Medical origami

My first GP tutor at med school was an inspiration. He would often whisk us away from other tasks because he had a patient with an interesting clinical sign he wanted us to see – some poor man with hyperreflexia perhaps, who would then be subjected to a line of six bright-eyed medical students inexpertly bashing his knees. He once drove us for half an hour across town for the sole purpose of listening to a pleural rub. And he’d come out with gems like “If you don’t know what’s going on, send the patient to do a urine sample. It makes them feel better and gives you time to think.”

Anyway, one day he taught us some quick origami for keeping children entertained in clinic. I promptly forgot his instructions, and a couple of years on I’ve lost count of the times I’ve wished I could remember them. I mean, as someone who spends most of her time hanging out in the corner of clinic rooms*, there are a lot of occasions when it’d be nice to have something to cheer up the restless little sister of the boy who’s been brought in with chickenpox or something. Luckily I found the original in a drawer the other day, so here goes:

Take a square of paper (the page from the back of your notebook is fine). Fold it diagonally, then turn over and fold horizontally, as so:

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Bring the corners in and fold down to make a smaller square. (I suspect this bit has a fancy origami name.)

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Fold the top and back layers down so you have this:

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Now fold the top sides down to the centre – both layers – to get this:

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Extract the flap that’s in the middle, and fold it up and over the outside, like this:

IMG_2697Turn over. The next part is the fiddliest, but worth it. Fold out the top layer of each triangle from the middle, like this…

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… and add personality!

IMG_2701Et voila! He fits on the end of your finger.

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Our tutor claimed that he wasn’t doing too well in his paediatrics clinical exam years ago, but then made this, made the kid smile, and passed. I reckon that’s a skill worth having!

*I mean obviously I’m working really really hard at the same time, but sometimes you can get away with this stuff while the doctor’s back is turned.

Medical mnemania

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There are hundreds of medical mnemonics out there to help poor hapless students remember their facts. I just found this photo illustrating one to help you remember the types of thyroid cancer: Please Feed My Alligator (papillary, follicular, medullary, anaplastic). Anaplastic tumours are the worst (and also closest to the alligator’s mouth). The picture also happens to illustrate brilliantly how I feel about my exam tomorrow.

While we’re at it, I found another excellent mnemonic the other day about catching cats as a way of remembering the Glasgow Coma Scale (‘decorticate’ sounds like ‘caught a cat’, which you’d do with flexed arms… oh never mind). It made my day anyway.

o-BRIDES-THROWING-CATS-570This could be a fun topic to go on with, but I suppose I should revise. Do you like mnemonics as a way of learning? Have any favourites of your own?

 

Some basic taxonomy

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Exams are back. Or, we’re back at exams. There are a few distinct species of medical student who emerge at this time of year. Here’s your handy guide to recognising them:

The super-competitive one.

Says: “I was in the library ’til 1am last night, then my housemates and I went through all the Parkinson’s plus syndromes before practicing the hip, knee and elbow examinations. Do you know the chemotherapy regimens for myeloma? They’re easy, I did them this morning.”

Found: on the ward or in the common room, discussing rare syndromes with other members of same species. Usually wears shirt, ID badge, stethoscope and smug smile.

The self-depreciating panicker.

Says: “Oh my god, I’m definitely going to fail. I spent all of yesterday looking at cardiology and I can’t remember ANYTHING!”

Found: in the library, semi-visible behind huge pile of books, notes, highlighters and can of energy drink. Wears stressed expression.

The overly nonchalant one.

Says: “Oh yah, whatever, I never do that much revision. I was playing rugby/trampolining/running a half marathon yesterday. I got 82% last year though.”

Found: having a coffee and chatting loudly at table next to self-depreciating panicker.

Note: no matter which species you identify with, or even if – god forbid – you think you’re normal, it is never ok to adopt either an a) non-competitive or b) contented demeanour. Think revision sucks but you’ll probably be ok? Nope, no way. It’s just not said.

Me? Well, I’ve clearly developed a fetish for post-it notes and have pink and green spots swimming in front of my eyes. Now, what’s that syndrome called again?

 

Crossing the line from a normal person to a doctor

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There are some things in medicine you’d think it’d be quite important to get right. To have good technique and know what you’re doing. For, you know, everyone’s sake.

Yeah, right.

Doctor: “So, what do you want to get out of this clinic today?”

Me [uncharacteristically prepared]: “Well I’d like to understand the basic management of some of the common urological presentations, like haematuria and prostate cancer. And I’ve never done a PR, so I’d like to learn how to do that if possible.”

