One down, three more to go

Just decided to pop back in, as I've just finished my cardiology rotation. The past six weeks have, in general, been pretty awesome, but it is interesting to see how people progress throughout the rotation.

As somewhat expected, towards the end of the rotation, people started doing things less. The number of students attending the morning 8am handover meetings steadily decreased. The number of students going home at 1pm (or earlier) steadily increased. And yet I soldier on. Woo, go me.

Cannulations are still tricky, my histories and examinations still aren't perfect, and sure, I don't think I'm ace at cardio now - but I've been encouraged by my supervising doctors, who have been brilliant in doing what they do and trying to accommodate us at the same time. Although we are exhorted to be part of the team and thus help the team, we're still a hindrance in terms of time - except when we do discharge summaries, which I actually haven't done since the fourth week, thanks to a very efficient resident that joined our team.

Whilst I'm here, for those who haven't got a clue as to who's who, here's a brief glossary of people you see in the hospital:

Intern - Post-graduate year 1 (PGY1) - they know the practicalities of being a doctor but definitely still need to be supervised. We actually didn't have an intern during our rotation.

Resident - PGY2 and above, aka RMO/MO (for Medical Officer) - good people to hang around, as they teach you many things.

Registrar - PGY3+, in a training program to become a specialist. These can actually be really great resources as well - the registrars I've come across have inspired and taught me a great deal. They're also quite up to date with details, seeing as they have to study for exams.

Consultant - completed fellowship of a post-graduate college; if they're not a staff specialist (i.e. employed by the hospital on a full-time basis) then you see them quite sporadically.

Nurses - come in a multitude of flavours; you'll mostly come across enrolled nurses (EN) and registered nurses (RN), as well as some clinical nurse specialists (CNC) and some nurse educators. They run the wards, love to let you try your hand at cannulas.

Allied Health - physios, OT (occupational therapists), speech therapists, social workers, pharmacists, dietitians - they're the main allied health professions on the ward and you see them very frequently. Important people, especially when aiming to discharge patients - which seems to be the main goal of the hospital.

Others - there's a number of other people, such as the ward clerks, jan itors, and of course the support staff at Blacktown Clinical School. Love those people ;)

So I'm heading off to my second rotation in Endocrinology/Geriatrics, they seem to be a lot busier than Cardiology, so I may not post back until the end of that. Meanwhile, apparently everyone has exams around this period - I would like to take this opportunity to say "SUCK IT!" - it's a rare occasion when medicine is able to trump other courses on workload, so I savour every opportunity that comes along.

On that note, I would like to reflect on something that's popped up quite a lot. There's obviously a great number of med hopefuls around Australia and even abroad, looking to study in Australia as a medical student. Over the last month or so, I've noticed a couple of situations where doctors begin to stress and agitate over the workload, physically and mentally, placed upon them. These are invariably the junior doctors (interns and MOs); we don't see enough of the consultants to observe anything like that (and anyhow, they've reached the end of the tunnel and are out the other side), and the registrars seem to be somehow dealing with it okay. However, to see the junior doctors with a vacated expression during a half hour lunch break, or to break down during ward rounds, or become frustrated with a difficult patient - I mean, we know it's not an easy profession to go into, but it still hits me hard. The overwhelming sense of everything crashing down upon you is something I've personally only experienced very rarely, and I don't wish it upon anyone, yet in the short space of a month I've already witnessed this. Support services for junior doctors are certainly an important aspect in this, but I don't expect that even brilliant support and continuous lobbying will stop these incidents from happening, it appears to be a part of the workforce - a 'just live with it' attitude. This is happening in a country where our health system is comparatively tame and standards, thanks to bodies such as the AMA, have been established to prevent burnout and, worse, mistakes being made - what about doctors in countries that aren't in these situations? The overseas-trained doctors that I've talked to all mention how Australia has beyond world-class standards for working hours and conditions of junior doctors - which makes me think what world-class actually means.

I'm no specialist in these kind of issues, so I don't really want to say anything more about this, but just thought I'd share this with people. A number of med hopefuls may also be members of forums or have talked to doctors, and have wondered, maybe, if the negativism that sometimes exudes from others stems from trying to prevent people from trying out to get into medicine and basically being self-serving by making out doctors to be messiahs and self-sacrificing members of society, of which no other profession comes close. I believe that it's not - it's out of a wish to open the eyes of those who have not had experience, and not to dissuade them, but, in some way, to encourage those who enter medicine to strive and work for what they believe in. To walk into medicine, knowing that these things exist, makes for a better student and a better doctor, and a better person, as objectiveness allows people to prepare for situations and make the best hand out of the cards they're dealt. I also want to say that this is not unique to medicine - I met recent law graduates who are undergoing the same thing; and in fact, worse - the attitude and culture is exactly the same; live with it. I've heard the same for business and finance as well - and especially important is the difficulty in hunting and securing that first job, which we thankfully do not have to worry about much.

