TLDR : recounting interesting cases in my first 2 years of medicine

I wish I had taken more notes. Created some form a logbook. There are too many interesting patients and stories, and already I find myself forgetting. Here are a few anonymised prominent cases (in no order), from the top of my head.

I think I will keep a logbook during radiology training (or maybe make a digital one).

Cases

1. Potato ileus : 48 year old man presenting with small bowel obstruction. CT identifies mechanical obstruction secondary to multiple rounded opacities within the bowel. On history, he reveals he swallowed 6x baby potatoes without chewing. He had to have a laparotomy(!) to remove these, and subsequently ended up on the ward for a few weeks. The surgeons were quite mean to him.

2. 21 year old RTA - the passenger died at the scene who was the father in law. I only remember this since it was my last surgical oncall shift, on Christmas morning.

3. COVID related deaths : speaking to family over the phone was the most painful aspect.

4. Swallowed foreign bodies : I spent a total of 8 months on gastro. Many swallowed foreign bodies that the reg/consultant had to hook out

5. Alcohol related deaths : these are the most brutal. Confused due to encephalopathy, Ascites leading to shortness of breath, jaundiced and itching. Sometimes young. One Asian man who was 35 years old with children and family.

6. Pancreatic cancer related deaths : one particular Scottish lady I met in Addenbrookes. I cried when she passed away.

7. Paradoxical embolus : causing a stroke. Interesting CT - had a patent foreman ovale, and a DVT…

8. Arm clot leading to amputation : Eastern European lady who developed multiple clots (during vascular attachment), who ultimately ended up having an arm amputation. Young.

9. Incidental brain tumour (x 4) on CT heads : During medicine rotations in ED, I distinctly remember multiple cases where they found incidental brain tumours. Crazy

Memory and documenting

There are too many cases. Availability bias : I can only remember the most recent ones in psychiatry, but those are too specific to mention here. Also too sad in many cases, domestic violence, rape and suicides.

I look back and realise I did reflect on many of the cases. But I never formally wrote it down or addressed them directly. I can’t go back and look through my notes, because I didn’t take any. I think that it is a shame.

Part of the reason I write anything down, is to examine how my views have changed, and how you handled a situation at the time / take away any lessons. Ultimately its a form of self knowledge.

So this is a reminder to document more : write more, take more pictures, take more videos. It makes you pay more attention.

I was talking to my registrar about how time seems to be moving faster, especially as you get older. You become set into a routine and the days take on the same flavour. This isn’t a bad thing. It is that your priorities change. Having children, a stable meaningful job, all provide a sense of purpose, even though they can seem mundane. She’s actually been a huge influence during my psychiatry attachment, perhaps why I have been so reflective in the past couple of months.

The problem with mundane, is that you can take it for granted. You forget those moments, even though they bring great joy. One way to mitigate this, is to write, take photos, take videos of your daily life. Not so that you can ‘hold onto them’, but so that you pay attention to them when they happen.

Take Away

• Keep a medical logbook
• Regularly write
• Take more pictures, take more videos, create
• Project ideas : Add a gallery to the blog, Medical logbook app

TLDR: All my thoughts on productivity collated

My YouTube algorithm is showing me productivity videos. I don’t know why. Please stop this YouTube. I watched one and found myself disagreeing with a lot of the advice. I don’t need to speed read, increase my typing speed and be beholden to a 15 minute tomato pomodoro timer. Here is advice for my future self in case you forget.

Work on the right problems

Productivity for the sake of productivity is dumb. You want to be working on meaningful problems.

What you are working on, is much more important than how ‘hard’ you are working.

Choose good problems. Micro problems over macro problems as an individual. Join institutions and collaborate for macro problems.

Have more than one problem you’re working on

Counter intuitive. But focusing on a singular problem to the detriment of the rest of your life is unbalanced. For example : you can work on improving medical knowledge, fitness, writing software- all simultaneously.

It also is much more enjoyable, and facilitates greater creativity. Fox rather than a hedgehog. You can connect concepts from disparate fields together.

This doesn’t mean that you can’t sit and focus for 8 hours. If you’re in the zone, absolutely go ahead. But you shouldn’t aim to sit for 8 hours on one single task.

write down what you’re working on

It helps to write down your problems and priorities. That automatically tends to fix how you spend your time, because you know your priorities.

Have goals, but rely on systems. Instead of the goal of performing a front lever, it’s more important to implement the system (train 3x a week with this set of exercises and progressions)

Uninterrupted time

You need to switch off distraction to get work done. You can condense all productivity advice into this one sentence.

Uninterrupted time is the biggest ‘productivity’ hack

Small hacks and thoughts

• Write down all your ideas and random thoughts. iPhone notes.

• Remove all ‘top down’ distractions from your phone.

• Inspiration is perishable. Act on it immediately. You never know where an idea will lead

• Tinkering is the mother of invention.

