'I'm free at last' or 'when all is said and done' or some other inappropriate use of a quote.

Exams are done. 

It was like being in a pressure cooker (even though I have never used one) and well it all got too much. For the first time all semester I had to call home (not for fun, but to be calmed down) and ask everyone for a whole heap of support. I would lay awake for 4 hours during the middle of most nights and study feverishly during the days.

On top of my tiredness and stress my neighbour freaked me out just as I was heading out to my last exam. This led to me crying on the train and having the whole carriage offer me support (I don't remember the last time I've cried in public- except for funerals). A middle eastern guy in my year offered to 'have a chat' with this neighbour and another found a shop that sold pepper spray for me. Numerous others kept checking in with me to make sure I was safe. I love my med family. 

To relieve some stress my med housemate and I started eating together and playing 'anatomical charades'. The aim is to contort your body into the shape of an organ or cell until the other can guess what you are. It a very nerdy game that she invented. Play it- it's fun. 

For those interested our practical exam was on the following:

cardiac history

respiratory history

psychiatric history

cranial nerve examination

elbow examination

vitals assessment (blood pressure, pulse, BMI)

The written paper focussed on:

asthma

leukaemia 

pregnancy 

stroke

kidney damage 

The cadaver lab paper focussed on:

Lymphatic system

blood sugar regulation- I think

the heart

the liver

the digestive system

the brain and skull

musculoskeletal

microbiology

 

I can't remember the other few stations! 

Well the exams went well I think- phew!!!!!!!!! 

Now it's time to head home and try and relax. 

:)

Exams. EXAMS. Exams. 

It's that beautiful time of year when that is the pervading noun that sneaks into every thought, conversation and action, and hopefully evades our dreams. 

People have been asking me for my exams times. Here they are:

4/11/11: 2 hour exam in the cadaver lab. It's basically on anatomy, physiology, pharmacology etc. It'll start 10am or 12:30, depending if I'm in group 1 or 2.

7/11/11: 3 hour exam in the exam hall. It's on EVERYTHING. 

9/11/11 12-5 (although it only goes for a little over an hour). MSAT this is where I get to wear nice clothes and take medical histories and exam 'patients'. This is my favourite as it's the easiest to prepare for. I just hope I don't get someone I know as a patient or examiner and freak out in the moment. 

And then.... BLISS. Holidays. This will be spent with as little sitting and thinking as possible. Some of us have given ourselves 'learning objectives' (we get these each week to guide our med learning) for the holidays. This is incredibly nerdy. Still time is precious. Mine are to:

1) write a Christmas puppet show with my cousin 

2) climb mount lofty several times

3) swim as often as possible

4) cook real meals (not stupid- 'let's cook and freeze heaps of foods so I can study meals')

5) make a quilt

6) love my Adelaide friends to bits

7) sleep

Most med people seem to be heading overseas, oh well Adelaide feels a little like going overseas. 

This is my last blog before exams. Lately I've been thinking how med has forced me to stop letting my weaknesses hold me back. My motor skills were shocking so I took up knitting. Now my fine motor skills are good enough to let me consider surgery. Now I am seeing if this method can be applied to my appalling singing ability.  During my study breaks I play my housemate's keyboard and attempt to sing in tune. Maybe in a year's time I'll no longer be ashamed of my voice. Wooohooo for medicine... it seriously is the best medicine. 

(my home for the next two weeks, with my favourite biscuits that are only allowed to be made during exam time. They are full of chocolate and ground coffee) :)

See you after exams. 

Hands are handy

My housemate decided one day she could out do me- both in the cooking with no dishes and being overly excited. Somehow she managed to make mayonnaise inside the egg while only dirtying a teaspoon. Hahaha she makes me laugh. 

There are some things I don't like about medicine (only a few).

I hate it that medicine can act as a barrier with people. Friends who used to think I was normal now think I am incredibly smart (I'm not) and newly met people regularly say 'wow' and then awkwardly walk away. In response to this I unintentionally ramble on about all the silly things I do. Basically say anything to disperse any wrong ideas about my greatness. Oooh and many of my med friends who are girls find that guys are immediately threatened when they find out they're studying medicine. Sometimes I just want to tell people that I'm an OT (nobody really knows what it is, but most people find it to be a satisfactory answer and let me continue with a normal conversation). Perhaps I should just treat med like any other course and normalise it. If I don't act strange then maybe others won't either. 

After people figure out that I'm studying medicine the next question invariably asked 'what speciality do you want to get into'? I feel very silly saying 'hand surgery'. It's just so specific!!! Who knows, maybe I'll end up falling in love with something else, but for now I love hands. Marry up OT and med and you end up with a hand surgeon (science plus functional ability and all that jazz). They go perfectly together- sort of hand in hand. Last week, on my birthday, I had a placement with a hand surgeon (best coincidence ever). Amazingly he let me stay on an extra 3 hours and watch a few surgeries (carpal tunnel, ganglion removal, removal of metal plate from the elbow, removal of golf sized bursa protruding from the elbow joint). I haven't seen any hand surgeries for 2 years now and I was afraid that my love would prove to have diminished. Certainly I didn't have the adrenalin rush that came with the first surgery that I watched. However the 3 hours felt like 30 minutes and and the operating theatre felt comfy just like the scrubs I got to wear. I think hand surgery will be like my knitting- fun, consuming, patient problem solving, creative, intricate, slow and steady. 

Do you have some movies that you watch again and again- finding yourself identifying with a certain character? The last movie Granny took me to see as a special treat (just her and me) was Little Women. I was 9 and incredibly embarrassed by the tame kissing scene and the fact that I cried when one of the main characters died. Over the years I've always seen myself to be like Beth (the girl who died). She was quiet, phlegmatic, shy and too cautious. It was a shock to watch it for the first time in 10 years and find myself frustrated by her and identifying with her older, adventurous, stubborn, outspoken, volatile sister Jo. Jo doggedly pursues her dream of writing, moving away from home at a time when girls ought to stay home and have babies. At first I was terrified. Has med really changed me so much that I am no longer  a 'sweet, quiet, other centred OT'? I began watching myself in PBL. I noticed that I would speak up if I thought others were wrong, even if no one else agreed with me. I no longer sit passively back, but am quite happy to jump in and argue. Friends have noticed that I now take the lead and my family say that I am more decisive. Truth be told I love being more like Jo. Life is more fun and less tame. I think med has forced me to grow up and stop hiding behind shyness and fear of what others think. This is good, but a person newly freed from shackles still needs some restraint. I'm hoping that, with time I'll learn to use my new freedom like a sword, guided by my OT values. This would be better than my random flailing movements!

I leave you with a photo of a scarf I just finished (it's made of lots of little stars) and my desk duck and cat. The duck has been a resident of my desk for many years now to remind myself of who I'm studying for (it looks so vulnerable and I'm sure many patients feel vulnerable). My housemates gave me the cat as a birthday present. It is a lovely wind back toy which is a good outlet when I'm sick of sitting at my desk all day. I love how the duck appears to be looking worriedly at the cat!  At the risk of taking symbolism too far- I think doctors are like cats. They appear to be self determining, confident, and equally good at comforting or harming. Maybe the cat can help me remember to hold onto OT values, which will lessen any harm I may cause in the future.

ps. Exams will be done and dusted in 6 weeks. The amount we must revise by then is phenomenal. I am scared. 

Hidden

I got a shock today, when someone came up to me and commented on my study plan. Apparently he had heard others talking about it (and they had found out about it through my blog). It's a little scary to think that med people are reading this, but they (or you) are very welcome to, although please let me know if my medical explanations are wrong!

These past two weeks have been a little tough. I found out that someone back in Adelaide is unwell (they'll probably be completely fine). Part of me wanted to be the tough medical student and logically reason that everything will be okay and just power on through with my study. The OT part of me wanted to take time out and cry a little, watch movies, go on long walks and basically let myself come to grips with what was happening. I thought I was coping just fine with a lovely balance between the med and OT coping methods. Yet I found myself very carefully refusing to cry when my best friend from back home tried to hug me through the computer screen on skype.

