Recovery

I woke up 2 hours later than I planned this morning, but I feel replenished and more motivated to study. This is a two-fold response: the first is that the sleep was all that I needed and the time that I've lost is increasing my stress levels. It's probably this coffee I've had in the morning as well.

Tribute to Nikola Tesla

So now I just need to go through the motions and revise, learn and research, just like the last two days.

I need to make the most of what time I have left and remind myself that it is alright to actually have a break from time to time.

Truthfully I'm not sure what kind of questions they will be asking in the upcoming examinations, though I am worried that they will be difficult. I'm also concerned because there may be discrepancy between what I am actually learning and what is going to be in the exam as I am using the USMLE preparations.

This is the first time I have used these resources and I must admit, they are brilliant. I think someone really needs to the sit the Faculty down and play a few of these to show them how to teach medicine. We are very behind, with most of our teachers being humble and lovely volunteers and for that I am ever so grateful. What worries me though is the fact that they spend most of their allocated time discussing their research, regardless of how relevant it is to our clinical practice, modern care and current medical and surgical protocols.

There is no point teaching me about what is to come if I don't know the ins and outs of the current practice. These USMLE preparations have got holes as their epidemiology will be different to the Australian figures, but I am hoping I can cover these holes on my own at the end of all my revision.

We will see how today goes. I don't have as much time as the last two days, but I am feeling happier than yesterday. It felt like I was a mess last night.

I'm confident that the sparks of this morning can carry me on through to Sunday evening. It was a good reminder to me that my body really needs rest after such a barrage of information, even if it is just revision.

I can only hope everybody else is looking after themselves and are studying well too.

Preparation

Study has been productive since yesterday and that's good. My issue is that it's only the second day of study and I'm already lapsing in and out of inactivity. One minute I'm nailing it, the other minute I just don't want to continue. Knowing that I need to means that I can't enjoy any leisure activities including exercise.

So far it's all about the medical exam. Formal study for the surgical exam is at an all time low because the discrepancy in knowledge expectation is driving me absolutely nuts. My understanding of the 'Core Curriculum' is that all of it could really be summarised by saying just read and learn all of Tjandra's Textbook of Surgery. It's a nice textbook, but so summarised that it feels like the author was slapped a few times with a mallet before he wrote it. Most of the enthusiastic surgical students have already read it, some have summarised the entire textbook (scary). I'm stuck between reading it and correlating its 'chapters' with Bailey & Love's Short Practice of Surgery. That book's title is so deceiving; Short Practice. The authors must have had a good laugh when they named their baby after measuring it to be several inches thick.

I'm stuck in a rut. I want to study harder but I can't process more. I need rest but I want to study. I try to rest but I can't because I'm guilty.

It's all very scary and I hope by Friday I'm at the point where I don't care. At this stage, I am caring more than anything else. I just need to keep persisting. It can be so demanding sometimes.

I am far from ready. These exams will be the hardest that I have ever written and the worst part of it is the lingering 20% failure rate in the O&G term just about a week ago.

The thing that's really slapstick hilarious is the fact that I'm almost 75% through this program and apparently completion of this program (mind you most of it is self-directed) correlates reliably with medical and surgical competence. Supposedly my opinion will be empowered with authority and I will be able to prescribe medications, counsel patients and break bad news to their families.

All I can say is that I have a long way to go and I'm far from ready for next week's assessments.

E-mail

The O&G co-ordinator told us that the results of the OSCE and written assessments would be available on Friday morning. Most of us, if not all, held our breaths as the e-mails started trickling through. We were all nervous. Coming out of the OSCE knowing that we had missed large chunks of information was not reassuring.

I had arranged to study on campus with my friend CA and I got a call from one of my colleagues, JJ, that the e-mails had been sent. I passed! Thank God! and I was glad she did. The issue for me was whether I passed.

My pulse started racing and my mouth was dry. Before I knew it, I was almost breathless and I couldn't hear the music over my heart pounding in my chest. In my state of sympathetic overdrive, I decided to pull out my laptop while I was driving after I switched on my wireless modem. After the symbols of connectivity showed up on the screen, I opened Entourage, the e-mail client. After a few moments, it grunted stating there was no new updates. At that point I realised all the beeping was from the cars behind me.

