The Skinny on Obesity (playlist)

Sugar: The Bitter Truth

Great Things

"It has been a pleasure sharing the journey through med school with you, and I know that you will go on to do great things..."

Such a simple statement from my friend Ruth and yet, it meant so much to me.

From where I stand right now, I can't see what's ahead of me. I certainly can't see any "great things".

And yet, something about her statement alludes to the potential of great things to come. Something in her statement gives me hope.

I suppose the lesson here then is, never underestimate the power of a few sincere, well-chosen, kind words.

The Morning After...

As we were driving through this little town where I will be starting my first 20 weeks of internship next year, I looked around at the towns people walking about and thought... These are my patients.

It's the most awesome thing. It's finally happened and I'm finally here.

Sure, I'm still learning. And as a doctor, I always will be.

But this will be where all the magic happens. This town... These people... They will be my first adventure.

And you know what?

I can't wait to get to know them all.

The Night Before...

Through the trusty rectrospectoscope, my final year of medical school is looking more than a little bit blurry.

However, amidst the chaos and confusion, I've managed to retain a few solid gold principles which I hope will take me through my internship year.

1. Take ownership of all that you do - it'll help you feel like you know what you're doing, even when you're still trying to figure it out

2. Everyone started out somewhere - So when you feel like you're at the bottom, rest assured that the only way left to go is up

3. Be safe, seek clarification, and ask for help

4. Everyone, even The Legendary Professor John Murtagh, feels nervous - Conquer your fears through rationalisation and by managing your expectations

5. Keep on learning, listening, trying, and believing in yourself - A little perseverance goes a long, long way

My father once told me, "Picture a cat. Toss it out a window, and it lands on its feet - despite never having to anticipate being thrown out of a window."

If there is one thing that I'd like to learn before the start of next year, it's the art of Resilience.

But then again, I'm still here. I'm still standing.

Perhaps that's a start.

Elizabeth Gilbert: Your Elusive Creative Genius

At present, I am struggling to write an article for publishing, after an incredibly long hiatus.

My writing brain feels atrophied. It feels like my genius has left me.

Something that used to come so naturally, now feels forced and staggered.

Inaccessible, unattainable, just barely out of my reach - but I know it's there, and that's what frustrates me.

But the more I try, the more I feel like I'm making progress. I'm finding my way back and opening up inwards.

When I was much younger, after writing a song or a poem, I would often look at my work and feel that I'm looking at something that I did not create, but instead, something that was already in existence all along, just waiting for me to pen it to paper.

And in that realisation, I would feel like a puzzle piece; part of a larger whole. I felt both humbled and honoured to be part of this bigger picture.

Over the years, one of the most important things that I've realised about writing and my other creative pursuits is this.

As with all things, perfect practice makes perfect. There is no shortcut to this rule, regardless of whether you're 13 years old or 31 years old.

This means, that if you have a skill that is important enough to you to want to excel in, you have to make time for it. You have to work at it, and you have to perfect it. Use it or lose it.

When I first enrolled into medicine, I promised myself that I would retain my literary and artistic skills throughout my course. What I didn't know then that I know now is just how difficult it is to do that.

However, letting that part of you atrophy is dangerous. You lose so much from it; most important of which is your sense of self.

What I'm learning at this stage of my life is to now and then take myself away from medicine and nourish my little genie.

And, in the long run? I have no doubt that I will be a better doctor for it.

This Won't Hurt a Bit (and Other White Lies)

Click here to view

Something To Write Home About...

Hello!

We can now breathe a little easier because I've hung up my 'Melancholy Pen' and I am now writing for good, not evil.

A couple of weeks ago, I entered a competition run by The General Practice Students Network in which I had to write, in 200 words or less, how I would improve the quality of care delivered to my patients if I was working as a general practitioner.

Given that General Practice has been on my list of differentials for specialities since my first year of medical school (with other top contenders being Paediatrics, Palliative Care, and Child and Adolescent Psychiatry), it wasn't too hard to come up with something honest and original.

To cut a long story short, I won!

GPSN has now offered me full sponsorship (including flights and accommodation) to attend the Royal Australian College of General Practitioners' (RACGP) Annual Conference in Gold Coast from the 25th to the 27th of October.

Needless to say, I am ecstatic.

I have been wanting to attend this conference since first hearing about it four years ago, and I'm psyched that I'll finally be able to be a part of it!

Without a doubt, I'll certainly be writing about my adventures in Gold Coast, so watch this space!

At the risk of mortal embarrassment, I've includes my winning entry below.

Go on... Have a laugh.


-----

When I think of my future and what I'd like to be

I would love nothing more than to be a GP!

Hand in hand with my patients, I will solemnly swear

To provide them with good continuity of care

I will listen and hear all their worries and sorrow

To ensure that my given advice they will follow

I will keep up-to-date with the research and times

To practice Best Practice on these patients of mine

Health-promotion and prevention will be my main aims

Towards better healthcare and Medicare claims

My colleagues and I will work busy as bees

To help ease the burden of chronic disease

To all specialists and nurses - my new found best friends

I will effectively communicate my patients' trends

As for all younger juniors and doctors-to-be

I will act as a mentor for all those to see

I will teach by example and learn like a sponge

Advocate for my patients, I will take the plunge

I will fight without end to end suffering and strife

And focus my passion on learning for life

Evidently I hope it is now plain to see

That I'd love nothing more than to be a GP!

Sir Ken Robinson: Do schools kill creativity?

For as long as I can remember, my answer to this question has always been 'Yes'.

I often look back to reflect upon my ultimate downfall (i.e. University) and think, "How do I reverse the damage?"

I never fully engaged myself in school (I found it brimming with silliness and preferred to have as little to do with it as I possibly could, with the exception of instances when it was beneficial for me) and therefore, growing up, I retained a strong sense of self and what was important to me.

My family and my upbringing made this incredibly easy. My parents built a beautiful world around me in which I was capable of anything and everything; a world where my potential was limitless, and that personal growth and development mattered far beyond the realm of personal gratification. I was raised to be curious, to value innovation and creativity, and to care.

Sadly, somehow along the way, I fell out of that world and into my current one, and it caught me quite off-guard. Understandably, I soon suffered from an adjustment disorder.

It has taken me a while to uncover my diagnosis, but my journey has led me to the underlying epiphany that, quite simply, I don't belong here.

Finding my way back to my world - a world in which I can thrive - is by no means an easy feat. My mind is now so strangely convoluted towards negativity that I cannot recognise it anymore and, like a fish out of water, I am suffocating.

It is painful, and very much a struggle. It hurts to be here, and it hurts to turn back.

But, you know what? At least turning back will lead me to a place that I know is good because I've been there.

Even if it's not here, I do know a place where I belong. The trick is finding my way back.

Karen Armstrong: 2008 TED Prize - Charter for Compassion

To be a part of this phenomenal movement, just add your name to
The Charter for Compassion

For more awesome videos showcasing The Charter for Compassion, visit http://www.youtube.com/user/charterforcompassion

Birthday

"You wait, little girl, on an empty stage,

For fate to turn the light on..."

Little things

It's amazing how much difference the little things make.

I had a great day at work today, and I did not see it coming.

I've been feeling a little run down this week and I've been unable to figure out why.

Shaz, noticing that I haven't been myself, suggested that today I pick a patient to spend some time with and just have chats.

