Erm... that's Dr TTBAMS, actually...

It's true, I have finally done it. Dr TTBAMS at your service.

After five long years of medicine and two years of "extra", I have at last passed everything and am legally permitted to call myself doctor. Oh, and look after patients, under supervision.

People keep asking what I've done to celebrate, and although fizz bottles were waved around (my sister and I shared a tiny bottle of pink cava on a bus, and the other half produced a bottle of proper fizz and a bottle of French kids' fizz, which is the lovely non-alcoholic fruit juice version, wish they sold it here) I have done very little. I don't feel particularly celebratory - my main response was "well thank goodness for that". At least I don't have to go through that ordeal again. "That ordeal" can be either final year or the entirety of medschool, depending on how exhausted I'm feeling at the time.

Honestly, I am just so glad it's over. I have been thanking the friends who got me through that last exam, and the other half for getting me through the whole thing, but I haven't really reflected on my achievements. One day, when I recovered from the relief enough to actually think about it, but not yet.

Maybe that's partly because the celebration is tinged with trepidation and nerves in the "OMG now I actually have to go and be a doctor and have responsibility for people" kind of way but I haven't been dwelling on that. I think gynaecology is a good place to start - there aren't too many life threatening mistakes that a junior can make. Don't miss an ectopic pregnancy (then someone actually could die and it be my fault), and if there's any risk that anyone has a lady-cancer, get a senior to check them out. I think starting in Accident & Emergency (or the Emergency Department, depending on the hospital) would be a lot more scary.

And so, non-existent reader, you may be wondering what's next for this blog - clearly the title doesn't fit any more. You can't try to be a medical student if you're already a a doctor. Or you'd be a bit odd if you did. I have it all planned, I will be moving to pastures new, or basically nextdoor, to www.tryingtobeajuniordoctor.blogspot.co.uk when the time comes that I actually am a junior doctor (i.e. next week). Please do join me there, and don't join me in my hospital, at least not in August - being ill in August is statistically not good for you*.

* I intend to find a reference for this at some point! In the meantime, don't test my claim!

Leaving the wrong job....?

For the last 5 years, I have had a vacation job during university holidays: I work in a museum. Not the small stuffy kind, the large, over a million visitors a year, amazing site, kind. It's had minor ups and downs over the lsat five years, but overall I have totally enjoyed it. I've been very lucky.

 This is not my museum! But it is a good one. Thanks to http://www.nyeparry.com/?page_id=619 for the picture.

I went back to work there recently after many months away (final exams) and was struck by a number of positives in this job which don't exist in medicine. I should have blogged about it at the time, but perhaps writing now will jog my thinking.

I love how in this job there is a team spirit, sometimes it's us against the world/tourists/tour group leaders/supervisors/powers that be, and that can unite a team, and sometimes it's us generally putting effort into ensuring that tourists and customers have a memorable few hours at our site, together. As a student it's difficult to really be "involved" in any hospital team, but none of the teams I've had anything to do with have had a team spirit that I could sense from my position as a student at the edge of the team.

One thing that particularly struck me is the culture of respect. It's a big group of people so of course some people grate on others a little, but even so there is a sense that the staff respect each other. In particular, people respect the supervisors, but not just because they're supervisors, but because a) they're (mostly) good at their supervising, b) are nice people, and c) they respect us. In medicine it sometimes feels like the seniors are respected because they demand respect, not because they deserve it. It creates a very different culture. It's not a big deal, and it's only noticeable when you start to think about it, or when you've been working elsewhere that doesn't have such a culture.

Recently in the museum a slight change in the system was trialled, and the supervisor asked my group of assistants for our thoughts and feedback - the senior staff genuinely want to know what the "junior" staff, the people actually implementing the changes, think about it, and will take those comments on board. It's not often that I've seen seniors in medicine asking for juniors' thoughts and feedback, except in a grilling and knowledge-testing sense.

Even at the busiest and most stressful times, people are generally happy and still so willing to help each other out. Again, not always evident in medicine. But maybe the stress is different - in the museum stressful times means long queues, angry customers, obnoxious tour group leaders etc. In medicine stressful times can mean the weight of the responsibility for patient's lives, especially when the line between a patient living or dying starts to thin. Perhaps the difference is stress contexts explains the differences in atmosphere here.


