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.