I was reluctant to do this at first because the last thing I feel like doing when I'm down is be around people. Bad states are often contagious and I didn't want to pass it on to anyone, nor did I want to pretend that I was okay when I was not.

However, when my resident Steph asked me to reinsert a cannula today, I pushed aside the dread and my instinctive 'No', and said 'Yes'.

It was a win.

Renal patients are notorious for their challenging veins. Thankfully though, my patient's were relatively good and more importantly, she was lovely to talk to and she was very patient with me.

I missed the first go, as I did not anchor the vein very well and it was extremely wobbly. This was silly of me (rookie mistake) and I could've kicked myself. It was a beautiful vein and a wasted opportunity. It also meant another needle for the patient and I'm never happy about that.

The second one was a success. I felt that the patient and I had developed a good rapport and I enjoyed talking to her. Although I've experienced it countless of times before, I still find it hard to believe that such a simple thing could change my outlook so drastically.

I love my work. I love my patients. And, more than anything, I love having a purpose. I love it when I get things right and if I can even make one patient smile or feel better, that constitutes a good day for me.

Having said that, I've got worries just like anyone else.

I'd like to have money in the bank. I've got $3 in there at the moment (no joke), and was looking at the prospect of starving today, except that serendipitously, it's my hospital's 25th birthday today and so a sausage sizzle was organised for the staff.

I escaped with a veggie pattie, cake and an orange juice. I was a happy girl :)

It seems that the Big Guy in the Sky still has a soft spot for me, despite my many transgressions.

Rest assured, I'll be working hard to return the love.

Mean

There is just something about medicine that brings out the best and worst of humanity.

Personally though, I find no greater reminder or motivator to be a better person than observing someone else behaving like a fink.

I've observed unpleasant interactions in all permutations between doctors, nurses and patients, and I am often puzzled at how easy it is for us to sometimes forget simple things such as good manners and common decency.

I myself am not immune to this. There are days when I get so caught up in narcissism that I may react to situations like a complete jerk and don't quite realise until much later just how horrible I must have come across.

Vanity... Conceit... Selfishness... Such ugly traits that are unfortunately all too commonly exhibited in the world of medicine, mostly due to the fact that the field consists of a large amount of human interaction and with that, so many different ways in which it can go wrong.

It's easy to forget crucial things if you fail to associate to them the level of importance that they deserve.

A little kindness, compassion and consideration goes a long way in our everyday interactions and it should be applied regardless of the person we are interacting with because in the end, I'm a big believer in the fact that you should be good to people, not because of who they are, but because it's who you are.

Sick

I feel miserable and gross and I can't bring myself to get out of bed.

Specific symptoms?

Pyrexia, fatigue, malaise, myalgia, and nasal and sinus congestion. Oh, and of course, guilt.

For the past 4 years, guilt has been a major symptom of every disease that my body (and mind) has encountered and I know I'm not the only one in the medical field who experiences this strange and unnatural phenomenon.

Here's the story: My registrar came to work last week clearly sick. She led the ward round but asked the resident to examine the patients as we are on the renal transplant team and of course, all our patients are immunosuppressed.

Two days later, she was still sick. And two days later, she passed it on to me.

I am now in bed feeling completely miserable and entirely guilty for being too sick to go to work (which incidentally is where everybody else goes when they're sick...).

How sad is it that we live in a culture where doctors are unable to comfortably adopt the sick role when they are genuinely sick?

I'm often told that doctors are not expected to be perfect. We are not expected to be flawless, and we are not expected to be superhuman.

And yet... Are we expected to have superhuman immune systems?

Why does there exist this unreasonable pressure for us to be 100% functional 100% of the time, and when we fall short of that, why is it so hard for us to cut ourselves a break?

As far as I know, doctors are just as vulnerable to illnesses as anybody else and at the same time, we're exposed to more diseases than the average person.

As logic follows then, doctors should literally be the sickest people on the planet.

And when they are sick, it's only fair that they're allowed to appropriately adopt the sick role.

Otherwise, it just seems a little cruel.

(Sadly) My Favourite Obituary

Today we mourn the passing of a beloved old friend, Common Sense, who has been with us for many years.

No one knows for sure how old he was, since his birth records were long ago lost in bureaucratic red tape.

He will be remembered as having cultivated such valuable lessons as:

• Knowing when to come in out of the rain; 
• Why the early bird gets the worm;
• Life isn't always fair;
• And maybe it was my fault.

Common Sense lived by simple, sound financial policies (don't spend more than you can earn) and reliable strategies (adults, not children, are in charge).

His health began to deteriorate rapidly when well-intentioned but overbearing regulations were set in place.

Reports of a 6-year-old boy charged with sexual harassment for kissing a classmate; teens suspended from school for using mouthwash after lunch; and a teacher fired for reprimanding an unruly student, only worsened his condition.

Common Sense lost ground when parents attacked teachers for doing the job that they themselves had failed to do in disciplining their unruly children.

It declined even further when schools were required to get parental consent to administer sun lotion or an aspirin to a student; but could not inform parents when a student became pregnant and wanted to have an abortion.

Common Sense lost the will to live as the churches became businesses; and criminals received better treatment than their victims.

Common Sense took a beating when you couldn't defend yourself from a burglar in your own home and the burglar could sue you for assault.

Common Sense finally gave up the will to live, after a woman failed to realise that a steaming cup of coffee was hot. She spilled a little in her lap, and was promptly awarded a huge settlement.

Common Sense was preceded in death,

• by his parents, Truth and Trust,
• by his wife, Discretion,
• by his daughter, Responsibility,
• and by his son, Reason.

He is survived by his 5 stepbrothers;

• I Know My Rights
• I Want It Now
• Someone Else Is To Blame
• I'm A Victim
• Pay me for Doing Nothing

Not many attended his funeral because so few realised he was gone.

If you still remember him, pass this on. If not, join the majority and do nothing.

Ignite

Meet Dr Jim Howe; Consultant neurologist.

I have so much respect for this man, I could virtually run a cult dedicated to Neurology with him as the poster boy.

Serendipitously, he was scheduled to give a lecture at the hospital that I'm currently attached to (I was unaware of this until I actually saw him up at the podium) and by far it was the most engaging lecture that I've had all year.

Not only has he reignited my thirst for knowledge and my fascination with medicine, I come out of every interaction with the good doctor wanting to be a neurologist.

His passion for medicine (particularly neurology, although not exclusively to) and medical education is invigorating. I have always believed medicine to be a field heavily reliant on mentorship and apprenticeship but sadly, good mentors are hard to come by and this goes against the essence of medical teaching and practice.

I have been lucky to have found quite a number of good mentors throughout my medical education, and this plays an important role in shaping my impression of different specialities.

Currently, my running list of potential specialities include General Practice, Paediatrics, Psychiatry (Child & Adolescent Psych in particular) and Palliative Care. Having said that, ancora imparo (I'm still learning) and thus, my decision is pending.

Ultimately though, regardless of vocation, I am drawn to people with good work ethics and those who are passionate about what they do because I seek to model good behavior.

In my mind, I believe that this is the best way to excel in my chosen profession.

And as my father has always said... If something is worth doing, it is with doing well.

Anchors Away

I value stability.

And unfortunately, this is something that my medical training has not been able to offer me.

In the past three years, I have lived in 3 different towns attached to 3 different healthcare services. But by far, my final year has been worse.

Due to my scattered placements, I have had to relocate hours away from every placement every 6 weeks this year, and I've hated it.

