Summer Holiday!

Well, after nine months of panic, pressure and procrastination, I have finally completed my first year at medical school. It seems an age ago that I stepped into the department for the first time, years since those introductory lectures on biochemistry and protein formation. And yet, it also feels as though no time has passed at all; the year seems to have gone past in a heartbeat. I know so much more than I did this time last year; however, I am aware that in the scheme of things, I know less than nothing.

There have been times where I have questioned my motivations for doing this difficult degree (mostly during anatomy class - still my least favourite subject), but on the whole I am still excited and enthused about the challenges that lie ahead, the new and fascinating things to learn. Year two is very similar to year one - we still have anatomy classes, and spend almost all of our time in lectures, although we do have Basic Clinical Skills to look forward to, as well our Selected Study Component, in which we study our choice of projects. Unlike the first two terms, we are now looking at medicine in a systematic way - we have already looked at the cardiovascular system and the musculoskeletal system. Next year, we'll be learning about the respiratory system, the endocrine and reproductive system, the GI system, the renal system and the nervous system. After year two, we become more like apprentices, spending more of our time learning clinical skills and spending time in placement.

I have spent the last six weeks being utterly sick of medicine, stressed and tired. Now, I can't wait for the first of October, when the lectures start again.

This will be the final week of lectures for the year; I can't believe how quickly it's gone. Of course, there are exams to go, obviously (there are always more exams), but it still feels like yesterday that I was walking into the medical school for the first time. I remember it so vividly; I was listening to The Fray's 'How to Save a Life,' on my iPOD, and felt my eyes welling up with tears as I walked in, feeling like I had reached the end of a long and difficult journey... only to realise I had walked into the engineering building by mistake, prompting one swift about face and two red cheeks.

While I'm amazed at how much I've learned in one meagre academic year, this year has really served to show me how great my ignorance is. I can see now why medics and doctors are constantly being examined - it is such a vast subject which is constantly evolving and changing, and ignorance is not acceptable. It is a huge responsibility and I am only just beginning to realise the necessity of keeping it highly regulated.

As I suspected, I will have one resit in July, although thankfully it is for a subject that I didn't really study for in the holiday; there are lots of people on my year who failed exams that they worked very hard for, and I think that must be so much worse. While initially I was absolutely gutted to have failed an exam, I am also learning to give myself a break; my background in English, not science, and I hadn't done any for five years when I began the course. I managed to pass all of my science-based exams, when many of my peers didn't; for me, that is still a great achievement, and I should feel proud of what I have accomplished.

I still feel like a fraud here, and even if I pass my resit and make it back for next year I suspect I still will; however, I think I will try to enjoy the ride a little more from now on; after all, there's still four years to go...

The Waiting Game

The exams are done; I am about 99.8% sure that I failed at least one of them, but I won't find out if this is actually the case until the end of May. This is unfortunate for my sanity, as I'm finding it very difficult to stop worrying about it and focus on the task at hand. To further add to my concerns, I managed to wheedle out of the office staff that 16 people so far have failed this particular exam, so my fears are only exacerbated. For every exam failed, we are allowed one resit, and that is all; after that, we're out.

We have already begun learning the new material; it is much more clinically focussed than what we were learning before the exam, but unfortunately it is much more difficult. The cardiovascular system is a truly fascinating one, but much more complex than basic metabolism. My new lecturer is totally amazing, though, and makes all of his lectures absolutely fascinating; I am much more inclined to get up in the mornings, knowing he is going to be instructing me!

The pressure of the new work, combined with the anxiety of the imminent exams results have led me to the discovery that actually, despite being a mature student, I am not coping very well with the stress, and it is affecting me in ways which I never thought it would. I am much more abrupt that usual, and far more irritable. For example, as I write this, I am irrationally angry that my lecturers do not use full sentences in their notes, so I am forced to re-write everything. It is a terrible thing to reach the age of 24 and realise that you have no idea how to handle stress.

