J'ai fait un stage

Due to the fact that my family are living in France and I'm attending boarding school in England, it's very difficult to do any work experience in the UK, despite my best efforts, but I did manage to find some to do in France. The obvious downside to this is that of course all of the doctors I was able to follow were speaking in french. Although at times this was frustrating for me because I was unable to ask some of the more technical questions I had, I am happy to say that I was able to understand the majority of the things the doctors were telling me in french. The anaesthetist who I was shadowing, Frederic, was extremely helpful and allowed me to see a wide range of things and also allowed me to get scrubbed up and sit in on 4 surgeries! 

I was so so excited to put my scrubs on and be able to watch all of the amazing things the doctors were doing. To start with, I followed around another anaesthetist, Carine, who showed me how they put up the fluid to put the patient to sleep. It was interesting to see the fact that some of the drugs had the exact same names, such as morphine, ketamine and adrenaline. I was able to talk to this lady about the surgery I was about to watch and she told me that it was to be on a man who's chin was too large and so they were going to perform a reduction. I was looking forward to this but was obviously a little bit nervous because it would be the first time I had watched a human surgery, and despite the fact that I was not phased by the surgeries on animals I'd watched, I still didn't know how I would feel. 

However, right before the op was about to start, I was ushered out by Fred who took me into another operating theatre, because apparently this operation was quicker and would allow me to see a larger variety of surgery. I arrived while the patient was still lying awake and so was able to observe the interaction between the doctors and the nervous patient. There were a lot of jokes made and the atmosphere was really light and fun despite the fact that this guy knew he was about to be cut into! I hadn't yet been told the operation that was going to take place but the interactions before the anaesthetic was administered illustrated to me how important good people skills really are in this type of career even if the majority of the time your patient will be asleep. 

Fred injected the drugs in the order Carine had previously told me about and the patient fell asleep. He allowed the patient to fall into a deep sleep and then explained to me that when the patient is under, they would stop breathing if the tubes were not placed into their trachea. He used a laryngoscope to open the trachea sufficiently to show me the vocal cords and explained that the tube is placed in between the vocal cords. Once all attached to the correct places, the screen began to beep, and Frederic explained what each number meant and I was then able to watch the different numbers change as the patient became ready for the operation to begin. 

I had not yet been told what this operation would be so obviously I was fairly shocked, being a 17 year old girl, when his genitals were revealed. I'm sure I must have blushed but luckily my mask should've covered that up! So all was revealed and it was very evident that there was a problem, because the scrotum was severely enlarged due to a build up of water. This was carefully removed by using an electrically charged instrument which burned away the tissue attaching the sac of fluid to the testicle.

I think it's fair to say that I was thrown in at the deep end and I wish I could say the next operation I was able to watch was slightly more pleasant (if operations can be pleasant to watch) but unfortunately it was probably equally as intense. I was watching a swollen prostate effectively be scooped out using an endoscope. The thing which I found really interesting about this was that there was a fluid pumped into the cavity of the prostate leading up to the bladder despite the fact that the instruments being used were electric. The doctor controlling the endoscope asked me if I had any questions, so I managed to ask how the fluid wasn't electrocuting the man and he told me they used a fluid which was non conducting. 

Next, Fred took me for a walk around several of the operating theatres. He showed me two theatres where heart surgery was taking place but unfortunately I was unable to see anything due to the fact that there were so many surgeons around the patient. Luckily though, there was also a lung operation taking place, and I was able to see this through a glass screen on a television connected to an endoscope. Frederic explained to me that this patient was a smoker and this was very evident by the black deposits on his lungs. I watched a section of his lungs be chopped off and removed through the tube. I was so fascinated by the fact that a part of lung tissue can simply be cut off and removed so easily, even if it was damaged or dead. 

Finally, I sat in on a surgery on a lady who's bladder was sitting too low down in her abdomen. Again this used and endoscope and the doctors simply made a hole just below her bellybutton and pumped air into her stomach to inflate it so that they had room to work. They then proceeded to use surgical thread the attach her bladder to the inside of her abdomen in a better area. The doctors showed me the various organs which were visible and after a rather funny conversation which involved me trying to explain the female reproductive system in english words for them, the operation finished and my crazy day in the hospital was over. 

