Hello from the Emergency Department

Hi all!

Sorry for the hiatus, but I’m back now after a hectic past few weeks! I completely underestimated the stress of belonging to two classes and being a researcher at the same time. I’ve spent these past two theory weeks basically running back and forth between lectures and classes (internal medicine with semester 8 and orthopaedics with semester 9) and trying to progress with our research. Finally those hectic weeks are over and therefore – hello from the Emergency Department in Jönköping!

I’m on my next final day at the emergency department, and I must say, today has been the least busy day of the week. I define least busy by:

  • having lunch for longer than 15min at around noontime
  • not having to run as fast as I can together with my doctors across the hospital
  • not having to respond to a single cardiac arrest alarm
  • not having to respond to a single stroke alarm
  • only going to the emergency room of the emergency department once

On my first day at the emergency department, there were at least three emergency alarms we had to respond to (meaning a load of running) on top of the regular influx of patients, that we didn’t manage to eat lunch until 5pm. During my second day at the hospital, we were anticipating yet more alarms to go off around the hospital that my doctor was prepared with his scooter outside our room. I of course had to run alongside with him.

Today was a surprisingly calm day, so calm that I didn’t need to run. It was only then when I realised. As I stood in front of our only high-priority (code red) emergency patient of the day, I realised I wasn’t scared anymore. I was looking at an acutely ill and quickly deteriorating patient without being the slightest bit concerned. This has been everyday for us all at the emergency department. It was then I realised, I’ve really been blunted after these past few days. Or perhaps, my trust in the capabilities of medicine and the healthcare workers around to quickly save a life has increased. Perhaps it’s a combination of both.

So, what have I learnt after a few days in the Emergency Department? Saving lives is a very reasonable job description for doctors.

Final day in the medical emergency department tomorrow here we go! 😀

let the doctor do his work maam gif giphy south park emergency room doctors

What do you tell someone who’s about to die?

(Disclaimer: I received verbal consent from my patient to share about my experience with him.)

This week I’ve been at the Cardiac Intensive Care Unit, and nothing has challenged me more physically, mentally and emotionally during a placement.

At the Cardiac Intensive Care Unit, many patients come in after suffering heart attacks. They are in critical need of care, where many patients are vulnerable and are fighting to stay alive… and the healthcare team fighting to keep them alive.

The week began quite calmly, which gave me lots of reading time, but since yesterday and especially today, I’ve been running.

Running. Trying to learn and help out during critical situations, but mainly trying to keep out of the way. Running to wherever the alarm rings. Another patient is dying. Every second counts.

Yesterday, in the midst of a flurry of doctors and nurses trying to save another patient from a cardiac arrest, everyone leaves the room to discuss. At this point, several life-saving electric shocks had been given, and I was there to witness them all. Even seeing the patient in pain.

I tried fighting my tears as I realise, I don’t like seeing patients in pain. And I really wish I don’t ever have to. But there I was.

I was left alone in the room with the patient and I take their hand to comfort them. The patient then looks at me straight in the eyes and tells me:

Jag kommer nu.” – “I’m coming now.”

Coming. Coming to a place beyond us. Coming to death. Coming to what I like to believe, life after death. Coming to Heaven.

I was silent, again fighting my tears. I look straight back not knowing what to say. What do you tell someone who knows they’re about to die, and you know it too? What do you tell someone who’s about to die?

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This question wracked my brain until the next day. Could I have said anything to improve the situation? What if that really was the last chance I got to talk to them? What if I was the last person they spoke to, and I couldn’t even say a word?

Fortunately, this story has a happy ending. After a rough night and morning of more emergency interventions, the patient is alive and recovering. I finished my day early and decided to pass by the patient’s room to talk to them. It didn’t really feel right for me to leave for the weekend, not knowing whether they will be okay or not when I return. I waited for their room to be free, came in, and in the end I stayed for over an hour chatting. At the end of it they took my hand and told me:

“You have an important duty to pass on your genes to the next generation and I hope you have many children… but be careful with your choice!”

I promised I will, and in return I made them promise they will be around when I come back after the weekend.