My health has suffered greatly because I have had no continuity of care. The General Practitioner that I have seen most recently has diagnosed me with Iron and Vitamin D deficiency today, and I need a follow up with her in 3 months. I'll probably be able to do that, but guess what? After that, I'll be 4 hours away, so I'll need to find yet another GP.

Don't even get me started with filling up forms that ask for a permanent address (I don't have one) or for any long term information (your guess is as good as mine).

If you want to know a major contributing factor to the decline in the state of mental health of medical students everywhere, I'd personally put my money on the lack of stability that the course facilitates. And I haven't even started taking about the trauma that comes with changing your working and living environment every 6 weeks.

Oh, and of course, it doesn't end there.

For the next 5 to 10 years of my medical training, although it gets slightly better, there's still a lot of moving around involved, and I'm not looking forward to it.

Last time I checked, I signed up to be a doctor, not a sailor.

Poor form, medical training. Poor form.

So long... Farewell...

I hate goodbyes.

I'm not good at it, and I've had to say it far too often this year.

My Emergency Rotation ended today, and without a doubt, it's been a good one. I've learnt a lot and there are a few things that's been reiterated.

1. Confidence: Fake it til you make it

2. Work on developing your "Doctor" persona

3. You don't have to be smart, but you do have to be prepared to work hard

I'm looking forward to having a job next year.

Solitude

I am on a train, homeward bound, and the sky has just darkened.

For whatever reason, I am reminded of one of my favourite poems.

'Solitude' by Ella Wheeler Wilcox


Laugh, and the world laughs with you;
Weep, and you weep alone.
For the sad old earth must borrow it's mirth,
But has trouble enough of its own.

Sing, and the hills will answer;
Sigh, it is lost on the air.
The echoes bound to a joyful sound,
But shrink from voicing care.

Rejoice, and men will seek you;
Grieve, and they turn and go.
They want full measure of all your pleasure,
But they do not need your woe.

Be glad, and your friends are many;
Be sad, and you lose them all.
There are none to decline your nectared wine,
But alone you must drink life's gall.

Feast, and your halls are crowded;
Fast, and the world goes by.
Succeed and give, and it helps you live,
But no man can help you die.

There is room in the halls of pleasure
For a long and lordly train,
But one by one we must all file on
Through the narrow aisles of pain.

What plot?

You are more likely to cause harm from the things you don't see rather than the things you don't know.

Okay, okay... I'll be the first to admit that I've lost the plot a little lately.

With all the stress that's been going on with internship results (no, I haven't found out yet), I've been doubting myself a little more and questioning my suitability in medicine, which is not something that commonly occurs.

Socrates once claimed that the one thing he knew was that he knew nothing. And really, if Socrates knows nothing, then who am I to presume that I know anything at all?

At the end of the day, I do my best to get by with what I know and to learn as much as I can. As far as I'm concerned, that's my job. Counterintuitively though, it seems like the more I learn and experience, the more I realise just how much I don't know. It's like swimming into the ocean, realising just how enormous it is and seeing no end to the vastness. You get lost in it.

Truth be told, there seems to be no end to self-doubt and feelings of inadequacy, particularly in an intensely demanding field such as medicine. There's just so much cause and opportunity for it that if you let yourself, you could pretty much go on forever. Ironically though, it is precisely in these demanding fields that you cannot afford to doubt yourself.

There is no room for self-doubt in medicine because medicine itself is already so full of uncertainty. Your job is to do the work and get it done right or the patient loses and therefore, you lose.

People say that you're allowed to be human, but in actual fact, you're not. The price is too high and most of us are not willing to pay it. And so we push ourselves and hope against hope that if we do eventually break, it's not going to be today. We'll worry about tomorrow when it comes.

People say that perfect practice makes perfect, but you know what? I still feel horrible performing procedures on patients when I know that a more highly skilled practitioner is standing right beside me, able to give the patient a much better experience with the process than I ever could, simply because I lack the skills due to not having had enough practice.

It's a Catch-22. And there is nothing that any of us can do about it.

After all, students need to learn and the only way to learn is through practice.

What I've discovered though is that practicing without confidence increases the likelihood of you getting it wrong and thus, constitutes as a wasted opportunity that wastes everyone's time, including the patient's.

So in the end, it's not just a matter of doing. It's about ditching the negativity at the door, preping yourself mind, body and soul, going through the process in your head, faking the confidence and making yourself believe that you've got it down because you are in fact your own worst enemy.

Getting through that mental hurdle seems to be a lot harder than identifying that it's there, but you know what? There's only one way out and I can't back out now.

I'm stepping out of my own way and getting back to work.

Doctor, doctor... Give me the news...

So tomorrow I find out if I'll have a job next year or if I'll be unemployed.

Although the prospect of unemployment is far from appealing to me, I have to keep in mind that it's still a very real possibility.

Ironically, I received a call today in which the caller referred to me as "Doctor".

I'm embarrassed to say that my initial reflex emotion was: Embarrassment.

After all, although I may technically be a doctor to the caller, I still feel like a final year medical student just trying her hardest to get through the year with as much knowledge and skill as humanly possible while still struggling not to feel guilty every time the IV cannula she's just inserted runs dry.

Is it wrong that I want to feel like I'm good at what I do before I start feeling more like a doctor?

Labels and designations come with expectations, and I'm just not ready to deal with this one yet.

Here's hoping that I'll feel a bit more ready tomorrow.

Adrenaline

After a long day of Emergency Simulation Training and all the skills we've learnt, I find myself wondering... Has this made a difference? Has my training today helped me save a future life?

I'd like to say, 'Yes'. But ultimately, I don't know. And that's a scary realisation.

There is no doubt that the day has taken its toll on me. I'm physically, mentally, and emotionally exhausted and I'm having difficulty shutting out all these high-pressure scenarios that are racing through my head.

Obviously, we all want to do the right thing when the time comes. We want to follow the algorithm, we don't want to make mistakes.

But at the end of the day, we can only do the best we can, and we can only do so much.

So right now, all I want to do is go home and toss-my-cookies.

The Unspoken

I humbly request that you take 3 minutes and 45 seconds  of your time to view this video.

An Open Letter to All Graduating Medical Students

To view the original article, click here.

"An open letter to all graduating medical students" by Steven L. Kanter, MD

The months of May and June are exciting times at many medical schools around the world as faculty prepare to anoint the next generation of physicians with a formal medical degree, and students prepare to make the transition to doctor.

I wish to celebrate this juncture with the following letter.

Dear Graduating Medical Students,

Congratulations! I write to you on the occasion of your impending graduation from medical school to say, with great pride and joy, Welcome to the profession of medicine!

You have worked hard during your years in medical school and you have accomplished so very much. And I know that your many successes are due, in large measure, to your own efforts.

But let me remind you that success, for many of you, is also due in part to your parents, your spouses and partners, your children, your relatives, and many friends - who have done so much for you. Their support and guidance have been vital to your high levels of achievement, and in the coming years, their love and friendship will be among your most valuable assets.

Furthermore, your success is also partly because you are the heirs to the long-standing traditions of those who have gone before you - individuals who were not only skilled and effective doctors and scientists, but who also had a strong sense of community and possessed broad humanistic aims for our profession.

Yes, you are part of a rich legacy.

You are graduating from medical school during a period of rapid change in medicine. Discoveries in biomedical science are occurring at a pace never seen before in the history of either medicine or science. Every day there are newspaper articles, editorials, and commentaries calling for broader and more sweeping reforms in the delivery, financing, and organization of health care.

