How to Survive: Christmas!

I hope you all have a Merry Christmas and can enjoy the celebrations with family and friends.

Christmas Day at my family's place tends to be an epic event. It goes for the whole day. If you are like me and are an introvert, and also have a few family members who you really have difficulty being around for any longer than a few minutes (NPD/antisocial/obnoxious/racist), it can help to have a plan of attack in order to get through the day without being rude in response.

Here is my survival plan for the day:

1. Distraction

When things get too much, there are other things I can do. There will be no less than three playful dogs in the yard, a cocktail bar and if I really have to, there is a quiet and dark room where I can go and read for a bit or meditate.

Also, the majority of people will be lovely. I will find urgent things to go and talk to them about.

2. Diversion

"Yes, I am now a Doctor, no I can't take a look at that skin lesion/advise you on your medication regime/tell you whether or not you have a legal case against that ED who made you wait more than 30 minutes when you went in with a sore toe. Go and see your own Doctor, and look over there, isn't that the cocktail bar/amusingly drunk cousin/dog stealing beer? Excuse me, I need to pee."

3. Deception

Yes, I may plead diarrhoea in order to escape. Nobody will doubt the Doctor, right?

4. Drinking

Of course, I am not entirely serious. Being a bit tipsy around people who are being incredibly rude/racist/obnoxious would lead to me shooting my mouth off and putting a big dent in the fake family harmony that is Christmas Day.

But a little bit, plus trips to the bar to mix cocktails for other family members? It might make for some fun.

5. De-stress

There it is again, me in that quiet, dark room. I even have some guided meditations loaded onto my iPhone just in case. I kid you not.

Family is a precious thing. In most cases, you do as well as you can and you all get by. In some cases, it can be traumatic, damaging and maladaptive. My family is a mix of both.

We all have people with whom with are thrown together once a year through circumstance or genetics. In small doses, I can enjoy the positive sides to their personalities, and if I have a plan, I can leave it at that. I know I'm also far from perfect.

Have a lovely Christmas and a wonderful New Year!

Done

We are done.

I feel like I could sleep for about ten years. I have been so focused on the exam that everything that comes afterwards is really have only half-considered and comes as a bit of a surprise.

Dinner? Birthdays? Parties? Really? I remember these things, but still felt that they were ages away - after all, they were happening once the End was over.

It feels so very strange to be out the other side when we have spent four years of hard work struggling to get here.

It has cost me a few friendships, a lot of stress, a lot of money (which will make itself up in the coming decades), but I have gained so much more.

Would I do it all again? Definitely. Maybe I would change my mind in a few years, but for now I am very happy to still be here.

The long stagger to the finish line

We are in our final few weeks of medical school, and have one big exam before it is all over.

I'm spending quite a bit of time just reading over things. Partly for the exam. Partly because I think they are things that I should at least refresh before next year starts.

In a few weeks, God willing, I will be a doctor.

I will be free of the medical school, but back in the clutches of the hospital system.

It will be interesting.

For now, I'm just stumbling along during the last phase of it all. I could probably pass without study, but the thought of tripping and falling at this point just scares me too much.

I'll write more once the exam is over. After that, who knows.

Testing for old bitterness

I looked up my old high school on Wikipedia today. Just for fun. It had the usual drivel about mission statements and mottos, which was probably cut and pasted directly from the school website.

It also had a list of Notable Students. The list reveals a lot about what the school values, and why many of us could not take it seriously or had our egos crushed as we grew up within its confines.

The list includes a car salesman, a lawyer and a couple of mid-level athletes. It also includes a journalist who recently wrote some home truths about school life in the public sphere, and has been removed from the official school website listed as a source for Wikipedia. He has been blacklisted, I guess, for not representing the school's ideals.

Who else doesn't represent the school's ideals? The medical specialists who have graduated and now work within the hospital system, along with all of the other health professionals who are prominent in their fields. None of us count.

The university professors don't count, either.

Neither do the artistic, the service men or women, or the internationally successful musicians. There are some astoundingly successful people who have graduated from my school, but you wouldn't know it. I guess they just don't fit the mould.

When I read the people they have listed on their site, it seems completely incongruent that they have lauded their chosen few while ignoring the rest. What sets these people above the others? From what I can tell, it is three things:

1. They stayed in the small town after school;
2. They have donated money and/or awards and been present at awards nights; and
3. They have personal family connections within the school community.

It all makes me very glad that I left high school behind a long time ago. Thank God I now live in the wider world. It is liberating.

Just for fun, you too can look up your old school on Wikipedia just to see if the rejection you felt in high school has lost its sting. It is a handy litmus test to tell just how much bitterness is left.

Thoughts on being at the end of medical school

We only have a few weeks left before we finish this little journey called medical school. I thought I would jot down some random impressions on the process.

It all goes so quickly. Blink and a whole semester is gone. As painful as it all is at times, it flies faster than anything I have ever done.

I'm so glad I am here. It has been the most challenging but satisfying time in my life.

I am in the course with some of the most financially rich people I have met in my entire life. I don't think they realise that not everybody has a favourite place in the world to go skiing, or aspires to have a whole wardrobe (or hallway) of designer shoes, rather than just the one pair that they have right now as a student.

Coming to the realization that I'm smart enough to be here was a personal discovery that I have only made in the past six months.

I'm still here and I'm genuinely happy. I think there is a place for me in medicine and I can see myself being content and challenged there for the rest of my career. This is brilliant.

How Not To Name Your Baby

When I was younger, it was before the days when being ludicrously creative with the names of your children was the norm and 'Crystal' was considered extreme. In those days, the main test to think about when choosing the name of your child was the Backyard Test.

According to this test, when choosing the name for your baby, you should think about how it would sound when yelled out across your backyard. Names that sound pretty when spoken can turn ugly when yelled. Some of them may be impossible to holler, or embarrassing.

However, after spending a couple of months in paediatrics, I have started to think that we need to encourage new parents to apply new and more post-modern tests to the names of their children. I have encountered some truly bizarre spellings of relatively normal names, names that have completely different and unintended meanings, and names that are entirely made-up. Often, the only way I knew how to say the name was to work out what it was meant to be rather than look at how it was written.

Perhaps somebody should publish a pamphlet to hand out to pregnant parents at the outpatient obstetric clinics, and save millions of children a lifetime of pain. It would be good karma, surely.

With this in mind, here are a few ideas:

1) The Google Test: This should be compulsory before you even seriously consider a name. It is a great way to discover what a word really means. It is also a good way to find out if the name means something really rude in another language.

2) The Serial Killer Test: Sure, Benjamin Barker is a nice name, but do you really want your infant son sharing his name with the Demon Barber of Fleet Street? Even if you don't get the reference, chances are that he will attend school with children who do music classes. Kids remember this stuff and are entirely merciless. Why not avoid the mental scarring?

2) The Takeaway Test: This is another one for those people who like to get extremely creative with spelling. Can the person on the other end of the line write your name down without a five minute explanation of how to spell it? Have you thought about what it would be like to live your entire life like this? Why add all of those silent letters. Think of the extra paperwork!

3) The Classmates From Hell Test: Kids are really mean. If your name rhymes with something awful, and it isn't too much of a stretch, seriously consider whether you like it THAT much. Little Charlotte probably doesn't want to grow up as Charlotte the Harlot.

4) The CEO Test: Say that little Talon or Harley grows up to avoid the biker gangs and becomes a white-collar manager. Uniqua or Sindi may decide to enter a career in law rather than become a professional singer or stylist. Will your name possibly inhibit their career, or at the very least, look entirely out of place on their name plaque? Will people wonder what they are even doing in the building?

5) The "I read it in a book and don't know how to say it" Test: This one is simple. Just don't. There are multiple little boys out there named Guy who have grown up with their mother pronouncing their name "Gooey" because they read it somewhere and thought it was exotic.

6) The Medical Test: This is similar to the Google test, just make sure that you google the name and leave the words "name" or "girl" out of the search. There are are girls out there named Melena and Candida. I have met them, so I can vouch that these are true. There are urban legends of worse names, but nobody seems to be able to confirm these as real. Thank goodness.

7) The Spelling Mistake/Stupid Baby Name Website Test: If the name looks like a spelling mistake when you write it down, please think twice. Also, if the name comes up on at website about stupid baby names, please consider why other people might think that your proposed name is less than ideal.

