MY LIFE AS A MED STUDENT

Once a medical student, now a baby doctor. Blogging about the ups and downs of being an intern, how to make it through, and all my awkward moments -- there's bound to be plenty of those. Contact me on twitter, facebook, or drop me a message in my ask.

[mylifeasamedstudent]

med school: expectations versus reality.

I decided that I was going to medical school when I was fourteen. I was going to complete my schooling, go straight into medical school, do my internship at some big fancy hospital, save a lot of lives, and then train as a psychiatrist.

I checked off the first two. And then medical school was happened and completely messed up my plans. 

Expectation: I can use the same study techniques I used in high school.

If I’m being honest, I coasted through high school. Then I almost flunked the first semester because I assumed I could do the same thing. Med school is hard, not only because it’s complex, but because there’s a lot of it to learn. Instead of having discrete subjects with set deadlines and small classes, medicine is a huge volume of material, the only deadline is the exam, and the classes are made up of hundreds of people.

I had to teach myself how to study for the first time. I wasn’t the only one.

Expectation: I don’t need to learn anatomy/biology/pharmacology because I’m going into (insert specialty here)!

 It’s easy to say that we don’t need to know this because we’re going into this specialty, or that specialty. But take the example of an elderly gentleman with hypertension. We can’t look at it solely from a physiological point of view because that misses the pharmacological management. If we choose to treat our patient with a beta-blocker, we need to remember to ask our patient about a past history of asthma. The patient may have an inherent mistrust of doctors because he feels that they missed his wife’s ovarian cancer three decades ago – how do you communicate the importance of managing his blood pressure without dismissing his previous experiences?

 No area of medicine exists in a vacuum. Most of what they teach in medical school, they teach it for a reason. There’s a lot of it, but we still need to learn it, no matter what we choose to specialize in.

Expectation: It’ll be just like Grey’s Anatomy!

It’s not. I met one person that good looking in my medical school days, he was married, and there were definitely no elevator dalliances. In fact, I’m pretty sure he didn’t learn my name… but that is entirely beside the point. The wards are not an episode of Grey’s Anatomy, where strange diseases run rife, junior doctors drink all night and then work all day, and no one ever seems to do that much paperwork.

As soon as we hit clinical medicine, we learn to do paperwork. If we party all night, we’re not safe to practice during the day. Doctors don’t use elevators – they take the stairs, it’s quicker. And trust me, the stairways are not ideal for mid-round throwdowns.

Expectation: it’s all about saving lives!

No one saves lives in the first year of med school. Before we can learn to save lives, we have to learn the physiology, anatomy, biology, and psychology of the human body. We can’t diagnose without understanding how everything works. No one becomes a doctor by merely entering medical school. It takes years to even feel remotely doctor-ish. And I’m two years out of med school, and I still haven’t saved a life. 

Expectation: I can survive without sleep/I can do it all!

I tried really hard for years to ‘do it all’. Work after university. Study after work. Socialise. Do all the things. But if I didn’t sleep, I couldn’t go to university because I couldn’t function. If I didn’t work, I couldn’t socialize because no money. I went to the gym instead of class because I needed to be healthy.

Yes, one can do it all. But not all at once. A lot of people need to work to afford med school – I did. But  plan your time and have reasonable expectations. If you need sleep, don’t hit that party tonight. Try and schedule work hours in such a way to leave time for studying. Make getting to class a priority. Don’t try and be everything to everyone all the time. Self-care is important. 

So, medical school didn’t meet my expectations. But it was still pretty incredible -- and it taught me that maybe, what I had wanted wasn’t really what I wanted for my life. 

[mylifeasamedstudent]

the ultimate night-shift survival guide.

Congratulations! Someone out there trusts you enough to manage a hospital full of sick patients overnight! You will be the first port of call for cannulae that slip out of veins, for patients in post-operative retention that need catheterisation, and for urgent reviews of chest pain and shortness of breath.

Nights are long. There is the cacophony of bleeps (why is everyone hypertensive at the same time?) punctuated by long stretches of silence where you find yourself afraid to fall asleep because the moment you do, your patient will crash and a code blue will be called.

But there are a few simple steps that will keep your night manageable and your sanity in check.

1.    Get a proper handover from the evening shift. Yes, it’s tempting to encourage your colleagues to get out of the hospital while they still can, but not getting a proper handover screws you over at three am. Does this patient need more fluids? Why is this patient fasting? This patient is hypotensive, is this there baseline? Asking your colleagues for a brief rundown of each patient’s plan and any expected issues overnight will let you anticipate any major (or minor) dramas.

