Vile Meaningless Doodles

Work Experience Day 5

2008-04-22T10:50:49Z

Sorry it's taken so long. I'm going to write it as though it just happened, though. It makes it quite a lot easier.

I was worried for a while today that Dr. Aristos was going to forget about us, so I got Reception to phone through and find him. I went up to the Wards, where he was with Dr. Miller (the man who had the ileostomy). Dr. Miller came out of his room and managed to walk halfway up the corridor and back. I'm not sure how long he has left, but he seemed happy enough.

We then went up to the Operating Theatres. I got him to call Paddy up, and I had to change into scrubs. They were very light, and looked like they had tiny holes in them. I had to wear a hat as well, although I couldn't fit all of my hair into a normal one, so I had to wear something resembling a shower cap. I also had to put on a mask and overshoes. The mask was tied in two places, and the overshoes were made of plastic (they're used to prevent static discharging in the Operating Theatre). I must admit, it wasn't exactly the most fetching uniform. I then had to help Paddy put it on as I did.

I was told that I'm not allowed to talk about it, but I asked later, and it seems it's mainly because the patients don't really like people knowing that they've had certain operations, and so it's fine for me to talk about the procedure. I don't know the lady who was on the table, and so I can't really do any harm by talking or writing about it. The operation was actually a breast enlargement and lift, which is probably why I was told not to write or talk about it to start with.

We went into the theatre, and the lady was anaesthetised on the table. She was half covered, and her head was covered once the operation started (presumably to prevent distraction?). Her Heart Rate was normal, although during the operation it went to below sixty and then to 130 or so (I asked why, and apparently she was waking up. I presume they gave her more anaesthetic at that point). We were actually in the wrong position to see the first part of the operation - we were at the head end, and all of the work went on in the other direction (if that makes any sense). However, it was explained to me by Dr. Aristos (he and a plastic surgeon were the ones doing the surgery, although there was also an anaesthetist and a few other people on hand, one of whom had to pass instruments etc). First, they rubbed iodine over the patient's torso, in order to disinfect it. They then rubbed something else on which took away the colour of the iodine. After that, they injected the patient with a mixture of adrenaline and xydocain under the breast, in order to puff up the breast tissue. Then they took something which looked like a paintbrush and put a few lines on the patient where they were going to make incisions. I remember they rubbed over the lines after putting them down - probably to make sure they stayed there. They then took a scalpel and made an incision under the right breast. They spent quite a while then making a pocket under the flesh of the breast with several instruments. One of these instruments was a long spatula-type thing, about an inch in diameter. They used this to hold up the flesh whilst they did the surgery inside. It was connected to something, so it might have also been used for something else, but I wasn't in a position to see. They had an instrument which looked like a pair of very long tweezers, which I believe were used to fuse flesh. When a pedal was pressed, they made a burning sound, and some smoke would come (and be taken away with a piece of gauzing), then they would be turned off (by taking the foot off of the pedal). Later, I believe I saw the effects of it - I seem to remember it turning the parts it touched black (they were burnt, of course). The smoke reached us, and it smelled sweet. I've never smelled burning flesh before, and it is a very peculiar smell. At intervals, the plastic surgeon would put his finger inside the pocket, presumably to make it larger. Once it was deemed large enough, a lot of gauzing was put inside it, in order to soak up all of the blood.

This procedure was repeated on the left breast, which took a lot longer - the pocket had to be made larger, as the breast was smaller. I got a bit of a look inside the pocket, although I could only see the wall of it. It looked bloody, though I imagine that's just the insides of the flesh - I suppose it's naturally going to be bloody. They put the gauzing into the left breast, then took it out of the right one (there was so much of it! It looked like some kind of sick magic trick - 'And now, I will pull an endless stream of cloth from inside me!'). The plastic surgeon then took a large lump of silicon (and believe me, it was large) and put it inside the breast. I don't remember in what order the next things happened, but the breast was sewn up temporarily with blue thread (they use forceps to hold a metal bit, which the put through the flesh and then pull the thread through - it's like sewing, except the needle is a small piece of wire), and the gauze was pulled out of the left breast, and that was sewn up, too.

We were then allowed to move round to the other side (they'd realised that we couldn't see very well). This allowed us to see the second part of the operation a lot better than we could the first. Again, the instrument resembling a paintbrush was used to paint out the areas to be cut. However, this time a ring shaped object was dipped in ink (or whatever substance it was) and pushed over the nipple, giving a perfect circle. The other lines made a sort of triangle underneath the nipple. A circle was cut around the nipple, giving some excess flesh which was then cut off and put aside. Other incisions were made, and a triangle of flesh below the nipple was laid bare. The flesh was then pulled together and sewn up, with the nipple underneath it. The nipple was pulled through (the reason for not cutting it off and sewing it back on is obvious - it needs a blood supply, and anyone who plans on breast-feeding their babies needs their nipples) and stitched to the skin. I don't remember exactly where the aforementioned incisions were made, or exactly how the skin was pulled back together, but I got the rough gist of it. The two breasts had upside-down T-shaped scars under them where the incisions were made, and an hour was spent removing the temporary stitches and putting in new ones which would be pulled out one by one for a week. This part was pretty boring from a spectating point of view - apparently it's the most difficult part, however. Looking the breast lift process up on Wikipedia, it appears that the inverted T incision is just that - you end up with three flaps of skin, which are then pulled up and sewn back together.

After the surgery had finished, we left the room and got back into our street clothes. It would seem I might be able to do some work on Fridays or Saturdays. That would be pretty interesting. Hopefully this has put off anyone looking to have cosmetic surgery. Incidentally, the blood didn't bother me at all. At some points there was a bit of it - the plastic surgeon had to change his gown once because he got blood or another fluid on it. However, it didn't make me feel faint, or want to throw up. I've managed to accomplish my goal of being okay with blood etc.

Hopefully I'll have a lot more to write about, if I manage to go in on weekends.

