Obligatory "end of year" blogging

2012 is drawing to a close and it's been quite a year!

I'm going to start off by looking back at my resolutions from the start of the year and seeing how I've done. I helpfully wrote them down here so I have no excuses and can't pretend I achieved everything! So, what was I attempting to do?

- Get fit again. Mission failed! I have been a lot more active this year and made a serious effort to walk rather than getting the bus etc etc, but for numerous reasons I haven't really got properly into exercising the way I'd intended to.
- Start eating properly again. Mission partially accomplished. I still have my moments, but am by and large doing a lot better than I was a year ago. This is probably due to finally admitting that I had an issue with things, which is something I should've done years ago.
- Sort out my finances. Mission partially accomplished. I've only been earning "proper" money for 5 months, but the credit card and overdraft are cleared and I'm chipping away at the student debt (albeit slowly).
- Attempt to be more positive. Mission partially accomplished. As with eating, I still have my moments, but I was described at work as "that quine* who never stops smiling" so I must be doing alright! *quine = generic term for female in this neck of the woods.
- Graduate and become a doctor. Mission accomplished!


I'm not going to reflect too much on the year as a whole. There have been ups and downs and happy times and sad times, as there will have been for anyone looking back on a 12 month period. Instead, I think it's time to look forward, and to make another set of resolutions I may well not stick to!

So, in 2013 I hope I will:

- Successfully be signed off for my FY1 jobs, gain full GMC registration and start working as an FY2. Fairly obvious I suppose but getting successfully through my first year of work has absolutely got to be a priority.
- Pass the first year of my MSc and PGCert. As above, fairly obvious, but given what I'm shelling out for tuition fees it would be a very expensive mistake if I didn't study enough towards my courses!
- Get in an application for paediatric specialty training. This will probably surprise absolutely noone, but it's a bit scary thinking that I'll be applying in less than a year. I haven't completely decided whether or not to apply for a normal ST (specialty training) post or for an ACF (academic clinical fellowship) instead, but no doubt I'll blog about the pros and cons of each later.
- Buy a car. I have made so many excuses for not doing things because not owning a car makes them difficult. I need to bite the bullet and get one, especially now money is less of an issue.
- Get fit. Again. I say it every year, but eventually I'll stick to it!

Hope you all enjoy seeing in the New Year. I'll be on night shift, so think of me as you tuck into your champagne and canapes!

xxxx

Survival

Apologies for my protracted absence from the blogosphere! I a few bits and bobs to update on, so I'll try to keep it relatively brief and free from waffle...

- In October I had the first week of teaching for my MSc. I'm studying towards this master's at Imperial, and so far I'm really enjoying it. As well as it being a fun week socially (it was down in London so I stayed with my sister, met @lilDrSunshine who is doing the same course, and caught up with some old friends from school I haven't seen in years), it was also just what I needed from a professional/academic point of view. The lectures were mostly on the foetal and early life origins of disease, which is an area I find very interesting, mostly due to the influence of a certain tutor who has been very supportive over the past few years. We also had some teaching in how to write research proposals, which will prove very useful should I succeed in my goal of becoming an academic. It was really nice just to be thinking again, using my brain to work through proper science. The fact that I didn't check my phone or tweet during any of the lectures just shows how interesting they must have been! I'm now working on my first proper assignment for the course, which is a research proposal - I'll let you know how I get on with it.

- I have survived my first job! Actually, technically I'm not 100% sure whether or not I have as I don't have my final end of placement assessment with my supervisor until Wednesday, so I may have completely failed but I'm banking on my theory that if I was likely to fail someone would have told me already - best not to count my chickens before they're hatched though! Anyway, I have physically and mentally survived my first 4 months as an FY1. Having spoken to a lot of people who've worked on those wards, they're notoriously difficult for junior staff, so I'm hoping my next job will be a bit less stressful! Even if the set up is mostly unchanged, I suppose I have 4 months of experience behind me now. I started my new rotation with 2 night shifts (covering the same wards I covered on nights in my last job) and I'm now on annual leave until 21st December, so I'll let you know how I'm getting on once I've worked my long day on Christmas day and night shifts over New Year!!!

- As mentioned, I've definitely drawn the short straw and am working both Christmas and New Year, however it does mean I have the week off in February I need for the next instalment of MSc teaching. I'm already looking forward to going down, although this time I won't get the overnight train back up north and then work a long weekend (seriously, it isn't recommended).

- I suppose I ought to take some time to reflect on my health at this time. As well health issues having been a worry for me in the past, it's also one of my "Duties as a doctor" (so say the GMC) that I'm aware of my own health and take care of myself. Having been told by various well-meaning people at various points that I would have a major crash in my mood once I started work, I've been pleasantly surprised. Working longish hours and being on my feet most of the days means I'm tired enough that I sleep pretty well when I go to bed. Eating is something to be done quickly when there's time, so it's fairly regimented too. The biggest "problem" I have, if it can even be called that, is that because I work intense bursts of up to 12 days on without a break, I also have quite a lot of free time where I'm  likely to over think. Fortunately I'm focussing on my MSc in this time so I'm keeping my mind nice and busy.

Right, I think that's me relatively up to date. I'll probably blog more in the next few weeks as I procrastinate whilst I try to write this assignment!

xxx

European Working Time Directive

The current bain of my working life is the European working time directive. Not only are my hours considerably less than someone in my position would have worked a few years ago (yes, that IS a bad thing, but my lack of clinical exposure is a topic for another blog), junior doctors are now subject to "monitoring". This involves having to write down exactly the hours you were working, whether or not you took your breaks and explaining what precisely you were doing if you were late finishing or didn't get a tea break. Should you have the audacity to stay late so as not to hand over a crappy job, or be too busy try to resuscitate a septic patient to go for lunch, you are reminded that you are breaking the law. It is also highly likely that you will be accused of having poor time management skills. I cannot think of another circumstance where commitment to your job, working extra hours for no extra pay and attempting to make life easier for your colleagues leads to criticism. Is it any wonder junior doctors are disillusioned?!!!

That's Life, That's What All The People Say...

Well, the past few weeks have been something of an emotional roller coaster. As well as dealing with some very challenging things at work, I've also split with the guy I was seeing (definitely for the best but I'm still gutted) and lost my Nana (we weren't close but I hate seeing my Dad so upset).

My first run of 12 shifts in a row was really quite exhausting. Being able to switch my alarm clock off when I went to bed on Friday felt like a definite luxury. Even though I don't start work particularly early (9am so the alarm goes off around 7), it's amazing how tiring it can feel just knowing there isn't the option of a lie in at all! The weekend in particular was pretty tough as I was working 12.5 hour days on Friday, Saturday and Sunday with very little in the way of senior support.

Being a doctor is much more emotionally demanding than I had anticipated. I'm not sure whether this is because I've also had other stresses in my life or I was just rather naive when I started. I seem to have a lot of patients who are either essentially dying or medically as fit as we can make them but unable to leave the hospital because there are social/care provision issues. I wasn't quite prepared to be discussing end of life care with relatives after only a matter of weeks in the job, nor was I aware that I'd be representing the "medical team" at case conferences and meetings so early in my career.

I'm now on a week of annual leave, which is a bit strange. I hadn't really anticipated having any length of time off so soon after starting work, but we get allocated our leave so someone will always have it in August - and at least I didn't have the first two weeks of the month off like some of my friends did! I'm not doing an awful lot but I get paid on Thursday so maybe I'll do something a bit more exciting when I have some cash...

Nothing more exciting to report, sadly, but my MSc starts in October so I should have something useful to write about then!

xxx

Working Girl

Apologies for the unintentional hiatus in posting recently. Things have been rather busy recently. I have moved into a new flat, graduated, been away for a week and started work since I last posted (there's also a boy on the scene but I shan't bore you with the details).

My graduation was absolutely lovely. I was lucky enough to graduate on the one day where it wasn't absolutely tipping it down with rain. Lots of close friends were there and it was a very happy occasion with plenty of wine and Pimm's too. The icing on the cake was my friend's boyfriend proposing to her just after the ceremony - very exciting and I'm delighted for them :-)

I've also had another week away with Over The Wall. Anyone who has read my posts from last summer will be aware that I'm something of an OTW evangelist. Once again I had an amazing week and met some really inspiring kids. I hope I can arrange my leave/days off so that I'm able to go next year - I'd be absolutely gutted if I couldn't. After a wonderful but tiring and emotionally draining week, it's sometimes easy to forget the real reason we do this, but the comments from some of the kids and their parents after they'd got back just sum it up so well. These are two of the quotes which really made this year worthwhile for me.

"I have just recently came back from the 2012 Tulliallan "over the wall" camp, i would just like to say thank you now because i did not have time to do it before i left.

Thank you for.....