Other health professions are pursuing, via legislative and other means, a broader role in caring for patients, particularly in primary care. Some say hospitals are becoming big intensive care units, and we all know that more conditions are being treated in ambulatory clinics and same-day surgery centers. Some even question the diagnostic value of time-honored physical examination skills.

If you sense within yourself feelings of doubt, anxiety, and uncertainty, I want you to know that you are not alone and that it is normal to have these feelings during this time of rapid change in the health care environment, amplified by a significant transition in your own lives. But I offer this thought: taken together, these big changes place before you extraordinary opportunities.

As I hear my own students express feelings that reveal excitement and enthusiasm blended with angst and apprehension, I talk with them about ways to convert the energy generated by those feelings into the confidence and actions that are needed to solve medicine's most pressing problems.

I remind them about the full range and depth of their considerable intellectual and other talents, and how they have a special opportunity to combine those talents with their medical education to contribute greatly to society. I tell them that their medical education has enduring value, that no one can take their education away from them, and that during times of hardship-be it a waning economy, political unrest, or natural disaster - its value can only increase.

During many discussions with many students over many years, I have been asked the following ten questions over and over again - perhaps expressed in slightly different ways, but nonetheless converging on these ten themes.

Since you are likely to have the same questions, I will recount them for you now - of course, with my answers and advice.

Number 10: What are the fundamental goals of medicine in today's world?

My answer: The fundamental goals are the very same goals that have been important for centuries: to promote health and well-being, to relieve suffering and pain, to rescue people from sickness and disability, and to save lives. In this time of broad-based change in medicine, it is more important than ever before to anchor our actions in fundamental goals, basic principles, and core values.

Number 9: What is the greatest privilege of being a doctor?

My answer: That a fellow human being will grant you his or her trust. It is trust that lets you hear the intimate details of a person's life, that allows you to lay on hands to examine his or her body, and that enables you to be present at the most personal of moments. Sometimes, you will be entrusted to be the first person a newborn baby sees as she opens her eyes. Sometimes, you will be entrusted to be the last person a gravely ill man sees as he dies. By virtue of your medical degree, you are granted the profound privilege of trust. You must do everything to promote that trust - and nothing to subvert it.

Number 8: Do I really know enough to have an MD degree? 

My answer: Well, you may not want to ask that out loud after you graduate. But, at the same time, don't worry, this is a justifiable feeling. And it can help you if it motivates you to continually learn new things about the art and science of medicine.

Number 7: Is it true that a physician must be a good teacher? 

My answer: Yes. You must teach your patients how to get well, you must teach the members of your community how to stay well, and you must teach your colleagues all that you learn. And if you have responsibility for medical students, please take good care of them.

Number 6: Has medicine basically become the business of health care? 

My answer: Those who choose to conceptualize medicine only as a business, physicians only as providers, and patients only as consumers, reduce health care to being only a commodity. And that limits the possibilities we might achieve. Those who choose to conceptualize medicine fundamentally as a profession - founded on competence, compassion, and commitment - not only ground our work in a strong philosophic and moral tradition, but also endow future generations of physicians with the capability to grow and develop in important new ways.

Number 5: Is it true that I will never again need to respond to the question, How many ATPs are generated by one turn of the Krebs Cycle? 

My answer: Well, maybe, maybe not. But remember, it is a deeper and more thorough understanding of the science underlying disease that leads us to new and better therapies. To illustrate, consider what would happen if, right now, we could wave a magic wand and provide health care to everyone who needed it at no cost. We would solve some problems, but not all. People still would suffer the mental anguish of schizophrenia, people still would suffer the physical limitations of multiple sclerosis and arthritis, and people still would die prematurely from cancer and trauma. Better health care requires more than just being able to get patients to their doctors, and requires more than patients being able to pay for their care: ultimately, better health care requires better science.

Number 4: Will I make a mistake that will hurt a patient? 

My answer: Yes. You are human and human beings make mistakes. The approach to preventing medical errors known as Name them, blame them, shame them does not work (my generation and those before us have proven that). It is up to your generation to pursue approaches that do work. You must advance the science of improvement, you must create systems in which error is least likely to occur, you must formalize better approaches to apologizing to patients when error does occur, and you must develop better mechanisms to compensate patients who will live with the consequences of error.

Number 3: Is it important to do what is right within the context of containing cost? 

My answer: No. It is important to contain cost within the context of doing what is right!

Number 2: Is it true that I will have rhinorrhea and/or diarrhea through most of my internship? 

My answer: Yes. But remember: your personal well-being is key to your success. Exercise often, get adequate sleep, and maintain good nutritional habits. Remember to be good to yourself.

And the number 1 question that every graduating student asks, as we part ways, is: Don't you think it will be great? As soon as I graduate, I won't have to say to each patient, Hi, I'm the medical student on the team. Finally, I will be able to say, Hello, I'm Dr. Jones, your health care provider. 

My answer: Don't sell yourself short. You will be much more to your patients than just a health care provider.

Now, don't get me wrong. It is very important to understand the physician's role as a health care provider. But it is even more important to understand that providing health care is only one aspect of being a physician.

As physicians, we are, as Cassel has said, healers, helpers, carers, advocates for the sick, and advocates for the health of all - and we do this as we strive to be ever wiser scientists and humanists. So, don't tell your patients you are their health care provider. Take the privilege you have worked so hard to earn - tell them you are their doctor.

Well, I hope that my answers to these questions are helpful to you as you prepare for the next phase of your professional lives. As you begin this new part of your journey, I am confident that I speak for all medical school faculty around the world when I say to you that our confidence in you is great and that our hopes for you are alive with promise.

We are so very proud to have been your teachers. You have taught us as much as we have taught you. You have touched our hearts with your enthusiasm for medicine. And you have touched our souls with your abiding desire to serve humankind.

Remember that you take with you such an amazing gift to offer to society. Some of you will advance our understanding of medicine by discovering new knowledge, some of you will ensure our future by teaching others, and some of you will attend to the very meaning of life, one patient at a time.

An Open Letter to New Medical Students

To view the original article, click here.

"An open letter to new medical students" by Steven L. Kanter, MD

 

At many medical schools around the world, the months of August and September mark the time when students complete the rite of passage from applicant to medical student. These rites most often include orientation sessions, social activities, and greetings from school officials.

One topic that permeates these sessions is professionalism. Through implicit themes and explicit messages, deans and faculty begin to educate new students on the very first day of medical school about the principles of professionalism, including excellence, humanism, accountability, and altruism.

Over the years, I have heard many presentations and read many articles about these principles and other aspects of professionalism, but rarely, if ever, have I heard or read a compelling discussion about when someone actually becomes a member of the profession of medicine. That is to say, at what point during the continuum of medical education and practice does an individual make the transition from being a lay person to being a member of the medical profession? It is in this spirit that I write the following letter to all those who have the privilege to matriculate as medical students.

Dear New Medical Student,

I know that you have worked extremely hard for many years to gain acceptance to medical school. I also know that your medical school has worked equally hard to screen and interview many applicants, each of whom wanted to occupy the place you now hold. So, congratulations and welcome!

Now that medical school has begun, I am sure that the deans and faculty of your school are talking to you about the unique privileges and critical responsibilities that accompany being a medical student – and ultimately being a physician. As you listen to them, and as you begin to reflect on what it means to be in medicine, I invite you to consider the following question: When will you become a member of the profession of medicine?