As a medical student, I usually joke that another day at the hospital is another life saved, but now I realised this is not a joke at all. As healthcare workers, we are given the unique opportunity to make great changes in people’s lives, and sometimes even save a life. However at times, we are also there as they take their last breath. Being prepared for both scenarios would make the best impact on people’s lives and today, I realised I still have a lot left to learn.

heart ECG tracing recording

 

I am now a T8/T9 student

I’m finally back in medical school! I have never had a more confusing introduction…

As how it turned out, this semester, I will be doing a part of T8 (termin 8 or semester 8) and a part of T9. Owing to this, I belong to two classes, namely my old class from last year and the class above. In addition to this, I’m a hired researcher for the university simultaneously. My introductory day last Monday went a little like this:

  • Roll call with T8 followed by introduction to the semester and presentation of important people
  • Department fika with my research group and meeting our new student in the group
  • Roll call with T9 followed by introduction to the semester and presentation of the SAME important people, hence same information
  • Lunch with T9 classmates
  • Orthopaedics teaching session with T9 classmates
  • Back to the lab

I have never had a more confusing first day. Where do I even belong?

The next day I was in lectures + practical session with my T8 class with a research meeting in between. The rest of the week I was in cardiology, which actually has been really good. I think now my schedule is finally stabilising at least!

So if you ask me what class I’m in, I don’t know. If you ask me if I’m working or if I’m a student, I don’t normally know how to reply either. I thought it was difficult being able to differentiate if I’m a Linköping medical student or a British medical student but well, now it got even more difficult.

But it’s okay. I like it this way 🙂

Confusing, but so far so good! Here’s to a good semester as a T8/T9/researcher! 😀

The news of Brexit is finally hitting me

Yesterday, my newsfeed was filled with news of my friends’ graduations from St Andrews (it’s graduation week over there), midsummer photos from my friends in Sweden and lastly of course, the EU referendum results. What was supposed to be a happy day, was tainted with sadness with the news of the UK leaving the EU.
 
I must admit however, my initial reaction to the results was a somewhat relief, as it further affirmed my decision of leaving the UK. But with the news following the result like the resignation of David Cameron and the crash of the pound, I cannot help but worry about the unpredictable future of the UK. However now that the results are set, we can only hope that the political leaders will steer this result into a mutual positive outcome for both the UK and the EU.
 
Two years ago, I graduated from the most amazing university in the world: the University of St Andrews, Scotland. St Andrews was a university filled with tradition and world-class teaching, attracting students from all over the world. From my time there, I believed that the UK was a welcoming country of opportunity, which valued ambition and talent. Please, let the future international students like myself and other professionals feel as welcome as I did. Please, don’t change 💔
me on my graduation day with a BSc Medicine (Hons) from the School of medicine in St Andrews Scotland

Me on my graduation day with a BSc Medicine (Hons) from the School of Medicine in St Andrews, Scotland

 

 

UK, you will be missed in the EU

Around this time year, I made the bold decision to leave my future in the UK, after four years of medical school there. While most who didn’t know the real story behind it (that’s a story for another day) told me this was a bad decision, I somehow knew my future was elsewhere. A few months later, my newsfeed was flooded with news of my friends on strike for better conditions for Junior Doctors. Today, the UK has now voted to leave the EU. 

If I had stayed, I would’ve had worse conditions as a newly graduate doctor than if I had worked in Sweden. However after today’s events, I wouldn’t even be able to work as a doctor in Sweden with a British medical degree. 

Earlier this week, I overcame my fear of officially leaving Manchester University (I’m currently on leave) and began the process of withdrawing my enrolment. Sure, I had to undergo a traumatic year to make me finally leave the UK, but somehow I feel that that was the universe/God’s way of directing me to where I’m supposed to go. If I had stayed, what would have I done now? 

To all my friends (especially those from the EU) in the UK, I hope the decision of the UK leaving the EU doesn’t affect your future plans in any way. UK, I wish you all the best in standing on your own two feet. Thank you for giving me a free BSc Medicine (Hons) from St Andrews when I could.

Revision Week vs Tenta-P

I can’t believe it. I just finished my first medical school exams in Sweden. I’M FREE!!! 😀

So I just underwent my first “Tenta-P” (Tenta = exam, P = period) aka revision week followed by exams. I must say, it is very different from my past revision weeks in the UK (at least in St Andrews). Here are a few reasons why.

Revision week – UK; Tenta-P – Sweden

Also, see my previous blog post on Being a medical student in the UK vs Sweden.

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1. Tentagrupp/exam study groups

Revision week: Your exam grade depends on the normal distribution of how the rest of the class does on the same exam. Owing to this competitive nature, preparing for the exams tend to get competitive as well.  You’re on your own, good luck!