2.    Caffeinate early. By all means, come prepared with a large coffee at the start of your shift. But more than one or two will leave you wide awake at the end of your shift and unable to sleep. Drink your coffee during handover, and then swap to herbal tea/fruit tea. Or better yet...

3.    Water. Drink lots and lots of water. I am for at least 1L per shift. Are you writing notes? Fill up your water bottle and drink as you do. Running between wards? Take your water bottle with you. Clerking patients? Drink while you write up their admission notes.

4.    Resist the urge to devour chocolate and candy. Yes, I know it’s hard when every ward has a selection of tasty treats at the nurses’ station. But too much sugar leads to the dreaded sugar crash and makes fatigue worse. Stick to low-GI, high protein snacks and you’ll feel much better. My personal favourites are sunflower seeds, pepitas, and nuts. Easy to munch on and don’t weigh you down.

5.    Try and eat a proper “lunch”. Having some sort of meal mid-shift tricks your brain into thinking you’re working normal hours. If you have a breakfast before your shift, a lunch during, and a dinner afterwards, it’s almost like working during daylight hours, except not really.

6.    Prioritise. Try and do bloods and cannulae in a round before patients go to sleep or when they wake up. Unless they have antibiotics due at 2am, there’s really no need to wake patients up unnecessarily. Also, if they need an IVC for 8am antibiotics, leave it until the morning. They will inevitably tear it out in their sleep otherwise.

7.    Ask for help. If you’re not sure, ask. Don’t worry what others will think – it’s better to ask and feel like a fool than not ask and not be able to sleep later.

8.    Keep a list. Write down what you’ve done for every patient you see overnight. It makes handover a lot easier, you won’t miss things, and it allows you to keep track of what you need to follow up on. Saw a patient with chest pain? Better write that down so I remember to repeat trops at 6am. Patient had pain? Better remember to ask the home team to review that.

Night shifts are a rite of passage for almost every junior doctor. Hopefully this list makes them a little more bearable and gets you through the night!

[mylifeasamedstudent]

the (literal) post-night shift crash.

A little while back, I finished my first set of seven nights. 

The next morning, my mind was racing. I’d been awake a few hours, and had done my best to avoid the second guessing that comes with being a junior doctor responsible for a number of patients overnight -- should I have charted antibiotics? Should I have called for help? Was that the right decision? 

I got in my car, distracted by my own self-criticism... and promptly reversed into my letterbox. 

In the grand scheme of things, it was probably one of the least-bad things that could have happened. I didn’t crash on a busy highway at seventy miles per hour. I didn’t fall asleep at the wheel. My car scraped through with only minor damage. 

But it was a wake-up call for me. 

During night shift, so much of my energy is consumed with anxiety and fear. Am I doing the right thing? Am I asking my seniors too many questions? Am I overcharting sedatives, undercharting analgesia? Should I wake the registrar at 2am, or is this something I should be handling on my own? Was the negative outcome of that code a result of my CPR or my inability to maintain the airway adequately? 

And when finishing time rolled around, it was eat, sleep, repeat. I’d exhausted my body completely, and it was into bed, get out of bed, back to work. I hadn’t allowed myself time to cope with the events of the night before. The eyes of the coding patient as I thump-thump-thumped their chest was pushed to the back of my mind rather than acknowledged. The fear that the surgical registrar was cursing my name on ward rounds simmered under the surface. 

And it doesn’t go away just because you leave work. 

So what do we do, as doctors and nurses who have to work nights? It’s almost inevitable that we will be up at 2 and 3am some nights, caring for our patients and praying that they don’t crash? We can’t avoid work, but we can look after ourselves. 

We need to schedule time to reflect and simply be after work. Take the time to be mindful and process the hard stuff, not simply numb ourselves with oversleeping and fast food runs and too much Netflix and too much booze. We need to prioritise ourselves and continue to do the things we enjoy, even when we’re operating in a different time zone to the rest of the world. Night shifts are not an excuse to let self care slide, which is what I did. It’s not an excuse to stop calling our family and our friends, simply because we’re working in what can feel like a parallel universe. 

If we don’t look after ourselves, we put ourselves and others in danger. Night shifts aren’t easy, but they shouldn’t leave us so vulnerable that we risk our lives. 

[mylifeasamedstudent]

how to be an awesome med student (and your intern’s best friend)

Medical students are a precious commodity in the intern world. A good medical student makes it a lot easier to get through the day and get all the jobs done. But it’s a fine line between being a clingy medical student and a helpful medical student, and one that’s difficult to work out. So, this is my wish list for all my future medical students – do this and I’ll be indebted to you for life.