Helping me push myself beyond myself beyond my limits
Making me enjoy at first seemingly immature songs :).
Letting me feel Normal for once"

"Thank you so much for letting me join you again this summer, for another amazing camp. This past week has been the best week of my life. I will never forget the laughs, songs, the dances, the tears (emotional/happy ones!), and the memories that have come out of it. I have met some fantastic people that will inspire me everyday for the rest of my life. It is truly impossible to put an Over The Wall camp into words. From the staff and volunteers, to the campers: every single person at Over The Wall is just incredible. Your camps are the highlight of my year and heaven on earth for me. I look forward to seeing the photos that were taken this past week, which I will treasure forever. Leaving camp this morning was so difficult and emotional for me - but that shows what a great time I've had there.
What you do is wonderful.
Thank you."

I'm feeling quite emotional reading those back. I know both the kids who wrote them and they are really wonderful young people who have overcome some really tough challenges but are none-the-less bright, talented, enthusiastic and kind.

I could talk about camp all day (in fact, I pretty much do) but I should move on to what I imagine is more exciting for most people who read this: starting work!

I was one of the slightly unfortunate people who drew the short straw and my first ever shift was a night shift. Although it was pretty nerve-wracking and hard going, I feel like in only two shifts I learnt an awful lot and am already much more confident than I was before starting. I've also now done 5 day shifts on the ward where I'm based. I'm quite lucky in that the other doctors are very supportive and helpful and our consultants are happy to be contacted if we have any queries or concerns. The nurses, therapists etc are also all lovely, which makes the whole process of settling into the job a lot easier.

Without giving away anything confidential, I have seen and done a real mixture of stuff. I was really worried about practical procedures as my last student placements didn't offer much opportunity for practising, however, I have successfully managed venepuncture, cannulation, arterial blood gas sampling and catheterisation in the past week. Hopefully this means that my colleagues won't think I'm incompetent should I struggle with a few difficult patients in future. I have also confirmed death and filled in death certificates - rather morbid but something every junior doctor needs to get used to doing.

Whilst it's true that being an FY1/JHO/lowest of the low is largely about organisation and paperwork rather than medicine, I have found I've had plenty of opportunities to assess sick patients, prescribe, examine and generally use my brain - something I was worried wouldn't be the case. In true Learnaholic fashion, I have also found myself some research to be getting on with, and my MSc starts in October.

Right, I must head to bed as tomorrow is day 1 of 12 and I need to get enough sleep!

Goodnight xxx

Impostor Syndrome

Today I was reading through the lovely @tablet_girl's blog when I came across this post where she mentions the concept of "impostor syndrome". It isn't a term I've heard used before but as soon as I read it I knew what she meant. In fact, I feel like it summed up things so well that I decided to blog about it!

I should point out that by impostor syndrome I don't mean Capgras syndrome (a disorder where the sufferer believes that those around them have been replaced by impostors) but the feeling that one is an impostor and doesn't deserve their successes and achievements. There's a totally unscientific but quite useful page on Wikipedia which explains it nicely.

Like Tablet Girl I've had low self esteem since the year dot. In fact, I think I mentioned it in my first mental health related post, The Real Confession back in January. I don't recall any reason for my lack of self belief. I was bullied at secondary school and I have no doubt that this made the problem worse, but I recall feeling inadequate years before that. I remember as a fairly young child (maybe 6 or 7) watching some sort of Pride of Britain type programme and feeling that nothing I could ever achieve in life would really be worth much because I hadn't encountered enough adversity. Ever since then, I've been plagued by feelings of insecurity and inadequacy. I brush off any compliments because I don't feel like I deserve them. Any successes I have are either flukes or not "proper" achievements for whatever reason. At uni, I was terrified that someone would one day "discover" that I wasn't really good enough to be there and would kick me out. In relationships I'm constantly convinced that once my friends or boyfriends know what I'm "really like" they'll have no interest in me any more.

There is only one thing which perhaps contributed to my slipping into this way of thinking. I don't know if it really has anything to do with it, but it's the only thing I can think of at the moment. I've always been aware that both of my parents grew up in relatively "poor" families - single parent, financially insecure, struggling to make ends meet. In comparison, my parents are happily married, my Dad has always had a decent job and although we've had to be careful, there has never been a time that food was scarce or bills couldn't be paid. I've often felt guilty for this. I am no more deserving than either of my parents, or indeed the many millions of people globally who live in poverty. It was a stroke of luck (my Grandma would've said "by the grace of God") that I was born into a fairly financially secure family. I'm not sure how this translated in my head as my achievements being less worthy, but certainly a part of me has always felt that my degree would be more impressive if I'd come from a less well off background (or something else "bad" had happened - serious illness, losing a parent etc). It is not logical, I don't even really understand it, yet I feel it.

I suspect it is as a "side-effect" of this guilt that I do not value my own successes highly. Objectively, I know I've worked hard to get where I am, but I still feel undeserving. After all, it was only luck/chance that gave me the intellect to pursue this career. I'm sure there are lots of people who would love to go to university etc but no matter how hard they work will not succeed academically. It seems unfair that my hard work results in such praise just because it results in a qualification/publication/degree. Similarly, I recently found out I passed my final medical school exams. My parents, naturally, are very proud and feel that I ought to change all my accounts, credit cards etc to say "Dr" rather than "Miss". In their words, I "deserve it". To me, it's just a qualification. Yes, I worked hard, and yes, I passed, but did I do anything more than teachers or lawyers or accountants? Not really, and they don't get to parade around a fancy title.

As I feel that I don't deserve my successes and my achievements in life are purely down to luck, it follows fairly reasonably that I feel like I haven't really achieved anything of worth and therefore must not actually be good enough to do what I do. Having no worthy achievements means, of course, that I must have only got my jobs etc through luck or deception, and at some point someone is going to realise their mistake and tell me to go away.

I'm not sure that this makes an awful lot of sense, but I felt like it might be useful to try to work out where these feelings come from so that I can attempt to change them.

Dr Learnaholic, at your service

That's right, I have passed finals and am thus Doctor Learnaholic! Extremely happy and relieved to have got to this point after seven years of pretty hard slog at university. I will be starting work as a very, very junior doctor on July 31st, with a week of shadowing beforehand. This also means that I've got on to my MSc (in paediatrics and child health), which I'll be doing part time over the next couple of years. Well, I need to justify calling myself the learnaholic, don't I?!!!

I was sitting, waiting, wishing...

Waiting for exam results is one of the most stressful experiences there is for students. The revision period, with all the worry and anticipation and studying to be done, is difficult, but I've always found that I can feel at least a little in control by working hard and being as prepared as possible. Now the exams are over, there is absolutely nothing I can do to alter things. Of course, logic would say that worrying is pointless because it won't change anything, but anyone who knows me will tell you that logic isn't always a word associated with my thought processes!

Since before I actually sat my OSCEs, I've been having flashbacks to my A level results day. As I said in my first post on this blog, I didn't get the grades I'd been hoping for, hence taking what I like to describe as the "scenic route" to medical school. I had all but forgotten about results day itself but suffice to say looking at that sheet of paper and realising I had screwed up was one of the most gutting moments of my life. I was lucky that results day for my BSc was a considerably more positive experience, but there's still a part of me that feels like a failure for having to do that degree in the first place (I am aware that someone with a decent degree who managed to get into medical school objectively is probably not a failure at all, but it's far easier to be objective about other people than it is about yourself).

At the moment, I don't really know what I'm most scared of. I could fail, have to decline my job, repeat the year of university, let down all my friends and family... I don't think after my experiences with my high school exams I would cope terribly well with that. The alternative might just be a bit more terrifying though. Maybe I'll pass - which case I'll be starting my first job as a doctor in 7 weeks time. Now that really is scary!

Finals

Just a very short update to say that this little Learnaholic has finished finals! If I've passed Wednesday and Thursday's OSCEs, then I will actually be a doctor. Scary but exciting times!

It's always really difficult to judge performance in OSCEs. There were a couple of stations I felt I really nailed and a couple I probably totally messed up, but overall I'm not sure how I got on. The great thing about medicine compared to my last degree was this is totally pass/fail. There is no grading, I don't have to worry about whether I got a first, 2i etc, which means that as long as I scrape through then I'll be happy.

I get results some time next week, so of course I'll update and let you all know how I got on. Now, if you'll excuse me, I need to get started on all the things I was putting off so I could revise....

xxx

PICU

Last night, watching the Great Ormond Street documentary, I was reminded of the moment when I absolutely knew for sure that I had to be a doctor.

For those of you who haven't seen it, the documentary focuses on a different department in the hospital each week. So far there have been episodes set in oncology, surgery and cardiac transplantation. Last night's episode was in PICU - the paediatric intensive care unit. One of the things I really appreciate about this show is that it doesn't only show the happy endings. Some children, sadly, do not make it. Despite all the advances in medicine over the years, there are some things which simply cannot be fixed. Death is still very much a taboo in our society, and child death even more so. I feel it's really valuable to expose the fact that children can, and do, die. But I digress.