Tenta-P: This is probably the best thing about Tenta-P. It’s more social, and you’re not alone. Most join a tentagrupp or an exam study group (including myself) where you meet everyday to go over topics and past exam questions according to your revision week schedule. It’s basically a way to keep yourself (and each other!) motivated and on track, since you know you have to go through the topic before you meet the rest!

community study group group work gif

2. Previous exam questions

Revision week: As previous exam questions tend to get reused, the medical school don’t provide a database with previous exams. Knowing this however, students of previous years collectively made their own “previous exam database.” After one’s exam, one writes all the questions one could remember that came up, to share to the coming students the following year (thug life). This document is constantly growing and is being secretly passed down year after year like an heirloom.

Tenta-P: On our internal school website, we have a database of previous exams (from several years ago up to the one from last semester) available for us to study on, including answers. The questions also have a tendency to be reused, so there were many moments when I was beaming during the exam – that meant I had seen that question before.

simpsons happy paper writing gif

3. I’m still on Facebook

Revision week: Every revision week every semester, I usually deactivate my Facebook to minimise my procrastination and hopefully increase my concentration. My friends were used to this so as revision week approaches, they would normally ask me when I plan to take my Facebook down – and make sure they have my number so I’m reachable.

Tenta-P: I didn’t close down any of my social media accounts, instead I even added another one – Jodel. It proved to be quite a fun method of procrastination.

4. More space to study

Revision week: Back in St Andrews, we only had one central university library for all 9000 students. One could say that it definitely was not big enough to fit us all. Especially during revision week. Once, I walked around the library for over an hour trying to find a space with no luck – I just ended up going home. To be fair though, it was also a form of procrastination since you see everyone there during revision week, as everyone take their exams at the same time. Because of this, an early version of Jodel and Tinder combined begun called Spotted at St Andrews Library, where students could post about their library crush anonymously. Procrastination at its best.

Tenta-P: There are several study spaces across campus and I studied in my campus which is part of the university hospital area. To my surprise, I never had a hard time to find a spot to study, and I still seemed to see my fellow medic friends at the medical school. Where do they come from? Where do everyone else study? Wherever they may be, I’m definitely happy they left me a spot to study at the medical school anyway.

5. I’m actually sleeping

Revision week: At first, I would set some alarms at about 6/7am to make sure I wake up and study. After a while, my body gets used to waking up so early, that I don’t need an alarm clock anymore, regardless of the time I go to bed the day before. My body gets used to the 5h a day sleep routine. However, when it’s an extra harsh study day, I can’t afford 5h of sleep. That’s when the caffeine pills come in. Believe it or not, all-nighters with the right company are actually quite fun!

Tenta-P: I never had an alarm during the entire time and I think I got about 7h sleep each night. I never pulled an all-nighter nor took my typical caffeine pills to help me study. I feel so much healthier – and definitely more well-rested.

6. Packed lunches

Revision week: Bringing food to university isn’t really a thing in the UK – well at least in St Andrews as there are no microwaves in campus. So during study breaks from the library, you go to a fast food place and get take out, or to a nice restaurant to eat. Considering one could get a three-course meal from Jahangir (my favourite Indian place ever) for £5 (at the time about 50kr), it wasn’t really a big deal eating out everyday. Which definitely explains why most of us gain weight during revision week. For example, a friend of mine gained over 3kg from eating take out pizza everyday during revision week. But pizza is bae so it’s okay ❤

Tenta-P: To save time, you prepare your packed lunches for the entire week you will be spending in the library during tenta-P, and keep them in the fridge. Then you bring them one by one, and eat with your fellow medic classmates with their packed lunches at the medical school. You end up eating the same thing everyday but who cares, it’s revision week. And definitely more economical (#studentlife). Thank God for microwaves in campus.

7. One doesn’t study in the evening

Revision week: As previously mentioned, late night studying and all-nighters is a thing back in the UK. I used to do at least one all-nighter every revision week and mastered the 5min nap. Literally, I’d put my head down and my friend would time me, but I would automatically get up after 5min anyway and keep going. Also, it’s so much calmer in the evening hence so much easier to concentrate!

Tenta-P: In general, the medical school clears out around 5/6pm during tenta-P. I tend to study more effectively during the evening, so I usually stay on until nearly midnight. Which is apparently unheard of as most during this time are at home relaxing – or better yet sleeping – after the day’s study schedule. I often wished I was them.

sheldon cooper from big bang theory gif all nighter don't need sleep need answers

8. I’m actually doing other things apart from studying

Revision week: Life is wake up, study, eat while studying, sleep (if you can), study. Breaks every now and then if you deserve it. Repeat.

Tenta-P: So my friend Arianne from St Andrews came to visit over the weekend (yes, the few days before the exam), and I also celebrated a friend’s graduation back home in Stockholm. Arianne was a regular revision week study buddy of mine back in St Andrews, and I must say she was quite surprised by how “normal” I was. Not sleep deprived, not talking medical jargon to myself and lastly, not too stressed to not have a good time out!

