Dinner near Baker's Street

Today after lecture, Jess and I went out to eat at Comptoir Libanais, a Lebanese resturant near Baker's Street.  Baker's street is famous for being the fictional residence of Sherlock's Homes.  It used to be dominated by high class London residences but is now mostly shops, pubs, resturants, book stores, and cafes. 

Jess is an amazing person.  She spent 6 months traveling thoughout Australia, New Zeland, India, and SE Asia!  I wish I was able to travel for that long.  She even worked in a hosptial in India when she traveled there.  She also had an amazing job working at the Yankee's stadium as a statistician for the broadcasters during Yankee games. 

I was in general pediatric clinic today and saw a 5 y/o girl with hematuria, 14 y/o girl with migraines, 10 y/o boy with enuresis, 9 month old by with possible acondroplasia (dad noticed feet were disproportionatly short), and a 6 mo old boy with eczema.  I don't have an April elective scheduled yet, and today after I read though the survey of electives, I really appreciate how chill this elective is.  I see diverse conditions, some very rare, other very common, and feel zero pressure and zero responsiblity.  I get in at 9:30, stay in morning clinic until about 12:30, go to lunch, then come back for afternoon clinic from 1:30-4:30.   I can go to any clinic I want or A&E and thus no one would miss me if I didn't come, but I want to see as much as I can!

Tomorrow night, Diva and Luny are going to take me to Nandos, a chicken store that they've been raving about.  They say all Americans love it and that P Diddy wanted to open a branch in the states.  Sarah, Tess, Carly, and Gina are going to a dinner and a friends place and then going out in the city.  I may meet up with them later. 

The first pictures below are of our night out in Dalston.  The last are of this evening.

Cat and Sarah 

 Izzy and Gina

 Tess and I

Me, Carly, Tess, Izzy, and Sarah 

 Jess and I on Marylebone Road

 Comptoir Libanais

My lentil soup and Morrocan bread

Jess and her mint tea

Hematology and Respiratory Clinic

I spent today in the hematology and respiratory clinics.  I really enjoyed the hematology clinic.  The consultant took the time to fill me in on the patient and do the exams on pts with clinical findings.  The first case was of a child with suspected ITP.  Her platelet count was 7.  She had a bone marrow biopsy which unfortunately showed dysplasia.  So the visit today the consultant explained the bone marrow findings to the mother.  It was very interesting the the consultant did not get into details about the worse possible implications of bone marrow dysplasia.  Instead, she said that it may get better or it may get worse and for now we are going to focus on preventing injuries that would lead to bleeding (including bike riding, poor kid!), and continue to monitor her counts.  I thought this was a great way to handle the meeting because as the consultant said, there is nothing that would change management now even if the dysplasia turned out to be progressive.  And if she had started mentioning all the severe outcomes the mother would not have been able to focus on what she can do now to keep her child healthy.

We next saw an intersting patient with severe sickle cell that kept having crises.  Unfortunately during 2 transfusions he hemolyzed and developed hematuria.  The visit focused on the next step in managment for him: either hydroxyurea (which he didn't respond well to in the past) or another transfusion.  We looked at a CXR from a recent hosptial admission.  The first CXR showed some infiltrates in the LL lung field.  A repeat CXR taken 12 hrs laters showed almost complete white out of one half of the right lung field.  I was so shocked to see how fast his acute chest syndrome progressed.  She asked me to examine the patient and when I did I felt his liver without knowing before hand it was enlarged.  I wasn't expecting it to be either.  So I was really happy that what I thought was going to be another routine abdominal exam I actually picked up that his liver was enlarged.  When she asked about my exam I told her I felt it about 3 cm below the subcostal angle and she said she agreed. 

During respiratory clinic in the afternoon I saw intersting cases.  One was a child with transposition of the great vessels, surgically corrected, now with pulmonary hypertension.  Another was a child with Leigh's disease with decreased respiratory function.  The consultant didn't involve me much though and I didn't know anything about the pt when they came in so it was pretty boring. 

The Pub Culture

The Sutton Arms is a pub just outside Charterhouse square.  Its closer to my dorm than the library is to the Towers back at Columbia.  So its a really convient place for students to go after classes, which in fact they do, at times with their professors.  Sarah and Tess told me today that their professor often goes to the pub after class and even gets wasted and starts talking about all sorts of inapproriate stuff.  Tess was really unhappy about it and felt it was very unprofessional.  I agree. 