When I was 17, I spent some time over the summer holidays doing work experience in my local hospital. I was shadowing a paediatric anaesthetist and he arranged for me to spend time in all sorts of different areas. By that point, I was pretty sure I wanted to do medicine; I hadn't seriously considered much else since I'd started secondary school. Lots of areas impacted on me during that period I spent in the hospital. I saw some amazing things and some things that made me go home and cry. I heard stories which inspired me and stories which made me feel sick and disgusted at what humans are capable. I don't think I'll ever forget an awful lot of what I learnt then.

Of all of the moments which impacted on me, one in particular will never leave me. I was spending a day on PICU. There were two patients on the ward, a little girl of about 2 and a 3 year old boy. Obviously I can't give further details, but clearly they were very, very poorly. I sat and chatted with the consultant for a while about what was wrong with them, why they were there, what was being done for them. And then he told me that they were both very difficult patients to treat because it was hard to know what was in their best interests. Technology could keep them alive, but was it giving them any reasonable quality of life? It wasn't easy to know.

Later that morning, we spoke to the parents of one of the children. They also had another child; a delightful baby who was just beginning to say her first words. She'd learnt 3 words, alongside her babble. Mama, Dada, and the name of her sibling. She sat on my knee whilst the doctors spoke to her parents. They didn't know what else they could do. They didn't know whether it was fair to push medical treatment. They could keep the child alive. Did that mean they should? Well, that was the question which no one could really answer. After some discussion, it was decided that further aggressive treatment was not in this child's best interests. They would withdraw ventilatory support.

As the Mum and Dad said that they felt withdrawing was the best thing to do, the Mum began to cry. Their baby looked over to her and said, with just a hint of a question in her voice, the name of her sick sibling. I can't explain why, but right there, at that moment, I knew. I had to be a doctor.

Showing Off

Ok, apologies in advance. This update is basically me just showing off. Please excuse me, I'm a bit over excited!

I found out on Tuesday I got accepted for my MSc - this came as a total shock as I genuinely expected them to give all the places to people who had more experience. I'm really looking forward to starting. Although it's going to be pretty hard work doing part-time studying alongside being a full time FY1 (and let's not even think about the loan I'll be taking out to pay my course fees), I am a massive geek. Learning new things and keeping my mind busy makes me happy. I'm pretty set on doing paediatrics as a career; unfortunately I don't have a paediatric job during my foundation years, so it will be nice to still be doing something child health related alongside my other work. Depending on time, I think the content will probably be quite useful in preparing for the MRCPCH exams, so I may or may not looking into sitting part 1 at some point.

Continuing on the theme of paediatrics (I'm possibly a bit over keen), I've just returned from a few days in Glasgow at the RCPCH conference. I  think I mentioned before that I somehow won some kind of prize (genuinely unsure as to how/why) which meant I didn't have to pay to attend - a brilliant opportunity as conferences are pretty pricey. My supervisor encouraged me to present a poster whilst I was there, so it really was a couple of days of CV boosting!

I had a fantastic time at the conference. There were 15 other prize winners from other medical schools there, all of whom were lovely. We had a couple of meals out and got on really well. It was nice to know that, regardless of institution attended, we all  felt pretty much the same about starting work (totally unprepared!). I met lots of lovely consultants and trainees who were all super-encouraging. I'm now even more keen on the specialty than I was before.

Right, I've procrastinated for long enough so I really must get back to revising. OSCE in 12 days and all this sucking up will be for nothing if I don't manage to actually graduate!!!

Hope you're all enjoying the sunshine xxx

The Final Countdown

After almost 7 years as a student I now feel like I'm into the home strait. One more week of teaching, a few weeks of studying and the small matter of a couple of OSCEs are all that stand between me and entering the big bad world. I am surprisingly calm about this, although provided I pass my exams I will be starting work in 2 and a half months. Possibly I ought to be more nervous about this, especially if day one really is like the bits they show on "Junior Doctors: Your Life In Their Hands" and I take 278 attempts to cannulate each patient.

At the moment, our teaching is all on "professional practise", which is essentially all the stuff that's quite important but noone teaches you. This includes such delights as confirming death, prescribing and fatal accident enquiries. I suspect that actually much of this has been covered in some ilk or other before but I ignored it because it was all "ages away". And now it is not ages away. It is a matter of months. Weeks, really.

This morning we had a session on dealing with "stress and conflict", where we were presented with some rather grim statistics on the mental wellbeing of junior doctors. I was delighted to learn that being female (check) and having a critical father (check - that doesn't mean he isn't lovely) increase risk of suffering burnout during the first couple of years after qualifying. On Wednesday we had a session entitled "support and sanctions" which involved the GMC, MDU and health board HR people telling us not to be naughty or we'd get struck off/fired. Despite these two rather depressing sessions, I'm actually feeling rather positive about starting work.

I had a phone call from occupational health yesterday, and was told they had "no concerns" about my fitness to practise. If you've read my blog before, you'll know that I've had one or two health problems in the past. Although I've played my worries down, I've gone through medical school being a little bit worried that someone would find some kind of loophole which would mean I wouldn't be allowed to start work, so it's a huge relief to know that, from a health perspective at least, I'm going to be ok.

I am keeping myself rather busy at the moment, even though I probably ought to be in the library trying to get the whole of medicine and surgery into my cranium... Last week we had a week off uni and I did absolutely no work at all. I went home to see Mummy and Daddy Learnaholic and had a lovely, relaxing time. Last weekend I went down to Brighton to the National Medical Student Paediatric Conference, which was fantastic. I met lots of lovely people, caught up with some old friends from other medical schools, enjoyed hearing different perspectives on paediatrics and drank lots of wine at the delegate ball.

In addition to uni and revision, I've also started helping out at Cubs (great fun), have a poster to make for a conference in a couple of weeks and applied for a Master's. I suppose I have to justify calling myself the Learnaholic, don't I?!!!

xxxx

Adolescent Psychiatry

Today was my penultimate day on what has been potentially my last ever placement as a medical student. For the past 4 weeks, I've been based in the Young People's Department at the psychiatric hospital. This provides care for young people aged between 13 and 17 who suffer from a range of mental health problems.

I haven't made any particular secret of the fact that, whilst I have found this placement fascinating and at times really enjoyed myself, I've also found things bloody difficult. I know that no one really has a particularly great time during their adolescent years, but having suffered from mental health problems myself (detailed here if you're interested/haven't read my blog before) which began when I was a teenager, this last few weeks have dragged up several uncomfortable memories. This may make uncomfortable reading for anyone easily "triggered" by talk of self harm, depression, suicide etc.

Where I grew up, we didn't have a separate adolescent psychiatry department. Anyone under 18 was sent to the Child & Family Mental Health Service. I vividly remember my first appointment there. I was 15 and it was the Christmas holidays. The department was located in an old, probably Victorian, terraced house which hadn't been particularly well renovated. The room I was seen in was freezing. There were two people seeing me; a middle aged lady who was a social worker and a younger man who introduced himself as a "trainee doctor" - I suspect that he was a psychiatry registrar but at the time I was pretty convinced he was a medical student. They sat behind a desk for the whole consultation and the seats for us (my parents were with me) were a good few metres away from them. There was also a little window at the top of the wall where someone else was apparently watching what was going on. On the wall were several posters about how to deal with your child's difficult behaviour and advising against smacking. There were toys all over the floor.

My first impression was that they thought I was a child (which of course I was, at least legally, but what 15 year old doesn't think they're incredibly grown up?). I don't recall much of the discussion we had. I remember them repeatedly asking whether I'd ever been abused, and then later taking great delight in asking my parents to leave the room so that they could ask me again. Actually I only wanted my parents out of the room because I knew they'd be upset if they knew the extent of my depression etc, but the doctor and social worker seemed pretty desperate to uncover some horrific trauma which must have caused my problems. The only other thing I remember was that right at the end, they asked what I would like if I could have 3 wishes. I still get a bit emotional when I remember my responses, because actually I think they'd be exactly the same if I were asked the same thing now. Firstly, I wanted to be pretty. Secondly, I wanted to be cleverer. Finally, I wanted to be better at music. They seemed rather bemused that I didn't say I wanted to be happy, but even now there are still moments when I think that if I had those things, everything else in my life would/will miraculously fall into place and I would be happy. ,

I didn't go back after that first appointment. They put me on fluoxetine the first of many antidepressants I took. They also wanted me to have CBT but I declined. In retrospect, I probably should have gone for it, but at the time the only time I could cope with being "mental" was to tell myself and everyone else around me that it was due to "a chemical imbalance in my brain". Taking medication to correct this was fine. To have CBT would have been admitting that my thinking was fundamentally flawed and that it was therefore some weakness of character resulting in my problems and not a "proper" illness. Of course I know now that that isn't true, but the explanation I got was such that that was what I believed at the time.

