Barriers

I'm sitting up in my bed right now thinking about the year that's just gone right by. It feels like yesterday I was anxious about starting my clinical years in medical school; now I'm but a few short weeks away from being a final year student. Do I feel competent or ready? I'm not sure... Probably not.

My window's open and I can hear the rain, drowning out the sound of cars flying by and the muffles in the house next door. It's always been cleansing for me to hear rain. Right now, it seems that this whole year is being washed away; some experiences I will never forget and others I most definitely want to.

Tomorrow morning is my last examination of the year and I cannot wait to put it behind me. I am sick of revising, taking new notes, looking for old ones, double-checking what I've learnt and testing myself with questions. I'm aware that one little test Faculty decides to throw at us with its wrath of 70 questions in 90 minutes on Psychiatry clearly doesn't suggest any form of competence other than adequate memory recall. It almost makes me feel like I'm taking an elaborate mini-mental state examination, testing things that we have acquired over the past 8 weeks in this rotation.

But that's not where all the fun lies. My supervising specialist insists that I attend on Friday morning, which means I still have a final day in the ward that I have come to dread. It's not so much the patients, but the atmosphere that I despise. Every time I walk through the electronically locked doors, there's a scent in the air that I can only identify as the mental health ward. I can't put a character on it, but I know it's not pleasant or welcoming in any way.

Psychiatry isn't just a cluster of borderline psychotic people sitting around a table deciding on arbitrary management ranging from couches, to pills and then even to convulsive therapy. Psychiatry does make people better and there is an effort that must be recognised - that the mind and body are inherently linked and must be treated together, in harmony. And until modern specialists and sub-specialists realise this clear, yet controversial fact, I cannot be sure that we are optimising the treatment of any patient under our care in any facet of medical care.

Some people have left Psychiatry saying "I can't wait to get back into real medicine". Others believe that's where medicine truly lies. I have concluded that the majority of patients under the care of Psychiatrists need far more medical care than dismissive people in "real medicine" think. These patients do not have regular contact with their General Practitioners and if they do, it is mainly pre-occupied with their mental health, not their blood pressure, cholesterol, visual disturbance, or headache. And the blissful world of ignorance where patients describe their pain, difficulties with function with an intact mental state, where their coping mechanisms are intact, are where people who enjoy "real medicine" want to take cover. Don't tell me about your feelings, just tell me when the shortness of breath started. 

Patients with mental illness really are the monument of medical neglect. The profession has dismissed these poor people as annoying and difficult.

Yet here I am, reflecting on the last couple of months and trying to work out whether my preparation for tomorrow's exam has in any way been useful. My doubts are in place and are difficult to shake. But this is a common finding in all medical students, or any insecure studious person who is hungry to justify their efforts in exams. Only, whatever knowledge I've shoved into my brain has been for the patients that I have seen; to understand them to help others like them and also, to keep the gate-keepers of the question bank in the assessment vault happy.

Like most other people in medical school, I need a break. Not only from the hospital system, but from work, from family, from everything that has become a chore. I need to leave this place, to relax and worry about things right before me in a different light.

There's still so much to tell. And in due time, I will share it with you all. Writing here has been one of my greatest discoveries and I really have enjoyed the hours I have spent thinking and reflecting, telling my stories and identifying my weaknesses. To those of you who I've invited to read these entries, I say thank you for checking up on me, for caring and being there for me by reading my work.

I have really enjoyed sharing it with you and plan on doing so for a very long time.