Phuket Calling & Playing With Bones

It's been a few days since I updated so here goes!  So last week I finished my placement at the ER ward and overall it was great. I learnt so much about wounds, rode in an ambulance, saw treatment for a massively swollen insect bite and assisted in the removal of a guys stitches (to name a few!). There was also an interesting case in which a man had lost 3 of the digits on his right foot from complications resulting from hypertension. As im into cardiovascular medicine, it'll be a good one to read more about when i get home. I also saw so many results of motorcycle accidents. The driving is so insane out here that it happens quite often, and most people dont even wear helmets so the injuries can be pretty severe. It's actually really inspired me. When considering specialities for medicine, cardiology has always been at the very top of my list. This is both for personal reasons and just because I find the cardiovascular system just so fascinating. I've also considered other specialities such as oncology, neurology and autoimmune disorders such as diabetes, but I really think that I shouldn't dismiss trauma as a potential speciality should I become a doctor. I really like the pace of trauma medicine, how you can encounter something different everyday, and having that much responsibility in your decisions. 

Anyway, since before I came to Thailand I wanted to visit the beaches. When you think of Thailand in terms of a holiday destination you automatically imagine stretches of long white sandy beaches, and relaxing. After a hectic week of placement you just want to unwind and relax anyway. So last Wednesday I was discussing with one of the other students here about doing it, but we ended up just being busy. On Wednesday evening we went market shopping. Chiang Mai is famous for its impressive street markets, so we went to do some souvenir shopping, and there's so much there, it ended up being a really late night. Then on thursday we went almost straight from placement to Tiger Kingdom. Tiger Kingdom is amazing, you get to go and actually stroke tigers, it's so surreal, I have a photo of myself lying on on of the tigers backs. Anyway, Thursday is the evening that at the Gapmedics house everyone goes out for a meal, as a lot of the time it's the last time that everyone's together as some people leave on the Friday and others go off to the hill tribe experience. This meant that nothing could be booked before then. We ended up getting to Friday afternoon after placement still without having booked anything, we still really wanted to go, so we went to the wifi cafe and booked flights and a hotel around 5 hours before the flight departed, it was absolutely insane! We ended up arriving in Phuket International Airport around 1am, to which we were immediately targeted by a company selling tours, so we bought a day trip to Ko Phi Phi, which is apparently the most beautiful island in the area. Because we booked this, we managed to get our taxi to the hotel for free. Now this in itself was an adventure. Firstly the taxi driver didn't know where the hotel was, Even when we showed him the address. Eventually after getting his bearings (and asking directions a few times closer to the hotel!) we end up in this quiet, remote area, of which the hotel as down a dusty track. We got to the hotel with '24 hour reception' to find it was quiet and dark with no sign of anyone around. So naturally we knocked on the door. This was met by loud barking from a guard dog inside, which managed to wake the owner who was asleep on the sofa in the reception area. When we got inside, they hadn't received the message that we were coming, so they had to prepare a room. The room turned out to be nice, spacious and clean, so everything we needed. We ended up spending around 5 hours there until our taxi arrived to take us to the port. So Saturday turned out to be a day of touring islands, snorkelling around Monkey Island, and lunch on Ko Phi Phi Don, the bigger island. We then basically went to the beach before heading back. So when we got back to the port in Phuket, we had no hotel to go back to, so we requested to go to this hotel I'd seen on a Phuket tourism website called 'SB living places'. The hotel was so lovely, comfortable room with air con, a pool, free breakfast, restaurant, gym, rooftop bar and massage suite. We settled in and relaxed there for a bit then headed out to dinner at a restaurant we'd read about in the guide book called 'Cook'. This had Italian and Thai influences, therefore I had a Thai green curry pizza, which was actually really good, especially when followed with white chocolate mousse cake! Thailand is insane, we turned down a ride from a man on the back of his 'motorbike taxi', got photos taken of us and showed a nice israeli couple to the hotel we were staying when they couldn't find anywhere else to book a room. 