Over the past 4 weeks I've met lots of young people who've suffered with, amongst other things, depression and self harm. Self harm is a strange phenomenon. No matter how much I read about it, I can't fully understand it. What I do know is that for me personally, there was an addictive element to it. Just as a recovering alcoholic may struggle to sit in a pub and watch other people drinking, I as a recovering self harmer find seeing obvious evidence of others' self harm incredibly hard. I know that it was a maladaptive pattern of "coping" with problems. I know it didn't make things any better in the long run. I know that not doing it is much, much better for me than doing it. Yet each time a teenage girl (they were mostly girls) came in with the tell-tale lacerations on her forearms, I felt a strange pang of envy. I do not envy their mental distress. I do not envy the having to wear long sleeves even at the height of summer. I do not envy the having to sprint from the bathroom to the bedroom after a shower so no one would see the cuts. But somewhere deep down inside, a part of me feels an odd craving to cut.

Although I have struggled with many things over the years, self harming hasn't been a major issue for me since before I came to university. I wonder, sometimes, whether I will ever be totally recovered from this issue. Will I be always fighting it? Each time I see a patient who has self harmed, will I have to fight the urge to go back to that pattern of behaviour? I don't know. Possibly. As I get better at coping with emotions - something I am learning more about all the time - I hope the desire will be less strong.

The most positive thing I can take from the past four weeks is that I have survived. Some days were ok, some were great, some were awful, but I got through. Perhaps, one day, I'll be ok...

Changeover Day

Just over a week or so ago was changeover day,- the day when junior doctors move to new jobs. Under the current UK system, all newly qualified doctors work for two years in "foundation posts" where they spend 6 blocks of 4 months working on a range of specialties and developing the skills they will need for their future careers.

As a student, I don't usually think too much about changeover days. Sometimes it's a shame when they happen halfway through a rotation as the staff you have got to know for a while all change, but that aside they don't really impact on us too much. This last changeover day has played on my mind for one reason, and one reason only. Next changeover day will be the day that I START WORK.

I've probably stated numerous times before that as a graduate medic I've been at uni for seven years. I'm in more debt than I care to think about, my younger sisters are both self-sufficient professionals (as are lots of my friends) and at 25 I feel that it's high time I stopped "tax dodging" and got myself out into the world of work. This does not make the prospect any less terrifying.

If you're planning on being ill at all, try to avoid the first week of August!

4:30 Psychosis

Doesn't have quite the same ring as "4:48" but I have been waking up at 4:30 most mornings recently. (If the original reference is lost on you, it's the title of a play/monologue written by the late Sarah Kane. I highly recommend it to anyone who is interested in mental illness. Kane suffered from depression and eventually took her own life; whilst 4:48 Psychosis is not regarded as a suicide note it certainly provides an interesting insight into the suffering she endured in her later years)

Insomnia is a pretty common complaint. I'm sure most people have had times when for various reasons they've slept badly - exams, breakups, bereavements etc. You know the drill. You're physically exhausted but mentally can't switch off. You get into bed but no matter how you toss and turn, you can't get comfortable. You feel simultaneously too warm and too cold. You may drift in and out of sleep - each time you look at the clock some time has passed yet you feel no less tired. Your head and limbs ache no matter how you lie. Finally, your alarm goes off and you drag yourself up, battling the sometimes overwhelming nausea that follows a poor night's sleep.

I am what my GP has scientifically termed a "crap sleeper". As a baby I apparently slept pretty well, but as a child I remember being the first to wake up most mornings. I used to get up and make my Mum and Dad tea and breakfast in bed just for something to do. I always had a book beside my bed and I remember I used to keep a torch under my pillow so that I could read under the covers once the lights were turned out. I suppose if I'd have been a more annoying child who got out of bed and wanted to play all the time, my parents might have taken me to a doctor about my poor sleep patterns, but as it was they didn't really affect anyone else so I was left alone.

I go through phases of sleeping relatively well and phases where my sleep pattern is atrocious. I've tried a variety of medications (some work better than others but generally the better they work, the more of a "hangover" I have the following morning). I've tried cutting out caffeine. I've tried setting myself a strict routine of going to bed and getting up at the same time every day. Generally my sleep is at its best when I have given up on trying to sleep properly. I'm not sure why, but that's the way it seems to work.

It strikes me as odd that sleep is such a primitive function and yet it seems to cause so much trouble. I've read a variety of articles on sleep patterns recently. They have suggested everything from having 2 hour naps throughout the day but never a long sleep to sleeping whenever you feel  tired. Sleep is an incredibly important function. Experiments into the effects of sleep deprivation have almost universally been terminated early because of the detrimental effects on participants. Lack of sleep will kill a person more rapidly than lack of food. Despite the obvious importance of sleep, there is no consensus on how we should do it best. Oh, and noone's exactly sure what it's for either!

Almost 3:30am not - suppose I should attempt to sleep again!

xxxx

The Other Side

As I've mentioned recently, I have my fair share of medical experience on "the other side", ie as a patient. I won't bore you all with all my (frankly relatively minor) health woes, but suffice to say my GP seems to be on a mission to refer me to as many different specialists as possible. This is rarely an issue, although sometimes causes slightly weird conversations, such as (at a BLS session in second year) "you look very familiar, how do I know you?" "you anaesthetised me last week" "oh *awkward pause* I hope you feel better now".  That could have been a lot more embarrassing for both parties if the answer had been "you treated my *insert intimate health problem here* recently".

There are two things I find decidedly awkward about being both a patient and a medical student. One is something that I've thought about in the past but that has struck me again more recently. It's accepted, especially if you live/train in a smallish area, that at some point you're going to be taught by someone who's treated you or vice versa. The GMC advises that, where possible, you shouldn't be taught by someone who is currently treating you. Obviously, sometimes this is unavoidable, particularly if you are in a particularly small geographical area or you are being treated by someone extremely specialised. Fortunately I've never had to be taught by someone I'm a patient of at that moment in time. I have, however, been taught by several people who had previously treated me and I am at present under the care of a doctor who has taught me several times over the past couple of years.

Being taught by a doctor who once treated me is not a particular issue, however there is one specific situation that I've encountered twice now which I find rather strange - being taught by someone who you've had a particularly negative experience of as a patient. Now I know as well as anyone that doctors are not superhuman and have their bad days, but it's a bit strange when you've come close to harm as a result of somebody's bad day and are then supposed to treat them as a knowledgeable professional when they are teaching you. In particular, if a tutor is stressing the importance of doing xyz and you know for a fact that they don't always do that - because they didn't do it when they were treating you. It's very easy to just dismiss everything they say thereafter because you've experienced something they tell you not being the case. In the two examples which spring to mind, the teaching sessions were not particularly crucial to my education as they were things we'd covered in multiple other sessions. It just made me wonder what it would be like for other students who have had numerous more interactions as patients than I have and may possibly have experienced more serious negative consultations etc. I suppose it's part of being a professional that you take people at face value and write off your poor interaction as them having had an off day. Hopefully I'm mature enough that it doesn't affect my studies or how I participate in teaching - even if sometimes there's a rather loud voice in my head yelling "nonsense!" when certain people are talking!

I suppose the above rather inarticulate paragraph relates to a difficulty in being a medical student who has been a patient. The second "difficulty" I've encountered relates more to being a patient who is also a medical student. Medical students are renowned for being hypochondriacs. We all joke about having "medical student's disease" - ie thinking that we're suffering from every condition we've every studied. At exam time last year several of my friends suggested that my attacks of sweating and palpitations could be due to a phaeochromocytoma (a tumour which produces adrenaline) or an overactive thyroid (given that they only occurred when I was feeling particularly stressed and resolved as soon as exams were over, I'm going to assume that the diagnosis was actually "exam stress"). It sounds somewhat nonsensical, then, when I say that medical students and doctors are really, really bad at actually going to the doctors. Yes, every time I have a headache I briefly run through a list of potentially fatal diagnoses (sub arachnoid haemorrhage - not acute enough, brain tumour - not worse in the mornings, multiple sclerosis - no neurological deficit) but equally when I am actually unwell I can take some persuading to actually go visit my GP. I would recommend that if you suspect you may have a chest infection or your asthma is playing up, you go and see someone before you become so breathless that you can't speak in sentences anymore - if you do you might get sent in to the acute medical assessment unit where you're on placement and have to be examined by the consultant who is in charge of all students on medical placements. It's really awkward and embarrassing. Just don't go there.