Work Experience Day 4

2008-04-17T15:25:59Z

Penultimate part of the series.

Went in today and was taken to the hospice by Dr. Aristos. I was pretty nervous, to be honest. I didn't know I was going there, and I don't think I would have done, had he not had some business there. Paddy was there, and we both sat around for a while, until we were told we could go and speak to one of the patients. They can have up to six patients at a time, but sometimes there are none. I'm not sure why that would be, but it happens. I feel awful for this, but I don't think we learned the lady's name, or if we did, I don't remember it. This was her fourth or fifth visit, I believe, and I don't know if she thought she was going to come out again this time. She was very tired, she said, and so we only spoke to her for a while, until her daughter came in and we left her with her. We talked about the hospice itself - it runs mainly on volunteers (retired nurses and others), which is wonderful, as it means that they really want to be there. They offer palliative care to people with terminal illnesses, and it seems as though it's a very calming, relaxing place. What struck me was how accepting everyone seemed to be of the fact that they were going to die. I know I've never experienced it myself, but I suppose you must come to terms with that fact by the time you go there. The lady had stomach cancer, caused by pernicious anemia (the stomach lining doesn't produce Intrinsic Factor, or rather, antibodies attack it (it's an autoimmune disease), and vitamin B12 cannot be absorbed. It can be managed with injections of B12, and I'm not entirely sure how it led to her cancer, but it sounds like an interesting case). She was terminal, and seemed, as I said earlier, very accepting of it. I think it was a rather sobering experience.

Once I left the hospice, I went down to A+E again, and spent most of the day there. I couldn't see many of the patients, as many illnesses tended to be quite personal (one man had an STD), but I did see some. There was a man there in a wheelchair who had cut open the back of his leg near the heel on some wood, and was worried about it. Chris washed the wound, put on a cream that promotes healing (I can't remember the name of it), as well as a gauze with that cream in it, and then put on an airing plaster. It didn't look like much of a thing to go to hospital over. His foot looked slightly swollen, but I don't think it was anything.

I took a man down to the X-ray room, but unfortunately didn't get to go inside myself. I did, however, get to see an ultrasound scan. Ultrasound works exactly like sonar - they pass a little thing over your flesh, which emits ultrasound waves, and the amount of time they take to return gives an image of the inside of the body, which is put up on a screen. I don't know what they were looking for, but it was somewhat confusing. It was a lot less clear than the gastroscopy, but then again, it's non-invasive, which is a good thing. Pregnant women have an ultrasound scan so that they can see the baby in development.

Dr. Aristos took Paddy and I upstairs to the wards, and showed us some CT scans. They're even more confusing than the ultrasound scanner. The machine takes images of slices of you, and so you can see all of your insides, but it's very hard to read. At the bottom is your spine, but sometimes it's your rectum (I mistook the spine for the rectum - that's how hard it is to see), then you can see different parts of you from a bird's-eye view. The liver takes up a lot more room than I realised, and the kidneys are quite small, really. You can see the abdominal aorta, and the vena cava (they're actually really large). But one of the main reasons for using a CT scan is to detect tumours, which, one you can read the scans properly, are quite easy to see. Unfortunately, though, it can't detect lesions of under a centimetre width.

They brought a ventilator down to the Casualty Surgery, as the government was coming round inspecting today, and they needed to show that they have all the required equipment. Chris told us about it, as well as some other things in the Casualty Surgery. It's used for when people are unconscious, or in respiratory arrest. They sometimes have to induce respiratory arrest/unconsciousness, for example with a person who has a severe asthma attack. What they then do is take a piece of equipment called a Macintosh Blade, which is a handle with a slightly curved blade type thing (which is left-handed, as its maker was, and it's not sharp, as it's about two centimetres across), and put it into the mouth, and remove the tongue from the back of the throat. The tongue can't be swallowed, but it can roll back and block the airway. Once they've taken the tongue off of the back of the throat, they put something called an ET tube (endotracheal tube) down your throat (careful to make sure that the epiglottis doesn't prevent the tube from going down the trachea, as putting it down the oesophagus will kill the patient), allowing them to ventilate you. There's a balloon type thing near the end of the ET tube, which they then inflate, to prevent things like vomit getting past it and into the lungs.

Apparently, if you discharge the two defibrillator paddles in the air, they make an electric arc. That thing is so dangerous.

I learnt even more about the ECG today. Your heart has 3 forms of internal pacemaker: the sinoatrial node, the atrioventricular node, and the Purkinje fibres. Normally, the sinoatrial node sends off impulses, which the other nodes carry (I believe). This happens about 72 times per minute, though a person can have about 60-100 bpm without any trouble. Lower than 60 bpm is called bradycardia, and higher than 100 is tachycardia. If for some reason the sinoatrial node fails, then the atria do not contract, and the atrioventricular node takes over. If you look back at yesterday's entry, you'll see the ECG graph. When this happens, the P wave is eliminated, as the atria do not contract. This means that blood will only get into the ventricles because of gravity. The heart rate will slow to around 45 beats per minute, and the patient may start to feel tired or light headed. If, for whatever reason, the atrioventricular node fails, then the Purkinje fibres take over as a last ditch attempt to keep the heart running. The heart rate will slow to around 20-30 bpm, and the patient at this point really needs to get themselves to a hospital and get a pacemaker fitted, or they will probably die. If a Bundle Branch (one of the things that carries the electrical impluses) stops conducting, either due to an MI (heart attack), heart disease or surgery (as I've just learned after looking it up), then you get what's called a Bundle branch block. This will show up on the ECG in the R wave. You can see that normally the R wave goes up sharply, then down. With a Bundle branch block, it goes up, then halfway down, then up again, then down, like a two-peaked mountain. When the heart is fibrillating, the ECG goes up and down very, very quickly. That’s how you know when to use the defibrillator.