I had had an amazing time watching all of the fascinating things the doctors were doing, and this definitely just made me more excited to start my application! I could see the various qualities required to carry out this job correctly, one of which, surprisingly, is most definitely a sense of humour! Everyone was always laughing and smiling and despite how serious the environment should have been, it was still a really fun day. 

Should we legalise cannabis?

The legalisation of cannabis is a heavily discussed topic for several reasons. I would say that these reasons fit into three main categories; economic reasons, democratic reasons and of course health reasons. I attended a heretics society lecture on this topic and it really got me thinking. What would the outcome be if we were to legalise cannabis and how could this affect my peers and I? I decided before I come to any conclusions, I need to fully weigh up all of the reasons for and against. 

Economic reasons

Of course, currently the price of marijuana is hugely higher than the production costs of the drug, but this is based on the fact that the supply is fairly low. People will often say that if the government were to legalise marijuana, they could profit massively from the taxation of the drug. However, I would argue that when the drug became legal, entrepreneurs would see the opportunity to profit from the ridiculously high street prices by driving them down and creating a competitive market while also increasing the level of availability which of course will drive the price down. I would argue that the government would benefit a lot less than the majority of people currently assume due to these factors. Of course the substance would be highly taxed due to the adverse effects it has but with the lower prices, the taxation is not likely to bring in the huge sum of money that could be expected. The government would be unable to set the tax levels too high because this could quite easily cause growers to sell on the black market where demand will be much higher if the legal product is too highly priced. This limits the economic benefits massively. So overall, I would say that the economic reasons are not enough alone to argue that cannabis should be legalised. 

Democratic reasons

The person who spoke at the heretics society claimed that we all have the right to make a silly decision which endangers our own health according to our civil rights and that democratically this therefore gives us the right to smoke marijuana. He compared this to the fact that we are allowed to drink and smoke tobacco despite the fact that it is not healthy. He was making the point that we cannot simply maintain that marijuana is illegal for health reasons. I definitely agree with this. There is not evidence of anyone overdosing on cannabis as opposed to the thousands of people who overdose on alcohol every year. It is fair to say that in a free society, it is unfair for the government to regulate substances based on anything other than the effect to the person and that there is a lack of consistency in the law today which allows a substance responsible for several thousand deaths per year to be legal and a substance which is yet to cause a death due to overdose to be illegal. 

Heath reasons

Obviously this is the most interesting to me, being interested in a career in medicine and taking an interest in the health of the population which I hope to one day be responsible for looking after. The stats which were discussed made me think a lot about the fact that we allow so many harmful, addictive substances to be acceptable in society. Obviously alcohol is the main example of this. Alcohol abuse costs the government over £21bn per year in healthcare and crime. This is absolutely ridiculous and in my opinion is a complete waste of resources. In 2011 there were almost 9000 deaths down to alcohol alone. On average 36 young people (under the age of 18) are admitted to hospital every day with conditions directly related to alcohol abuse. There are an estimated 1.6 million people dependant on alcohol in the UK. To me, it seems unbelievable that a substance like this is still legal. There is no evidence whatsoever to suggest that cannabis has lead to a death by overdose and also is much less addictive than both tobacco and alcohol. This begs the question, why is this illegal and other substances are not? Well one answer to this would be that previous prohibition of alcohol has failed and is therefore likely to fail again, making it very difficult to attempt to ban it as a drug. However, I would argue that the prohibition of cannabis is not working. It is still fairly easily available and a lot of young people are using it. The worrying thing about this for me is that young people have easy access to cannabis on the streets and mostly that, due to the fact that it is illegal, no standards can be placed on the substance. My view is that if we were to legalise cannabis we would be able to impose laws about the quality which is allowed to be sold and we would most definitely be able to better control the standards of the drugs people are taking, which in theory should make it more safe to take. In terms of addiction to cannabis, the drug is less addictive than drugs such as alcohol and tobacco which are legal. Frankly, I  disagree with all harmful substances because as someone wanting to enter the healthcare system, my main concern is the health of people who are at risk of becoming addicted to these substances, and these people are usually already suffering from other conditions, such as depression or other mental health issues. However, I also believe that we should have some consistency in the systems we have in place and the fact that the legality of the substance, which is already not incredibly harmful in comparison with other legal drugs, could in fact make it less dangerous means that to me, it seems almost sensible to legalise it for the health of its users. I also believe that its legality may in fact decrease its popularity among young people because it is no longer taboo. It could be seen as less 'cool' to use it because it is no longer illegal, making it less of a thrill. A question which was posed to the society, which I found particularly thought provoking was regarding the types of people who could potentially use this drug if it were to be legalised. Someone asked if we would be happy for primary school teachers to be smoking cannabis, and I have to say, it seemed ridiculous to even think about at first. However, after thinking about it, I asked the question, what is the difference between smoking cannabis and drinking alcohol as a primary school teacher. I don't see a difference. Of course it is not acceptable to smoke cannabis when you are teacher or to turn up to teach a lesson under the influence of the drug in the same way that it is not acceptable to drink while you are teaching or to come to work drunk. 