Each year, during the first week of class at my medical school, I go before the new first-year students and pose this question to them. Some students respond that it occurs when one becomes a practicing physician. Some say it happens when one receives a license to practice medicine. Others contend that it takes place when one enters a residency program, and still others call out that it happens when one officially receives his or her MD degree.

So then I ask my students whether they think that something magical happens at some point during medical training, such that an individual suddenly merits membership in the profession. For example, could this happen with the granting of a license or degree? What about the first time you touch a patient? Or, perhaps, the first time you save a life?

We always come to the same conclusion: that there is no better time to begin the transition from lay person to professional than the very first day of medical school. It is so important to start, as soon as possible, to incorporate attitudes and values of professionalism, to integrate in your own mind ways to think and act in a professional manner, and to develop an underlying identity of yourself as a member of a profession. That's right—it is critical that you begin this process now. And, as soon as you do, I believe that you have become a member of the profession of medicine!

Considering yourself a member of the profession of medicine, starting right now, will begin an important process of socialization and acculturation. It will help you begin to think about yourself and to conduct yourself in new ways and to mature intellectually and professionally as you develop an identity as a student-doctor, and eventually as a doctor.

This is important for many reasons—let's consider three. First, it is very likely that sometime in the next few weeks, one of your professors will bring a patient before the class. As a student, you may see it as the order of the day that a patient is brought in to help you learn. But, if you consider yourself a member of the medical profession, you will begin to sense a larger perspective, and you likely will reflect on your own responsibilities in such a setting.

You may decide that it is important to present a professional appearance to the patient, and so you may wear your white coat that day. You may think about how the patient views you (not just how you view the patient). A patient once commented to me that he saw medical students not only as members of the medical profession but also as representing the very future of the profession. Because patients will often see you as a member of the profession (even though you are not yet a licensed physician), they will share with you the most intimate details of their lives. This is truly a privilege and important to your learning.

As you extend your thinking along these lines, you will begin to think more about the patient in the context of his or her own life. For example, the patient may not be confident in his or her decision to appear before a class of medical students, but was swayed by the desire to please his or her doctor (who also is your professor). Recognizing this as a possibility may help you include some comforting words as you thank the patient for contributing to your education. For instance, you might decide to say something like, “I realize how much courage and effort it takes to appear at an event like this, and I just want you to know how much it adds to our understanding of other people who have an illness like yours and who work so hard to deal with it.”

When you conduct yourself in a professional manner with patients who consent to come before a medical school class, it validates their feelings that they are contributing to the education of health professionals and thus helping others who have the same disease or syndrome that they do.

Second, considering yourself a member of the medical profession is also important to your basic coursework. Soon, you will begin to study the gross anatomy of the human body and, in most medical schools, you will have the privilege of dissecting a cadaver. If you think of yourself as a professional person, it will enhance your ability to understand the relationship between you and your cadaver and it will help you as you think about how to regard a body willed for anatomic dissection.

And third, if you are walking down a road and you see someone get hit by a car, and you believe that you are a member of the medical profession, then you have no choice but to go to that person's side and do what you can to help. A lay person may do that – perhaps should do that – but is not obligated to do that. You are. I realize that you may not feel qualified at this stage to do much, and it is certainly important to do no harm. However, I believe that there are many things you could do to help in a situation such as this. For example, even as a new first-year student, you could call for help, make observations about what transpires that could be useful to qualified personnel who subsequently arrive on the scene, and comfort the individual.

So, congratulations again on securing a seat in your entering class. You will hear a lot about professionalism—its definition, its principles, and how your school will measure it—but please consider what it means for you to be a member of the medical profession, beginning right now. It will influence how you think about yourself, how you approach the task ahead of you, and how you interact with patients, colleagues, and others.

Remember that nothing magical happens at the time a degree is awarded or a license is issued or a ceremony is held. These are milestones that mark achievement, but they will not suddenly and miraculously convert you from a lay person to a member of a profession. It is up to you to begin a process of reflection as your underlying identity evolves from undergraduate student to medical student, from lay person to professional person, from learner to health professional.

Thinking about yourself in this way is hard work and takes time and will continue throughout your professional life. But the rewards of being a member of the medical profession are some of the greatest a human being can know.

Welcome to the profession of medicine!

Limits

What constitutes a bad day to me is as listed below:

• Making a provisional diagnosis of an exacerbation of pneumonia in an elderly patient and finding out through investigations that she's actually got heart failure (how did I miss that?!)
• Cannulating an elderly patient with really tiny veins and getting it -- And then missing it (what a difference a second makes...)
• Ending a shift in ED feeling like you really haven't got much right today

Don't get me wrong, I am loving my Emergency rotation.

But if there's one thing that I've realised more and more since starting my final year, it's that being a medical student comes with an expiry on your level of usefulness.

When the Emergency Department is bustling with acute incidents and there's so much to be done, at the end of the day, the nurses work faster than you do, so you just end up being in the way.

While the doctors are busy doing doctor-things and you've done your medical-student-things, you need to get things signed off by a "real doctor", guess what? They're occupied.

So you just wait til they've got a free milisecond to sign off that pathology form for the blood you've just taken or the investigations that you've written out to be ordered, and until then, you've hit a brick wall in terms of productivity.

I certainly won't be missing those limits when I'm a fully qualified doctor. I'm looking forward to being able to sign for things in my own right and follow through with the workup of my patients. In short, I'm looking forward to having more control.

However, I am aware that more control comes with more responsibility and as much as I am eager for it, I don't know if I'm good enough just yet.

I know I've got to work hard to be better, faster, sharper... But it's hard work. It's like climbing a mountain and having rocks fall on you as you struggle to get higher. At the end of the day, you just feel extremely battered, but not much better for it.

You might recall that a couple of weeks ago, my friend Keira took me to see a performance at the National Institute of Circus Arts. Inspired by the show, I signed up for a beginner's course in aerial acrobatics.

I expected my first class to be an introductory session, but instead, the first thing we were asked to do was monouvers on a static trapeze. Sure, they were basic moves, but having never seen a trapeze up close before, actually getting on it was an incredible feat itself without taking into consideration that I actually had to move on it! And trust me, the static trapeze was the easy part of the night.

Needless to day, it was a brutal session. By the end of the hour, my muscles burned and I could barely walk straight. I came out of my first class last night with the stark realisation that my body and my will were truly weak. After all, my teachers and classmates made it look so easy! And if their expectations of me were anything to go by, it really should not have been that hard.

They climbed and curled and defied gravity like it was second nature to them. It was beautiful to watch, whereas my efforts would probably have seemed less dainty and more ghastly. Contrary to them, I was weighed down by my lack of strength, coordination, and confidence. I felt the limits.

The parting words of one of my teachers (whom, by the way, I fell on top of during one of my attempts to climb the rope) were this: "Don't give up... You can do this. You have the strength, you just haven't figured out how to use it yet."

They say that the key to gaining competence is to just keep at it. But what do you do when you're just plain tired?

What do you do when your muscles ache and your mind has turned to mush and you just cannot squeeze even an atom's worth of effort any longer? What do you do when you're just not good enough?

Trying to be better is a simple concept to grasp, but the actual feat is far from easy.

And, in my opinion, despite loving the climb, being at the foot of the mountain and knowing that you have such a long way to go is not much fun.

Just Like Me

"Just think, though... The best doctor you've ever known started out just like me!"

