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.