I can't quite believe that the sun is setting on my days at medical school. I feel a bit like I have just woken from a deep sleep; The kind of sleep that facilitates profound, eventful dreams that seem to go on forever, only to end abruptly when you suddenly blink your eyes open and find yourself back in the real world. This five years has passed in a flash, but at the same time I can't remember what my life was like before I got here. Some of the early memories feel like they happened yesterday, whilst others seem like a lifetime ago. It's confusing and disorientating, but I guess that's part and parcel of living in the all consuming bubble of medical school. There is the impression amongst some of the senior doctors who teach us that medicine is becoming de-professionalised, but the medical school experience has certainly felt very vocational to me. I'm honestly a totally different person now - I speak a different language, I see people differently and I see life differently. 5 years ago I was incredibly idealistic and I had an incessant need to be heard. I have since learned to listen and also to be pragmatic; I have accepted that I'm not going to change the world and I will be a flawed doctor, treating flawed people in a flawed system, but by opening my ears and advocating for my patients I will hopefully be able to make small, but meaningful differences to people's lives. So what's next? Well, after med school we must all complete foundation training. When you hear about 'junior doctors' in the media, they are most often referring to those doctors currently in foundation training. It's a two year programme where you do six 4-month rotations in a range of areas. You are fairly heavily supervised in this time, but you get ample opportunity to independently assess and treat unwell patients. We all apply for our foundation posts using the same system. All final year medical students are given a score out of 100. Up to 43 points are awarded for your academic performance in medical school exams. Up to 7 points are available for those that have extra degrees or scientific publications. Then there are up to 50 points awarded for your performance in a single exam called the situational judgement test (SJT), which you sit in your final year. This exam tests your ability to make ethical and rational decisions: That brings me to my first piece of advice for any current or prospective medical students reading this - don't get caught up in the intense competition at med school! It will ruin your time, plus you'll look like a knob. Get on with your peers, treat them respect and focus on doing the best you can. So many people take themselves far too seriously and sacrifice all fun to get great educational scores, only to fluff the SJT. I was a distinctly average student, I just about passed all my exams, but I ranked somewhere down in the bottom half of the year, however I did pretty well in the SJT and ended up with more than enough points to secure the job I wanted. These are some of the best years of your life, just chill and enjoy them. As mentioned above, thankfully I have secured a decent job. The application process is a bit unusual. First you have to apply for a deanery; this is essentially just an area of the country. I grew up around Cambridge, so decided to apply for the 'East of England' deanery, as I want to be close to home. 75 points is enough to get you into most deaneries, apart from London which requires around 85. Once you get into the deanery, you then get a couple of weeks to rank the individual jobs in your order of preference. The higher your score, the higher chance you have of getting one of your top preferences. However many foundation jobs are similar, so in reality most people will end up doing something acceptable. I'm happy because I'll get to do obstetrics & gynaecology and I also get to do some teaching at the University of East Anglia. This is an extra perk I was offered because I applied for a 'priority' programme, but the specifics of that are long and boring. In short, pretty much everyone I know is happy, so don't panic if you're set to go through this process in the near future. Everyone gets a job one way or another other. So that is it. I imagine this will be my last post as a student. Thank you so much for coming on this journey with me. Before I go, I'll just leave a few of my top tips for surviving and enjoying medical school. 1. As I've already said, don't take yourself too seriously. There's no prizes for being the biggest name on campus or for being first in the year. Obviously I don't want to diminish the achievements of those hard working geniuses who do exceptionally well, I'm in awe of them. However, I knew my strengths lied elsewhere and I struggled just to pass some exams and that's fine. I've had the best time, I'm a better person, I've made friends for life and I feel ready to be a doctor and that's all that matters. 2. Learn to listen. Your peers are all talented people with interesting and enriching stories to tell and the same goes for many of the patients you will meet. I regret being the kid who always has his hand up in first and second year. I regret speaking more than I listened because to listen is to learn and grow. Open you ears and open your heart. 3. Study hard, but enjoy the downtime. Some of the best revision is done in the pub. 4. Don't worry if you don't know what to do with you life. The aim is to graduate ready to be a competent junior doctor. I still have no idea what kind of doctor I ultimately want to be. 5. Go to placement, it's the best way to learn. Medicine can't be learnt from books in my opinion. I found my best way to learn was to see patients with certain conditions and follow them through the hospital seeing how they were managed. They then stuck in my mind. 6. Embrace the fact that your place in the hospital hierarchy is at the bottom. Nurses and HCAs have a lot to teach you. Don't ever think you know more than them and don't be overly proud if you get shouted at for being in the way. 7. Make mistakes. Everyone expects you to be shit, so it really doesn't matter when you are. Try things under supervision, get feedback and try again and again until you're good at something. 8. Don't be afraid to ask to do things. If you have gone to a surgery with intention of getting some suturing done, then be sure to introduce yourself to the surgeon at the start of the procedure and tell him/her that you want to do some suturing. If you don't ask you don't get as they say
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September is upon us once again. Despite the Corona virus pandemic, the year seems to be disappearing at an alarming rate. Our medical school managed to make arrangements for us to sit our final written exams whilst observing social distance requirements. I'm relieved to say I have passed those and progressed to my final year. I can't believe I'm here, after 7 long years at university in a row I will finally be applying for my first post as an actual doctor in a few months time. I have spent the summer working in my local hospital in a kind of 'pre registration' role, completing tasks under direct supervision of the junior doctors on the wards. It has been hugely valuable for me and hopefully I've been able to do my small bit to help the NHS in it's hour of greatest need. I've also managed to save a fair bit of money which should just about tide me over until I start work full time. I'm at a crossroads now, almost wishing the days until graduation away, whilst also trying to make the most of my final chance to learn without great pressure. I'm already beginning to feel a bit nostalgic about my time at Keele and I do want to enjoy this last evening before the sun finally sets on my university career. If you're reading this and wondering if you can stomach studying medicine, I can tell you with absolute honesty that you won't regret it. There's times when it seems all consuming, times when it seems that you'll never be ready for that next set of exams, times when you get tired of directly competing with your peers to achieve a good ranking (more on that later), but in the end I've gotten to this final hurdle, whilst also having the most incredible time. I don't have an exceptional mind and there's been times when my motivation has dropped. I've procrastinated, panicked and ground out results by the skin of my teeth, but I've done it up to this point and therefore you can too.