We went to the ambulance again, but once again didn't get to completely finish up. I was reminded of the two hazards for putting pure oxygen into someone: the name of the weedkiller in the first one is Paraquat, and as I said, it's banned in the UK. In the second situation, the people at risk are bronchitics and people with COPD (Chronic Obstructive Pulmonary Disease - it actually refers to many lung disorders including bronchitis and emphysema). CO2 is what stimulates their breathing, I believe, and so giving them pure oxygen is generally not a great idea. The second piece of equipment I mentioned yesterday on the ambulance is the respirator (but it automatically tells you if the airway is blocked). The percentage of pure oxygen in it can be controlled, so you can give someone pure air, pure oxygen, or a mixture. They have, as I said, high percentage dextrose drips, which can be given to people with hypoglycemia, as well as plasma expanders (blood thinners) to give to those with hypovolemia (lack of bodily fluids or blood). They had to go off in the ambulance to collect a patient, so we had to stop with the explanations. I went up to the hospice and thanked the lady there for allowing me in that morning.

I forgot to mention that at one point, a Russian man came in, and was put on a nebuliser. A nebuliser basically steams up, and you breathe in the steam. It expands the bronchial tree, thus helping with things such as chest infections.

When I came down from the hospice, Chris was bringing the man from the ambulance in. He was in a wheelchair, and was hooked up to an oxygen cylinder when he got inside. He had, apparently, been exposed to quite a lot of sunshine, and so it’s possible he had heatstroke, or some kind of heat infection. He had been vomiting all night, and some of it had been bloody. There’s a possibility he has a bleed in his stomach. We took him upstairs to the wards, and then laid him down in a bed. He was hooked up to the main oxygen supply in the wall. Chris took some blood from him, then went and got two tubes for it, and squeezed some blood into each. He took it downstairs to the lab and registered him at the same time. The man is seventy seven years old, and has been taking aspirin for the last thirty years, because his doctor told him to. Doing that could have messed up his gastric system, so that’s more evidence for the bleed. The nurses came in and hooked him up to a drip (you do that intravenously, too), and we left and went downstairs, leaving the ECG machine in the room. I assume they were going to do that soon. I think I’m going to visit him tomorrow morning to see how he’s doing.

Tomorrow I’m in surgery for quite a while, watching a breast reduction, I believe. I didn’t get to go to the lab today, but I’m sure I’ll be able to do that another time, along with finishing the tour of the ambulance.

That's it for today.

Work Experience Day 3

2008-04-16T18:08:08Z

Third of the five-part trilogy.

Dr. Aristos (Dr. Georgiou) was in surgery for the first part of today, operating on a Russian man with a benign tumour on his right buttock. I was with him when he was writing up the case, so I know some of the details. The man booked the operation a month in advance, and came specially from Russia for it. His daughter has cancer, and she knows Dr. Aristos, so I assume that's why they came all the way here. He refused General Anaesthetic, and so was given Local (which meant he was awake during the surgery, and also that I couldn't be there). He was given 750mg of an antibiotic (Zittol or something) before, and 500mg after (to help defend the immune system, which would be shot to pieces at that point, I believe). He has to wash instead of wipe after going to the toilet for a while, and use something called (something like this) Benazine Scrub. I'm not entirely sure if that's a scrubby thing, or an antibiotic. He was the second Russian to joke about preferring to take alcohol (the Russian man in the Endoscopy room had said he would prefer vodka to Dormicum), saying that he would rather have some whiskey.

The lady with the abscess on her heel came back to have her dressing changed today. I went in and saw it done. The previous dressing was taken off, including the packing put inside the wound. It was then washed out with saline fluid (painful - the lady was wincing), and a cream applied. A gauze lookalike thing was then stuck onto it, and she was good to go. She's got to come back on Friday to have it changed again, I believe.

Dr. Keith (the man with rectal cancer) was the person in surgery all day yesterday. He had an ileostomy. An ileostomy is a procedure in which the rectum and large intestine are bypassed, and the ileum (the last, narrowest part of the small intestine) is stitched onto the surface of the skin, making a stoma (Greek for mouth). Most people have heard of a colostomy - where the rectum is bypassed, often because of disease. This is even worse. An ileostomy bag has to be attached, and all waste goes into that. It's not a nice procedure, but if you have to have it, then you have to have it.

Flashback to Monday - I spoke to Chris about the blood type thing again. All blood groups can accept the letters in their own name, plus O. A can accept A and O, B can accept B and O, AB can accept A, B, AB and O, and O can only accept O. The positive and negative that go along with the blood group refer to the Rhesus factor - whether or not the person's blood has the Rhesus antigen in it. About 85% of people are Rhesus positive. I'll come back to blood type stuff later.

I was down in A&E for a lot of the day again. Paddy went into the X-Ray department and the lab. Apparently X-Ray is really boring. I really want to look around the lab - I think I might have a chance tomorrow. Chris was there today, so I could ask him a lot of questions. One of the most useful things was learning how an Electrocardiogram (ECG) works, and how to read the output. The skin on the wrists and lower legs is wetted (and if the patient is particularly hairy, it has to be shaved), in order to aid conductivity. Four clamps are placed - one on each limb - with the conducting piece on the inside part of the limb ( I think). What I mean by this is that, on the wrists, you have the radial artery. The clamp is placed so that the conducting piece is on this artery (I have something else to say about this later). I can't exactly remember where the leg clamps were placed, but I think it was so that the conductor was on the inside leg. Then things which looked like suckers are placed on the patient's chest (I think in specific areas - some on the apex, some on the sternum (the sternum being the right hand side of the chest)). The machine then starts to beep in time with the pulse (which it measures, along with oxygen saturation) and it writes out something that looks like a receipt. It has 4 sections - they're a diagram of the electrical current in the heart, from 4 different viewpoints. The right-hand section looks like this:

P: Atria contract. The atria are the top two chambers of the heart.
Q: This is kind of a calm before the storm. Not everyone has a Q wave.
R: Ventricals contract. They are larger than the atria, and they cause a much bigger surge in current. At the same time, the atria are repolarising, but this is lost in the wave.
S: This is after the ventricles contract.
T: Ventricles repolarise, ready to pump again.