Race Against Time

My exams start on Monday. Unlike January's exams, these are important, and if I fail any, I have only one chance to resit. Should I fail on the resit, I will be made to withdraw from the course. I have five exams from Monday to Friday, and my list of subjects to study is:

Embryology
Membranes and Cell Structure
Physiology
Metabolism and Homeostasis
Pharmacology
Molecular Genetics and disorders
Pathology and Immunology
Cancer Biology
Society, Health and Medicine
Medical Ethics
Whole Person Care
Epidemiology
Anatomy
Histology

So, to summate: 15 subjects, 5 exams, and 1 tiny, tiny brain already filled to capacity. I feel like every time I speak, or think about something else, my brain leaks information. Don't ask me about the nightmares. See you on the other side.

What If?

This is an essay which I am entering for a competition, entitled 'What If.' Participants were asked to consider what their lives would be like if they hadn't made the choices in medicine that they have. Enjoy!

What If?

When I was 21, and in my final year of my English degree, a man in his sixties collapsed with cardiac and respiratory failure in the shopping centre where I worked. Without hesitation, I began to perform CPR until the paramedics arrived. It was a strange place to have an epiphany, but, as I tilted back the man’s head and began to breathe for him, for the first time in my life, I realised what I should be spending it doing.
After completing my degree, the thought of studying medicine never left me, but, not having the means to put myself through university a second time, I tried to forget about it and embark on another career that satisfied me. However, after a year, I still could not lay the dream of becoming a doctor to rest, and I made a daunting decision: I left my job to do work experience, and sold my flat in order to finance myself through university. Getting into medical school with an arts degree was not easy, and initially I was not successful; happily, in August, a university offered me a place, and I began the course.
While I enjoy the rigours of the course, there are moments when I wonder what my life would be like if I hadn’t applied for medicine. I see an office job in publishing, or maybe advertising. There are occasional holidays to Italy and France, and eventually, a small two-bedroom semi-detached in the suburbs. I see dinner parties with port nightcaps, and brunches in delis on Saturday mornings. I see pencil skirt suits, and cashmere jumpers, and more shoes than will easily fit in my wardrobe. There are dinners of risotto with asparagus and Parma ham, tomatoes on the vine, roasted with a little olive oil and served with cool mozzarella cheese. I see lazy afternoons spent walking in the park after a Sunday roast, and evenings spent curled up on the sofa with a glass of full-bodied, ruby red Zinfandel, perusing perhaps, the latest edition of Elle magazine.
These days, toast and breakfast cereal have encroached upon most of my meals, and delis are now the enemy, since I can’t afford even a small jar of sun-dried tomatoes. My 2’6” bed takes up the majority of my room, which is more fittingly described as ‘draughty shoebox,’ and sharing a kitchen with ten other students has provided an introduction to microbiology earlier than anticipated. My budget for shoes has decreased dramatically, with my cherished pair of Converse trainers finally succumbing to two terms’ near-constant wear and unravelling at the seams. Jumpers are infinitely more likely to have been made from the fleece of the acrylic sheep than they are to have come from any actual animals. Purchases of glossy magazines have also been severely curtailed, and evenings are usually spent staring at textbooks and writing notes in scruffy handwriting until either cramp or exhaustion set in.
In short, I am poor and overworked, with ever-decreasing employment and financial prospects. I have never been happier. I believe the life I would have led, while probably more profitable and certainly comfortable, would have been a life with little fulfilment, and even less purpose. It is true that medical students entering the profession are facing a more testing time of things than in former years; rising debt, the lack of accommodation for F1 doctors, and the shortage of training placements being just three of the recent difficulties to befall new doctors. However, I think it is easy to forget how privileged we are; we are able to spend our days getting to know new people, in a job which is challenging and constantly changing. Bu it is more than that: we go to sleep at night with the certain knowledge that we made a difference to someone’s life, whether it was a life-saving intervention, a difficult diagnosis, or simply relieving pain. I am often asked by family and friends, given the current climate for new doctors, whether I regret embarking on this career change. My answer is always no – I miss my creature comforts, but I think I’d miss my future more.

Haiku

Today we were asked to do some 'creative witing,' in the hope that it will make us more receptive to the 'art' of medicine, as well as the biochemical model. I decided to write haikus. They are part of a creative piece I will have to hand in next week, which will be entitled: 'Things I Cannot Say:'

To The Patient:

I'm sorry you feel

Ill. Now take your cold and get

Out of my office.

To The Doctor:

You never seem to

Get irked by stupid patients.

I wish I knew how.

I know they are irreverent. But they make me feel better!