Our final year is spent almost exclusively in the hospital. I start on the acute medical unit (AMU) for 5 weeks. This is an assessment ward, attached to A&E, where patients stay a short time before a plan is made for them and they move elsewhere in the hospital to receive definitive care. This will be fairly fast paced and I have a mixture of day, night and weekend shifts. After this I will spend a week on Intensive care. This is where the most critically ill patients in the hospital are. It's a high pressure area and I'm looking forward to working as part of the team in that environment. Following this I have some time on a liver ward before spending 10 weeks in General Practice seeing my own patients and hopefully planning their care fairly independently. Finally I finish with more emergency medicine and a stint with the orthopaedic surgeons. Our knowledge exams are all done now, but we will have practical exams at Christmas and in May. As well as this, we will sit the situational judgement test early in the new year. This is a huge exam that tests your decision making in certain scenarios. For instance you may be asked how to deal with a colleague who arrives to work drunk, or what to do with a child who refuses treatment. We receive up to 50 points based on our performance in this exam relative to our peers. a further 50 points are available for our academic performance. We get between 34-43 points based on which decile we lie in within our year: Our year has around 120 people left in it, meaning each decile has 12 people. if you're in the bottom 12 students, which is therefore the lowest decile, you get 34 points. If you were in the top 12 you'd get 43 points; the next 12 would get 42 and so on. Your decile is calculated based on how you have performed in exams compared to others in the year throughout the course. up to 7 points are then awarded for extra degrees or writing scientific papers, giving a grand total of 100 available points. When we come to apply for our junior doctor jobs, we make a preference of which area of the country we want to be in and then we rank the jobs in that area from our most preferred to least preferred. Each individual job is given to the applicant with the most points who is still without a job. This means if you score poorly you may be given a job very low down on your list. In most deaneries there are more jobs than applicants, so almost everyone will get a job, but in London and Manchester this isn't the case and some people end up having to move to another part of the country. Phew that was confusing, well done if you're still with us. To cut a long story short, this is the aspect of medical school I hate the most. I wish we could muddle through at our own speed, apply for jobs and go for interviews like everyone else, but it simply wouldn't be possible to fill 3000 odd posts this way. I hate that I am in direct competition with my mates and it breeds behaviours that are not desirable from doctors, but it is what it is. My current plan is to head home to Cambridge, but my chances of getting two years at Addenbrooke's hospital are slim. I'm likely to have to spend a year in Bury St. Edmunds or Peterborough , but that's okay. The junior doctor post itself is 2 years long and is usually made up of six 4-month posts in various specialities. After this you choose what you would actually like to do with your life and start on specific training programmes. I've been inspired by the recent calls for change around the world. Medicine is not without it's racial issues, with black patients still facing worse outcomes than their white counterparts in almost every area. Also, uncomfortably for me, medical schools are still full of students from middle class backgrounds, meaning black students face an uphill challenge to get in as they are often in poorer demographics. I did my GCSEs and A levels at a private school and this is something I always try and hide. I feel guilty that I have had a much more straightforward route to medical school than is available for some. I do medicine as a second degree, which means I get no government funding for the £45,000 fees. Without a wealthy family to support me there's simply no way I'd be where I am. Obviously I can't, and wouldn't, give up this life that I have still worked hard for; all I can do is recognise this huge privilege I have and try and use it to change things. As such, I have decided to help organise a conference this year looking at addressing the racial inequalities experienced by patients in the field of Obs and Gynae and I am excited to continue tutoring again this year. I was very happy at the government U-turn over A level results. If teacher predictions hadn't stood, it would have meant that many exceptional kids at poorer performing schools would have had their grades reduced, such was the nature of the algorithm. Most medical schools require A's across the board to get in, so it would likely have meant an even less diverse cohort than normal. For me, diversity of medical students isn't just desirable, it's essential. If people can't find doctors they relate to, they are far less likely to adhere to treatments. Also some conditions, particularly some psychological illnesses, can be the direct result of trauma. I'd argue that it is very hard to understand how these patients truly feel if you haven't experienced any trauma yourself and I'm sure that's why some conditions, like personality disorders, for instance, are not taken seriously by many doctors. I'll try and update this more regularly through my final year, but I'm sure the months will roll by in a flash, so stay safe in the meantime x One thing medics have is an appreciation of just how fragile life is, but I don't think I ever appreciated how delicate society, as a whole, could be. The COVID-19 pandemic has literally brought the world to a halt in the space of a couple of months. In early February I was one of the people saying that nothing would come of it. I'm just about old enough to remember SARS; then more recently there was swine flu and ebola. The outbreak of all of these diseases caused some degree of public hysteria, but they quickly passed, with life in the UK remaining pretty much the same. I'm one of those people that believes fire drills kill more people than they save. When I hear a fire alarm I automatically assume it's a test and I tend to complete whatever task I'm in the middle of before retreating to a safe place. There are countless stories of people perishing in office blocks because everyone ignored the alarms and continued working. I feel Corona virus almost caught us off guard in a similar way. In the western world most governments initially told us to continue with life as normal - "this will be like SARS, it will mainly affect China and it will pass." This was the line that I towed until a few weeks ago. Late February came around and I was still on my obstetrics and gynaecology placement, which I was absolutely loving. I was training three times a week for a charity boxing bout; certainly no social distancing going on there. My stress levels were beginning to rise ever so slightly at the thought of my impending final exams. Now I'm sat here on April fools' day and it's finally dawned on me that this isn't a prank. Placement has been cancelled, exams are postponed indefinitely and I certainly won't be donning my boxing gloves any time soon. I feel for our colleagues in the year above, who were due to be jetting off on their elective placements soon: The elective is a 2 month period at the end of med school where we are encouraged to travel abroad to have a taste of another health care system. It is often people's favourite part of the whole course, but this year all electives have been cancelled and the 5th years will be graduating early in a bid to plug holes on the 'front line'.