The clamps and suckers have to be kept tidy, in case you get someone who needs an ECG very quickly (e.g someone having a heart attack - a myocardial infarction, as I learnt today).

I was reminded today what the name was for an artery that doesn't go in the right place on the radius. It's an aberrent artery. It can also be called an ectopic artery. Ectopic/aberrent mean that something is located away from its normal position - e.g. an ectopic pregnancy is when the baby grows in the fallopian tube.

Can you swallow your tongue? If you answered yes, you're wrong. It's impossible, as the tongue is attached to the bottom of your mouth and all the way down your throat. It's possible for it to fall back and block your airway, but it cannot be swallowed.

When I finally managed to catch up with Dr. Aristos (not until after he'd drained an abscess on a man's head - which I wasn't allowed to watch, unfortunately), we went up to the Russian man and he discharged him. Then we went down to his office and sat and talked. On Friday I get to be in the operating theatre. He has an operation scheduled from nine 'til one, and I think he said it was a breast reduction. I'm looking forward to it.

Right before I left, Chris started to show us around the ambulance. It's a converted van, and so isn't really that big. There's one bed in there, so they're in trouble if they have more than one patient. There's also a wheelchair, but not enough room to get it down the side of the bed. In Cyprus, ambulances are seen more as taxis than as a life-saving tool. They have all of the equipment that an ICU trolley (Intensive Care Unit) has, and so are just as useful, if not more so due to the fact that care can be administered immediately. They have several extremely useful things which he showed us. Unfortunately, I didn't get to see it all, and so he'll finish showing me tomorrow. There's a thing called a trauma mask, which is like an oxygen mask with a bag attached. It's attached to a bottle on the side of the ambulance, which is in turn connected up to the oxygen cylinders in a compartment near the back. You turn a switch to point to a sign that says 'Bottle 1' (it can turn on one of two bottles), and the bottle, which is filled with water, is filled with pure oxygen. The bag attached to the mask inflates with pure oxygen and water vapour (the water vapour is used because pure oxygen would make the throat too dry). The mask is applied to the patient's face, and they can breathe a lot better. There are, however, two cases where the oxygen can be dangerous. The first is when a patient is trying to commit suicide with a specific weedkiller (which is banned in the UK, but in use in Cyprus, and I do not remember the name of). The oxygen aggravates it, or speeds up the process, and can lead to a quickened death. The other situation: normally, a person breathes due to sensitivity to oxygen in the air. In some people (I'm not sure who or why, I shall ask tomorrow), their breathing is sensitive to carbon dioxide. So taking the carbon dioxide out of the air and giving them pure oxygen causes them to stop breathing.

Another piece of equipment we were shown was a thing which detected if an airway is blocked. If it is unblocked, it makes a crackling sound (again, I'm not sure why), but if an airway is partially or completely blocked, an alarm rings, alerting the paramedics. It's very useful.

On the ambulance, they have a lot of drugs that can be used, including ones such as adrenaline and hydrocortozone (I'm not sure if I spelt that correctly). They also have drips, such as solutions of 20% dextrose, which is very useful for people in hypoglycemic shock.

They don't carry blood on the ambulance, but at the hospital I believe they have a store for use on casualty patients, and if they need blood immediately, they can call someone out to them. The blood they use if O negative, because, as I stated earlier, it can be given to absolutely anyone.

One thing I forgot to mention up until now is another thing I asked about this morning: organ donations. For organ transplants, as well as blood group, they have to match up tissue groups. This is easy for things such as the liver, which can be partially transplanted (only part of it is taken off, and it will grow again), and doesn't require many point of matching, but for kidneys, six different tissues need to match up. Or rather, it's best if six different tissues match up, but since this is so rare, 5, 4 or 3 need to be used mostly. Even a completely non-matching kidney can be used, though, as a last-ditch attempt at a transplant.

I also asked about iodine, and why it's used to disinfect wounds and prepare them for treatment, but I didn't get much of an answer to it.

That's about it for today. 'Til tomorrow!

Work Experience Day 2

2008-04-15T18:59:30Z

Second of five!

Some of this is from notes, mainly the names of diseases and drugs.

Today wasn't as good as yesterday, mainly because Dr. Georgiou spent most of the day in the operating theatre, and I was left with paddy in A+E kicking my heels until 3. However, I did learn some stuff at the start, so it's okay.

First off, some notes that are about yesterday. The lady with acute gangrenous appendicitis had something called a retrocecal appendix. Usually, the appendix goes downwards, away from the cecum (part of the colon). With a retrocecal appendix, the appendix is located behind the cecum.

The drug that they inject you with when you have a gastroscopy is called Dormicum. It makes you unaware of what's happening, and makes you forget what happened. The old woman was putting her tongue up because it's a natural reaction, and she was also distressed, I think. The drug they spray your vocal chords with is Xylocain. It's used for numbing anything, I think.

The drug that they injected the lady with the abscess with is called Lidocain. It's a local anaesthetic.

The blood type thing: in over-simplified form, AB+ can take anything, and O- can give to anyone. But it's not that simple, apparently.

That's about it for stuff about yesterday.

The only patient I got to see today was a lady with Actinic Keratosis. It's raised spots on the skin, which are pre-cancerous (if untreated, they can develop into cancer). She'd noticed them herself. Unfortunately, there's not really much I can say about it.

I was also told about Saberrheic Keratosis, which are benign changes in the skin, apparently.

Whilst sitting around, I had to take a couple of blood samples and a sheet to the lab. It's pretty scary down there. I'd like to spend some time there, though. It looks interesting and high-tech.

