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.

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)

Attempting to Access Adult Asperger Support Services Part 1

The Family Cracking-up-and-significant-breakdown Prevention Project (in family, I don't include my father - he's far too in his own head and own world to notice anything going on around him that could cause cracking up. That sounds like an insult; it's not, it's just how things are): so far, so good.

Whilst on an employability training scheme year, run by a special school, my sister spent a few nights at a residential independence skills training organisation, and that organisation will very happily take her again, on a regular basis. No prior assessments or referrals required. Hooray!

But this is only funded if she has a social worker. She last had a social worker under Children's Services. However, being a disabled and vulnerable child with a learning difficulty, requiring a social worker, seemingly does not mean one will become a disabled and vulnerable adult, with a learning difficulty, requiring a social worker. So she doesn't have one, and my next task is to get her one.

Once we've got her one, accessing this regular residential service should be easy, as the council's social services accept that independence training saves them a lot of money when the young person comes to move to a more independent place of living. A more independent person (as a result of independence training) requires less support, saving the council money.

So Part 2 will be obtaining a social work assessment. No idea how easy that will be or how long it will take.

Saving the world, one starfish at a time (or not)

Before I start, I am under no illusions - I am not saving the world!

This morning, as I went out early, I found a starfish on the pavement, just by the doorstep. A real starfish - the photo is at the bottom. It looked wet and it seemed reasonable to think it might still be alive. I was amazed and wondered if the storm or rain last night had really been bad enough to pick up a starfish and carry it the 500m+ it would need to travel.... and rushed off to my appointment.
When I got back half an hour later, it was still there, so I took photos, and went to tell other half about it. He very sensibly pointed out that it was probably dropped there by a seagull (not as exciting as the idea of wether-induced flying starfish, but far more plausible). I dragged him out of bed and we hatched a plan to take it back to its home and put it in the sea.

I'll explain here that there is a sort of parable by which I'd like to live my life, commonly known as "the starfish story" or The Star Thrower, written by Loren Eiseley in 1969. It's been re-told many times in different ways, and I heard about it from my utterly uninspiring headteacher, who managed to inspire me with this - I can't remember anything else remotely inspirational or even interesting that he ever said.
The version I remember I think of as having a small boy as the thrower, others have an old man or a girl. The beach is covered in starfish which have been washed up after a storm. Someone, let's say a small boy, is walking along the beach, throwing starfish back into the sea, one by one. Someone else, I think an old man, walks up to him and says "why are you doing this? there are thousands of starfish here, you can't possibly make a difference". The boy picks up another starfish and throws it, saying "I made a difference to that one".

It's such a simple, beautiful story, and although I don't think of it often, it's stayed with me over the years. I understood the message to be: you don't have to change the whole world, but you can make a difference to someone, or even a few people. Even if you make a difference only to a few, you have still made a difference, you can still change lives.

Others perceive it as meaning you should do what you believe in no matter the criticism. On looking it up just now, some versions have the old man deciding to join the boy in throwing the starfish, and more and more people join in, ending with the rather twee "all the starfish were saved" (personally I don't think saving all the starfish is the point, I think the point is that it is always worth making a difference, even if you can't make a difference for everyone; you can't save the world - saving all the starfish kind of is saving the world, and feels unrealistic). In that version, the message can be that you achieve something if you all work together, or if you can persuade everyone that it is worth making a difference.

I think this story is one of the things that spurs me on to do what I do, or what I'm going to do, be it medicine, volunteering with seriously ill children (more on that another time), campaigning, volunteering in schools... Each patient in my medical career could be a potential starfish. Not that they've all come to me to be saved, but that even if I can't do everything, I can still make a difference. To remind me of this, I have two beautiful pictures of starfish - one a birthday card from the other half some years ago, and one a sparkly postcard I bought last year while presenting my work at a conference abroad. I want to frame them both.

Back to this morning: given that this story really means something to me, I thought it would be a great idea to live in out (on a minute scale) myself, and take our doorstep starfish back to the sea. I didn't want to do it on my own - I thought I might need help (my intention was to carry it on a baking tray, I thought that way it might not dry out too much), I wanted it to document the starfish saving adventure photographically, and also I thought I would feel less silly and look less nuts if there were two of us poking and picking up a starfish and carrying it along. So I woke up the other half, got back in bed for a bit, waited for him to properly wake up and get dressed and got some plastic bags and an oven tray together, took other half outside with me.... only to find the starfish had gone. I don't know what happened. Maybe another seagull came along and thought it looked tasty. Maybe the first seagull wanted another go. Maybe some other people had the same idea and got there first, and the starfish is now happily floating away.... I'll never know. But I'm kind of kicking myself for not getting straight back outside and doing it myself. Specially if the seagulls got it.

