Saturday, 30 July 2011

Where do we go from here?

Always Be Nursing
I've not blogged in a while and I feel pretty bad about that. It undermines the first rule of blogging, which is "Always Be Creating Content" (he said, paraphrasing Glengarry Glen Ross).

That said, it's been a busy few weeks for me. There were end of year results which were thankfully passes across the board. My school gives you percentages, the mean, the pass mark and (as I think I've mentioned before on this blog) a mark of A for acceptable, CC for cause for concern or U for unacceptable. So, for the first time in a while I'm a straight A student, though in real money I'm a slightly above average student which I'm totally happy about.

It wasn't until I received my grades for this year that I realised where I was in my life, academically speaking. I'd approached medical school with a "I wonder how far I can get" attitude - Which is to say at every step of the way I've not been living and dying by the result. I passed the GAMSAT (the Australian version of the MCATs) and was pleasantly surprised. I passed the interview and was pleased again, but I hadn't walked in with the fire of a zealot in my eyes (which I think helped - some people want to be a doctor so much it hurts their chances). Repeat for every exam so far, apart from this last set. I guess that previously I have been a nurse in my mind. Like some kind of interloper, a spy from the wards seeing how the other half live. Learning about the bigger picture beyond bedpans, food charts the myriad other tasks of nursing.

Not that I wish to denigrate nursing, far from it. Whenever people ask about why I went from nursing to medicine (something that happens with regularity on the wards whilst I'm bank nursing, I've discovered), my answers fail to satisfy. The best I can come up with is that I want a different set of challenges. The stuff that really stresses me out in nursing is organising discharges and chasing down junior doctors to remind them to do paperwork or arranging transport or chasing pharmacy for drugs I need sent up *now*. It was stuff that would forever plague me as a nurse and really took the shine off the stuff I genuinely enjoyed - people and their problems.

I'm sure there will be plenty of paperwork BS in doctoring, but it also opens up a world of other challenges that I think will outweigh the new stresses.

The point I'm trying to get across in a ham-fisted way is that having passed the first year has made me realise that I am all in. I really want to be a doctor and I'm less a nurse than I was this time last year. I am changing. There will always be a part of me that enjoys the intimacy that nursing affords, but I am becoming Other. It'll be interesting to see where this goes.

Friday, 8 July 2011

Because it's Friday...

And I'm a total sucker for a girl with a uke. Sue me:


She has, I think, one of the most tender voices. And if you can spare another 2 minutes:

Wednesday, 6 July 2011

Hyperarousal

A lecturer this term stated that, physiologically speaking, you can only maintain an adrenaline-fuelled state of hyperarousal for about 60 minutes. This was disputed by some of the ex-soldiers in my class, but I guess for civvies like myself, it sounds about right.

I held tightly onto this when the OSCE's came around. Written exams never provoke the same level of sympathetic response in me. It's not because they're a "you know it or you don't" event so much as they're a "sit on your arse and only move your hand event".

OSCEs by comparison are a full-systems-go-hello-my-name-is experience with actors or simulated patients and an individual examiner. OSCE stands for Objective Structured Clinical Examination and is just that. There is a task to be completed. You're running through mental check lists: Look, Feel, Percuss, Auscultate if it's something like a cardio exam or Passive, Active, Resisted when you're examining someone's wrist and elbow or even the classic History of Presenting Complaint, Medical History, Family, Social, Medications, Allergies when you're taking a history. You stand outside a cubicle, a buzzer rings, you read your handout, figure out which checklist you're going to need, memorise the patient's name, another buzzer rings and you're in.

You learn to introduce and consent in roughly ten seconds. Maybe 20 if you need to explain a more intimate exam. You're gently smiling, making the right amount of eye contact and trying to remember the first point of call on your checklist.

Checklists beget checklists beget checklists. Remember where you are. Comment on what you don't see. You can't be negatively marked so call out everything. Start at the hands, don't miss the capillary refill.

I sat in the one of my uni's many coffeeshops with my course buddy CRM and we listed 10 things to look for in the hands alone. Just call them out, you're bound to hit most of the ones you need for this specific exam. And anyway, in real life, you'd be looking for everything anyway, not just the finger clubbing of respiratory issues or the leuconychia of hepatic problems.

So back to my lecturers comment. when I turn up to uni before the exam, I sit on my adrenal response. Lots of revision of my checklists, not thinking about the exam. Drink me some coffee, try a little synthetic stimulant replacement. About 30 minutes before the exam, I imagine what it must feel like to stand at the door of a plane in the sky, about to do a parachute jump.

And Woosh

There it is.

At my word, unleash catecholamines.

Energy, alertness, fine tremor, my sympathetic response. My ancestors used this to run from wolves, I use this to stay focussed on a simulation of real life for 50 minutes. Which, incidentally, really doesn't feel that long when you're doing it.

But it's over for another year (god willing and I don't have resits).

I didn't have to revise anything today. It felt amazing.

Friday, 1 July 2011

So, Google+

So I finished my Musculo-skeletal exam this morning and came home to find a Google+ invite in my inbox. It's pretty neat and I can see me enjoying using it more than Facebook - if my cadre of friends get involved.

However.

If you add people who aren't on Google+ yet to a group and post a message to your profile that they can see, Google+ offers to send them an email. Useful right? Not so much if you've lumped everyone together and you say something which your friends might find funny, but your parents/ in-laws not so much

At first I was like



But then I was like


I've spent the last 4 hours furiously revising clinical skills. And will be doing that tomorrow. And Sunday. So whatever. Ask me about finger clubbing and spider naevi and sub-acromial bursitis.

I dare you.