Why is it that we are so reluctant to seek medical attention? I think there's definitely a large component of thinking that our symptoms aren't serious enough  to be deserving of a doctor's time - after all, that old lady we admitted last week was walking around with a raging pneumonia for 3 weeks before she saw her doctor, so our cough/pain/bleeding/whatever is just not worth wasting someone's time over. I find that this is something which has worsened dramatically for me since I was told about "heart sink" or "fat file" patients. This is a horrible term that some (and I must stress NOT all, by any stretch) health care professionals use to describe patients who are forever appearing with a variety of ailments and complaints which rarely turn out to have any identifiable organic cause - the term "fat file" is obviously because they have huge volumes of notes, and "heart sink" because they walk into the room and your heart sinks knowing that they will have another complaint you are unable to resolve. I now have a dread of being labelled one of these "heart sinks". I'm relatively young and have seen, as I mentioned, various specialists for different problems. I'm horrified by the idea of being that patient who the GP dreads, that person who is discussed at practice meetings because no one knows what to do with them any more... I know realistically that I probably am not the type of patient our tutors mean when they talk about this sort of thing - but it doesn't stop me thinking twice (or three or four times) before actually seeing my doctor!

Right, I was up at 6 to go to a clinic 2 hours away so I think it's bedtime now!

xxx

What A Week!

The Learnaholic has had a bit of a rollercoaster week. After scary-but-actually-ok hospital appointment on Thursday, Friday was the last day of my surgical placement. Big relief as I didn't enjoy it much (although it was much, much better latterly). I also had visitors in the form of Mummy and Daddy (and puppy) Learnaholic for the weekend.

Despite plans for long walks along the beach and going out into the hills, miserable weather meant we actually ended up spending a lot of time drinking coffee and eating cake. Absolutely not complaining! Also, Daddy Learnaholic is very clever and fixed all the things around the flat which have been broken (like the kitchen light which didn't work for almost a year...). I had a bit of a heart-to-heart chat with Mummy Learnaholic about my "issues" and it turns out I am rubbish at hiding things because she's known all this stuff for years! It's good that she knows what's going on though, means I won't be constantly biting my tongue around her in case I give things away. We had a really nice weekend together. I do really miss them as I'm so far away most of the time. That was the first time I'd seen them since Christmas.

On Monday I started my new placement, however this was overshadowed by the death of a family friend. It was very sudden so everyone was pretty shaken up by it. I feel a bit guilty about being so far from home at times like this, as I'm not able to support people as much as I'd like. I also can't make the funeral. I will send a note and some flowers to his wife but I haven't quite worked out what to say just yet. I don't suppose there is ever a "right" thing to say or do in this situation.

This week of placement has been all teaching, so I haven't met any patients yet. I did have to go to the mortuary on Tuesday morning for teaching in confirming death and all the associated paperwork, which was pretty difficult under the circumstances, but I suppose it will be coming in pretty handy once I'm working. I've also done some "breakaway techniques" training so that I can escape from aggressive patients, which was good fun although the bruises still haven't gone away! The rest of teaching was less eventful, but I did enjoy getting to role-play a stroppy teenager (although I may have traumatised one or two of my classmates!).

Yesterday I had to go back to my last placement to get all my paperwork signed off as my supervisor wasn't around for the last couple of weeks I was there. I got an unexpectedly good mark. After our last meeting, I was expected a bare minimum pass, but I actually got the same mark as I got for my medical placement before Christmas, so either I impressed all the other staff whilst he was away and they fed back to him, or he really felt sorry for me because I cried last time I saw him! He did mention the importance of "work-life balance" again which is getting a little dull now but I appreciate that he meant well.

This week has also caused a bit of a career panic. On Wednesday morning we had a careers session. Although it was largely focussed on psychiatry and general practice, all the comments about how difficult and expensive post-graduate exams are, how competitive it can be to get onto specialty training etc made me panic a little. On top of that, my supervisor yesterday was emphasising the importance of a strong portfolio to me. In his words, nowadays "noone gets in for being a nice chap or knowing Mr Smith" and it's important to have lots of publications, presentations, extra-curricular achievements - eek! I am, however, trying not to think about it too much. I think I work pretty hard and have a not-too-terrible CV so far. At the moment, my biggest priority is passing my OSCEs in June!

I'm quite looking forward to next week. I'm starting my new placement (psychiatry) properly on Monday. I'm also meeting up with a couple of friends during the week, and on Thursday I think I might go to my first "Skeptics in the Pub" event, which should be fun. Hope everyone is enjoying the weekend x

What's Eating You?

I've been meaning to write this post for the past week but it's taken until now for me to have the time to sit down and properly work out what to say.

Last Thursday I had my first appointment with the Eating Disorders service. Although I've had issues with my eating on and off for probably the past 10 years, it's only in the past year that I've really accepted how much of an issue it's become. I am lucky enough to have an excellent GP who I've known since I moved here. She's very approachable and knows me pretty well, which meant bringing up the subject was a lot easier than it could have been. Anyway, in short, I spoke to her about things last summer, got referred to the specialists and was seen last week.

I wanted to write this on the off-chance that someone might read it who had been struggling themselves and been afraid to get help. Walking into the appoiuntment was one of the scariest experiences of my life. I had no idea what would happen, and I knew it was quite likely that they would want to weigh me which made me totally panic.

I really needn't have worried. The consultant was absolutely lovely; extremely perceptive and very understanding. He made me feel like my issues were not unusual, and he repeatedly emphasised that it was just another illness and nothing to feel ashamed of. He didn't weigh me because I told him uncomfortable it would make me.He's arranging a variety of things to help, including dietetic support, therapy and continuing medication.

Having got through the initial appointment I really feel like I have a chance at controlling this, rather than it continuing to control me. I'll let you know how things go, but I just wanted to reassure anyone in a similar situation that there's nothing to be scared of.

xxx

Making Changes

Some of you will know that I've recently had a bit of a blog-related stress. I'd always thought that I was pretty much anonymous uunless you knew me, bbut after speaking to a friend it transpired that it was pretty easy to work out my identity if you so desired. Now, I've always been pretty careful about what I say on here. I don't mention names, locations, diagnoses etc. I pretty much behave myself so I'm unlikely to reveal any inappropriate behaviour. However, I hadn't realised how easy it was to misinterpret some of the things I'd said.

I've taken the old blog down, but posted everything I'd originally said there on this blog. I have made some modifications and clarifications where it seemed necessary, but the content is largely unchanged.

I just want to make a few things clear. These are just things that have been recently brought to my attention and I think it's best they're addressed so I can move past this.

1 - With regards to my mental health, my regent is aware of the situation and none of my doctors have any concerns about my fitness to practice.

2 - I do not and have never used hard drugs. In a previous post I mentioned something regarding controlled drugs - as I've now stated, this was in reference to working in a pharmacy.

3 - I do not believe any patient I may refer to is identifiable - I avoid mentioning locations, symptoms or specific diagnoses. If you think something I've said is dodgy and potentially breaks confidentialty, let me know.

I think that's everything addressed and I'm looking forward to getting back to blogging properly :)

xxx

Exam Chat

Over the past week, I have spent a lot of time thinking about my exams in June. That sounds a long way off, and it is, but this time last year I had properly started the hardcore revision and I feel slightly weird that I haven't started studying for these exams yet. I think the oddest thing is that because I have no written exams (two OSCEs, one of 5 minute stations and one of 10 minute stations) there are no past papers to go over so I feel like I have no idea what could come up.

We had a "mock" OSCE during my last placement but that was only quite short. I'm trying to remember what came up in that and I recall the following salient points:

- Check the femoral pulses first in a lower limb vascular exam (apparently starting distal and saying "that's there so the more proximal ones must be ok" won't cut it)
- Being able to use a hand-held doppler is useful
- If it feels like a spleen, it is a spleen - not a kidney trying to trick you
- If there is reference material, read ALL of it, not just the first bit you see in your sense of blind panic
- Have a differential for your findings. Even if you know the patient and you know exactly what their diagnosis is.
- Never, ever, ever (ever, ever, EVER) forget the occupational history. Especially if the patient has dermatological or respiratory symptoms.

That's about it - presumably they were the stations I embarrassed myself in, hence why I can remember them. I was, erm, a bit tipsy when getting my feedback so I don't recall that much about it (we went to the pub for a swift pint whilst waiting for the feedback session, but I can't handle booze at all and someone bought shots - I am convinced the consultant knew I was wasted but he didn't let on - I tell myself it's because I did really well in his "pet" area)

I keep trying to work out what could come up and I am totally clueless. Obviously lots of practise at examining and history taking is useful (basically what I've been doing all year on placements anyway) but I also need to do some proper studying. I do recall someone saying a few years ago there was a patient with Cullen's and Grey-Turner's signs coloured on them in felt tip. And no, I can never remember which one is flank and which is periumbilical!

Any suggestions for what to study before a final year OSCE much appreciated!

xxx

Struggling a little

I know before I even write this that this is going to be a moany, annoying, rather teenage-sounding post. I am warning you now so that you have the option of clicking on that little red X in the top right-hand corner of the screen before I bore you to tears.