Doctor: “Great! We’ll see what we can do.”

Half an hour later, in walks Mr Unsuspecting Prostate.

Doctor: “I’d like to examine your prostate if that’s alright”.

Mr P: “That’s fine, doctor”.

Doctor: “And we have a medical student here today. Do you mind if she examines your prostate as well?”

He sits back down at his desk, leaving me standing there with a glove, a sachet of lube and a patient in front of me in the foetal position. I think this is most awkward I’ve felt since coming to med school. I guess I thought there might be some…instruction. I’m aware that if I ask what to do it might make Mr P feel more uncomfortable. And yet if I don’t, I might as well be any old person off the street who just happened to find a glove, some KY jelly and an interesting opportunity.

Oh well, perhaps that line was crossed a while ago. Anyway, I should know. How hard can it be?

I sigh, choose a finger, and go for it.

—-

Fitting: https://dailypost.wordpress.com/2014/03/27/prompt-the-great-pretender/

 

Standout

Anyone white person who’s ever been to Africa will know that you can’t come here and expect not to stand out.

Each country seems to have a different word to describe its white visitors. In South Africa they say ‘mulungu’, in Rwanda ‘muzungu’. Here in Ethiopia it’s ‘farange’, or ‘farangi’.

Sometimes it feels like a taunt; more often just an exclamation. I’ve walked through South African villages and had small kids literally run down hillsides towards me, shouting “Mulungu mulungu mulungu I’m fine how are you! I’m fine how are you! I’m fine how are you!”

My Ethiopian hosts, however, are a little more restrained. Who are they to be seen running from hillsides? Anyway this is Addis; anyone who tried that would probably be hit by a taxi.

Oh, I stand out alright. And there’s no discrimination: I can count on being equally ‘farange’d by young girls, teenage boys and old women. But it’s the delivery that never fails to crack me up. It’s so completely deadpan. I can only imagine that the conversation goes something like this:

“Yeah, I know, what a bastard right? So I told him if he ever treats me like that again – white person – I’ll be going out with Worku instead.”

Or: “Can you believe the price of nappies these days? I might have to start getting those reusable ones, but they’re disgusting and anyway – white person – what can I do when there’s no water half the time?”

Clearly the only explanation is that there’s a nationwide Ethiopian game of farange bingo going on that I don’t know about. I love it.

http://dailypost.wordpress.com/2013/08/15/daily-prompt-standout/

Bedrest

The patient limps through the door and eases himself into the chair by the surgeon’s desk. I’m sitting in on a private orthopaedic clinic. I’ve only been here ten days, so my Amharinya is limited to things like ‘thank you’, ‘coffee please’, ‘no’, ‘yes’, and that strange sharp intake of breath that means yes.

This man is obviously in pain though, and the pelvic x-ray tells me why. He has avascular necrosis of the hip – his hip bone is wearing out.

I listen to the surgeon taking a history, pointing at the x-ray. The patient nods, shakes his head, looks tired. Eventually the surgeon produces a pad and writes out a sick note. I peer over his shoulder.

“He needs bedrest.”

The patient nods, takes the note, limps out.

“Bedrest?” I say. This is nothing I’ve learned before.

“Sure”, says the surgeon.

“Of course what he really needs is a total hip replacement, but he can’t afford it. He works as a security guard, so all I can do is tell them he needs bedrest, and at least then he can take the stress off his hip and he’ll be in less pain.”

Bestrest, not surgery. Just a single moment, a tiny glimpse for me. Here, a daily reality.

Audacity

Have you ever started a sentence and realised you have absolutely no idea where it’s going?

Yesterday I found myself sitting in the Dean’s office, in the biggest university hospital in the capital of Ethiopia. Huge, shiny table. Award certificates. Business card holders. The Dean is a thoracic surgeon, for Chrissake. Very Good English.

“So, what can I do for you?”

Did I mention that this trip was somewhat fly-by-the-seat-of-my-pants? I suddenly feel a wave of guilt at my own audacity, that I thought I could just walk into this hospital because I’m a medical student and I felt like it. I can feel myself blushing. Deep breath. I got this far, I think. Don’t be intimidated by a shiny table.

I tell him who I am, some approximation of why I’m here. I can hear myself as if from outside. Am I being completely ridiculous?

“So I hoped it would be possible to spend some time in the internal medicine department.”

He looks at me for a long moment.

“Of course! Welcome. Anything you need, just let me know.”