A colleague, for whom this is also "just" a vacation job, asked me today if I don't find this job a bit menial, since I have a good degree and will be a highly qualified professional (clearly indicating he finds it menial for this reason). I first told him he needed a slap, then pointed out I have two good degrees! Just because I'll be a qualified professional, in a totally different area to this job, doesn't mean this job is beneath me. It has taught me a great many skills, such as: communicating across language barriers and cultural barriers, communicating with children, diplomacy and tact in customer service, particularly with difficult customers (which transfers to diplomacy and tact in dealing with patients, particularly "difficult patients"), conveying complicated information in a way the recipient will understand, and the ever-useful skills of voice projection and crowd control. None of these are medical skills, but all of them are likely to be useful during my medical career. That's not something to sniff at.
There is the additional benefit that this role has enabled me to be competent and above all, confident, in dealing with many, many people, and confidence is not something one can acquire overnight, or just by magic or good intentions. The confidence I've gained from putting effort into this job, and knowing from the responses from colleagues and customers that I'm doing it well and making a small diference to someone's day, is something I couldn't have gained simply from being a medical student. A medical student I've found is frequently too much of a fifth wheel to have much of a sense of achievement (that's not to say that achievements aren't made, but just not on the same level).


Now the terrible bit is that I realised recently how much I enjoy this job, and how many of the things are appreciate are not present in medicine. I could only wonder why I'm leaving a job I've enjoyed, for one that predominantly scares me, in an environment which I don't always enjoy or feel respected or comfortable in. It feels a little bit mad.

Perhaps part of the reason I've enjoyed the job is because I know I won't be doing it forever, and perhaps if I were I would have a different approach to it. But I hadn't really thought about the fact that I would one day be leaving this job, in order to take up my forever-job, (the one I've been studying seven year for) but now it's suddenly here, and I'm leaving tomorrow. I'm really not sure if I want to!

I can at least be thankful that I've had employment which I enjoy, to return to every holiday (and some weekends), in a group where I feel part of the team even if I've been away for months, and have been able to go through my education with far more financial security than I otherwise would have.

After all, if medicine all goes pear-shaped, I might always have a nice job to return to! I could be a museum-doctor.

First, I have to get through, and make the most of, my last day tomorrow. It feels like the end of an era, and it feels silly to leave a job I like*. Needs must....

(*It was suggested to me that I'd have enough holiday from my doctor-job to return to my museum job occasionally, but 1. I do quite like the idea of having a holiday which is entirely a holiday, no job or revision or essay-writing to have to do, and 2. most importantly, I couldn't justify it. I'd be on a nice NHS salary, taking part-time holiday work away from school leavers, students and other people who really need the money, when I really won't - that's not right, and I wouldn't have particularly wanted someone earning good money to take my shifts away from me the last few years, when I've needed the money.)

Carer's holiday, and a holiday for the carers

As I discussed extensively with Steph at Steph's two girls, I have a sister with Asperger syndrome (an autistic spectrum disorder). This week we went on holiday together. It was the first time she'd been away without our parents, so while it was a welcome break for them, it was a bit of an adventure for her.

My mother was convinced we would come back not speaking to each other, but we were even still laughing with each other.

However, I've come back with a newfound respect for people who can organise and take responsibility for a holiday and for other people's needs, when the other people can't communicate those needs. Taking care of meeting someone's needs without knowing what the exact needs are at that time and place is a skill I haven't yet perfected.

I've also come back with a newfound understanding of the little difficulties in coping that, when added together, make an independent life currently impossible. And a wonder about how outsiders, such as the lovely people at ATOS who will assess her disability living allowance, can possibly notice or understand such minutiae, and comprehend how someone who at first seems competent if a bit odd, actually requires extensive support.

But we survived, and had a lovely (if exhausting) time. Would we do it again? Yes, but preferably with better communication on what each person's preferances, needs, and limitations are, with updates when they change. That would be the life...

And also ideally with a sense that all the independence training that the holiday involved was in some way wanted or appreciated. It's difficult to have no idea but feel the need to pursue the ideas of independence and gaining skills anyway.

But yes, we would do it again.

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)

Ideas, Concerns and Expectations, Baby

I've seen this wonderful video/song via Wishful Thinking in Medical Education, about asking ideas, concerns and expectations (ICE) of a patient in an exam. It often seems contrived, and though this video is about exams for general pracctice trainees, it's so true for medical school finals too. It's definitely on my mind given the final OSCE in a few days, though I find myself running out of time before asking it.

Also, I've been told the real skill is not about whether you ask ICE, but how you respond to it.



I would love to know the guys that put this together... they must have more interesting characters than some GPs I know!

This is what an anti-rape and anti-sexual abuse campaign looks like

via Khale at http://misspixnmix.tumblr.com whose wonderful "I do not have an eating disorder" comic I've mentioned previously.