I don't even know if it was still alive in the first place. But I'm still a bit sad about it - next time I'll seize the opportunity to throw a starfish when I see it, not half an hour later.

However, the positives: I saw a starfish! I never even knew they lived in this country.
In this time of considerable stress about exams, whether I'm good enough to pass, whether I'm good enough to be a doctor, whether I even really want to be a junior doctor with the stress and responsibility and total lack of confidence in my non-existent abilities that that involves, it was nice to be reminded of a reason why I came here in the first place - to make a difference, even if only to a few starfish out of thousands. That I can be that difference, and that it's worth it even if you can't save the world.

To have a real starfish to remind my of all this, to make me keep going - maybe that starfish was on my doorstep for a reason. I don't believe in fate - that would have been a nice explanation. But sometimes things happen for a reason, and today's starfish could have been there to rejuvenate and encourage me, to remind me to keep going. So I will.

[I realise this post could give away where I am, and therefore which medical school I'm at. And this is supposedly an anonymous blog. Please note I am not necessarily at home, or not necessarily at the place where I study - I might have gone away somewhere. Or be staying with family. You never know - make no assumptions.]

Ouch... and breathe.

Wow, you could even smell the despair in that last post on Sunday, couldn't you? Apologies for that. I have picked myself up a bit since then.

I've been doing considerably better mentally, partly from attending revision lectures in which I actually understood what was going on (very reassuring) and even did ok in the questions they asked in the lectures, so all cannot be lost. I think the biggest difference by far was made by hearing how lots of other students are feeling as horrendous as I was. I'm not in this alone - that makes everything a lot better.
And if we are all filled with dread and terror and fear, that must be ok because we can't all fail, right? At least, none of my friends failed in January and they seemed about as nervous then as I was.
I've also done some bits of practising skills, and although I'm fully aware I need to be working on confidence, it's good to feel like I'm making a start at getting there. I just hope others are as intent on group practising as I am, I think that's the key.

Also spending time with other people helps, I think it leaves me alone with my thoughts less, which means less despair. Much of this week I've been hanging around with friends between lectures, and half of that has been spent working or practising or discussing revision but that's ok, because it's still with other people who have the same problems I do. Maybe not quite the same extent of procrastination, but definitely some.

Another helpful thing was making a tally chart spreadsheet thingy on Excel to mark of what work I've done, how I've done it (podcasts, books, questions etc), what areas I've worked on, which has the two benefits of being able to see how much I've done and feel good about it, and also to see which areas I need to do more work on. So today I have mostly focused on Infectious Diseases and that row in the chart will soon become nice and colourful. As will my infection knowledge, hopefully.

I decided on Monday that I needed to make an effort to do things to preserve sanity - exams and exam thoughts cannot take up all my brain time. So Monday I went for a bit of a run on the way to and from the supermarket, which felt really good (very much a bit of a run, not a proper run - I'm using the first week of CouchTo5K to help, but I only do it occasionally so haven't got past the first week!), watched an episode of Glee which is awesome. Yesterday I realised late that I hadn't done anything to maintain sanity, so we listened to the News Quiz in bed - I am a massive Radio 4 comedy fan. And today a friend came round which was really lovely; we ate together, and I worked while she and other half watched a film, then we all had ice cream, and we watched some exam revision videos together (she's a medic in the year below, so it;s useful for her too) so it was sociable and work at the same time. It gives me more incentive to get the work done if there's fun stuff to do and people to chat to one I've done it :)
 So I'm planning to do something vaguely sanity-maintaining each day. I hope that will prevent me going as up the wall with despair as I did on Sunday.

I should note, just because I'm doing better in myself, doesn't necessarily mean I'm doing more work. It doesn't seem to be that simple, unfortunately. Today has been pretty good though.