I spoke to a man with pain in his shoulder. He'd been playing a lot of tennis, but the pain was in his left shoulder, not his right. It also hurt more when he moved. The doctor said that the tests showed it probably wasn't osteoarthritis, and gave him a muscle relaxant and anti-inflammatories, as well as something else, I think. He was already taking something for his stomach, which was set off by another medication. All very complex, really. He played Squash to county level, and had had 5 operations on his right knee, and 4 on his left. They looked completely different to each other. He was a nice chap.

That's about it for today, unfortunately. Hopefully tomorrow will be more interesting.

Work Experience Day 1

2008-04-14T19:32:37Z

So I'm doing my work experience in a hospital. I'm going to log everything I do until Friday here, 'cause I expect I'll have to write a report.

When I got there this morning, Dr. Georgiou (the contact) didn't actually know I was meant to be there during the week - he thought we were going to do weekends. Evidently somebody screwed up. Once that was sorted, he took me to see a couple of his patients. It's a private hospital, so he said that I was a pre-med student to stop any awkward situations (evidently I'm very, very Pre-Med). The first lady had had Acute gangrenous Appendicitis, and was on her third post-op day. Apparently the appendix was in the wrong place in relation to the Cecum (first part of the Colon). Then I went with him to a place where he typed up what had been done to her, and then we went to see another patient. He was an 82-year old doctor, and he had (poor guy) cancer of the rectum. I saw the stitches where he'd had an operation. It almost looked like something out of Frankenstein's Monster - you could see the stitches right down the middle of his stomach, and he was bloated. I can't quite remember the complication that had called for surgery. He also had bedsores on his feet - the body's reaction to most things, or something. After that I was shown a couple of X-rays of the man. There was fluid in him, I'm not sure why. It had gone down in the second X-ray - a good thing. I learnt how X-rays work - the photographic paper gets burnt in the places where the X-ray can pass through, causing the darker parts, and where it can't get through (e.g bone) is lighter. I've never actually learnt that before, probably because I've never broken anything.

Then I went downstairs and met up with Paddy (he's also at the Evangelismos hospital for the week), and I watched two gastroscopies. The first one was on a Russian man, who took it fairly well. The second was on an old Cypriot lady, who seemed pretty distressed. It took about 10 or 15 minutes to get the endoscope into her oesophagus. The man had chronic Gastritis, and the woman had two things: her bile duct was open, causing bile to leak up into the stomach, which burnt it; and she had some ulcers, which could possibly have turned cancerous, but I think they said later that they wouldn't. They took a load of biopsies with an attachment on the endoscope. They look massive on the screen, but they're about a millimetre in circumference. The endoscope shows the insides of the patient on the screen - they put a tube down your throat which utilises optic fibres and total internal reflection, and the image comes up on a screen. The blood from where the biopsies were taken looked copious, but apparently they'd feel no pain. I forgot to mention how they deal with the patients during this time: they give you a drug which causes you to be unaware of exactly what's happening, and also causes you to forget everything afterwards. The old woman's instinct whilst under this drug was to put her tongue up to stop them sticking the tube down her throat - quite understandable, really. They also spray your vocal cords with something which numbs them.

Chris, one of the doctors in the Endoscopy room, then showed us some stuff. He took us into the operating theatre and showed us the defibrillator. You know how in all the medical soaps it starts the heart after it's stopped? It doesn't. It actually stops arhythmia and stuff in the heart, or when it starts beating really fast, it discharges electricity and brings it back to normal. I think that's right. It's really dangerous - if someone's leaning over the patient when you do it, and they're touching something metal, you can kill them. The two paddles go in specific places. I don't remember where the first goes, but the Apex goes on the left side of you, slightly lower than your chest. There's three little monitor things, too. There's a red one, a yellow one (I think), and a green one (although there they had a black one). The red goes on the right of your chest (again, I might be getting this mixed up), the yellow on the left, and the green around where you put the Apex paddle.

We were also shown the basics of First Aid. There's an acronym which you use for emergencies:
Danger - check to see if there are any dangers around.
Response - There's four stages of responsiveness:
Alert - they're completely conscious.
Verbal - they respond if you talk to them.
Pain - They respond if you pinch them - preferably their ears or their nails.
Unresponsive - they don't respond at all. They're unconscious, pretty much.
Airways - check to see if the airways are clear, then to see if they're open. Turn their head to the side away from you to clear it if you can't pick anything in it out. Then open their mouth/nose.
Breathing - Are they breathing? You can look, listen and feel at the same time here. Put your ear to their mouth, look down their chest, and put your hand just below their jaw (I think). You can feel the air coming out of their mouth, you can see their chest rise and fall, and you can hear them breathing. If they're not breathing, perform CPR (though I'm not sure if you do the next step first, or perform CPR immediately).
Circulation - have they got a pulse? Don't use the radial pulse (on the wrist), because some people's veins go differently to others, and you may not get a pulse. Instead, use the carotid pulse (the one in the neck. It's about 3/4 of an inch to the left or right of their Adam's Apple (though don't put your arm across their neck, or it'll look like you're strangling them). Check both breathing and circulation for ten seconds each - the patient may have a particularly slow breathing rate or pulse.
So that's DRABC for First Aid. Everyone should know this, it's really useful.

I also got to help with draining an abscess on a lady's heel. It looked like a giant white head. I helped cut it open with a scalpel. First, though, I had to put on those latex gloves. You're not allowed to touch the outsides with your hands, because they're sterile. They're half folded over, so you can touch the insides. They put iodine on the area around the heel, then injected it with a local anaesthetic. Then we sliced it open, and then Dr. Georgiou squeezed it out, and took some gunk out with a pair of forceps. Apparently, she had little cysts in there. There was a LOT of pus, and quite a bit of blood. It looked like a black hole in her heel. It didn't hurt her a bit, though. There were so many little white things (I think they were cysts).