The next day we decided to visit a beach near to the airport to make it easier to get back. The beach seemed like it would be quite relaxing, which is what we wanted, so we got a bus to the area,which the driver couldn't actually find,which should have been a warning sign. The beach in itself was quiet, but too quiet, it was literally just the beach, whereas we were expecting at least one shop or restaurant in order to buy a drink or something. So after a walk down the beach, we'd started to get thirsty. It took 15 minutes and some getting lost in the forest until we found a shack out the side of the road. It served the most amazing authentic Thai food, and so cheap! We ended up paying 130 Baht (around £2.50) for us both to eat. After food we really didn't want to make the walk back to the beach, so we got a taxi to another temple. We looked round a little, got given our fortunes (albeit in Thai) and took some photos. This however really didn't fill up all afternoon, therefore, after failing to get a song tha-ou to another beach, we found a shack at the side of the road and finished our trip with ice cream, before heading back to the airport. It felt like we were properly backpacking, so not quite the relaxing weekend I was envisaging, but still great. 

This week I've been placed in the orthopaedics ward in a much larger hospital in Chiang Mai, which is giving me more trauma related experience. The first day started out with a ward round, visiting the trauma patients in the male and female wards of the orthopaedics department. As all of the cases on this ward was fractures, we managed to see a variety of fixation equipment/ braces which was pretty interesting. Yesterday I was placed in the orthopaedic OPD, in which I saw a variety of different cases. A couple of people came in with osteoporosis, needing a repeat in prescription of their normal drugs, I had a patient come in who'd had a nonunion fracture in her foot for six months that needed surgical treatment, another patient who'd experienced a compression injury in her lumbar region, causing pain in her sciatic nerve, but had also discovered a kidney stone in the x ray to diagnose. An interesting case was 2 different women of similar age, coming in for similar symptoms, neck pain radiating down thier left hand side extremities, however one had negative symptoms in a series of tests including a compression test and a weakness test in a physical examination, the other had positive. However on x ray examination, both had the same diagnosis of neck sprain, with tennis elbow, and prescribed painkillers. I also came across a couple of cases I hadn't heard of before, one having previous treatment for a condition known as meningomyoceles, a mass growing on the spinal column, and as a result had been left with a significant difference in leg length, causing her to walk with a limp. We also had a couple of patients come in with spinal chord stenosis. A final case that was interesting was a man who had had tuberculosis, which had spread to, and deformed, his spine. He'd had previous surgery to correct this, and was taking TB medication, but was concerned about a rash on his shoulder, and was referred to a dermatologist for further investigation. I learnt so much from OPD, and found it amazing how many of these cases would have been dealt with by a GP at home. The Thai healthcare system is so different, many cases just come straight to hospital, and they don't seem to have the alternatives that we have available in the uk, such as walk in clinics, GP surgeries and advice available from pharmacists.

Changing slightly today, I was on orthopaedic surgery. Which was slow, but still interesting. We managed to watch a knee replacement operation and a hip replacement, as well as seeing part of an operation to remove extra digits on a young patient presenting polydactyly, with six digits on each hand, and six and seven digits respectively on the feet.

Tomorrow I'm back in surgery, which should be pretty interesting again, but for tonight it's market time! 

3 days left, I'll keep you updated! 

XOX  

  

Midweek update

I think this might be one of my new favourite places. Thailand is great, literally amazing. Is it what I was expecting? The answer is both absolutely and not at all. I expected the jungle with sprawling banana trees and the lush greenery. I expected to see temples covered in gold and I expected the street food, all the rice and noodles. I even expected the conditions of the hospitals here. What I didn't expect is what's amazed me. Big streets, filled with nighttime markets selling the most amazing handmade items, crazy shopping habits such as literally having to dive into a pile of clothes in a thrift 'store'. The crazy driving, or the red taxis which you can stand on the back of and ride. The mountains which are covered in jungle and give fantastic views from the top. I really wish I could stay longer. 