9. The fear of failing

Revision week: In the UK, passing is not the difficult part and passing is not enough. You need to get a good grade as well because the better you get, the better it will be for you later. Also, your grade once again depends on the normal distribution of your class’ results. The fear was never about passing, so in a way I never had the anxiety of failing. Rather, the fear was getting a bad grade.

Tenta-P: The day before my exam, I had the biggest pre-exam anxiety ever. So bad I even had to go to church to calm myself down – God was the only one who could help me now. As we don’t receive grades but just a pass or fail on our exams, the fear was on passing as there’s nothing else to aim for unlike before. 65% total minimum was the goal, otherwise you gotta come back in August to do the resits!

spongebob rips in half gif

10. Meh, I’ll just do the resits

Revision week: If you fail an exam, you have one chance of redoing it during the summer. No matter how well you do on the resit, the maximum grade you can get is a pass. Also, it will state on your academic transcript upon graduation that you had to do a resit. If you fail the second time however, you need to repeat the year – touch luck! In other words the mentality is: failure is not an option.

Tenta-P: Once I overcame my pre-exam anxiety of failing, I accepted the fact that I know what I know and I can simply only do my best during the exam. I accepted my highly likely fate of returning for a resit in August. I listened to my friends’ advice who have this embedded within them – doing a resit is not the end of the world. At least the information will be fresh in your mind when the next semester starts! Meh if I fail, whatever there’s always next time 🙂

cat rolling psh whateva whatever i'm out gif

Time for summer vacation. Ehh, Linköping see you during resits in August? 😂

Tonsillectomies are not just routine operations anymore

Sorry for the hiatus, but I am finally feeling better now. I have returned to my normal activities-ish. I now only have a plaster over the surgery site and wear a wrist splint every now and then. Thankfully, my recovery was quick! I promise to write about the surgery and put photos ASAP!

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I am currently on my ENT (Ears, Nose and Throat) placement, now on my final week. Last week due to my newly operated arm I missed more than half the week. But I’m bouncing back now!

Yesterday I attended my first ENT operation (tonsillectomy) ever. This is the first time I’ve attended a surgery for almost a year, and almost two weeks after my own surgery. Suddenly, after being newly operated on myself, my attitude towards operations have changed. It really is different when you’ve been on the other side of healthcare.

Despite tonsillectomies being routine, a range of new thoughts popped up in my head that I’ve never thought about before during operations. Thoughts such as:

  • I wonder what the patient is dreaming about right now. Are they dreaming?
  • Would they remember being woken up and leaving the operation room?
  • How would they react now that their tonsils are gone?
  • How long will their pain last?
  • I wonder if they’d be able to go back to work/school with their throat – sooo painful…

I no longer only think about the long term effects of the surgery, but how the patient will feel right after the operation. I was there too. You enter the hospital with full control of your body and feeling okay. Then you go to sleep, and all of a sudden, you wake up and everything has changed.  

After my operation, I was in pain. I was in such excruciating pain in my arm, that I was dependent on strong opioids such as oxycodone and morphine. I remember how debilitating it was, and how one was so helpless and dependent on others. The pain took over one, and all one can do is wait until it passes – or until the opioids knock you out. But then you wake up several times in the night with the pain needing more. Then you take more painkillers and can finally fall asleep again…

When I see a patient get operated now, I can relate. I can relate to their fear, anxiety, and sympathise for the pain they will undergo post-op. I recall how it was for me and realise, even though this is one of the hundreds of routine tonsillectomies done, the bi-product of the operation itself is the same. All patients will experience a change in their daily lives, with its impact highly underestimated in the beginning. That was definitely the case for me anyway. Of course I think like myself too, all patients are willing to undergo it. Patients have so much hope and trust in the treatment, that its bi-products is long overweighed by its benefits.

After being a patient myself, I understand now why patients feel the way that they do before an operation – even one as common as a tonsillectomy. One is scared for the drastic change that is about to happen – both the good and the bad. One is scared because there is nothing one can do but accept the change, and be patient.

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Arm is that you? I've missed you 😭

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I’m about to get operated.

I know I’m in my fifth year of medical school, I know I’ve grown up hearing about operations, I know I’ve seen countless surgeries… But somehow I’m still somewhat scared. Even though this is a quick and non-invasive surgery. 

It’s definitely a completely different experience being the person on the other side of the bed now. Now I understand what patients feel when they come to the hospital. Now I’m one of them lying here waiting for my turn to get operated on.