Today after dinner, Cat and I went to Sutton arms.  I met 3 of her classmates and her TA.  I think its so amazing to be able to just walk over to the pub and meet up with so many people.  I seriously love this culture.  Its so nice to be able to have a drink after work and just sit and chat.  And to them its so normal. 

I talked mostly to Katy, (from Leeds) tonight.  She told me how shes has a friend at Cornell and has been wanting to visit him but was disppointed when she found out it was far from the city.  I told her about couchsurfers.com and that one of my classmate hosts people and suggests that she try it so she can stay in the city for free.  She asked me how I met Cat and I told her it was through Sarah and we both agreed that Sarah is an amazing person who just speaks her mind.  Katy said that she would be at a pub, and have several drinks and Sarah will join compeletly sober and can join in with the rest of them.  Katy said I was really luck to be on my floor and not with a bunch of weirdos. 

The TA, Jay, asked me about which health care system I thought was better and I told him I honestly didn't know at this point.  I told him the things I liked about the UK system, mainly the 4 hour wait room in the A&E.  He told me about channel4tv.com and mentioned New Girl!  I told him how much I love this show!  I'm sooo happy I can watch it now.  He also told me about the medical drama Casualty, which I'll check up.  One of their classmates was there typing her essay on her laptop in the pub. 

After work today it was still a bit sunny outside so I decided to explore around Barbican which is the tube stop near where I live.  I walked passed the station of bicycles that you can rent.  To hire (i.e, rent) a bike, you simply put in your credit card, select a day rental, and out prints a ticket with a code on it. Then you type in your code at any bike and the bike rack unlocks and releases the bike. You don't have to return the bike at the station you took it from which makes it great for getting from one place to another. I wish I had thought about it before buying my 112 pound montly pass for the tube. The rental is FREE for 30 minutes! Gosh, this city is amazing! For 24 hours it is 1 pound. It so cool to just pick up a bike and go anywhere.

It was an exhilarting experience to ride in London!.  For one, it was totally spontaneous for me today so I was still wearing what I wore to the hospital-- a dress and ballerina slippers, and had my purse on my shoulder.  Second, you're riding with the traffic on the left hand side of the road.  The bike lane goes right by the bus lane.  I was riding really slow!  So many people passed me.  And when you get to a stop light, you wait for it to turn both red and yellow, and then its green and you can go again.  I didn't even know where I was going and was afraid I wouldn't be able to locate another bike station.  But I did.  They are all over.  So you put the bike back into its holding place and it locks!  So cool!

Jess (the other Columbia student) and I have sent a couple of emails back and forth.  I think we are finally going to meet up on Thursday after work and do some siteseeing.

My interesting case today was a baby who had a questionable febrile seizure, with type 2 oculocutaneous albinism.  She had brwon hair and brown eyes thus probably has a form only affecting her retina.  The resident said her red reflex was enhanced.  I also saw a bone marrow aspiration.  I saw a boy as cute as a button with EBV and a huge spleen, 10 cm.  It was almost sitting in his pelvis.  You could feel the edge of it cup around like a C.  I interviewed and examed a pt with sickle cell admitted for chest pain.

I went to a BLS (basic life support) 2 hour lecture today.  We took turns running a simulated code on an infant.  I forgot to do a very basic step-- call for help, and realized this when my patient had no pulse and I needed someone to bag for me while I did compressions.  Sometimes the courses seem like such common sense but I totally forgot to call for help!  My other mistake was when I gave the pt 5 rescue breaths I heard the air leak out of the face mask.  The chest was still inflating so I continued.  One of the SHOs explained to me that compressions are completely useless if deoxygenated blood is circulating, which makes complete sense.  Again though when in the senario of a pt not breathing, you think should you waste time trying to get a good seal, or just keep bagging.  THe SHO told me its better to "waste time" to get the good seal.

Inpatient wards

Inpatient wards are run very differently here.  The day team arrives at 8:30AM.  The attending is present for the signout given by the night team.  After signouts, the team rounds and the SHOs and consultant see the patient for the first time that day.  We all go into the patient's room and the consultant picks which SHO will take the history and do the physical, and outline the plan.  Then the attending reiterates the main paoints.  During this time, another SHO is documenting the history, exam and plan in the chart.  

