Time to fly

I'm not sure if anyone reads these infrequent posts, but if anyone is reading, heads up! I am about to head to Tanzania on elective for 2 months so posting will be even less reliable than it already is. However, if I do get internet access I shall keep you posted on the state of medicine in Dar Es Salaam and the sunshine in Zanzibar.

Foundation forms

I am prevaricating on an award-winning basis today, the culmination of a week spent successfully avoiding facing the dreaded form.  But it has to be done.  My goodness I wish it didn't.

To go or not to go

To answer Little Medic, who knows where I shall go! The other major issue with the evil application forms is where to apply. All deaneries with have their equivalent of Chase Farm, or Maidstone, the only difference being you don't know in advance which one it is outside your medical school. So, to stay in London or not, question one. I think I lack the balls to go, as it were. My friends and family are here, and when you get down to it, that's what makes me happy. Then, to stay in the deanery related to my medical school or go elsewhere. Pro of staying: I know most of the ophthalmologists and they know me and that's what I one day want to do. Con: I will feel as though I never left medical school. Pro of going: if I want to experience a new hospital/area, I will be in the same boat as a whole bunch of other new FY1s and it will be easy to make friends and settle in this time around maybe more than later. Con: I am a scaredy cat.

Foundation Training Application forms

I think this is the hardest bunch of pointless questions I have had to answer! There is something about the format that makes me anxious just looking at it.  The worst question for me is thinking of an example of prioritising information.  

"Describe one example from your undergraduate medical training of your ability to prioritse tasks and information from any clincial or educational area.  What was the outcome, what have you learned and how will you apply this to foundation training?"  

I know I prioritise things non-stop all day, like whether to go to clinic or the computer room, whether to clerk a patient or drink coffee and read the paper...  But I cannot think of a decent, clinical example.  I am starting to get quite stressed about the whole thing. 

Having a cold

I make a terrible patient. I am in fact an impatient. I have a cold, sufficient to cause cold sweats on walking to college and a nasty cough which hurts my chest. This is all pretty minor in the scheme of things, but I am going mad with boredom already. The problem seems to be that I feel pretty much ok when I am sat down. However, any activity that exceeds, say, turning the page of my book, makes me feel faint and sick. I am not impressed. I went to radiology teaching this morning at the hospital and coughed my way through it. I think I learned something, but I decided not to go up to a ward full of chemo patients and expose them to my virus. By the time I got to the bus stop I felt quite unwell again, which only confirmed my confidence in my choice.

Now I'm at home, making a desultory effort to read a cancer biology textbook and I am bored brainless and feeling much better. I am now very impressed by the stoicism and fortitude embodied by the patients on the ward, who seem to take infinitely more serious and distressing illnesses with infinitely more patience!

Kids and cancer

I know in the last post I said I wasn't scared of cancer patients. I'm still not. But today was sad indeed. I went to a radiotherapy clinic and saw 5 children with cancer one after the other. I normally talk in clinic, to patients and doctor alike, asking questions, getting involved and so forth. Today, however, I sat in the corner very quiet, feeling a whole range of emotions for the children, their parents and about the random events that change people's lives so much.

I thought too about my cousin, who committed suicide 2 weeks ago. He was a lovely lovely man who felt he had nothing to live for. It's hard not to contrast that knowledge with those children fighting so hard to live.

It was a strange morning indeed.

Don't be scared of cancer patients...

In a lecture at the start of our oncology block on Monday, we were told that it will take time to learn to talk to cancer patients. Cancer patients will be scary to us young uninitiated things, we will be awkward and find it hard.

Ok, I thought, fair enough. I can imagine some people will find it hard to know where to start. But I was a little puzzled at this idea that cancer patients were somehow beyond the pale for us. We have all talked to patients who are terminally ill by now, after 2 years of clinical medicine. I spent 2 hours talking to a patient yesterday, ah, the time luxury we have as students! I thought it was sad that a young (52yo) woman had metastatic breast cancer, in her bones, her liver, lungs, uterus and now her brain too. I was amazed at her fortitude and determination to be as well as she could be. I was impressed by anyone talking even more and even faster than me. But I wasn't scared of approaching her and asking if she would talk to me. I wasn't scared to hear her say the word 'cancer'. I wasn't scared at all. In fact, I was glad I could talk to her and I wish we were encouraged to spend time with people in this situation, stuck in hospital for 5 days of radiotherapy. We're about the only people in the hospital all day with big chunks of spare time. I think I will mention it to the lecturer, as the only thing I found scary was the attempt to scare us in the introductory talk...

Ah, freshers!

I helped move a load of freshers in to halls over the weekend. They make me feel old! I know it's just that I'm older, but they look younger than last year. It was scary. I'm quite glad Uni is nearly finished now, after 6 years, but it did make me nostalgic for the days when my liver could handle drinking until 3am and still making a 9am lecture.

Are medics really that clever?

I worked at a posh reception this evening, as a waitress to supplement my measly student loan. I've done this for about 4 years now, and normally the guests completely ignore you. This is ok, as in a sense we get paid to be invisible service providers. When people are outright rude, as does happen, I still get cross. Luckily this is rare. Rarer still though is when people treat you as a human as happened today.