Ask for our number and give us yours. I’m always happy to be texted by a keen medical student who wants to put in lines and take blood and clerk patients. If you let me know you’re free, I’ll let you know how you can help.  Just don’t page me. Interns are perpetually one page away from a nervous breakdown.

Please carry files on ward rounds. I know that you’re not a human bookshelf, but there are a lot of files and I only have two hands. Any help here is greatly appreciated, and extra points if you volunteer to write notes. It lets me give my hand and my pen a break!

Learn to love the list. The patient list is the most important thing an intern has, and we need our medical students to value this. Whether it’s writing down jobs on the list, helping us type it up, or keeping track of the registrar’s list (he or she will inevitably misplace it), your contribution is noted and appreciated.

Ask questions. Interns are fresh out of medical school and know a lot of things. Most of the time, we’re happy to answer (and it makes us feel like we might actually be semi-competent doctors!). Just pick your moment – over coffee is good. During a code blue is not so good.

Volunteer to do practical things. An IVC resite can take half an hour. If you volunteer to put a new drip in (or even put an IDC in!), we will be forever grateful. I’m even happy to supervise whilst you do it – it gives me a moment to sort through my pages and even delete a few).

Remember that you’re going to be an intern soon – and internship means paperwork. The more you can help us with our paperwork, the better prepared you will be for your internship, and the more likely we are to pay you in coffee.

If the interns are busy, ask us for patients to clerk. I love it when medical students show an interest in my patients and in learning – do this, and I will always listen to you present your findings. It’s a good skill to learn, and it shows that you’re keen to be a part of the team.

I know this sounds demanding, but spending time on the wards with your intern not only prepares you to be a junior doctor, it gives you a lot of hands-on experience that you can’t get from your physiology textbook. And the more time you spend on the wards, the greater your chances of being rewarded with coffee.

Hope to see you on the wards soon!

[mylifeasamedstudent]

when a loved one has depression.

As a doctor and general human being, I’ve seen a lot of depression in my lifetime. I’ve seen the depression of a young woman dying and in pain. I’ve seen the depression of an adolescent, struggling to understand why they feel low and hopeless while their peers seem so happy. The depression of the man who battles alcoholism, the young adult in ED on a Friday night wanting to die... I could go on.

But there are protocols for treating the patient with depression. Someone else to refer them on to for further help. Pills and potions and therapies that can be recommended. Letters written to family doctors and psychologists to ensure that these patients aren’t lost to follow up. And then, home time. We can go home and turn on Netflix and debrief. We can leave these experiences at work. 

None of the standard rules apply when a loved one has depression.

With a loved one, it’s not as simple as calling a psychiatrist and making a referral. Psych triage can be called, but the wait list is long and unless it’s a crisis situation, they are limited with what they can do. A loved one can’t be forced to speak to a general practitioner or family doctor, can’t be forced to take an SSRI, can’t be forced to do CBT (unless they’re under the mental health act, but that’s a conversation for another day).

One of my favourite people in the world has recently been diagnosed with depression recently. It’s been a steep learning curve – after six years of training in, and over a year of practising medicine, it’s difficult to step away from the doctor hat and simply be a friend. It’s difficult to just be there for the person and not try to cure them, because that’s what I’m supposed to do.

But depression affects one in five of us. In health care, the statistic goes up. This isn’t a comprehensive guide, but these are some of the things I’ve learnt on my journey thus far.

Don’t be a doctor or a nurse. You can recommend a doctor, you can explain medications, you can explain the different treatments. But don’t tell them what they should or shouldn’t do. Don’t tell them what their doctor should or shouldn’t do. Being a friend is much more important than being a health care practitioner.

Do offer choices. Let your loved one know that there is help available. There are counsellors and psychologists and webchats and helplines. Let them know that there’s no one size fits all approach and that you will support them in their decisions.

Don’t tell them that it’ll be okay or that it’ll get better. In the moment, nothing feels okay. In the midst of hopelessness, it’s hard to believe that there’s anything else. Instead, try validating their feelings. Let them know it’s okay to be sad or angry or despairing.

Do be there. Even if it’s sitting next to them in silence, or having stilted conversations about weather, or the occasional text to let them know you’re thinking of them.

Don’t tell your loved one that it’s easy. There’s nothing easy about depression, or recovering from depression. Each moment can be difficult, even with help.

Do look after yourself. When a loved one has depression, it’s difficult to switch off. It’s hard not to worry. That’s normal. But looking after yourself has to take priority. Sleep, eat, exercise, debrief. Don’t be afraid to talk to someone if you’re suffering.

Not everyone is the same, and not everyone experiences depression in the same way. But maybe, if a loved one comes to us in their moment of need, we’ll be able to slip out of hospital mode and into friend mode and support them as much as we can.

