Friday, 16 September 2011

And the good news

All that stress and faff in June has paid off. Some important people (who must surely be of questionably sound mind) have decided that I am deemed trustworthy and responsible enough to be given a job. A real, proper doctor job. Where I have responsibility not just for patients, but for children (who are patients) - the academic focus is in Child Health. And whilst the location is unexciting (there are plenty of reasons why I rejected the offer to study medicine there!) and was far down my list of 3 areas, it's the only one I got interviewed for and it's a darn sight better than the mystery lucky dip that is MTAS. Writing the "white space" questions would be a thoroughly traumatic experience, and my chances of scoring well and being where I want to be would be very low. So here goes.. I'll be off to this new job in August next year for two years. First I have to decide what rotations to do in the first year, by Monday. Obs & Gynae or Intensive Care?

Just goes to show that forgetting to mention at interview that I'd been invited to present my research at an international conference is not the end of the world. And rambling on about a man in Wales who is a paediatric palliative consultant, paediatric oncologist, paediatrics lecturer and children's hospice doctor, and telling the panel which included a paediatric oncologist how I wanted that man's life, seemingly did not put them off. Maybe I just looked endearingly enthusiastic.
I also rambled on about my museum job (that I love), which seemed to go down well too - medicine is not everything!

Of course the whole "being a doctor" is a reason to pass finals, but having a specific, and good, job to go to does give extra incentive to pass everything. So I shall put that 30-40 hours in October that everyone else will be spending tearing their hair out about MTAS, doing purposeful things like revising and learning all about what a heart attack is, as I felt very stupid in teaching today.

All in all, I should be super duper excited about this. And not just excited about not having to do MTAS! I'm getting there. Though I found calling up home (family home) and telling dad, who has been out of work for 4 months without much success at jobfinding, "hey I've got a job!!!!!!!!!" a little awkward. It feels like it should be the other way round, him getting the job and me doing whatever I do. I know the family are all really happy for me though. Specially now they've worked out what the job is - took a little while, even though they helped with the applications!

I'm going to attempt to find the anaesthetist registrar who is conveniently now at the same regional hospital as me and give him a bottle of wine or something next week. Without him I wouldn't have stood a chance at the practical assessment.

There was conveniently a chocolate pudding in my flat which I combined with Torchwood for celebration, and bought myself a box of blueberries. Blueberries always bring happy memories, or a good time, I think they're well deserved today. Going out to celebrate would have been fun, but of the 3 friends I have who live in this city and aren't busy being doctors in other towns, one is on the other side of the world, one in London, and one busy, but the solitary celebration was still ok. And tasty.

Anyway, woop-di-doo for me.

First the sad news

This made me cry real tears, even for someone I'd never met:

Without wishing to sound cliched, I really found Rosie inspiring. She was so positive and funny throughout. If I had to face the things she had to face, I wish I could do it like that.

Monday, 11 July 2011

Communication - dilemma and success

Not long ago, I took an extensive history in oncology from a man who completely reminded me of my other half's dad. It was uncanny.
From thoroughly taking the piss for calculating his age from his date of birth embarassingly wrong, and his little jokes throughout, to the way he put down his wife whenever she tried to chime in and add to the history. Admittedly, some of her additions were irrelevant, but some were likely to have been useful, and either way, if you're going to build a rapport with the patient, you need to consider the accompanying relatives within that; it's no good building a great relationship with a patient and ignoring the relative sat in the corner.

It brought me on to a dilemma - how to encourage the wife to contribute, without publicly contradicting the patient telling her to shut up? Openly contradicting him (eg, "no, it's fine, that's [what wife just said] a useful thing to know"] could be detrimental to any rapport that I was building with him, but at the same time ignoring his comments firstly worsens any rapport with the wife, and secondly may prevent her from chipping in with more vital information for the history.
I also need to recognise my own innate "don't talk to her like that!" reaction which would automatically favour the encouraging the wife/contradicting him response, even if that isn't overall the most appropriate. Keep personal feelings and reactions in check! (more on that another day)

Probably a mountain out of a molehill, but I like examining the minutiae of communication. Whether that's productive or not is a different matter.

