Monday, September 25, 2006

Back to it, people!....please?

So, new block started today. And I am doing ARICM – a delightful and unpronounceable acronym which we call ‘arikim’. It involves:

Anaesthetics

Respiratory

Intensive

Care

Medicine

(Ooo would you look at the text formatting on that. And please appreciate how hard it is to spell anaesthetics. This is one case where I like the American way of spelling – to be an anaesthesiologist would be damn cool.)

It may be new block today, but its also… drum roll please…..MISSION MONDAY!

(Go read Carmen’s blog, she is fabo! And even mentioned being enough the other day. Could I puffy heart her more?)

The mission for this Monday was to be sweetness and light and smile at everyone – especially people providing you with a service. Score! I knew I could do this one. I am ridiculously good at smiling at people, especially when finding directions or going to a new place. And what was I doing today? Off to a new hospital…

Yes, I did get lost when looking for the undergrad centre on campus. Yes, I did smile and ask nicely for directions, and everyone was so friendly and helpful. Being lost doesn’t seem half so bad when people are kind to you.

<>I do it automatically. If you ask nicely - ‘Would it be possible…?’ ‘I’m a little bit lost, do you think you could help? I’m looking for…’ people are much more willing to go out of their way to help you. And saying thank you doesn’t cost anything, and it makes someone feel valued. Which they most certainly were today!

When I worked in jobs providing a service (as a sales assistant in a gift shop at Wakehurst Place, a receptionist at the local physio department and a barmaid) I always gave the extra bit, you know, smiled more, did everything I could, tried to make the customer/client/drunkard feel listened to and appreciated. And I always felt so appreciated when people said thank you. It really made me smile.

Always seems as though it’s the people who ask in the nicest way who are most appreciative. Maybe because they don’t expect you to do everything, so they are genuinely pleased when you go the extra mile.

One of the loveliest pubs in Selly Oak, where I live in Birmingham, is nice because of the staff. Apart from one or two rather yummy student lads, ahem, they have one of the nicest bar maids ever. She’s always bubbly and smiling, and has a chat with you. Last time we got on to the relative calories in a gin and tonic or vodka soda lime (I’m a drinker of the latter, in case anyone wants to buy me a drink anytime…). That’s the kind of thing that makes the difference.

O, and my personal top tip for being the nicest shiniest version of you that you can? Smile when answering the telephone. Always works for me! I have a stupendously good telephone manner. In one of my hospital placements, I booked some teaching on the telephone with a doctor’s secretary, then rang up and booked room for it, while sitting with the rest of my group. They spent the rest of the day clamouring why couldn’t I be that nice to them!

Finally, I do one more thing to make myself feel I am not a bad person. If a homeless person offers me the Big Issue, I always say ‘No thank you’ if I am not buying one. Its common courtesy.

Currently reading: A Game of Thrones, Geoge RR Martin. I am finding this one hard work. I had heard good things about the Song of Ice and Fire series (of which this is the first book), but it is mostly political type drama, with lots of plotting, and murder, and devious twists. Not sure I will bother with the rest of the series, because I like good old adventure fantasy. Sword fights and wizards, dragons and dwarfs. O, and anything Discworld!

Wednesday, September 20, 2006

Holiday post with extra rant...

I love having a holiday. I’m at home and it is wonderful. Meals cooked, clothes washed, decisions made… I do kind of just switch off totally when I come home for the week. You know, hand over the reins to my parents and just sit quietly in the corner.

Or not so quietly, as I have a new guitar. A beauty too. My little brother chose it, as he is the fount of all (well, much) guitar knowledge. He would die without his. This is a replacement for a previous acoustic – a cheap starter instrument that died a slow death being abused by me and my bro. How sad. But me and the new one are fast making friends, and I promise not to drop it! I have been searching for simple tabs on the internet (did I tell you how much I love the internet?!) and found lots I like… The fingers of my left hand however do not. Anyone got a method for toughening the tips? Apart from practice, because I am already doing that, and it’s not the point of the question – I know practice will toughen them, but I want to cheat. I want it now. I am part of the instant gratification generation, you know, and we don’t know how to do hard work and patience.

Otherwise all is quiet on the Western front. Going t’pub with some old friends tomorrow – could be ok, could be bad. Unlikely to be good. Although the last few times I’ve seen them it hasn’t been as bad as expected. I’m seeing a very good and old friend on Friday – she’s at uni in Brum too, but at a different one to me (an ex-polytechnic, not a redbrick like mine teehee!) doing fine art. I may laugh at her, but a bit of me is jealous that she gets of paint and draw all day. But then I think about job security and satisfaction and doing some good in the world and I say to myself ‘But I want to be an artist!’.