Some of the pros I see with this system is that it is great for the patient.  The patient is woken up once, if that, since we came to seem them at around 9:30 AM and most of the parents are already awake at this time.  Also there is no confusion with the resident telling the patient one thing and then the attending seeing the patient later and telling them something else.  Then of course there is no prerounding!  Your day starts at 8:30.  All the documentation is done in the room so you don't have to go back and write notes.  It seems very streamlined and efficent.   And what an amazing concept to actually have the attending there during signouts instead of the incredibly redundant system in the US where the night team signs out to the dayteam, who then examines the patient, and then tells the attending, who then examines the patient again. 

So now the cons.  In the US system, the intern sees all the patients and the resident see all the patients.  Here, each resident/SHO saw 3-4 patients.  No wonder they have to train for 8 years after medical school!  With the floor divided up among the SHOs, each sees a third of the number of patients a intern or resident would see in a day.  This is the trade off.  Get in at 6AM and be stressed out trying to see every patient and write every note, or get in at 8:30, see 1/3 of the patients and write 1/3 of the notes.  So it also sucks for medical students becasue the whole morning I felt like I was shadowing.  I was so bored just standing there.  On peds in Harlem everyone on the team listened to the patients lungs and heart.

Today was a very unorganized day since the house officers were all new.  We rounded until 1:30pm, then went to a peds radiology conference, when that was over went for lunch, and then continued rounding at 2:30pm.  Today I saw reflux, 2 cases of questionable pertussis, bronchiolitis, constipation (hahah, its so funny to me when patients are admitted for severe abdominal pain and xray shows constipation, lool), and eczema herpeticum.  Also we have a very intriguing case of a young girl who keeps on spiking fevers.  She had a group B strep positive joint, then got chickenpox, and keeps spiking fevers.  We don't know if its a septic joint, (MRI is nl), chickenpox (fevers don't usually reach 39F like hers are), antibiotic fever (no good test), or an infected line.  I feel so bad for this poor girl.  She screamed so much when we tried to get blood on her Friday and her affected knee is twice the size of her unaffected one. 

I really love watching my consultant interact with the patients.  She is so sweet.  Shes motherly and childlike at the same time.  Its really amazing.  I feel like the way she expresses what is going on with the patient and the plan for the day is really reassuring to the parents.  E, an SHO5 is also so amazing with the kids.  She bends all the way down on her knees by the patients bed to talk to them. 

I was also suprised at how causal lunch was today.  After the conference, the consultant, 2 of the SHOs and I went across the street to a cafe and my consultant bought my lunch so I wouldn't have to go back and get my purse.  And then we all chatted and had a very normal conversation.  It was so less awkard than when my medicine attending decided to invite himself to come out to sushi when I went out with the residents at Stamford .

I joined an SHO who does the PASSU which is the admitting service.  So instead of one team being on call and admitting for the day, one of the SHOs does the admitting the whole day.  Its been so confusing here trying to understand how things work.  I saw a pt in the resusitation room who was found to have meningoencephaltis, and an 11 yr boy with seizures.  I didn't do any of the history or exam though.  So in that way, today was a bit boring for me.

I hope tomorrow will be better now that the doctors had a day to settle.

A Night of Techno Music

I am SO happy to have met Sarah (from Istanbul) and Tess (from Austria) on my floor on Friday.  Sarah had invited me to go out on Saturday night with her and Tess said that they meet in the kitchen for drinks and then head out.  So on Saturday, when I got back from doing some grocery shopping, I headed to the kitchen and found Sarah, Tess and Izzy (Tess's visiting friend from Vienna), and met Cat (from Canada) and Gina (from Barcelona).  They were all drinking wine and socializing.  As soon as I started cooking, Sarah started telling me that when she first moved on the floor, people kept to themselves and she was afraid it was going to be really boring.  Then Tess moved in.  Sarah said she introduced herself and said "I'm on my way to a party, do you want to come?".  They said told me how other girls on the floor seem to get mad at them for going out a lot.  I told them how afraid I was that I wasn't going to meet anyone and that I'd be spending Friday and Saturday nights by myself alone in my room.  They were all so nice to me.  Word had spread that there was a new girl on the floor and they all were looking forward to meeting me.  And then they were really happy to know that I love going out as well.  Gina kept saying, "We are so happy to have you here".

