Balance

I feel that I need to get my balance back again. I felt that I haven't learnt much this week. But there's really nothing much to be learnt this week. Patients just happens to have boring, unchanging old problems. Staff in my ward were bit stress due to a C. diff outbreak in the ward. Hence I have made the decision regarding learning - I would keep enthusiasted but I won't hang around earlier than 0900 or later than 1700.

Short term solution to treat my burnt out feeling - Weekend plan: Ride bicycle, Play piano, Shop for winter clothes, Jogging at Platt Field and Watch movie.

I have lost 8-9kg since I came back from summer holiday. All my pants and skirts are annoyingly loose now. (Annoying because my fob watch and name badge shake vigorously when I walk around the hospital).

I miss mummy, papa and all my sisters.

Bitching

This post is a waste of time. Unless you have too much time to kill, don't bother reading.

Basically I just want to rant about my PBL group. They are alright generally. Just one or two people whom I wonder from time to time why the hell are they doing medicine. One of them is my clinical partner. She is lovely but she is simply not keen to learn medicine. She doesn't bother remembering patients' names and clerk patients only because Dr New said 'we must have 8 clerkings by the end of the firm' - and as soon as Dr new said it's ok to only have 2 or 3 clerkings, she went straight back home for a lay in. She doesn't want to learn anything else other than what we are suppose to know at this point. And she's often with the attitude - we've got to let our tutor see that we are doing work so we don't get marked down, then we'll be ok. Our group sort of got told off yesterday that our PBL discussion isn't up to scratch, and today in the GP surgery, she was actually reading her PBL notes rather than learning from the consultations, seeing interesting signs and symptoms from the patients and paying attention to the doctor's excellent communication skills. I mean, if you are still not mature enough to get out of this schoolchildren attitude towards learning (put on the hardworking act when the teacher sees you, and when the teacher leaves just throw away the mask), then I'm afraid medicine, especially in such self directed learning environment, isn't for you.

I always get very excited after clerking a patient, especially whose diagnosis is yet unknown, reading a lot and trying to work out if I could out what the problem is. My clinical partner and many of my groupmates just never showed any interest to discuss these queries. My clinical partner would rather discuss her cat, her boyfriend, her going home every weekend or her car insurance with our GP than asking him any medical questions. Maybe it's just me the boring medical student with nothing else to talk about other than medical topics. And none of my groupmates wants to hang around the ward to learn stuff no matter how many times I've asked them to join me. Maybe I am just too keen, bit overenthusiastic for them to cope with. I have to say, nevertheless, that having a group with this low level of motivation does hold me back a bit. I actually feel more accepted by the doctors in the ward than my group. I'm constantly reconsidering should I actually be less enthusiast.

I don't generally bitch about people. Since a few years ago when I discovered my tendency to prejudice, I take extra effort all the time to make sure I keep an open mind about people. But this is just too frustrating.

Disorientation

I'm always disorientated in the ward, but today was particularly bad. After PBL at 4:30pm, I thought I would go on to the ward and practise examining some patients. I examine my first patient's abdomen. After the examination, I thank him and said 'have a nice weekend'.
Then went on to the next patient. This is a chap whom I already know (I've taken a history from him last Friday). He said 'what are you doing here on a sunday?', and I naturally went 'it's not sunday today, it's friday'... 'patient looking confused' ... I added 'no, I'm not trying to wind you up, it's definitely friday today'. So we went to arguing for a while, I even asked somebody else to come and clarify to the patient that today is indeed Friday!
Then, I made my way to the bus to go home. On the bus, I thought about the Crossing Borders meeting which I would be going to, which reminded me that today is a monday, not a friday! Aaaaaaaghhhhhhh!!! So I'm as confused as some of the patients in the ward..

Apart from the disorientation I had a great day. The first patient I examined has spider naevi and probable hepatomegaly, and the second chap has a clear basal crepitation. Ward round was enjoyable. I always feel like part of the team in Janet's ward round. I'm really grateful to be included in the team. I think when I become a consultant I want to be like her. And it's very nice to finally have a role model to look up to after 6 weeks in hospital.

Have I reached my limit?

I would like to think I haven't but I'm not sure. My life definitely need sorting out now. It's just a problem of the balancing act, a vital component of being a medic. Since starting the clinical year, I've been feeling really exhausted everyday. I normally wake up at 5am just to do some reading and get ready, and then go out at 7:15am to catch the bus to reach the hospital at 8:30am. Then I don't leave the hospital until about 4:30-5pm, and usually reach home at about 7:30-8pm. As you can imagine, I'd be totally drained off by then that I would mess around with the computer for a while then go to bed. If I'm not too worn out, I might cook something or shower. If I need to do some any assignment for the next day, I would wake up at 2:30am to do it.