We could get on to a whole thing here about doctors doing good in the world… butI haven’t the time, space or inclination to right now. Maybe one day…

Does anyone else have a little list of ‘Things I should blog about’? Mine are all deadly intelligent and would change the way you think about me. Honest to gods, they are all worthy, interesting and thought provoking topics. However, whenever I sit down to write, all this utter drivel comes out, and so the internet never gets to witness my genius.

Which may or may not be a good thing….

Talking of thought provoking, Med Neophyte’s latest post, on patient-student consent, was extremely so. Consenting patients for students to examine is always tough. I hate being introduced by a senior doctor as ‘training doctor’ or ‘young doctor’. Some of my peers also hate ‘student doctor’, but I think that is probably the most accurate way of explaining us to a lay person – ie a patient. I have been mistaken for a student nurse, pharmacist and physio when introduced that as a ‘medical student’.

But what can you do when a senior colleague – and its invariably the consultants who say it – introduces you to a patient as a young doctor? Technically it is lying, and lying to get consent makes a mockery of patient autonomy and any examination I do battery. I hate it – firstly, that I am made to feel like a liar by a doctor who is supposed to be supporting and encouraging my learning, and secondly that I do nothing about it. I stand by and let it happen. By my silence I comply, I say that it is ok to lie to patients.

But it is not ok. It is not ok to lie so that the patient is trickedinto thinking I am a qualified professional. I am so grateful to every patient who gives me the chance to speak to them, examine them and generally inconvenience them in the name of education. I should not undermine the trust they place in me. And I understand that patients may not wish to see a student, unlike some. Some of peers moan and complain when a patient refuses to see them or be examined by them. I respect that choice. If I was sick as a parrot (and patients in hospital are, as a rule, ill in some way…) I would not want to be prodded by a gang of teenagers, or tell my life story including the state of my bladder, bowels and sex life to a fair sized group of people. Lying to them to get consent is a gross misplacement of their considerable trust in us.

Medical students and doctors alike need to remember that being grateful goes both ways. Yes, patients should be (and most usually are, very) grateful that we are treating them, and remember that expertise needs to start somewhere, but we as doctors also need to remember that patients are people to, and be grateful to them for sharing their woes to further our education.

The best consent to see a student I know of is the form used by own GP practices. It states that we are students, and how many years we have been studying, plus (more importantly?) how many years to go until we qualify. It has separate sections for consent to take a history, and another to examine. It’s clear and concise and very difficult to administer in hospital.

And therein lies the problem. I don’t know how to make it better – for doctors, patients and students. For me. And so I will continue on, like many medical students, wincing every time a consultant calls them a ‘young doctor’, not knowing how to change the situation.

Goodness, rant over now. Phew. Congratulations if you managed to read this far!

<>(The post ended up so much bigger than I expected - I have been writing it on and off all afternoon. At least it wasn't all day, I guess...)

Currently listening to: The Amateur Transplants. Fan-bloody-tastic. Played some to my mum and she was in fits. Like me.

Wednesday, September 13, 2006

See - they just don't like me

Photos that is. Or maybe the internet is just not ready for my ugly mug!

Anyway, here's another go...



Previous description:

'O, and for your delectation (as the other picture worked, thanks again to Marysienka!) here’s something cheerful: my cousin Helen, my brother John and me, at my parents wedding anniversary party. The funny thing is, John and I were sober (performance pressure…), and Helen was absolutely ratted. You’d think otherwise from the photo! God, I look so tired… I’m desperate for our week holiday – which starts on Monday! Yippee!'

Edit (10 minutes later):

Bloody hell, its still not bloody working. That's it. I am not trying again. Officially giving up.

I told you they didn't like me.

Tuesday, September 12, 2006

Tired

Palliative medicine is pretty amazing. I hesitate to say I enjoy it – perhaps it is better to say I find it medically, emotionally and spiritually challenging, yet fulfilling. It dabbles into all areas of medicine, yet gives there is time to talk to the patient; indeed, the psychosocial aspects that can only be assessed by discussion with the patient are a fundamental pillar of palliative care.

And I like that. I like the talking therapies. Although I am a hands-on person, I enjoy communication with patients, finding out about all aspects of their lives.

(Probably because I am essentially very nosy.)

This placement has been hard – not intellectually, but emotionally. I have met some incredibly sick people, and been privileged to sit in on some intense consultations. The hardest was a 21 year old girl dying of refractive Hodgkin’s lymphoma. Firstly, she looked dreadful, and was obviously very ill, which was distressing. But most distressing was her own complete denial of her mortality. And I can understand why. 21 year olds shouldn’t die. They should be looking forward to everything life brings. The world should be her oyster, but instead life is sliding out of her grip.