Two Wrongs Don't Make A Right

It has been difficult for me to accept that 'right' and 'wrong' actions are often not well defined, and that the best we can hope for is just to do our best.

I recently had to visit a patient with a chronic illness as part of my GP placement, which allows us to learn what it is like to be a patient and also examine the doctor-patient relationship, rather than teaching us anything specifically medical at this early juncture in the course. The lady in question had a form of arthritis, for which she had had ineffective surgery. Our role was to ask questions about how it felt to be in her position, her experience of the health service etc. At one point, I askedher if she felt angry because of her illness, or whether she had an acceptance of it. She began to become tearful, which continued into the interview.

I felt awful, and felt that her tearfulness had been as a result of some insensitivity on my part. However, it transpired that she had recently discontinued antidepressants due to their sedative action, and that her unhappiness was probably largely related to this. When the GP asked how she was, and I told her that she had been tearful and rather blue, she asked me if I thought she had been simply having a bad day, to which I relplied: 'No - I believe that she is still depressed.' The doctor believed me and said she would see to the patient as quicly as she could. Although I was concerned that I may have caused the patient some sadness, I know that some good has come of it. I hope I don't have to make all my patients cry, though...

'Cause I Gotta Have Faith

It's amazing how quickly your certainty in things can be shaken. When you look at something every day, it's easy to miss the little details that mark the passage of time and indicate change; the peeling paint on the ceiling that you don't see any more, or the gradual change of the light as summer shifts into autumn and the days shorten. I think it's normal to assume that your life will follow a route that you have planned out, that everything will fall into place. When life doesn't run according to plan, or people do not act in the manner you expect, I think it's easy to be discouraged. I have recently realised the importance in faith. I do not necessarily mean faith in a religious sense, although I think that for some, that is how it is manifest; however, I believe that all of us have faith in something, and it is not until this faith, this certainty is shaken that we realise its importance.

For example, some of us believe in 'the system;' that the bad guys will be caught, and that justice will prevail. Others appeal to a higher authority, and some have faith in the power of human compassion. My faith has always been that there is a reason for everything, however obscure that reason may seem to us at the time. When I failed, upon originally applying, to get into medical school, I believed I had been wrong about the reasons behind our lives; I realise now that the time I spent believing that I would never be a doctor made me realise how much I needed it

. It was not until I lost this faith that I realised how important it had been in the way I made decisions; I am glad that this faith has been restored, and the world seems a more ordered place. Circumstances at the moment are testing this belief, this faith once more; but I am discovering that change is rarely 'good' or 'bad,' but simply change.

The Diving Bell and the Butterfly

People forget that it's not all just drinking and clubbing when you're a student. As well as prioritising your work, you also have to feed, clothe and organise yourself - the shopping, the washing, the work... As an old hand at this, I do not find it as difficult as some of my housemates; I usually have enough food in the house to make myself a suitable meal, enough money to buy what I need, and enough time to see the important people in my life. However, I seem to have inordinate difficulties in putting myself to bed at a sensible hour. Although I realise its importance in my life in keeping me healthy and happy, sleep seems to be such a waste of time. Although I enjoy it immensely, when bedtime draws near, I become acutely aware of all the more constructive things I could be doing: working, writing this blog, watching Scrubs (am on series 5 now - hurrah!). Come the morning, I invariably regret my folly, and wish I had gone to bed at half past ten... But I never learn. Come the next night, I do it all again. Last night was no different, and this morning I was reluctant to get out of bed. It was also my anatomy class, which I hate. I decided, unusually for me, to skip it, which turned out to be a most fortuitous decision: at 1030, I was awakened from my warm and cosy slumber by the shrill peal of my doorbell. Being our anniversary, Himself had sent me flowers and champagne. Once again I am reminded of how lovely he is - and how good it is to pull a sickie, once in a while!

