I get by with a little help...

...from my friends, and other medical students who I don't even know that well.

The burnout that I mentioned has really been affecting my ability to work. I'd got books out from the library, from which to re-learn everything I knew in January, and hardly opened them. When I did open them (following an extensive internal battle to make myself do some work), I either struggled to concentrate or just fell asleep. I needed to leech off other people's energy to get things done, as I didn't have any left of my own.

A few lovely friends had offered to help; I found this really useful. There was no internal battle to work, as I'd met with them specifically to work, so I had to do it, and they wanted me to. A friend played the patient and either invented a history or tookone from a book (book review coming soon!) while I played the doctor and took a full history, with OSCE-style strict time limits. Friends in my year who had passed everything gave advice on how I needed to improve my performance. I also practised examinations, such as orthopaedic joint examinations, again to time limits.

This was so helpful and avoided me having to motivate myself (unsuccessfully); I realised I needed more of this. But three friends couldn't provide the help between them, and I'd feel bad taking up so much of their time.

I posted a status on facebook asking if anyone could help over the weekend, and had conversation with a friend offering me advice, but nothing more. Eventually I realised that motivating myself was getting nowhere, and although having three friends to help was wonderful, it wouldn't see me through the exam. So I sent a facebook message to 16 other people, students in my year and the year below, good friends and less good friends. I explained my burnout and need for people to help, what I needed (extensive surgical knowledge not required!) and the times that I needed help. Within 24 hours I had seven wonderful replies, all encouraging and movtivating me, and each offering different times that they were free to help.

Just reading those replies made me feel that this huge task might be possible, that maybe there was a chance I could face this big exam with confidence, and succeed. All except one stuck to their word and came to help (the one who didn't, didn't live near and we hadn't made as concrete a plan), all for over an hour.

For a whole week I did no work on my own, and felt very little guilt about it, because I'd worked with nine different people, and the quality of the practice was so much better than anything I could do alone. Quality over quantity, number of hours less important.

I had a little further help the next week, to ensure that I maintained my history taking skills, which had improved greatly, becoming slick and fluent. I there had some confidence going into the exam, I  knew that I could do it because I'd done it many times before. There is nothing like preparation to grow confidence.

Failure lies not in falling down, but in not getting back up again. For me to get back up, I needed help. There is no shame in needing help, the failure is in not seeking help. Asking a whole bunch of people to help me was one of the best things I've ever done. If only I'd recognised the neeed and could have asked for it earlier. Oh, hindsight.

If you need help, ask, and keep asking. Ask for specifics - I told everyone what I needed, and when, in timeslots for people to choose (e.g. "I need Thursday evening, Friday morning and evening" etc). It was easy for people to help because they knew what I needed.

In paediatrics people sometimes talk of "the team around the child" (or the team around the family). I've had so much support the last two weeks it felt like the team around the [TTBAMS].

If I have passed, it will be thanks to all these lovely people, and because I asked for help.

That's "me" in the middle of the team huddle - having that much support feels amazing. (Thanks to the Nigerian football team for the picture)

Like a little piece of charcoal

I woke up on Monday with so much dread for the week ahead and the work required that it suddenly came to as I was lying in bed: I am burnt out. On the one hand, that's horrible and means that I have no energy to do any work at all. But on the other hand, it's greatly relieving. It means I'm not lazy and useless, it's not all my fault that I haven't done enough work, it's just that I've done so much work and been so stressed for the exams in January and May that I just don't have enough energy left to keep going.

It felt so good to put a name on how horrendous I've been feeling about this exam and having to work for it. Burnout is a recognised concept, and a friend of mine had it after the January exams. I contacted her on Monday and she gave me some advice, including: get away from everything, go for a run even if you don't like running (which I did, briefly), burnout usually means you've done enough work already (yes, I did enough work in May, but unfortunately not for this re-take), to go easy on yourself (definitely), and to make a list of all your achievements, to push you on through this last one. I like that list of achievements idea - I haven't done it, but I have been thinking a little more about good things I've done, and that this re-take is really just to put the cherry on the cake. Except you can't have the cake without the cherry on, it is essential.

I realised that if I don't have enough energy to keep working through this revision period to the exam (which I don't), then the solution is to use other people's energy. Leech off them to get me through it, and work with others.

Which is what I've been doing. The only self-directed work I've done alone all week is to listen to a few podcasts whilst out walking places. So far, so good. Boo for burnout, but massive hooray for recognising it and getting through it.

The (hopeful) graduation ball...