This is an anti-rape campaign that places no blame, and no responsibility (except on the perpetrator), but encourages bystander intervention. It is amazing. Men Can Stop Rape, an American organisation, also seem amazing.

Did I mention I'm a feminist? It shouldn't come as any great surprise, as I hope this blog has so far made clear that I'm no doormat. TTBAMS is what a feminist looks like.

                        "I only know that people call me a feminist whenever I express                        sentiments that differentiate me from a doormat"

                                                                                        - Rebecca West 



Before anyone thinks, I do know full well that this kind of campaign does not prevent every rape or sexual assault or abuse. But maybe it makes a difference, starfish-wise.

Anonymous

I knew from the beginning that if I were to write a blog that included my experiences of medicine, and possibly some of my experiences with patients, it would need to be anonymous. I've mentioned this briefly before but it does need a post of its own to explain this.

Posts like this one, and one in my head about a patient I saw die, seem to require anonymity to protect the patient's identity as well as my own. Of course I do everything I can to protect the patient's identity anyway (changing identifiers etc), so that even the patient themself wouldn't necessarily recognise themself in my blog. But it's easier to ensure nobody recognises the patient if they don't already know which hospital, city or even area of the country the patient was seen in, or which medical student or doctor they saw.

There's also the issue that I don't particularly want my future patients to read this and know that it's their doctor, looking after them, who wrote it*. They could easily lose faith in me or not want me to be their doctor. It's not that I'm lying to them, but my doctor-face that I present professionally is confident and professional, and different to my blog-face and the things I share on here - my fears and failings, along with some potentially more contraversial thoughts.

I talked to a (non-medical) friend recently, and told them I had to re-take an exam and only narrowly passed a few others; their response was "I'm glad you're not my doctor" - I can see why. But once I have passed, I am deemed safe and competent enough to practice, and I'm no different to any other doctor. I hope my patients would see that, but some wouldn't and there's no need to tell them all and make an issue out of it.

I don't necessarily want all my colleagues to know that this is me, I don't want my consultants to know my fears and failings - if I did, I could tell them.

My posts about my medical school have sometimes been far from positive, but I don't want to bring them a bad reputation, just because I blog negatively about this medical school and people may not about others. And you never know, they could pull me up on things I've posted - it wouldn't be the first time a student had been reprimanded for things they'd put on the internet.

Since my posts about my family aren't always complimentary, I don't want them to see this blog and know that it's me, either.

If this blog weren't anonymous, I'd need to censor it and be more careful of what I wrote and how it could come back to bite me in the future.

I'm aware that other medical students don't always blog anonymously. The medstudent in the link implies that being proud of what she writes is part of why she doesn't blog anonymously. That's not to say I'm not proud of what I've written, I am to some extent (the mopey and despairing posts, less so), but I think the reasons for anonymity far outweigh the reasons against.

I hope that doesn't make me a coward - I don't think it does, but I'm sure it could be suggested.


If you know me personally and want to share this blog, feel free to but I'd prefer it if you don't blow my cover. Please do share it, it would be nice to have more people read it, but please don't share it in connection with my name or identifiers. This post has been a long time coming, and it's because of this bit that I haven't really felt able to share this blog with people I know until know. Apologies to people I know who've come here, you've got 34 posts to get through if you want to read this blog!

*If you don't know me, and you've read this, would you want me looking after you? Really?

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.

Breaking the stereotype?

At the medical school's graduation ball last night, for medical students/soon to be doctors and their guests, and some faculty, most of whom are doctors, there were some speeches and presentations made. By far the biggest applause of the night, with a standing ovation from the whole room (about 170 people), and two giant bouquets of flowers, were not for any doctors at all, but for two nurses.

Two nurses who were both previously intensive care nurses and are now clinical skills facilitators, and teach us so much of what we need to know, and if any of us save the life of someone who's seriously ill in August, it will be thanks to them. In fact for many of us, passing all the exams and becoming doctors at all is thanks to them. Especially for us re-takers, as one of the two nurses oversees the re-take program and eggs us on through this tough few weeks.

They completely deserved their applause and flowers and all our thanks, and it made me think because doctors and nurses don't traditionally have the best relationship, and sadly the culture is still one were some doctors look down their noses at nurses, but last night there were over 100 new doctors with more gratitude and respect for two nurses than they've ever had for any doctors.

Hopefully we'll take that gratitude and respect with us into our many different hospital workplaces, and whenever we meet and work with other nurses, and particularly if we're frustrated or challenged by them, we'll remember the gratitude and respect we had for the two nurses who got us there.

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...