I read a brilliantly inspirational book today, 'The Diving Bell and the Butterfly,' about a man who suffers 'Locked-In' syndrome after suffering a massive stroke. Paralysed apart from one eyelid, Bauby narrates his memoirs to his speech therapist, by a communication system that involves blinking. Poignant and compelling, Bauby's memoirs remind us of how fortunate we are in our everyday lives, and the indomitable nature of the human sprit. I think it is a good lesson for the treatment of patients who have problems communicating; although it can be frustrating and difficult, we must never forget that they are people inside, with needs and dreams. In the midst of a busy day on the wards, where one is constantly in demand and undersupported, it's amazing how easy it can be to forget that. When I got offered this place, I promised myself that I would always give 100%, and strive to be the best doctor I could be. Only two terms in and, while I do work hard, I often procrastinate, and skip the odd lecture here and there. The Diving Bell and the Butterfly reminds me of why I began this course in the first place, and inspires me to redouble my efforts.

Equilibrium

As a medic, our curriculum is divided into several components, teaching a broad range of medical topics. This term, I am taking: Histology, Anatomy, Pathology, Cancer Biology,Medical Ethics, Whole Person Care, Genetic Technology, Pharmacology, Epidemiology, and also undertaking my GP placement. Although reading so many subjects sounds a daunting prospect, I enjoy the variety they provide. However, this does make the workload feel somewhat intense; my current workload for the next week or so is:

• Epidemiology coursework - appx 6 hours
• Pathology notes - appx 4 hours
• Genetic Technology notes - appx 2 hours
• Pharmacology notes - appx 2 hours
• Ethics notes and further reading -appx 3 hours
• GP placement reading and case notes - appx 1.5 hours.
• Anatomy notes -appx 4 hours

This list will, of course, be added to every time I have a lecture, when I will have to add those notes to the list. The current workload will take approximately take around 23 hours, in addition to my attendance at lectures. Although we medics try to enjoy ourselves, the course is no picnic, even in the first year. While I will endeavour to get most of the work done over the coming weekend, I know that the backlog will only increase during the term.

A workload of this magnitude cannot help but affect my relationships with others around me: I see far less of my friends than I would like, but it is a sacrifice that has to be made. Similarly, it also affects the relationships I have with the people I care for most, namely my with my family and Himself. Surprisingly, the day-to-day relationship I have with my mother has actually improved; presumably because I am not 'constantly underfoot,' as she would put it, and messing up the house. However, I know she worries far more because she sees less of me. I don't get to see Himself anywhere near as much as I would like; I wanted to see him this coming weekend, but my workload prevents it. Thankfully he's an understandng guy, but I won't pretend that it isn't difficult on both of us sometimes. The course will, hopefully, teach me to strike the optimum balance between my personal and professional life, enabling me to perform the the best of my abilities while appreciating the times I am not working; however, this ideal equilibrium often remains elusive.

I assume that it is because I am a medic that causes people to believe I can fix all problems. Certainly we are supposed to demonstrate a level head during a crisis, but my flatmates persist in beliving that my function is to solve their difficulties. However, while I find it time-consuming and frustrating to have to run around after people who really should know better, I also know that I would be saddened, and perhaps even hurt if they felt they could not ask for my assistance, and am scintilated by my involvement in their lives. It would be fair to say that I, and perhaps others in this profession, are driven by a 'Messiah Complex;' a deep need to 'save' people. While I believe that to some extent that this is a healthy thing (indeed - I do not even wish to contemplate the possiblilty of doctors who do not wish to save their patients), I am concerned that this desire, this need, if you will, is inextricably linked to my self-esteem. What will happen to me what I encounter a patient who cannot be saved?

Work Hard, Play Harder

It is commonly said that med students work hard and play harder. From my own observations, I would have to say that this is true, although I suspect that it is usually because we are procrastinating, and those moments spent in diversions from the books are the sweetest of all. This weekend has entailed a lot of procrastination, although this early into the term I do not feel totally wracked with guilt over it. I spent yesterday morning taking my flatmate, Julia, to a local clinic, which meant a depressingly early start for the weekend. I spent a large proportion of the day reading an online novel, until about six, when we went out to eat. I know, I know - eating out two nights consecutively smacks of the most lavish decadence on my student budget.

After dinner, I went to visit an old friend whom I had not seen in a year or so, and we wound up talking long into the early hours. There are a few people one meets in life that you can be completely honest with, and he is one of them. When I finally left his house at three to walk home, it had finally stopped raining, and the wind had died down, and I would have enjoyed a quiet walk home, were it not for the fact that the clubs were closing for the night, and my reverie was interruped by the cries for a taxi by drunken men.