I watched a lady having an injection (actually, two). She'd developed an allergy to mosquito bites. Chris injected her with an anti-histamine intra-muscularly, then with something else intravenously (into the vein in the underside of the elbow). We also watched him take blood from a lady. He put a tourniquet on to pump up the vein, and she had to clench her fist a bit, presumably for the same.

I asked Chris to show us how to take blood pressure, which he did. You put a strap thing around your elbow where there's an artery. Then you pump it up and watch the mercury in the meter thing. Then you take a stethoscope and put it to the place where the artery is. I'm not entirely sure what you listen for. He took my blood pressure - it was something like 110 over 80 - normal ^^.

It occurs to me that I don't actually know my blood type. Apparently O+ people can give blood to anyone, or most everyone. I'm not sure about the really rare types, like AB+. I guess I'll have to wait two years until I can give blood to know.

I think that's about it for today. More tomorrow! Oh, I forgot to mention when talking about the gastroscopies: they have a little thing which you put over your finger or toe, which measures your vitals (e.g. Heart Rate and Oxygen Saturation of the blood). Apparently it can't tell the difference between oxyhaemoglobin and carboxyhaemoglobin. Interesting. I wonder what my O2 saturation is.

Graphics Tablet

2008-01-14T18:05:22Z

I bought a graphics tablet! ^^

It's a Wacom Intuos3 A4 Oversize, and I got it for £185 off of eBay (+ P&P). That's a saving of over 150 pounds!

I cannot wait.

tehmoogles @ 2008-01-10T15:49:00

2008-01-10T13:51:29Z

What Tim Means

You are a seeker. You often find yourself restless - and you have a lot of questions about life.
You tend to travel often, to fairly random locations. You're most comfortable when you're far away from home.
You are quite passionate and easily tempted. Your impulses sometimes get you into trouble.

You tend to be pretty tightly wound. It's easy to get you excited... which can be a good or bad thing.
You have a lot of enthusiasm, but it fades rather quickly. You don't stick with any one thing for very long.
You have the drive to accomplish a lot in a short amount of time. Your biggest problem is making sure you finish the projects you start.

You are confident, self assured, and capable. You are not easily intimidated.
You master any and all skills easily. You don't have to work hard for what you want.
You make your life out to be exactly how you want it. And you'll knock down anyone who gets in your way!

What's Your Name's Hidden Meaning?

The first bit's utter bollocks, but the rest is okay.

tehmoogles @ 2008-01-02T13:01:00

2008-01-02T11:06:13Z

Nyarr, I have flu. And it's my birthday. It started on Sunday. After squash (that was a bloody hard game) I got this horrible headache and my parents thought it was lack of blood sugar. So I ate lots of sugary stuff , but didn't get better. Then I could barely eat any dinner, and I went to sleep really early, even though we had guests.

Then Monday I had fever and stuff, and mum didn't want me to go to the News Year's Eve party, but I did. I was fine whilst I was there, but once I got back it was pretty bad.

Yesterday was the worst. I woke up pretty much okay, but got steadily worse until the evening, when the fever was horrible, and I found it incredibly hard to sleep.

Today I'm pretty much okay. Temperature's a bit high, but the fever's pretty much gone and the headache's nearly gone. I'm coughing quite a lot, so mum made honey + lemon. It's surprisingly nice, even though the thought of hot drinks makes me feel a bit ill.

Who am I?

2007-12-09T16:37:43Z

Someone asked me a couple of days ago, 'Where do you consider to be your home country?'

I realised that I don't actually have a country that I can call home anymore.

I moved from England 2 years ago, and have barely any ties back there - I talk to 1 or 2 people from time to time. But I don't think I would consider staying in Cyprus my entire life, either. I've met some brilliant people here, but I don't feel thrilled every time I return here.

Maybe, when I'm older, I'll find a country that I will call home.

He's making a list

2007-11-20T13:39:50Z

Dear Santa...

Dear Santa,

This year I've been busy!

In March I donated bone marrow to cura_te_ipsum in a life-saving procedure (300 points). Last Sunday I broke pinkphooka's X-Box (-12 points). Last month I signed my organ donor card (28 points). In June I put gum in pixal's hair (-12 points). In February I helped ciwey hide a body (-173 points).

Overall, I've been nice (131 points). For Christmas I deserve a new dolly!

Sincerely,
tehmoogles

I'm a good boy.

Sorry, Steff.

Also, I gets dolly. Yay.

Halloween

2007-10-31T18:57:25Z

Another Halloween comes and nothing happens. For this, I am glad. I've never been allowed to Trick or Treat, because my parents view it as begging and being aggressive. This is probably why I'm so prejudiced against it. As innocent as it is for children, once they get to teenage years (at least in England) it becomes more than a fun game. I remember staying up in my room, listening to the on or two groups who would come to our house. I remember when my mum said, as she always did, something to the effect of 'Sorry, we don't do trick or treating,' and one of the people had the cheek to stick his foot in the door when she went to shut it. Then the cry of 'GET YOUR FOOT OUT OF MY DOOR NOW!'. I still laugh. I'm not sure how Halloween goes in America, maybe your lot are more subdued than ours, but I know that I wouldn't like to be out on the streets tonight, if I were in England. Mind you, I wouldn't like to be out on the streets on /any/ night if I were in England.

Sorry, I'm ranting again.

tehmoogles @ 2007-10-02T21:46:00

2007-10-02T18:46:36Z

Take the Role-Playing Stereotype quiz.

Shitpit!

Thingy

2007-09-18T14:33:14Z

Create your own Friend Test here

Do it? Please?

Oh Yeah

2007-08-11T20:11:50Z

I've just finished the thing that I've been doing for the past month? Want to know what it was? No. Okay.

I'm going to tell you anyway.

But not now.

Soon.