I pulled the car over and restarted the modem. Maybe its a connection issue. Again, grunting from the e-mail client. I decided to go through hotmail and sign in - after an agonising two minutes, it signed in and there was nothing in my inbox. My blood pressure must have been through the roof.

There was little choice - I called the co-ordinator. The internet has been down for about thirty minutes. I'm sending out the results one at a time. I'm sure you'll be fine. That sort of reassurance isn't really reliable, especially in my state of mind. I thanked her in my breathless state and started making my way over to meet CA.

Drenched in sweat, I saw CA waiting there for me and I explained what had happened. She had a similar experience with her examination results. After drowning my anxiety with 600mL of water, we spent half an hour trying to find a quiet place to study. All the library rooms were booked out and there wasn't much we could do other than study in our anatomy museum - a very peaceful place.

After an hour of watching some lectures, I checked my e-mail again and it read Congratulations, you have successfully passed all the summative assessments in PWH.

I was able to relax now. It wasn't a "hooray!" because of all the tension that accumulated over the past hour, but indeed it was very relieving to hear that news. We exchanged phone calls and messages with results; so far it seemed that we were all satisfying the Faculty's ridiculous assessments.

Friday ended up being nice, studying and chatting with CA and spending time with my girlfriend over dinner was a magical way to spend reminiscing four and a half years of our relationship.

I made a few phone calls after work today to some of my friends to see how they went in their exams. SW just finished Psychiatry and he too had passed. However, he knew of at least 9 people who was unsuccessful in the O&G OSCE assessment. By that time on Sunday I had already heard of a few people failing as well and that meant about a dozen people had to re-do the OSCE at one of our metropolitan hospitals.

The problem was that even colleagues in the rural schools had to travel to metropolitan Sydney to attend the second round, meaning that they would lose hours if not a day of much-needed study for the exams just over a week away. This ridiculous principle also applied to colleagues that were unsuccessful in other specialty assessments.

Of course it would be too courteous of our Faculty to schedule the re-sit assessments after the week of final examinations. That would obviously make so much sense that it would be inconsistent with their repertoire of stupidity and protocols of idiocy.

My description of how I feel can only be described as bittersweet: I'm relieved that I have passed my speciality assessments but depressed about my friends and colleagues having to re-sit for the second time just before the final exams that determine whether we are eligible to be final year students. The final assessments are also very difficult as they more than likely examine disciplines that we have not been exposed to at all, meaning that certain disciplines that we may have studied are not relevant. But that's a whole other story.

All the best to those having to sit the second round assessments. I hope they pull through. I really do.

Precipice

Lost case. It's the term we used for the guys in high school when they were completed spaced out. That definition has described my last week or so in my attempt to prepare for the Obstetrics & Gynaecology examinations, which we were subjected to yesterday and today.

Once again I haven't written in this blog for a while, given the events of last week. What I should really be doing right now is writing the ethics essay so I can have it over and done with. What I'm actually doing is writing here after cracking open a cheap bottle of wine.

The weekend was intense with work and other things I can't remember, despite it being Wednesday. Though that's funny because I had to be reminded of that a few times as well.

It was Monday morning and I was having a cup of coffee with mum. It was the day I planned to spend preparing for the Objective Structured Clinical Examination (OSCE) for O&G. I had already started studying on Saturday.

Frustration loomed as I realised we didn't have our seat numbers for the written test on Wednesday. So I e-mailed our co-ordinator and she revealed that the seat numbers will be available to view on the morning of the exam and please remember the exam is on Tuesday.

Say what? Oh no... I've just spent the last 2 days preparing for the wrong exam. Different questions, different approaches. That's not good. My entire body flinched as if I had been stung by a stingray. Mum noticed it from across the room and freaked her out.