Life has completely altered for almost everyone and we are left with a lot of time to think. I have been thinking a lot about whether we tackled this virus in the right way. Even now I often wonder if mass isolation is really worth it. The former chief justice raised a valid point yesterday when he stated that the poverty caused by this total shutdown could kill 1000s in the long run. Then I wonder what's happening to all the patients currently missing their routine appointments. If someone with poorly controlled blood pressure doesn't get to see their GP for their medication review and subsequently dies from a stroke, will that class as a corona related death? But then on the other hand, what is the alternative? As doctors we treat people as and when they present to us. The fact is, thousands of patients are presenting to A&E in need of critical care due to this virus. No clinician would have the heart to tell those patients to stay at home and die quietly just so we can keep the country running. The measures we are taking now are not necessarily to stop the virus spreading, but rather to ensure it spreads at a rate that the health service can cope with. We will have to deal with the consequences of isolation once this crisis is under some kind of control. Indeed, as a nation we have a proud history of recovering from ruin. The NHS itself was created after the second world war and quickly provided jobs for 1000s, which helped get the country back on it's feet. Hopefully the creative amongst us are using their time at the moment to sculpt a post corona world that will be better for all. We finally have a widespread appreciation of who the key workers are in society and this is a once in a lifetime chance to create a world that is fairer for those people. I have really struggled with isolation. As an extrovert, I need a degree of human contact and I get quite down without that. I've been helping an elderly neighbour with her shopping, which has at least provided me with some purpose, but I did feel it was a waste for me to be predominantly sat at home. However, I've just found out that my local hospital have created positions for medical students, so at least I now have something to get me out of bed in the morning. The role involves taking bloods and performing various other tasks in A&E, then, as our skills develop, there will potentially be scope to undertake some of the jobs usually carried out by junior doctors. I'm hopeful that it may be an educational, as well as rewarding, experience. I will try and find time to write in the near future about how that is going, but until then, stay safe. I remember when I first started the course, the new decade seemed like a lifetime away. I spent a lot of time wishing that it could just be 2021 and I could finally begin living the life that I wanted. As it stands, 2020 has come around in the blink of an eye and now that the end is in sight, I think I'm finally starting to appreciate what a privilege being a medical student is. I'm currently splitting my time between Shrewsbury and Telford hospitals. This is my year to experience life in district generals, which are substantially smaller and less well resourced than the Royal Stoke. I'm starting to get the hang of the hospital routine now - the morning ward round starts at 8:30am on most wards and after this jobs are divvied out, which the juniors spend much of the afternoon getting on with. I'm finally at the stage now where I feel confident enough to help do some of these jobs. I back myself to take blood from, or cannulate, most patients; even those with 'difficult' veins and my history taking skills have come on in leaps and bounds. There are some skills that I still need to work on, as there is less opportunity to practice them. Things such as inserting a nano-gastric tube - this is a tube that goes up the nose and down the food pipe to sit in the stomach. Once in place we can use it to feed patients who are having trouble swallowing, or we can syringe off fluid from the stomach via the tube, thus relieving pressure for people with bowel obstructions. There is a common phrase in the NHS: 'watch one, do one, teach one' and as much as this is slightly facetious, I don't think I appreciated before starting the course that every doctor/nurse has to try things for the first time and this can be highly unusual when the thing you are trying involves putting pipes up peoples noses, potentially causing them a lot of discomfort. But anyway, I had my first opportunity to attempt an NG tube a couple of weeks ago. The nurse asked me if I knew what I was doing and I said I had done all the training. She said "great, the things are in clean utility, let me know if you have any problems." I could see that the ward was very busy and the chances of getting supervision were slim, so I decided to take one of my good friends on the course to assist me. We went and introduced ourselves to the patient requiring the tube and gathered all the equipment. I was nervous, but confident that I knew how to perform the technique, so I went for it. The tube passed up the nose and down into the oesophagus fine, but then the patient asked us to pause. Listening to him was a huge error. After 4 years of having the importance of listening to patients drilled into us, I fell for it and did what I was told. I stopped inserting the tube, which by this point was half way down the patient's food pipe. It turns out that getting things stuck in this area causes you to vomit... Violently. 3 bowls of green bile came out of the patient's mouth in a projectile manner. My pal was wearing a white shirt which has since been thrown away (sorry Soph!). The nurse that tasked me with the job will forever think I'm an absolute moron and the patient may well make a formal complaint (kidding, he was semi okay with it, but he did quite fairly say he wouldn't let us touch him again).