D:

2007-07-20T20:04:17Z

Steff seems pissed at me.
I'm tired.
I haven't got enough free time.
Movement Training is knackering.
I shouldn't eat cheese before bed; I did last night and I dreamt the whole night. Mainly about the book I was reading and I think it must have been a partial nightmare, due to the fact that I ended up running away from someone who was about to kill me. I hate those dreams.
Why does everyone else need less sleep than me?
No email from her for several days D:
I've pretty much got the weekend free, huzzah!
My spots are getting worse. I hate them.
Oedipus is disturbing, Medea even more so.
Infanticide is more disturbing than gouging one's own eyes out.
Especially when the children are your own.
I mean, Jason was a prick anyway. She wasn't losing much when he went off with that other woman. No reason to go killing your own bloody children!
I need to do more French and Maths.
Can't get Harry Potter until Monday. It's released at 2AM tomorrow morning (Due to us being 2 hours ahead of GMT), and it won't get in to the stores until Sunday (This is Cyprus >.>), so I can't get it until Monday. Stupid system. They're not even the most amazing books ever, either. The quality of the writing is nowhere near as good as a huge amount of authors, it's only the story which holds it together.
In truth, even the stories weren't enough to keep me interested in the 4th and 5th books. I didn't like those, I seem to remember. The fourth one took me ages to read. I hated that book.
I need to do that Art thing.
I don't want to get up and do Movement Training toromrom.
I wish I could hold people's attention.
I also wish I had more social graces than a potty.

Woo

2007-05-04T12:51:00Z

Last night was fun, and it went well. The first performance, by the other private school in Paphos, wasn't that great. We didn't see the second one, as we had to go and get changed etc. I felt really ill throughout the proceedings. I don't think it was nerves, it was probably the stagnant water that I drank at school which gave me indigestion. Our performance went really well, I shan't go into details as none of you know anything about it. The adjudicator was slightly annoying, in that with the first two (the second of which I've heard wasn't great) he said which bits he liked, then eventually said a couple of bad things. With our production, he launched straight into the negatives, which were all really minor (some of the entrances weren't quite right), and he said that he didn't particularly rate the play itself, but he did rate the way we did it. Though I wouldn't be surprised if she gets Best Actress when the awards are given on Saturday. She was so good.

That was a long paragraph.

I'm absolutely bloody knackered today. Didn't get to sleep until about 25 or 20 to one in the morning. I tried to go to sleep during break time, but it didn't work.

Liz, I'm busier than you :P

2007-05-02T17:39:59Z

Right, tomorrow I'm performing for the Rosebowl. Wish me luck. Then I have a rehearsal on Friday, dress rehearsals from Sunday to Monday, and then performances from Tuesday to Saturday. Goodbye, sleep. I will miss you. Goodbye, free time, we have some lovely memories.

In other news, I was walking down to the kiosk to get something to munch on, when I saw a cat in a ditch. It looked like it was sleeping. A split second later, I realised it was dead. There were flies buzzing around it, I think. That wasn't great. I hate their attitude to animals here. Barely a day goes by without seeing roadkill on the way to school.

Also, the moustache that they glued onto my face (yes, glued) today was very itchy. I then had to rip it off afterwards. That really, REALLY hurt. Also, I couldn't really eat biscuits during the coffee break, due to bits getting stuck in Mr. Tache.

That reminds me. I'm going to start shaving O: I've got a razor, but I don't actually know what to do. I've got arsefluff all over my chin currently, but not for much longer.

Nicked from Liz, because she forced me. I'm expecting a maximum of two comments, 'cause there are only two people (I think) who actually read my crap.

Comment in my journal and:
1: I'll respond with something random about you.
2: I'll challenge you to try something.
3: I'll pick a color that I associate with you.
4: I'll tell you something I like about you.
5: I'll tell you my first/clearest memory of you.
6: I'll tell you what animal you remind me of.
7: I'll ask you something I've always wanted to ask you.
8: If I do this for you, you must post this in your journal.

Sports Day

2007-04-20T14:50:56Z

I am absolutely bloody knackered.

We had Sports Day today. I ran the 100m, 400m, relay, and then went into the tug of war. I should've done javelin, I would've won :/

I did crap in the 100. Came third in heats. I blame it on my bad start, though it may be because I didn't get to play squash for the entire Easter holiday, due to the court being repaired.

I ran the 400, and put everything into it. I came 4th, and nearly got 3rd. Afterwards, I honestly felt like my legs were going to buckle.

The relay was awful. I came out behind everyone else, I guess it was because I was dog-tired by that time. Afterwards, I wouldn't get up for a while.

Went and played squash after, but only for about half an hour. I was just too tired. I went for a walk, and alooked at all the lizards. That was quite cool.

And now I want sleep, but my mum won't let me because it means I shan't sleep tonight.

Audition

2007-04-16T18:34:13Z

I've got my audition tomorrow. It shouldn't be too bad. I've practiced a bit today, and whilst I'm a bit shakey on doing middle-of-the-road accents (I'm auditioning for a Policeman), I think I should do okay. Considering I don't think anybody else is auditioning for the part, I may get it. I keep doing it with the accent of my character in Waiting in the Wings, though, which is more upper-class. Ah well. You wouldn't think there to be so many different accents and intonations that one can do.

I'll stop boring anybody reading this now. Well, it's rather short, so it shouldn't bore you, and that last sentence makes me look like I'm seeking compliments; which, subconsciously, I probably am.

End.

Another thingy.