[mylifeasamedstudent]

a letter to my registrars.

Dear registrar, I know I can be frustrating at times. I forget things. I make mistakes. Sometimes I let you know about insignificant results, sometimes I think I can handle more than I'm able to. But I'm scared. I feel like a fraud most of the time. I look up to you and think that I'll never be as confident and as capable as you are. As an intern and a resident, I often feel like I'm wasting your time with questions and referrals. But truth be told, I'm asking because I know you've got more experience and more knowledge than I do. I'm hyperaware of the mistakes I make, and no one will hate me more for making them than me. So, please, please, please be gentle with me. Let me know when I've messed up and how to fix things, but don't yell at me. Don't be aggressive or mean -- I doubt myself enough. I will forget things and stumble over referrals and sometimes, sometimes I will waste your time. But this all stems from inexperience, not incompetence. How you treat me today will affect me later. Your behaviour teaches me what is and isn't acceptable. Your behaviour teaches me how to treat my juniors. You are powerful -- you have the ability to change the culture of medicine. Treat me how you want to be treated, not how you were treated. Thank you, Your interns and residents.

[mylifeasamedstudent]

internship and depression

It started so insidiously. I was in the middle of a general medical term, not enough hands to balance patient files with observation charts and patient lists. Medication charts that were never perfect, discharge summaries piling up, the never-ending beeps of my pager. Cover shifts that extended beyond finishing time and the post-take days, afraid to come in to work because the patient load would have doubled overnight, the ward round bound to take twice as long.

That was why I was tired all the time. If I finished early, it was to go home and sleep. If I had a rare moment of silence on the wards, I went to the doctor’s lounge and slept. Eight pm was my preferred bed time, and even then, I struggled to wake with my alarm. Breakfast was sacrificed for five, ten, fifteen minutes more sleep. I didn’t want to leave the house to buy groceries or visit friends. I didn’t have the energy to call or text friends. I had no energy so I stopped cooking. It was easier to eat pizza and curries that arrived on my doorstep.

I wasn’t depressed. I was just tired. I was overworked. I made excuses for my fatigue and my amotivation and my anergia. I made excuses for the low mood and anergia. I ignored the voice in my head that suggested reaching out as an option. Everyone else was coping. Everyone else was working harder and better. You’re attention seeking, narcissistic, nothing more.

That rotation ended. I moved to a different ward. Three days in, I was in theatre watching a case. My registrar asked me to chart antibiotics. I stepped to close to the anaesthetist and was promptly reprimanded. In hindsight, he wasn’t mean or rude or nasty. But tears sprung up in my eyes and I couldn’t make them go away. I tried mindfulness. I tried thinking about happy things. But five minutes later, I was out of the operating room, hiding in the women’s bathroom, trying to get myself together. I couldn’t think of a reason to cry, but I couldn’t stop crying.

I escaped the hospital and forced myself to see a family doctor for a medical certificate. She said the word depressed. She talked about medication and reviews and time off. That’s what happened. I took a week off. I slept most of it away. I told a colleague and a friend and they helped with food and driving and appointments and covering my shifts. I started being awake more, more motivated. Things gradually got better. I survived nine more weeks of theatre.

I’m in a much better place now.

Intern year is difficult, there is no doubt about that. It is exhausting at times. But please know that when bad days turn into weeks, there is help available. Know your warning signs. Know that when you start feeling like your symptoms match the DSM, that you are allowed to reach out. Know that you are not weak or attention seeking or a failure. Don’t assume that everyone else is coping and that you should simply harden up.

You are not supposed to be infallible. You are human first, doctor second – there is no shame in asking for help.

[mylifeasamedstudent]

surviving your worst day of internship.

Internship can be really hard at times. For each day that you have time to catch your breath, there are two where you’re frantically trying to finish discharge scripts so your patient can go home while answering page upon page and trying to work out exactly what you’re going to do with that patient who is still in rapid AF despite your prayers that they’ll spontaneously revert and will your registrar think you’re an idiot if you call them for help?

Yeah. Those days are stressful. And some days, cover shifts and sleep deprivation and too many pages combine and you find yourself sobbing in a toilet cubicle, trying to get it together long enough to get through the next six hours of your shift.

That was me a few weeks ago. Every intern has a breakdown sooner or later, and it was my turn. Late nights and sick patients left me feeling I was incapable of being a doctor, incapable of doing anything right.

On those days, I can’t tell you that things will be okay, because in that moment, nothing feels like it will ever be okay. But I can tell you how I got through it.