The hospital's been great over the last 2 days too. The highlight of which has to be riding in an ambulance. We did a patient transfer to a bigger hospital, so I went into what was like an ITU, it was so interesting, I was definitely in my element. On the way back we were called to an RTC also, the driving here is insane, literally any road rules don't seem to count, including staying on the correct side of the road, therefore there are so many motorcycle accidents, which is what we went to. I've also seen suturing, which was great because I've never seen it before, and the doctor performing it was fantastic at explaining things too. I even saw my first case of infection today, with a patient coming in for severe diarhoea, which was interesting to see how they treat. I've been doing a little more aswell, minor but helpful tasks, and chatting to the English speaking patients which has been great. The people I'm working with are lovely too, so much that I don't even mind that this particular placement is just me. I've learnt so much already, a lot of which is also relevant to me as a first aider as well as a potential doctor. 

I've learnt a little Thai since being here too, which is making me want to persue it, so maybe that'll be my hobby for next year! 

Spending the evening now however exploring a little more, with a night market and potenially a ladyboy show!

ลาก่อน

XOX

Placement day 1

These posts are probably come later than written and clusters due to the lack of wifi here. Today was my second day in Thailand and my first at the hospital on my placement. I was in the Emergency room, where I'll be for the rest of the week. It's striking how different it is here to back home. It was much smaller than I expected, a&e back home is massive, in the Royal Berkshire Hospital, the Royal Sussex County Hospital and the John Radcliffe in Oxford, all of which I'm relatively familiar with, the departments have multiple assessment rooms, waiting rooms and beds, which are almost always full. However here the department is much smaller. There is just one waiting area with a triage area to the side of the room, there is then the 'treatment area' consisting of a trauma area and a couple of beds to the other side, which seems to be for resting patients and patients requiring medication as an example. There is also a couple of doctors desks in the main treatment area, where the doctor comes and speaks with some of the patients before going onto further treatment. Even with the difference in size, the department was actually much quieter than we see at home, and much slower in pace than I was expecting. Despite this I managed to see quite a few different treatments. There was a lot of treating of wounds, and replacing of dressings. Most of this was fairly similar to some of the first aid duties that I've done with the red cross, but it was interesting to see the cultural differences in terms of dealing with that kind of injury. I saw other minor procedures also, such as the removal of stitches, insertion of an IV Line. These were mostly done by the nurses. The more interesting procedures were performed by the doctors. I saw a cut which had gotten infected, the entire area was swollen and the wound was filled with pus. I watched the doctor numb the area, using a local anaesthetic (this amused me as it was the same anaesthetic as in the numbing cream I use for my piercings back home), and then go on to open the wound further, draining away all of pus from inside the wound. There was also a suturing today, performed by a doctor, and a dislocated shoulder. The dislocation was probably one of the most interesting for me. I had a patient at my last first aid event back in England, who had dislocated his shoulder. He was treated by a combination of paracetamol, then later morphine and entonox administered by the paramedic called, before being taken to hospital. At this point I hadn't seen before how a dislocation is actually fixed clinically, so this patient was particularly interesting. The doctors were great and explained exactly what was happening to me. He'd initially gone to radiology to confirm the diagnosis of a dislocation and to check that there wasn't also any fractures. He was then given through a line a painkiller and some Valium, which works as a sedative, relaxing the muscle and facilitating relocation. I then watched the medical team manipulate the shoulder back into place by raising the arm. This seemed to relieve the pain the patient was experiencing. But he would have needed to return to radiology  to confirm that the relocation had been successful, and no new fractures had been obtained in the process. 

Anyway today was a half day, and I spent my afternoon visiting a temple on the top if a mountain. It was so beautiful, everything was covered in gold, and it had the most beautiful views over Chiang Mai, which is amazing, and massive in that it sprawls right across the landscape and into the horizon. Whilst there we got blessed by a Buddhist monk. We paid 20 Baht for a small medical box, to give to the monk as an offering. In return he said a chant, and splashed us with holy water. We then got given cotton bracelets, which are meant to give good luck. I also got the opportunity to take my first touristy, scenic shots of the holiday, which made me immensely happy! 