Baby names are a very individual thing, and it is up to the parents to make a responsible and personal choice. Kids don't thank you for having names that are different or weird. I have friends who grew up with slightly odd names, and they have named their children very pretty but mundane names. To me, this speaks volumes.

They all have horror stories of growing up and being given a hard time by kids, teachers, employers and complete strangers when filling out forms. Those who have first names that are gender ambiguous get letters sent to them addressed to a person of the opposite gender. This gets tiring after a few decades.

A name is for your child to live with, not you, so think of them and their life before you gift or burden them with something just for the sake of being different. Or not. It isn't my place to judge. Just have fun with little Yoda before he is old enough to visit the registry office and don't take it personally when he starts asking everybody he knows to call him "John".

How To Survive Medical School Part 3: Prioritise

This is quite a timely post, as I am on a very busy rotation and have not been writing much recently. Also, I am going to be keeping this brief, as I have to keep going with the study.

If you cannot prioritise, you will not survive medical school. That may sound extreme, but it is very true. If you have gotten in, you are probably already pretty good at prioritising, but compared to other areas of study, medicine is so huge that you need to improve on this skill rapidly if you are to keep your head above water.

There are so many things that you feel expected to know and to do, and you will never have time for them all, even if you had twice the hours in the day that you do. Perhaps you are one of those brilliant people who does not need to study and who remembers everything forever the minute you read it. I'm not, and neither are any of the people I know.

If you are like me, you have to sit down, study and understand things before they stick. Then you forget all about them until you are examined or asked on the wards. Krebs cycle, anybody? If you are a physician and work with metabolic defects, it probably sticks in your mind because you understand it and can see how it works on a practical basis. I have finite room in my brain, and it tends to be reserved for things that I use regularly. Thus, until I work with patients with these problems, my understanding will never be any more than superficial.

Yes, these things are all important and I would love to have the time. One day I really hope I can have a deeper understanding. But at the moment, when we stare down the barrel of regular and very specific examinations, things like this get left to the side, apart from the odd revision where I open the textbook, look wistfully at all of the things that I would like to learn, then close it and go back to the things that I need to learn right now.

What do I think are the important priorities as a medical student? That is completely and utterly up to you. My advice is to work out what you need to do the most, then do that first. Take it all in baby steps.

I have tried to write out my priorities as they are, but they do change from time to time.

1) Personal health and hygiene. Yes, I need to shower and eat breakfast. I also need to go to the GP on occasion. My dentist regularly nags at me because I don't see her often enough and I'm not an obsessive flosser, but I don't really care. I brush twice a day and don't need fillings, so beyond that is just too much for me. Medical students get sick, too, so get that pap smear done, keep up to date on your jabs and health checks and make sure that you are still around to finish the course. You can generally schedule these things around your class times or rotation obligations, so make sure you keep up with them.

2) Aim to be a safe and competent doctor. This is my number one priority after being alive and in one piece. This is why I desperately try to be better at pharmacology than I already am (and why it terrifies me that we don't cover more of these things in our course).

This is why I like to focus on the "Red Flag" diagnoses that you should never, ever forget about. The things that will kill your patients, or seriously harm them if you drop the ball. There are the diagnoses that you need to think a little bit laterally to spot. Then there are seemingly small things like the decimal place or the units on a drug chart. This is scary stuff. What is the point of doing really well in medical school if you aren't a safe doctor?

This might mean that you have to speak to somebody at your school or clinical rotation if you feel that you are not being properly supervised or taught, or find alternative ways to learn. As one wise person told me, if you are in court defending yourself a couple of years from now because you didn't know how to do something as well as you should have, they won't be interested in your excuses about not being taught properly in medical school.

3) Passing exams. I know it might sound obvious, but it is sensible to do your best to pass your exams. I would like to think that if you used common sense and studied topics from the viewpoint of how you will be thinking as a doctor, you will be fine. You might not be. It depends on the course. Don't forget to name the most likely diagnosis first and use common sense. Past papers can be very useful, so look at them to see the type of question you might be asked, but don't forget to study more than just the past exams and don't forget aim number 2.

You can split your content into what you really need to know, what you should know and what you would like to know if you had the time. It can be hard to sort these things out in first year, but this is where the other more experienced students come into it.

4) Study may have to come first, before other things that are more fun. Yes. this hurts, but it is true. You need to have some fun, but it needs to be in moderation, and your learning needs to come first.

Really important family gatherings are something that you should try not to miss if you can. Less important get-togethers may have to become a lot less frequent. If you never, ever miss an episode of Neighbours or CSI, you may have to change your priorities.

This is one of the reasons that some medical students get the reputation for working and partying hard. They spend most of their time studying their butts off, then when it is time to let their hair down, they get it all out of their system in one hit. I favour a more balanced approach, but we are all different. I'm more of the tortoise to their hare.

Binge drinking is dangerous and I feel strongly that there should not be medical student society events that endorse it. Clearly I'm odd, but if you are studying so very hard to fill your brain with knowledge and build up a respectable career, why take part in an activity that can seriously harm or kill you, or ruin everything that you have worked so hard to achieve? I like alcohol, but binge drinking on the scale I have seen in medical school has been an unpleasant surprise.

5) Occasionally you may have to take some time out to recharge. This might be as long as a weekend off uni work, or an hour or two to watch your favourite movie. I would choose to pass exams over taking some time out, but if you can afford it and need to de-stress, see if you can salvage some valuable time for yourself, even if it is just an hour or so for a massage or to get your hair done.

These are the priorities that have gotten me through medical school so far. Things might be different for you, and that is okay. The most important thing is to learn to take things one step at a time and to work out what you need to do the most, and get that done.

Good luck.

How To Survive Medical School Part 2: Ask For Help

I have tread a few paths in life before I started medical school. I have studied three very different careers at university, all of which involved stress, personal criticism and hard work. (I finished one - I have a low tolerance for things I don't see any point in.) I had a career in which I worked in a stressful role and ended up in a semi-senior position before I jumped ship to study medicine.

None of this was anything like the kind of stress, personal doubt and anxiety that I went through as a medical student. I know that this is by far the norm. Medical students (and doctors) may be the types who are good at keeping up appearances, but don't let appearances fool you. If you are going through extreme levels of stress and personal difficulties, the odds are that you are far from alone.

I'm not an expert and there are other resources that do it better and in greater detail, but there are many reasons that people cope differently with stressful challenges. These are my personal observations, and others may have quite different and valid ideas. Everybody deals with things differently - it is part of the beauty and diversity of the human experience. You really have to make up your own mind on these issues and how you would deal best with them, but getting help is vital to learning how to reduce the stress levels and emotional distress you are experiencing.

There are many studies on stress and anxiety in medical students (and doctors) and you can find reviews of the data on Pubmed and other databases. It is an issue that often isn't spoken of openly, and more work needs to be done as it is an extremely prevalent issue that impacts on our profession and our lives.

Medical students on average are more likely to be obsessive personalities who need control and desire perfection. When you put people who have generally been very high achievers into a situation in which they are now not even certain of passing, it adds a lot of stress.

Add into this mix the ambiguity of the goals set for us, particularly in the first two years of study, tutors who can mercilessly rip apart your performance (because, as they will frequently tell you, if you are an underperforming physician you will kill and maim more patients) in a style that scars more than teaches (pimping portrayed on the medical dramas/comedies is real, and frequently less merciless than in reality), and an environment in which you not only may be an average student but may be failing in spite of your hardest effort, and the result is an environment in which the emotional reserves of the toughest student may quickly be depleted.

When you go into the clinical years, it is not uncommon to feel completely incompetent and clueless just about every time you walk into the hospital. To be frank, you know so little at this point that a little uncertainty is a good thing, but it should be to a point that motivates you to learn more and try harder, not crush you and make you doubt your ability to ever be a competent physician. In time, you get used to this feeling, recognise it as normal and know that you are only expected to be safe and ask for help when you need it. At the start of your clinical years it can be a hard pill to swallow.

About a year ago, Captain Atopic wrote a brilliant and soul-baring post about failure in medical school. I think that everybody who is considering medical school or is already a student should read it. He is an intelligent and capable student, and if it can happen to him, then it could have happened to any of us.