So what is the best way to 'cope'? Is there are good way? There are a few things that I know. I absolutely refuse to be someone who lets my sadness become a method for seeking attention, or even part of my identity (I probably take this too far and don't let people help me nearly enough). I also refuse to pretend that nothing is wrong at all and make no time to grieve. I now know that when I'm upset I have far less reserves for standing up for myself, or simply telling people that I need space. When I am sad I feel vulnerable and hide.

I'm crazy for metaphors, did you know that? This last week pink daisy like flowers have been popping up everywhere. I love them- they happily bob and sway and generally look very pretty. Early one morning I went for a walk/run and saw them. Their petals were all wrapped into a tight little bud, protecting itself from the cold air (I suppose, although I know nothing about flowers). When I feel vulnerable I am like this. People come and, unless I feel safe, I will wrap the petals more closely around me. Sometimes people come and try and rip the petals open. This is dreadful, this is when I close down completely. If only they had come warmly and gently and INVITED me to open, rather than demanding it. This made me wonder about how patients must feel when they are sick and vulnerable. Doctors have to come and ask the patient how they are going- no excuses. I think a warm, gentle, humble doctor (who also gives an air of being competent) would be far more successful in building a good rapport and thus getting a good history than a busy, demanding doctor who fails to see the best in the patient. For all this though, I'm amazed at how kind everyone has been to me.

So enough of trying to be deep and reflective! This week we got to conduct ECGs on each other. In my little group of three, we couldn't figure out why one girl had so much interference showing up on the reading. It took us at least an hour to remember that she is pregnant and therefore has second heart being inside of her!!! Oh dear. We also learnt that the heart beats a little faster when breathing in and a little slower when breathing out. This is for two reasons. Primarily it's because the respiratory control centre is very close to the cardiovascular centre in the brainstem. Breathing in requires the diaphragm and some muscles that move the ribcage to contract. This requires electrical signalling from the respiratory centre. It's proximity to the cardiovascular centre means there's a little bit of electrical over flow and thus the heart beats more. The second reason is that as the lungs expand it creates a drop in pressure, thus sucking more blood back to the heart (venous return). My ECG reading is now proudly decorating my bedroom wall. 

Finally I am so sick of being ridiculously shy. I hate being the only person in my clinical skills group who blushes profusely week after week. This week the tutor said he'd been deliberately avoiding me all lesson so that I wouldn't get stage fright, and could concentrate on learning. Far out!!!  Is there any way of not blushing at the thought of blushing? Is there any way of not being shy? I've moved states, made new friends and still I'm shy!! Perhaps I just need to stop worrying about it, laugh,  and continue to get on with it!

I had a ball (at the ball)

Mmm I just stole my brother's joke- but I'm sure he won't mind.

The last few times I've tried to write a blog, it's been awfully difficult. I've just been way too happy and not nearly stressed enough to write. This is probably related to mid year exams comforting me that med is not quite as impossible as I first believed.

I've been trying to feel more down, but it's just not working. Somehow I'd got it into my head that med is really difficult and that studying constantly should feel like wading through a swamp (an amazingly interesting one, but nonetheless a swamp). This semester studying has felt more like running through a forrest or darting in and out of the treetops. Sleeping is difficult, not due to stress, but simply because I'm so full of joy and excitement. This has made me feel like I am not studying properly. Yet on reflection I am getting so much more done- and understanding everything better too.

We learnt how stress makes it difficult to transfer short term memories into long term memories. So that partially explains why this semester is easier. Also last semester I was learning everything for the first time. Most of the prefixes and suffixes were new. Now I know things such as 'salpingo' means tube and that's why the ligament near the fallopian tube is called the mesosalpinx and the salpingopharyngeus is a muscle near the eustachian tube (between the middle ear and the pharynx) that helps open up the tube when we swallow. You make like to know that testes means to testify and that one of the key cranial nerves, the vagus, means vagrant simple because it seems to wonder everywhere through the body. The body's organ systems are all interconnected and that means that it was impossible to understand all of one system without studying the others. Now that I've studied a few organ systems everything can be understood in context.

Since I last wrote we have studied mental health and the ear. I've always just presumed that serotonin only affected our mood. Yet this neurotransmitter  also affects sleep, appetite, nausea, bowel movements, obsessions, headaches, anxiety and phobias. This is because it is released in multiple parts of the brain. To be honest though I probably enjoyed studying mental health the least out of everything so far. The ear was a refreshing break from chemistry and tiny details that can't be visualised. The ear is a beautiful tool that seems to primarily use physics. I love physics. The ear drum is a thin membrane that divides the outer ear from the middle ear. It's literally like the skin pulled over a drum. It amplifies sound when sound vibrations make it move. Remember the vagus (wandering) nerve I mentioned above? Well the ear drum (tympanic membrane) is innervated by this nerve. This nerve also does a lot of innervation for our gut. This explains a bit why when our ears feel pressure/pain we may feel nauseous.

I really should have checked what I wrote about last time. I don't think I mentioned the med ball. I'm so glad I went. Everyone looked so dressed up and wonderful and there was a massive jazz band with a few jazz singers. I don't think that I'll ever be able to say that I can dance well, but dancing to jazz music is 1000 times easier than other types of music and lots of fun. The med ball was so much bigger and more flashy than my OT grad dinner. Perhaps this is because one of the WA mining companies sponsored it.  Med always seems to do things well- (with med insurance companies always throwing money at all the events).

This is a photo from the ball.

These are some peas from my garden- finally something grew that I can eat!!!

This week I have been lucky enough to see two movies. Plant of the Apes and The Green Lantern. I love it how med seems to attract a few nerds (though perhaps they wouldn't like to be referred to as this!) who like science fiction too. The week before I saw Red Dog- an Australian movie set in WA. It was so quirky and reminded me of the type of movies that I watch with my family. Three movies and a ball in two weeks- I really must get back to study!!!

Relief!

The suspense of waiting... waiting... waiting. We were told we'd have our exam results by the end of last week. Each day the school apologised and made us wait another day.  It got to the point that I was dreaming about opening my results fearing that I had got the dreaded 49%. Today around 11am they were finally released! I did as I had hoped, and so I am glad.

I'm a little bit sad that I haven't written anything deep or profound lately. It's just so much easier to write when life seems terribly hard. So I'm taking it as a sign that Perth is feeling like home, med is feeling doable and I'm feeling more and more like 'Annabel' again and less like a 'med student'.

My new study routine is WORKING!!! Somehow I'm getting through the content and revising and still have time just to do non med things.  It's amazing how taking time out to just 'be' clears my mind to 'do' study and keep me more than sane. Perhaps a day of 'rest' is a good investment after all. Please don't be fooled, med is still hard and sometimes stretches my brain more than I think is possible. However it's a lot more fun to study knowing that I can actually pass, rather than constantly fearing that I don't have what it takes.

Each week we have a class when we practice clinical skills. At the moment we are studying mental illness. We walked into class ready to practice taking a psychiatric history on each other. Instead we had some actors come in. The actress we had was incredible. For a while I got lost in the role play and actually believed that she had schizophrenia. She was responding to voices, paranoid, agitated and afraid. Afterwards I practiced with a friend and pretended to have grandiose delusions- I was 'Annabel the Great'. Although I'm sure mental illness is not at all fun- acting it out is. My tute group talked about an experiment conducted in a psychology class. The professor told his students what symptoms to act out and present themselves to a psychiatric institution. They all got admitted. After a few days they stopped acting and were just their normal selves again. Unfortunately the staff refused to discharge them. The professor had to convince the institutions that they were just students. It's interesting how a label affects people's perceptions. Perhaps first impressions work in the same way?

Tomorrow I start my first placement, observing a GP. I don't know how, but they managed to place me with the only doctor I have seen in Perth! The uni has assured me that there are no ethical implications. I am glad as the doctor seemed to be really kind and he lives very close to where I live. So I'm rather excited about this and the med ball which is on this Saturday. I did not realise when I got into med that it'd involve more than most of my time and brain power. It also involves wonderful peripheral things like wearing lovely dresses and meeting lots of interesting people.

I'll leave you with a photo of my stethoscope case that I made during the holidays and the scarf I knitted during exams.