I want to fail

Before I go much further, I should update this, that I failed one of the final exams this year. Taking the title of this blog literally – trying, but not succeeding, to be a medical student…

It was a big deal at the time (I wrote a blogpost about it in my head, entitled [insert list of expletives here] because that was how it felt) and a big stress involving an appeals process relating to a “procedural error” during the exam, which was not in any way caused by me but impacted considerably on me (and only me). The appeal took two months, but was eventually as successful as it was ever going to be (not necessarily as successful as I’d have liked) and I’m allowed to take the re-take as though it’s my first attempt. This has no effect on the actual resit itself, but means that if I fail it, the medical school won’t be able to kick me out as they otherwise might have been able to. It guarantees me a third go, were I to need one. Let’s hope it doesn’t get to that, it’s already dragged on long enough.

So the advantage of this appeal result for now is simply in stress management – I should be less stressed going into it knowing that it’s not my last attempt, not a sudden death situation. And should therefore be more likely to do ok, at least that’s the theory.
(The other advantage is that it could, just possibly, be perceived as the medical school admitting responsibility for the “error” – which has not happened so far, and has not explicitly been said (quite the opposite, I was told it was one examiner’s fault and therefore not the medical school’s responsibility) but perhaps this appeal indicates that it was their responsibility. An apology would have been nice too, but I won’t ask for miracles.)

The re-take will be a three and a half hour long practical exam (as was the first one) at some point in June; I don’t anticipate finding out when any time soon – that would be far too useful.

So I have four final exams in the next four weeks, culminating in the massive scary practical one that expects me to know everything and prove I’m good enough to be a doctor. Which I’m not (obviously). Not yet anyway.
And then around four to six weeks after that, I’ve got the re-take of the one I’ve failed. Which is equally as big, but probably requires a bit less knowledge, and is re-learning what I learnt last time, rather than just learning, which is what I’m currently doing. And since I failed it by 3% last time, my chances can’t be too bad. And then about three weeks after the last exam (or medical placement or other medical school commitment, whichever comes later) I start work. I do six days of shadowing the junior doctor I’m going to take over from, and then on the 1st of August, same day as all the other junior doctors in the country, I start working properly.


Back to now: I very much wanted to pass all the exams in January. But this time around, I’m not sure if I care. Or even, I can see the benefits of not passing.
It would at least mean I get a break. If I fail something in May, if it’s a minor thing I might be able to re-take it in June with the other one. If it’s the major one I have to re-take in November, or re-take the year. If I fail more than one, I definitely re-take the year. Re-taking the year would not be fun – I haven’t particularly enjoyed it first time around, but I do have some friends in the year below (including a very good friend who is lovely), and I’d get through it, and maybe it would be good to understand what I’m seeing in practice, rather the see it and then understand later when it comes to revision/learning. Though that didn't apply to everything.

But the most important bit: if I failed in May and had to re-take the year, I would have no commitments between May and re-starting the year at the end of August. Three months with nothing. No commitments, nothing, just time to re-learn how to be a human being rather than a vile, miserable stressbag that is set to implode at any second. I like the idea of being a human being.

I know I said that I get three weeks off between end of exams and commitments, and starting work. Plenty of people could say that I’m lucky to get three weeks, that’s as much holiday as they get all year (and it’s not the only holiday I’ll get – I imagine I’ll have at least two weeks holiday from the job before the end of this calendar year). But those three weeks won’t fully be holiday. I’ll still be stressed for at least one week of it, or however long it takes for the medical school to give me my results. And I’ll be moving house, moving cities and finding somewhere to move to if I haven’t already found it by then. I’ll be moving away from the other half, which will be sad as it’s been quite nice living together again these last 6 months. Nice for me, not for him – I wouldn’t want to live with me at the moment.

So let’s say I get two weeks between getting my results saying I’ve passed and am allowed to be a proper doctor, and starting work. And though I intend to holiday then, though not quite sure of the details since other half’s job does not allow holiday in July or August (bit of a bummer when the only time properly off I’ve had this year has been one week in January and the three weeks in July. But a job is a job, so cannot complain), those two weeks will have some elements of stress to them.