They told me I have to go to Broadway market.  Iffy got an amazing black vintage dress there.  I told Gina about my friend who lives in Madrid and how she is s so Spanish now she forgets English words, haha. Tess said the same happens to her and that the other day she forgot a really basic German word.  Tess told me about Salzburg being the birthplace of Mozart and the Sound of Music.  I told her that I had heard that most Austrians never heard of the Sound of Music unitl several years after the movie came out.  Izzy said that the first time she saw the movie was 2 years ago, when she was 25!  Tess said that when she visited the states, when the sercuity person stamped her passport he said, "Land of the Sound of Music" and she had no idea what he was talking about.

Sarah is hilarious.  She had a smear of cream cheese on her face and I pointed it out thinking she didn't know.  She said, "Thank you.  I know.  I felt it.".  Gina was sitting with her head out the window to smoke her cigarrette.  Someone asked if she was cold and Sarah said, "Of course not.  She has that firery Spanish blood". 

We went to The Nest, a nightclub in Dalston, a part of London with a lot of bars and nightclubs.  Before going inside, we went next door to a convience store to buy drinks.  We bought a bottle of wine and Sarah tried to convince the seller to throw in a pack of M&Ms since they were both Turkish!.  Tess said that she does this all the time and sometimes it works, haha.  Then the six of us split the bottle outside on the sidewalk.  It's legal here to drink outside here! 

So The Nest is a one room rectangle.  It was so dark I could barely see anybody.  There were some neon lights in the corners.  It felt like a rave you'd see in the movies. 

All they played was techno music.  I really enjoyed it because I like techo.  All of the music was new to me.  The whole night I didn't hear a single song I knew.  At then end of the night I told Tess that I like techno but I'd also like to dance to R&B.  She said that the music got better toward the end, which I found really surpising that she could tell the difference.  Most of the songs sounded alike to me.  But I did get to really liking a song I heard which I googled when I got home.  Its called Move Your Body, by Marshall Jefferson.  It was released in 1986 and is regarded by some as the best house song of all time. 

We stayed at the club until just after 3AM.  Our feet were really sore.  Thankfully it was the bus stop was right oustide the club, and a couple of blocks away our dorms in Charterhouse Square.

I went by my cousin on Sunday and got home pretty late.  I'm starting this week pretty exhausted.  I think time here is really going to fly.  I'm in the hospital until about 5:30 each day.  I'm going to ask my consultant if its okay for me to take one afternoon off a week to do some siteseeing.

*names have been changed

Accident and Emergency

This is my second day working at a UK hospital and I honestly can't say yet which system is better, US or UK.  There are a lot of problems I feel with the UK system.  For instance, if a child has a complaint, a parent can't take them directly to a pediatrician.  Instead, they must first go to a GP (general practioner).  Then the GP either treats them or refers them to A&E or a pediatrician.  So a general pediatrician is in a way a specialist.  GP training varies widly and I very commonly hear the SHOs complain that the GPs have no idea what they are doing.  In fact, some GPs have NO PEDIATRIC TRAINING.  Amazing.  On of the SHOs was complaining today about a kid she saw on inpatient who was "white as a board" and ended up having leukemia.  She said that the kid was seen by a GP several times over the past week and the GP dismissed it.  She said that it wouldn't even take a doctor to see that the kid looked near death and that something serious was going on. 

On the plus side, there is a 4 hour wait rule in the A&E department, such that the hosptial is fined a huge amount of money if any patient stays in the ED for longer than 4 hours.  WOW! Talk about amazing access to medical care!  I told the SHOs that in the US its more like a 14 hour rule.  So every patient we saw today was seen within 1-2 hours after presenting to the ED.  If a patient is deemed stable to go home, they are discharged.  If its unclear what there course will be, for instance today a girl with asthma was still wheezing after getting several treatments of salmeterol, they transferred to a holding unit where the general wards team looks after them.  If they are ill, then they are admitted. 

The A&E was so calm.  Everything seemed to run so smoothly.  Columbia's and St. Luke's ED always feel so chaotic, like a bomb just went off, or a tornado just swept through the buliding.  Charts are everywhere, you can't even find the patient, and EKGs aren't with the chart.  Its a nightmare.  Here it was so ordely and calm.  There are several waiting rooms for patients.  I would bring a patient into one room, do the history and physicial, and then they would go back to the waiting room while I presented to the doctor.  Then the room was free for another patient to go in and be seen. 