The caterpillar ate my eggplant.

Last time I wrote was was in the mist of exams and now I'm only a few days off knowing how I went. This is a little scary. To be honest I probably passed, but there is always that doubt. It is weird to go into exams hoping for at least 50%, rather than something over 70%. I guess that is medicine!

These are my favourite memories from the exam time:

1. The cadaver fridge breaking. This meant that our exam which was meant to revolve around dead bodies involved printed pictures and plastic models. This was good as cadavers smell, require a cold room and everything is a pink-grey colour. I prefer plastic models which have lovely defined shapes and colours. That being said, two years back when I was lucky enough to watch some surgeries, I was entranced by the vibrant colours of the ALIVE human body. The red blood, the yellow fat, the white nerves leave cadavers well for ...dead. Sorry bad joke, but I am glad that we have cadavers- it's probably my favourite class of the week.

2. Getting locked in my own house on the morning of my exam. The windows were locked shut. My keys had disappeared and my housemates were interstate and on placement. After some frantic running from door to window to door and desperate prayers I found my housemate's keys and managed to get to my exam and hour early. Two days later I found my keys... in the back door, on the outside! Med brain, it never ceases to amaze me.

3. Practising for my practical exam where we take histories and examine patients. I temporarily stole my housemate's bear and dressed him up as every patient and spent two days talking to and examining him. During these two days a med friend texted me a picture of a teddy bear she'd been practising on. It was the exact same bear.

4. An Adelaide friend was over during this week, she helped to keep me sane and in the evenings before exams. We knitted and watched wonderful med shows such as Grey's and Offspring.

5. Coming home from my final exam to find that one of my housemates and her boyfriend had put all these balloons up in celebration and then we ate a massive feast of curry, naan bread and chocolate pudding.

Exams being over I got to spend two wonderful weeks at home. Two weeks of no study. For the first time in 6 months I felt intelligent again. I also felt so loved. It is rather overwhelming how good my friends and family are to me.

Space away from study gave me room to reflect on my Perth life. I realised that my love of med was perhaps even bigger than at the start of the year. Yet I am more than medicine. My biggest fear when starting med was that I would lose all the little things that I love. That I would no longer get to go on long walks, that I'd stop knitting, that I'd stop learning new recipes, that I'd stop writing stories. I have lost a little of each of these. So if possible I am going to take at least half a day off a week just to do whatever. More importantly this semester I am going to start to make Perth my home, and maybe even build up a community outside of medicine.

Let me end with my beloved veggie patch. Out of everything I originally planted (aside from food ) scraps) only the eggplant remains. I came back from my holiday and picked the one eggplant and cut it open. A caterpillar crawled out. What a tragedy! Oh well, at least it made me laugh. Maybe the newly planted sweet peas will fare better.

In the midst of it

I feel like an athlete near the end of a long long race-  surprised that I'm actually near the finishing line. Also though, struggling to gather the final oomph. My first real exam is in 6 days and yes I am calmly studying away, hour after hour, day after day, but I am so very ready for a break.

Every day (bar Wednesday nights) is like this: Wake up. Breakfast. Study. Lunch. Study. Exercise. Dinner. Study. Bed. 

I used to laugh at med students and think surely it is not necessary to study every night or all weekend! However it is. Of course not every med student studies this much. Many people in my course have come from undergraduate degrees in biomedical science. They've been lucky enough to do some learning and lots of revising this semester. OT although wonderful in so many areas, has not really helped with medicine so far- I'm hoping it'll shine forth when we're actually relating to patients. I'm still overwhelmed how much my peers know, but at least now I feel like I can hold my own. Finally in PBL I understand what they are talking about and can contribute! 

It seems like all us med students are feeling a little sorry for ourselves at the moment. Sometimes though, we discuss the greater horrors of applying for medicine and not getting in. This cheers us up immensely. 

We had our first exam on Thursday. It was theology and it's pretty difficult to fail. As we were filling in the cover sheets everyone was whispering questions such as: 

'What's the date?'

'Is it June or July'?

'Is it 2010 or 2011'?

'How do you write numbers in words'?

Hahaha. Oh dear our poor poor tired brains!

We are all a little crazy. I'm pretty sure 90% of us are studying in track pants and/ pyjamas and ugg boots. I'm so cold that I've taken to tying a hot water bottle to my stomach with a scarf! Procrastibaking is a new favourite hobby of many of us, much like watching 'medical' shows such as Grey's Anatomy and Scrubs and classing them as study.  As I sit and study  I have the misguided words of Abba in my head- ''study study study, must be funny, in a non-med's world''. 

MUST KEEP STUDYING

Some people are asking me for my exam times so:

• 24/06/11, sit in a lab and rotate around cadavers and models and answer science questions
• 28/06/11, sit in an exam room and answer some science (eg. this person is lying in the middle of the road why could this be??) and some population health (prevalence, statistics) with medical issues (eg. a mother wants to donate her son's kidney to her daughter is this allowed)
• 1/07/11, rotate through 4 stations where I take a medical history or do an examination on an actor. This could be: gastrointestinal, skin, reproductive, renal.

Too relaxed.

If you were writing a blog every week or two what would you include?

Medicine is getting harder to write about. I think perhaps this is because I am now a med student- and I know this to my core. There is no doubt about it- my uni isn't going to suddenly realise that my place was a mistake and ask me to leave the course!

When kids are little they seem to have the need to let everyone know that they go to school or that they are now a 'big' kid. However as they grow into being a student and an actual big kid there is no need to dwell on the fact. Studying medicine is beginning to feel normal and I am starting to feel secure in my ability to 'make it' as a doctor.

This feeling of security is a little bit of a shock. I know last week that I made the decision not to stress about passing exams anymore, but this is ridiculous. I haven't felt this peaceful or full of joy for months, possibly since I found out that I got into medicine in October last year. Exams are in two weeks and everyone is freaking out and me the 'stress head' is laughing, skipping and relaxing. I feel like I'm on holidays. Don't worry though I have revised everything at least once and have a plan to revise it all again, with a special focus on pharmacology (which does my head in).

This brings me to my big 'ah ha' moment for the week. Oh dear what an occupational therapy phase- 'ah ha moment'! Perth is pretty sunny during the day, but nights are freezing. I literally study with my winter coat on, uggboots and a granny lap blanket and sometimes even a warm hat. A couple of nights ago this cold was so penetrating that I couldn't sleep for two hours despite numerous socks and blankets. In the end I put on uggboots and crawled back into bed. Never before have I had to sleep with shoes on!!! The following day I purchased a hot water bottle and my house no longer feels cold. The hot water bottle was so simple and yet it solves everything. Maybe medicine is like my house- yes it is harder than most degrees, but perhaps there is something simple (like a hot water bottle) that will make it more possible.

The wonderful thing is I think I've discovered it. A simple yet comprehensive routine makes medicine quite easy (we'll see if I pass these exams if this is true!!). This is my recipie for passing medicine next semester.

1. Always go to bed around 10/11pm. Get 8 hours sleep.

2. Always get 30 minutes of exercise each day- preferably through running

3. Always complete the core learning material for each week on the weekend

4. Always cook one big meal each week and freeze lots of serves

5. Always revise the anatomy pracs and do readings on the train

6. Always revise each week (Thursdays) in this order:

• The week before's content
• an earlier week (starting with the first week of the year and then the next the following week and so on)

7. Give my self a quick pharmacology test or clinical skills test every week night that I study

8. Always take one night off each week

9. Stop being a fool and use my OT skills to buy an office chair that won't hurt my back!

10. Stay in regular contact with people back home

This means that I'll be healthy, happy and have revised everything even before exams hit. Yay!!!!!!

Can you now see why I feel so happy? I finally have a plan- and a plan that is GOOD.

This week we've continued studying reproduction and the urinary system. I had no idea how complicated the whole system is. Things I do like though is that the prostate gland makes an antibacterial substance to help protect the sperm and the oviduct makes glycogen (stored sugar) to feed the fertilised egg. It's also amazing to hear how wrong our previous understanding of the system is. Some of us used to think that the egg exploded inside the uterus and that's where periods came from. Other people thought women laid the eggs a little like chickens and yet others thought both females and men make sperm. Ah how fun our tutes have been this fortnight!!!