Thankfully, my patient laughed.

In all honesty though, I often forget that although the struggle to perfect your medical skills is something that all medicos have in common, a lot of the time, that's where the similarities end.

Every time I meet a fellow medico, I have this innate (and extremely naive) notion that I'm meeting a kindred spirit. After a few minutes of conversing with them though, I may be proven wrong and this can at times be disappointing.

Medicos are people, and people are different. Although some have said that the practice of medicine attracts a certain kind of personality (or, in my opinion, a certain kind of crazy), there is in fact a lot of very different people in medicine.

Our values are different, our motivations are different. Our opinions and approaches are different. Our priorities are different. And often, our perception of our patients and the profession in general are different.

In a perfect world, this would be okay.

However, in reality, it is often hard for a person altruistic in nature to relate to a person egoistic in nature and vice versa. And although this is true in all facets of life, I can think of no other profession in which these two personalities collide to the extent that they do in medicine.

Medicine has the capacity to fulfil the needs of both these archetypes and therein lies the attraction.

It is easy to put down the surgeon who is in it for the money or the psychiatrist who is in it because his best friend committed suicide and say that they've got it all wrong. But labels and stereotypes are poisonous and they pollute our thoughts and behaviour, and ultimately pitch us against each other when it is in our best interest to stand together.

Mutual respect is an easy thing to say, but amidst our pride and respective prejudices, it can often be quite a challenge to implement.

At the end of the day, nobody will appreciate the full extent of a doctor's responsibilities and the risks involved in the profession better than another doctor. Despite our differences, we are comrades in arms and the world needs all of us in every which way we come.

The Great Balancing Act

"So be sure when you step, step with care and great tact,
And remember that life's A Great Balancing Act!"

'Oh, the places you'll go' by Dr. Seuss

Believe it or not, I was first introduced to Dr. Suess when I was 16 years old.

Anna, who was 18 at the time and my very first soulmate, read to me her favourite book, 'Oh, the places you'll go, and I loved it.

Since then, I have found the wisdom of Dr. Seuss to be very relevant to my daily life.

From my observation, life is a circus - Not only is it A Great Balancing Act, there is also plenty of juggling involved. And sometimes, there are clowns (both of the funny and scary variety).

At the moment, I am juggling the end of my formal medical enrolment with the beginning of my medical career. This involves keep up with my medical studies in term of the university's curriculum and assessment requirements, along with all the on-the-job learning that I do on my clinical placement everyday from before dawn to beyond dusk, and at the same time, address the requirements of my internship applications for next year which includes months of researching different hospitals and training programmes, CV and Cover Letter writing for each hospital, obtaining spectacular references, and lastly but most importantly, wow-ing the interview panel with my dazzling charms and sparkling personality. If I can manage it.

Trust me, it's not easy.

Where do I find the time? The short answer is, I don't. But life goes on regardless.

In the end, I do the best I can, the only way I know how.

For internship, I applied to 25 training programmes and have so far completed interviews for 10 of those places. It took a lot of time, planning and effort, and at random points in the process, I was utterly mentally, physically, and emotionally drained. Some of my interviews were hours and hours of away from each other, after which I still had to go to work the next day, and for the past three weeks, I've had multiple interviews per week, some of them back-to-back.

But this is the price we pay. Our time, effort, and energy is the sacrifice we make in order to increase our chances of getting to where we want to be next year. Having said that though, even after all that, nothing is guaranteed.

For now, there is a still moment of silence before the next round of interviews come-a-calling. I'm hoping that by then, I'll already have a job offer in hand. If not, the saga continues.

And, of course, in and amidst all this internship drama, I've actually got to focus on completing my personal learning objectives to ensure that I make an excellent intern next year.

All I can say is, I can't wait to finally have a job secured so that I can start focusing once more on what really matters, and that's getting the job done right.

Also, by the way, it'll be nice to finally get paid.

On purpose

It's been a long day... And not a particularly easy day, either.

Still, long days or not, easy or not, I love my job.

A number of things plague my mind tonight.


One of my patients informed me today that she was dying.

Not knowing how to reply, I did the only thing I do know. I was honest.

I told her, "We're all dying. It's just a matter of how and when."

And then I said, "No matter what happens though, my job is to take care of you and make sure that your time here, however long, is as comfortable as it can be."

Thankfully, she smiled and replied, "Good answer."

~~~

One of my Palliative Care patients was in dire straits yesterday, but following our treatment regime, she has improved markedly, and I've been very, very happy with this.

However, despite having COPD and a chest infection, she still continues to smoke.

Rightly or wrongly, it feels like we are fighting to give her a better quality of life (however long she's got), and she's fighting against all our efforts.

It's against my nature to give up on my patients. Palliative Care or not, she's still alive now, and I firmly believe that her life CAN be better. If her lung function improves, her appetite may as well, and really, that's the only thing that's holding her back.

She has not got a terminal illness as far as her records show (no more than the rest of us, anyway - Life is a terminal illness, after all), she's just got really crappy lungs. But that's not killing her - the smoking is. Slowly, but surely, and most certainly torturously.

I know I'm new and inexperienced, but I just think that if she were managed better, she COULD come out of this, despite her many near-death episodes.

Unfortunately, my opinion in this case means nothing because as things stand, I have more faith in her potential recovery than she does, but she's the one calling the shots.

~~~

A young man showed up today after having his first episode of generalised tonic clonic seizure.

He is my first patient of this variety, and I couldn't help but recall the words of my Neurology mentor.

"Before referring to Neurology, ALWAYS check the tongue."

And I did. And sure enough, he had bite marks on his tongue; an observation I included in his notes as any conscientious medical student would.

Naturally, I did feel proud when the admitting physician said that my notes were "perfect".

In medicine, it's those kinds of moments that get you through the day.

We spend so much time swimming against the tide, fighting the odds, and being thrown around by waves of uncertainty and by so many factors beyond our control that we will pretty much take any victory that comes our way.

Even if it comes in the form of perfected paperwork.

I have now come to the end of my day, and I'm exhausted.

Every patient I see is unique and important and I care for them in different ways.

In a way, they've all had a piece of me today. And today, I'm feeling it.

The stretch, the weight, the tension...

Regardless, I wouldn't give up my job for anything.

It's what I'm here for. It's my role.

It's my purpose.

Dr KR/Ms K

As I had always anticipated, medicine has turned out to be an all-consuming reality; a fact that had deterred me from it initially. The people I most often see day to day are associated with hospitals, the tasks that plague my never-ending to-do list are medically related and, most sickeningly, when I'm out on social dates with my friends (all of whom are unfortunately also in the medical field) the topic of conversation that eventually creeps up and takes over is, of course, medicine.

And in the midst of this inescapable, personality/individuality-sucking medical black-hole, my head screams, "How did I get here? I am not this person!"

For certain, I am not.

And five years ago, I most certainly did not envision myself where I am today.

I was an ever-curious and adventurous child; my favourite activities being reading, arts and craft, experimenting, exploring and treasure hunts. I was also very active and I loved swimming, swinging, and just about anything that involved running around and expanding energy.

Twenty years later, I'm still this person. One could say (and many have) that I really haven't grown up at all.

Throughout school and college, I always found my niche, and it always involved more than just academics.

In high school, it was music. I was the drummer-girl of a rock band with three other guys, and I loved it. That virtually sums up my memories of high school, although I'm fairly certain there were plenty of other things that kept me busy.