So, we who are not working - enjoy, savour, treasure the time we have as students. For those who are living with parents, enjoy the fact that you only contribute partly (or, even not at all, as I did for the last couple of decades, I will admit) to the running of the household. Procrastination is fine, but use this time to grow in other aspects, find out where you want to go and what you plan to do, and be hungry to learn, not just the contents of your course, but skills and abilities that you want to pursue - because there is no better place or time to do it, than now.

And with that, I shall head off to bed - off to another rotation, and looking forward to it, the experiences and relationships with patients and staff I will soon acquire, whatever it may bring :)

P.S: The experiences I've mentioned do not happen every single day. Nor to every single doctor. In addition, everyone else is not immune - although I've yet to see anyone else besides the doctors in emotionally charged situations, possibly because I'm following the doctors around. And yes, they're true, I'm not exaggerating.

Life is moving at a fast pace...

As we reach the half-way point of the first semester of year two, I'm starting to feel a little overwhelmed by the amount of effort required to do well in Medicine. I know that the upcoming years will be tougher than this year, with a full-time 9-5, 5 days a week attachment and intense Conference weeks filled with lectures, I can't help but feel a bit apprehensive that if I'm lagging behind now, I will be lagging behind in future years. In the space of eight rather short weeks (in my opinion, they flew by pretty fast), we have covered both renal and musculoskeletal systems. At the moment, my knowledge on musculoskeletal is close to nil, and I'm brushing up on my renal block now; and to help things, we just started neurology. I guess it's just a tiny worry, but it's a worry nonetheless, and I guess I've just got to keep at it. Good thing I'm finding all of this interesting (well, maybe not the renal), but still, it's a heck of a lot to keep track of - indeed, I didn't expect musculoskeletal being only three weeks in length; there's so many tendons, muscles, parts of the bone and functions of the whole system to learn! I'm glad we have mid-sem breaks not combined with Easter (that gives us, effectively, an extra day), and we don't have any mid-sem exams (definitely felt good last week walking around the university and seeing everyone heads-down).

I think that me and my mates playing Starcraft at every break is hardly helping the issue either. Or that we now have a Starcraft club. Oh what have I got into...

So Tired...

I thought I'd name some of my posts in honour of several of our PBL cases. So this one's an appropriate one to start off with. PPD today - a 3rd party recollection and informal presentation based on our patient barriers to care interview - was alright. It kind of killed the mood for the day though - 2 hours listening to person after person speak; it was HSC English speeches all over again, except a little bit more interesting, haha. I did concentrate though, which may or may not have been the right thing to do, as I was phased out for the rest of the day (it was first thing in the morning). I think our PPD tutor is getting better (obviously, no names); he genuinely does care, although presenting with a few rather conflicting ideas. Our next two sessions are all going to be about talking about ourselves. And our life experiences. YAY...
I've found that taking a few lectures off and a friday PBL session really knocks you back hard in terms of keeping up with what's happening. Everyone is talking about the cardiac cycle this week, and I feel that I don't really understand them. I'm not exactly a model student, but I do make a serious effort (this is medicine after all) - this kind of thing worries me; not because of whether I'll do good in an exam or not, but rather just the feeling of inadequacy. I guess one gets used to it as the entire field is littered with over-achievers; but still, it is nice to feel like you know something.
ICM though was once again as interesting as always. We had a patient with an arteriovenous (i.e. arteries and veins) fistula (a bulge or protrusion) in his wrist; the turbulence in the vessels was so noticeable, both via a stethoscope and by simply resting one's fingers on the area. We started the cardiovascular system exam; I do feel like we're making serious progress in ICM, with the abdominal exam out of the way in just a few weeks, cardiovascular for these few weeks, and probably respiratory in the weeks to come before our big OSCE (clinical examinations). ARGGGH SCARY
It's before our theoretical exams, in October. So close. Yikes.

The leg bone's connected to the thigh bone...