Let me leave you with this cartoon. I think it's pretty obvious which one I am!

Teddy bears!

Gah life.

I really want to capture the small wonderful bits of med life. One day I'll look back on this and laugh.

Everyone at uni is slightly hyperactive, manic and basically a little on edge. Friends can be snappy and those who never ever get stressed say things like 'Ahhhh I'm just so stressed', just to fit in with the mood. Exams are looming and so the atmosphere is tense with electricity like the sky before a storm. 

Conversations have therefore become a little weird. One lunch break was spent discussing what type of cell we'd be- any cell in the human body. I said a neuron as I'd always be excited. Guys tended to say sperm or macrophages as it'd mean they could go on adventures and eat lots of stuff (even though it's mainly rubbish and germs). My favourite though was the student who wanted to be a cancer cell- as they are immortal (if not treated).

Despite they craziness of this pre exam rush- I've taken today off from study!!! Since starting med in January I've only had 6 full days off (including today). I'm beginning to think that so much study is a little counter productive. Hopefully the day off will end in amazing study tomorrow and on the weekend.   Today was a little special as I got to be a teddy bear doctor. 8 first year and 3 second year students went to a primary school to treat around 60 teddy bears. We walked in wearing our white lab coats with our stethoscopes around our necks. It was amazing have kids scream excitedly 'look at all the doctors, doctors, real doctors' and then the teachers gently correct 'teddy bear doctors'. Seeing 60 patients in 2 hours was exhausting (even though we only did around 6 each).  It was amazing how many teddies had sore tummies or broken legs. The camel with the four broken legs and broken tail who got hit by a car was my favourite. To help kids overcome their fear of doctors we tried to involve them in the treatment. This kid was quite pleased to inject antibiotics into the poor camel. At least 20 injections were given. 

Last night I went to a dinner with 20ish female med students and three female surgeons. The food was delicious, but I was more excited to be sitting next to a colorectal surgeon. She said earlier that day in theatre poo had got everywhere- but she'd managed to squeeze in a shower before dining with us. It was nice to hear that surgery is a very real option for females and that being enthusiastic is the key to being remembered by consultants and being given opportunities. It was also interesting to hear that surgeons are generally not allowed to operate for the rest of the day, if they lose a patient on the table. Finally girls can be surgeons and have kids- they just need to have a nanny and possibly a cleaner and maybe even a cook. 

Each week I talk a little about something I learnt that is medical and something that is not. Why do I always go through a crazy stressed period where I think I'm going to fail? Yet I never do. I march around telling everyone, including myself, that there is no hope. It makes me miserable. This year I'm going to try and break this stupid habit. I know I use it a little like sharks use blood- it razes me up into a study frenzy. It's not worth it though and others shouldn't have to put up with it either. 

This week we studied the male urinary system. I'm not going to discuss it too much here. I know I have to have frank discussions about such things with patients- but it's not normal to do so with my non-med friends or family (well not in a blog anyway). It was pretty funny though to be reading my lecture notes on the train- to suddenly realise that all the school girls were giggling! I forgot that the lecturers like to include lots of photos. 

I love medicine- it's full of funny moments.

A kick in the kidneys

Today I want to write about the little things of med. Primarily because nothing huge has come along lately.

Some people say that it's a gathering collection of little losses that can lead to the unrelenting burden of sadness. Can this work the other way around? What is the effect of a life full of many of little joyful things?

Interestingly last year my life was filled with a thousand 'little joyful things'. Every couple of days before work I'd get a chai latte from my favourite cafe and walk around the beautiful old buildings and parklands of North Adelaide. Sometimes a koala would grace the gum tree at the bottom of our driveway. Kookaburras would gather in our backyard and blue wrens repeatedly fly into the back window. Friends and family were always around to go out for coffee or a dark chilli hot chocolate. I had a kitchen full of interesting food to cook with and an endless supply of colourful wool to knit with. I even had time to watch as much House as I wanted to (although it drove my family a little up the wall). Yet the unfulfilled longing to getting into medicine remained with me.

Often I now feel like my life is completely reversed, that I know have the one thing I've always really wanted, but at the expense of all my favourite little things. Of course this isn't completely true!! (I still knit and cook a little and I have some lovely friends here too) Yet medicine is worth the cost- overwhelmingly so. Everything we learn is INCREDIBLE (although sometimes I wish the biochemistry was a little easier). The constant hard study is like a an endless bush walk where it is always too hot or raining, but the scenery makes up for the pain. Beyond that though I love a fight, an adventure. Finally my life doesn't feel tame!

So then perhaps 'happiness' is deeply affected by 'little losses and joys' but it is driven by purpose. Crazily enough purpose is only fulfilling in the context of flourishing relationships. I, and so many of my med friends, find that they simply cannot study without taking time out to be with friends and family.

Just to convince myself that medicine also has some 'little joyful things' I'll list them:

• The one footed seagull that seems to meet me each day at uni
• The cozy place under the stairs in the med building that seems to act as a people magnet 
• Refusing to store my lab coat with any of my other belonging- cadaver smell is horrible
• Getting to hold pig kidneys
• Our tute room that smells of feet not matter what
• That it's so cold at home that the printer gives off steam
• That every organ is stunning from its gross anatomy right down to its biochemical functioning 
• That the content of med is like a never ending pit of treasure
• That I haven't tried to get off the wrong side of the train in two weeks and I stopped myself from applying highlighter (thinking it was lip balm) just in time
• That despite all odds it appears that my veggie patch will produce at least one eggplant
• Last week I got the state's medical journal in the post- reminding me afresh that I'm actually a med student!
• That I've learnt and probably know more in the first semester of my course than I learnt in my whole OT degree, and yet can't seem to remember what year it is. 
• That after a scary talk on the upcoming exams the lecturer felt the need to show us a powerpoint of cute animals to describe how we may be feeling. I love my 'warm fuzzy' uni!

I'll end really quickly on kidneys. I've never really known what dialysis is. It seems there are two main types: haemodialysis and peritoneal dialysis. Both are done because the kidneys aren't working well enough in managing the water, sodium, pH, toxin levels  etc of the blood. Until damaged kidneys have recovered their function (they are pretty awesome at regenerating from an acute injury) or a kidney transplant is performed dialysis will have to be done for life. 

In peritoneal dialysis the person has a permanent catheter into their abdomen (peritoneal cavity). Gravity is used to put up to 2.5 litres of fluid into this space. This cavity is rather cool in that it is separated from the rest of the body by the peritoneum. This membrane can act as a filter. The fluid that is pumped in matches the fluid content of the body except in the things that are usually eliminated by the kidneys, through the urine it produces. For example this may include urea and hydrogen ions. Using simple dispersion all the solutes (dissolved bits) all spread across the peritoneal membrane until there are equal concentrations in the fluid on each side. The fluid is then removed from the peritoneum 4 to 6 hours later- taking with it many of the toxins etc that crossed over the membrane. Brilliant. This can be done at home, without medical help. Sadly though bacteria love glass and plastic. One scientist figured out that bacteria and pass from one end of a 1 metre water filled glass tube to the other in 17 seconds! Inevitably the catheter will attract bacteria leading to an infection in the peritoneum. Infection can lead to scarring- if it happens too often the peritoneum membrane will be too scarred to let dialysis fluid pass through it. Most patients have to stop this form of dialysis after two years for this reason. 

Haemodialysis works on the same principle. This time though blood is pumped out of the body and through a machine that acts at the peritoneal space. Inside is a membrane. The blood passes on one side and on the other side of the membrane is the dialysis fluid. This procedure though is done in the hospital, so the poor patients have to disrupt their lives a bit more. Even though dialysis saves lives, it is never quite as good at filtering as the kidneys are. As a result patients tends to feel tired and nauseated a lot (due to the not quite right balance of chemicals in their blood). Also if they aren't urinating- they need to limited their fluid intake. Some fluid will always be lost through sweating and breathing, but without urinating the body's fluid content will swell in a disturbing way!