For those that think that students doss around and being a student is a perpetual holiday, 2012 has mapped out thus: January – massive revision, final exams, one week off. February and March – full-time placements (full-time being around 8.30 til anytime between 3 and 8, minimum 4.5 days a week), three pieces of horrible written coursework case reports, compiling the horrendous and enormous student formulary, which is just a giant list of 180 drugs and everything you might want to know about them, and completing all the clinical skills for the year. Which I made difficult for myself by losing my skills book in December, and having to start all over again in February. April – one week of placement, one week full-time revision (“vacation” is a lie), two weeks organised revision with lectures etc, then final exams. May – final exams, one week off, which isn’t really when you have a re-take in June looming, then placements and/or intensive revision for the re-take. June – more intensive revision, re-take final exam, then more placements as required. I hope that makes clear that my requirement for some actual time off is not me being pathetic. The only time off I’ll have had all year, the only time off since August last year, was one week in January. Not enough to maintain sanity.

Anyway, my main point is that two weeks is unlikely to be enough to re-learn how to be a human being. Or to fully catch up on sleep and learn how to sleep properly again (I can't remember when I last had a good night's sleep). Especially not two weeks involving moving house and beginning to become slightly petrified about actually having people’s lives as my responsibility.

So failing and having three months off becomes more and more appealing. Which might explain my total and complete lack of motivation for revision and working and any kind of real exam preparation.

The other possibility is failing the big one and re-taking it in November, which would give me five months between the last June exam and the re-take in November, a little time to re-gain my sense of human. And the best bit – no commitments between November and the following July. Seven+ months in which to go nuts and have a great time, go travelling, well and truly re-learn how to be a human being and maybe even how to be a good one. Put it into practice.

The only reason not to go ahead with this genius plan is that I’d lose my academic foundation programme. Which is potentially my passport to whatever post-graduate training I want, and an overall good career. Seems a shame to forgo that. There’s also the issue that I’d have to do all of the exams all over again, but I think doing them a year later (or even five months later with the November option) and with some pre-existing knowledge, I’d stand a much better chance.

Maybe the academic place is a good thing, as it’s the only thing really keeping me going. Though it’s not doing a very good job of that at all, since I’ve been averaging less than two hours work a day this week. Admittedly there have been some revision lectures, and I spent yesterday at a revision course (watch this space for a review) but even so, an hour or two a day is pathetic. And nowhere near enough to pass the big ones.

But despite the incentive of the academic place, I can’t really bring myself to care. I imagine if I do fail, I’ll look back at this post with great regret and think about what an idiot I was. Whilst enjoying my three month long holiday, becoming a better person, and having a great time…

Maybe this is all just because I can’t in any way envisage myself passing (the last time I passed all my exams including practical ones was four years ago, and I’ve got a lot less good since then), so rather than dwelling on that negative, I’m looking for the silver linings in the, what currently feels inevitable, failure. It’s a shame the silver linings seem so tempting.
And that the academic programme isn’t as much of a carrot as I had hoped. Anyone have any tips on where to find motivation when all you need is some time off? I’ve already tried down the back of the sofa, and it wasn’t there.

(Feels a bit silly asking for tips, when no one's ever commented on anything in the year and a half history of this blog... maybe I need to find some readers, an audience. If you've read this, share it?)

Procrastination is killing my blog

Not because I procrastinate about writing blogposts, it's more a matter of finding time. But I have a massive amount of work to do - have had since end of Feb, will have til end of June. And although I've finally handed everything in and all that remains is finals, I am very bad at getting work done. So I've blocked the entire internet for the daytimes, and blocked Facebook and blog sites into the evening - including my own blog. Also blocked everything overnight to minimise the preventions to a normal sleep pattern. Leechblock is wonderful when you have no willpower (and when it works and FireFox works - mostly).
Yes I could write in Word and just post online in my permitted two minutes (in every two hours) but given the current situation of my lack of revision, would be very risky.

I still write blogs in my head on a regular basis. Not that there's much point - that's just an internal monologue.

But right now I'm on a train, on my phone - which will prevent excessive waffling since typing on this is slow and frustrating.

I probably should try to blog more often, it might be a bit cathartic and help reduce stress levels, which, pre-finals, are definitely on the way up.
I have lots of planned blogs. Making time for them to materialise would require lots of organisation... you never know.

TMI

Interestingly,* it would appear that the usual prescription daily mild laxatives (best treatment for endometriosis I've come across) are suddenly no longer required when medical finals are looming. And that was just for a writing exam. I dread to think about the OSCEs - practical exams - coming later this week.

It never ceases to amaze me, all the complex effects that stress can have on our bodies. Mind and body are so intricately interwoven.

*Yes, I realise it's probably only interesting for me, because I'm a medic. Apologies for the TMI if this is not your cup of tea.