I went to go pick up my recent 'study buddy' and told him that the exam was on the Tuesday rather than Wednesday. He was unhappy to be corrected as well. We were under the impression the OSCE was first. And Monday had to be our day of desperation - to cram in whatever we could for the written O&G assessment. We were not ready.

12 hours later, we realised there was not much else we could do. Consecutive study for 12 hours is detrimental and I advise anybody against it. The truth is that I have never learnt so much in my life. Lecture after lecture, book after book, article after article, discussion after discussion; if I had a cerebral aneurysm, I definitely would've known about it on Monday.

And then came the exam on Tuesday -  very difficult and unforgiving. The questions were confusing, some had several correct answers meaning we had to decide which one was 'most correct'. Others gave laboratory values for investigations without normal ranges (and I'm talking about FSH & Prolactin levels, not Hb or something straightforward). There were even questions about syndromes and disease none of us had come across before.

The weather after the exam was reassuring and had a healing effect for me. We needed to continue our preparation for the OSCE. After a short break for lunch, it was time for the common scenarios given by one of the Professors of O&G and students from the years above.

Exhaustion crept in. Focussing and maintaining concentration was challenging. I was starting to believe that I knew enough and that is when I am in the greatest danger. This block has given me the bitter taste of failure and although I am aware of how lacking my knowledge is, I couldn't bring myself to study any further from 2100.

This morning the drive was good and we studied in the car, at home; pretty much everywhere except the bathroom. We were not desperate enough to exchange answers through the bathroom through but maybe we should have been.

We had 7 stations: 2 Gynaecology, 2 Obstetrics, 2 Folder Stations (questions only) and 1 Neonatology station. There was one rest station as well but who cares.

All 8 of us walked out like we had been hit by a train. It was awful. The scenarios they had given us and advised of were not in the exam. I shouldn't complain about that I guess. We should know 'everything' right? But the scenarios were difficult and well most of us agreed that we drew blanks in almost all the stations.

I could not be more demoralised. After the exam, I just wanted to disappear, but I had promised some of the first year students to go over their OSCE stations. That took about 4 hours: answering questions and giving feedback. It takes so much out of you.

So once again - I've got my tail tucked in between my legs and I'm walking home with a headspace of insecurity, uncertainty and just a wish that I do not have to deal with these exams again. Because as my colleagues know, we have our final year examinations in about 2 weeks and we are far from ready. Doing a re-sit examination would require revision of O&G just before the finals testing Medicine, Surgery and GP/O&G. We don't need this. I don't need this.

But until Friday, I won't know if I passed. So in the meantime, I just have to work on my deficiencies... I.e. the ethics essay.

Pressure

Since I've written yesterday's post, I have received some reassuring messages. A few people have offered to read my essay and I appreciate the offer, though at this point I just need to focus on completing my clinical logbook and the upcoming examinations. I will be meeting the Head of Discipline tomorrow and I have been convinced that everything will be alright. I've got my fingers crossed.

In fact the most therapeutic thing yesterday was being woken by a message from AT and a phone call from LZ. You were critical to me yesterday night and made today so much easier. Thank you ever so greatly.

When I spiral out of control like I did yesterday, shaking the notion of being incompetent is near impossible. To shake myself out of it, I needed to be in the deep end. Today was a new day and new opportunities would arise.

I took a few histories, performed some assessments, presented a short case to one of the registrars. She asked me a dozen questions and my differentials were good. I felt better. I made arrangements to see some sonographic investigations in pregnancy. It was good. It felt good know I had potential. Then I caught up with one of my friends who I hadn't seen properly in what feels like 2 years. CA is a person I got close to last year and her support was invaluable during some very difficult times. She and I drifted apart after the Clinical Schools separated us and our professional commitments to patients and colleagues facilitated the lack of communication. She is a very unique friend in that we hadn't spoken in almost a year and when we bumped into each other yesterday for the first time since then, we were so excited to spend time together. It was a chemistry that I don't often feel with friends and that made it all the more special to me. Finally today we spent about three hours talking and catching up; and we still want to catch up. It's friends like this - people who aren't in touch but then remember the value of the friendship when times are testing - that restore my faith in people. This holds true for AT & LZ as well.