Enough for now- in a little over a month exams will have passed and hopefully so shall have I! So looking forward to a break:)

It's all in the genes

Today was a lovely day. In fact this last week (apart from a little hiccup in the stress department) has been lovely too.

Why this week has been lovely: 

Last time I wrote about how I was sick of the stressors that came along with medicine. I would like to finish that story. Burdened by the stressors of med I sadly chose to spend my money on printer ink rather than the upcoming med cocktail party. My friends somehow picked up on this and rushed over to give me a giant group hug. Secretly they then conspired to buy me a ticket to the party. I was so touched when I found out. My housemates lent me a dress and helped me do my hair. I felt like Cinderella who got to go to the ball after all. I wanted to include this little story to show that although med students can be grumpy (due to excessive amounts of stress), they'll do anything to help each other. I love my med family!

So what's been so lovely about today? Everything I wanted to get done- I did. It was a lovely sunny day. I got to study in the uni  courtyard, then by the beach and then inside my tute room. I studied when I got home- to Eva Cassidy and made some crochet flowers while watching Dr Who. A perfect day! 

After studying at the beach I went to my favourite lookout- where the cannon faces out  to sea. Earlier in my blog I talked about how passing medicine is like firing a cannon ball to a far off island and doing everything possible to make sure it makes it. Today I was struck by the cannon itself. It sits on runners and is chained so that when it fires the after shock doesn't make it shoot too far backwards. If I am so focussed on passing medicine, what will the aftershock be in me? In other words- how is medicine changing me? I know that I am far more decisive and confident. I also do a lot of stupid things and regularly have school kids mutter 'how embarrassing' about me. This doesn't bother me too much. What disturbs me though is my short fuse with people. In the past I only ever told treasured friends when I was upset with them- because I valued the friendship so much. Now it seems so easy to speak out my annoyance straight away. I don't want to become this person. I don't want med to make me become grumpy, overly vocal, quick to judge and basically always acting out in stress. What a horrible outcome!!! Particularly as studying occupational therapy taught me to be kind and to patiently search for the value in everyone. I do not want to lose these invaluable interpersonal skills. 

So perhaps I need to put runners and chains down for myself- so that I don't run off course. What though? How can I nurture my 'OT self' amid this high stress med world? Taking time to see friends, knit, crochet, run, cook etc will help. Insight into what is causing my short fuse and grumpiness will help. On top of that acknowledging my negative feelings, but choosing to act in a way that I'm proud of will help too. To keep a marker of who I want to be I'll continue to read stories of people I aspire to be like. It may seem trivial to focus so much on my character, as well as medicine, but I'm hoping it'll be worth it. Who wants a proud, short tempered, judgemental doctor anyway??!!! Not me. 

Now for something awesomely cool and medical. Well I can't really do that this week- we've been studying cancer and it's quite difficult to understand. Biochemistry drives me insane. Someday I'll conquer it. As well as that cancer seems to affect most families and evoke feelings of fear and grief. Here are some very very basic facts about cancer.

1. It's genetic. There are genetic mutations that take place in the DNA. These revolve around the genes that regulate cell growth. The genes that pause cell growth to allow any damage to be repaired are decreased. The genes that encourage cells growth are increased. 

2. The genes can be mutated due to all sorts of things ( we don't fully understand this yet) such as radiation. Also people may have a genetic predisposition too. For example they may have one healthy gene and one bad one (genes come in pairs, and the good one often compensates for the bad one). This person then requires only one mutation in the healthy gene to get cancer, instead of one in each gene.

3. The cancerous cells therefore have a genetic mutation and grow heaps, dividing and dividing making lots more cancerous cells. They grow so quickly that they don't have time to differentiate. This means choose what they want to be. For example the white blood cells will only grow enough to exist, but not to carry out their immune function. 

4. They don't have the normal 'time is up gene' that tells them to die at the appropriate time. Most cells in the body have this and die, thus removing old damaged cells from the body. Therefore cancer cells can be immortal. 

5. They are able to make blood vessels grow near them. This way a cancerous lump can get enough nutrients to survive. 

6. Most cancer cells are killed by our immune system. Only the really tricky ones escape. These ones are far more similar to the normal cells and this means the immune system treats them as such- not realising how dangerous the impostors really are. Radiation therapy aims to create further mutations in the cancer cells so that they are less about to hide and thus can get knocked off by the immune system, or simple be so badly damaged that they cease to be immortal and die. 

7. One in three people will get cancer. One in five will die from it. This is scary.

To sum up, cancer is quite clever, horrible to study, yet there is hope now and in the future due to our growing understanding of it.

Bye for now- so much study to do!!!!

ps. here's a photo of my beloved textbooks and some flowers that I've crocheted recently.

Iron deficient

Gah medicine. I mean really- sometimes I hate all the baggage that medicine brings with it.

I wish that medicine was simply- medicine. The wonderfully fascinating science that can be used to extend the quality and quantity of life.

It's not though. No matter how much I try, some of the baggage will haunt me- tempting me to carry the stress of that too. I know the metaphor is becoming a little hard to follow- so I'll try and explain.

At least 70% of people in my course are struggling financially to get by. Some of these people astound me with their ability to hold down jobs on top of the mammoth task of studying medicine. 100% of us don't keep in contact with our friends and families like we did in our past lives. The list goes on. Perhaps what I dislike the most is being so vulnerable all time. It is so strange to go from competently holding down a job and looking after others to need constant support from those around me. Should a 25 year old still be calling home for help? Should a 25 year old burst into tears in front of strangers? Should a 25 year old need care in much the same way as a toddler learning how to walk does? It is embarrassing.

Yet I wonder if this humbling time has value? I know a lot of my med friends are going through the same thing. In hospitals patients are often seen by doctors during their most fragile moments. For example to go from working one day to lying in bed being catheterised the next- must be a horrible adjustment to the person's identity. Perhaps like me they need help, but also long to be seen as the competent  happy person they normally are. So then how should I treat these patients? Should I get them well as quickly as possible? Yes. Should I acknowledge their pain? Yes. Should I acknowledge who they 'normally are'? Yes.

I want to thank my family for putting up with my many phone calls. I want to thank my friends for loving me just the same- even though I write letters far less than should. I want to thank my housemates for encouraging me daily. I want to thank my housemate's family for having me over during Easter.

Enough of that deep thinking for today. Two weeks ago I went to suturing night at uni- we lacerated and sewed up pig trotters. It was pretty incredible. I loved it. Being a surgeon must be exhilarating. Soon I'm going to be part of the Teddy Bear hospital and pretend to treat school kid's teddies- how fun! I've finally given in to Ugg boots. All my life I've hated them- they are so ugly. However they turn out to be vital for studying in my cold house. My friend's wedding was stunning and it was so refreshing to be home for it.


Cool medical fact for the week- we can get iron through eating it, but it's a lot harder to get rid of. Our body cells take up what they need and store a little extra. Some protein (transferrin) carries it around our blood stream allow the iron to reach cells all over the body. If the cells don't need anymore iron the body seems to know to not absorb any from the intestines. Yet why do we keep needing to eat iron- if the body doesn't get rid of iron once it's been absorbed from the intestines? Simply because we lose cells every day. Hair falls out. Dead skin rubs off. We fall over and a bit of blood oozes out. This is the lost iron that we need to replace. Pretty cool hey?!

I shall leave you with a picture of my room. The angel reminds me to pray. The picture by my brother reminds me to hope. The skeleton makes me laugh.

Deadly words

Oh my dearie dear me. I have not written for two weeks. How completely dreadful.

My excuse is that I had an essay due and I'm heading home this weekend for a beautiful friend's wedding. Somehow I had to study extremely hard so that I could do absolutely NO study for those few days at home.

Over these two weeks I've thought a lot about the power of words. Does saying something negative really make it happen? To me this has always been a ridiculous belief. Yet, I now wonder otherwise. I have a veggie patch- that I nurtured from seed. The soil in Perth is basically sand and yet some zucchinis and a pumpkin were beginning to grow. Every morning I'd eat my breakfast by my garden and lovingly water it. It was one of the best times of the day.