• Break down hard problems into constituents - this is the only time I would use a to do list

• Work on the edge of your competence. deliberate practice.

• It is possible to make it fun.For example, I gain a lot of satisfaction from writing these short blog posts. If someone were to force me to do it, it would lose a lot of the appeal. Not everything can be ‘fun’ (revising pointless trivia for medical exams I will forget), but it is possible to inject some joy into this (revise with friends).

• Use deadlines for serious projects.

• Procrastination is natural. It’s a sign that you’ve hit a mental block. You need to process. Go for a walk.

• Autotelic activities: enjoy the process rather than the outcome

TLDR : (Very) short story about digital manipulation of selves

Marianne preferred her real face to her digital face. Not that it ‘felt’ any better when looking at it. Obviously, being able to proportion her face so that it was entirely symmetrical, get rid of acne and rein in her crooked nose, ‘felt’ aesthetically better. The issue was, it didn’t ‘feel’ authentic to her.

She tried to bring this up whilst walking back from school with a friend. “Imagine if we all just switched off our glamour, wouldn’t that be crazy’ Both the teenagers had grown up with glamour. They had gone their entire lives looking at well proportioned symmetrical faces, aesthetic curves and toned physiques. The fact that everyone was beautiful, meant that no-one was beautiful. It levelled the playing field and made it paradoxically more equal. This is what led to the institution of glamour in the first place. Thought leaders argued that the ‘Halo effect’ : a cognitive bias where those who are more attractive are seen to have ‘better qualities’ can be bypassed. It would be a step on the road towards equality of opportunity.

“I don’t really see the point of switching it off, I’m happy with the way I look now, why would I want to change that?” Marianne thought about that. “But it’s not your ‘real’ face is it?” “It’s real enough to me. Every time I look in the mirror, this is what I see” Marianne found herself agreeing. I guess if everyone saw your glamour, then it was as real as it could be? Probably more real than what people used to do with makeup and wigs. The conversation drifted, and they walked back lost in talk of future plans.

Prediction : AR Avatars

I’ve been on social media a lot more than in the past, after almost being off platforms for the past 4 years. One road I’ve been going down is how the ‘sense of self’ is affected through images/video. Also exploring ‘influencer’ culture (which is new to me)

Social media involves the creation of a digital self.

Personality is not stable. It’s not unified. You act differently in various contexts, around different people. You’re context dependent. There really is no ’true’ baseline self, there is just a self arising in different contexts. Social media is one of those contexts.

We all know that with instagram for example, it’s a highlight reel of the best points of a life. But what is interesting is, that what you choose to post kind of ‘shapes’ a digital personality, that then can impact your irl personality’.

For example, if you post your workout videos, and give updates on progress etc– you’re actually reinforcing an identity of a person that cares about physical fitness. In the past, maybe you shared it with irl friends, but now your digital personality has this trait.

I think social media can be really useful in creating a stable sense of self. But there is a dark side we all know about, especially for teenage girls. You can ‘fake it’ in certain ways.

I think everyone knows this. But that doesn’t mean that it doesn’t have an impact. But what is interesting is, that if everyone perceives you in a certain way online that is how you end up perceiving yourself. The digital and physical become intertwined. This is the ’looking glass theory’ by sociologist Charles Cooley

Others perception of us, shapes our own perception of ourselves

I feel this is something everyone intuitively knows. Irrespective of if you care about someone’s opinion of you, you still project a reflection that takes into account how others perceive you.

This isn’t a bad thing, its just an observation. I wake up, and style my hair in a certain way, partly because I am presenting myself to others. I can fool myself into pretending I’m doing it for myself, but if other people vanished off the face of the earth, and mirrors didn’t exist, would we still care about appearance?

It’s an interesting thought experiment, I would say- No, because being perceived by others is part of the creation of a self.

Prediction : Augmented Reality Faces

Physical manipulation of appearance e.g. makeup, hair - has been around for a while. It’s presenting a version of the self. (If I haven’t said, this isn’t a bad thing)

Now with digital technologies, we can asynchronously change our photos to present a version of ourselves to others. Everything from lighting, to angle, to photo brushing, to snapchat filters.

A prediction is that the next leap forward will be with augmented reality. We can change our faces and appearance in real time. We can already do this in crude ways, but I think as the tech improves, it will be hard to distinguish reality from animation.

Interestingly, if everyone perceives you in a certain way with AR, then that becomes a reality. Shared consensus is what we call reality anyways. We both agree that the ‘grass is green’.

Quick google search - ARCore framework added the below.

Now imagine if AR glasses became as prevalent as smartphones. We could literally alter how others perceive us in real time. That is incredibly cool, and also incredibly terrifying.

Like any good sci fi, I’ll leave you to ponder the implications and potential scenarios.