Last night was the graduation ball. The re-take is in two weeks, so I don't yet know if I'm graduating. I remain fairly convinced I won't be - I've bought the guest tickets and am wondering about what to wear, but all in a "just in case the unimaginable happens and I am actually supposed to be there" kind of way, not in a way that I expect to be there at all.

I'd originally decided that I wouldn't go to this ball for this reason, but friends persuaded me, and I did half want to go, especially since I was so gutted that for my original graduation ball - the one I would have gone to had I not intercalated for my BSc for a year and then taken a year out - my friends forgot to (or decided not to) tell me about it or invite me. The photos of every single one of my original medical school friends at the ball without me were a little tough to see.
Anyway, I decided to go. My main trepidations were that it would take time away from revising and would be difficult to go to before having finished exams. I didn't pay attention to the idea that at the grad ball everyone else would know they were graduating, and I wouldn't. Well, about four other people there don't yet know, but since there were over 170 in attendance...

Going to the grad ball before knowing I'm graduating was very very odd. Much as the other half kept reminding me that I had as much right to be there as anybody else, it didn't feel like it at all. I felt like a spectator rather than a participant.

The worst was walking in to the dining room in the fancy hotel to take our seats for dinner. All the place names said Dr so-and-so for everyone graduating. That was hard. There was one at my table place saying Dr TTBAMS, which on the one hand is lovely because it means the guys who made them believe I'll pass, but on the other hand it's bloody horrible because I am not yet Dr TTBAMS. It all got a bit too much for me... I couldn't really hold it together and started crying. Everyone at the next table were taking group photos with everyone holding their little Dr place name, which made it worse. Thank goodness for waterproof make-up (yes me, in make-up), and for dinner jackets requiring a silk hanky in the pocket (or maybe it's just that other half does these things properly - it did match his bow tie). Thank goodness also that our table was in the corner, and that no one else had yet arrived at the table - my friends were pushing fashionably late to the limit. Thank goodness also for the wonderful other half, who reassured me that I do deserve the place name, but tactfully turned it away and moved it out of my view for the rest of the evening.
I regained my composure, but it wasn't the best way to start the night. I don't think I was great company all night really, conversation dried up where it wouldn't usually.

In retrospect I should have given a little more thought to the difficulties I might encounter during the evening, other than my bad my nail varnish skills were. And I should have approached it with dignity in mind. I think focusing on celebrating other people's achievements, rather than dwelling on my own lack thereof, might have helped.

Friends have said we'll have a celebratory get together, with the sweets (goody bags), glowsticks and lottery scratchcards from last night, but I don't know if it will happen as I get my results after term is over and people will have gone on holiday.

In conclusion: it wasn't a great night. But I don't regret going, really, I regret not being better emotionally prepared. If I hadn't gone, I would have regretted it.

Other half told me last night he's saved my place name, ready for when I am Dr TTBAMS. I'll have a party all of my own when the time comes. Whenever that may be...

I keep my visions to myself

Guess the song lyrics title at the bottom....

The night before last I dreamt that I'd found a patient, a rather mad lady who clearly needed some help, just outside a hospital (that looked a bit like Berlin Tegel airport somehow), but I couldn't get any phone signal to call an ambulance. So I had to take the patient into a hospital waiting room while I got some help, and I couldn't find any. I was upset that I couldn't help her. Somehow much later on someone pointed out that I could take her to Accident & Emergency, and I was so relieved, but also very worried at how I'd managed to forget that A&E existed....

Last night I dreamt there was a very special revision lecture happening. I spent a long time trying to find out who was giving it, trying to track them down, and find out where the revision lecture was. This somehow related to a wall hanging. But I couldn't find the lecture, or who the lecturer might be (I was looking amongst friends and acquaintances, rather than anyone who actually is a lecturer), and I got very stressed about it.

If I carry on like this the nights for the next few weeks will be very interesting. And stressful. Why I didn't feel at all able to help the patient in the first dream I don't know, maybe it reflects my lack of confidence. And maybe the fact that I was so desparately searching for the revision lecture reflects my lack of sel-motivation and need to have people teach me rather than me learning anything for myself.


I hope I get some more sleep than this in the next few weeks though, I'm going to need it.






Dreams, by Fleetwood Mac. Who are wonderful (and were not in anyway murdered or destroyed by Glee - in fact that episode reminded me how amazing Fleetwood Mac's music is and made me dig out my old CDs)

There are no laurels to rest on

Nice as it was to learn that I'd passed all of my recent exams, that silver lining had a cloud. Yesterday I was given my exact marks for the exams, and discovered that my two recent practical exams were very, very narrow passes. By 4 or 5 marks, and since the overall exam has over a thousand marks, that is tiny. I scraped through both exams, and it was very very close. Too close, there's no margin for error.

