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.