I left the ward feeling a bit dejected and inadequate that day, but one of the best pieces of advice I have ever been given by a tutor is to get back on the horse as quickly as possible. I spent the next week seeking out patients who needed an NG tube until eventually I found one. This gentleman had required several tubes before, so he knew exactly what to expect. He even gave me some tips on the best position to lie patients in etc. Normally we ask patients to swallow the tube down with water as we insert it, but he preferred to use Lucosade. This time I quickly advanced the tube, being careful not to pause and the whole process went very smoothly. I knew the tube was in the stomach and not his lungs, because when I aspirated it, i got a syringe full of Lucosade. That day, I went home feeling epic. Like I said at the start of this post. I'm finally starting to appreciate what a privilege it is to do what I do. As a student I learn new things every day, I get to try things for the first time without the pressure of expectation that doctors have to do things perfectly, and finally, I get to meet interesting people, who put their trust in me, even if that is sometimes misplaced. Another year has nearly been and gone. I completed my third year exams a couple of weeks ago and I'm now sat nervously awaiting results. Unlike last year where I struggled with motivation, this year my lack of 'blogging' can only be attributed to the fact that I've been fully immersed in this all consuming subject.
The third year provides the first real taste of life on the wards. There are two main hospital blocks, covering cardiovascular medicine and gastroenterology (the digestive system and liver). These each last four weeks and students are assigned to a ward, where they are essentially given free reign to speak to patients and practice examination skills. Initially I was totally out of my depth. I think all third years spend the first couple of weeks being a spare part. You quickly learn that the hospital functions to serve patients, as it should. No one has the time to take your hand and show you the ropes. But I slowly began to assert myself and many of the junior doctors who have just graduated and remember their first days on the wards are incredibly helpful when they have time to be, as are the more senior students. One bit of advice I would give is make friends with the nurses. They are the people who will find you jobs, especially performing essential skills like blood taking or cannula insertion and they know their patients better than anyone else, so are fountains of knowledge. Besides these blocks, there are also placements in psychiatry, elderly care, paediatrics and surgery. I really didn't expect to be exposed to as much as I have been, but I'll give you the smallest snippet of what I've experienced: I've seen people in their first days of life, people in their last days of life and I befriended a lady going through chemotherapy, which provided my first taste of the bitter sadness of losing a patient that you'd began to call a friend. I've been to two or three crash calls and seen people literally teetering on the edge. Obviously, it isn't all like an episode of Casualty, but I've found joy, even performing what are now mundane tasks like taking basic histories. The thing with medicine is that it has so many avenues. Some people get off on scrubbing up and being involved in complex surgery for the first time, but I've greatly enjoyed the company of people more than anything. Doctors are quirky and patients are even quirkier. Some doctors live to biologically 'fix' people and there certainly is a demand for that type of physician, but I did medicine because I wanted to be surrounded by human beings and truly understand what it is that makes them tick. I didn't just want to take joy in the fact that I could (hopefully) keep my patients alive, I wanted to know what is is they were living for. I used to worry that maybe I should have done a career in the arts, as there is more preoccupation with these notions there, but thankfully I have realised there is a place for doctors like the one I hope to become. Some specialities like, psychiatry for instance, do require a fully holistic outlook, so I'm finally getting some sense as to where I may eventually be headed. This year has also been great because I've lived with a wonderful bunch of housemates and I feel much more connected to my family than I have done. My sister has been contemplating her own future and is beginning to lay the ground work for a career change. She has been a great support to me this year and has really tried to get me to see that what I'm doing is something to be cherished. Many of my past posts are forward looking, it's hard to be a skint student and not wish your life away a bit. However, I'm doing something everyday that challenges me and inspires me and I'm slowly learning to accept that these days are going to be just as special to me, if not more, than anything that will come after. We have both had the realisation that money isn't everything and I shouldn't be counting down the days until I earn a steady wage. One final thing that I got to unexpectedly do this year is write a play. We all get to chose a module after we finish our exams and as I mentioned above, I've always had a love of literature and the arts that I haven't been able nurture as a medical student. With that said, when I saw there was a medical humanities placement on offer I jumped at the opportunity. People involved in medical humanities believe, like I do, that the arts can provide doctors with an education that science alone can't. Notions of ethics and empathy are much better explained by the arts and it has been great to have had the time to read again and be encouraged to go to the theatre etc. I do a lot of tutoring these days and one thing my students often ask me is how they can strengthen their medical applications. There can be a tendency to abandon the humanities and fully focus on science, both when applying to medical school and once you're in. However, it is my very humble opinion that being interested in what makes people emotionally and spiritually healthy is just as important as having a full knowledge of the science of disease. So my advice is always keep doing things that make you rounded and turn any experience with people into a selling point. A book that I've just finished reading is 'When Breath Becomes Air' by Paul Kalanithi. I would recommend it to everyone, not just people in the medical world, as it is a beautifully heartbreaking book. Paul writes in the book that only the physician can understand the 'physiological-spiritual' man and I'm glad that I get to spend everyday in the pursuit of that understanding. Another quote from the book which sums up my current internal battle is: "I do not believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment." What I take from this is that a life lived in the pursuit of the next challenge is a life wasted. The most insightful people live for today and find joy in what they're doing right now. I hope to write again, maybe soon, maybe in another year, but I hope that in my next post I've found even more satisfaction in what I'm currently doing. I'll still be skint and living out of a suitcase somewhere between Stoke, Shrewsbury and my parental home near Northampton, but the reason I started this blog was to serve as a memory that these days really are THE days. It's been a been a year since I've posted and that probably speaks volumes about my levels of motivation in the latter portion of second year. I think, for me, second year will end up being my toughest year of the course. It was a year that required lots of private study, and if I'm honest with myself, I've always struggled to be enthusiastic about reading research papers and text books relentlessly over a long period. I'm very good at shutting myself away during exam time and doing long days of hard studying, but medicine isn't a degree you can cram for and I almost paid the price for trying to do so. As it stands, I did enough to get by and I made I've made it into third year, but once again I'm sat here feeling like I've not quite performed to my full potential and I'm motivated to do better.