As I may have mentioned, I am not at all enjoying my current placement A couple of weeks ago, I went to see a consultant I'm doing some work with as we needed to discuss the paper we're attempting to finish off. Being a) lovely and b) perceptive, he soon noted that I wasn't my usual self (apparently I'm normally rather "Tigger-ish") and asked what was wrong. Without going into too much detail, I mentioned that I was having a bit of a rubbish time on placement. To cut a long story short, the following week I ended up going and having a chat with him about what was happening - largely hoping for some advice. This culminated in him going to speak to my current supervisor to explain the situation (I didn't know he was going to do this until after the event). That prompted me to email my supervisor myself and telling him basically that I was having a bit of a rubbish time, apologising for probably spending less time on the wards than I should and assuring him that I was keen to learn and was using time off the wards to study.

I thought this was pretty much the end of it and planned to ignore the bitchiness and crack on with the final few weeks of my block. However, although I still have 2 weeks to go here, my supervisor is away for those 2 weeks so we had a meeting on Friday so that he could do my final assessment. It was honestly one of the strangest meetings I've ever had. He wasn't impressed with me at all, so I basically told him that I was very sorry but I'd been really struggling and I felt that rather than stay on the wards feeling useless, I would rather study privately as it would be more productive. You know how uni likes to remind students that they're adults and in control of their own learning? Seems this is only true when you decide you learn best the way they tell you to learn... He wasn't horrible or anything. In some ways I wish he had been, but there we go. Anyway, he's actually going to give me my grade when he's back to give me 2 weeks to get myself a better mark...

Once we'd finished discussing what an inadequate student I was (ok, I'm exaggerating), we then moved on to what seems like everyone's favourite subject at the moment - my lack of a life. I'm a little embarrassed to admit that he actually made me cry when he brought this up. There are only so many times you can stand to be told that you're fat, lazy and pathetic without getting upset. Ok, those weren't the exact words he used, but his persistence in telling me it was important to exercise and keep myself physically fit hammered the point home well enough.

I can't say there is much point to this, but sometimes a good rant helps, even if it's only through the medium of my keyboard!

On a happier note...

Actually, despite my last entry, things aren't all doom and gloom. Forgive me for my excitement and big-headedness in dedicating an entire post to this but... I got published :-D A little bit giddy about this to be honest! Ok, so it was a piece my tutor was commissioned to write and he was kind enough to let me do a bit of it, but still, it's the first time I've seen my name in print that way. It comes up on PubMed and everything *giggles like a maniac* Fingers crossed it's the first of many for me!

In which I get upset about a patient

It's odd how different human beings are. How even two people who can be considered relatively similar may be confronted with the same situation and respond completely differently.

I remember a discussion I had with a friend of mine about our placements at the start of fourth year. She was on neurology at the time, and had seen a patient newly diagnosed with a progressive condition. I couldn't understand why on earth she was so upset by it. She'd gone home, she told me, and cried. Her poor patient was "only 50" and seemed "unaware that there was no treatment". I didn't understand why that was so sad. Sure, progressive neurological conditions are horrible, but her patient was 50. Thousands of people are diagnosed in their 20s - including a relative of mine, who died in her 40s. That night, I phoned my Mum. I was worried, really worried. I'd always thought I was a caring person, but perhaps I was wrong. My friend was obviously extremely moved by something that didn't really bother me. Since then, I've seen probably a few hundred patients, each one with their own (often tragic) story to tell. At most, I've felt a little sad for them.

Last night, for the first time, I was genuinely upset by a patient I'd seen. I was moved to the point of tears, felt nauseated, couldn't focus. I can't explain why it was last night that this really hit me. The patient was a child* I'd seen on my elective who was diagnosed with an advanced malignant condition. He was 3. He'd only been ill for 2 weeks. Something about this child really got to me, and I've found myself thinking of him numerous times over the past few months. Perhaps it was his family set up (older sibling and then twins) being the same as mine. Maybe it was that despite having worked with many children who have cancer, I've never actually seen the process of diagnosing it. Possibly it was that he was just so cute and cheeky. Who knows. Whatever the reason, he affected me in a way I haven't been affected before.

We are all different and we all have different reactions to scenarios we are confronted with. Our own experiences and personalities shape how we respond, but sometimes we can't see any logical reason for the emotions stirred up inside us. As a future doctor, I am well aware that I will shed many more tears for patients. Patients and their friends and families will in turn make me happy, sad, angry, amused and a whole range of other emotions. In my opinion, the important thing is that I care for them all appropriately, regardless of how I feel about them.

When I started medical school, I wanted to know everything. I wanted to be the sort of doctor who could answer any question, who could "solve" any mysterious case, who knewthe solutions to the rarest of problems. I still think that would be great (if unrealistic). But for now? I just want my patients to feel that I care.

*I would hope that by not mentioning where I was and keeping the medical details vague that confidentiality is not broken here but if anyone senior thinks I'm being unwise, please do say something.

General happenings

On Tuesday I received some rather exciting news - the abstract I submitted for the RCPCH meeting in May has been accepted! I'm quite nervous as I've never done a proper presentation before (even though it's just a poster so it isn't too stressful) but hopefully it will be really good experience as no doubt I'll need to do more presentations in future. It's also hopefully going to make a nice little addition to my CV.

I'm spending a fair amount of time working on a paper at the moment, and I'm actually really enjoying it. Rather sad, but there's something satisfying when you are finally able to make some decent conclusions after spending a while looking at something. I'm hoping to finish it off fairly soon and then if I'm lucky it might lead to publication, which would be nice. Of course, once it's done I'll need to find myself a new project so I should probably start harassing people now so they give me something to do. I've had a couple of ideas of things which might be interesting to study but of course they've all been done already so I'm not sure whether there would be any point actually doing them.

Uni is difficult at the moment but I'm trying to rise above it. The new middle grades who started last week are really nice, which is good as it's them who will probably do the bulk of my assessment. I got a pretty decent mark for my mid-block assessment; I'm pretty sure the SHO assessing me was far too generous but I won't argue! I'm struggling to get DOPS (direct observed practical skills) completed as there isn't much I'm actually allowed to do - I actually sunk to the level of getting one completed for hand washing, something which is listed as something you can be assessed on, but not really something where useful feedback is going to happen.

After posting my "confession" last week I feel a lot more positive about the mental health aspect of things. The fact that it isn't a "dirty little secret" any more is probably helping a lot. I can't pretend I'm totally on top of things, but I think I'm ticking along on a relatively even keel at present.

My big goal for myself at the moment is (aside from managing to get through my current placement) is to come up with my own research idea and then actually carry it out. At the moment I've only helped other people carry out studies they've devised, and I'd like to get more involved in the planning process. Obviously as a student there are limitations to what I'll be able to do but it would be nice to approach someone and say "I want to research X, would that be feasible and can you help me?" rather then just "Please give me some work". I'm not sure when this will actually happen, but at least thinking about it is keeping my mind actve :)

xxx

Overwhelmed

Blogging twice in one week is a rare enough occurrence for me, so posting twice in the space of a few hours is basically unheard of, but I just wanted to attempt to respond all of the wonderful comments I've received since I last hit "post".

I honestly could not have anticipated the volume of responses I have received, and each and every one of them has been positive. Whether you have commented, tweeted, direct messaged, text, phoned or simply read my post - thank you. You are all fantastic people and I must admit I may have "had something in my eye" a few times.

To those of you who said you could relate in some small way to what I'd written - thank you. I hope that you now feel, as I do, slightly less alone. To the amazing friends who have said they are proud of me - you are all incredible people and I feel extremely lucky to have you in my life. To the people who have called me brave, courageous or inspirational - I'm extremely flattered. I don't feel worthy of your comments, but your kindness means a lot.

If only one person reading has felt just a little relief in knowing they aren't alone, then it was worth all the (completely unnecessary) worrying. I actually feel fantastic for getting this out in the open. There have been so many times when I've worried about saying something in case I "gave away" my issues. Now they're out there, I think I can just get on with things.

Much love to each and every one of you xxx

The Real Confession

When I started this blog and called it "confessions of a learnaholic" I didn't have any intentions of making any real "confessions" on it. It was going to be solely about work and uni-related stuff, documenting my journey from medical student to (hopefully at some point) academic clinician. I was going to keep "personal" stuff away from it. The thing is, the longer I've been writing, the more I'm realising that actually keeping the "personal" things away is almost impossible. My decisions and choices regarding academia, studying and careers are influenced as much by my past, my experiences, my personal demons as by anything else. After reading a beautifully honest piece of writing by @LellyMo (follow her on Twitter by the way, she's lovely) which you can read here I decided that actually, it was OK to be open about things. My experiences are vastly different to hers, and I am in no way suggesting that what I've been through is in any way comparable. However, without reading her blog I would never dared to admit what I'm about to say in public. I advise you to stop reading now.

*takes deep breath*

I have depression. And bulimia. Right. It's out there.