In college, it was foosball. I was dubbed 'The Foos Queen' by the boys on campus after winning first place in the A-levels tournament with the help of my infamous 'Kate-shot'.

Those were the days. I was young and carefree, and my only responsibility was towards self-development. And in all honesty? I feel I did a good job.

These days, I'm a final year medical student. One of many; but I love what I do.

I'm one of those lucky people who gets to wake up in the morning, go to work, and feel like I'm where I'm meant to be. I fit in, I belong, and I have a purpose that I feel capable of fulfilling. And that fulfils me.

If I had all the time in the world, I would publish my novels and non-fiction work, work on my art and sketches, record my musical albums, open my school of philosophy, and devote my time to the hundreds of other items on my non-medical to-do list that often gets neglected due to my more pressing medical priorities.

Medicine has not changed me. Not one iota.

However, out of necessity, my priorities have been reshuffled and it's easy to forget that there is another side of me that needs just as much nourishment as the medical side.

Self-care is something that is taught in most medical curriculums. After all, it's hard to care for others if you're having difficulty caring for yourself.

Often though, it's something that needs to actively be worked on as the work will steal your soul if you let it.

And a soulless doctor is no good to anyone.

Successful Aging

I was reading up on the concept of 'successful aging' when ironically I met a woman on the bus who seemed to be the epitome of the phrase.

Maria is a woman of European descent who is close to celebrating her 95th birthday. On the day we met, she had just been to her great granddaughter's birthday party and was on the bus heading home.

When she let slip that she was 95, I could not hide my surprise. She looked like she could have been in her mid-70s to 80s, but mid-90s? I wouldn't have guessed.

The thing that came to mind next was, what was her secret?

In life, we often imitate actions and behaviors that we believe are proven to have good outcomes. This is where our personal evolution meets our survival instincts. This also happens to be the basis of evidence based medicine.

For me, this woman was a walking testament to the fact that successful aging does in fact exist.

And so it was that a woman in her third decade of life found herself with the curiosity of a child, sitting beside a woman approaching her eleventh decade of life, wanting to learn.

Maria was not a woman without her fair share of challenges. Four years ago, she had lost her husband to metastatic cancer, and four years before that, she was struck by a thoracic aneurysm (which, ironically, the doctors advised not to operate on because she was apparently "too old").

It just goes to show, doesn't it? Doctors don't always know best, and our patients can often still surprise us by beating the odds.

In that short 45-minute bus ride, I regret to inform you that I did not end up getting Maria's secret recipe for successful aging (although given more time, I'm fairly certain she would have gladly listed them down for me).

However, I did note a couple of things:

1. Maria values her independence and does most things on her own

2. She has a good support system in terms of her friends and her family, despite all family members living in different regions, interstate and overseas

3. She keeps mobile and seems fairly active, despite the normal limitations of her physical state

Overall, Maria states that she is satisfied with her life and she has no regrets. She told me that she has no desire to live forever and would be quite content to meet her Maker, whenever that may be.

One thing she did comment on was her difficulty with her husband's passing. Although she had initially thought that time would heal all wounds and she would eventually get used to being on her own, she has found that this is not the case.

And after almost seven decades of marriage, one could certainly understand if it is something that she never gets used to.

I wish Maria the very best in life and I hope that life continues to treat her well. I am thankful to have met her and grateful to have had the opportunity to learn from her.

And, without a doubt, I hope to one day be able to help my patients age as successfully as she has.

The Essence of Aged Care

This poem was found in the belongings of an elderly woman who died in a nursing home in the UK.

It's one that I keep at the back of my mind to remind me that patients are people; first and foremost.

Many of my Aged Care patients have pictures lining the walls of their room, and I am constantly amazed at the stories that come with them - often detailing a rich and full life.

At times, when all you have in front of you is an elderly man or woman who can barely walk or even speak, it is hard to envision that in the place of weakness and clumsiness, there once had been strength and vitality.

This poem reminds me of two things regarding the elderly:
1. They've all been there from the very beginning
2. We'll all end up there at the very end

And, with that in mind, I hope you appreciate this beautiful poem as much as I do.

----------

What do you see, nurse; what do you see?
What are you thinking when you look at me?

A crabbit old woman; not very wise,
Uncertain of habit, with far-away eyes.

Who dribbles her food and makes no reply,
When you say in a loud voice, "I do wish you'd try!"

Who seems not to notice the things that you do,
And forever is losing a stocking or shoe.

Who, unresisting or not, lets you do as you will,
With bathing or feeding; the long day to fill.

Is that what you're thinking; is that what you see?
Then open your eyes, nurse; you're not looking at me.

I'll tell you who I am, as I sit here so still,
As I move at your bidding; as I eat at your will.

I'm a small child of ten with a father and mother,
And brothers and sisters who love one another.

A girl of sixteen with wings on her feet,
Dreaming that soon now, a lover she'll meet.

A bride soon at twenty; my heart gives a leap,
Remembering the vows that I promised to keep.

At twenty-five now, I have young of my own,
Who need me to build a secure, happy home.

A woman of thirty, my young now grow fast,
Bound together with ties that forever should last.

At forty, my young ones have grown up and gone;
But my man stays beside me to see I don't mourn.

At fifty, once more, babies play 'round my knees,
Again we know children; my loved one and me.

Dark days are upon me; my husband is dead,
I look to the future; I shudder with dread.

For my young are all busy rearing young of their own,
And I think of the years and the love I have known.

I'm an old woman now, and nature is cruel,
‘Tis her jest to make old age look like a fool.

The body, it crumbles; grace and vigor depart,
And there now is a stone where I once had a heart.

But inside this old carcass, a young girl still dwells,
And now and again, my battered heart swells.

I remember the joys; I remember the pain,
And I'm loving and living life over again.

I think of the years; all too few, gone too fast,
And accept the stark fact that nothing can last.

So open your eyes, nurse; open and see,
Not a crabbit old woman; look closer - See me.

~ Written by Phyllis McCormack ~

The Art of Happy

Happiness is a puzzling thing.

There are some days when I've got every reason to feel miserable and yet I don't. And then there are days when I've got every reason to feel happy, and yet I find that I can't quite get there.

Clearly, happiness is unreasonable.

People often talk about happiness as being a choice; that you can choose to be happy.

Rightly or wrongly, I am not one of those people.

I don't think you can choose to be happy any more than you can choose to have a hundred dollars in your wallet.

You've either got it or you don't.

However, if you'd like to have a hundred dollars in your wallet, there are ways of making that happen. Just like there are ways to making yourself happy. In both cases though, it is a process, not a split second materialisation.

The mind is a beautiful thing.

After over twenty years of living with mine, I still haven't quite figured it out, and it's not from lack of trying.

I am certain that I'm not alone in my quest for happiness. For a lot of people, it's a never ending struggle.

The funny thing about happiness that I've found is this. You need to have had it to fully appreciate it. You need to have tasted it to want it bad enough to actively seek it out.

In a sense, happiness is like an addictive drug. The more you get of it, the more you crave it, the better you are at recognising the things that give you that high.

Just like it takes money to make money, it takes happy to make happy. If that makes sense.

And so, my summary of it is this. Happiness can only be attained in pursuit of happiness. It is both the journey and the destination. Every little success that gets you closer to your ultimate happy goal, gets you there.

It is an elusive conundrum that plays us all for fools, and yet, it's worth living and dying for.