Prof. MHK in whatever spare time he had co-authored a play about a family's journey through the Intensive Care Unit. I bought myself a ticket to go and see his perspective on healthcare. Us medical students were wondering how he had the time to raise two children, have four degrees, a Masters, PhD, several commendations and medals from the Royal Australasian College of Surgeons and be a Professor of Clinical Surgery. Oh and did I mentioned he had setup a Tertiary Institute for students in developing countries? If I ever want to feel that my achievements mean nothing, I just pull up his resume. It's available from the Staff Profile website of our Faculty. There's no better reminder that I am merely Shadows in Dust.

I arrived at the theatre with a few medical students. It was packed with healthcare professionals and dozens of other people. I do enjoy catching up and seeing people I haven't seen in a long time, especially Staff Specialists that I have worked with before. After seeing some of the well-known Professors from our hospital, I noticed Prof. MRC, one of the Professors of Surgery at our hospital.

He was an example to all Surgeons. His etiquette, conduct and patient devotion was envied by many. What I envy most is his resistance to the power his position entitles him. He can still be a decent man, a good Doctor and a fantastic Surgeon without being an arrogant, self-centred God.

We made eye contact in the crowd and I thought I'd walk over to say hello. He greeted me with a handshake despite holding his wife's drink. Beside him was a person I presumed was his wife, but in fact was a College Interviewer for admissions. Allow me to introduce you to one of our senior students. He's interested in surgery and did a double-project with Prof. MHK last year and won a prize with the Urological registrar. She raised her eyebrows and shook my hand. I was moved by his introduction that I forgot her name. I didn't have much to talk about so I left soon after.

But that encounter gave me something to think about: People's expectations of me. How would they react if they found out about this essay result? What if they already know? I found myself being paranoid.

I have made some kind of a name for myself. Prof. MRC made it clear that people have not forgotten about me, despite their seniority and a world of other things to do.

My fear must be overcome by the motivation of pressure. However it must be moderated so that I do not implode or explode.

Good friends are supportive and caring; their opinions to me are very important. Their support invaluable. But I confess that having faith and expectations from the very people I idolise - that is pure pressure for it is they I wish to become.

And God forbid they expect that dream to become reality one day.

Hiccup

The drive into the hospital was like any other day. Moderate traffic and occasional slow points. The weather was a different story - some sunshine and even a hint of heat. I'm looking forward to the weather in September.

My friend JH messaged last night telling me he had completely ruptured his right Achilles tendon during sport. He was admitted to my hospital and asked if I could take him home after the Orthopaedic registrar reviewed him. Problem was that I was still on the other end of Sydney and he wasn't sure when he would be reviewed. We both decided I'd come in the morning, but if he should need a lift, I would make a few phone calls that night for him.

He was in bed 22. Sleeping when I arrived, he had a cast over his right lower leg. Shit, they operated. I had a peek at his observation chart; everything was in order. When he came to, we had a chat. The poor guy told me they operated at 2330 and he woke up at 0100. The problem was that he was doing a specialty rotation and the Faculty demands that we sit an exam at the end of each specific to the rotations. But Faculty didn't know the Orthopaedic registrar ordered strict bed rest for a week. That meant JH needed special consideration. If I was his friend, I was going to sort it out for him.

I got the forms ready and left them with him before I left for my classes.

Could you do me a favour?


Sure JH, what do you need? 


I parked in the lot outside ED. If you get a chance, could you drive it back to my place for me? It's only a fifteen minute walk from the hospital. 


No problem. When are you getting discharged?


They said tomorrow.


No worries. I'll sort that out after my classes. I'll be back around 1400. Cool? 


After getting him a jug of water, lip balm and today's newspaper, I felt that I could leave knowing he was somewhat more comfortable.

I'll let a few people know you're here, including one of the Faculty staff so we can sort out your special consideration. 

Thanks. That would be great.


Off to class. It was good to see a couple of my friends in there chatting away. Then it happened. The administrative officer called me outside moments before the presentation started. She didn't look happy.