Overall, I feel that the reasons for legalising cannabis outweigh those for it to remain illegal due to the factors outlined above. I feel as though its legality would make it safer and would mean that its use could be controlled. 

Paediatrics, Hormones and Murder...

Today I attended a lecture given by Dr Tim Cheetham from Newcastle University who spoke to a small group of us about his life in paediatrics and mostly about hormones. I found his talk extremely interesting, especially because he gave us a detailed incite into the life as a paediatrician.
He opened his talk by posing the question 'Why do children get ill?'
We came to the conclusion that there were six main causes of illness among youth. These were;

• Single gene defects, such as PKU (phenylketonuria) or cystic fibrosis
• Multiple gene defects, such as type one diabetes
• Environmental insults, such as foetal alcohol syndrome
• Diseases we understand, such as meningitis
• Diseases we don't understand, such as congenital hypothyroidism
• Injury

We discussed the first point at length. He used the idea that hormones and glands worked using a switch system. The hormone is the mechanism which turns the switch on, with the gland being the switch. He used the concept that a defect is caused by the switch either being constantly switched on or the hormones having no effect on the switch meaning that it cannot be turned on at all. I found this extremely interesting, especially when the concept was put so simply.

Leptin

One example he used was a cause of obesity, which is of course a very relevant point to think about in this day and age. He told us about his time at Cambridge university where he met Professor Sir Stephen O'Rahilly, who conducted an experiment on a pair of mice, one of which was leptin deficient causing it to be obese. In the experiment he connected the two mice by their blood vessels, and the blood of the mouse producing leptin was transferred to the obese mouse, which reacted to the leptin and lost a considerable amount of weight. This got me thinking about the hormone leptin. Leptin is produced by fat tissue (adipose tissue) and is the 'full hormone' which informs the brain of the nutritional state of the body. It basically tells your brain when you have eaten enough. If your body is resistant to this, it obviously causes you to feel hungry and for you brain to feel as though you need to eat more. This is a cause of obesity. I then began to wonder if we could use the injected or consumption of leptin as a treatment for obesity and Dr Cheetham quickly answered my question. He spoke about the use of the drug Rimonabant. This is an inverse agonist for a cannabinoid receptor. This very basically means that it has the reverse effect of cannabis, which causes a feeling of elation and an increased appetite (or so I've heard.) So a loss of appetite is the required effect, and this effect is gained. The drug blocks the 'cannabis switch', which causes a block of the hunger switch as well. This, of course, however has the desired affect to reduce the calorific intake of the patient. However, Dr Cheetham proceeded to tell us about another side effect of the drug, which was actually rather easy to predict once we heard about it. It also had a depressive affect, which seems sensible when we look at the effect cannabis has which are being 'blocked' by the medication. It also blocks the feelings of happiness experienced when cannabis is consumed. The medication was taken off the market.