So what do you do when happiness serendipitously pays you a visit?

Ask no questions and simply bask in the glory.

And that's just what I intend to do next.

Fly

Ever since I was a child, I have had dreams of flying.

In these dreams, I have have full control of my flight (i.e. I am able to fly higher or lower, turn left or right at will), and occasionally, although I am aware that I am dreaming, I am so intoxicated by the freedom and exhilaration that comes with my flight that I just go with it.

Of course, as all dreams in sleep must end, I eventually wake up to reality. Despite it being all in my head though, I still value these dreams very much.

Yesterday, Keira took me to see a performance at the National Institute of Circus Arts (http://www.nica.com.au/) and I realised that for some people, what I only experience in dreams, they taste snippets of in reality.

Ultimately, we are all a product of chance or fate; whichever you choose to call it.

It dictates the opportunities that we encounter, as well as everything that influences us (directly or indirectly), which includes our environment, and the people we meet.

I found myself thinking yesterday that I would have been happy as an acrobat. If the opportunity to learn and experience the profession had been available to me in the past, perhaps I would have found myself walking down that path. Or at least engaging in it as a past time.

But today, I am who I am. And I am where my life has brought me.

Having said that though, it's never too late to discover sides of yourself that you've never known, and it's never too late to incorporate new things into your life that can make you happy.

Lesson for today?

Insight comes with new experiences.

So, go ahead... Immerse yourself.

A Good Death

So this morning, Vincent and I were asked to put in an in-dwelling urinary catheter.

And one hour, two final year medical students, two doctors, three sterile packs, four attempts, and multiple glove changes later... The procedure was a success.

Now, before you start yelling out "Medical incompetency!", let me just enlighten you on our patient, Cassandra.

Cassie is a 98 year old woman with a pelvic fracture.

Here's hoping that bit of information put things into context for you. And if it still doesn't... Let's see you do better.

On another note, one of my first patients at the Lodge passed away today.

I met her two weeks ago when I was assessing her for her back pain (she referred to my palpation technique as a gentle massage) following which, I advised her to practice deep breathing exercises, keep mobile, and practice all those good healthy habits that keep your lungs happy.

I recall that at the time, her lungs were clear. It didn't take long for that to change, however. Once the pneumonia hit, she deteriorated quite rapidly. Despite our best efforts, it came to a point where the most we could do was keep her comfortable.

In the end, we managed her pain, she had her family with her, and as far as it can go, I'd like to think that she experienced a good death.

Is there such a thing?

I'd like to think so. One would hope that it exists, as given the fact that death is the one sure thing about life, it's nice to think that it could actually potentially be a positive experience.

However, only time will tell for sure. And on my part, I'll do my best to keep you posted.

My House is an Ice Box

*ehem*

My house is an ice box of red bricks and wood

The latest attraction in my neighbourhood  

I wake in the morning and nobody knows

If overnight I've lost all my fingers and toes  

My house is an icebox all frozen inside

Despite my warm heart, there is no place to hide  

With icicles and snowflakes aligning the hall

Tomorrow the Snow Queen might pay me a call  

'Tis the season again, evidently, it's clear

My house is an icebox now that winter is here.

Needless to say, it's another harsh winter. By my standards, at least.

Coming from the tropics, my threshold for the cold (and the heat, for that matter) isn't particularly high, but given that it's been four years, I'm learning to cope.

I am currently on my Aged Care rotation and enjoying it tremendously. It rekindles my love for Geriatrics and Palliative Care, and interestingly enough, Mental Health.

The polarity of Aged Care, however, can be quite a roller-coaster ride. All in one day, you could celebrating a successful treatment of pneumonia in one moment, and delivering bad news about terminal metastatic lung cancer in the next. At the end of the day, it's about taking in all good and making the best out of a situation that may be less than ideal.

And, of course, it's about knowing that even with an impending death, there is still good work left to be done.

That is, assuming I escape from my ice castle soon enough to do the work required!

Australia's Intern Crisis

Original article: http://www.mjainsight.com.au/view?post=james-churchill-an-intern-crisis&post_id=9436&cat=comment

----------

An intern crisis

Written by James Churchill

HUNDREDS of students graduating from Australian medical schools this year may not get an internship in 2013.

The Australian Medical Students’ Association has been concerned for years that the rapid and sustained increases in medical student numbers would, at some point, lead to the clinical training system failing to provide sufficient internships for graduates.

The number of medical graduates has rapidly doubled from 1633 in 2006 to this year’s predicted 3512. With the lack of adequate workforce planning over a number of years, it’s no wonder that our health systems are struggling to keep up with graduate numbers.

In 2006, and again in 2010, the Council of Australian Governments (COAG) guaranteed “to provide high-quality clinical placements and intern training for Commonwealth-funded medical” students.

Despite these guarantees, it is concerning that many state agencies have advertised fewer internship positions than the estimated number of domestic applicants. In these states, the job prospects for Australian-trained international students are even more alarming.

International students, who make up about 15% of graduate numbers, are not guaranteed an internship in any state or territory, and are generally prioritised after domestic students in the allocation systems.

Our estimates show that, overall, 456 medical graduates will not gain an internship that is required for full medical registration, and will therefore not be able to work as doctors in Australia. As domestic students get first allocation, it will be international students who will bear the brunt of this lack of places.

Many of these students will be forced to seek internships overseas after being trained specifically for the Australian health care system and the complex medical needs of its ageing population.

The prospect of medical graduates not being able to continue training in Australia represents an appalling lack of workforce planning by governments and universities. It is concerning on a number of levels.

First, producing medical graduates without jobs will not solve the shortage and maldistribution of Australia’s medical workforce, and will leave graduates unable to serve communities in need.

The recent Health Workforce 2025 report predicts a modest undersupply of doctors by 2025 in a range of likely scenarios. It also highlights that Australia’s current reliance on overseas-trained doctors goes against many conventions to which Australia is a signatory.

We are now in a ridiculous situation where, on the one hand, Australia produces more doctors than internship positions, forcing doctors to continue their internship training overseas, yet, on the other, we continue to rely on vast numbers of overseas-trained doctors to meet Australia’s health needs.

Second, significant federal, state, university and private financial resources go into training a medical graduate, all of which is wasted if that graduate cannot practise. The waste of immeasurable and valuable clinical resources is equally significant given the various pressures of increasing student numbers.

Third, this situation has significant implications for the sustainability of Australia’s medical education sector. As many of those students likely to miss out on internships are international full-fee paying students, a loss of confidence in graduates’ ability to continue training in Australia may precipitate a decline in demand for international full-fee places at Australian medical schools.

Many medical schools are significantly reliant on international student revenue, the loss of which may have severe consequences for the quality of medical education in Australia.

Progress on this issue in the coming weeks will be critical for those medical students concerned about their future careers.

Sufficient funding and support must be provided to health services to ensure that the maximum number of quality internship positions is available for Australia’s medical graduates.

It will not suffice for university medical schools, and state and federal governments to simply blame each other for the problem and hope that it will somehow resolve itself.

Governments and their agencies must recognise the significance of failing to provide medical graduates with internships and the ability to continue the training that is needed for Australian medical school graduates to fully participate in Australia’s future medical workforce.

Mr James Churchill is the president of the Australian Medical Students’ Association.

Updates on the internship crisis are available the Australian Medical Students’ Association website. AMSA has also started a petition — Health Ministers of Australia: Train the doctors Australia needs.

Posted 4 June 2012