What have I done now? - I asked playfully.

She gave me some papers. This is the ethics essay you handed in a few weeks ago. The marker says you'll need to give her a call.

Are you joking? 

She wasn't joking.

I stood there in shock. I've never failed anything in this program. Going through the marking sheet, I was put as 'Borderline', not Unsatisfactory. So does that mean I passed? Why do I need to call the marker? I was very confused.

At that point I couldn't focus on anything. I wrote notes in the lectures, provided correct answers to a few things, but it was all autopilot reactions when people looked in my direction. I decided to tell a few people and the immediate response was Oh shit how did I go? I better find out.

Yes, now I understand that they must've freaked out about their own assessment result knowing they got released. But my distress was completely ignored... forgotten in a flash. After realising that I told several people wanting some form of reassurance, I realised that the reaction was the same.

The problem was compounded at lunchtime. FV offered to read it and made some comments. Your perspective is somewhat limited and I understand what the examiner means in her feedback. I felt like smothering him. I just wanted some reassurance, even if I had not met the criteria or understood it.

After trying to call Clara (the examiner) a few times. She finally picked up and told me that she had a theatre list to do and that she would call me back at about 1800. Is that okay?

But I had to put all that behind me. JH was waiting. When I arrived, he had the forms filled out so I could take it over to my mentor Dr. KF to sort out the Practitioner section. She had a look through my ethics essay and believed it was worth a pass. Your principles and perspective have been well described, even if they are limited. So an unsatisfactory is overkill I think. 

I was running from one part of the hospital to another to sort out JH application for special consideration. The administrative officer for the Faculty told me that he forgot to sign a few pages. So I went back down and by that stage it was 1500.

They'll be discharging me in about an hour. 


What?! What happened to tomorrow? 


I don't know.

He already had his medications in a paper bag and it was a matter of time before they kicked him out. The plan now was to take him in his car back home that afternoon. Knowing that he didn't have much food prepared, I gave him whatever mum gave me yesterday along with some pasta, stir-in sauce and some instant noodles.

SG, one of my close friends, listened as I unleashed how angry I was about the essay situation. Our exams start next week and I'm not a fraction prepared. On top of all the stuff I need to do, this was the last thing I cared about, which is why it frustrates me so much. I didn't learn much at all putting it together and I won't learn anything more if I re-write it with more perspective. Essentially all they want is "look at the literature and regurgitate it", even if it is an ethics essay.

JH was ready to go at 1600 and I took him home. It took him 10 minutes to get up the stairs, another 5 to settle into his living room with the crutches.

Clara called at 1800 and pretty much told me she wanted me to re-do the whole essay. She explained the limitations, expecting an elaborate piece of writing. I made it clear that exams were around the corner, how anxious I was and that I really didn't need this right now. This was after I had tried to clarify certain points and that there was actually a word limit. She provided some surface-scratching empathy and then said I'm afraid you haven't fulfilled the requirements. This was despite labelling me as Borderline.

You know what? I think that's fair enough - if it means doing it again, I will. But that's not the problem anymore. The problem is how fixated people were on not giving me a hand. Not even a word of reassurance from anybody except SG. A few people realised how upset I was after I agreed that I looked like shit. Interesting - I actually had to agree before they acknowledged it.

My colleagues, people I thought would be providing care were the very people who walked away when I needed them most.

The icing on the cake was that JH had to actually drive in yesterday from a location an hour away with his left foot on a highway because the friends couldn't spare the time. On top of that, people in JH's rotation, even after finding out about what happened, only but visited him for a few minutes at best. This guy is being discharged home, has a flight of stairs to climb with crutches, exams in less than a week, next week and the week after and he can't cook, shave, shower or sleep properly from this day forth. No one batted an eyelid. After all the histories, management plans and discharge summaries, they still missed the point.

I thought my friends cared about me and about their friends. Sharing a cup of coffee with someone was valuable time spent with them. It was a growing reassurance that we were good friends, regardless of who they may be. But now it's obvious what's going on: Friendship is justified by a few messages sent from phone to phone, or sharing a cup of coffee at a mutually convenient location and perhaps studying together if it helps but a few of us learn so we don't fail those exams that we face in such a short time.