Some highlights of second year included that post mortem I spoke about in my last post. It was obviously quite a humbling and raw experience, as it was my first exposure to a fresh corpse and I was acutely aware that the family of the deceased lady would be mourning her loss. However it was a privilege to see the procedure. In March I was also first on the scene of a road traffic accident. A teenage lad had been hit by a car and I was able to do some simple things to assess him and keep him safe until the ambulance arrived. It was the first time that I'd felt clinically useful and I was commended by a passing GP. Having that praise at a time when my motivation and confidence was low really picked me up and gave me the belief that I could be a good doctor one day. Away from medicine, another highlight of last year was being part of a successful campaign with the medics rugby team. We are one of the smallest medical schools in the country, but despite that we made it to the finals of a national medical schools trophy! If any prospective or new medical students are reading this, I would really recommend joining a medics sports team. Trust me, you don't have to be particularly talented to do so - anyone that knows me will vouch for that, but by joining a team you get the chance to form close friendships with colleagues from all years and some of the best teaching and advice you will receive at medical school will be from more experienced students. A particular lowlight of last year was the large amount of free time. In first year you have packed days of lectures and practicals, whereas second year is much more like a normal degree, with only 12 hours of supervised teaching some weeks. Given the vast breadth of the medical field, I found it very difficult to do self directed study. Some weeks I had no idea what I needed to be reading and to what level of depth. My Biology degree was conveniently broken up into concise modules, so it was much easier to do the private work, but I found studying overwhelming at times last year, because there really is so much to know. Another thing I struggled with was living alone. I have never been a person that is comfortable in my own company, but because of various personal factors I found myself living in my own flat 4 miles from campus. Whilst it was good for me to gain the ability to live alone, I did find it very lonely at times and it certainly affected my motivation. But as always, the days rolled by and summer came. I spent my summer punting on the river Cam in Cambridge. I did briefly think about sacking it all off and making that my permanent career, especially as I have a particular propensity to bullshit, which is a highly desirable trait as a punter. However, sat here now on this rainy autumnal day back in Stoke, I'm glad I'm not still pushing boat loads of tourists down a river for £10 an hour... And in all reality I'm so glad to be back. 3rd year is a breath of fresh air. We're finally on the wards, taking part in daily ward rounds and putting our clinical skills, such as taking blood and inserting cannulas, into practice. I finally feel like a doctor in training and I'm more certain than ever before that this is exactly what I want to do and exactly what I should be doing. After struggling to gain the required knowledge last year, I feel like I'm soaking up information like a sponge this year. Every single interaction with a doctor, nurse or patient is valuable and interesting. There's barely any time to breathe, let alone be bored. I'm on a cardiology block at the moment and that entails 9-5 days on the ward and several evenings spent in A&E, which again, is a highly stimulating environment. As much as we, as third years, can do very little to help patients, I've already found that doing simple things like taking histories and allowing a patient to vent their concerns, or doing a set of blood tests for an overstretched nurse can be hugely rewarding. I'm excited about being a doctor once again. I can't wait to gain new skills and gradually become more useful. It's also been a pleasure to work with passionate junior doctors. The media makes out that the NHS is in crisis and that doctors are disenfranchised and exhausted, but so far most of the juniors I've met have been highly enthusiastic about their jobs and about teaching us as the next generation. I've also seen some amazing care - at UHNM if you present to A&E with a suspected heart attack, within 3 hours you're likely to have been diagnosed and to have had cardiac stents put in place and you'll be well on your way to a full recovery. For the first time in a while I feel rejuvenated. I feel excited about my future career and I feel like I deserve to be here. Motivation ebbs and flows, but whatever challenges you're going through at the moment, stick with it. I can't wait for the year ahead. Much has happened since my last post. I survived year one by the skin of my teeth, scraping through my summer exams and I now begin year 2 with the same sense of optimism that I had this time last year. Once again I have promised myself that I will work harder and achieve more academically than I did this year, but I need to find a way of keeping up the intensity and good intention throughout, not just for a few months. I also feel I've grown more in this year than I have done in any previous years. This time 12 months ago I had some quite childish dreams and expectations about what life as a medical student and a doctor would be like. I still feel like becoming a doctor is my best chance of changing the world for the better, but I've realised that I must first focus on the unglammarous task of putting the work in. I'm not the only one feeling stressed, I've spoken to many of my peers who feel they haven't achieved the personal goals they set themselves and some friends have even decided that medicine isn't for them and have made the decision to call it a day and take another path. This degree isn't like my first, if I'm truly honest with myself, I only worked intensely for 6 weeks before my final exams in Biology and whilst I was always reading and had an interest in the subject, I didn't have to make many sacrifices because I knew I could enjoy a packed social life and still achieve what I needed. However, I have now seen how tight the margins are in medicine, whilst I did well in my practical exams, I was just a few percent over the threshold in the written papers and re-sitting a year simply isn't an option for me, as my family are already under intense pressure to find £9000 a year tuition fees, so adding an extra year would be crippling. I also don't have time on my side, like some of my younger peers and I would like to be in full time work before my 30th birthday.