An achievement that I was a bit proud of - during my time with this patient, I learnt that he didn't want chemotherapy, or was at least very wary of it. We discussed why (a friend's experience) and we discussed that chemotherapy isn't just one drug, but many different drugs, and different people get different types of chemotherapy, with different side effects. That felt like a good discussion, he seemed reassured.
Of course, I passed this on to the oncologist discussing the patient's treatment plan with him. I was a bit disappointed that oncologist didn't take it on board and went straight in with "we will give you chemotherapy and it will be like this, fait accompli". No mention of "I heard you had some concerns about chemotherapy..." Oh well, tried my best!

Said oncologist was at a presentation in which a student discussed burn-out in doctors in oncology. Having a good relationship with your patients is a risk factor for burn-out, apparently (though I did meet a wonderful palliative care lady who explained why she thought the complete opposite was true). I wonder if oncologist already knew this, and was putting it in practice with my patient...

Just another occasion on which I wonder why all the extensive communication models and doctor-patient relationship psychology that came up in general practice theory is restricted to general practice. Surely it should be universal?!

All in all though, it was a good learning experience, boosted my confidence, and I build a great rapport, despite the patient's put-downs grating me.

Tuesday, 28 June 2011

And now for something completely different...

Yes, I am a fan of Monty Python.

Anyway, a quote I read today made me think. A genderqueer performer, CN Lester, who identifies as neither male nor female, and seems to have something to do with opera, did an interview with the Pink Paper, about talked about transphobia and descrimination they'd experienced. This follows on:
"It’s enough to keep you indoors…

Well…. I think we’re so f**king hard on ourselves anyway. I don’t know a single trans person who doesn’t spend every single day sort of going: “Am I OK, am I allowed to go out into the outside world, Oh God, Oh God, it’s all so tragic!” I sometimes even wonder what will happen if I’m in a terrible accident."

This is why I stopped - I just can't be arsed with all of that crap. I used to think that "matching the inside with the outside", ie. presenting in the way that I identify (whatever that may be) was a big deal. I got over it. Now I feel like what's on the inside is not really anybody's business but the people I choose to share it with, and that the outside doesn't matter all that much anyway. I'm still of queer/alternative/non-binary/whatever the hell I don't know and I don't care gender, I'm just not as loud about it. It's not a big deal any more, and that makes my life so much easier. I never got the kind of harassment that CN Lester describes (maybe they do a better job of presenting how they want to than I ever did) but I'm definitely less paranoid now. I have no desire to be the centre of attention, and now that I'm not obviously "gender freak" I'm not, or at least I don't feel I am. Unless I want to be, which would be around friends, and often my presentation could change then anyway.

I think my deciding it wasn't a big deal tied in with having bigger deals to deal with: being ill and having surgery, and actually paying attention to being ill - I think gender provided a great distraction from my health when I was getting sicker in London (in retrospect, distraction/denial didn't work out great, but maybe needs must, coping mechanisms etc); being in Germany, a new country where my language wasn't great. It was a lot better than my partner's, so I had to communicate for the two of us for a while. Finding my feet in a thoroughly new job, working out how to fit in and understand Germans (not the language, the people). And, other than the other half, being totally independent. Bigger deals.

I'm happy enough, but I still feel like I miss queer stuff, queer spaces, and it's been over two years since I was last at NUS LGBT which, despite its bitchiness and cliqueyness, had wonderful people and felt like home. Bar Wotever, places where nobody cared - I miss that.
Stay Beautiful, a club night for beautiful people of every gender (I don't know if that's their tagline, but it fits) is coming near us soon so we'll get glammed up/transed up and try not to care what we look like and have fun. I love make-up, in a performative way. Like Michael Stipe (out of off of REM).

