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
Sunday, 26 February 2012
Sunday, 19 February 2012
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!
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!
Sunday, 12 February 2012
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.
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.
Thursday, 9 February 2012
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
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
Sunday, 29 January 2012
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
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!
*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!
Saturday, 28 January 2012
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!
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!
Wednesday, 18 January 2012
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!
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!
Saturday, 14 January 2012
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...
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