Another experience that has made me grow this year was dealing with my first major bereavement. My grandma sadly got ill just as the summer exam period rolled around. She was an amazing woman who did a lot for my sister and I growing up. Seeing her dying was a reminder of the challenges facing the NHS. I couldn't help but feel that she was subject to some quite ageist treatment. She was placed on palliative care after having an unexplained seizure and she passed away before anyone really had the time to even determine what was wrong with her. She never even had a scan to prove her potential diagnosis of secondary cancer. It is like everyone gave up on her and no one gave her a hope. Finding the problem would have meant trying to treat it and it seemed as though there was neither time nor resources to do that. She wasn't even given sustenance in the final few days of her life. There is no way a woman 30 years her junior would have been able to die in this way, but I have seen first hand now how the necessity to prioritise care in our hospitals is potentially leading to poor outcomes for some patients, especially older patients. I have since began thinking about becoming a geriatrician, because I want to ensure that older people are given the care they deserve. All in all I think I shouldn't be too hard on myself. I definitely need to up my game, but I made it through, I overcame some tough personal problems and I'm ready to hit the ground running. One major challenge this year is going to be budgeting. I have saved some money from my summer jobs and really want to make it last until Christmas, because working as a science tutor through my first year definitely ate up too much time which should have been spent studying. I need to spend this year focusing on my own exams, not helping other students succeed in theirs. It's good to be back. This year I will be exposed to many new experiences. There is more of a focus on clinical placements, we get to learn exciting new skills like taking blood and we may even get to watch a post mortem exam. Second year, I'm ready for you. The first semester has passed in the blink of an eye, as did the whole of 2016. We began 2017 with exams, which were harder and more intense than any I've sat previously. I went into these exams with a fairly relaxed attitude, I did some work over the holidays, but I enjoyed my Christmas and New Year. In all honesty, I headed back up to Stoke early in the New Year and left myself just over a week for solid revision. I did not expect that after our first semester they would give us an exam which required fairly extensive knowledge of the actions of chemotherapy drugs. Nor did I think that we would be expected to interpret images of CT scans after just a few months. However, I was wrong to be so chilled. They will test the full breadth of your expected knowledge in medicine. If something was mentioned just once or twice in formal teaching, it is still likely to come up in an exam. In my Biology exams, which were mainly essay based by the final year, I could get away with learning just over half the major topics and be confident that I could do well, as we were given a choice of essays to answer. I knew that this exam wasn't going to be like that, but I assumed it would focus a lot on the major anatomical structures we have studied, such as the heart and lungs. In reality, there was virtually no anatomy on the paper and there were quite a few complex physiology questions.
As well as a written paper, we also had 4 OSSE stations to complete. These are 7 minute practical exams testing skills we have learned, such as performing ECGs, patient interviews and blood typing. I like this style of exam, because I consider myself to be a confident speaker and performer, but again none of these stations were particularly easy and it's surprising how many mistakes you make when the adrenaline is pumping and the clock is ticking. The difficulty of this exam season has given me a small shock. Previous academic qualifications count for very little in medicine and if you want to be above your peers you really have to work very hard. Don't assume if you are a graduate that you will have an advantage, because many of the school leavers that get into med school are exceptionally talented and focused. Everyone that gets in deserves to be there. It's obviously important to have some leisure time, but my new year's resolution is certainly to go up a gear. After a stressful exam season and with the news saturated with stories of the 'NHS crisis' my resolve has been tested. On top of this, my father, who I consider to be an incredible GP, is having a really tough time with the health authorities at the moment. He runs a small practice which has 3 GPs, none of whom have any special interests (specialities in other areas). Therefore, his referral rate is much higher than other practices which are much larger and have doctors with lots of different specialties. This is because in these practices patients can be referred to other doctors within the practice rather than to secondary care (specialist hospital doctors). This means that the overall costs of dad's practice are higher and we feel as though he is under huge pressure to merge his practice, forming a large super surgery. However, the thing my dad has always loved about general practice is that he has a great relationship with his patients and knows them on a personal level, something which often can't be achieved at a large surgery. I too was excited about forming good rapports with my patients, but I just don't know what the future holds anymore for doctors. Our prime minister launched a scathing attack on GPs this week claiming that their 'lazy' working hours are the reason the NHS is struggling. However, this simply isn't true. Most surgeries are running with all doctors working more than full time, therefore how are they supposed to open any longer than they currently do? I just worry that the public won't see these truths and will turn against medical professionals. If we lose our trusted place in society then where will we be? I also see the stress in my father's eyes and am aware that after almost 40 years in practice, the last few have been the hardest for him by far. However, these are testing times for all of us. Medicine is still the greatest profession in my opinion and the politics of the day could never change my view. This profession allows for life long learning and provides huge job satisfaction. I am doing this because it is the way I feel I can best make a difference, whilst still having a comfortable and stable existence. Also, in a way these troubles are quite exciting - growing up I was hugely political, the state of the world did, and still does make me angry. However, I was a rebel without a cause - a middle class boy that really had very little to be angry about. Now I have a channel for that anger, I can qualify as a doctor and fight for our NHS. I can one day sit on a CCG and decide where the funding should go. I can do my bit to keep the public faith in doctor's. Finally, should we fail to save the NHS, should the country keep shifting to the right and towards total privatisation of public services then medicine offers a reward that no other profession can. It offers a passport to the world, regardless of Brexit, as very few countries would turn down our services. If the country shifts to a point where we feel we can't do the best for our patients, then we can move to a country where we can. Hopefully this fact is enough to ensure the government makes the right decisions, because they need us more than we need them. Since I last posted the ground has become scattered in Autumn leaves. In the US, campaigning has come to an end in one of the most entertaining presidential elections in modern times. The hugely fast paced nature of the course really is making the days disappear at an alarming rate. As I edge towards my 23rd birthday and the