However, here's a quote with a different perspective, a comment from an American article about transphobia:
"In the mean time, a very few of us try to combat transphobia by being publicly gender-transgressive while yet maintaining acceptance by friends, family, and colleagues. It's an awkward balancing act that few find personally satisfying."
I do sort of feel, occasionally, like I'm letting the side down. By being so fitting-in, by no longer making my gender a statement. I long for the world to change, yet I'm not really helping. I do other things: I can educate, and next time I'm at the GUM clinic (I'm on GUM/HIV/Infectious Diseases currently) I want to talk about why the clinic is so gender segregated and why that works for everyone.
When I was challenging stereotypes, and more than that challenging general gender perceptions, I guess it was something I was little bit proud of. In a "look, I'm doing my own little bit to help change the world, broaden people's experiences of people, and make things slightly better for the future".

But as the quote says, few find it personally satisfying. I know some who do, and good for them. They've got bags more confidence than I'll ever have. Maybe I'll get back to playing my part and not letting the side down a little more in the future, when I'm more settled and more confident, and less trying to fit in.
Hospitals and medical school definitely don't encourage being different. It's like being the odd one out, and I'm clearly that already, particularly in my year where I know very few people (ok, I know 1/6 of the year. Not much). Maybe it's just that I feel an odd one out, and that's a harder thing to get out of your system.

Anyway, enough waffle. Reasons to be, and not to be, openly, actively and obviously of queer gender. And why I'm not, but sometimes wish I was. My identity isn't a whole lot different, I just don't spend time thinking about it - it still confuses me. I think it always will. No big deal - I've got bigger deals to focus on.

I've just read another quote that fits in to this quite nicely. It's from a trans awareness article, linked to by the previous article:
"she belives that transgender people should have the right to "exist without definition". The only thing I do know is the fact that I don't know," she says. "I live my life not knowing, but that's OK"."
Oh look, I'm not the only one. Always nice.

Friday, 17 June 2011

Look at me I'm such a prolific writer

The title is heavily sarcastic since I'm still struggling on with writing the applications.

A positive that I meant to add: I was reading the old posts, and how miffed I had previously been about having to give presentations in pairs when everyone else knows each other and has friends, and that I'd have a horrible time every rotation trying to find a partner... not so! In haem/onc there were 4 of us without partners who got together after someone asked (turned out there were a few others no there at that point), one of which was my previous partner, but we tactfully agreed that working with new people was better, so I worked fairly successfully with someone else. No prizes again, but the presentation was functional and practical, whilst other people's were fascinating.
Neuro we could do it in groups, so I worked with the two that is was grouped with for clinics - made life easy. Again no prizes, but I know something about the pituitary now so yay for that.
Derm was individual presentations (I presented my mum!! She conveniently happened to have a major skin thing during my derm rotation, and was more interesting than lots of the patients I met! Also I got a good insight into how it affected the life of a patient...) and ENT I have to write a case report. Which is due next week so I should get on that pretty damn soon!
Next rotation may have a presentation but things are not as cliquey as I first thought so I don't really care.

I had posted previously that I wanted a prize so I could it on academic foundation applications... well applications are now, and prizes awarded in August. So it doesn't even matter.

In other thoughts - do I shout about working for a drug company on my job applications or not? It was lots of useful experience, but evil pharma has a bad reputation. Dilemma.

Hello again

Oh look, time flew, again. Didn't feel like it at the time, as I spent months solidly working. Paid off, in that omg can-you-believe-it I actually got an A in the essay that I had previously said I didn't stand a chance at. It turns out (yes, it has taken me 5 years of Higher Education to learn this) that the trick is to write a draft, and then revise and alter and add and edit it. Who knew?!? Unfortunately I spent a month discovering this, a month that would have been much better spent on writing the project that comprises 50% of the marks for this year (the essay was 40% of 25% so a lot less). The trick of doing well, it seems, is to get really into it. Ok, so I didn't really learn how to actually do something about anxious patients frequently attending, but I had a good think about it. And I learned that Sure Start centres can be pretty amazing! Shame they're being somewhat cut.