1. Don’t hand in your stethoscope. When everything falls apart, whether it’s an unhappy consultant or a patient telling you that you shouldn’t be a doctor, don’t rush to quit. It may feel like you’ll never be good enough, but it’s just one moment. It’s not your entire medical career.

2. Cry, then breathe. Find somewhere quiet, where you won’t be disturbed, and cry. Unleash every single emotion, sadness, anger, shame. Get it out of you. Feel the strength of your fear. Don’t rationalize it, don’t try and find meaning in it – it is what it is. Express it, and then breathe. Ground yourself and walk back onto the wards.

3. Let your co-interns know that you’re suffering. I burst into tears in front of a co-intern and she sat there while I sobbed. Another one asked me what was going on and she made sure I was going to be okay, offered to take my jobs on a ward where I’d felt like a failure. Every intern knows how crap days can be. It’s okay to be vulnerable.

4. Don’t go home and drink it away. Alcohol may soften the emotions, but it’ll still be there in the morning. Plus, you’ll be hungover, and I can tell you from personal experience that feeling awful about yourself and having a hangover is the absolute worst.

5. Get whatever help you need. If internship is making it hard for you to get out of bed and look after yourself, you may need professional help. It’s not weak or pathetic to ask for help.

Your worst day is just that – a day. It passes. Sure, weeks and months from now, the memory may still sting. But it doesn’t define you as a doctor. Keep on answering your pages and fluid assessing your patients – it’s only one year.

[mylifeasamedstudent]

surviving clinical medicine.

My first year of clinical medicine was my favourite year of medical school. Medicine felt like nothing more than lectures and PowerPoint slides until I found myself in the hospital. Initially, I felt like I’d learnt nothing in my first few years. I couldn’t recall a single sign or symptom of cardiac failure.

But I learnt quickly. You pick up more on the wards than you do in a lecture. Things begin to make sense. But I don’t think anything could have prepared me for what it was like to be on the wards and out of university.

Here are the things that I wish someone had told me before I started clinical medicine.

Patients die.  

I’m not sure if I was just young and naïve, but it had never occurred to me that people die in hospitals. Sure, I’d seen enough Grey’s Anatomy episodes to know that not everyone makes it out of hospital alive, but their deaths were always dramatic and accompanied by the perfect music.

In real life, most patients simply… slip away. Often, a body is found before rounds and between obs, the owner having escaped to another, perhaps better, place.

Most bodies don’t fight against death, they embrace it.

And it’s hard to understand that, despite our desire to practice medicine and save that world, hospitals are places for dying as much as they are for living.

You have a right to be in the hospital…

For most of my clinical years, I felt as if I was in the way of the real doctors and nurses. It’s hard not to believe that you are a nuisance when you’re constantly being shoved out of the way on rounds and in operating theatres.

Yet, as long as you are a medical student, you have the right to be on clinical placement. Sure, you will be in the way. But this is your opportunity to learn. It is impossible to be a good doctor without exposure to actual patients with actual pathology. It is impossible to be a good doctor without hearing firsthand what it is like to have cardiac failure, liver disease, appendicitis.

It is only on clinical placement that you can learn these things. Move out of the way when asked, but don’t let that stop you from feeling like you belong.

…But being a medical student is mostly a privilege.

As a medical student, you see patients at their most vulnerable. They are exposed, literally and figuratively, and reveal intimate details of their lives to you.

You might know more about your patients than their closest friends do.

You know their name, their address, their medications, and their bodies.

This is a privileged role, and you must treat it with respect.

Therefore, not only should you abide by the tents of clinical medicine, consent and confidentiality, but you should be kind. Smile. Make the person in front of you feel safe. Speak highly of your team.

The patient in front of you is not a room number. They are not a pathological process. They are human.

And though you may be soon to be a doctor, remember: your body is just as fragile as your patient’s.

Patients will teach you more than any textbook can.

A textbook will teach you what disease is. They will tell you symptoms and signs and treatments.

But a patient can explain what it means.

I only understood cancer until a patient, a few months post diagnosis, explained the fear that ruled her life. It was no longer an overgrowth of cells – it was the sense that her body had betrayed her. That this cancer was growing inside her and that she’d never known.

Cancer is simply mutations and anorexia and metastasis until you see it in front of you.

Seek opportunities

Your consultant will only see you briefly. They may not remember your name or offer you a chance to scrub in or present a case. But it never hurts to ask.

Start small. Ask if you can observe a procedure (with the patient’s consent, of course). Ask if you can scrub and hold a retractor (you’ll get a better view). Ask your intern  if you can do their drips and bloods. If the nurses are swamped, offer to do their ECGs and BPs.