So, for the past few weeks, I haven't been eating or resting well. My standard of hygiene has fallen, and my room is in a big mess.

Plus, I feel bad that I'm not doing enough for medsin as I hold the vice president post. To be honest, I don't really know what the way forward is. My job is to liase with the projects and make sure the projects get the support they need. The thing is no one from the project has contacted me for help, so I assumed that they're all doing ok. I'm not really looking for work to do at the moment. I know I should be communicating more frequently with the projects but I just have no energy or time left to do that. In addition, I have my own Crossing Borders project to coordinate (At the same time, Gemma the co-coordinator is also have a stress-related break down). Also, there seems to be a communication problem within the medsin manchester committee. I have a feeling that people are not too happy with me but they are not saying it. This is really frustrating because everyone may think that I'm a bitch but I don't know what the problem is. Medsin is a constant source of headache I wonder why I took up the position in the first place. And for the past two weekends, I've been away from Manchester to attend national medsin events.

Luckily papa and mummy relationship problem has eased off a bit. It was quite emotionally taxing to be a mediator between the two of them over the summer.

So, as for last week, I was at least still quite motivated to read through stuff I've picked up in the ward and clinics. But now I just don't feel like doing anything. The medical team in the ward is nice. Janet who is a consultant has learnt my name and has started to boss me around to do stuff in the ward, but I like it. The other doctors have been really kind to me as well that now I'm beginnning to feel like part of the team. Maybe that's why I feel that I need to know everything I've learnt in the ward in order to not appear stupid.

I have yet to tear but I'm having a really hard time controlling it. Hopefully I'll be able to get some good rest this weekend and get my balance right again.

Getting better

These two weeks, particularly this week have been productive eventhough I actually spent less time on the ward compared to the first week. We are getting braver at voicing our concern for lack of quality teaching to registrars. I also found myself communicating a little more to the medical team, which obviously makes life easier even if it only means that one of the consultant has learnt to recognise that I'm a medical student attached to the renal ward.

Just going to summarise what I did this week:

Monday: Teaching for the whole day, learnt catheterisation, otherwise unproductive
Tuesday: Went to contact lens clinical trial in the morning and earned 20pounds. HPN clinic in the afternoon - very very good, learnt loads.
Wedsnesday: Consultant ward round-learnt about CV exam, leg exam, enterocutaneous fistula, read observation chart, anti-anginal drugs, pCO2 etc - very useful, consultant said 'the medical student don't know anything but very enthusiasted', took it as a compliment. Practised venupuncture and cannulation on dummies, getting steady. Clerked two more patients. Watched ST insert a femoral line and the nurse preparring and finishing dialysis.
Thursday: Good clinical teaching on abdo exam. Took a history togather with 3 other people in my group as part of the teaching(... sort of realise that my history taking being more systematic). PBL on renal artery stenosis - especially enjoyable because I've picked up quite a good amount of renal medical knowledge.
Friday: First time in theatre for Permcath insertion, wore oversized scrubs (size S). Dr was nice, cared to explained things to me, nurses was friendly showing me around. Also discussed an SLE patient's management with the doctor and learnt immunosuppressive therapy. Went to ward and took blood from two patients. One failure (stabbed him 3 times still no blood...) and one success (at my first go!) [overall venupuncture stats - 3 successes 2 failures]. Examine a lady's abdomen and took a history from a chap who spoke very little English.

Mummy asked if I'm quite busy nowadays because I'm seldom online. Indeed, I'm really busy. I shouldn't be, there's only 6 hours of scheduled teaching in a week in our timetable. We are expected to fill up the rest of the time ourselves (self-directed learning). I think I've done fairly well in maximising the learning opportunities available. I lack sleep every night because I was trying to do so much reading about conditions or procedures I've learnt during the day. But its been really exciting. I love renal medicine!

Disappointing start

So I held high expectations. So I should have been warned. Firm attachment isn't as exciting as I thought it would be. Renal ward is good. I recon I will learn a lot not only about the urinary tract, but also the cardiovascular as well as the respiratory system. But I'm just kind of lost. The consultant just told us to clerk lots and lots of patients, and attend time tabled ward rounds and teaching. Did not bother to introduce us to the medical and nursing team in the wards. So you can imagine the staff seeing us as just 'some medical students' buzzing around the ward. Patients are nice. Only sometimes a little crowded, having eight of us in the ward at one time. Medical staff are not very enthusiasted to teach, just looked busy all the time. No, we don't feel like part of the team at all at the moment. It was just quite pointless being there besides opportunity to clerk patients and browsing through the electronic patient records. Clinical teaching sucks. Two person presented a case each, and the doctor commented on the history taken. No discussion, no teaching and little learning.