My over-riding feeling of the mega-project is that it was a bit shit, but largely cos everything I did in the last 24 hours before handing it in (an embarassingly large amount of it) was a bit shit. I think it will take a while, and probably the final result, before I can remind myself that everything I wrote in the 6 weeks preceeding was not a bit shit.
The fact that I'm presenting it at an international conference probably helps, though is significantly terrifying.

I spent much of the project saying "this is hell, I am never doing this ever again" but yet my life plan includes doing a Masters, and I am currently applying for academic research jobs. Nutter. At the same time, the feeling of "look, I found out something, and I did it all by myself!!" is kind of good, possibly motivating, and gives some kind of rational explanation of why I might be putting myself through it all over again. Though with something I'm much more interested in.

The academic foundation applications are hell, though I learned yesterday that the non-academic foundation applications are hugely hell-er. "Describe two cases you have seen, with the same diagnosis, the differences in their management, how they were managed by multi-disciplinary teams and what you learned from this, and how you would apply this learning to your work as a foundation doctor, and what learning needs you identified. In 5 words." Ok, I made that last bit up (well, I made it all up, but the rest is accurate), it's probably 150. But when the question is almost as long as the answer, you know you don't have much hope, unless you're a professional writer. Which I'm clearly not. It annoys me how much the application depends on writing skills and not doctor skills. Hand-writing skills would be more relevant than this!

The academic foundation applications involve talking a lot about achievements. I think if you're someone with a lot of confidence, that's going to help a lot with the application, even though it doesn't necessarily mean you're a better doctor.

Enough ranting.

Other half still living a hundred or so miles away, still applying for jobs where we supposedly live.

Social life still improving. Still haven't learned how to get people to leave at bedtime, but getting better at it.

Despite not feeling like I've done all that much clinical stuff other than sitting in corners of clinics, I am actually getting better at talking to people. Keep going with that I guess...
Not better at talking to children, since I haven't really met any all year, but crossing all fingers and toes and belly button (it's kind of crossed anyway) that I'll get back to Over the Wall ( this summer, which will help greatly with that, but in a fun way. What else could I cross?!

Anyway, back to applications in which I pretend to believe in myself and my supposed capabilities.

I feel like I should talk about non-medical stuff too, but I can't think of anything right now, without going off on political rants, which wouldn't bring anything new to the debates anyway.

Saturday, 12 February 2011

Nothing too important

Just a bit of a general update really. Nothing too intelligent.

Generally: I have handed in logbooks for both musculoskeletal and oncology. Combination of yay and thank god for that. The musculoskeletal one was lurking for far too long - supposed to be handed in before Christmas but my lack of pushiness/luck in getting the right patients or right consultants meant I was missing a few skills. 6 hours in A&E and some helpful SHOs later, it got done (and a fracture clinic that was no help with skills at all, but I guess I know a bit more about fractures now).
I enjoyed oncology, but only because it's a topic I'm interesting, and less because the rotation was actually enjoyable. Quite how six weeks of oncology and palliative care managed to be uninspiring I'm not sure. Except for the palliative care bit, which was amazing, but more on that another time.
So, logbooks done. Woo.

I have started German lessons, which is wonderful and not great at the same time. I may not always be accurate or have a wide vocabulary, but 9 months of Berlin and a lovely friend who always talked German with me means I can very much hold a conversation. I don't think some of my classmates have ever spoken German outside the classroom... it doesn't make me better but it means our language is quite different. German lessons where you're allowed to speak English is a novelty too! Ultimately it just made memiss my lessons in Berlin because they were great fun.