The day of the big exam was a "good day". I'd done a load of confidence building and affirmations, put my positive mindset on, and got in the best frame of mind. Nothing at all went wrong, and I was the best I could be for almost all the exam (although towards the end of the three hours I did get pretty tired, everyone does). So if my absolute best is to scrape through with the tiniest margin of error, what happens if I'm not at my absolute best next time? I might have a streaming cold, a headache, too much nerves, a grumpy examiner - anything that could lose me those 4 or 5 marks.

This has at least put the frighteners on and given me a considerable kick up the rear to get me back into revising and not sitting around beinig complacent, but for a good 24 hours it pushed me too far. I think there's a scale of:
complacent, unmotivated, not working enough ----to---- motivated, hard-working, slightly scared but in a healthy way -----to---- panicked, totally terrified, unable to work, so convinced of failure what's the point in working
and I went from the left end to the right end, completely bypassing the healthy middle. An email from a friend, an email from a mentor, and some time with the other re-takers later, I'm feeling a bit less chicken-heady (I am no longer running around with my head chopped off, which I was mentally doing this morning). I'm towards the right of the middle and it would be good to get even further towards the middle.

It would be easier if I knew what I was actually doing wrong in the exams and had some idea of what to improve, but no, that would be too easy. Medical school is a cryptic crossword. It's very frustrating to have a station which I thought went amazingly (patient/actor clearly liked me, I asked all the questions for the diagnosis and all the others to rule out a differential diagnosis, I answered the viva questions brilliantly - I am not a show-off, but I thought it was my best station of the day), the examiner gave largely positive feedback comments, with the only negative that I was "a little slow to get through all the points" - this does at least suggest that I got through all the points, to fail the station getting a little over 50% of the marks. How does that work?!

So in the absence of really having an idea of what to improve, I just need to spend the next three weeks becoming the most incredible doctor all-round that there could possibly be. I will dazzle and amaze all the examiners. A tall order but who knows what could happen...

And I will not spend the next three weeks wondering whether these horrendous results suggest that actually I'm not really ready to be a doctor, and it would be much safer for me and the general public if I did re-take the year, learn how to be a good doctor, and make a better attempt next year when I actually know something. That is not productive thinking. But it is tempting.


The above is yet another reason why this blog is anonymous. My patients don't really want to know how much I've failed, or how close I came to failing. At least, they don't want to know that and then continue to be treated by me. And I will want them to continue to be treated by me - it would be embarassing for me and problematic for the hospital if not. Much as medicine is trying to break with the tradition of paternalistic "the patient doesn't want to know X [often that they had cancer]", I feel it's appropriate here if only for my own peace of mind. I want my patients to have confidence in me. If I pass, I've passed and I am good enough to be their doctor. If they knew the numbers this may be less obvious.

Thank goodness for that

I passed my exams, I am deemed safe enough and competent enough to be an almost-doctor. But of course I am not yet a doctor, because I have the first-attempt re-take still to go in five weeks' time.

I've just passed four big exams, which should be a celebration, but all I can feel is relief: thank God for that, thank God that's over, thank God I don't have to do that again. Oh and hooray for me as well? Maybe. Not so sure about that bit.

The full extent of my celebrating has been having a cream tea yesterday, and a fancy readymeal from Waitrose. All of my friends who actually are now doctors (no re-takes for them) must have gone big on the celebrations yesterday, but they'll just have to join me in my celebrations come July. Or they won't because when I get my results, we'll all be on holiday.... but July can be my big party.

The only extra benefit of these results is that it gives more weight to the argument that my failure in January was the medical school's fault, not mine. Their "mishap" did throw me off, and now that I'm over that, nothing can throw me now.

There's very little to stop me now - four weeks of exam preparation, which is all re-learning things that I already know, and then time to ace the re-take, which I fully intend to. Medical school in its simplest form is five years, and when I started I was told it costs £250,000 to train a doctor (it's probably a fair bit more now). So after we passed each year, there were various claims of "I'm now two fifths a doctor!" or my favourite "I am now worth £100,000" (after passing two years).
So now that I've done 4 years and 34 weeks (out of 40) of a 5 year course (let's not include my extra years, for simplicity's sake - they weren't strictly medicine), that makes me 97% a doctor. And 97% of quarter of a million is £242,500 - that's what I'm worth! That's got to be something to celebrate... it's too much money for anyone to want to waste (though it wouldn't be the first time) so I am going to ace the June exam. With bells on.

Watch this space for the mega-big-time-party-celebration in July. In the meantime, thank goodness for that.