Environmental insults

The main environmental condition which Dr Cheetham spoke about to catch my attention was foetal alcohol syndrome. This can cause some very serious conditions and is a lot more prevalent than it should be, especially considering the level of knowledge we have about the dangers. This caught my eye particularly because it made me wonder why there was so little being done about it. We often see antismoking adverts on the television warning of the health problems which can follow from smoking but we very rarely see anything about this. It is widely known that drinking while pregnant is bad for the health of the baby, but I do not feel that the extent of the damage which can be caused is heavily publicised enough. An example of this is septo-optic dysplasia which is often seen in children whose parents have consumed alcohol during pregnancy or have used recreational drugs. It is a mutation affecting a particular gene. This causes failure of the pituitary glands which are extremely important. A child with this could present as hypoglycaemic because of a lack in growth hormones and cortisol levels or they could present with problems in their eyes due to lack of development of the optic nerve. It can also cause excessive urination and thirst due to the irregular production of ADH, or they could present as hypernatraemic. My main question after having heard about this was simply, why is nothing being done about this? Women are falling pregnant and damaging the lives of children and I feel as though more needs to be done to prevent this. The first step to this, in my opinion would be to educate pregnant women more about the dangers because of course people know it is dangerous but often women are unaware of the exact danger it can cause. This is especially important when it is a child's quality of life which is in play. 

Changes to the system

He also asked us to think about the changes in the medical system recently. We came to the conclusion that the two main changes to the cases seen in paediatrics were due to vaccinations and better knowledge of risk factors of common problems such as cot death. The vaccination and screening programmes have not only reduced the levels of child deaths due to diseases such as meningitis but also allows us to place preventative measure in place if certain genetic disorders are identified, such as congenital hypothyroidism, which we are all now screened for as infants. This would present as an abnormally high level of TSH due to the under active thyroid which is not being 'switched on' by the hormone. Screening for this began in 1984 and this has allowed for the administration of thyroxin in order to combat this condition. 

The best bits of the job

Dr Cheetham did a great job of selling a career in medicine without even really trying to. He showed us that the job requires a lot of problem solving and, by showing us several case studies, he showed us how one must piece together all of the information we are given about a case to come to a conclusion and treat a patient. This is such an exciting concept because it demonstrates that the day to day life of a doctor is ever changing and that each day presents a new problem to solve. He also displayed the importance of working as a team in the medical profession by combining knowledge and skill to help to find the best cure for a condition. He demonstrated that when this teamwork is not achieved, the system can fail using the examples of Harold Shipman, Dr Death, who killed elderly patients and Nurse Allit, who murdered babies in Grantham. As upsetting as this is, it teaches us a lot about the way in which we should work in hospitals to ensure that this cannot happen. It highlights the importance of teamwork and the continuous education of medical staff, and I personally cannot wait to be involved in such a system. 

Pathologists: hidden heroes

Everyone thinks it's the doctors who save the lives, but what people don't realise is that the doctors would be stuck without their multi disciplinary team. The MDT consists of several other important members but pathologists certainly play a massively important role. People often see pathologists as these glamorous people who wander around their shiny labs until a brutal crime takes place which they are then expected to solve to save the rest of the city before the evil villain is able to do any more damage. Hate to shatter this illusion but no, most pathologists do not lead a life like these people...

In fact, there are branches of pathology which people are not even aware exist. Most people only know about forensic pathology and are convinced that pathologists are either off CSI or are crazy scientists who like to chop up dead people. Of course this is not the case. Pathologists work mostly on people who are still alive, in a branches of pathology which are massively important in hospitals. Two of these branches are called histopathology and haematology. 

Histopathology: the study of tissue sample in order to diagnose disease. 

Haematology: the study of the blood in order to diagnose disease. 

Obviously both of these studies are extremely important in hospitals in order for the doctors who are seeing patients to gain a more detailed insight into their condition. When people are admitted to hospital or are sent to get blood tests from their GP, the majority of them will not realise that behind the scenes are the pathologists carrying out all of the tests and research on their samples and that without them there is no way that they could be diagnosed as accurately or efficiently. 

So what do they do? Well pathologists supervise labs, interpret results, carry out patient consultations, do ward rounds, teach other doctors and carry out research among other things. It is clear that the hospitals could not run without these people, even though they are never mentioned as the heroes in all of the stories we hear. 