But when shit hits the fan, when people realise that events may occur when their respect, dedication and love for a fellow human being, colleague and friend is tested... they fade away into the background and become an observe, no different from any other person I barely know.

So what's the point?

To add insult to injury, these are colleagues who are supposed to care about people, about human beings and about each other. If senior medical students can't show such affection, courtesy and respect, how can they expect the same from their families, their colleagues and above all else, their patients?

What a fucked up day.

The Promise of Spring

I didn't know what the date was until I was adding milk to my tea this morning. I looked at the 'best before' date... I strolled to my room to finalise the presentations I had to give today. It's the first day of September. Yes, Father's day is on the weekend, then his birthday in a couple of weeks and mine at the end of the month. More importantly, exams two weeks from now, then four weeks from now. It was obvious everyone was stressed because even the most optimistic people were having second thoughts, people who aren't around were suddenly around.

The tragedy was we all had other things in the short term to do before we could start studying formally. There are still so many forms that need to be looked at, criteria to be met and signatures to be received for minor victories of (temporary) knowledge retention. If only it actually helped as much as the Faculty had hoped.

These presentations I had to prepare had taken me about ten hours over the past few weeks, which is a lot given that the expectations are constant attendance and revision. The problem is they decided to group people into pairs and give them Neonatology (i.e. NICU) topics. My friend and I received five topics, which was the most any pair received. No complaints, but obviously the workload was demanding and the topics were quite large.

I got the two 'big' topics: Chronic Lung Disease (i.e. Bronchopulmonary Dysplasia) & Intraventricular Haemorrhage (IVH) and my colleague had to cover Patent Ductus Arteriosus (PDA), Retinopathy of Prematurity (ROP) & Periventricular Leukomalacia (PVL). And seriously, her topics weren't small. I would say she was generous to take up three. I owe her a favour.

My biggest issue was fear. Public speaking is usually my strength and that allows me to deliver a talk to a large crowd. But the intimidation factor goes through the roof when the audience are my colleagues in my year studying the same topics as I am. Their questions are fantastic and often very appropriate, despite being beyond our required level of knowledge (if there are such limits in place).

Today was the big day and I presented my topics alongside my colleague. We met the night before to go through each other's slides and give feedback, but we ended up watching an interesting English documentary about a 50-odd-year-old man with Neurofibromatosis and a 21-year-old lady who routinely had botox and spent two hours of every morning applying facial make-up. It was a very interesting contrast. He went to his maxillo-facial surgeon for follow-up after 27 essential surgeries and she went to her cosmetic surgeon for botox injections. They accompanied each other and their reactions to one another were so interesting. Though obviously, it was a very saddening contrast. Each diseases were debilitating in their own way.

But I digress. My colleague openly admitted she was a lousy public speaker and her nerves made things very difficult for her. I wish I could help but there was nothing I could do except offer to alternate our presentations so she had a chance to relax between presentations.

We both received great feedback and to receive such an applause was so satisfying after so much effort. Nothing could dull my day after that.

I spent the afternoon in the Colposcopy clinic and that was quite good, seeing some patients for biopsy and others for follow-up. At the end, I saw one of my friends, FV, and we decided to have dinner in the staff cafeteria. Next thing I know we're studying vigorously, asking each other questions for about 2 hours. I decided to study on Friday and drive back to my parents' place and FV lived a couple of post codes away. So in the car, we listened to lectures, went through O&G questions and quizzed each other over and over. We learnt so much and for once, we both felt motivated to learn even more, clarify points and work through the physiology.

We ended up going to a cafe until they forced us out at 2230, going through more and more questions. It was brilliant. In fact, we both decided to meet tomorrow morning to keep this up. As long as we keep the ball rolling, we're going to accumulate enough hope to keep our heads above the water and perhaps even be 'Satisfactory' according to the Faculty.

I Accept your Challenge.