Of roles and expectations

I've just finished listening to another excellent episode of Pseudopod, a weekly podcast of horror short stories and this week's was particularly interesting for me. It focuses on a woman who comes to a village under the guise of helping when in fact she has a darker motive.

Alasdair, the host of the podcast, does a wonderful job (as always) of deconstructing the themes of the story. For anyone in healthcare they are juxtaposed between being an everyday part of the job and so very important that if you stop and think about it, our responsibilities are staggering.

The patient will see you as a caraciture

People put their lives in our hands and, more often than not, accept that whatever we do for them or ask them to do is in their best interests. When I push the drug trolley around people accept that because I am dressed like a nurse, seem quite comfortable and friendly, I must be giving them the right medication at the right time etc. etc.

Every nurse I know has made at least one drug error.

Every doctor I know has made at least one drug error/ misdiagnosis.

And yet they come to us. Because we look the part, because they believe in us, our uniforms, our stethescopes, our strange language. There is another component, I think. We have entered into a social contract. We have chosed our roles and promised to fulfull them to the best of our abilites. That, I would argue, is the reason people come to us.

It is both a privilege and a responsibility.

Runner's Hip

What is this hip pain?

So nearly 4 weeks ago I was finishing up a 6 mile run and there was a sudden, sharp pain in superior lateral aspect of my thigh, which made walking so painful I figured I'd pushed myself a little too hard and I had a few days of hobbling.

Like I say, 4 weeks ago.

TFL to its friends

I carried on hobbling and stopped running and felt annoyed. It got slightly better after a couple of weeks, but one running session took me right back to square one. So, off I went to the GP, running through SOCRATES in my head:

S - Site - Superficial to the greater trochanter

O - Onset - 4 weeks ago

C - Characteristics - Hurts when I run, not much else

R - Radiation - Nope

A - Alleviation - Not running (!)

T - Timing - Uh, no

E - Exacerbating factors - Again, running/ not running

S - 2 normally, 8 running

My GP went through a range of motions with me, poked and prodded and said "You've damaged a muscle". Indeed. As it wasn't constant and didn't limit my range of motion, we could rule out any joint damage or ligament-related hilarity, thankfully. Nope, the culprit is Tensor fasciae latae. So now I'm taking a further 2 weeks off running and chowing down Naproxen 500mg BD in a bid to tell my body to calm the eff down with the immune response already. In general my GP was against the idea of running "Swimming, yes. Cycling, yes, Rowing, yes. Running? No, no, too much impact", but I think that was idealogical rather than lifestyle advice!

Creative Writing?

He lay in bed, staring at the ceiling and knew he had to go back to work.

It wasn't that his current life was easy or that he especially wanted to go back to the proving ground of the wards, but he knew that going back was important - both financially and because he felt himself getting soft.

As his wife lay with her head on his chest, gently twitching as her breathing became deeper and slower, he looked up at the ceiling, his eyes burning like coals. He ran through permutations, likely complications he had been schooled in: hyperkalemia, hyponatremia, common analgesics, IV fluid prescriptions, the contents of the drawers of the crash trolley, urine output, FBC, biochem, coag, CVC management, venepuncture - the list rolled on and on in his mind.

His wife moaned in her sleep and turned over, freeing his arm and allowing him to bring both hands across his chest. Still staring up at the ceiling in the dark of their bedroom, his mind wandered on. He knew that going back to the wards meant going back to the places where people went sick, where the job ground you down to a fine powder that could be, and often was, blown under the door at the end of a shift. MAU, HAU, Acute Elderly Care, Respiratory Medicine, these places wouldn't be easy and he would earn every penny, every shift.

He realised he hadn't exhaled for what felt like a lifetime. Lying there in the dark, he had held his breath as his mind raced and ran over the likely issues that would arise on a Saturday night shift on an elderly care ward. And he wasn't scared. He needed the money, he was good at the job and for better or for worse, he missed the satisfaction of handing over his patients at the end of the shift and feeling like he had done something useful with the last 12 hours of his life.

He knew it was time to go back.

One down, a few more to go

So last Friday was the first exam I have done in Med School. And it was "just" a formative. Being a formative is nice because it meant that we could use it as a way to test how appropriate our work in PBL has been.

Allow me to expand on this - PBL involves a lot of self-directed study and this provides an opportunity to decide how deep you want your own learning to go. This can go either way; you can study too little and not have the detail the exams expect you to have, or you can go too deep and learn way more than you need and consequently expend more time and effort than you need.

I felt the exam went okay. You never can tell before the results and I don't intend to jinx myself! It did demonstrate to me that although it was a formative and a learning experience, people were still quietly obsessing about doing well. The talk was all "I just want to pass", but I suspect otherwise.