Maladaptive personality traits and tendencies are extremely common in the general population, and if you put people with these traits (i.e. most of us) into the stressful situations in medicine, your previous coping mechanisms may be stretched to the point where they no longer suffice. You can adapt to the stressors in a number of ways.

Ideally, students can learn resilience and bounce back quickly when something happens that upsets them and floors them completely. This is a skill that we should all try to gain, as it is a healthy way of coping with the knocks that life deals out. Still, sometimes the existing strength of our resilience isn't enough, particularly when many things overwhelm us at the one time and we stop coping.

You can develop a thick outer shell and a protective layer of cynicism about the whole process. This is the approach that is caricatured in the extreme in the medical characters Dr Cox from Scrubs or Hugh Laurie's character in House. A little bit of toughness and cynicism can serve you well, but letting it become your entire personal style is dysfunctional and can lead to great misery.

If a clinical teacher acts rudely or is unreasonable, you can learn to take it with a grain of salt. Being excessively cynical, antagonistic and tarring every clinical teacher with the same brush is maladaptive and unhelpful. You need to protect yourself and be able to distance yourself emotionally, particularly from the "heart-sink" patients who can be a great source of frustration to every staff member in the hospital. Treating every patient you encounter with the cynicism that House exhibits would be, quite frankly, abhorrent. There is a healthy balance, and you need to find it to cope.

If you have experienced significant personal trauma from something in your life and haven't dealt with it, it may come back up again and result in worsening anxiety, even to the point where you stop being able to function. If something you haven't dealt with is just sitting there under the surface and you are simply getting by through ignoring it or pretending it isn't a problem, diving into the stress and demands of medicine will likely rob you of the reserves that you were previously using for denial, and so you can be overwhelmed by something that isn't even related to the course.

Depression and anxiety disorders are frequent amongst medical students, and should ideally be dealt with as soon as it is possible, but there are a number of reasons that this doesn't happen. One of these must certainly be the culture of silence that exists around these problems. Medical students don't want to admit vulnerability and worry that admitting they have had issues with anxiety or depression may be seen as weakness and that they may be perceived as not suitable or strong enough to bear the burden associated with their stressful careers.

You may already be experiencing burnout. The medical school experience alone will put you through most of the potential causes of burnout, so it is important to learn how to deal with these pressures now when you are more likely to have time and space to do so.

It is a dreadful irony that admitting to emotional distress and getting help and dealing with your problems can actually make you a stronger and more capable person in the long-run. Denying a problem with these things is like denying a physical illness. It doesn't just go away because you don't admit it is there, and it may well get worse rather than better.

There are many places that you can go to for help, depending on how you feel. If you think that you may need it, don't put it off. It can be as simple as having a chat with an appropriate clinical coach or teacher, and students will often know of one staff member associated with the medical school who can help them or refer them to more appropriate care.

Here is a short list of some resources that you should not hesitate to access:

1. Your GP. Every doctor or medical student should find their own GP - somebody they can go to regularly and talk to when they need support, as well as dealing with health niggles that crop up from time to time. It is great having somebody who knows you and is an independent professional. If you don't have one, you can ask around to find a GP who is interested in counseling or has a good reputation. The rewards of finding a good GP are well worth the effort. They are also great for referring you onwards if you need to see a psychologist or psychiatrist.

2. A psychologist. In Australia, you can claim a number of visits per year on Medicare if you are referred by your GP with a Mental Health Care Plan. It may only take a few visits to help you develop skills and strategies that can improve your quality of life and make the difficult times easier to deal with.

3. A psychiatrist. In Australia, you are more likely to be referred to a psychiatrist if you have an identified mental illness that is being treated with medication.

4. The University Union. Some university unions in Australia have staff counsellors who you can visit for a free chat. These counsellors can also help you with strategies or just be a sympathetic ear.

5. The School of Medicine. Ideally they should have somebody you can go to when you encounter difficulty, who can then refer you to another service. Some schools have a budget for this so that they may be able to pay for an appointment for you with an independent psychologist or doctor who can assess you and refer you for appropriate treatment.

Be aware that these resources can be hit-and-miss, but if you encounter somebody who didn't help much, don't give up and try a different tactic. Don't ever feel like you can't be helped. You deserve to be well as much as the patients you yourself will be trying so hard to help.

Other places to think of include:

6. Lifeline, and other anonymous phone counseling services.

7. On-line information such as Beyond Blue and self-help tools like Mood Gym. (Incidentally these are both worth a look even as a student with no current issues, as they are tools and sites to be aware of than can be invaluable to your patients.)

8. Books. Your library should have a good selection of these, and if you want to buy one for yourself, make sure you have a good look through them first.

9. Your friends and family. Sometimes you get to the point where you really need help from an independent professional, but never forget that your friends and family can be there for support, too. If you are brave and come out and tell them that you are having difficulty and are seeking help, you may be surprised at their positive and caring reactions.

10. Mindfulness training and meditation are also good skills to develop. Learning how to live in the present and focus your attention is a skill that can help improve your life and make you a better clinician. If you haven't tried mindfulness training before, it isn't as hippie-ish or crunchy-granola as you might expect.

It goes without saying that anybody who is having thoughts of hurting themselves should seek help and support immediately. You are worth being helped.

There are a number of great resources out there, and this is just a summary of my thoughts having gone through the mill of medical school. Things can get better, and you can come out the other side stronger than you were before you started having issues. Asking for help is a sign of strength, not weakness.

Public Blog Redux

Hooray, the blog is public again, and hooray, I got to use the word redux in a title! (I'm slightly addicted to it after reading it all the time in the excellent Life In The Fast Lane.)

I have decided to make my blog public again, as I have kept to myself where I needed to over the past year.

Honestly, there is nothing on here that I wouldn't tell anybody anyway, so I'm not worried about somebody reading it and working out it is me. I may deny it when asked socially, depending on who does the asking.

Even when private, I don't say anything about patients or bitch about colleagues or particular hospitals or systems. I just consider this to be normal polite behaviour.

I have just come to miss the contact of being more open and public with the blogging community. I thought about (and briefly started) another blog under a different name, but it seemed better to just re-open this one and make the blog posts I wanted to make and post them here instead.

Thanks to those of you who stuck with me and logged in over this period. I appreciated your ongoing support and comments.

Now you get to read and comment without the rigmarole of logging in. ;)

How To Survive Medical School Part 1: Friends

So, you have passed the MCAT/UMAT/GAMSAT/interview, and accepted the offer. Congratulations. Good luck.

You have quit your job, graduated from your university degree, finished high school and tied off the loose ends of your previous life.

You have perused forums, delved into the medical school's official website, grilled doctors in your circle of family or friends, and maybe bought some books.

But where do you go from here? How do you survive? There seems to be so much that you have to do. When you stand at the bottom of that hill, looking up at the mountain of information, expectations, exams and tasks, it can seem like too much for one person to take on.

That is because it is. There are bound to be some rare individuals who went through the whole process without asking for help or looking for handed-down notes or pointers left behind by previous students, but they would be hard to come by, particularly as they would be so stressed and busy that you would never see them.

If you have gotten into medical school, chances are you are now in a group of people who are (on average) extremely intelligent and motivated. As cynical as we can be sometimes about some of the people we work or study with, they could not be where they are if they weren't very smart.

It is worth remembering that very few of these people got over the hurdles and through the hoops by themselves. You need your friends, and you need the help of students who have been there before you.

Before I had gotten into medical school, I had no idea how much medical students rely on each other and are willing to help each other to get through. Each year of students has relied on the advice and help from previous years, so they help the coming years of students to get through to return the favour.

This can be in the form of tutorials, study notes and summaries, past exam papers or just encouragement. The directions from the medical school about how and what you need to study can be overwhelming and almost impossible. Student advice can keep you sane and quite literally help you pass. If you haven't heard of anything like this, make sure you ask around. There is bound to be something that can make your life easier.

Having a good group of friends (even one or two buddies) can also help keep everything in perspective. If you are feeling the pressure and feel like it is all too much, chances are that many people around you are feeling the exact same way, even if they stay calm on the outside.

It really helps to have other people there who you can be honest with about what you are going through, and when you learn how they are coping, it gets easier for all of you. I don't need to go into why having friends is important and how wonderful it is to have people around you who understand what you are going through, I'll just say that making time for friendships is vital.