I was topping up champagne for the guests, the employees and clients of (I think) a property firm. Two separate groups engaged me in conversation, which made me feel like a person instead of a robot. Both asked what I did when not waitressing/if I was a student, and what I studied. When I told them, both said I must be terribly clever, despite one having studied engineering at the same university as I attend, and the other having been to another prestigious university. I was basically embarrassed! And it's not the first time it's been said either. People seem to assume medics are very clever, which I actually disagree with. So many other courses seem conceptually harder than ours. I don't doubt that intelligence is there (and needed) in most medical students and doctors, but I don't think they have extra brains compared with other students. Rather than sheer intelligence, I think what we have is tenacity and a facility to manage great quantities of information. I'm not sure this is the same as intelligence. Any thoughts?

Noah and The Whale

I'm always a bit nervous when I go to see a friend's band. I worry about what to say if they were awful, or just dull. Luckily, today's experience was a gem. I have seen Noah and The Whale before, but this time I took my flatmates. They were able to say they really liked the band, and the place was packed. Hooray for Noah and the Whale!

Dessert

I have just experienced something new. So far, boyfriend has cooked excellent savoury food, but in 3 years together he has never made dessert other than fruit salad. That is, until today. He made chocolate fondant bake things with truffle in the middle. It was death by chocolate and it was heaven. I think I might explode.

Business Visa

I felt very grown up today.  I went to Bond Street to get my visa for my elective.  It turns out I need a business visa, not just a tourist one.  Don't ask me why, but it's quite exciting. And I even got some work done.  I may not have learnt my eye anatomy properly but at least I have read it once.  

By the way,

My last post before going away was to complain about exams. I did recover things on the OSCE and I passed. I found out in Namche Bazaar at over 4000 metres above sea-level.

Traveller returns

There's a bit of a gap between now and my past post. Pretty much as soon as exams were over I hopped on a plane to Kathmandu. From there, 56 other students/junior docs and I hopped on other tiny propeller planes to Lukla. The airstrip there starts at the edge of a sheer drop and finishes up against the solid rock of a cliff-face. It was not my favourite flight ever, especially when I noticed that the windows were mostly held in by duct-tape.

From Lukla we walked for about 10 days up to Everest Base Camp, including stops to acclimatise and stare at the views. Then walked back again over 3 days. They were long days.

Our junior docs were in high demand. We had 2 of the team get AMS, and 2 of our guides get sick, one with a suspected perforated gastric ulcer, he was carried a day's walk to hospital. The docs were tracked down in tea-lodges by other trekkers, the locals, and by one woman who walked for hours to find us, as she had a wound infection and their village had not seen a doctor for years. It felt very very strange to get back to Kathmandu and the flushing sit-down toilets, let alone to get back to London on Saturday. It made the stresses of a London teaching hospital seem pretty tame.

Still, I'm glad to be back. Ophthalmology is suiting me very well. The instant-gratification aspect has a lot of appeal, especially since the results of cataract surgery are so good. I've not seen so many happy people in a clinic for a while.

So, back to the grind-stone and more updates on final-year medicine in London will no doubt follow.

One down, one to go

Well, we have discovered that written exams are not my forte.  EMQs are a funny format and only work of the question is well written.  The ones yesterday were too ambiguous.  Lets just hope I can recover things a bit on the OSCE tomorrow...

Oh dear, exams melt the brain

I have been frantically avoiding revision for weeks now. And I still have managed to do some Obs reading. Shame about the Gynae and the Inf. Diseases. Ah well, the career system is so stuffed up anyway a few exams down the pan won't matter anyway. If the MTAS lottery is still in place I could be straight As or scraped by and still get the same job random allocation.

If anyone has any top tips for O&G last-minute revision do let me know...

2.5 hour tutorial

I really appreciated that the O&G prof made the time to teach us for two and a half hours.  But I'm not sure I remember much of it because the sheer quantity of information got too much!  

GTAs

For those of you who are not in the medical sphere, a GTA is a gynaecology teaching associate. That means a lay-woman who is trained in performing speculum and bimanual pelvic examinations and then teaches them to students on her own body. We had this session today, two GTAs with 5 students. We each passed a speculum, talked through a cervical smear test, and performed a bimanual examination.

I'd got the impression (as many might) that this would be weird. It actually was very straightforward, not awkward and I thought a really good way of learning the skills. It helps to get feedback on technique, what is uncomfortable for the patient and how to phrase things. Definitely better than doing your first exam on a patient, who is nervous like you.

If only I'd had this session before my first O&G attachment...

I can't help but judge...

I spotted this in clinic today, above the trolley of speculums and paraphenalia for gynae examinations. I know it's wrong, but I can't help but judge. I just HATE it when people abuse grammar like this. For some reason, the fact that the perpetrator clearly thought they were being accurate and authoritative makes it much much worse. Oh dear, I am going to make a bad, judgemental doctor...

PDS the bane of our lives

PDS, or professional development spine, is the bane of our lives. Today we learnt about bereavement after miscarriage or perinatal death. We saw a very interesting video about a couple who had a termination for serious foetal abnormality. The video was good, but the session before, more than an hour long, was not.