I breathe again, grin, and shake his hand. I often have a suspicion that much of medicine is about bullshit. This is just practice, right?

Moved to Tears

In Addis you have to take internet time as it comes. Today’s Daily Prompt was to “describe the last time you were moved to tears”. I initially missed the end of that sentence [by something beautiful] in my haste to get everything done before the next power cut. So here there are rather more tears, less beauty.

Yesterday, following my Ethiopian surgeon friends on their ward round, I realised that – until that moment – I had never seen someone really, truly in pain.

After surgery on a joint, perhaps a knee or an elbow, it’s important that the patient starts to move it again so that the joint doesn’t stiffen into one position.

Picture yourself standing in an operating theatre watching a boy’s leg being sawn in two. And then imagine, the next day, seeing him literally screaming in pain as he’s told he has to move it, swing his knee over the bed and kick it back and forth. You know exactly what’s under that bandage. You can only imagine what he’s feeling.

I realised I’d never witnessed that amount of pain before. It was worse than blood or needles or seeing someone cry or be sick or fall.  I didn’t know it would be that visceral, immediate, personally excruciating. I didn’t know it would make me want to faint, vomit, and be moved to tears.

http://dailypost.wordpress.com/2013/08/10/daily-prompt-beauty/

On learning to love surgery

“The way these things usually go wrong”, says the surgeon, muffled through his green mask, “is when you don’t take out enough bone”.

Several months ago in the deepest darkest English winter, I decided that I wanted to have an interesting summer holiday. To do something useful, something exciting, maybe have a bit of an adventure. Some emails, a grant application and some disorganised packing later, here I am. In the CURE paediatric orthopaedic hospital in Addis Ababa, Ethiopia.

CURE is a private hospital. Operations are performed mainly by local Ethiopian doctors trained at Addis medical school, but funding comes from external donors – national and international. The hospital is relatively small and quiet, the equipment is good and there’s plenty of time. The waiting list, though, is long.

Children come from all over the country for specialist operations they can’t get elsewhere. One very common presentation is clubfoot, a congenital condition that means the foot (or feet) turn down and inwards. At home this would be treated early using combinations of foot supports, braces and special shoes, but here the kids have no choice but to walk, and years of walking means that the bones deform. If they’re lucky enough to get to CURE they can have corrective surgery. Much of the problem with clubfoot is in the tendons and ligaments, so they have ingenious surgeries such as Achilles tendon lengthening, posterior medialis release or anterior tibial tendon transfer. If the bones are deformed they might have a triple arthrodesis, which involves cutting out a wedge of bone in the foot, tearing out the cartilage with pliers and letting the bones fuse in a new position.

I’ve been known to be squeamish about surgery. Hey, this is the blog of a medical student with needle phobia, right? I was fully prepared to come here, the strange medical student from the UK, and faint in the OR while watching something hilariously minor. But I’ve been fine. Actually I’ve watched some of the most gruesome things I could have imagined: a little girl with osteogenesis imperfecta having her femur sawn in two and rejoined with a metal rod; a total hip replacement; a 13 year-old boy having his entire back opened up to remove 11lb of lipomas. I even helped sew a skin graft onto a little boy’s hand, metal rods drilled into each tiny finger to keep them straight – and for some reason I’m just fascinated, and awed.

Surgery here seems simple, and necessary, and utterly life changing. I can see exactly why some people like it so much.

Heart sounds

Clueless

The patient has a congenital heart defect, which means that when it comes to cardiology clinics he’s seen it all before. In stark and somewhat hilarious contrast to me.

The consultant hands me the ECG. “What do you make of this?”

“Um, well… there might be some right bundle branch block”.

This invites a glare. “What do you mean, there might be some bundle branch block? What year are you?”

He turns to the patient on the bed. “Alright if this student listens to your chest?”

“You might learn something interesting”. This is aimed at me, clearly. I pull out my stethoscope and start to listen.

“No, never do that! If I saw you doing that in an exam I’d fail you immediately! Do it like this.”

I replace the stethoscope, feel for the carotid pulse and listen again, until I’m distracted by an unexpected sound.

“Well, have you heard it yet?”

“Er, no… because the patient’s laughing.”

The consultant spins round. “What are you laughing at?”

“Oh, sorry. Sorry. It’s just that I’m a student too, so I know what it’s like to get shouted at.” The patient is trying to suppress a smirk. Unsuccessfully. “I’m just glad it’s being aimed at someone else for a change.”