There was one trauma case I saw today of a 2 year old, "pedestrian versus vehicle" as they say.  There were no severe injuries but it was cool to be a part of the trauma team in the resuscitation room as we waited for the patient to come.  After the trauma call goes out, ortho, peds surgery, peds neurosurgery, anesthesiology, the wards team and of course A&E reports to the trauma room.  A&E does the initial assessment and whatever department isn't needed, A&E dismisses. 

I saw mostly benign cases today, 2 soft tissue injuries the parents thought were fractures, and a petechial rash, unclear etiology, likely from viral infection.

My attending and I went over my schedule for the rest of the month.  I'll have a lot of flexibility.  I'll spend some time on neonatology, PICU and the various clinics.  Other days I'll round with the ward in the morning and join A&E in the afternoon.

Living in London so far has been alright.  I'm still don't know many people so it sucks to not be able to take advantage of what the city has to offer since I have no one yet to go out with.  I just met a 2 more girls on my floor, one from Istanbul and one from Austria who invited me out tomorrow.  I really appreicate people going out of their way to be friendly towards me.

Oh yeah, a funny thing happened today.  I offered to call Homersmith hosptial to get lab results for a patient today for my SHO.  By the way, you don't need to send any consent form to get results read to you or faxed from an outside hospital.  All you need is the pateint's date of birth.  Confidentialty breech!  I dialed 0, then asked for the operator in the automatic recording but was instead transferred to somewhere else.  I told the resident that the machine probably couldn't recognize my American accent.  So I had to call back and say "operator" in a British accent, and that time it worked!  haha.

Some things that English people actually say:
1. "Naughty", ex, "The surgeons didn't come like they were supposed to.  Very naughty."
2. "Darling", ex, "Are you alright, darling?"
3. "Sneaky feeling"  ex, "I've a sneaky feeling there won't be a lot of people at teaching confenence?"
4. "Isn't" or "hasn't" after any statement. ex,  "Hes got quite a rash, hasn't he?"
5. "Loo, ex, "I'm just going to run to the loo."
6.  "Cherrio", ex,  "Cherrio"

The Royal London Hospital

I was sarcastically expecting amazing things today at the Royal London.  To my surpise, I was blown away!  The Royal London Hosptial is brand new.  The staff moved in 1 week ago.  Construction begain in 2005 and cost over 1 billion pounds. 

The hosptial has a helicopter pad for emergencies and covers a large area all the way to the M5 (wherever that is).  There also a lot of interesting history regarding the hospital.  The "Elephant Man" was treated there and apparently his skeleton is on display at the medical campus.  Forensic evidence from the murdres by Jack the Ripper are also on display.  Acutally, most of his murders were done in Whitechapel, the location of the hospital.

I didn't meet with my consultant (attending) today as she was on leave.  She told me to join morning rounds.  When I joined the medical team, I was immediately pimped by the consultant.  I was not expecting this.  He asked me to tell him about pancreatitis.  I said, "Me?" and he said, "yes you're not here for decoration".  He also asked me about bronchiolitis, and rotavirus.

I asked if there were any medical students that worked with the team and he said that they were but that this group hasn't been showing up.  I told he we would not be able to get away with not even showing up at all for the day.

I worked with the SHO1, (senior house officer year 1, US equilivant of a PGY 2), SHO2 and the SHO3.  Both were extremely down to earth and nice.  No one wears a white coat and it think it helps get rid of the hierarchical feeling.  No one.  In fact, the white coat is prohibited.  LOL.  Boy I wish it was like that in the states.

I didn't have any responsiblites today.  I did a brief history and exam on a patient who has hemangioblastoma, as well as PDA, ASD, and VSD.  The SHO3 told me that medical students don't really have responsiblites on the ward.  Instead, they have a day when they visit a GP and do an exam on one of the patients.  I think a 3rd-4th year US medical student has more experience interviewing working up and managing a patient than a junior doctor (US equlivant of an intern). 

The house officers here do all the blood draws.  There are no phlebotomist. 

Today was the last day for the house staff before they switch.  Just when I had bonded with most of them.  Seriously, I really liked all of them.  Again, they are so down to earth you forget you're in a hospital working with doctors and feel like your hanging out elsewhere.  We went to the pub Sams (The Good Samaritan) after signouts and they each took turns buying rounds. 

Tomorrow I'll join my attending on Accidents and Emergency.

Differences between US and UK medicine
1. UK does not vaccinate against VZV, Hep B or rotavirus.  I saw a pt today with chicken pox