Work experience

Exciting times! After a fair amount of pestering I have finally secured work experience at a care home next week, I have passed the interview for work experience at a cancer unit, and I have an interview for work experience with the local air ambulance! (Cue ecstatic shouting). I think that due to the times when I can go, I’m going to ask the air ambulance and cancer unit if I can do a block of work experience with them (two to four weeks) the year after next, as I’m planning on applying for deferred entry (having a gap year).  However, I do want more experience this year, so I’m approaching other organisations with the hope of doing some in the school holidays – at the moment I’m in correspondence with a hospital and a local GP. I’m finding it very difficult to secure any work experience at the moment, mainly because most of my emails and phone calls go unanswered. If anyone out there has a few tips about who to talk to/where to go, I’d be very grateful.

During this upcoming year I want to organise my gap year by securing at least three to six months of solid full time work experience at numerous places to get a feel of what it will be like to work in the medical profession, and also about what kind of doctor I’d like to be, and what speciality I want to work in. The other six months I’m going to break down into working and part time work experience, and possibly travelling, but I’m not sure about that yet.  

So I’m excited, about all of this, and if any of you guys out there have any suggestions about where to get some work experience in the health industry, please shout!

Skin Grafts

 This might seem odd to most of you but the other day I was watching a CSI which featured a burn victim. They mentioned skin grafts, and I couldn't help but wonder how skin grafts work - obviously skin is taken from one part of the body and grafted onto a damaged part, but then what happens to the area the skin was taken from? I was puzzled so I did some research to find out.

Skin grafts are given to a patient for multiple reasons. These can be:

• burns
• as a result of surgery
• to close large wounds
• cosmetic reasons
• and others

 There are two distinct kind of skin graft. These are used in different circumstances. As far as I can tell, the most common, and easiest to perform skin graft is a partial or split thickness skin graft. This refers to the fact that when they take the skin from the donor site, only the epidermis is used. On a full thickness skin graft, the dermis is also taken, but these are only used for more serious and deeper skin damage. 

http://www.nlm.nih.gov/medlineplus/ency/imagepages/8912.htm

 

The skin is taken from the donor site using a dermatome, and attached to the graft site using stitches or clips. The graft site is then covered by a sterile dressing and left for 5 to 7 days so that it reconnects to the blood supply. The donor area is also covered and allowed to heal. Apparently, the donor site is often more uncomfortable than the graft site.

So, it turns out, you aren't left with a bleeding skinless area as I once thought, because they only take the top layers of skin! It sounds an uncomfortable procedure for the patient, but I can see why they'd want to have it, even for cosmetic reasons.

http://www.nhs.uk/conditions/plastic-surgery/pages/how-it-is-performed.aspx

http://en.wikipedia.org/wiki/Skin_grafting

http://www.nlm.nih.gov/medlineplus/ency/article/002982.htm

Ecuador!

Ok, so this year, our optional biology field trip was to Ecuador and the Galapagos. I can hear some of you saying already, “OK, that’s cool, but where’s the biology in that?” and I have to admit, there could have been more. We spent 3 nights in Quito, 8 nights in a place called La Hisperia, and 5 nights on San Cristobel, one of the Galapagos islands. 

In Quito, we did mainly touristy stuff, but that wasn’t a main stop of ours – we just stopped there when we were in transit. We visited the national culture museum, a market and went sightseeing. 

In La Hisperia, everything got a whole lot more biological. We did a fair amount of sampling – we did a river sample, an insect sample, a forest transect, and a whole bunch of treks. We even went “bat hunting” where we put up net, and checked them, and recorded the bats we caught. It was all very fun, especially learning a bit more about the samples we caught when we had out lectures in the evening.  We were in a research station which is open to volunteers, and every one of the staff there was lovely, even if they weren’t all fluent in English. The research station had a few cows (which I milked!), some chickens and some horses. It was very near a school and was part of an initiative which showed that the local community could live in harmony with the splendid and increasingly rare cloud forest environment which surrounded it. 

I saw some amazing things, like puma prints, blue morpho butterflies, and a hundred other things which I couldn’t begin to name. I saw a plant which was among the first in the evolutionary race to develop a vascular bundle, a tree which despite being dead looked alive and healthy because of the wealth of bromeliad on its branches. 

But it was in Galapagos that I had the most mind blowingly amazing time. We swam with sharks, snorkled with sea turtles and followed giant tortoises around their enclosure. We saw frigate birds with their impressive red pouches, sea iguanas snorting salt, and sea lions lying about pretty much everywhere. It wasn’t just the quality of the wildlife, but it was the quantity, and the fact that they would let you get so close you could touch them. We learned about how the tourism industry was important to the Galapagos, as it was the largest industry, but also how harmful it was to the environment, and the balance that had to be struck between letting everyone in, and the islands getting trashed, to letting a financially elite few in, and preserving it only for those with lots of money. 

All in all this trip was phenomenal and it is an experience which will stay with me for the rest of my life.

Me holding a snake in La Hisperia!

Tony Nicklinson and ethics

Tony Nicklinson is a 58 year old man. In 2005 he suffered a stroke which left him paralysed and unable to do anything except blink and move his head. He has “locked in” syndrome – where physically he is almost completely paralysed but he has unimpaired mental abilities. He wants to end his life but due to his complete physical disabilities, he cannot do it himself. This means that any end to his life would not be euthanasia (assisted suicide), but actually classed as murder.  He was in the news a while back, but today I was listening to a podcast called “Inside the Ethics Committee” (http://www.bbc.co.uk/iplayer/episode/b01ksc3b/Inside_the_Ethics_Committee_Series_8_Restraining_Patients_in_Intensive_Care/) which reminded me of him, and some of the other ethical decisions which can face the doctors of today. 