I have spent years worrying about whether I should admit this to anyone, either publicly or privately. My regent (personal tutor type person at uni) knows, as do occupational health. They haven't really batted an eyelid and told me as long as I take my pills like a good girl then I'll be fine. Mental health conditions amongst doctors are apparently not at all uncommon, yet no one seems to talk about them. The taboo experienced by the "general population" seems to be felt just as much by those of us who are trained to understand and treat these problems. One of the things which held me back from talking about this previously was the worry that one day, a patient would find out and it would change their perception of me. After all, who wants to be treated by a "crazy" doctor? On one hand, I can completely understand their worry. I wouldn't want someone with impaired judgement making decisions regarding my health (or indeed life) either. The converse to this is that actually, I'm very, very good at knowing when my judgement is impaired. Over a decade of symptoms means I can spot problems incredibly early on. If I'm in the least bit worried that I won't be able to safely care for patients then it's time for a quiet word in someone's ear and possibly some time off.

I am frequently criticised, in the most well-meaning ways possible, for my lack of self esteem. As I'm in a "getting this out in the open" mood, I suppose a bit of an explanation is due (I must place a *trigger* warning here. I suggest that no one reads this at all, but if you must, it's a bit sensitive). A lot of what follows is copied directly to an email I wrote to a friend of mine not long ago, purely because I phrased it about as well as I could then so may as well reuse it. I won't mention any names, but to the person who allowed me to write that email - thank you. Your acceptance, support and love means more to me than you will ever know.

"Right, so, self confidence. Something I don't think I've ever had much of. One of my earliest memories is of me standing in the bathroom just about to have a bath when I was maybe 4 or 5. I distinctly remember my Mum looking over at me and I instinctively held my stomach in, and she told me not to. Now, logically she probably just meant that there was no need to do that, but I remember thinking that she must be looking at how fat I was. My sisters are both naturally very slim and attractive so I always felt like the fat one growing up, even though until my late teens I wasn't at all overweight. I've been cursed with the skin of a greasy teenager which is of course not ideal. Coupled with the glasses and braces I had in high school, you can just imagine the kind of time I had. Horse teeth and fish lips were particularly frequently given "nicknames". *sigh* Now, I'm well aware that no one really has a good time in school but for some reason, probably just my natural personality, I find it hard to forget it even though it's now 8 and a half years since I left...

My consolation prize in life, which went part way to making up for my ugliness, fatness, lack of abilities in art or sport, lack of friends etc, was my intelligence. I might not have been popular but I *was* clever. Sport and art aside (which I was intrinsically untalented at), I was a straight A student without an awful lot of effort required. I did work hard because I enjoyed most of my work (was a complete science and maths geek and I loved music) and I loved reading, but there was never any real need for me to study. I say this not to brag or boast, but so that perhaps it makes sense that I am a little sensitive when it comes to my intellect. It was the one thing I clung on to that I actually had.

I've always been quite a serious, melancholy type but when I hit my teenage years I became quite seriously depressed. To cut an extremely long story short, I got through day to day life by self harming and made numerous suicide attempts. How I never ended up in hospital is something of a miracle. Anyway, when I was almost 16, I had a major low episode. My parents finally caught me cutting myself and making a fairly hashed up job of wrist slitting (a knowledge of anatomy would probably have come in useful then...) and after several horrendous arguments we somehow reached the conclusion that the best thing for me was to stop going to school. It's not a decision I fully understand but it happened. Anyway, I didn't go to school at all for the majority of year 11 and due to being incredibly miserable and having no concentration span I made a bit of a mess of my GCSEs (2As, 5Bs, 2Cs - not terrible but I was predicted 7 A*s and 3 As).

Having missed so much school and having so many bad memories of the place (bullying mainly but lots of other nonsense I'll not go into just now), I wasn't keen to stay on for sixth form, so I went to college to do my A levels. I was largely much happier there but on some fairly bad medical advice, I came off my medications. I worked pretty hard in my first year and did pretty well. When I applied to medical school I got a couple of offers and it was generally accepted amongst my family and teachers that I was going to get in with next to no effort. I will never be able to explain exactly what went wrong during my exams, but between a not very pleasant situation at work (colleague threatened to prosecute me for controlled drugs offences...*) and foolishly getting involved with a boy who turned out to be horrible (in the sense that "no" apparently means "yes"...), I suppose my mind just wasn't in the right place. I can still remember the sinking feeling I got on results day when I realised that I'd screwed up and I wasn't going to get to be a doctor after all. The worst part was that because I was only one grade off what I needed, I had to wait a week or so for the uni to actually decide they weren't letting me in (I suppose they had to see how many people declined offers and things).

When I went to uni I was totally miserable. I was doing the "failed medics" degree, I was miles from home and I was living in horrible accommodation. I suppose it was around then that my eating started to really go wrong. Food made me feel better when not a lot else did, but after I'd stuffed myself senseless I'd feel so guilty and dirty that I'd have to make myself vomit... I went through various stages where I got on top of things but I never really controlled the binges. Hence how I ended up so bloody fat (at my heaviest I was 13 stone 3. I'm 5' tall. That gave me a BMI of 36.).

I can pretend that some things have got better but really little has changed. By some miracle I got through my degree and graduated with a (totally undeserved) first. I got into medical school and skipped first year. I've just about got through OK (resat first OSCE I ever had to do, mainly coz I was so nervous it was all I could do not to vomit all other the examiners). I've got myself a job to start. I had a really, really good appraisal from my last placement. I've published two papers and am working on a third. I've just been awarded a national prize. Yet I still feel completely inadequate and I don't know why. I can look at all the evidence and *know* I can't be shit - but I still feel it."

Since I wrote that, I've been doing a little better (save for the 7 creme eggs I ate in one sitting yesterday - that's what happens when you think "ooh I'm doing well, not binged in a couple of weeks). As I said in a previous post, I think "getting a life" is going to be very helpful. I have now accepted that I may never be fully rid of these issues. By talking honestly and openly about them, I hope that eventually they will be a background irritation. They no longer consume my life the way they once did, and every time I let myself think "I look OJ today" or "I did well in X at uni" then I know I'm a teeny, tiny step closer to "normality".

If you have read this, thank you. If you've struggled with similar issues, I hope this makes you feel less alone - no two cases are ever the same but even knowing someone, somewhere has felt that unbearable emptiness and loneliness that can occur may help just a little.

So. That's me. That's my story. Obviously lots more to it but I suppose in essence that sums up the past 10 years or so. Now I just have to be brave enough to hit post...

*People have interpreted this as me saying I was using hard drugs; I absolutely wasn't and never have done. Actually, I used to work in a pharmacy and someone falsely suggested I had tampered with a controlled substance. Nothing ever came of it and it was pretty quickly forgotten, although of course extremely stressful at the time. I just felt it best to clarify as someone suggested that the GMC could get the wrong end of the stick!

A Life Outside of Medicine

It's official. I need to get a life. This isn't an epiphany I've had after getting particularly excited about some trivial scientific finding or having yet another rant about the misuse of apostrophes (although I confess they are both frequent occurrences). This is the realisation that when several senior, experienced people tell you something often enough, they are quite likely to be correct.

I did, once upon a time, have a life. When I was doing my first degree I was very involved with the drama society (committee positions, acting, directing...), I was a class rep on numerous occasions, I did all sorts of things with the student's association, I volunteered for several charities... In and around all this, I managed to somehow do enough work to get a good degree, had a job and went out a fair amount.

My descent into loserville began quite slowly but started at about the same time I got into medical school. As I was staying at the same university, I'd been elected onto the drama society committee again. Unfortunately, because the medical school is on a different campus to the rest of the university and because I had a fairly full timetable, I wasn't able to make the majority of meetings, so I had to resign almost immediately. For my first couple of years, I was still quite involved in the student's association, but as fourth year started and I got busier, I had to take a back seat with committees. Irregular holidays which no longer occurred at the same times as school holidays meant I was no longer able to volunteer at holiday play schemes.

I don't say any of this to moan - it's hardly an unusual set of circumstances and I'd be surprised if a lot of other medical students haven't found the same thing. Towards the end of last year, when I was revising all hours for my exams, I basically stopped doing everything - drinking, socialising, going to the gym...

This has got to change. I may sit here argue that medicine is what I enjoy and what makes me happy, but I'm only kidding myself when I say that I'll get through my foundation jobs without some other hobby or thing to do. My social life has taken a bit of a battering this year because my friends are on placements here, there and everywhere so there are fewer people around to do things with.

From now on, I'm going to make a concerted effort to do things. Non medical things. Things that I'm not doing to help me with exams or boost my CV or make contacts. Things that I'll be doing just because I enjoy them. Tonight, I'm meeting with a friend I haven't seen in years for a drink and a catch-up. As I haven't been out socially since before Christmas, I feel that this is a decent start. I'm also looking at local bands/orchestras to see whether there is anything I could join. I was really into music whilst I was at school but have neglected it recently. I've had a bit of a dodgy chest recently, but once that's cleared I'm going to get back into going to the gym. Rather than just doing my own thing though, I'm going to try and get to some classes, that way I might meet new people as well as exercising.