Don't forget to try to maintain your friendships outside of medical school. Sometimes it is lovely to go out to dinner with a group of people and know that there is no chance of them describing their latest complicated laparoscopic surgery or FB retrieval. I have friends who apologise for talking about the latest adventures of their toddlers, but I love hearing about it. Normalcy is refreshing.

There are also avenues to ask for more substantial help, but I will talk about that in another post as I think it deserves its own space.

Another piece of advice I have to give is to remember that the people who are studying with will one day be your colleagues. You will refer patients to each other, call for advice and one day one of you may be the other's boss. They will know and work with people who you may desperately want to impress.

They may also be your treating doctor or the doctor of one of your friends or family. If you think they are hopeless, feel free to remember their names, but don't tell them so to their face.

Don't burn your bridges. Be civil, even if you find somebody really grates on you. You don't have to be their best buddy, but remember that one day you may have to work together as professionals, so it would be good to not get to the point where things get nasty.

Even if you are an important consultant and head of your department, having everybody you work with despise you is a very bad idea, and as a medical student it will be a long time until you will seriously consider being in that kind of position.

Hospitals are very small places, rife with gossip and intrigue, and so are medical schools. It is not the end of the world if you don't get along with another person, but if you can avoid being outright hostile, I would at least try to be neutral. Good luck. Ask for help.

Fools rush in

I keep running into doctors who used to want to do psychiatry for the same reasons I do, and didn't go into it in the end because it was too draining emotionally.

These same people keep trying to talk me into following radiology.

I enjoy imaging, don't get me wrong. There is something really nice about looking at a picture and understanding what is in front of you, and being able to label the anatomy with certainty, understand the physics and the likelihood of the pathology.

I'm just confused. Fortunately I have an elective scheduled where I do four weeks of each, one after the other. This will help me make up my mind.

God knows, maybe I'll end up in a completely different field. This would also be okay. :)

I'm starting to think that I really should take my time getting into something and pay attention to the old proverb of "Fools rush in".

And the good news?

I got my first preference for internship!

I'm so relieved. And a little scared.

I think it will all become more real when the paperwork starts to arrive.

OSCEs

I finished the last of our exams for this rotation today!

They went okay and I think I passed all of them. I know I did well on the last OSCE, as the examiner told me so (the patient ovarian torsion due to a dermoid), and I looked over the first case and worked out that I covered what I needed to cover (discovering a twin pregnancy that then goes into early labour).

For those of you who haven't done a medical school OSCE, it goes like this:

You walk into the room and meet the examiner. They are a consultant (i.e. attending doctor if you are in the USA) and they are sitting in the room looking at notes that you can't see. They say hello, introduce themselves and you exchange pleasantries until the bell/buzzer/knock on the door tells you that it is time to start.

They introduce the case with a simple statement (e.g. Jane Doe comes into your GP office complaining of X) and you have to take a history from them, say what you want to examine, organise texts and talk to the patient as if it were a real situation, except you are being examined and drilled at the same time and have nothing to refer to in front of you.

There are generally multiple patient encounters, so after you are finished with the first encounter (and the examiner has finished prompting you, mostly to help or sometimes the occasional examiner will mess with you a little), they lead into the next encounter which follows on in time from the first. This might continue on in a different location, at a different time, for example, "Jane Doe comes into the emergency department and you are a resident there, her results from her GP read as follows" and you then have to continue care of the patient. And so on and so forth.

It is challenging because it is a foreign situation, sitting in a room talking with an examiner rather than being in a hospital/office with a patient in front of you. It is harder to remember to do the basic things that you would do out of habit, such as get a drip running or call for help from the registrars of the other disciplines if it isn't immediately apparent that they are needed.

If you get a helpful examiner, they can help you along by describing the situation in more detail for you, and leading you to answer things rather than forget them, because if they describe the situation more and you know the answer then you are familiar with what you have to do but have just been put off by the format.

You should still be able to pass without that help, but I won't ever knock back a couple of extra marks for things that I actually know but would have otherwise forgotten to mention due to nerves and the strangeness of the situation. ;)

It is actually kind of fun if you can relax enough to enjoy it. That said, I'm glad I'm done with this lot. Now I only have two big exams, both of them multiple-station exams, and I'm done with medical school. It is very exciting.

Exams, again

We have our exams this week for O&G. They consist of a long T/F paper, and two OSCEs where we are given a fake patient (who can be male and is also the examiner and an O&G physician to boot!) in a structured assessment situation.

I'm mildly nervous, but much less than I would have been a year ago. We have been through so many exams in the past few years that it seems so mundane and normal.

The thing that is starting to weigh on my mind is internship. I have two lots of rotation exams (including this one), one elective rotation, one MSAT at the end of it all, and then I am technically a (junior) doctor.

In studying for these exams, I keep seeing myself actually being in these situations in a year or so. This is helpful for study, as it really makes it stick, but on the flip-side it is also scary.

Quite a lot of girls I went to highschool with are now experienced nurses in the system, with over ten years on the job. I have lost contact with them over time, but it would be very strange to interact with them in a work situation, particularly as a junior doctor. I actually think that most of them would be good to work with, and if things get uncivil, we can threaten to show the rest of the staff pictures of each other in dreadful 90's garb and fluffy hair. ;)

I'm also possibly going to be doing internship at the hospital where I have worked for years in my previous profession, which will also be odd. On the bright side, I have a good reputation there in my other role, so hopefully that will make the transition a bit smoother.

I have worked and studied in the same corner of the world for my whole uni and working life. As Mr TGWTBS has said, it will be a bit of an adventure if and when we get to go elsewhere, in the not-too-distant future.

One week and one day to go

In one week and one day we get our first offers for internship. It is a very exciting time.

It has been very interesting that I have made it this far, mainly because I have been focusing so much on taking things one day at a time.

I'm trying to work out where the following years may take me, but it isn't easy, particularly as some information is hard to come by. I don't feel like I can call people and ask just yet, as I'm still only a medical student, and email responses are either slow or don't happen. That said, I have received a couple of very helpful responses.

Fun times are ahead.

Flying away!

Today I fly down to Hobart for the Global Health Conference. I haven't done any med-related travel in the past four years (rural rotation doesn't count), so I wanted to do something before I finished the course.

A lot of people I know have done wonderful electives overseas, but I can't justify spending the money on that. I guess it is easier when it is just your money and you don't have a mortgage and a partner who is still working full-time to support you both.

Anyway, I did the fair thing and he is coming with me to Hobart for the four nights, so he gets some time off work and I get to sit and listen to talks on global health. I hope it is interesting - there look to be some good speakers and good topics.

Unsurprisingly, I am very keen to go to the ones on mental health, and they are addressing some pertinent topics such as mental health in refugees and other disenfranchised people. Of course, you could also argue that the severely mentally ill of most cultures have lost a lot of their power, rights and autonomy, but I can imagine that it would be an incredibly powerless situation to be a mentally ill refugee or asylum seeker.

I'm in the middle of packing, and things would run a lot smoother if I hadn't decided to be a complete nerd and type out my list of things to double-check. Unfortunately my Macbook is now three and a half years old, so it is getting clunky, and I keep getting the Beachball Of Death every few seconds in Word.

Still, a packing list is worth it. I find that it doesn't matter too much if you leave packing until the last minute, as long as you have a solid list. On our last holiday, I made a list and Mr TGWTBS didn't. I remembered everything, and he forgot underwear. Did you know that some tropical islands don't sell men's briefs? We know now.

Anyway, I had better get back to packing. Have a lovely weekend. :)

Now to wait

For three and a half weeks until our provisional offers come out.

At least now I know my odds. It isn't a shoe-in, but it isn't the worst, either.

Fortunately I also have a very unpopular hospital within driving distance of my home as my second preference. I don't quite understand why it is so unpopular, as I have heard good things from people who have been interns there, but I can imagine. It isn't a big centre with a load of support. Their interns work hard and learn a lot. I guess it is in a poor area that is too far to drive from most areas in the big city, so they would have to move closer to an area that they don't like. (I would deal with the long drive, I think. I live on that side of the city.)

