long story about parsnips, but was delish in the end) aaaand home made Yorkshire puddings. The spellchecker just saw fit to capitalise my Yorkshires. Good decision spellchecker. We then watched Tucker and Dale Vs Evil. It was great to see the family, including Adopted Aunty from next door, both Little Brother and Medium Brother (both of whom are looking a bit more like Ticket To The Gun Show Brothers these days) and Sister In Law, who I don’t see enough of. Then bussed it back to London.

I have a dirty confession to make. In the space of a week I have been shopping three times. Three times. Once is too often. I have enough clothes down here with me to last and can probably get by with minimal food purchases for the next two weeks (still have a cupboard full of tins). Iam currently unemployed and living a bit hand to mouth. So why in hell have I purchased a new skirt, two new dresses and two pairs of shoes? (I don’t even usually wear these things! I’m a trousers and sweater and ‘the same pair of boots until they fall apart’ kind of person) Cos I’m a sucker for sales. They were all bargains. But that’s not the point. One pair of shoes originally cost more than the whole spree. But that’s not the point. And everything I have bought is beautiful. But that’s not the point. I don’t have money to be throwing around. I am choosing to interpret it as some kind of subconscious cry for help. No other explanation. And to justify my purchases I have punished myself by wearing my new high heeled ankle boots (uh, suede, oh, beautiful) all weekend and now I have sore ankles. I think that’s penance enough. Well, until I can’t pay my rent.

Other than that the past couple of days have been all but completely uneventful. Fantastic. I’ve been living on The Mother’s couch, watching rubbish TV and films and just eating and dozing until my little heart was content. Now, well rested, I’m back on the case. I realise that I have only two weeks left here and I need to make them count. This week’s tasks are to include:

• Getting on top of this project for Mr Consultant and working out how I will stay involved in the write-up once back in Nottingham. I may have to organise a couple of extra trips to London in the three weeks after I leave to wrap things up and still keep my finger in the pie. 
• Writing up my Case Report.
• Working out this Art Project I’m supposed to be doing. Art Friend has exams impending and so I need to be independent and brave and just make a few decisions. I need to talk to the ladies at The Charity and see what they say. I need to come up with a coherent plan for an exhibition to raise awareness for the charity and what sort of format that’s going to take. Enough Blue Sky Thinking. It’s time for action.
• I need to do more illustrations in theatre and turn some of the illustrations into stand alone pieces. My watercolour technique better buck itself up.
• I have to do a market stall on Saturday (anyone in Nottingham come to the art gallery on St James’ St on Saturday!). I have nothing to sell. So I need to make some things here and now and quickly. Thus, in a cunning but potentially very blasphemous fashion, I rescued a handful of my old comics from The Mother’s place today. Twenty year old copies of The Complete Spiderman. Now, obviously after I have read them again, I will see if I can be brave enough to cut them up, varnish bits and make them into various accessories. Nail biting.
• Finally shake this bloody cold.

So I have my work cut out for me this week. Along with attending a few galleries, catching up with a few friends I actually have to go in and see some patients and stuff. Although I’m thinking that ‘clinical’ attendance can be allowed to slide at this point in favour of getting work done.

I foresee a week of sniffles and reading comics.

Medical Elective- Day 28

28 Days. That's pretty much a month. And isn't it theoretically the time taken for the Zombocalypse to reach completion or something? (the internet does not back up this speculation). Mm, Cillian Murphy.

Anywhoo... I'm at The Mother's for the weekend. That means another retrospective portrait upload when I can be bothered to do one tonight. Had a lovely sleep last night on The Mother's couch, then went into London with Mummy and The Aunty, who works for the London Arts College or somesuch. Thus meaning we got free tickets to see some BA Acting today. So sporting my new high heeled ankle boots we enjoyed The Changeling. Although I could tell none of us were really following it as we almost left during the interval, thinking it was over.

Sore feet later I'm now back on the couch, full of pizza and garlic sauce. I have learnt nothing today nor done anything that could reasonably be construed as constructive. Be Kind Rewind on the telly (they're just re-filming Ghost Busters). About to consume three tiny cheesecakes. Happy.

Medical Elective- Day 27

Not much to report today. Postgrad teaching happens on Friday mornings, scheduled from 9.30am for 2.5hours. In actuality it started about 10am and lasted for an hour at a push. But we got an interesting lecture in facial fractures.

Here are some things I learnt:

• Ecchymosis means bruising (but makes you sound way intelligent if you say it)
• Orbital floor fractures in children can rarely present as vasovagal attacks and unresolving nausea and vomitting
• Ruptured globes are very rare but if a patient presents with one they will be in extreme pain and will not be able to open the eye for you to inspect, this is an opthalmological emergency

I learnt a few other things too but, I must confess, I am writing this retrospectively on The Mother's couch and I didn't bring my notebook of knowledge with me. So, after teaching, I popped back to The Hospital to visit a patient, who is doing very well, then came home and had a nap, then did the day's portrait. I decided to experiment a bit with some paints. It has sort of worked. It has definitely highlighted the fact that pictures are best done with a sketch first, rather than just stabbing wildly at the paper with a paintbrush. Watercolour is a subtle medium which demands controlled use of the white space of the paper. This is not how I use watercolour. And as such the colour tones are a bit on the um, tanned side. But layering of watercolours is a lot of fun and I've done previous portraits with this technique (but with more time and finesse) and those have worked really well.