I feel tired and battered by this placement, but in a healthy, constructive way. I feel this is an area of medicine that could challenge me for the rest of my life.

But I am also feeling a little sorry for myself, as another year has passed and I don’t feel as though I have achieved anything. In my head, I know that this is not true, but in my heart I still feel I haven’t grown up yet.

I know, I know, 22 is hardly old, but I still feel like a na├»ve, shy teenager. Logically I know I have grown and changed so much in the last 3 years, especially this last year. But I still don’t feel as though I am enough.

And I know you’re thinking ‘Here she goes again, harping on about being enough’ but that is the title… When I started this blog, I picked that name out of the air. I felt it reflected my struggle to get through medicine. However, I have learnt, in the last 9 month of writing, that it reflects the fundamental core of me: I do not feel like enough in any area of my life. I don’t think I ever have. Maybe I never will do.

Currently listening to: my favourite mix of emotionally charged stuff, including Tracy Chapman (The Promise), Eva Cassidy (Kathy’s Song), Coldplay (The Scientist), REM (At my most beautiful), John Cale (Hallelujah)…

O, and for your delectation (as the other picture worked, thanks again to Marysienka!) here’s something cheerful: my cousin Helen, my brother John and me, at my parents wedding anniversary party. The funny thing is, John and I were sober (performance pressure…), and Helen was absolutely ratted. You’d think otherwise from the photo!

God, I look so tired… I’m desperate for our week holiday – which starts on Monday! Yippee!

testing...

fingers crossed you can see something... all thanks to Marysienka!



(it should be the Margot Fonteyn pencil drawing I did for Mirabelle)

Monday, September 11, 2006

Busy bee

Having a tres busy week:

- hospice placement
- winning the pub quiz
- cooking dinner tomorrow night (chicken and pea risotto, followed by panfried pineapple)
- becoming twenty two....

Promise to post something real soon!

Currently reading: An Anthropologist on Mars, by Oliver Sacks. Love love love.

ps. Still can't get the photo thing to work. Tips anyone?

Wednesday, September 06, 2006

Life can be magnificent and overwhelming – that is its whole tragedy. Without beauty, love or danger it would almost be easy to live.

Albert Camus

Tuesday, September 05, 2006

Thoughts

I just had a very long IM conversation with Jenna about being enough. And I got really upset. Crying at the keyboard and all. I need to think about what we discussed before I can write about it. But I will.

Sunday, September 03, 2006

25 Long Years

My parents celebrated their 25th wedding anniversary this weekend. The actual anniversary isn’t until 10th October, but they thought the first weekend in September would have better weather.

Well, you’d think so, wouldn’t you?

Personally, I think it was fate. The original event was rained out, and then it piddled down at the 25th wedding anniversary party.

It was supposed to be a beautiful garden party, but instead it was slightly damp inside party with guests nipping between the house and the marquee in the garden. But the food was fabulous (thanks to some great local caterers and my Mum’s ace puddings), the drink was freely flowing, and the guests were the loveliest people my rents know.

Some very dear family friends came to stay, bringing their youngest son, who was my little brother’s best friend from the age of 3 until they moved away when he was 10. I’ve seen them sporadically since, but I hadn’t seen him for about 4 years. He’s now 20, and so grown up. Still acts like another younger brother though! Funny how some things never change, however old you get.

My cousins Helen and Lisa were also there, from my Mum’s side of the family. We’re really close to them, and Helen, who’s 17, kept us royally entertained getting steadily more pissed as the night wore on… She’s planning her next visit to Birmingham to go out with me in her school half term holiday. Birmingham should start preparing!

Our other cousins, on Dad’s side, are mostly very pretentious, and I always think they consider themselves are better than us. They treat me as the geeky unfortunate younger cousin. And I always feel slightly inadequate next to them. I truly have no reason to be. They went to private school, and have been to uni, graduated and got engaged/married. Nothing special, but I always feel as though I am behind. I’m still a student, I’m not even in a long term relationship, I don’t have money or posh friends… But I am bright, over halfway to being a doctor, a talented singer and average pianist, and I am socially well-adjusted.

They just always make me feel like a deprived child they’re being nice to out of pity.

But it was a truly great party, and so nice to see so many family friends who I haven’t seen in ages. Everyone wanted to know how I was doing, and what I want to do when I’m finished, and wished me well for the future.

Currently watching: the rolling English countryside from the train window. Today has been the most beautiful afternoon – clear blue skies, with that slow slanted sunlight you only get in late summer. And now an almost full moon has risen in the evening sky, settled on a bed of soft lavender clouds. I could never leave my country: its changing skies and rolling hills are too close to the heart of me. But the feeling is a little bittersweet. The slanted light, the start of September, the evenings drawing in; Autumn is so close I can taste it.