Exciting to see what tomorrow will bring!!

XOX

Arrivals! (Thailand day 1)

So this morning I arrived in Thailand, and despite a slight mishap in attempting to go through Bangkok customs forgetting I had a bottle of coke purchased at Heathrow in my bag it was actually pretty stress free. The flight was strange through, flying east during the day on London time was completely disorientating, especially when sunset was at what seems to have been mid afternoon. As a result of this I've barely slept, not that I didn't try to on the 11.5hr flight to Bangkok, I just wasn't physically tired enough. I slept on my connection though, and woke up to my tray table down and a bag containing a bottle of water and a slightly suspicious looking pie on it, which I decided to leave on the plane. 

Chiangmai itself is bigger than I expected, with miles and miles of roads filled with shops and restaurants. We're actually properly out in the jungle! The house and the people here seem nice, although, due to it being term time, its pretty quiet. It's very different to home, but I think that's a good thing. Today I found myself knee deep in clothes at a thrift shop, it's just a completely different way of life, which I guess just seems so quirky. Moths are giant here also, making them much more frightening I'm looking forward to exploring a little later, but right now I need to nap. 

XOX

Trips, New Jobs and the UKCAT

I started this blog yesterday, but apparently I'm unable to start a blog without stopping midway through!

'Let me set the scene on what im doing right now - Firstly I'm alone. It's a sunny Thursday afternoon and im sat in a Starbucks in Reading with a vanilla latte in hand and an apple fritter doughnut. Im meant to be on a health kick, but apparently I have no self control when starbucks is concerned. Two days from now I'll be boarding a flight to Bangkok, which in itself is exciting. I'm going to be in Chiang Mai, undertaking various hospital placements and I guess I'm looking forward to it, even if I'm incredibly nervous. But right now I want to look back. 5 days ago, I started a new job, and it was really enjoyable, but opened my eyes to how much i still need to learn. It also involved a lot of patient contact and far more medication and treatment than I could have ever dreamt of seeing with the Red Cross. It's made me see how far I actually want to advance in my skills as a first aider, naturally, but its also cemented how much I actually want to do clinical work. When I started my biomedical science degree, a lot of people said to me that I'd like it so much, I wouldn't want to continue perusing medicine afterwards, and I can see why a lot of people feel that way. There are a lot of attractive career prospects  that come with doing a degree like mine, and ones that I don't doubt for a moment I would get great satisfaction from, but my heart definitely lies with medicine. 

Let's now go back to this morning. I sat in a room, surrounded by people clutching their green licences and counterparts. Now I'd be lying if I said that it didn't entertain me considerably sitting there with my pink photo card, but that's irrelevant. I went back to a room I'd been in almost 4 years ago, but for an entirely different purpose. So if you've read my previous posts on my blog, you'd know that I have a lot of work to do in terms of my exam strategy, as in if I can do it without going slightly crazy, I consider it a win! So naturally I was nervous. And then I got into the exam room. The UKCAT screen was in front of me, and I looked at the questions which were an entirely different format for the verbal reasoning from the practice ones in the books I bought. I then got onto the quantitative analysis section and my time keeping was just terrible. I mean worse than I've ever had in any exam before. I missed out 13 questions. So by this point I was contemplating univerrsities that didn't require the UKCAT. then it got onto the abstract reasoning section. I've always been good at this one, so this helped to relax me a little. I then got onto the decision analysis. When I started practicing questions back in June, this was my nemesis. But I'd practiced the question format so much, and after relaxing a little during the previous section, I went through this really calmly, and finished the section 5 minutes before the time was up. This actually turned out to be my best section, and I achieved a near perfect score on it. 

Anyway I ended up averaging 750, which is good in terms of getting into medical school, but not quite as good as my practice tests, which I attribute to the lack of finishing the quantitative analysis section, however this is another 'green light' to continue my application to medical school this month, so I'm relatively happy about it! '

Now to embark on my next adventure! Expect lots of posts

XOX