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. 

Crisis.

Imagine that you are a canon ball. You have to be shot over a vast ocean to land on an island. There are crosswinds.

Med is like this.

Flying over the ocean and hitting the target is the most incredible experience in the world. Just think of the views and the rush of flying.

Imagine if you don't bother to take into account the force of the wind and align the cannon correctly. This is what the first two weeks of med is like. It is very hard to make a cannon ball that has missed its mark float to the island.

Sooo... tomorrow I'm going to stop ignoring the crosswinds, face them and design a workable study plan. No more land plonking into the ocean and having that horrible sinking feeling for me!

I always knew med would be so full on, but lectures from 8:30 am to 7:30 pm four days a week, with only 30 minute breaks is slightly ridiculous (especially with study thrown on top). I've been so so so tired. Twice I've attempted to get off the wrong side of the train, much to the amusement of the school kids. Once I ignored a man who was trying to talk with me (thinking he was one of those men who gets a bit too friendly with girls on trains), only to find out he was a fellow med student!

Okay so apart from freaking out and crying on the bus and momentarily considering quitting med and going home- med is still pretty special. Already I've had three hours of exploring cadavers. The smell is dreadful and the worse thing is it makes me hungry. I've grown cultures, learnt how to put gloves on and wash my hands.

Yay for med!!!!

ps my veggie patch is growing pretty well- despite it being more sand than dirt.

Adelaidian to Perthian or as I prefer Perthite.

A week ago I was all geared up to leave Adelaide to study medicine- when I suddenly began to vomit every 30 minutes. At first I thought it was nerves. After all I did vomit on my first day of school and of OT. Six hours later I was diagnosed with gastro- with a delayed flight. For the first time ever for a domestic flight I’d got insurance- phew!

While lying on the couch I managed to squeeze in some Doc Martin viewing. I’m probably the only person under 50 (apart from my cousin Emma)  who enjoys it- but what does that matter? In it the main love interest was single and pregnant and was a little tired of everyone offering to help. ‘It’s about time I learn to manage on my own don’t you think’ she said. How silly! Sure she needs to learn a whole heap of new things, but most of all she needs to learn to ACCEPT help.

This past week has been just that for me. Strangers put me up in their study for 3 nights and leant me (for as long as I need) important things such as chairs and saucepans. A friend lent leant me a bed, linen, desk and a printer for the year. My landlord drove me to my house to see if I really did want to rent it. My new housemates (not yet in Perth) message and call me every few days even though they don’t know me (yet). A friend took me out for lunch and yummy Spanish chocolate and donuts. A stranger watched chick flicks with me and took me (and another Perth newbie) to Kings Park for a picnic. People are amazing.

Oooh now for the exciting things. The garden at my house is DREADFUL. This is a BRILLIANT thing, for the landlord said that apart from ripping out the trees I could do anything. She even pointed out a bed and said I could get rid of the ugly rosebushes. This is a dream come true. For years I’ve wanted to plant my own veggie garden- but wasn’t allowed to. So… the rosebushes are gone and I’ve planted tomatoes, eggplant, pumpkins, basil, lettuce, and zucchini. After doing this bare foot I saw all these baby brown snakes slithering through the bed. Thankful to be alive I rushed in doors and emailed a picture to my parents. They asked my trusty botanist uncle and it turns out they are sand sliders (I think). Either way I now wear shoes and gloves while gardening!!!

I have also bought new sneakers and a book of funky squares to crochet. What better hobbies could a med student have?! Crochet for fine motor skills. Gardening for healthy food and stress relief and running to stay fit despite spending most of my time on my bottom studying. 

Each post I’m going to give a tip for being a med student. This weeks: Do all grocery shopping (apart from perishables) prior to the term. I have a farmers market on my street every Saturday so that’s all the shopping I think I’ll need to do for the next 8 weeks.

Finally I can’t wait until my housemates come- it’s hard making myself believe that no one is about to sneak into my room and kill me. I should probably stop reading Half the Sky before bed (all about terrible things done to women around the world and how to help them). 

The West is Best. Really Perth is GREAT. Everywhere is near the beach. The spanish chocolate cafe chain is better than Bracegirdles. Still I miss the Adelaide hills. Does Perth even have hills? I also hate the feeling that if I just stop and sit I'll start missing my friends and family like crazy. Perth feels further from home than Scotland. I keep thinking that i need to change my money into perth currency! 

One week until med actually starts!!!!

Are we there yet?

I'm going to be a med student. 

For the first month after getting into med I would wander around the house telling family members this. It was just so unbelievably good- it had to be said out loud (again and again). My poor family!

It's still so hard to believe. I even have a fear that a letter will arrive in the mail saying that it was all a horrible mistake and that I was not offered a place after all. This is silly. 

Ignoring this stupid fear I'm going to focus on what sort of doctor I want to be and how I'm going to get there. 

This was all put into focus with my Granny dying on Christmas eve. It is incredibly sad- but long expected. What touched me about Granny was that she was the best granny possible. Throughout my childhood I knew that she loved and delighted in me. Many others would say the same about her. She loved in word and deed. Always she was telling me that she loved me. She also took me to movies, left a fredo on my pillow when I slept over, hugged me and knitted and wove me blankets and toys. 

A bit before her death I wrote my own Eulogy (pretending it was 50 or so years into the future). It was interesting to see what really mattered. For instance the following is ridiculous!

..... was a stunning girl who never went above a size 8 her whole life. Her sense of fashion was impeccable.  She had hundreds of friends and everyone admired her. ..... was very wealthy and she was renown for being a great doctor. 

Seriously what a waste! More than anything it is the heart that matters. I too want to be remembered as someone who loved and loved well consistently over a lifetime. I don't mean that I will be obese and frumpy and hug everyone while smiling inanely. 

This is how I want to be remembered:

1. A person who made time for people, who was generous, who encouraged people to be the best they could be, who was faithful and loyal and consistent. 

2. A dedicated doctor, who was excellent in their field and used it to serve those who otherwise would not receive the best standard of care available in the world. Who also valued teaching and passing on skills patiently to others. 

3. Someone who had a quirky sense of humour and loved life.

So.... how can this be achieved? Can it? YES. 

Firstly med is going to be HARD and BUSY. I will have to be focussed. I choose to focus on:

1. Being a good student with a thorough knowledge of anatomy and physiology and practical skills and problem solving. This will require regular revision and a lot of time (even my evenings and weekends).

2. Being healthy. I had the flu last year- I never knew it was possible to be so ill for so long. At one point I even hallucinated and thought I was a building with broken plumbing! This must not happen again. I will eat lots of fruit and vegetables and meat. I will have a good routine for sleep. I will take Sundays off, just to rest and let my mind relax. I will build up my running until I can run for 30 minutes every day. I will knit to have good fine motor skills. I will buy a basket ball and practise shooting and catching to improve my sense of my position in space. (Excellent surgical skills are nothing if I then accidentally knock the patient off the bed). I will keep away from sick people (except when on placement). I will wash my hands incessantly. 

3. Friends. I will build up friendships in WA. I will also keep in contact with all my SA and overseas people. For this I have begun collecting addresses, cards and stamps. Sunday afternoons will be spent lying in a park sipping coffee and writing letters. 

4. I will remember daily, with thankfulness, how I got into med. 

I will need all the help I can get. If I every begin walking away from who I want to be- please tell me with a hug and a laugh. 

Now I will go and make the most of my last few days before I leave SA, perhaps forever.  :)