Show your seniors that you want to be there, and soon enough, they’ll want you to be there too.

 It’ll be hard being in a hospital. But it will be amazing. Take a deep breath, step forward, learns lots, and have fun.

[mylifeasamedstudent]

the importance of talking to your patients.

Today, I was asked to review my very first not-emergency-but-clearly-not-well patient. I went in, guns blazing. Rattled off my questions. Wrote path and radiology slips. Asked the nurses to help. Promised to review, told the ward to page me if anything went awry. 

I felt like a mess, but at least I felt like I was dealing with the matter at hand. 

In the hustle and bustle of my own madness, I’d rendered the patient as nothing more as cardiac failure superimposed on a rising creatinine. I saw the numbers, but I didn’t see the woman. 

I could make excuses. I was tired, anxious, frustrated. I couldn’t hear her soft buzz over my racing thoughts. 

I went back in a second time and sat down next to her. I held her hand and explained what each test was for, what I wanted to find, what I worried about, what I expected to happen. I tried to be as gentle as I could.

She opened up to me. In that same soft voice, she started revealing how, in her many years, only one doctor had ever explained her treatment to her. How most doctors simply expected her to fill the script and take the pills. Get that scan and this one too. How she never felt listened to, and she definitely never felt heard. 

I tried to validate and explain that sometimes, doctors think they know best. I told her my thoughts: that she knows her body better than I do. That maybe I know biology, but I don’t know how it feels to breathe while your lungs are drowning. I understand pharmacology, but I can’t see how the drugs interact with her liver and cells and kidneys. 

My words didn’t fix her pathology. But for a moment or two, she seemed settled. 

It was only later that my registrar told me that she was approaching death. 

As my doubts disappear and I try not to blame my decisions for her deterioration, I wonder how many other patients feel the same way. How many people get sicker and sicker and still feel as if they haven’t been heard. 

I know you have jobs to do and discharge summaries to write and drug charts to copy. But talking to your patients and explaining procedures and tests only takes five minutes. 

Paperwork can wait. Please, let your patients know that they’re not numbers and breath sounds – they’re people.

[mylifeasamedstudent]

eating disorders and medical school: some notes on making it through

Over the course of my blogging, I’ve been open about my eating disorder and the impact it has had on my life and my journey through medical school. And every so often, I receive messages about eating disorders and medical school. How does one get through medical school with an eating disorder? Is it possible?

Of course.

But make no mistake. Eating disorders are awful, hideous creatures. They hide in the recesses of your mind and attack relentlessly, turning innocence into obsession.

Most days, I have this creature under control. Most days, I manage to ignore it long enough to get my jobs done and get into bed safely.

Other days, the stresses of med life get to me and I relapse. I’m not proud of it, but I know that each relapse is shorter and shorter, and that I’m capable of getting back on the recovery wagon.

This is my guide to getting through medical school while in recovery from an eating disorder. It’s nothing revolutionary, but it’s handy to keep even the simplest tips at the forefront of my mind.

1.       Get help early. As soon as you notice your eating habits changing, or the thoughts coming back, or the urges becoming more stronger, go directly to help. Do not pass go, do not collect $200. The longer you let the behaviours go, the harder it will be to get them back under control.

2.       Let someone know. Have someone close to you know that the creature exists. It doesn’t have to be a work colleague. My partner is the one who knows about my eating disorder, and when the obsessional thoughts rise, he’s the cool head telling me to get help. He’s also my cheerleader and my constant source of encouragement.

3.       Know your triggers. For me, feeling inadequate is my biggest trigger. As soon as I begin to believe I’m not good enough, the eating disorder begins to warp my thoughts.

4.       And when faced with your triggers, know what to do. What makes you feel good about yourself? Bright clothes? Craft? Watching baby laughing hysterically at ripping paper on youtube? Have a list and keep it handy. Store it on your phone. Make it accessible.

5.       Have a distraction. I play 4 pics 1 word or do puzzles when my mind ruminates. Some people find games work.

6.       Have healthy snacks on hand at all times. Don’t let a lack of food be the eating disorder’s opportunity. Have something on hand, and eat.

7.       Don’t skip lunch. I don’t care how busy you are on the ward, you still must make time to eat. And eating means food, not coffee.

8.       Take time out. When it gets busy on the ward and you’re feeling overwhelmed, take a moment or two to breathe. Take a quick walk around the ward and pretend you’re looking for a file while you catch your breaths.

9.       Delete anything that counts calories from your phone. Use that space for med apps.

Eating disorders suck. But don’t let an eating disorder get in the way of medical glory. Recovery is always possible.