One of the problems with our current system is that the government panicked at the doctor undersupply and then gave the universities free reign to increase medical school places and medical schools which they did exponentially, so we are on the lip of a tsunami wave of fresh graduates.

This means that the two largest hospitals in the state will have 95 interns each, another has 85, and smaller places have also increased their intake to help cope with the increase, so that we don't have massive numbers of unemployed interns.

This is good in theory, but what do you do with 95 interns? You put them in education sessions. You double them up on the ward. You put them in radiology, pathology or GP surgeries doing educational work, or the scut work that they are capable of. You send them out to smaller places or private hospitals, which could be good as long as you are getting appropriate work.

This isn't to say that the interns in those big centres aren't going to work hard. They do work, but some of their rotations aren't ideal. On the bright side, they get shiny doctor's facilities to use. Free fancy freshly-ground coffee is a bonus of sorts.

Their experiences will be a little different to the people who get to be based at the smaller hospitals, both metropolitan and semi-rural.

As I am still dreaming of all things psych, and most centres have psych units with registrar positions, I didn't really need to make contacts in the big hospitals, which is a relief. I have applied to a smaller hospital (600 beds) that only takes a few interns and has more residents (PGY2 and above) to deal with the more medically complex rotations (e.g. transplant medicine). It was slightly oversubscribed, so I have to wait to see if I got a place, but the odds are good.

I don't have anything against the larger places, but 95 interns in the one hospital is an immense number. I do better in smaller crowds. Now to wait and get on with life in the meantime.

Master Procrastinator

Our ballot closes very soon.

Clearly (from the blog design change) I am procrastinating.

Perhaps I need to pull my finger out and do something that would distract me a little better - like, perhaps, studying? :P

More changes

Due to the shifting numbers in the live intern ballot and logistics involved in attempting a renovation while only one of us is working, we have decided to put off the move until next year and I will be applying for the hospital that I have been at for a while, which is only about 20 minutes from my house (in traffic).

We looked at moving to a place in between our works, and there are some lovely neighbourhoods that would be closer to his work (via the motorway, cutting out the big suburbs drive that he now has), still close to where my hospital would be (as well as other hospitals I might switch to) and that would allow us to upgrade our area, if not the house as much.

My husband has only been working for his current employers for a little over a year, and most employers in his industry are in the city centre, so planning a big move based on his job may be a little premature when he may change jobs in the next year or so and go back to the city centre. His industry can be a little volatile with work contracts.

I don't really mind not upgrading the house much, if it comes to that. Our current house is quite comfortable, and could be a lot nicer if we did some renovations.

I am just not a huge fan of our neighbourhood. It is quite a safe one, but there are lots of "bogans", lots of fast food places and no decent restaurants nearby. I don't have much against bogans, but when your neighbour thinks it is okay to work on his motorbike/car at 10:30pm on a weeknight right outside your bedroom window, it can do bad things to your quality of life.

This way, we will get to take our time doing the place up, do a better job of it, and live in it for quite a few months to enjoy what we have done. It will be nice to not do one of those crappy renovation-on-a-shoestring-budget that you see for sale around the place.

If you live around my area of the world, you will know what I am talking about. Some people try to make a faster sale and profit by slapping on a quick coat of paint and polishing the floorboards over the whole house.

Frankly, polished floorboards in the bedrooms in a highset home is a BAD idea. There is no sound buffering, there is no insulation and it seems quite cold and uncomfortable. We have lived in places like that in rental properties, and I would never do it if I were renovating.

To be honest, I kind of prefer carpets, or tiles if you don't like carpet. Even floating floorboards are a better option than having nothing between you and downstairs than one thin layer of wood that may have holes through it big enough for venomous spiders to use as an entrance. (Yes, this has also happened to me.)

I have to wait for Mr TGWTBS to get back from working thousands of kilometers away, and then we will start to make plans to actually kick things off. It is still exciting, and not having such a set timeline is much more pleasant!

Time, machinations and all that stuff

I have completely switched my preferences around for the intern ballot. I figured that it was fairer on Mr TGWTBS to move somewhere closer to his work while we have the chance to do it (relatively) easily.

The only problem is that this means we have to sell our house. Which means that I have to tidy and unclutter it. REALLY unclutter.

I'm not a hoarder, but we have inherited furniture from his parents when they moved interstate, plus we kept some old cupboards that we had to buy for earlier rentals (which had no built-in wardrobes).

Then there is all of the clutter of 6 years that builds up with time. I really need to get vicious and go through things that we haven't used or don't need any more. A lot of it can be donated or maybe sold, I just have to work out where and who I have to contact.

We have been in this house for 6 years as of October. I started this blog in this house. I started contemplating medicine when we were living here. This is where I studied for gamsat, prepared for interviews, fell apart, pulled it all back together again, and lived a lot. It is amazing to think that so much can happen in such a short space of time.

I get attached to people and places, probably because we moved a lot growing up, so the thought of moving is challenging. However, I may end up with my holy grail in housing: an indoor laundry!!

I have always wanted one, and never had it. The closest we got was in our first unit, which had the laundry in the garage, two stories down from our bedroom. Not fun.

Previously we have been moving from rental to rental, so appearances meant very little. However, now that we have to dress the place up a little to sell it, I have to get my bum into gear.

On the bright side, we may get to upgrade our house a couple of months sooner than expected (or move into a rental in between) and I might actually live somewhere that has a decent asian vegan-friendly restaurant nearby. That would be entirely too brilliant.

It just feels like the right time to move.

Intern applications have started!

I have put my name down in the ballot process.

We can watch our results live as the numbers change over the two weeks, keeping an eye on how full our preferred hospital is, and changing preferences if we need or want to.

This means that people tend to shift their preferences if certain hospitals become over-subscribed to maximise their chances at staying in the big smoke. It also means that less people need to be balloted after the date for change of preference closes, because most hospitals don't end up being massively oversubscribed.

Fingers crossed!

My Day

I had another good day in O&G. We spent the morning in obstetric clinic, the afternoon in gynaecology clinic, and got free pizza for lunch.

It doesn't get much better than that. ;)

I really love how positive most of the interactions are in O&G. The outcome for most of them is a healthy baby and the gynae surgery can make a real difference.

On the other hand, when it doesn't go well it can be completely shattering. I don't think I could deal with that.

Even if the labour was going really badly, was not likely to end well and your intervention saved the mother while the baby dies, you can be blamed. Having a dead or seriously ill child is heartbreaking, and society seems to expect a healthy child out of every labour, so obstetricians catch a lot of unfair blame for things that they have no control over.

At least with other areas of medicine you are dealing with people who are already ill. People are generally more guarded and less likely to have expectations for a flawless outcome.

Having a dreadful outcome at the end of a healthy pregnancy would be horrific for everybody involved.

Changes

Having been around for a few years and lived through a great number of changes and shifts in my world, I know that there are periods in your life where you feel things move and alter, and you come out the other end a slightly different version of yourself.

I feel like I'm going through one of those now. The next stage in my life is on its way.

I'm not entirely sure why. We apply for internship in a few days, and so I know that I'll be back in the working world very soon. This could be it. I'm starting to get back into the working-person mentality.

I'm so very glad that I have had a previous career. Starting out into the time of your life where you begin your first career job is challenging. A lot changes about the way you see the world and see yourself, and it can be a painful process, even though you may not admit it to anybody else.

Students are both coddled and dismissed as a general rule. You are sheltered from most of the responsibility. As much as you might think that you are acting as a doctor/nurse/radiographer/whatever, you are still directly supervised by somebody who has to clean up your mess or check up on you all of the time. Although some might think that we are going to be in a similar situation as interns, being supervised by registrars, the interns still have assigned work, responsibility and their own job role.

When things get really shitty, you are just the student and can be pushed out of the way for all of the actual doctors to take care of things. As the intern, you are one of the doctors - albeit a junior one.

I also think that I have matured a lot in the past four years. I'm a lot tougher, and things that I would have taken personally and would have made me cry now just make me shrug or not even blink. Social slights from friends (unintended or not) just slide off me like water off a duck's back. Sometimes I wonder why I'm not more included in things, but then I wonder whether I would really want to be. I'm happy being an introverted homebody.

