Monday, 26 March 2012

4:30 Psychosis

Doesn't have quite the same ring as "4:48" but I have been waking up at 4:30 most mornings recently. (If the original reference is lost on you, it's the title of a play/monologue written by the late Sarah Kane. I highly recommend it to anyone who is interested in mental illness. Kane suffered from depression and eventually took her own life; whilst 4:48 Psychosis is not regarded as a suicide note it certainly provides an interesting insight into the suffering she endured in her later years)

Insomnia is a pretty common complaint. I'm sure most people have had times when for various reasons they've slept badly - exams, breakups, bereavements etc. You know the drill. You're physically exhausted but mentally can't switch off. You get into bed but no matter how you toss and turn, you can't get comfortable. You feel simultaneously too warm and too cold. You may drift in and out of sleep - each time you look at the clock some time has passed yet you feel no less tired. Your head and limbs ache no matter how you lie. Finally, your alarm goes off and you drag yourself up, battling the sometimes overwhelming nausea that follows a poor night's sleep.

I am what my GP has scientifically termed a "crap sleeper". As a baby I apparently slept pretty well, but as a child I remember being the first to wake up most mornings. I used to get up and make my Mum and Dad tea and breakfast in bed just for something to do. I always had a book beside my bed and I remember I used to keep a torch under my pillow so that I could read under the covers once the lights were turned out. I suppose if I'd have been a more annoying child who got out of bed and wanted to play all the time, my parents might have taken me to a doctor about my poor sleep patterns, but as it was they didn't really affect anyone else so I was left alone.

I go through phases of sleeping relatively well and phases where my sleep pattern is atrocious. I've tried a variety of medications (some work better than others but generally the better they work, the more of a "hangover" I have the following morning). I've tried cutting out caffeine. I've tried setting myself a strict routine of going to bed and getting up at the same time every day. Generally my sleep is at its best when I have given up on trying to sleep properly. I'm not sure why, but that's the way it seems to work.

It strikes me as odd that sleep is such a primitive function and yet it seems to cause so much trouble. I've read a variety of articles on sleep patterns recently. They have suggested everything from having 2 hour naps throughout the day but never a long sleep to sleeping whenever you feel  tired. Sleep is an incredibly important function. Experiments into the effects of sleep deprivation have almost universally been terminated early because of the detrimental effects on participants. Lack of sleep will kill a person more rapidly than lack of food. Despite the obvious importance of sleep, there is no consensus on how we should do it best. Oh, and noone's exactly sure what it's for either!

Almost 3:30am not - suppose I should attempt to sleep again!


Thursday, 22 March 2012

The Other Side

As I've mentioned recently, I have my fair share of medical experience on "the other side", ie as a patient. I won't bore you all with all my (frankly relatively minor) health woes, but suffice to say my GP seems to be on a mission to refer me to as many different specialists as possible. This is rarely an issue, although sometimes causes slightly weird conversations, such as (at a BLS session in second year) "you look very familiar, how do I know you?" "you anaesthetised me last week" "oh *awkward pause* I hope you feel better now".  That could have been a lot more embarrassing for both parties if the answer had been "you treated my *insert intimate health problem here* recently".

There are two things I find decidedly awkward about being both a patient and a medical student. One is something that I've thought about in the past but that has struck me again more recently. It's accepted, especially if you live/train in a smallish area, that at some point you're going to be taught by someone who's treated you or vice versa. The GMC advises that, where possible, you shouldn't be taught by someone who is currently treating you. Obviously, sometimes this is unavoidable, particularly if you are in a particularly small geographical area or you are being treated by someone extremely specialised. Fortunately I've never had to be taught by someone I'm a patient of at that moment in time. I have, however, been taught by several people who had previously treated me and I am at present under the care of a doctor who has taught me several times over the past couple of years.

Being taught by a doctor who once treated me is not a particular issue, however there is one specific situation that I've encountered twice now which I find rather strange - being taught by someone who you've had a particularly negative experience of as a patient. Now I know as well as anyone that doctors are not superhuman and have their bad days, but it's a bit strange when you've come close to harm as a result of somebody's bad day and are then supposed to treat them as a knowledgeable professional when they are teaching you. In particular, if a tutor is stressing the importance of doing xyz and you know for a fact that they don't always do that - because they didn't do it when they were treating you. It's very easy to just dismiss everything they say thereafter because you've experienced something they tell you not being the case. In the two examples which spring to mind, the teaching sessions were not particularly crucial to my education as they were things we'd covered in multiple other sessions. It just made me wonder what it would be like for other students who have had numerous more interactions as patients than I have and may possibly have experienced more serious negative consultations etc. I suppose it's part of being a professional that you take people at face value and write off your poor interaction as them having had an off day. Hopefully I'm mature enough that it doesn't affect my studies or how I participate in teaching - even if sometimes there's a rather loud voice in my head yelling "nonsense!" when certain people are talking!