In a few hours my five years of pain in my right arm will be over. Soon, I can play the violin again! 

Wish me luck and prayers are warmly appreciated! Time for me to become the patient! 😊

Primärvård (primary care) placement – done!

 

During one of my first lectures during my first year of medical school, our lecturer asked how many of us in my class wanted to be surgeons. More than half of the room raised their hands up including myself. Afterwards our lecturer asked how many of us wanted to be general practitioners/family practice doctors/distriktsläkare. About five people raised their hands up. I wasn’t one of them.

Why is it that primary care is often perceived as one of the “lower,” “less interesting,” “boring” specialities? Statistically, more than half of all medical students in a class end up in primary care in the end. I guess people eventually realise how great the specialty is, after one overcomes the social stigma of the “super-shiny” status of surgeons and other specialists. And there is a high demand for primary care doctors too of course.

Here are some examples of the privileges of working in primary care:

  1. You do medicine, surgery and other different types of treatment approaches on a daily basis so it’s hard to get bored
  2. Patients come in with literally any symptom possible, and it’s up to you to decide which system they belong to – exciting detective work
  3. You really get to personally know your patients and their families through the years, as families tend to stay within the same practice/clinic/Vårdcentral
  4. It’s easier to plan your time and time-offs as the patients are not acutely ill
  5. NORMAL OFFICE WORKING HOURS – what night shifts?
  6. It’s very well paid, especially in rural areas

I could definitely see myself pursuing primary care in the future with those perks.

I have been in Värnamo for my primary care placement for the past two weeks and absolutely loved it. It’s such a varied specialty with all sorts of patients, you never knew what people would come in with as they walked through the door. And they always have the most amazing stories to tell. Definitely far from boring, which most have an understanding of primary care to be.

This is my fourth primary care placement ever, after three 4-week placements in the UK. Because of this I wasn’t really looking forward to this placement thinking it’s a repetition of the past. But this has been the best placement I have ever had so far.

The people have been most welcoming (like amazingly welcoming, they even hugged my goodbye!), even giving me an office for both weeks to make sure that I felt like a part of the team/family. I was given lots of responsibilities, and they really pushed me to my abilities. Everyone has been super friendly, even have driven me home sometimes and had coffee or fika outside the clinic! I’m sure these experiences I gained here I will have use for throughout my career.

Värnamo, thank you very much for an amazing two-week placement in primary care. My four-week tour around Småland is now over, and I can finally return to Linköping. No more travelling, I can finally settle back in my new home in Linköping until the summer.

See you soon Linköping, I’ve missed you! 🙂

Samuelle Valles name outside office door for patients to come in. Red light showing that I am inside or busy. Upptaget in Swedish. Being a medical student or läkarstudent/läkarkandidat in Linköping is fun!

Closed the door to my office for the last time. See you my-name-by-the-door again soon when I finally can call myself Dr. Sam!

I JUST OPERATED MY FIRST PATIENT EVER

Not gonna lie, who knew that Primary Care/GP/primärvård in Värnamo could be this fun?!

My surgical skills diploma from Manchester isn’t just a paper hanging on the wall anymore! Those general surgery days with McCloy paid off – the best teacher I had in Manchester for sure.

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Earlier that day, the doctor I was shadowing excised a lipoma, and told me that should another patient come in wanting something removed, I would be allowed to do it under his supervision. Yes I know, he is pretty awesome like that, wanting me to have as much hands-on experience as possible.

Our last patient came in who was a young patient with a congenital nevus (mole), about 3x3cm. Yay I thought, another skin patient and a possible surgery candidate! We examined it and decided that it was benign, but asked whether he wanted it removed anyway – me secretly hoping that he did. He said he wanted it removed. The doctor and I looked at each other and smiled. I GET TO CONDUCT MY FIRST SURGERY EVER!!! 😀

As per my doctor supervisor’s instructions, I injected the anaesthesia, excised the nevus/mole and lastly sutured/sewed it up. All by myself. Except for when the doctor helped me cut the thread after every suture/stitch I put down. In the end it became 6.

After finishing the last suture/stitch, we said goodbye to the patient and left the room. BOOYA. SUCCESS.

It’s gone a few hours now and I still haven’t stopped smiling. I feel so happy and honoured to have been entrusted with such an opportunity which I’m sure I never will forget!

So now baby doctor Sam has performed her first baby operation. I have to start somewhere right? Next time it will be much bigger. Like what my friend said, maybe next time, I will operate on a mole 5x5cm big instead! 😂