I am having a weekend off extensive train travel, and instead going to London for the GLADD (gay and lesbian association of doctors and dentists) tomorrow. Whilst I may be neither of those, and not a dentist either, I'm looking forward to it, though feeling a little ominous about the LGB-ness of it all, and the distinct lack of T or Q. I may not have been to an NUS conference for nearly two years, but I still think like I'm in the midst of it! Self-definition/lack of definition altogether please.
I got a message from someone from LGBT (a former NUS celebrity) who I had no idea ever knew that I existed, but will be there tomorrow, so that's cool. I'm hoping for an interesting day.

I haven't been sleeping much, mostly my fault. I have been having a bit of a social life, yay. However I really need to learn how to ask people very nicely to leave because I have a 9am clinic and am in desperate need of sleep.
My stats course in London last week meant I stayed a night each at two different friends, which was great, the previous weekend I'd met with lots of old friends at home, and this week I had fencing friends for dinner, and a lovely wonderful friend is here currently for a flying visit. I had two good online chats with two wonderful people who I hadn't heard from for a while, and tomorrow I'm meeting in London with friends who I knew when I lived in London. Sunday, lunch with people from my original year of medschool, who I haven't seen since a wedding in July, so that's exciting. And to top it all off, other half has two days off next week, for the fist time since November, so is staying for a whole three nights, I'm so ridiculously excited I might explode.
This is so social (for me, at least) there's no option but to be positive and generally cheerful, whenever possible (ie. when I have energy to be). My mental health has to be benefitting from this.

My health isn't terrible, but how I feel about it changes on a daily basis. New meds are good but took a little getting used to. Plan to go wheat-free has been shelved for now - I'm just not that organised. I've been eating relatively well though. I haven't yet decided if the reduction in sinus headaches is worth the nostrils full of crusty blood and crusties... Oh well, not long til ENT specialist appointment.

My sister has passes her probation at her job and is basically set for life, or until the day that her job is done by machines (not very soon).

At the risk of blowing any anonymity I had to my medical school (it's a legitimate thing to worry about: a student once got severely reprimanded for posting something disrepectful about dissection on an online forum like the student room or similar. Not that I'm being disrespectful but I'm sure they would feel that imaginary headlines of "trainee doctor scared of people" would not reflect well on them): I got complained about my a member of medschool staff. Three things to learn from this: 1. Don't stress at people (I wasn't nasty, just stressed), 2. If you ever think there is reason to complain, bloody well do it! I so almost complained about the person in question myself, and am of course kicking myself as two people complaining about each other is a different story to a member of staff complaining about a student, and 3. Do not tell tutor that it will all be fine because you can just avoid each other, and never have to have dealings with each other. It does not go down well. Though has highlighted to me that I seem to be quite a fan of conflict avoidance rather than conflict resolution.
Other things: this will not go on any permanent record. Thank god. And I still feel that admin staff saying "everyone else manages to hand things in on time, what's your problem" should not be acceptable. Oh well, done now. I just have visions of said person being malicious next time we have to have dealings with each other. I do not like being scared of a person. Scared of people generally is one thing, scared of a person is different. Reminds me of my old flatmate, who does not need to be discussed now.

I am quietly having a nervous breakdown about my research project but mostly pretending it will all be fine. Which it might. The essay about general practice I stand less of a chance on, but that's ok because I didn't have much hope in the first place. I have a mental block around essays anyway.

I've been struggling to get work done somewhat, I was planning to do lots this week but other things happened, some of the time. It's largely due to tiredness, and that's multifactorial and only partly due to me being stupid. Partly due to just being knackered generally, it happens.

I think that's it for news.

I'm becoming increasingly ok at dealing with people in a medical student sense, and actually really enjoyed my time in A&E this week. I forgot a couple of questions in my histories, but they weren't earth-shatterinly important. Need to practise stopping patients going off on compeltely irrelevant tangents without just interrupting, seeming rude, or spoiling the rapport. Tricky.