The IEC episode I was listening to was about Monty, a severely autistic adult with acute pneumonia. Pneumonia is an infection in the lungs and can be life threatening. The problem with this situation was that he was sedated, and to allow him to get sufficient oxygen into his body, he had a tube down his neck. When the doctors feel that he is well enough, they can wake him up, and give him a mask instead. However, being autistic he doesn’t like change so when he gets woken up he refused the drips and the mask and begins to flail around. When he does this, the exertion uses up what little oxygen there is in his body, and as he cannot breathe sufficiently without the mask, he turns blue. This means that the doctors have to sedate him again and give him the tube back, but there are complications with someone being on the ventilator for longer than normal. I won’t give you a blow by blow account of what happens (you’ll just have to listen to it yourself!) but it is an extremely complex situation which brings about questions like how do you determine when someone has capacity (ability to make informed decisions about their own care) as well as others. 

One thing in particular which I found interesting was the fact that there are cultural differences in practicing medicine. In Monty’s situation, the doctors and nurses found themselves considering physical restraints as opposed to chemical restraints (sedatives to keep him unconscious). This is very uncommon in Great Britain, so much so that the nurse who wrote the guidelines actually didn’t know much about the mechanics of the situation – that is, how to actually restrain someone. The programme did say, however, that it is far more common in other countries. I assumed at first that they meant poorer countries where the drugs and methods of administering them were too expensive but Australia and other developed countries were on the list as frequent users. 

The cultural differences on that one topic I think go to show haw varied opinions are on all sorts of ethical debates within medicine, and the kind of problems that doctors can face. One reason that they have to be so careful with these issues is not only the fact that they obviously want the best for their patients (another question was who gets to decide what the best course of action is for a patient?) but also that in today’s society it is normal for doctors to be sued. This can make them very cautious and I think that this is fair. For example, when doctors prescribed Thalidomide, a whole generation of people were affected, and the doctors and pharmaceutical companies were rightly held responsible. In the past few years, I have heard of a couple of cases where doctors have been criticised for not prescribing drugs to patients which have seemingly beneficial effects, because they were waiting for the full courses of long term tests to run. It seems that they are between a rock and a hard place, and the fact which exacerbated the public reaction was that some doctors were prescribing them, while others refused to.

All in all, doctors’ lives are very complicated, and I think that as a result to be a doctor you need to be able to think analytically about the circumstances of any situation and come up with your own opinion and reasons for it. 

Edit: On Thursday 16th of August, judges ruled that they did not have to power to decide whether a doctor should be allowed to kill Tony Nicklinson. Subsequently, he stopped eating, and died on Wednesday the 22nd of August, from pneumonia. His last tweet was "Good bye world the time has come, I had some fun".

http://www.guardian.co.uk/uk/2012/jun/23/tony-nicklinson-assisted-suicide-twitter-interview
http://www.telegraph.co.uk/health/healthnews/9492021/Tony-Nicklinson-right-to-die-campaigner-with-locked-in-syndrome-dies.html#

Aberystwyth!

I haven't updated in a while because I've been away on two biology field trips, and I decided that telling you about them would be a swell way to get back into the swing of things. My compulsory biology field trip went to Aberystwyth and the optional went to the exotic Ecuador and Galapagos. 

I found Aberystwyth useful, fun and informative. We spent a week sampling and analysing data during the day, and attending lectures in the evenings. The sampling was fun, but I thought it was also very interesting because it gave us all an idea of what it would be like if we were to go into a job that required raw data to be gathered outside of a laboratory – in chemistry (particularly organic) or biology there are many jobs which need someone to go out and sample.

We took our samples and we assessed them for:

·         Indicator species

·         Oxygen content (Winklers test)

·         pH

·         Temperature

·         Nitrate concentration

·         Nitrite concentration and others

We also took transects along certain areas (mainly the shoreline) to get an idea of zonation and repeated this in a number of locations to show how the external conditions (exposed or sheltered rocky shore) could influence the species living there.

The teachers emphasised the need for everyone to use the same methodology so reliable results could be obtained and also for everyone to be as precise as possible. We then gathered all the results together and collated them to get a much larger picture of the area we were looking at. I already knew that there were some species which only lived when conditions of pollution were particularly high, and you could use these as a basic measure of how clean the water is, but I didn’t realise that the presence of other species which thrive in polluted water would be used as an indication that the water quality was fairly poor. 

The lectures in the evening were a bit tiring (lectures went on until 9/9:30, we had to be up at 6:30 to get ready for the day) but very interesting. One evening the teachers showed us a video of a man who wanted countries to put a price on the value of the ecology and environment so that he could show businessmen and women how much the environment was worth financially, to get them behind conservation and supporting the environment. I thought that this was a fascinating idea and I hope it works.

We stayed in university halls, and I really enjoyed the camaraderie and the whole experience of being slightly more independent. 

I also thought that I’d take the time to mention that I have work experience organised at a care home (two weeks! Very excited!), I’m in the process of talking to another hospice as the last one I contacted fell through, and I’m also pleased to mention I may be volunteering with the Berks, Bucks and Oxfordshire Air Ambulance trust!