Thankfully I seem to have retained some capacity for empathy and joy with patients. I get all misty-eyed when I see the new dads weeping at the sight of their newborn resting on their wife's chest, and I feel so proud of them sitting there and supporting their wives, being themselves proud of how hard she is working and what she is going through. The women amaze me.

The same thing goes for patients elsewhere. It is just easier to relate positive empathy, as you feel more distanced towards people who are going through rough times. I have been in the lift on multiple occasions with families who have just lost a loved one. Their weeping would break your heart, if you let it.

It isn't my burden to bear, and I couldn't do my job if I let it get to me, but I can be kind and empathetic and give them as much time, talking (or not-talking) and tissues as they need.

Years ago when I was a student in my first career, I heard the dark jokes of the staff about patients and was mortified. I nearly left health at that point because I didn't want to become cold like that. The impression I had was that they were heartless. Now I know that it is just a protective mechanism (and several of them were just pricks anyway), and having that impact on me so early in the piece, I like to think that I'm more conscious of any tendency to become that black.

If you told my 22-year-old self that at 32 she would be nearly finished medicine and have retained empathy and not become a hard shell of a person, she would be both disbelieving, happy and relieved at the same time.

So, what is shifting right now? I'm not sure, I can just feel a change coming. I think I've become more honest with myself about certain social patterns, and know that I'm not as close to some people as I thought I was. This is nobody's fault, it is just the way things are.

I think things will change a lot when we all start work next year. It will be one hell of a test, and some friendships won't make it and will die natural deaths, and new ones will spring up in their place. This is the way that life works. We change, we grow and we move on.

To be honest, I can't wait to be back to work. Being a student has been a challenge, but on my worst day I never felt as awful as I did leaving work on my better days as a radiographer. However, as much as I disliked my job, there is something that I love about working - actually working, not student "working". I like responsibility, I love feeling part of a team, and I like being a part of the big machine rather than an onlooker. I miss genuinely being able to help.

I could also be stressed, but my husband has said that he is beyond proud of me finishing medical school, and is happy to move to wherever I go. There are some rural places where he is more likely to get a job than others, so I'll put them up the list of preferences.

It could also be PMS. But not really.

This has been a long post, so if you have gotten this far, thanks for reading. It felt good to get all of that off my chest.

How To Have An Afternoon Nap, TGWTBS-Style

1. Lie down after lunch on your bed in a semi-dark room and read a book. It doesn't matter how interesting the book is, if you have had a long and draining week, it will work. Within ten minutes, you will have put the book to the side, turned off the reading light and gone to the land of nod.
2. You are disturbed by the sound of your own snore, which scares you as much as unexpected bodily noises can, and wake up and roll sideways, going back to sleep immediately.
3. Twenty minutes into your sleep, your parents call. "I knew you would be asleep," they say. Way to use your psychic powers for evil instead of good, Mum and Dad.
4. Get back to sleep after a blurry conversation about the rain and somethingorother about school meetings.
5. Get woken up by a marketing person who demands to talk about marketing and advertising to somebody over twenty and working. Telling them that your number is unlisted and you are on the Do Not Call registry is beyond you, so you just say "No" and hang up. Marketing people have the Gift and will call during dinner or naps. Evil.
6. Doze off.
7. Get woken up by a kid next door playing trumpet. Must be a visitor, as I have never heard him before. Why? Perhaps he, too, has psychic powers for evil.
8. Doze off again.
9. Get woken up by remote-husband's text message, telling me that he is going to see a movie. 2000km away. Awesome.
10. Get woken even more by a second text telling me that he also got a haircut. I won't see it before it all grows back again. Even better. Sweetness and evil together are the most fun combination.
11. Try to doze off but am now surrounded by hungry cats who are obviously confused as it is a good two hours before their dinner time. They take turns purring and miaowing. Cats never try to hide the evil.
12. I give up, get up to finish Saturday chores and resolve to not feed cats for another two hours. Evil rubs off.

The end.

Blah blah blah

I haven't written much in the past few weeks because somehow so much has happened, but there is so little that I feel I can write.

I have done something to my hip, and it hurts. It is much improved from when it first started, but I don't know if I should run the 10km tomorrow, and I have been training for this one for months. At least I did a different 10km a couple of weeks ago and managed my goal time in that one (58 minutes), so the disappointment is mildly diminished.

I can run about 5km at home without any issues, but I'm concerned that if I did the full 10km, it would aggravate it even more.

Obs and Gynae rotation is going far better than expected, and I am really enjoying it. Apart from nearly fainting during my first caesarian and being chased out of the theatre by an overly aggressive nurse before the second one could start, the experiences have been positive.

I don't think I could work in that area, as I would be so very concerned for the mothers and babies, but it is a fantastic area to do a student placement in. The vast majority of patients have happy outcomes, and I get to see a lot of babies and pregnant ladies, both of whom I really enjoy spending time with.

Mr TGWTBS is also away for work for a great many weeks, so I'm grateful for long days. I really don't like being home alone, and as much fun as the cats are, they aren't the same as human company. Intern applications are also coming up, so I'm stressed about that as well.

What are the healthy ways for a medical student (or anybody) to cope with stress? Exercise. Find positive and fun active things to do in your down time. Plan out your day. Minimise the stress by delegating the things you don't have to do. Laugh. I know it all in theory, now to put it all into practice.

Rotation 2 - done!

I'm glad the last rotation is over.

I didn't mind the individual areas, but mixing them up like that with no particular goal in mind was very tiring.

Now we have a week of holidays, and Mr TGWTBS and I are flying off to the tropics for a week at the beach. I'm very excited. :D

My next rotation will involve catching babies, and I'm looking forward to it.

I have also confirmed my elective placements for the end of the year, which should give me a much clearer idea of what I want to do. Half will be in radiology, the other half in psychiatry.

Better

Today was brilliant, and made up for the rest of the week. I got the chance to do a lot of things. I need to work on a lot of skills if I want to be proficient in certain things, but as I am unlikely to be an anaesthetist (or ICU specialist or ED physician), these aren't vital to my future career.

I'm grateful for the chance to have a go at improving these skills, and grab the chance when I can get it. God knows when I will need to use the in the future, and I would prefer to be as skilled as I can.

Running also helps clear out the cobwebs. I am not physically tired, and it is fascinating that when you go for a run, the mental exhaustion just clears away.

The remaining days aren't looking so bad, after all.

Enough, already

I am so exhausted right now. I feel like I just want to lie down and sleep for months.

I am happiest when I'm busy and have a list of things to do, but right now I just get to sit back and watch the anaesthetist do most things, and when the surgery is happening, I am pretty much watching somebody watch somebody else, which is the most exhausting kind of watching of all.

I would jump in and assist the surgeon, except there are third-year medical students on prac who should be doing it before me.

I would jump in and help intubate or put lines in, except there is a paramedic student there who takes precedence. I can sort-of see the point of this, except she is only in her second year out of four and is not very keen to touch a real patient, and I am in my last year and almost a doctor and will be expected to be able to be competent at managing airways in six months. Sorry, please forgive my frustration.

We are in the last week of an eight week rotation, in which we have been changing areas every week or two. This is thoroughly exhausting, as we have very little idea of what we are supposed to be doing apart from turning up every day. There are no lectures, the only teaching we get is from the staff we are working with on the day, and to be honest it feels like such a token exercise, which is a bit of a concern considering that this is the only critical care rotation that we get all year.

I would love to go to a lecture or three rather than take myself through a set of slides that may or may not have anything to do with what I am learning. I don't deal well with not having goals. I am very goal-centered.

Three more days, then I go on holidays, and then I have my Obs&Gynae rotation. I am looking forward to digging into this rotation, figuratively speaking. Bring on the babies!

The dreaded lurgy

There really isn't a lot to talk about medicine-wise, except that I have managed to catch an URTI from the doctors. I'm not sure which doctor, as they were all coming into work as sick as dogs (which doctors are pretty much expected to do). I have taken a little time off to get well.

Normally I push myself to go in and then have to pike after a couple of hours, but I am making myself stay home and rest for a day or so in the hope that I will get over this silly thing faster.

The really sad thing is that I am going to have to miss the 8km Mother's Day Classic fun run. :( Oh well.

Randomness

Benicio del Toro: making me want to eat an icecream that I would never normally touch.

Whatever they paid him, Bryan Singer and that girl for that Magnum ad, it is worth it.