Neurology starts next week, and I'm dreading it because 1. I know very little about nerves, dermatomes, sensation, important stuff, and 2. 7am buses for 9am starts. I will need to learn how to sleep/go to bed properly.

There, that was unexciting. I feel this blog needs to become more intellectual - the stuff is in my head but I need to get round to writing it.

Sunday, 2 January 2011

woops (but never mind)

This blog lasted even less time than I had anticipated. In excuse: my phone really doesn't much like blogspot, and trying to move the cursor around in the post takes about half an hour (more fool me for wanting to add something to what I have already written two lines above). Additionally, the spelling on posts from my phone is appalling (due to predictive test/fat fingers). Anyone know what "shot scared" means?! Internet at home arrived only in the last week of term, and any time I spent on the internet during that week was for far less productive things than writing a blog.
The library cancelled 24 hour access for ages, and I wouldn't have gone there just to write a blog anyway...

So maybe I'll write more often here, maybe not. I guess it doesn't matter if not, it's not for anyone else's benefit really! So nothing to feel obligated about.

To be honest it's a good job I didn't blog then. It would have been miserable and self-pitying, except for the few days that a couple of old friends from home came to visit, while other half was also down, and we had a wonderful time. Pub with boardgames (Trivial Pursuit is difficult!) and old-style sweets (Love Hearts and Caramac) was a big hit.
Otherwise this would have been some pitiful dirge of wallowing so best to stay quiet and just sleep-deprive until I'm so out of it nothing matters anyway. What a coping strategy...

Things I was going to write about but then didn't: the day that my last post was about actually wasn't too bad. I started off with two other students (they did most of the talking) but then the surgeon arrived and said three was too many, so I went off by myself and didn't do too badly of actually talking to a patient all on my own, though had to cut short because the surgeon arrived. I forgot important things when presenting (effect of osteoarthritis on daily life and general functioning - who'd have thought orthopaedic surgeons would be interested?! Sorry.) and felt somewhat uncomfortable with the surgeon's old-school style of giving us a full teaching session in front of the patient whilst talking about the patient but not really involving them - if he's going to do that he should at least give them some warning at the beginning! But maybe they were just glad of the distraction before surgery, I would have been. But then I'd have been interested in the teaching.
I even got to scrub in to surgery that afternoon, and hopefully the patient hasn't died from me introducing any infections since then. I wouldn't have found out so here's hoping. Glasses slipping so far down face they were almost of my nose, and not push-up-able under the beekeeper style headgear that I think was a head-cooling fan (and covering hood) required for orthopaedic surgery not the highlight of the day.
All in all not a terrible day.

Other things: it was Trans Remembrance Day and the first time in a few years I didn't make it to a service (family trip to France took precedence). I was going to expand on the concept of Trans Remembrance and for me how it also includes an element of thankfulness.
It was also World Aids Day and I wrote a blog in my head about that but I can't really remember the content.
The frustration that even in 4th year we still have to do group work, and worse, choose our own partners to work with, and the humiliation of having to email my group of 20 to see who else didn't have a partner. Thank god the group is an even number, that could have been even more humiliating. What's worse is the knowledge that I'll have to do this another five times this year (or alternatively work with the same person as last time - since we didn't come near winning the group prize I'm not averse to a change. Not that my share of work was necessarily of prize-winning quality either). Quite why we're not trusted with independent presentations at this stage of the course I'm not sure, but it probably hasn't occurred to anyone that the student who has intercalated two years and therefore knows no one isn't going to do too well when some people have picked who to do the presentation with (best friend) before term started. And I would quite like a prize, since I'm hoping that somewhere in the country a paediatric palliative care Academic Foundation Programme still exists and has my name on - prizes etc would help put my name on it.

I would probably have blogged about some other stuff if I'd thought about it at the time.

Conclusion: I may blog more, I may not. I will try not to care either way. I have more important things to stress about and nobody yet knows this exists anyway.