I suppose the above rather inarticulate paragraph relates to a difficulty in being a medical student who has been a patient. The second "difficulty" I've encountered relates more to being a patient who is also a medical student. Medical students are renowned for being hypochondriacs. We all joke about having "medical student's disease" - ie thinking that we're suffering from every condition we've every studied. At exam time last year several of my friends suggested that my attacks of sweating and palpitations could be due to a phaeochromocytoma (a tumour which produces adrenaline) or an overactive thyroid (given that they only occurred when I was feeling particularly stressed and resolved as soon as exams were over, I'm going to assume that the diagnosis was actually "exam stress"). It sounds somewhat nonsensical, then, when I say that medical students and doctors are really, really bad at actually going to the doctors. Yes, every time I have a headache I briefly run through a list of potentially fatal diagnoses (sub arachnoid haemorrhage - not acute enough, brain tumour - not worse in the mornings, multiple sclerosis - no neurological deficit) but equally when I am actually unwell I can take some persuading to actually go visit my GP. I would recommend that if you suspect you may have a chest infection or your asthma is playing up, you go and see someone before you become so breathless that you can't speak in sentences anymore - if you do you might get sent in to the acute medical assessment unit where you're on placement and have to be examined by the consultant who is in charge of all students on medical placements. It's really awkward and embarrassing. Just don't go there.

Why is it that we are so reluctant to seek medical attention? I think there's definitely a large component of thinking that our symptoms aren't serious enough  to be deserving of a doctor's time - after all, that old lady we admitted last week was walking around with a raging pneumonia for 3 weeks before she saw her doctor, so our cough/pain/bleeding/whatever is just not worth wasting someone's time over. I find that this is something which has worsened dramatically for me since I was told about "heart sink" or "fat file" patients. This is a horrible term that some (and I must stress NOT all, by any stretch) health care professionals use to describe patients who are forever appearing with a variety of ailments and complaints which rarely turn out to have any identifiable organic cause - the term "fat file" is obviously because they have huge volumes of notes, and "heart sink" because they walk into the room and your heart sinks knowing that they will have another complaint you are unable to resolve. I now have a dread of being labelled one of these "heart sinks". I'm relatively young and have seen, as I mentioned, various specialists for different problems. I'm horrified by the idea of being that patient who the GP dreads, that person who is discussed at practice meetings because no one knows what to do with them any more... I know realistically that I probably am not the type of patient our tutors mean when they talk about this sort of thing - but it doesn't stop me thinking twice (or three or four times) before actually seeing my doctor!

Right, I was up at 6 to go to a clinic 2 hours away so I think it's bedtime now!


Saturday, 10 March 2012

What A Week!

The Learnaholic has had a bit of a rollercoaster week. After scary-but-actually-ok hospital appointment on Thursday, Friday was the last day of my surgical placement. Big relief as I didn't enjoy it much (although it was much, much better latterly). I also had visitors in the form of Mummy and Daddy (and puppy) Learnaholic for the weekend.

Despite plans for long walks along the beach and going out into the hills, miserable weather meant we actually ended up spending a lot of time drinking coffee and eating cake. Absolutely not complaining! Also, Daddy Learnaholic is very clever and fixed all the things around the flat which have been broken (like the kitchen light which didn't work for almost a year...). I had a bit of a heart-to-heart chat with Mummy Learnaholic about my "issues" and it turns out I am rubbish at hiding things because she's known all this stuff for years! It's good that she knows what's going on though, means I won't be constantly biting my tongue around her in case I give things away. We had a really nice weekend together. I do really miss them as I'm so far away most of the time. That was the first time I'd seen them since Christmas.

On Monday I started my new placement, however this was overshadowed by the death of a family friend. It was very sudden so everyone was pretty shaken up by it. I feel a bit guilty about being so far from home at times like this, as I'm not able to support people as much as I'd like. I also can't make the funeral. I will send a note and some flowers to his wife but I haven't quite worked out what to say just yet. I don't suppose there is ever a "right" thing to say or do in this situation.