I suppose love is blind. What I thought was beautiful, was scorned. My housemate's friends would come over and they would stand in front of my garden and laugh. Every day it seemed, someone would give me some more advice on how to improve my ridiculous garden. This upset me. My beloved garden was now a laughing stock. I no longer ate my breakfast by it and hence forgot to water it.

Over  the week I got upset enough to forbid my housemates from paying it out. However by the end of the week most of it died through lack of watering. Only the basil and eggplants continued to thrive. If only people hadn't paid out my garden. If only I hadn't let their words destroy my enjoyment of my garden. If only... then my garden would not have mostly died. Quickly I just want to say that I'm not blaming my housemates (Australians basically pay out anything thing that they can). Still I think this is a part of our culture that we ought to lose.

So words killed my garden... sort of.

Applying this principle to my studies intrigues me. Each day I plug away at what I need to learn. Yet I regularly feel completely inadequate. I am vulnerable to attack. Imagine if I believed that it was no use and that I should not bother. Imagine if in my vulnerability, people began talking and saying that I didn't have what it takes and laughed at my poor grasp of medicine. Would I study harder to prove them wrong? Or would I slowly lose motivation to study and believe that it's no use anyway?

Normally I would be resilient and prove them overwhelmingly wrong. Yet now I am pushing myself to the extreme. I am tired. I am stressed. My brain is working harder than it ever has. I am away from home. My defences in other words are down. Therefore I've come to the conclusion that as med students we should encourage and support each other. All pushing each other to believe that we can in fact pass and that yes.. all the study is worth it.

Enough deep(ish) thinking. This week has been full of med brain instances. I poured cereal into my coffee mug. I tried to pay for my printing with my transport card. I boiled the kettle with the lid off. Despite this med is still wonderful. I love it how our lecture went 30 minutes overtime tonight, but it was so engrossing that no one told the lecturer. I love it that as many of us chat on the train ride home (7:30pm) after a day of lectures, we laugh and share our favourite parts of what we've learnt. I love it that we love med.

I'm way too tired to describe something medical in detail to finish this post off tonight. Instead I'll leave you with this cool fact. Some people don't like big scars. This poses a problem when surgeons want to remove something big like a kidney. So they make a tiny cut to slip the scalpel in and detach the kidney... but how to pull the kidney out through that tiny hole? Well they make a cut into the colon and put the kidney in there and then suture up the colon and abdominal wall. What... so they leave the kidney in there??!! Yes! The person then wakes up and excretes it like they normally would with anything else in the colon, ie faeces. Now that is gross, but awesome.

This is a giardia cake that I baked for my tute group.

My favourite new things... (mentioned in the blog below)

Gut instinct

Have you ever listened to someone's story of woe and instead of feeling sorry for them, have felt jealous of them? Or at least wanted to shake them and say 'Dude you have no right to complain, your life is 1 000 000 times easier than mine'?

This week this has happened an awful lot. So far I have managed to listen, nod my head sympathetically. Yet what is going on inside my head is a different story. 

We were warned right at the beginning of our degree that this would happen. That when when we graduate and work as doctors we'd come home and our families would complain about their days and we'd snap and say 'here's 50 cents, go call someone who cares'. 

I know that I'm not a doctor yet who cares for others all day. However I have to study A LOT and therefore have very little time for myself. Last weekend I studied from 8:30 am to 10pm on Saturday and Sunday and then followed this by a week of lectures from 8:30am to 6pm with extra study when I get home. All with the added stress of still being behind and not knowing enough. On top of all of this I am meant to cook, clean and wash my clothes, oh and sleep. 

So when people complain about their busyness and I know that they at least have time to see their friends most days and certainly don't study on their weekends I have to restrain myself from saying something horrible. To me it's like they have a splinter in their thumb and I have had a whole arm chopped off- their pain seems negligible. 

BUT... I do not want to become this person, the sort of person who only has compassion for other doctors (single parents probably also work as hard or harder). Pain is still pain. There are also different types of pain. My pain is grief for my free time, my friends and family back home and all my nice pretty things that simply won't fit on a plane. Yet perhaps my pain is not that bad, I CHOSE this life and I although the cost is dear, I GAIN medicine and a whole lot of new friends. 

The lecturer who warned us of this horrible attitude, that we may develop towards others, gave a lovely solution. Instead of saying 'I'm such a mean person' and feeding our self pity even more he suggested that we must find time to CARE for ourselves too. No one can give and give and give without receiving. Far out even Jesus took time out early in the morning away from everyone who wanted his help. 

So this week I've done two things. I've bought lots of brightly coloured stationary to make study more fun (back in high school aqua and purple highlighters did not exist). I've also decided that I don't care how far behind I am, I AM going to take Friday night off to watch a movie, eat yummy food and crochet. 

When I had my interview to get into medicine they asked one final question- 'Do you have any other achievements you'd like us to know about'? This freaked me out. I mean I've done nothing amazing. I was sure that all the other applicants would be amazing athletes, volunteered in orphanages overseas or at least won the nobel peace prize. All I could scramble together was my passion for knitting and crocheting. Weirdly enough this got an overwhelming response from the three interviewers. For 5 minutes they drummed it home to me that no matter what I must maintain this passion- that it was vital. The doctor on the panel was particularly adamant. I wonder now if this was because he knew, that without it medicine would take over everything and I'd become the bitter person I described above. 

Do I have a cool medical fact for this week? YES. This week has been all about the gastrointestinal tract. I seriously think this is my favourite part of the body- it just makes sense. 

Helicobactor pylori is a bacteria that can survive the acid of the stomach and it has a few tails (flagella) to help it swim to the mucus wall. There it uses spikes (frimbrae) to attach to the wall (so that the intense muscle contractions of the stomach don't knock it off). It the secretes urase  (enzyme) which helps to break down urea in the stomach to carbon dioxide and ammonia. The ammonia makes the area around it more alkaline (protects it from the acid that it can survive in, but not thrive in) and the CO2 is absorbed through the mucus, into the blood and is finally breathed out through the lungs. It also releases toxins that destroy the mucus layer of the stomach wall. This means that the acid can now destroy the stomach wall and an ulcer forms.  The only way to heal the ulcer is to kill the h. pylori with antibiotics and to slow down the acid secretion in the stomach. 

An Australian from University of Western Australia discovered this bug and is now a hero. I can't count the number of times we've heard about him and the person who helped him. Before him the world thought that ulcers were stress related. So now patients no longer are blamed for their ulcers and treatment is pretty non invasive. The poor surgeons get less work though.

Okay so that is all rather specky. However what I really love is one of the key diagnostic tests done to detect h. pylori. The Urase breath test. The patient swallows a tablet of urea which is made of ammonia and an isotope of carbon. (isotope means it is difference to the normal carbon breathed out in CO2). If the h.pylori is in the gut it'll break it down and with 30 minutes a sample of the patient's breath is taken to see if the isotope is in it. This is AWESOME. Finally I get to use a little bit of physics. 

The other cool thing I learnt was about faecal transplants. Now I understand that most people are squeamish. However if you're not, google this! It's exactly what you think it is. If you were dying from gastro you may let this be done to you. Maybe. 

Duckling

Ask any med student what could be harder than studying medicine. I think most would say- 'not studying medicine'.

It sounds silly, but it's true. 

So many times over the last two months I've wanted to throw it all in and go home... and yet I couldn't. There is nothing else that I'd rather do. 

Being an occupational therapist I would say this is because people in life are the most fulfilled when their lives centre around activities (occupations) that are suited to their abilities and are profoundly meaningful to that person. 

The whole selection process to get into med hopefully means that we all possess the ability to be good doctors! 

However what makes medicine so meaningful that people stick at it- even when it seems to take all they have and more?

My peers have given a variety of responses from: it's a challenge, my parents want me to, it was the next logical step etc. Most though, would say that apart from wanting to help people- they find medicine the most fascinating thing they've come across. It's a passion that bubbles up from deep within us. 

Personally I have two reasons for studying medicine. Firstly I have loved 'blood and guts' for as long as I can remember. For example as a little girl I came home to find my cat had cut open her abdomen while jumping over a fence. Carefully I laid her down and gently probed her stomach fully absorbed in viewing the exposed muscle. This is not a normal response. Later I did cry and dream about her for months when she died a day later. Everything we have studied so far in medicine absorbs me in this way. It's as though every week I fall move deeply in love with medicine. 