I recently read two really interesting stories on pathological cases dating back hundreds of years, which I personally found really fascinating;

• Pathologists can find themselves investigating all sorts of cases, such as how famous people died, hundreds of years in the past. For example, pathologists recently investigated the death of Beethoven, and found that in fact his own doctor may have killed him. We knew that Beethoven had suffered from lead poisoning but this pathologist found that he was in fact poisoned accidentally by his doctor, who punctured his abdomen to relieve him of an edema and used lead-laced poultice to seal the wounds. This resulted in Beethoven's liver absorbing the lead and causing him to suffer from cirrhosis. The most interesting part of this story, however, is the way in which the pathologists discovered this. He used samples of Beethoven's hair which fans had cut off on his deathbed. He formed a time line of his decline and discovered that the spikes in lead in his body were only on days which his doctor had visited. This pathologist clearly used his own depth of knowledge and problem solving to come to this conclusion. 
• Scientists want to exhume the body of Galileo to determine whether or not an eye problem caused some of his findings to be inaccurate. It is thought that Galileo suffered a bout of childhood illness which caused him to have eye problems later in life. This means that a lot of his work could be deemed inaccurate. Pathologists hope that if they are able to exhume his body, they may be able to use DNA tests to find out which condition he was suffering from and therefore simulate the things he was seeing through his telescope. They think that this condition is the reason he was seeing Saturn as an oblong shape, because his poor sight prevented his from seeing Saturn and her rings as separate.

Technology- Staying focused

http://www.newscientist.com/article/mg22029484.500-mindreading-light-helps-you-stay-in-the-zone.html?utm_source=NSNS&utm_medium=SOC&utm_campaign=hoot&cmpid=SOC%7CNSNS%7C2013-GLOBAL-hoot#.UrW3ORaYcb0


The link above will direct you to an article that I recently read in the New Scientist magazine and found particularly interesting. I'm always baffled by the crazy technology we have access to nowadays and I must admit that the majority of the time I have no idea about any of the science behind it. However, with this particular innovation, I can understand the simple concepts which have been built upon in order to produce a rather fascinating idea. 
The basic concept is that we can use light shone into the eyes to monitor the level of activity in the brain. Of course this is extremely simple as a concept and in fact we have been using light through the eyes as a portal to the brain in many ways for years already. For example, in your GP, I'm sure you've had a torch shone into your eyes to check for various things and not even thought about it. With head injuries, in more serious cases in hospitals, a torch is used to check the responsiveness of the pupils, with certain irregular reactions relating directly to neurological conditions. For example, when the patient's pupils fail to react or there are changes in the size or shape of their pupils, this can often be linked to raised intracranial pressure and pressure on the optic nerve. This is mostly due to a rise in cerebrospinal fluid or a mass on the brain such as a tumour or a bleed, which can be caused by things such as head injuries, encephalitis or meningitis. 
So, the idea of using light to understand what is happening in the brain is not a new concept at all. The complicated part is the way in which the light is recorded and interpreted. This whole idea is brought together using various different scientific domains and will no doubt be extremely useful in the future. The ability to tell whether or not someone is using their full capacity of concentration could be used in numerous ways. For example, as mentioned in the passage, to work with air traffic controllers and ensure they are able to handle their stressful workload. This could further be extended to professions such as long distance lorry drivers, where this technology could be used to gauge when the drivers need a break. 
This technology could pioneer new advances in testing systems. If we imagine a new form of driving test which uses this system. When someone is a very capable driver, they are able to drive without too much thought and their brain is calm and is not overworked. This would show up on the monitor, and would act as proof that this candidate is competent enough to be allowed to drive without supervision. However, if someone is finding it difficult to drive properly or is having to overly focus and is becoming stressed by driving, this would be evident. If this information could be passed on to instructors, it could be used to determine whether or not the pupil is allowed to pass their test. This method could be used in all other types of skills based assessments. 

#heartsave

On Medlink, I was told about an amazing campaign which has just been started on Instagram called #heartsave and I want to encourage as many people as possible to get involved. 
There are thousands of portable defibrillators located around the world which could save someone's life is they were to go into cardiac arrest. All you have to do to get involved, is to take a photo of these defibrillators when you see them and post it to Instagram, with the hashtag 'heartsave'. Instagram geotags all of its photos and the plan is that, if enough people get involved, we will be able to create an app based on these posts, which will show the location of the defibrillators, meaning that if someone were to have a heart attack, people nearby would be able to quickly use their smartphone to locate the nearest defibrillator. The probability of survival after a cardiac arrest can decrease by as much as 10% for every minute of delay after collapse without treatment. If a bystander could locate an AED more quickly than the emergency services are able to arrive and begin treatment, this could hugely increase the chances of survival for this person. This campaign has the potential to save lives if enough people will get involved. It's easy and takes no time at all, please get involved if you can. #HEARTSAVE

Medlink 2013