This week of placement has been all teaching, so I haven't met any patients yet. I did have to go to the mortuary on Tuesday morning for teaching in confirming death and all the associated paperwork, which was pretty difficult under the circumstances, but I suppose it will be coming in pretty handy once I'm working. I've also done some "breakaway techniques" training so that I can escape from aggressive patients, which was good fun although the bruises still haven't gone away! The rest of teaching was less eventful, but I did enjoy getting to role-play a stroppy teenager (although I may have traumatised one or two of my classmates!).

Yesterday I had to go back to my last placement to get all my paperwork signed off as my supervisor wasn't around for the last couple of weeks I was there. I got an unexpectedly good mark. After our last meeting, I was expected a bare minimum pass, but I actually got the same mark as I got for my medical placement before Christmas, so either I impressed all the other staff whilst he was away and they fed back to him, or he really felt sorry for me because I cried last time I saw him! He did mention the importance of "work-life balance" again which is getting a little dull now but I appreciate that he meant well.

This week has also caused a bit of a career panic. On Wednesday morning we had a careers session. Although it was largely focussed on psychiatry and general practice, all the comments about how difficult and expensive post-graduate exams are, how competitive it can be to get onto specialty training etc made me panic a little. On top of that, my supervisor yesterday was emphasising the importance of a strong portfolio to me. In his words, nowadays "noone gets in for being a nice chap or knowing Mr Smith" and it's important to have lots of publications, presentations, extra-curricular achievements - eek! I am, however, trying not to think about it too much. I think I work pretty hard and have a not-too-terrible CV so far. At the moment, my biggest priority is passing my OSCEs in June!

I'm quite looking forward to next week. I'm starting my new placement (psychiatry) properly on Monday. I'm also meeting up with a couple of friends during the week, and on Thursday I think I might go to my first "Skeptics in the Pub" event, which should be fun. Hope everyone is enjoying the weekend x

Friday, 9 March 2012

What's Eating You?

I've been meaning to write this post for the past week but it's taken until now for me to have the time to sit down and properly work out what to say.

Last Thursday I had my first appointment with the Eating Disorders service. Although I've had issues with my eating on and off for probably the past 10 years, it's only in the past year that I've really accepted how much of an issue it's become. I am lucky enough to have an excellent GP who I've known since I moved here. She's very approachable and knows me pretty well, which meant bringing up the subject was a lot easier than it could have been. Anyway, in short, I spoke to her about things last summer, got referred to the specialists and was seen last week.

I wanted to write this on the off-chance that someone might read it who had been struggling themselves and been afraid to get help. Walking into the appoiuntment was one of the scariest experiences of my life. I had no idea what would happen, and I knew it was quite likely that they would want to weigh me which made me totally panic.

I really needn't have worried. The consultant was absolutely lovely; extremely perceptive and very understanding. He made me feel like my issues were not unusual, and he repeatedly emphasised that it was just another illness and nothing to feel ashamed of. He didn't weigh me because I told him uncomfortable it would make me.He's arranging a variety of things to help, including dietetic support, therapy and continuing medication.

Having got through the initial appointment I really feel like I have a chance at controlling this, rather than it continuing to control me. I'll let you know how things go, but I just wanted to reassure anyone in a similar situation that there's nothing to be scared of.


Thursday, 8 March 2012

Making Changes

Some of you will know that I've recently had a bit of a blog-related stress. I'd always thought that I was pretty much anonymous uunless you knew me, bbut after speaking to a friend it transpired that it was pretty easy to work out my identity if you so desired. Now, I've always been pretty careful about what I say on here. I don't mention names, locations, diagnoses etc. I pretty much behave myself so I'm unlikely to reveal any inappropriate behaviour. However, I hadn't realised how easy it was to misinterpret some of the things I'd said.

I've taken the old blog down, but posted everything I'd originally said there on this blog. I have made some modifications and clarifications where it seemed necessary, but the content is largely unchanged.

I just want to make a few things clear. These are just things that have been recently brought to my attention and I think it's best they're addressed so I can move past this.

1 - With regards to my mental health, my regent is aware of the situation and none of my doctors have any concerns about my fitness to practice.

2 - I do not and have never used hard drugs. In a previous post I mentioned something regarding controlled drugs - as I've now stated, this was in reference to working in a pharmacy.

3 - I do not believe any patient I may refer to is identifiable - I avoid mentioning locations, symptoms or specific diagnoses. If you think something I've said is dodgy and potentially breaks confidentialty, let me know.

I think that's everything addressed and I'm looking forward to getting back to blogging properly :)