If only it were in stock at my local bogan Coles, all would be well with the world.

Hell, there is nothing wrong with eating half of it and putting it back in the freezer, right?

ICU 1

Everything is going to plan and fourth year is grinding along, managing to pass with painful slowness and terrifying speed all at the same time.

I have been on my ICU rotation for a couple of weeks. It is an interesting but difficult rotation. I have always been fine working in ICU as a radiographer. You do a mobile x-ray round, come up a few times during the day and that is it.

However, as a medical student I don't entirely feel comfortable and it has taken me a little while to work out the reason for this. As a person I like to talk to the patients I work with, communicate well with them and hear what they have to say.

A lot of the time in ICU, unless you are in extreme amounts of pain or having great difficulty, the doctor doesn't want to have an in-depth conversation with you because they are too busy and focusing on the machines around you and your body to actually have a chat about the mundane things that you probably focus on just to get by.

Many of the patients have taken neurological damage and they keep asking for the same things again and again, and so the nursing staff don't communicate with them very well, either - particularly the difficult patients.

I'm not saying that they should. If they sat and listened to everything the patient was asking for, nothing would get done and the patient would suffer. I just find it to be a shift in viewpoint to not be listening, and I'm not comfortable with it.

Some of the patients are very difficult to deal with. There are patients with pre-existing personality or mental health issues who are going through a hell of a lot of pain and fear, and regularly act aggressive and abusive to the nursing and medical staff. There are patients who have suffered brain damage and have difficulty communicating, and spend a lot of the day being inappropriate or asking for things that they can't have, or even things that the nurse is in the middle of giving them.

Medically it is fascinating, if a bit scary. I'm learning quite a bit about the extremes of illness.

There are also a lot of family meetings, which must be very difficult for everybody involved.

Mostly I'm tired of this year, of being a student and of not being able to settle and get to be good (or at least competent) at something before having to move on again. Almost there.

Spinach: the multi-purpose food

Good for eating AND good for applying to sore lower legs as an improvised ice-pack!

I have also decided that you can't say you are into running training until you have your first real chafing experience.

There aren't photos. I wouldn't do that to you.

Let's just say that I am in love with band-aids that can be cut to an appropriate size, and have also invested in some anti-chafe stuff.

ENT and a long story, old-timer-style

We have spent this week in ENT. It has been interesting, and the staff are really nice and keen to teach.

This is fortunate, as it isn't really an area that I'm interested in, and I am feeling like I'm disinterested in all things study-related right now. You know how it is - some weeks you feel like hitting the books, other weeks you open a book and close it again and walk away.

I also have a couple of weaknesses in medicine - one is the neck area, the other is phlegm/drool, and ENT is filled to the brim with both things. I haven't actually dry-retched yet, which is nice, and I tend to feel really bad for the patients. Seeing something that you aren't comfortable withon somebody else is nothing compared to having that actually be something that you have to go through yourself.

The nice thing is that I am getting my elective organised. I'm going to do the whole thing in psychiatry, since in the last month or so I have settled firmly on pursuing it as a career. It really feels like the right decision, and I'm entirely comfortable with it.

I can't afford to go overseas for the elective, and just about everybody else around me is organising overseas electives and flying around the globe, which makes me a little sad and jealous from time to time, but that is how life is. I hope medical students realise just how privileged we are as a group. When I did radiography it was a big thing for somebody to go interstate for elective. Medicine is another world entirely.

People are really well-off, but I don't think they realise it, because they study next to other people who fly overseas for skiing holidays on a regular basis, whose parents own massive mansions and have actually bought them accommodation to stay in that is close to where they are studying. They don't really flaunt it, it is just there, unstated. I'm not really close to these people, and I don't get asked to go on their jaunts, which is probably a good thing. I don't fit in as one of the rich kids, and I'm glad. Everything I have, I have earned though my own blood, sweat and tears, and even if I don't have as much, I am bloody proud of what I have achieved.

I'm not saying that these aren't nice people - some of them are, some of them aren't, just like the rest of society. Some of those who travel overseas regularly are lovely people, and a lot of my close friends are going overseas for elective, and I care for them a lot. It is just a different perspective to mine. Perhaps it is even a generational thing, or a personality thing.

Sometimes I really wonder how I got to be in the middle of a group of people who don't even blink at buying tickets for a quick one week overseas holiday. I have never been in that place. I think that it probably has to do with growing up without much. When we flew, we did so for free in the back of a RAAF Hercules (cargo plane), sitting sideways on canvas seating that were less comfortable than your average canvas deck chair, with industrial ear covers on to protect our hearing for the entire flight.

There was no food, and in-flight entertainment consisted of trying to read whatever you could while the plane shuddered, and attempting to not be airsick. The first time I went on a proper commercial plane, I was confused because we didn't have to wear ear protection. I kept expecting the flight attendants to hand out earplugs, at the very least. The fact that they wore makeup and dresses also confused me as I had only seen this on the TV before.

Dad was in the Royal Australian Air Force as a fitter and turner, which explains the free flights in the belly of a plane that travels at half the speed of a standard commercial flight, and Mum worked occasionally as a supply teacher. We lived in Housing Commision houses, generally in areas that were set aside for defense force personnel, but often side-by-side with the other families who qualified for free government housing. The neighbourhoods were not the poorest in town, but weren't far off it. Once we even rented furniture because the regular stuff was in storage far, far away, for safe-keeping. You got a little bit of assistance with moving and so on in those days, but nowhere near as much as they get now. As a RAAF kid, and somebody who didn't live in the nicest area of town, it was often harder to fit in. I still have a massive chip on my shoulder, and tend to be quite sensitive sometimes if I think that I'm being slighted or rejected by people I want to be my friends. Meh.

I know that some of this may reek of the old-timers telling stories of how "when I grew up, I was so poor that we had to paint our feet instead of wearing shoes!", but in a way it is also fascinating and entirely different.

People compare notes about which medical specialty earns the most, and some even target their careers towards the specialty which would give them the lifestyle that they want. When I was a radiographer, I was earning more than my parents ever did. We are comfortable at the moment, even without me working, and even without being able to fly overseas for electives/holidays.

(We are going to Hamilton Island for a week in the middle of this year because we got REALLY cheap flights and have organised some reasonable accommodation, and I saved quite a bit after working over Christmas.) Choosing a specialty based on money has never even occured to me, as no matter what I choose, I'll be earning far more than I could imagine when I was a radiographer. If I even complain about how "little" I earn, please slap me. Clearly I would have lost perspective.

Life and family can make you smile

My Nanna has advancing dementia.

My brother is a smart-arse.

When you put the two together at a social functions, snippets of the conversation run as follows:

Nanna: "I have never seen bread rolls that huge before!"

Brother: "Well, you have obviously never been to Paris!"

Neither of them have been to Paris.

And the bread rolls were not that huge.

More running

I ran over 26km on this four day weekend. I did one long run and two easy runs, and one of what was pretty much a pacing run.

The good news is that I'm getting faster. The bad news is that I'm still slow. I'm getting down to 6:30min per km, which is slow in the scheme of things but a lot faster for me. When I could run for 5km non-stop, I started in the high 7's. I could cut another 30 seconds off that for a few minutes, and hopefully I'll be at that point in a month or so when I get my fitness up and some more strength in my legs.

My aim for this year is to run a 10km race in under 1 hour. When I get to that point, I'll enter a half-marathon and see how it goes (after appropriate training, of course!).

I would love a pair of those awesome strong runners legs, with decent calf muscles. I have always had wimpy legs. Maybe Santa will have brought me a pair by Christmas this year. ;)

April Fool's Day

I was tempted to try an April Fool's prank on Mr TGWTBS this morning.

All I could think of was telling him that I'm pregnant (I'm not).

Then I thought, if I told him this and then he was happy, I would have to tell him that I wasn't, and if he was disappointed that would just feel mean.

I'm no good at lying. I had to settle for telling him the plan and not trying to make the prank work.

What a wimp! :P

Wading through mud

Ophthalmology - not the biggest fan.

I like tinkering with the toys and examining the patients, but I'm not so enamored with it that I like sitting down and studying for an exam over a few days, when the exam is supposed to cover just about the entire textbook and we have only been doing the rotation for a week and a half.