My second reason is what gives me the motivation to study when my eyelids are twitching with tiredness  and the sun is calling me out to play. It's the deep set feeling that this is what I was created to do. I remember looking down at my hands in grade four thinking that they were made to heal. In year eight I would sit next to one of my oldest friends and we would joke that there are some very vulnerable people out there that needed our help- without us they would surely die. We would imagine these people as ducklings with a crocodile following them eating them up one by one. I have no idea what made me think that I too wouldn't be eaten (maybe I was in a boat)! 

Over the years this metaphor grew to illustrate people in developing countries who were living restricted lives or simply dying prematurely because they didn't have access to world class health care. Desperately I wanted to go there and provide them with that care. Sometimes I would catch glimpses of myself in the future doing this. I saw a clinic, made out of dried mud, with kids running in and out laughing and one of them held flowers for me. I stood in the door, full of joy, with a stethoscope around my neck. Glimpses such as these would be painful when I thought that I'd never get into medicine. Now however they are a source of inspiration. I am not studying simply for myself. The more I learn, the more I will be able to help my future patients. It is an act of love for those I do not yet know. What a romantic notion! Who does not want to be a hero, who overcomes many obstacles to rescue people?! I wonder if others have their own 'ducklings'?

The friend who used to sit next to me in year eight gave me a plastic duckling that sits next to my laptop. I've included a photo just for fun. 

Usually I finish each post with my favourite medical fact for the week. I'll be brief this time. T cells (are good at killing germs) are white blood cells that are made in the bone marrow and then are sent off to T cell school in the thymus. Here they go through rigorous training and testing- for 2 to 3 weeks. Of these cells only 3% pass their exams and are allowed to leave the thymus and go to live in the lymph system (eg lymph nodes  and the spleen). The rest are cruelly forced to kill themselves. We are all (hopefully) born with a thymus which continues to grow until we reach puberty. After this it slowly shrivels and changes into a heap of useless fat, going from 40g to 12g by the age of 50. Why? Well, hopefully by this stage our bodies have been exposed to most germs and therefore have enough memory T cells specific to these germs. As we get older and the thymus starts falling apart, some T cells manage to escape some of the tests in the thymus, which would normally have resulted in their demise. Occasionally these T cells are unfortunately untrained and dangerous- they don't recognise some of the body's own cells and start killing them- hence causing an autoimmune disease.  Please med students (if you read this) say if this is incorrect! 

So please honour and help us med students who are giving up so much to study such a great discipline, and delight with us that we have the reciporacle honour of studying something so absolutely wonderful. 

Scary face

Each week I am able to love med with less fear. A few weeks ago med felt like an interesting monster who followed me around. Now it feels like a Willy Wag Tail that flutters and hops around me. When these birds try to be scary they puff up their eyebrows- which to me is the most ridiculously funny 'scary face' that I've come across! It is such a delight to study what I love with minimal fear.

This week the same thing happened three times- and I think I've finally learnt my lesson! For years I've 'hidden' myself from others. Oh I've been friendly and smile at everyone, but that's like being a nicely wrapped present that is never opened. I do this so that I don't annoy people- thinking that perhaps I'm a rather a specific sort of present. Such as a box of 80% cocoa chocolates filled with fig and caramel. These are brilliant chocolates (my favourite actually), but not many people like the taste. 

Basically three times this week I've hidden even more, trying not to annoy people. What a tragedy!!! Especially since in all three cases the people where worried about annoying me. If only I had not hidden, but instead taken the lead and fixed things straight away! What a silly week it's been fretting. 

Doctors, of all people, cannot hide. They must be leaders. Surely doctors do what they know is right (hopefully with sensitivity and compassion) instead of shyly waiting for the patients to take the lead. Growing into this role will be this year's project (as well as my veggie garden, the blanket I'm crocheting, and passing medicine).

Okay onto cool medical facts. All day I've been studying the immune system- my favourite thing has be B cells. These are lymphocytes (Along with T cells and Natural killer cells)- this means they like to hang out in the lymph system. B cells are white blood cells and are made in bone marrow. Once made, they travel through the blood and hang out in lymph nodes hoping to meet a pathogen (germ). Once they meet the pathogen (and a whole lot of other things happen) they produce antibodies (which give the kiss of death to pathogens so that other cells know to kill it). Okay that seems sort of boring, but.... not only are these B cells specific to different pathogens they are able to produce antibodies that are suitable in different circumstances. All the the types/classes are Ig- something. 

IgG are the only type that can pass through the placenta to help protect the foetus. Even better than this they have a half life of 3 weeks so they can tide the baby over until they start making their own antibodies!

IgM antibodies are shaped like a flower and give the kiss of death a pathogen on each petal at the same time- all while attracting two explosives close enough to to each other (imagine explosive rubbing each other until they spark) and the pathogen (on each petal) to cause an explosion which kills the pathogen. This antibody is made from the first trimester. 

IgE antibodies are sort of similar in that they too can cause an explosive near the pathogen. Except in this case they are best with BIG pathogens like parasites that are way too big to be eating. This is the class of antibodies that can cause anaphylactic shock. This is because the explosion uses histamine that makes fluid leave the blood (eg swelling or a runny nose) and can make smooth muscles (muscles that you don't have to consciously move (except the heart) eg. around the windpipe) contract. If too many bombs go off  too much fluid may leave the blood = heart failure and you may suffocate. 

IgA antibodies though are my absolute favourite. They cover the 400 square metres of mucous in the body (eg around the gut, airways) They are shaped like a long stick and therefore can easily squeeze through the tissue in the body to the mucus area. They are also resistant to digestive acid. Using their four hands they grab pathogens who are trying to squeeze through the mucus to get deeper into the body. They are now a much bigger lump that the mucus can get a hold of and carry out of the body. This is AWESOME. This class of antibodies are in breast milk and therefore line the newborn's mucus from its mouth through to its gut with. How good is this? Especially as babies put all sorts of germs in their mouths.

Finally everywhere I live I quickly find my 'favourite place' just to go and think. In Scotland it was the beach (even in winter). In Whyalla it was the wetlands. In Darwin it was the coastline. In Fremantle it is the round house. From it I can look over the sea, be refreshed, and then walk 5 minutes back to uni. I LOVE it. 

Just keep breathing.

I want to talk a little about trying to 'fit in'. Basically I am not outrageously different, but all my life I've quietly gone and done exactly what I want to do.   That was until I've hit med- or it hit me! This approach is SO much harder in med. Let me describe the people in med. Everyone is ridiculously good-looking, skinny/ buff, well dressed, intelligent and LOUD. Of course this is an exaggeration, but this is what it feels like. Last weekend we had PBL games. This is where as tute groups we compete in our own version of the Olympics- with some awesome costumes chucked in. I LOVE this kind of thing, but I NEED time each week to just hide in my own little cave. Otherwise I become a crazy person (grumpy, teary, paranoid, worn out etc). Med being med, there is little time for this sort of thing. I knew that the PBL time would be the only time available for this.

Yet I was unable to tell my PBL this. I paid the money, I said I was going, I helped make costumes and when the time came I simply didn't turn up. I hate this. In the past I'd just say that I'm not going and not care. Yet in med I couldn't. Could you say 'no' when crammed into a tiny room of people all facing you expecting you to go? For the first time I realised what it must be like for a patient when they don't agree with the doctor. Are they going to say something, do what the doctor says anyway, or just like me- quietly (without telling the doctor) not take the treatment prescribed (or worse still take left over  medication from home)?

I wonder if just how I feel completely overwhelmed by the greatness of my med peers, my future patients will feel overwhelmed by me? Somehow I need to create a safe environment where they can discuss their concerns and yet I as the doctor don't stoop too far and bend to their every whim.