final pennies from my summer job are dissipating, the reality that I will be scavenging money off my parents until I'm nearly 30 has begun to hit home. I've spent much of my free time in the last couple of weeks frantically applying for jobs, but finding something that won't take up too much time whilst still bringing in enough money to survive is proving quite tough. I'm unlucky that I'm at the age where I don't count as a mature student, so my student loan is still dependent on my parental income. This therefore leaves my bank balance at minus £400 after paying rent. I am told that once you are 25 or over, or if you can prove you've been financially independent in all of the 3 years prior to starting the course, then you can receive at least a liveable amount of loan, however neither of these apply to me. Another option would be parenthood, but I think at this point in my life social services would be forced to ruin that plan and I would undoubtedly end up before a fitness to practice committee. That leaves very few options. I've contemplated starting a T shirt business, becoming an uber driver on the side, I've even briefly considered accompanying older women to corporate dinners after hearing how lucrative it is, but I think working as a male escort would likely result in a black eye from my girlfriend at best and I'd be lucky to escape some kind of GMC sanction. After some soul searching I have now decided to try and market myself as a science tutor (shameless plug - spread the word) and I've applied for a couple of 10 hour a week bar jobs. Essentially though, what I'm saying is if you want to be a doctor and you're still at school, for God's sake park everything else and get those A's. It will save you literally thousands of pounds. Also, if you wanted to do the degree in my situation and you didn't have anyone to help pay the £9000 tuition, then you probably wouldn't physically be able to do it. There is very little help out there these days for graduates studying medicine. That seems crazy to me considering we, as a nation, are facing an NHS staffing crisis that will cost us billions in the long term. However, our 5 year political system doesn't think in the long term and the government is currently trying to save a quick buck by imposing these tuition fees with no option of a loan.
However, just as the reality of how financially difficult the next 5 years may be has begun to sink in, the amazement of just how incredible this profession is has also continued to hit home. Last week I got my first opportunity to go in to theatre and it was an absolutely brilliant experience. At my medical school every student is given a personal development tutor who provides them with one to one pastoral support and careers advice. I recently received the details of my PDT and I contacted him to arrange our first meeting. Most of my peers have gone for a coffee with their tutors, or met for lunch, but to my amazement my tutor invited me to join him in surgery! The following week I nervously made my way down to the hospital. I was lucky that a jolly anaesthetist, who was just starting his shift was on hand to let me into the theatre area and he found me a set of scrubs. He also lent me a spare pair of theatre shoes, as I wasn't aware that you aren't supposed to enter theatre in shoes that have seen the outside world. My tutor soon came and retrieved me from the doctor's room. I was pleasantly surprised at the lack of formality he commanded, he told me to address him by his first name and he seemed genuinely interested in my future plans. However, you could tell from the way he spoke and the way his colleagues sought his advice that he was hugely knowledgeable. That is one thing in general that I love about the medical profession - there is a distinct hierarchy in terms of knowledge and experience and first year medical students are at the bottom of that pile, yet no one ever talks down to you. All the doctors, lecturers and other medical professionals I have encountered have spoken to me as though I am an equal, as though we, as medical students are their proteges. This is a stark contrast to my undergraduate Biology days, when we were often made to feel like we were purely a pay cheque to those above us. Bar a couple of great tutors, I felt most of my Biology lecturers viewed teaching undergraduates as a chore they had to do because it was in their job description. We were merely a distraction from their own research. Anyway, rant over... My tutor took me into the theatre where his first patient was already anaesthetised ready for surgery. Now came possibly my biggest challenge so far here, scrubbing up. I never thought washing my hands could be so hard, but every time I thought I'd succeeded I would turn around and scrape the wall or accidentally touch the tap and I would have to start all over again. Once my hands were finally passed as clean I attempted to get my gloves and gown on. Now I hit the wall trying to get my arms into the gown and I had to re-do that procedure. After literally 10-15 minutes I was finally ready to enter the operating portion of the theatre. However, bar a couple of jokes at my expense, no one made me feel like a fool. We saw three patients and the scrubbing procedure was repeated between each one. For the first couple of patients I stood next to the registrar and he explained what the team were doing. They removed bone and ligament fragments from a patient that had fallen off a 12ft wall and shattered their ankle. Next they reconnected a severed big toe tendon, this injury occurred after the patient dropped a knife on their foot. Finally, we saw a big lad who had broken an ankle playing sport and now needed screws inserted after previous treatments had failed to repair the fracture. I noticed the nurse struggling to hold the patients leg in the correct position and offered to help carry some of the weight. I was surprised at how much strength it required to hold a leg up. Towards the end of the surgery, I was asked to suck blood up from the wound using the kind of plastic tube you'd find at the dentists. The consultant had previously induced bleeding from the healthy bone above to promote the release of growth factors that would encourage the broken portion of the bone to heal, but now the team needed a clear line of vision to insert the screws. I felt really fulfilled that I had been able to actively participate in surgery so early into my med school career, but now my tutor even asked me if I would like to insert the final screw (disclaimer: there was very little risk involved in me doing this, as the hole had already been drilled, I purely had to turn a screwdriver a few times under very careful supervision). I left feeling so ecstatic! I had observed a multidisciplinary team deliver three successful operations. I always thought I would be a GP and never imagined that I would enjoy life working in a hospital. I had an impression that as a surgeon my communication skills would be somewhat wasted. However seeing my tutor command a team such as this has opened my eyes. For them it was a routine afternoon, but for me it was a reminder that all doctors have to be leaders, team players and teachers on a daily basis. Medicine is a world of opportunity with so many different avenues. I left in the knowledge that one day I will be part of a profession which will allow me to earn a decent, honest living. One day my scrounging will come to an end and it will all be worth it. I then legged it back to my car, as I realised the time was 8 o clock and I'd only paid for parking until 6. A £70 parking fine really would have taken me to the limit of my overdraft. To my relief I found no ticket on my car... Happy days. Before I begin this post, I think it's necessary to say that much of what I'm about to disclose may sound a little vague, but that's because a big part of being a good doctor is maintaining confidentiality and dignity in all that you do...