[mylifeasamedstudent]

the dos and don’ts of first year med.

Recently, I got a question from @party-shaker about being a first-year meddie and surviving.

Let me tell you about my first-year self. I failed my first exam. Not ‘failed’ as in ‘I only got eighty percent’, I ‘failed’ as in ‘bottom of my class, warning letter from the faculty’ failed. First year med is tough. The content is new, you constantly feel like you’re not good enough and you have no idea what you’re doing, and everyone seems smarter than you.

But I got my act together, and got some really good grades by the end of the semester. Mind you, I made a lot of mistakes in the process. Here’s my dos and don’ts of first year med.

DO get adequate sleep.

DON’T trade sleep for studying. Early in my med school career, I had an anatomy tutor who petrified me. In order to learn everything, I would sleep at 10pm, wake at midnight, study until 4am, and sleep until 6am. I was able to answer some questions in the tutes, but I recall none of that anatomy now.

DO find out how you learn. Mind maps, flash cards, bright colours, lists. Do what works for you and don’t listen to anyone else.

DON’T skip class. Yes, the lecturer may be boring and you may be tired. But you’ll have a head start on your learning by going, and the lecturers write the exams.

DO ask questions.

DON’T assume everyone else knows the answers. They don’t.

DO spend time every day revising. Even ten minutes pays off in the long run.

DON’T cram. In fact, you can’t cram medicine. I tried cramming for my six years in med school – I can guarantee that it doesn’t work.

DO have breaks. Run, walk, see your friends, get some Vitamin D. Being stuck in your study or library all day will inevitably drive you crazy.

DO make a study group. You’ll learn more and make friends. It’s win win.

DON’T be competitive. Don’t tear other meddies down or humiliate them. Be nice to other students, help them, but don’t put them down. Not only is it mean, but medicine’s a small world. The kid you were mean to in med school will not refer you patients when they’re a consultant.

Even if you do everything on this list, you will still be tired most days. You will still have moments where you feel like you can’t make it. But this will hopefully stave off burnout and keep you loving what you do for longer.

[mylifeasamedstudent]

the patient guide to the emergency department.

If you’re lucky, you’ll never have to present to your local emergency department (or accident and emergency, as you may know it). But sometimes, you have to. Here’s your handy guide to being a patient in ED.

Before seeing a doctor

When you first enter the emergency department, you will be directed to the triage nurse. The role of the triage nurse is to assess you briefly, and determine how quickly you need to see a doctor. He or she will ask you a number of questions, take your ‘vital’ signs, and key it into the computer. Their job is to assign you a triage category, and will call you into the department as soon as they can.

Sometimes, you have to wait a long time. Sometimes, patients who came into the department after you will be seen before you. And we know that this is really frustrating. These patients come in more quickly than you not because they are ‘more’ sick, but because their symptoms are more concerning. For these patients, delaying treatment may have fatal consequences. And, at the same time, we have ambulances bringing patients to us at another entrance, and often these patients need to be seen urgently. We will do our best to see you in a timely manner. We don’t want to keep you waiting. But sometimes delays are inevitable, and we’re really sorry about that.

Please be patient with us. We will do our best to keep your wait as short as possible, and inform you when we are falling (even more) behind schedule.

When your name is called

When your name is called, someone (normally a nurse or a doctor) will escort you to one of the cubicles. There are lots of gadgets on the walls in these cubicles. Please don’t pay with them. Instead, you can plug your phone into the wall and play with that.

You will be asked to undress and hop into a fashionable hospital gown. The nurse will take your vital signs again, ask you what brings you into emergency, and examine you. They may also take an ECG (which measures the electrical impulses of your heart) and take blood, depending on your symptoms. When this is done, a doctor will come into review you.

With the doctor

The doctor will ask you your ‘history of presenting complaint’. This may involve many questions you’ve already been asked, and we understand that this can be frustrating. The reason we do this is to make sure that nothing gets missed. We are not trying to annoy your or accuse you of lying, promise. We simply need to make sure that we have the most accurate picture of your illness. We will also examine you to try and work out what is happening.

Sometimes, we can work out what’s happening here. We may be able to reassure you that you have a virus or give you treatment without doing further tests. This may be frustrating if you’ve come in expecting a certain treatment, but this doesn’t mean that we are not taking you seriously. I can guarantee that we take every patient and symptom seriously. We don’t think your illness is unimportant, but sometimes, recovery is better at home than at hospital or with medications that have more risks than benefits.

If you are discharged at this point, remember to see your family doctor in three to seven days to check in. If your symptoms worsen or you are concerned, see your family doctor sooner or come back to emergency.