I have made a deliberate decision to fall and remain in love with med. This is one of the key reasons I write this blog and focus on what has captured my imagination during the week. I was warned that med will wear me down and somehow I had to keep the joy of med. What a tragedy for a 'dream come true' to become a 'never ending nightmare' of hard slog! This being said I am so thankful that I have friends to make me stop (when I feel like I don't need to) and eat cake and savour other good things and even discuss the sucky things about med. Focussing on the good of med can't be done without acknowledging the hard stuff. So here's my brief sentence on why I don't like med: I hate how people from back home are contacting me less and less, I hate it that I don't have time to go on long bushwalks, I hate it that it makes me an idiot (med brain is 1000 times worse than baby brain), I hate it that I never know enough no matter how hard I study and most of all I hate it that med is like sprinting through a marathon (the whole way).

Okay enough of that negativity- this week a dream came true. Back in primary school I remember a boy telling me that his sister go to blow up lungs during science. All through primary school and then high school and finally OT I waited for this to happen. The closest I got was cutting up a cow's eye. FINALLY on Monday we got to play with a pluck (imaging ripping out all the gut through the mouth) of a pig. Gas was pumped into the trachea and the lung filled up. The lungs were so slimy and soft and.... beautiful. The colour of the fresh pig was so much more vibrant than our old cadavers.

Looking at the title you've probably guessed that this week we studied the respiratory system. This is probably basic stuff, but maybe you'll enjoy it. The throat has a mucus layer with cilia (like lots of fingers pushing in the same direction). This is called the mucus escalator. If germs get into your throat the cilia slowly push the germs towards the mouth so that they can be swallowed and killed by the stomach. Awesome hey? When this part become infected the doctor (and your body) tells you to rest. Why? To stop it spreading downwards (eg breathing deeply with running around), especially into the lungs (there aren't as many germ killing agents down there). Also bacterial infections can follow viruses because the virus can destroy some of the mucus protective layer- allowing the normal flora/ or other germs (I described this in my last post) to get deeper into the body.

Finally let me talk a little about antibiotics. Some kill specific germs and others (broad spectrum) kill all germs including normal flora. If you don't finish a course then you'll only have killed off the weaker germs and left the more hardier ones to continue multiplying and attacking you. DON'T DO THIS. If you don't take the right one, you may kill off the good normal flora and not even touch the germ, which will leave room for a bad pathogen to take over. DON'T DO THIS EITHER.

Last week two friends read my blog and told me off for not eating lots of red meat as I had promised in earlier posts. So I went home and cooked steak. I call it a dad meal. When dad cooks it is basically always meat based with way too much salad. Some potatoes were added in honour of mum who loves them because of her Irish heritage.

So I'll leave you with a photo of my giant, yummy meal.

Getting under my skin

Finally med has got 'under my skin'. Now if you are a fellow med student you'll know that I'm making a very bad metaphor- as this week as been all about skin.  It's such a relief that med is now finally drawing me in and captivating me, not just throwing me into a panic with how much we have to take in. 

Perhaps in my last few posts I have tried to focus on how awesome med is rather than being completely honest about how overwhelmed and scared I have been. 

• This is the first week that I haven't called home crying. 
• This is the first week that I am beginning to wonder if I do in fact have what it takes to be a doctor. 
• This is the first week that I have come to grips with the possibility of failing. 

Really what does it matter if I fail? If I fail I'll cry etc and then I'll pick myself up and do first year again. 

Aside from that I'm looking after myself- I'm refusing to let med take over. I've found time to start knitting again (how I've missed it!). Today a med friend and I decided to pretend not to be med students for two hours and do normal things. It so special just to wander through lovely clothes store and sit and have food in a real cafe. We couldn't resist talking about our favourite med things from the week, oh well so much for forgetting med!! 

So what can I tell you about this week? My favourite things of course!!

1. The skin is covered in pathogens  (microoganism capable of producing disease). This is... good. They happily live there in safe numbers basically taking up the space and food so that no one pathogen can take over and cause oh no... disease. The immune system also gets daily practice at killing off and keeping these pathogens in check. Finally the microorganisms sometimes produce vitamins that the body needs and toxins that kill bad pathogens. We have around 100 trillion of these microorganisms on our skin, in our gut, eyes and noses etc. Beautiful. It's only when a microorganism that is usually found in one place and moves to another- say from the gut to the mouth that problems happen- it puts the whole beautifully balanced normal skin flora out of whack. Taking broad spectrum antibiotics can also clear off the normal microorganisms letting the more resilient microorganisms take over. 

2. So yes that is all cool, but I particularly like the gore. Learning about abscesses etc this week was awesome. If you aren't too squeamish you may enjoy the following link: 

http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DXf8G-c_eAhs&h=cac7a

Abscess: I hope my understanding is correct. Here I go. Something gets through the outer layer of the skin. This could be a  pathogen or splinter etc. The body sends in white blood cells to kill it and eat it up and clean out the wound. These cells struggle as it is not an easy war. Many die as do some of the invading pathogens/bits of the object. This creates a pool of dead fighters from both side= pus. The body is also sending in fibroblasts (builders) to rebuild the damaged war zone and isolate the infection. Now the pus is completely isolated. There is no blood supply and the nice alive good body tissue is dying inside the capsule. The pool of pus is getting bigger. Antibiotics won't help as they can't get through the capsule. This is a dreadful situation. What if the capsule fails and the infection, which is now big, gets into the blood and goes EVERYWHERE??? So what happens? Cool doctors comes along and open it up and let out all the pus, clean it up and all is well again. Although it would be temping to do it at home just like the people in the video above!  

Now I must go and do my share of the cleaning and SLEEP. Is not sleep the best invention in the world?! 

uprooted

Going into med I was under the impression that med would make me more smart. Unfortunately the opposite is true. My brain is fried. Kaput. 

Let me give an examples. Coming home from uni I thought I'd shower my neglected garden in affection. I pulled up many weeds. Sadly the next day I realised that the 'weeds' were the tomato plants and the plants that I had rescued were weeds. I have replanted the tomatoes and am hoping and praying that they somehow live. 

This leads to me to my title uprooted. In a sense I am too uprooted. I have been pulled up out of the clay-like soil of Adelaide and planted in sandy Perth. Weirdly this did not hit me until three days ago. All night my dreams were filled with searching for missing friends and attending the funerals of my family and close friends. I woke feeling disorientated, wondering why my quilt was black and my bed was facing a new direction. I had a little cry and then had a good day of study. Plants, no matter how tough, cannot be uprooted without a struggle as they adjust to their new environment. 

Still apart from a fried brain, missing home and still not taking in nearly enough information each week I LOVE med. Each day I fall more deeply in love with med. Seriously it is the most special, unique degree  ever. We all attend classes four days a week from 8amish to 5-7pmish. It's almost like we're all living in a giant mansion together (going home to sleep seem to be insignificant). Apparently next week we all have to weigh each other and strip down to our underwear (or bathers) as we practise clinical skills. I am not looking forward to this! I think we'll all know each other in quite a different way by the end of the four years than we know our non med friends. 

On Mondays we hangout at Curtin uni and do all the core science stuff. (we're extra nerdy as we have student cards from TWO unis). On this day we done white coats and spend two hours exploring the anatomy of cadavers. Despite the smell that makes me disconcertingly hungry and the chemicals that make my eyes red and watery, this is the BEST two hours of the week. I am SOOOO thankful to the people who donated their bodies to help us learn. Seeing the body parts in real life blows me away. Let me tell you of the two best things I saw this week. The area beneath the heart and above the pelvic floor is the peritoneal cavity. The guts are all shoved in there as I thought. Instead there is the this sheath like thing that is interspersed in the cavity that hold every thing in place. The tissue is called the mesentery and is connective tissue that has an awesome blood and lymph (can hold germ killing agents) supply. The greater omentum hangs down from the stomach and flaps over the small intestines. It is described as the watch dog. When an organ is infected it wrapped around it. This means that the infection is isolated and can't spread. It also means that the lymph supply can FLOOD it with germ killing agents to fight the infection. This BLOWS me away. On a lesser note the same material is attached to the small intestine like a pretty frill. I've attached a gruesome picture below, which I found with google. Also see my beautiful garden- this is a photo of my pumpkin plants.

MED IS DREADFULLY DIFFICULT BUT NOTHING COULD BE BETTER.