Meh. I'm not upset, surprised or protesting. I'm just bored.

The running is going well, and keeping me sane. It is also helping with the fact that I am eating chocolate more because I'm not at the hospital all day long. Mmm, chocolate.

This is one of the first Easters in a long time that I haven't been vegan. I walk into the chocolate aisle and know that I can eat any and all of it, and it blows my mind. Joy! It is probably just as well that I am running. ;)

Twilight 10k

I ran my first proper 10k on Sunday night. It was the Twilight Running Festival (nothing to do with sparkly vampire-wannabes) and was along the river as the sun set.

It was humid but pleasant (mid-20s), and the atmosphere was amazing. There were teams manning the water stations and cheering everybody on, and they all wore costumes.

People whose homes were along the route put their chairs out on their front lawns to watch and cheer.

Some nice family put a sprinkler onto the road so that runners in both directions were sprayed and cooled down. The run was a circuit, and I am still quite slow, so at the end I was overtaken by the leaders of the half-marathon, who were running 21k rather than 10k. They absolutely fly along! I will never be that fast, but one day I won't be overtaken by the end of my race. ;)

The face finished on the athletics track under the stadium lights, and there were people milling around everywhere and cheering the finishers on. It was a wonderful feeling to be cheered by people who had finished the race and other supporters. I indulged in many fist-pumps as I did the final lap and when I crossed the finish line, I had both arms in the air.

I was so high and felt wonderful for hours afterwards. I had never run 10k before, even in training, so I didn't know if I could do it, but I managed it at the same pace that I do 5k, so I was ecstatic.

It is quite a funny thing. I gave up alcohol for Febfast, and haven't started again. I have taken up running and doing quite a few fun runs, and with the weight loss and feeling better in the mornings and more alert when I go out socially, I'm not inclined to start drinking again.

It is easy to say no to a drink when you have a big run the next morning or the morning after that.

Anyway, I am following a training plan courtesy of Run Coach on my iPhone, and am training to be at peak for the 10,000m at Doomben on the 6th of June on the same day as the Queensland Half Marathon. There are other races that I'll be doing before and after then, but that is the one I'll be aiming to improve my time.

After that, the next goal for improvement will be the Bridge to Brisbane on the 29th of August.

It is really nice to have found something that I am REALLY getting into that is healthy and gets me away from medicine. I'm loving it. :)

More on the Boots of Doom

I have been stomping around town in my Boots of Stomping and Crushing.

They are entirely too fun. I suspect I will own another pair by the middle of the year, particularly as it is my birthday in May.

It is so nice having a week off. I worked during my holidays over Christmas, so now I get the time to do the things that I didn't get around to doing then.

I have given blood today. It is a donation in Australia (you don't get paid), and they give you a free cuppa and some chocolate. The new centre I visited is pretty swanky - they even had little sausage rolls and a fancy dishwasher for the volunteer to clean the cups in.

I am also doing other fun things like getting the car serviced and going to the dentist. I haven't been to the dentist since first year, and then tend to call me every six months to try to get me in for a check-up. Life has been getting in the way.

The last time I went I had a very small filling. It was so small that I didn't have any anaesthetic, as the injection would have hurt and been more annoying than the filling process itself. I feel terribly hardcore and awesome about not getting a needle for my filling - some days you need something to be proud of, right? ;)

Anyway, this is a fun week.

The Day My Brain Exploded. Again.

The super-sized 43st mother who is determined to become the world's fattest woman

There are days when I really wonder about our western society.

Clearly we live in an extremely liberal and wealthy society. This woman is intent on intentionally and consciously self-harming until she destroys herself. Yet we will let her do so.

She is clearly deluded as she thinks that she is healthy, although she is unable to walk 7m, yet we will leave her go on her merry way, as she has the right to her own opinion. When do we stop calling something an opinion and start calling it a delusion?

People will pay her money on the internet so that she can consume 12 000 calories a day in food, when people in the same country do not have enough to eat. The same people will not give money to charities that feed the starving.

Australia is not very far behind the USA in this madness.

What are we to do?

I am not a fat-hater. But this isn't fat. This is 'bariatric'. Intentional and conscious morbid obesity.

She isn't just having a problem maintaining a healthy lifestyle and getting enough exercise. I have a lot of empathy and compassion for people who have difficulty losing weight. It is something that we all struggle with. But this is different.

It is like having somebody sitting proudly on a couch and declaring that they are going to drink themselves to death. That isn't a choice we would accept as valid. We question the number of drinks that people have each day in a medical interview, but we don't question the number of calories or meals that people consume.

When does your life get so bad that you have to destroy yourself to feel good?

Ladies like this on You-tube just make me sad - I really feel for her, as she is trapped in a bad, bad place. She has insight into her problem, and it is a heartbreaking video.

It is the woman in the initial story who makes my brain explode - boldly declaring her conscious intention to make herself a cripple and die an early death. It isn't just about the food and filling a hole. It is about the weight, and to me that is a fundamental difference.

Boots of Stomping and Crushing!

Yes, I went shoe shopping this morning.

We went to the store that sold the Dr Martens, but they didn't have a huge range. The Mary-Janes were okay but they didn't have them in my size, so I went with the Boots of Stomping and Crushing and Other Fun Things.

For some reason, buying them in cherry red seemed more girly than in the black. I wore them all afternoon and they are really very comfortable, plus I can Stomp people and look like I mean it. ;)

If I love them enough, I may just get another pair in a different pattern now that I know my size.

For bonus points (or the status of geek extraordinaire), name the monster I am crushing and the computer game it comes from. :P

Exams and Shoes and Empty Thoughts

The Exam went as well as was expected.

I'm not sure whether it was because I finished last year on Surgery rotation, which had notoriously difficult exams, or whether this exam was designed for everybody semi-competent to pass, but it was not bad at all.

Honestly, I think it was a bit of both. Some of the questions were so easy that it was shocking. Of course nobody is complaining. We have been through too much in the past few years to look a gift horse in the mouth.

My registrars questioned me a lot during this rotation (I didn't mind), and it REALLY paid off during the exam. I knew things about areas that I hadn't covered on this rotation because they asked me about things outside of the area that we were working in. I felt very lucky to land in such a helpful, proactive team.

I did not buy a pair of stomping shoes just yet. I'm contemplating buying a pair of Docs (then I can rename my blog Doc in Docs after I graduage - bwahahaha, that is awful!) but don't know if I can go that far into the realm of Stomping shoes. I love pretty shoes, but they keep falling apart, and Docs would be so much sturdier and comfortable.

What do you think? Perhaps I should buy a pair with flowers all over them - that would be more feminine, right? ;)

I also think that today will involve cooking. I haven't made a good old-fashioned spaghetti-bolognese in a while, but I have all of the ingredients in the fridge right now (apart from the mince, which isn't hard to procure). Tonight will be a little cool, so it will be a good evening for spag bog and a movie! Normally it would also involve a glass of wine, but I haven't touched a drop since FebFast, and am feeling great. The wine will have to go into the spag bog instead.

I would like to imagine that the lack of alcohol made this exam ridiculously easy for me, but then that would just be deluded. ;)

Stomper

One more hurdle and then I am finished with the first rotation of fourth year - The Exam.

If it weren't for the excitement over what this exam means in relation to my planned escape from medical school, it would not warrant the capital letters. You see, it is an exam that is about anything and everything, and thus it is almost impossible to "study" for. Thus, we are all experiencing Learned Helplessness and are suitably apathetic. I am more nervous about the drive in the morning traffic than the exam itself.

The learning has happened over the last three and a bit years (including all of the seemingly random cellular physiology from first year) and if it isn't in our heads now, then we won't know it.

My main aim on this rotation was to focus on the things that will make me a safe and competent intern. I think I have achieved this as much as possible given the circumstances. If I happen to pass the exam (which is fairly likely, unless they happen to base the whole thing around the fine details of the krebs cycle) I will be happy.

I have the afternoon off, which is something I am very excited about. The afternoon may involve shoe shopping. They will be Sensible shoes, particularly because I have managed to demolish three pairs on this rotation by wearing out and detaching the soles. The new shoes will be solid and suitable for stomping. Solid stomping shoes don't lose their soles after 8 weeks of walking.

So here is to finishing the first rotation of year four, and new Stomping shoes!