I'm a bit out of ideas for now but I'm definitely going to take this "getting out more" things seriously. Oh, and I'm not doing any revision at the weekends anymore. Not until nearer exams, anyway!

Too keen?

Anyone foolish enough to follow me on Twitter will have realised that I've been a little fed up recently. I'm rather inclined towards melancholia at the best of times so a few really quite trivial things have been enough to get me quite down.

This year of uni is proving very, very challenging. For my first block, I was on elective. That was absolutely fantastic; I was made to feel part of a time, the house officers were happy for me to help them out as much as I could, the registrars enjoyed teaching and, of course, I was working in my favourite specialty. Since getting back, things have been pretty tough. I suspect that, in no small part, that is because my elective experience was so ideal. It makes any imperfections and annoyances in my other placements seem so obvious. I find myself thinking "when I was in NZ, x would never have happened" or "when I was in NZ, I'd have been able to do that" on multiple occassions throughout the day.

I am struggling with something alien to me at the moment - it's being made pretty clear to me that my enthusiasm and desire to learn can be pretty irritating, to say the least. This is making me question absolutely everything I say and do. Previously, if someone asked a question I thought I might know the answer to, I would volunteer an answer. Now I'm biting my tongue. I don't answer questions to look good, or to make other people look bad. I simply think it's a useful way of finding out whether my knowledge on a subject is accurate, and if it isn't, of learning something.

After getting really quite upset about it last night, I decided the best plan was to avoid the ward as much as possible. This is a real shame, as it's my best chance to learn how to be a good house officer. It's also the ideal place to clerk lots of patients and hone my history and examination skills in time for the OSCE in June. However, I've decided to spend as much time as I can in theatre and clinics instead. It might not be ideal (and I know for a fact it isn't what uni want us to do during our placements) but at least I might learn something. And even if I don't, I know the consultants won't criticise me just for turning up!

Reflections on a previous post

Since I wrote my last-but-one post regarding Twitter and networking, I have been trying to work out what it is that makes me feel so uncomfortable. Today, I think I finally cracked it. In the past, when I've got some extra experience in a specialty or been involved in an audit or research project, it's always been because I've sent an email or approached someone involved. I'm not used to people offering to help me out, and I feel a little guilty about accepting. I'm pretty sure that this is what made me feel so awkward about meeting up with people I'd met via Twitter - it actually had nothing to do with the medium on which we'd first communicated. It was all that *they* had suggested meeting, *they* offered to help me get extra experience. I think that's where the feeling of cheating comes from. With other "extra" stuff I've done, it's because I've approached people and asked, so any benefit I get is "deserved" - I've "earned" it be being pro-active and asking if can get involved. In this scenario, totally new to me, I am potentially benefitting purely from the right people having heard/seen things I've said. So, I've worked out just what my crazy mind is worrying about. Now to try and make it stop...

Career Stress!

As students, particularly students of a profession, a lot of what we do is a "means to an end". We don't go to university for 5 or more years because we have a deep love for our subject, because we enjoy learning, because we enjoy the challenges posed by essays and exams (although any or all of these may be true). We go to university to become doctors.

As I've mentioned previously, I did a BSc in order to get into medical school. I hated my A levels, but I did them because they were necessary to get into university. I was pretty miserable doing my GCSEs, but I had to do them to do anything I wanted to do in the longrun. You get the picture. In essence, I've spent the best part of a decade doing things that I don't particularly enjoy, but because they are (or were) necessary for me to be able to do what I hope I will enjoy one day. That isn't to say I've hated everything I've done. GCSE drama was fantastic, I loved my Maths A level (seriously) and there were courses I took during my BSc which were fascinating. There have even been bits of medical school that I've enjoyed, although those have been few and far between (I don't hate medicine, I just really miss proper science sometimes).

Today I met with a couple of very friendly paediatricians (yes, we arranged it via Twitter, and yes, they may well read this at some point - hello if you're reading *waves*) to have a chat about career related things. Despite this being a pretty positive discussion, at least in the sense that they think I at least stand a chance of getting into paediatrics in future, I still find myself feeling hugely stressed. I can't pinpoint exactly why, but I wonder whether it's the fact that it's all been brought home just how much longer I'm going to be doing things as "a means to an end". The rest of this year is a given, of course. And then there's my two foundation years, which may or may not be enjoyable (they may also cause me to be killed falling asleep on the drive home from work or to jump off a multistory if recent news stories are anything to go on, but I'm choosing to ignore those particular "risks" for now). Let's be honest, I'm not actually going to have a "proper" job until I'm about 40. That's fine. But what if I get there and I hate it. I've already spent 10 years working towards being a paediatrician. I have at least another 10 to go. That's a very long time for something I might not actually a) like or b) be any good at.

I'm very aware that I'm rambling utter nonsense here. I shall leave you with a last thought: Why is it that even when we can objectively say that we're ok, even good, at something, we can't quite bring ourselves to feel/believe it?

Thoughts on Twitter

I appear to have updated more than usual in the past few weeks. You may blame the uni holidays, and also the fact that I really ought to be doing some preparatory reading for my next placement and thus of course absolutely anything else in the world seems more interesting and appealing than what I should be doing.

It will come as little surprise to most of you to learn that I am a huge fan of Twitter. I joined initially because I thought it might be fun to follow some of my favourite "celebrities" on there (Stephen Fry mentioned it a lot in his podcasts). Having joined, I discovered some of my friends had accounts and thought it was worth following them. As a lot of my friends are medics (quelle surprise...) I soon found myself connecting with medical students and doctors around the UK and indeed the world. Now, this is great. I get to chat to people who are experts in their field. I can compare notes with students at other unis. If I have a question, I can "Tweet" it and most of the time I have a reliable answer in minutes. All of this is fantastic, not to mention that I have made some lovely friends who I probably wouldn't have met any other way. Recently, however, I have started to have a few concerns about how I use Twitter.

As a soon-to-be (I hope!) doctor, I have followed with interest recent discussions on various media regarding professional conduct and social networking. My profile is semi-anonymous, in that if you access it you can probably work out who I am, but I don't think you could find it by searching for me directly. I tend to lead a fairly dull and mundane life. The most "unprofessional" behaviour I engage in is the occassional vodka (ok, a few vodkas) once in a blue moon. I don't do anything illegal and I don't think I ever do anything which would make people worry about my suitability as a doctor. At least I hope not. Thus, I am rather unlikely to "reveal" anything on Twitter which isn't common knowledge. On occassion I have been slightly concerned that a jokey comment could be taken out of context and imply something quite different from what I intended, but for those situations there is of course the "delete" button. If I feel that something I've said has caused offence or annoyance I am generally more than happy to apologise and remove the tweet in question. I also have the utmost respect for my collegues, so if it is suggested that I've said something unwise then I'll listen, take down what I've written and try not to say similar in future. My concerns regarding Twitter, then, are not really related to professionalism.

I have recently found myself in something of an interesting situation. Given the vast numbers of people using social media and the ease with which one can find and follow those with similar interests, I have been followed by (and follow) several doctors who work in places I have been on placements or may work in future. As I stated above, I'm not really concerned by this as I don't say anything online that I wouldn't say in person. However, it got me thinking. I have expressed an interest, via Twitter, in several areas of medicine. One of the perks of social media for me is that if I say I'm interested in, say, Urology, a trainee or consultant in that area is fairly likely to contact me and offer advice and encouragement. Where I begin to feel somewhat awkward (that isn't the right word but it's the best I can think of for now) is when people offer to meet up for chats etc. Now, I've met plenty of people from Twitter, some of whom are pretty senior, but it's always been purely social. I'm starting to wonder whether meeting people for what is essentially professional networking is ethical. Should I be interacting with people who might be assessing me in an OSCE in a few months? On the face of it, I don't see a problem. I'm not silly enough to expect special consideration just because someone's read my tweets - if I screw up, I expect to fail. I very much doubt that any of the examiners are unprofessional enough to be swayed by something so trivial. In fact, if they are I should probably feel more guilty about doing extra work, audits etc for various people as they definitely know me fairly well. So what's the problem? Well, I wonder whether I'm gaining an unfair advantage by using Twitter. I'm not sure whether contacting these people and taking them up on their kind offers of tea and mentoring is being assertive and seizing an opportunity or if I'm doing something somehow dishonest. I feel in some ways like I'm "cheating" a bit - after all, not everyone has access to Twitter. Is it fair that I potenitally benefit in my career because I use a medium not available to everyone?

I would be interested to know what other people think. I'm pretty sure that I'm massively overthinking what is actually not a problem at all ("how unusual" I hear you cry!) but none the less it's been on my mind somewhat so I thought it worthy of a blog post.

Hope the New Year is treating you all well xxx