Maybe it's me. I should make some readjust my own expectations.

Unfortunate fate with bicycle - I NEARLY DIE!

I am back at Manchester for the third year of my medical course. The course now is based at Hope Hospital, which is about 7 miles away from where I live. Since I was informed that I will be placed at Hope, I have planned to cycle to the hospital everyday. Cyclist friends have been telling me how refreshing and amazing cycling is and I am of course absolutely convinced, being such a natural cyclist - I have never fall off my bicycle before - until this week.

Before buying the bicycle, I did think long and hard about the distance, the traffic, the maintenance etc. While I had those potential worries, I am sorely tempted by the prospect of burning off 800+ calories per day and saving money on transportation. So I bought a bicycle - Trek T10 for ladies which costs 276 pounds including helmet, light and puncture resistance tyres. I actually wanted a second hand one but they didn't have them on the store, so I chose the cheapest one available. This was last Saturday.

Excitedly, I thought I would try out the route to Hope on Sunday morning. I went out at around 7:30 as that was not a peak hour for traffic. Cycling was great, I enjoyed the breeze and the sense of freedom. The bits uphill was quite a bit of hard work, but it was not too bad for me. It took me about 50 minutes to an hour to reach my destination. Good job! After a quick rest, I started to make my way back home. Then I arrived at an roundabout tunnel. It was a downhill slope and I thought I could control the bicycle. I took the risk and I fell, abrasing my knee. But that was no big deal. The disaster came next. I was just at Chorlton Road when the paddle wouldn't go forward anymore. I pulled over and inspect the bike. An portion of the inflated bit of the front tyre was butting out of the wheel... what a scary sight! I tried in vain to force the it in. After a few minutes, there was a loud bang on the tyre, followed by another explosive bang. At that point, I was at least 5 miles away from home and I need rescuing... So I called Lauren to pick me and my bicycle up with her car, and luckily she was really kind enough to spend her Sunday morning helping me. And on Tuesday, I spent 2 hours dragging the bicycle with the punctured tyre to the shop for repair.

As I would not judge a person by first encounter, I was determined to count my fate with this bicycle because of this incident. Yesterday, again, I cycled first along Rusholme and Oxford Road to the student union for the freshers fayre. That was fine. Later on I made my way to Hope - another smooth journey. I managed to arrive in 40 minutes! After our venupuncture and cannulation session, I followed Tess to cycle back home. She cycled really quickly... About a mile away from the hospital, I tried to change lane by hand signal and the tyre sort of got trapped into the tram railing and I fell off my bike. This time was much scarier. I fell on the road and if the car at the back had not brake in time, I would have been run over. Disorientated for a while, I quickly regain my height, pull the bicycle to the pavement. A lady was asking me if I was all right, said loads of things to me but I just remembered that she said the tram line is known to be dead slippery.

I sat on the pavement for a half a minute to get my bearing. I stood up again, looked at the bike - the steering was twisted and locked to one side, the brake line and the chain came off. A fellow cyclist helped me put my steering facing forward again and put the brake line back. I fixed the steering alignment and the chain. But I decided that the bike was not safe to be ridden, and I was not safe to be riding, so I push the bicycle back to Hope's bicycle shed and went to A&E and get my wound on my knee and my hips sorted - don't worry, they only involve the skin. I was more worried of head injuries as the helmet did hit the road (having learnt about the effects of subdural hemorrhages etc). But I thought I was ok, still being able to push the bike all the way back and play sudoku in the waiting area. In A&E, the nurse gave me paracetamol while the doctor covered my knee with a dressing and gave me a tetanus jab. Then I left my bicycle locked at the hospital shed and took the tram back.

Now it's time for the pertinent question again: to cycle or not to cycle? I was first really put off by the punctured tyre on my first ride and now this accident seems to be an obvious indication for me not to continue cycling. True, I may be on my way making a nearly 300 pounds loss and daily deficit in 800+ calories burnt; but still, I can't risk my own life. When not at the verge of death, I always feel that death is nothing to be feared of. But at situation such as this accident, I was making a completely different stand. I don't want to die yet. I still have plenty of things to learn. I have yet to take a complete history from a patient. I have not tried abdo and respiratory examination on real patients. My effort in bringing my family together is still very much needed. I just have so much things to do. So, I've made up my mind. I will not take the risk of cycling anymore. I will no longer be cycling to Hope.