A 2-hour anatomy practical really doesn't get you into the mood for a 2-hour statistics lesson (Yes, Statistics, you may be thinking wtf? in Medicine, but believe me it has it's purposes) straight afterwards. Add to that a lecture in the afternoon (which half the grade dozed off in) and I think Wednesday was a pretty long day...

I actually enjoy anatomy, to be honest; it's wonderful to know where everything's connected (actually we were looking at the abdomen this week, not the leg as the title so subtly implied), and wonderful to have some really great teachers of anatomy (we have this fairly old surgeon who's awesome at teaching, I think everything he taught went right into my head and displaced something else), and the cadavers themselves were (today, at least) far from obese, which was nice. It's just that learning anatomy, for me at least, requires intense concentration, somewhat alike to playing chess. Although I've played a four-hour chess game, a 2-hour anatomy prac seems just that much more tiring and satisfactory. So all that intense concentration took me right out of the zone when we started on database analysis in Statistics. *zzzz*

And oh dear, my computer just restarted after Automatic Updates. Thank heavens for Blogger's autosaving of drafts ^^

We were also meant to do our 'Interviewing of a Patient' (not official name) assignment, our first one so far (Yes, come to UWS if you don't like assignments!) yesterday. This is part of our PPD segment in the course, and the aim of this particular assignment is to interview a patient and give a recount of his/her experience, and empathise with the patient via means of a written response and a presentation. Our patient had his son come over to visit him, so he was busy, and as such we decided to reschedule the meeting, probably to next Wednesday. It's quite nice to have friends that can drive; Camden isn't exactly the most accessible place via public transport.
We were about to skip our last lecture so we could interview our patient, but since that didn't go to plan, we had the enormous privilege of dozing off through our lecture; I think I should go and look at the lecture notes/synopsis now. And probably revise anatomy... and probably write up my clinical ICM notes...and probably revise the statistics stuff as well... arggh.

Ah, no uni today...

This medicine degree, in terms of contact hours (i.e. hours spent at uni or hospital), is pretty easy-going, when I think about it. Contrary to popular belief, we have close to 1 and a half days off - Tuesday is my clinical day (1.5 hours, so that counts as half), and Thursday is my 'off' day. It's kind of pleasant to have all this time to manage yourself, although it presents a great danger in that I more-or-less don't fully utilise this time off. Although I love this self-directed style of learning, because I never really was the kind that did well with 'spoon-feeding' (I think that's a pretty derogatory name for rote-learning, but anyhow), the week always ends up with Thursday being used for half-playing and half-studying, whilst the rest of the week was mostly unremarkable in terms of productivity. From my fellow cohorts collective responses, it seems like this is the case with more than just a few people as well, so I wonder how our time could be best utilised...
So this week we're dealing with starvation (more specifically, a 40 day fast due to being caught in a blizzard 4000m above sea level in Nepal) and I've got a heck of a lot to do, hence I'll be off now.

Laziness

Even though most of the content in Medicine is really interesting, there are times, like today, where I can't seem to do any work. And it annoys me because I'm trying to read a textbook or something productive, but I don't concentrate because I'm not in the studying zone. Or a gaming zone. Or anything-at-all zone, really; it feels like a do-nothing-cause-I-can't-do-anything-else day. All the while it's paining me that I could be using this time to work towards something, anything.
*yawn*
I also tutor high school students in my subject of interest, Software (SDD), for HSC. To be frank, tutoring has nil impact on my study situation at the moment (which I think is ok compared to my HSC, but still dismal), and I tutor... 7 hours a week. So it seems like its more than doable to hold a job whilst studying Medicine.

I'd like to comment on Medicine's workload so far - and it's lived up to the expectations in terms of the amount of content covered, but also the relative ease of the content, versus some really brain-boggling stuff my friends are dealing with in Law, Computer Science and Engineering. The exception to this is probably the huge mechanisms for things like the Kreb's Cycle (google or wiki for the goodness of this 8-step cycle taking place in the mitochondria of a cell) and the biochemistry; and perhaps some pharmacology, but the rest is pretty easy to digest. It's also possible, at the moment, to only do 4-5 hours of week per week and still manage to get by, by simply using the time at university productively (I'm doing about an hour a day, which is pretty low methinks - aiming to obviously ramp it up a bit). I'm certain both the difficulty and quantity of Medicine would increase, mainly the latter. It's all just a matter of keeping up with the program though, and you're in no danger of having no time for a social life in your med student years. The future, however, is a little less uncertain...