# 004 ... Rollback

Having had time to take a breath and recover from blog entry #003 I ruminated on other memories as a medical student.

I discovered, or rather rediscovered, a few memories from the previous year ... my first year in clinical school.

After three years of attending university campus, the clinical apprenticeship starts in earnest, an apprenticeship of a further three years of rotations through as many of the generalist and specialist fields as the training hospitals can get their hands on for us.

The beginning of that year, before our studies started, I went out west to the farming district with my wife-to-be and stayed with a mutual friend on that friend's parent's sheep farm.

It was haymaking season ... the old style, with hay bales like Lego blocks that were tossed up into the back of a tray truck for stacking into a barn for the upcoming winter. None of those modern, new large rollup bales that would sooner roll over you and grind you into fertiliser as stay well behaved where placed.

It was an adventure when it started, but I over the few days became more and more irritable and it strained relationships. Two days later, after arriving back home, the fevers and rigors hit. I was not well. My throat burned, my body ached, my mind was poisoned by the high fever and I could not connect to the real world around me.

My parents took me to my family GP who diagnosed glandular fever, took some of my blood for testing but "just in case" it was tonsillitis gave me an injection of penicillin ... to all intents it looked like I had tonsillitis, I was toxic, had large angry tonsils covered in exudate, tonsils that almost met in the middle of a throat struggling to swallow - all this despite that fact that I was supposed to have little or no tonsillar tissue left following a tonsillectomy at the age of five years. We all had tonsillectomies then ... the conventional wisdom was that it was good for us.

The tests for glandular fever came back negative. My dear doctor (who incidentally was a very good doctor, one of the few, and is still a very good doctor in practice in the same location now despite being past retirement age) arranged for daily penicillin injections. I still remember the deep, visceral discomfort of those injections. I learned to dread the visits, despite my rational mind telling me that they were helping me get better. Every time I give an injection now I connect with that time.

I recovered, in more way than one, but slowly. Six weeks later, still somewhat fatigued, but now in the full swing of my first clinical year of study, I attended the student clinic at the hospital I was studying. I still had a palpable spleen and generalised lymphadenopathy ... the young doctor (probably a junior resident) looked concerned and ordered more blood tests.

This time they came back positive for glandular fever. I continued to recover without the need for any further attention, but I did not perform as well as I might like for the first three months of my clinical training, and my need for sleep exceeded my normal requirements.

First Lesson learned: trust one's own clinical diagnosis - if the test results are unexpected, then the diagnosis is right and the tests are wrong.

That year as a student I spent many hours in that teaching hospital trying to learn what was being taught. It was a struggle, especially those lectures where the professor would breeze in, put up lists of topics on the overhead projector, replace them with more lists, finish the lecture by saying "These are what you need to know about" and then breeze out again. Bastard! A fucking lecture giving us lists of things we needed to know about but no true dispensing or sharing of knowledge. That same professor gave us a series of "lectures" ... all the same, all as frustrating.

Most of what I did learn in my first clinical year was found in odd places and odd times. Every morning a list of patients admitted to the hospital was posted onto the medical student notice board. The conscientious students were up early to see that list, and were off to see the patients with good signs. Patients in the hospital were referred to by their sign or their illness. Over morning coffee the chatter was along the lines of ... "Did see that spleen that was admitted to 4East?", "Did you hear that murmur that came in overnight into 6West?" I was never a morning person, and I never could be bothered to be the first to see that list in the morning.

However it was a ward round very early in the first week or so, which confirmed for me how dehumanising it was to be a patient in a teaching hospital. During that ward round, relatively late in the morning the group of 6 students, registrar and resident were lead by our teaching consultant to a patient in the wards. It happened that the patient who's bed we were swarming around had been a "good sign" to see and had seen the normal early morning queue of students and been the object of three other group ward rounds already. As the patient began to complain, the consultant stood menacingly over that patient and asserted that because they were privileged enough to have the best hospital that could be provided they had the duty to allow medical students to learn from him. I cowered, and when it was my turn to auscultate the patient's chest to listen to classical sounds that were indistinguishable from the mess of normal and environmental sounds I looked at the exhausted patient and thought a sincere apology that I dared not give voice to.

That day I gave myself permission to sleep in to a normal time in the morning and not join the vultures of the pre-breakfast sign hunt.

Lesson Learned: respect the humanity of the patients we work with.

I remember one night I had a phone call from the emergency department to come down and "do some suturing". Great ... I needed the practice. I extracted myself from the lounge in the student quarters and headed over to the hospital.

The patient was a male, drunk and had tried to walk through a plate-glass window. He was already placed on the table in the emergency department operating theatre. I, and another medical student, were directed to find, clean and stitch all the lacerations. My colleague started at the head end, I started and the feet. We measured out the maximum amount of local anaesthetic that was non-toxic for the patient (not that any local anaesthetic was needed given the inebriated state of the patient), shared the measured amount, scrubbed, gloved, masked and gowned and started.

An hour later my colleague was approaching the patient's chest area and I was just about to start examining the patient's groin area for wounds. We had already run out of our allocation of local anaesthetic and suturing without it did not seem to distress the semi-conscious body on the table. The nurse had already been in twice to re-stock us with gauze and suture silk. We were both confident and looking forward to finishing.

I found a wound in the groin, with a small piece of glass protruding. No big deal, we had removed almost enough glass already from wounds to reconstruct a beverage container. Clean, window drape, prepare my position for exploring the wound, remove the glass and suture. It didn’t feel right ... something didn't feel right. I stopped. I looked at the wound and waited. The glass was twitching, only so slightly but noticeable if one paid attention. No, I just didn't feel good about it.

I called the senior resident of the emergency department to look. He called the surgical registrar who consulted with the vascular registrar who took the patient into theatre and repaired the lacerated femoral artery that had been plugged by the fragment of glass.

An approving glance from the vascular registrar the following day was enough to give me a glimpse of the good things that could come from being a doctor.

Lesson Learned: find your instinct, foster it and trust it.