2007-04-08T19:43:51Z

I found this in Tanner's LJ:

Basically shuffling songs on the music library, then putting them to different statements:

1. How does the world see me?: Spanish Inquisition Revisited (I roffled at this. Makes me sound awful)

2. Will I have a happy life?: Like You - Evanescence (Oh crap. This is a song about sadness and death)

3. What do my friends really think of me?: Haunted - Evanescence (That just doesn't make sense)

4. Do people secretly lust after me?: Confessions Part III - Weird Al (XD)

5. How can I make myself happy?: In The End - Linkin Park (o.o)

6. What should I do with my life?: My Immortal - Evanescence (eh?)

7. Will I ever have children?: Cheese Shop - Monty Python (WTF?)

8. What is some good advice for me?: Weight of the World - Evanescence (O... k. This requires interpretation)

9. How will I be remembered?: Baby Appeal - Red Hot Chili Peppers (O_O)

10. What is my signature dancing song?: Cherry Orchard - Monty Python (HELLO MR GUMBY)

11. What do I think my current theme song is?: Lose Control - Evanescence (Makes slight sense)

12. What does everyone else think my current theme song is?: Good Enough - Evanescence (Eh?)

13. What song will play at my funeral?: Your Star - Evanescence (it works)

14. What type of men/women do I like?: Alfie - Lily Allen (that's weird, not least 'cause I'm heterosexual)

15. What is my day going to be like?: Marilyn Monroe - Monty Python (She's dead! o.o)

16. Will I ever have love ?: Buckle Down - RHCP (Sounds adventurous)

17. Will I have an adventurous life?: Mary's in India - Dido (Going to different countries?)

18. Where will I live?: My Last Breath - Evanescence (Where?)

19. Where will I travel?: Spanish Inquisition Part 1 - Monty Python (Spain!)

20. What is the opening song in my life soundtrack?: Imaginary - Evanescence (Cool)

21: What is the ending song?: Don't Leave Home - Dido (University a bad idea? xD)

Well, that didn't really work.

Music and English

2007-03-19T18:56:37Z

Two things I always disagree on with my real-life friends: Music and application of the English language.

First, music:

I realise that everyone has a personal taste in music, and all that. I personally like stuff like Red Hot Chili Peppers and Evanescence, as well as Comedy such as Weird Al Yankovic and Monty Python. I cannot stand (c)Rap or, in general, hiphop and 'RandB' (I'll get onto the bastardisation of that phrase later). My friends all disagree with me: they think 50 Cent (that's about 25 pence or so) and such are the best thing since sliced bread. Why? How can anyone think that his music (which, I might say, is profane and obscene, as well as chauvinistic) comes from his heart and, above all, is actually written by him? Yes, it may be about personal experience of living in 'da Ghetto' (a phrase which, sadly, most people do not know did NOT originate with poverty in America), but this man can barely string a coherent sentence together, does anyone really think he wrote the lyrics and backing to his 'music'? His, and a lot of other 'gangsta rap', is obscene to the utmost, and, what's more, it's what is being listened to by the majority of our generation (at least in England, I'm not sure about the US). No wonder we have a culture in which chavs and yobbish behaviour are rampant. Is it any surprise that we have so many idiots (excluding those, who through no fault of their own, are not as gifted as others) in our culture? Ugh. If I've offended anyone in this bit, I'm sorry, but it's my opinion. I have strong opinions, you see. Oh, and this is not a putdown of those who like rap. It's more of a expression of distaste at the genre and what our society has become. Obviously some people like it, and I don't think less of them, but I just find it rather... obscene, I guess. Not all people who listen to Rap are idiots, it's a minority. And that minority aren't idiots, they're bloody fools. ( Classmates, this isn't referring to you. You guys aren't idiots or bloody fools, I just don't like the same music as you ;) )

Second, English and text language:

Nigh on all of my friends (save one or two) write on their phones and on the internet using text language. They claim it's quicker. I challenge anyone in my school to type faster than me using text language, whilst I use full sentences and punctuation. This is not a boast. I'm trying to say that, with practice, full sentences are faster and more legible than text language. Of course, I can understand text language when people, well... text. But do other peoples' eyes a favour, and when you're on the internet, type in full sentences and use punctuation. It makes people respect you more, and, really, it's good practice.

Again, sorry if I've offended anyone.

Disgusted of Tunbridge-Wells.

In Sickness and in Health

2007-03-19T14:53:55Z

A note on illness and school:

    Today, one of the people in my class had a cold and was feeling rather... ill, I believe. She was harping on about it during English, and I was telling her to shut her moaning and get on with work, whilst others got rather annoyed with me for this. She was saying, 'Oh, I want to go home,' and other things to that effect. Eventually that was what happened.

    This really annoys me. I can understand being off school for one of several good reasons:

: You're quite literally vomiting, which would really be a bad thing to go to school with.
: You've got some kind of horrid illness, such as tonsillitis (maybe this isn't really good enough), or the flu, and going to school      would have no beneficial effects.
: You're seeing a relative who is ill, and not in close vicinity (i.e. the same country)
: You're coughing your lungs out.
: You've broken your writing hand (Your other hand is no object, and nor, really, is a broken ankle or leg).
: You're dead.

This really sums up the excuses which are acceptable, in my mind. Early morning sniffles, or a headache, is NOT a valid excuse for being off school. If you wake up with a headache, chances are it'll be gone by the time you go to school, and if you do decide to stay at home all day, what're you going to do? Sit there and play video games? I thought so.

    Whilst you're at school, your education is paramount. Once you're out, you can loaf around and live on the streets if you want, but if your parents are paying money for you to go to school, that's what you should do. If you have a cold, or are feeling drained, go to school anyway. You're not going to get any better staying at home, and if you go to school you can get people to feel sorry for you by spreading it around a bit.

    Another one that really gets on my wick, is people taking their holidays during termtime.

Why?

    It's a waste of money, and your education. Your parents pay money for you to go to school, either directly, through school fees; or indirectly, through taxes. This money is wasted if you take your holiday in termtime.
    'But flights and holidays are cheaper at that point!' I hear you cry. Yes, they are, but are they cheap enough to waste your education?
    Another common excuse is, 'but I haven't been to suchandsuch and visited my friend Yadayada in ages!' This is just stupid. If you haven't been there in ages, can't it wait a few more weeks for term to end? It really is rather silly.

If you take so much time off for illness and holiday, don't come crying to me when you get bad grades in your GCSEs.

Have a nice day. :-)