London Medical Elective 2021 (I)


The path to Evelina, with a backdrop of 3rd floor Atrium where the morning handover occurs


Part 1:

i) Prelude

ii) Applying

iii) And it all begins!


P R E L U D E:

Before the elective, every one of us goes through a series of thoughts: What is our aim? Where do we want to go? Who with? It is worth bearing in mind that even the most well-planned elective can be derailed (cue COVID’19 oh wait, it is COVID-20 and 21 too ) but no matter! I’ve always believed that an experience is what I make of it.


Briefly about the aims: Did I want to be involved in research and publish? Did I want to be placed in a specialist tertiary centre? Did I want an overview of a specialty? Although I had twinlinked with Alfred Hospital (Monash University, Australia), the change of plans meant that my elective was (is now) with the Evelina (St Thomas’, London) (And spoiler: it has been amazing! No regrets. As one consultant said: ‘You could sound a bit happier to be here’ (I truly am, it is just that the weather is not quite the same!)



A snowy day at Westminster, overlooking the River Thames, County Hall, and London Eye

My Aims: to get all the surgical experience I possibly can – 1) in view that I probably will not have the luxury of that again 2) also, because actually standing around in surgery is not very high-yield in med school – not to say I completely skipped it - perhaps somewhat last-ditch effort to have that surgical experience (is it as matchida as people make it out to be?) and lastly 3) to rule out surgery definitely for a career) – what a joke. We’ll see!


A P P L Y I N G:

For medical students, oftentimes our universities have pre-existing partnerships with overseas universities (twinlinks) – not only are these universities often renowned, it can also save significantly on placement fees. It can be competitive though and I would highly recommend all students treat the application seriously (more on that next time).

With the local elective, I must say our undergraduate admin and paediatric leads have been absolute stars – quickly sorting opportunities out and ensuring that they went ahead despite the second wave. And hence, I was lucky to secure my #1 choice: general paediatric surgery at my #1 hospital choice: Evelina Children’s Hospital. Initially 4 weeks but a friend wanted to swap so we ended up half-halfing Gen Surg/Haematology. I must say though, it certainly helps to be EARLY. Do not send in emails thinking that the opportunities will still be there – the spaces filled up quickly. (And surgery was because I had a project idea – otherwise I might not have gotten surgery at all! It is quite popular.)



Statue outside St Thomas' Hospital, representing the union of Guy's and St. Thomas' Hospitals

(Quick note to all students: always sort out admin, IT, access cards, scrubs, orientation etc before the actual day)


(And if you are Extra Good: read up on common conditions, surgical procedures (and anatomy especially if you are in a surgical rotation), refresh your data interpretation including radiology, clinical chemistry etc)


A N D S O I T B E G I N S:

*Mild anxiety* 8am – I can’t find the team! And what if the typical surgeons’ stereotype is true? What if my anatomy knowledge is lacking? What if there’s nothing to do? Perhaps we tend to worry too much – but honestly, these are fleeting and pointless… literally – just move on, stop wallowing. Perhaps as I heard somewhere, it is ok to have a ‘thick face’ or rather, ‘no face at all!’ (but of course, within reasonable boundaries – do not be excessively unprepared or entitled in expecting your every whim answered – seen that too much…)


A query testicular torsion was the primary urgent case that morning – did I want to see my first ever testicular exploration? Of course! But there was a Year 3 Medical Student who would only be there for a day so she went instead whilst I went on the ward round (I didn’t mind at all! Ward rounds – as opposed to popular consensus – I find helpful and interesting because pre/post-op are what we will be dealing with as junior doctors, plus it’s a nice little overview of the breadth the team sees, PLUS you can pick out the *especially* interesting patients for later!) Here was the rough schedule: 8AM handover à Ward Round à NICU handover (Hand of God reference from my consultant to the NICU team who was struggling with access for a rectal examination “my medical student here (me) has particularly slender arms…” I then bid farewell to the NICU team who were especially sympathetic “Good luck, Sarah…” à NICU/HDU/SCBU à whatever theatre procedures (Any time)


Oh yes, if anyone was wondering, it turned out to be inflammation of the appendix of the testes, not torsion! (Some bit of anatomy for those with a surgical bend)

And yes, day 1 – I was lost as can be! But if anything, that’s somewhat acceptable and good – its time to be a sponge and absorb (what was especially liberating was that we had finished all our major exams! There was no pressure to scurry off for revision or social engagements (the latter is non existent in this covid era but perhaps also as part of ageing… tad less FOMO LOL). Mucous fistula? Stomas? Output recycling? Through and through iatrogenic perforation of the bladder in appendicectomy? (Shocking and also, rather scandalous!) Bilious vomiting differentials? Ladds’ Procedure? Associations of Downs’? (so many…)



Even the bins here are extra special...

Stay tuned for Part II. Here

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