Still we worked hard and then partied hard for Halloween. My costume was bloodied scrubs and a theate hat (the obvious choice?) and my drink of choice was Guiness until I was told it was time to go home. It felt very good to tie one on in a most cathartic way. And totally wasn't "using alcohol to relieve stress" like the questionnaires say ;)

Now we've moved on to the immune system and infectious disease which is pretty cool and definitely something I have more interest in than reproduction, so hopefully the revision for this bit will be easier!

You are not a unique and beautiful snowflake

This is not you

Just a quickie, but I just thought I'd share an experience I had yesterday that has really helped me deal with the self-doubt and associated shit that this week has brought to the surface.

I have a very good friend with whom I go drinking and she has a good friend who has just taken his entry exams for the Royal College of Surgeons.

Apparently the night before his exams, he too was wracked with self-doubt, suggested it was all too much, how could a person remember all this, he should chuck it all in now etc. etc.

My friend, Hazel, opined that this was just how doctors (and by extension, med students) are, full of self-doubt, neurotic and constantly feeling overwhelmed by the volume of knowledge they are expected to have.

So, in one respect, yay! I'm not behaving in an abnormal way, my negative emotions are validated and guess what? It doesn't mean everything is doom and gloom, it's probably just a emotional survival strategy.

In another respect, boo! I am not a beautiful and unique snowflake and hey, guess what? My emotions really aren't anything special!

*sigh* I jest, I'm feeling a lot better and more capable. And maybe just a little bit apprehensive about the future ;)

Have you got what it takes?

So it feels like I need to work on my clinical self-confidence.

I'm finding the transition going from senior staff nurse to wet-behind-the-ears-med-student hard. It's hard going from being on top of your game, in a comfortable place - the go-to guy full of how-to and confidence - to being uncertain and feeling vulnerable. Before I started this course, I didn't realise how fragile my ego is.

It's compounded by being surrounded by a group who are effectively the top 10% of the class. Imagine the equivalent of a class filled with the girl who has a dozen different coloured highlighters and does extra reading for fun. I know I've earned my place here, but it doesn't make me feel any more comfortable. I know this is all in my head and I should just deal with it and crack on with the work...

It's pretty tragic that this is taking up so much of my run-time, as the course is full of work I need to do and is more than capable of giving me stuff to worry about. I think I just feel like the fact I'm an awkward nerd who tends to make friends on his own terms, is being thrown into sharp relief by the naturally gregarious and socially-engaged behaviours of med students in England. Why that is the norm, I don't know, but it's just helping me to relive a whole bunch of shit that I thought I'd dealt with in high school but apparently really haven't.

Good grief, this is a wee bit self-indulgent, isn't it? Hopefully telling the internet my deepest, darkest worries will help me get a handle on them. It would be really nice to be over all this kind of nonsense so I can really focus on worrying about how much I need to learn in four years!

This medicine thing takes a lot of time

In space, no-one can hear you be a massive nerd

I can't believe it's taken this long to find the time to do another post. Even worse, I can't think of a cohesive topic for a Friday night, so I (and subsequently, you) will have to make do.

Here's some thoughts:

1) I'm pulling 8 hours a day, a couple of hours in the evening and I don't think this is going ever let up. I'm not complaining, just sayin' is all. I'm balancing it out by knowing that you have to make sacrifices to get what you want. And any time I feel I'm a bit stressed by it all, I watch a little Randy Pausch and get a bit of perspective and a renewed eagerness to work harder.

2) My uni seems to think that one lecture on pharmacology per quarter is acceptable, but we have 3 comms sessions a week. This is the kind of thing I'm just going to have to address with a "suck it up and walk it off" mentality. I can't change it - we've had an opportunity for feedback, but I don't feel like The Man really wants to address this kind of thing. Whatever, I'll play the game, pass the tests and try and do more individual learning to make up for this.

3) Channel 4 do a good line in getting Britons to show off their embarrassing bodies. (Apologies to people who 

4) This week was a good week. I felt like I was on top of things for the first time in a long while. With PBL it seems very easy to cover just the Learning Objectives your group agrees on and not go much deeper. Then you rock up to the next PBL session and realise that other people have pulled out the lead a bit more than you and have gone deeper. Then you feel stupid and lazy and it means you feel at a deficit for the next round.

This week, however, I went deep enough and really nailed the issues we discussed in group. I feel more comfortable with the menstrual cycle than I have done for aaaaages. I feel like learned a lot and had plenty of positive input in the group sessions. My group of friends is getting tighter, too, which is awesome. I'm hitting the gym with one of my PBL homies on a regular basis and really lifting weights, on top of my prep for the Hastings Half-Marathon - so that's all good.

5) I may have also reactivated my EveOnline account. I'm not going to apologise - I need to indulge my nerd a bit and if by playing at being a spaceman every now and then, so be it!