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.