Anyway, nuffathat. I got the bus to The Mother, bunch of daffs in hand (unfrortunately via a shoe sale) and spent a lovely evening with ma famile.

Medical Elective- Day 26

Woke up today with a sore throat and a headache. Am about to go to bed, sore throat and headache still present. Diagnosis: Man Flu. I can’t even really remember what I did today. I spent the whole day feeling ‘a bit ill’. I had the gravelly voice and weak-ass cough to show for it. I think it helped that on the whole today was pretty uneventful.

This morning in at 8 for ward round, then up to theatres. They were inserting a trache under GA and half way through I was invited to scrub. Now, I thought I should perhaps err on the side of caution and not scrub in if I’m only going to have to de-scrub ten minutes later. But I braved it. And felt fine, then nauseous, then fine, then feint, then fine, then just plain ill, then fine, then it was all over. Right at the end dear old Reg turned to me and said “ok, now you pop in the sutures this side”. I had to put in a total of two sutures. On my four week placement it was the first bit of actual anything I’ve gotten to do. Smile. Good job I remembered how to suture.

I’m not complaining. Technically I don’t think I’m supposed to be doing anything at all if I understood the bumph from the University who I’m on placement with. Something to do with insurance and how I’m a wild liability (did someone give them the heads up or what?). As far as I can tell I’m not even supposed to breath near patients. Which is interesting since this is essentially medical work experience and I’m due to start actually working as a Doctor in five months, so I’d like to think I’m at least vaguely competent at the basics. But still, I’ve been quite enjoying spending most of my time in theatre drawing, bantering or just watching (and desperately riffling through the anatomy textbook I’ve taken to carrying around everywhere).

After the trache there was a half hour wait until the next patient, so I nipped home and hung out the laundry (good girl). When I went back we were told another 45minutes to wait so I went with the SHOs down to A&E. All of the SHOs have been really nice to me, considering I’m an outsider to them. It’s like when there’s a party for all the kids in the class and your brother is in the class and he’s invited but your parents have negotiated that you can go too just to get you out of the house. Everyone is nice to you, but you don’t really know who each other is. And you inevitably end up finding something to read in a corner while everyone else plays Action Man. But I went down to A&E as one of the gang. We saw a lady who had had a fall and sliced her lip. It was a tiny slice and the SHO popped one suture in the outside and two on the inside. Now I have always struggled in these situations- this kind of stuff makes me feel oh so feint. Always has. I’ve had to go and lie down before in A&E with minor lacerations. Lips especially. Just makes me queasy. And as an aspiring MaxFacs I will be expected to sew up a lot of lips. So, having spent a portion of the time bracing myself against the bin, I managed to assist as best I could and not hit the deck. Go me. I reckon if I just keep seeking these things out eventually I’ll just get used to it. Or eventually have to chuck it all in and be a Psychiatrist.

Back to theatre, another interesting case on the table. Neck dissection for massive neck lump (malignant node). Nice patient, had seen them in clinic. Mr Big Cheese turned up too which was nice, and we were all treated to his favourite topic of conversation: the lack of RCTs in surgery, the lack of Evidence Based Surgery, the lack of anyone having impetus to establish any research base, his mission to establish a National Centre of some kind and that we should all give to his research charity so that we can benefit from it’s collected data later in our careers. What I understood of it sounded good. But I won’t lie, some of it was a little over my head. I can’t donate any money to his charity but one of the SHOs suggested whoring me out as an artist (at which point I mentioned I was already whoring myself out as an artist for the charity). Well, that’s the plan. Eventually.

I stayed for a couple of hours of the surgery, was kindly donated some paracetamol but eventually just decided that Man Flu was better treated at home with bed rest, DVDs and tea. So slunk off home. I was given the opportunity to join one of the Consultants at an Art and Anatomy examination day, but couldn’t face the journey. Another time. On arriving home and sauntering into the kitchen to get teabag, trod right in a massive puddle of water. Further investigation showed a completely defrosted freezer. Went to find paperwork on ‘what to do in case of...’ and could only find the advice of “In an emergency bleep 2222”. Now, for those of you not in the know, 2222 is the crash bleep. It’s for real emergencies. As in, someone’s heart has stopped emergency. Not the freezer has defrosted. After a bit of trial and error I managed to contact someone in security who sent up two young men who flicked a switch, said ‘there you go’ and immediately fucked off again. I had to ring up again to request a mop. The kitchen floor was soaked, I’d already slipped on it once, and there’s no mop here. I had to ‘book’ someone with a mop to come up. Totally weird. The infrastructure is exactly as if I were living in the hospital. And it doesn’t help that various floors in this building are currently being used as offices- not great for me to meander around in my PJs of an afternoon.

Anyway. So, after that and several small dinners, I spent a leisurely evening watching the Men Behaving Badly back catalogue and drinking tea. And not sleeping the whole evening away. Which made me happy. Happy enough to paint in fact. Painting on the bed was interesting- only one paint stain on the covers. I’m pretty proud of this one- I think it may be my best one to date (shame it's not a great photo). What’s this? Improvement? Finally, a tiny, niggling, sense of achievement.