One of the biggest surprises I had after arriving here was just how little introduction there was to be. If swimming lessons followed the same format as medical school then they would have kids attempting to swim butterfly across the serpentine within a week. As a science graduate with quite a sound grounding in physiology and anatomy, I had envisioned breezing through my first year doing little more than occasional revision... How wrong was I? In the three weeks I have been here so far we have had a fairly complete overview of the whole upper body. I have spent more time in the library than I did in my first 2 years of Biology and I have filled two notebooks with text and diagrams. Somehow, though, none of the work has seemed tedious. I have already formed what I know will flourish into close friendships and we do much of the work together in small groups. Many people told me that Medical School was like a bubble, and it certainly is, but it is one that I don't really want to burst. It was lovely to go home this weekend, I am blessed to be so close to my family and girlfriend. As a 22 year old lad I'm not ashamed to admit that I miss them up here and I look forward to seeing them, but I didn't get that feeling of dread on Sunday night that I used to get when going back to London. As much as I enjoy my weekends, I'm also enjoying being a student and an academic in a way that I never did before. However, the biggest shock I faced in the opening week was definitely the initial anatomy class. This med school is one of three in the country that allows first years to dissect full cadavers. Our cadavers are people that have chosen to donate their bodies to us, they are preserved in formaldehyde and there is one cadaver to 12 students. We get to work on the same body every week for the year and then a funeral service is held and the body is cremated. Each 12 students also has one anatomy tutor who talks them through the dissection procedures each week and ensures we are as neat and precise as possible. This is all I will say about what we actually do in our anatomy classes, as I have to be very careful about what I publish. The information I have provided here is readily available online, so if any of my year leads happen to stumble across this blog, I hope they won't take exception to what I've said. What I now want to talk about is how these classes made me feel. Learning anatomy in this way is an incredible privilege and it surfaced many emotions that I didn't necessarily expect. I am someone that thinks of myself as being quite mentally strong and not at all squeamish. Working as a healthcare assistant on a dementia ward in a nursing home I often faced scenarios that required a strong stomach. Working in these kind of healthcare jobs also necessitates a level of emotional resilience, as dealing with people who are at the end of their lives requires a degree of empathy and is sometimes a sad business, without sugar coating it. However, working with the bodies of those who had already passed presented a unique challenge for me. Seeing your first dead body in itself is quite a strange experience. Also, I find that somehow when caring for living people, it is easy to block everything out. When you have another human being in front of you who needs your help to perform their basic tasks, you just seem to find a way to get the job done in the most dignified way possible, but when working with cadavers that element of emotional connection is gone. I spent the majority of my first couple of sessions trying not to be sick. I anticipated a smell which wasn't actually present. I was expecting a scent of decay, but in all reality, everything just smells clinical. The clinical smell of the formaldehyde actually presented it's own challenges, as it gave me a near instant headache. Also, despite the lack of human connection one gets when working with living people, I still struggled to detach myself emotionally. I instinctively wanted to know more about this person who had left us the gift of their body. the rigidity of their limbs made me irrationally wince with pain. However, now three weeks in I am getting used to the weekly anatomy sessions. I am now actively able to take part in the dissections without too much trouble. I don't think I'll ever get over my desire to know what kind of lives the people once lived, but that's just me. As I'm sure is the case with many anatomy groups, the conversation has turned once or twice to whether we ourselves could donate our own bodies. I like to think that I could donate mine, as I'm not a massively a spiritual person and I don't perceive my body to hold any particular sanctity that will last after I die. As well as this, I am truly grateful to be able to learn anatomy in this way and it would be comforting to know that you could continue to be of use to someone after death. You really can't appreciate the intricate nature of the human body until you see it in the flesh. I guess it's quite odd at our age to think about the end of our lives, but these sessions have certainly made me appreciate the finite nature of life, especially as a couple of the cadavers died at a younger age than my father is now. So, with that said, I just want to extend a personal thank you to the people that once were, who made a decision to leave us their bodies and I also want to leave a message to my future self (as I am doing this mainly as a diary) to appreciate life. Right now I'm still in a honeymoon period with medicine, but I know the wider medical climate is challenging and will be trying at times. I hope I can always remember that this is my dream and I hope to find pleasure in every day on this journey, because life is too short not to. |
AuthorMy name is Stephan. I'm a 23 year old medical student. I like to travel, play the odd game of rugby and I'm very vocal on formula 1 fan forums (yes I am a bit of a sports nerd). Archives
April 2021
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