Medical students definitely need to be aware of the serious emotional distress experienced by women and their families after a death, but we're not morons, I promise! We spend a lot of time learning how to avoid becoming robots. We resent time we see as wasted going over and over the different theories of bereavement reaction, when the information has been covered before and could be laboured a lot less. Make it specific for heavens sake. I really wanted to be home before 6:30 today, but no.

Medicalstudentitis

I have a severe case of medicalstudentitis.  I have a runny nose, sneezing, coughing, lethargy and sulks.  But, rather than the common cold, I am suspecting many things, including TB, leukaemia and HIV seroconversion.  And I wouldn't dream of asking an actual doctor.  I'll just mutter darkly about my suspicions to medical student friends who will tell you about how they diagnosed themselves with Crohns and Behcets last time they got a mouth ulcer....

Things that make me sad

I saw a man today who had recently developed AIDS. Only he did so with probably lymphoma, so the prognosis looks a little bleak, even if he starts HAART. For some reason, his optimism, his little rationalisations and his conviction that a definitive diagnosis would make all the difference all made me feel heartbroken. He showed me his wedding photos. His partner has HIV too, and has been on ARVs for years. He is a lovely man.

It makes me worry that medicine is not the career for me. I am going to spend so much time heartbroken.

I'm reading about HIV today. An ABC of AIDS is the book, but it was last updated in 1999/2000, so I'm pretty sure some of the stats are so far out as to be wildly misleading. Oh well. I am learning, by reading everyone else's medical blogs. I'm just not sure this will help me pass my exams...

I was reading the http://fatdoctor.org/ blog today, talking about this sense of entitlement that people seem to have. Ok, it's US not UK, but it sounds very familiar. Is society going down the pan?! It's always me me me, isn't it?

I was at the check-out with my boyfriend and our groceries. At the next till was a little elderly lady reaching slowing and determinedly into the bottom of her trolley to get her shopping out on to the conveyer. Boyfriend and I looked at each other and the elderly lady toiling away, and he went over to help. Initially, she was totally baffled, then she realised he was offering to help and accepted. At the other side of the counter, as boyfriend was packing our shopping and her husband was packing hers, she came to talk to me. She said at 91 her back was fine, but her feet were easily tired. She explained that initially when boyfriend had gone to help she hadn't understood what he was doing, she rarely gets offers of help from strangers. How sad is that? Made want to give her a hug.

It reminded me of being on the bus, sitting on a double seat downstairs, no-one next to me yet. Lots of others were in the same position as it wasn't very busy, but no double seats were left. A woman got on with her small child and looked around for somewhere to sit with him. He must have been about 5. So, I got up and moved across to another seat so they could sit beside each other, no big deal, involved me moving about 3 feet. She was so amazed and so grateful, when I had hardly done anything at all. I have to assume that people don't often do these little things for other people. If it costs you nothing, then why not? I don't think my parents did anything special, I am no different than anyone else, but I do these things if I notice or realise (not always the case I admit). Is this a new thing, have we got less friendly or have people always been oblivious and selfish?

Well, my finalist friends got their results last night. I know somone who got their rota for their FY1 post already, taking them from August to January. At least he knows what he will be doing next year. Sadly, there wasn't much rejoicing last night. MMC/MTAS has completely knocked the stuffing out of junior doctors, but also out of their future colleagues. Not that many people were running around full of joy to be entering the medical profession in a few short months.

No great suprise there then. How can you get excited about joining a so-called profession where you are not even allowed to apply for the jobs which are available? How many other public sector workers would put up with not being allowed to have any say in where in the country they were to work? Is it any wonder that the suicide rate among doctors is higher than any other profession, that people are dropping out like rats from a sinking ship and heading to the city, so at least they can afford to live where they want to? On the topic, where is the European Working Time Directive that tells city boys that they can't work all night?

I applied for an academic foundation post today. If I do get it, I will know by the end of July where I will be working in August 2008. So, can't complain in that sense. But, what is the point of fighting for a prestigious post when like as not I will have to enter what is effectively a lottery in 2 years time to the point where I won't even get much choice as to what branch of medicine I will specialise in? Having just spent a week or two doing nothing but fill out a form, I am starting to get an insight into how it must feel to be a junior doctor. How can you justify yourself in 5 or 6 150 word questions without a CV? I was stressed enough and I got to list my academic achievements (such as they are) on my form.

Watch this space, you might find it turns into "my accountancy adventures" all too soon.

...

We raised over £500 for Great Ormond Street tonight as part of our run-up to a trek in Everest for research and fun and fundraising. It was a really good night actually, 5 bands played, mostly with medics in. I'm suprised they all get out so much!

Wow, a blogging widget!

Aren't macs wonderful?!  A little dashboard accessory to let me fill this blog up with totally pointless wittering whilst I fail to finish my application form.  I am hoping a promised trip to the pub will motivate me to get it done, but we shall see.

Foundation applications

Justify your application to this competitive academic foundation training post in 150 words each over 5 questions. Shouldn't be to hard, right?

Why is it taking all day and feeling like banging my head against a brick wall? No fun at all.