Today I do actually have plans to do work, and have a date this afternoon to go over some coursework and some lecture notes. However, I look forward to a happy distraction this evening, as I am meeting another friend for coffee, as she is in town unexpectedly. Tomorrow, though, I will pay for my inattention to my studies, as I must spend my afternoon making up my anatomy notes from this week - my least favourite subject.

The faculty has made it clear that they expect us to spent 40 hours a week working, minimum. Only 20 of these are actually spent in lectures and tutorials, and if you are bright and very lucky, this is all you will need to do. For the rest of us mere mortals, who do not absorb the contents of a textbook simply by sleeping on it, this really is only the tip of the iceberg, and many more hours of private study in the evenings at at weekends. This is the reason that most medical students do not have a job in their spare time; or, indeed, any spare time to speak of.

For this reason, many medical and vetinary students tend towards poverty, and for many of us (myself included) our student loan of a £3000 per year is all most of us have. Because medicine is such a long course, and because most people cannot afford to study it without support from their families, I think it is a course which can discriminate against poorer people. On the other hand, I am learning many valuable lessons about budgeting, and the true worth of money. And why paying £3 to wash and dry one load of washing is absolutely criminal.

A Beginning Of Sorts

Writing to an audience is inherently more difficult than simply writing a journal for oneself, and it is easy to become plagued with doubts; is my narrative style too self conscious? Too stylised and contrived? Too simplistic? It is almost impossible to predict how a reader will react to a writing style, as so much of the inflection of speech is lost when pinned to a page. So I have decided to write this blog as though it were only for my own eyes, in the hope that my candour will be best able to express my thoughts and experiences.

I am now in my second term at a medical school in the south of England. I am a little older than many of my fellow students, having studied for a degree previously in a different field. I am by no means alone, though, as many of my contemporaries also have degrees, in such subjects as neurology, or biochemistry. I can only wish that my own was so useful. At first I thought it would be difficult, being older than the majority of my peers, but to my surprise, most medical students seem to be more mature than other students of the same age, and do not treat the 'mature medics,' as we are know, as social pariahs.

Because I am slightly older than most 'Freshers,' I decided not to live in halls, but in a student house with ten other residents; they are a diverse group, none of whom are other medics. While I regret this lack of a study partner in my housemates, I am glad that I shall have a chance to branch out, and make other kinds of friends. This is largely because medical students can be quite elitist, becoming close only to other medics. While it has been a few years since I used a communal kitchen, as a 'grown up,' I had come to the conclusion that I could not be fazed. However, I was wrong, and I am somewhat ashamed to say that the state of the amenities here regularly causes me to fear contracting botulism, or salmonella poisoning. Thankfully, few boys use the bathroom on my floor, although I can only assume that they are responsible for the continued non-existence of the loo roll. I am not sure what they do with it, although I am beginning to wonder if they consume it when they have no pot-noodles or take-away curry. But for all that they are often somewhat untidy, I generally get on very well with my housemates, and even hope to live with some of them next academic year.

I've actually just returned for a meal out to celebrate another medic's birthday; around twenty people were there, and, although we should have relished the opportunity to forget about university and discuss other things, the conversation invariably became 'shop talk.' 'How were today's lectures?' 'How did you do in your exams?' Although we tend largely to befriend other medics, ultimately we cannot forget that they are also our competitors; our place in the year group directly affects our chances of getting the training job we want.

At a wedding I attended recently (two doctors were getting married, so about 80% of the guests were also doctors), a urology registrar told me that "medical students are a constant dichotomy of pride and insecurity," and it is true. I am so proud of getting as far as I have done, and yet, I am regularly terrified at the thought that they may discover that I am not worthy of my place, that I am not as good as all the other students. This is partly because my degree is in an arts subject, and hard science has never come easily at the best of times (let alone after six years of neglect), but largely it is something we all feel, because medicine is all something we want to be involved in very deeply. I suppose that is why I have decided to keep a blog: I have just found out that I have passed my first set of exams, so I feel much less of a fraud, and that I may just manage to hold on to this place; so I should treasure the memory of it while it is mine to keep.

Tomorrow I have an unpleasant, yet necessary task to complete, and unfortunately it is not my homework. Although there is that, too. There is always homework.