In other cases, we need more information before we can treat your illness. In this case, we may send your blood to the lab, take a urine sample, and order x-rays and other scans. If you are worried, tell us. We will gladly explain our thought process to you. If you are in pain, tell us. We can help with that too. These tests may take a long time. Trust me, I’m annoyed, too. I sit in the doctor’s office refreshing the computer every five minutes to check on your results. But you can (politely) ask me for an update. You can ask for pain relief or a cup of tea. I’m an expert at making tea.

In some cases, we can’t give you food or drink. This is because we think you may possibly need surgery. Keeping you fasted means that if you need an operation, we can do this as safely as possible.

When we have the results

Soon, we have all the information back. Sometimes, everything will be normal and we can send you home. This doesn’t mean there’s nothing wrong, it simply means that we have ruled out life-threatening emergencies, and think you will recuperate better at home than in the hospital. At home, you can sleep in your own bed, eat your favourite foods, and not pick up hospital-acquired infections.

But, in other cases, we may think you need to stay in hospital. We will call our specialist doctors and ask them to come and pay you a visit. We ask them to review you ASAP, but sometimes they are delayed with other patients, or they may be operating. But rest assured, they are not procrastinating or having a long lunch break.

When the specialist doctor sees you, they will ask similar questions to what we have. That’s not because we haven’t told them your story, but because they want to make sure you get the best care. These doctors will decide if you stay in hospital, or if you need surgery, or if you can go home and see a specialist doctor as an outpatient.

If you need to stay, we can tell your loved ones. We will organize a bed for you on the ward and look after you.

We know that being a patient is tough. We want to make your stay as easy as possible. I hope that this explains the process of being a patient and lets you know that we, as emergency staff, are doing the best we can.

[mylifeasamedstudent]

the internship survival kit.

Internship has represented many transitions for me: moving out of home for the first time,my first “real” job… needless to say, I was completely unprepared. But I’m eight weeks in now, and I think I’m starting to get the hang of the “grown up” thing. These are the things that I think every intern needs in order to survive their first year on the job.

on the wards

·         A notebook. I use mine to keep track of jobs that I need to do for my patients. For each patient, I take a bradma, and alongside it, write what needs to be done, and check each job off as I go. I recommend A5 size – mine comes from Daiso, but you can get just-as-aesthetically-pleasing ones from any stationary store.

·         Multiple pens, because people will steal them. Most of mine are the free ones from conferences and medical indemnity companies. But any pen will work, as long as it’s a ballpoint pen with black ink. Black ink photocopies better, and ballpoint pens are necessary for any paperwork that has a carbon copy.

·         A “nerdbox”. My nerdbox was the best thing I purchased in medical school. Essentially, it’s a plastic box, slightly bigger than an A4 sheet of paper, and easily stores all your pathology slips/note paper/pens/notebook/mobile phone/muesli bars/stethoscope/notebook in it. As an added bonus, it has a clipboard on top! This is my baby.

·         Mobile phone. Mine functions as a watch, resource for drug dosages, holds all my prescriber and provider numbers, and also holds cash and credit cards. My phone is my life. It’s all good for texting your fellow interns, and calling your registrar about a patient.

·         Coffee money. You will buy coffee. You will buy lots of coffee – get to know which baristas make the best brew, and make sure to get a loyalty card.

·         A good reference book. I tend to carry this one in my handbag for downtime of night shifts. I’m sure my copy is cursed though – I read about swollen knees, and my next patient has a swollen knee. I read about atrial fibrillation, my next patient has atrial fibrillation. It’s quite freaky.

·         Snacks. Ward rounds are long. You may not get a designated lunch break. Having a stock of muesli bars, nuts, and fruit on you will get you through long shifts and hunger pangs.

 at home

·         Frozen meals. As much as I try to eat healthy and cook well, sometimes I get home late and/or exhausted, and the last thing I want to do is spend hours cooking. Frozen meals, whether from the supermarket or home-cooked meals, will make sure you get some nutrition, and they’re cheaper than take-away.

·         A comfortable bed. A good night’s sleep will make you a better doctor.

·         A hobby that isn’t medicine. Sometimes, I need a mental break from medicine. I craft, I read, I take long, hot baths. It keeps me sane. Find an activity that makes you happy.

·         Friends and family. You will have days that you need to debrief, you need to rant, you need someone to remind you that you have the capacity to be a doctor. Pick up the phone and call someone who cares about you and loves you. It helps.

·         Direct debit. Set it up for all your bills. It’s one less thing to worry about, and none of us get paid enough to pay late fees.

I hope this helps – feel free to add your own suggestions!

[mylifeasamedstudent]

sexual harassment and medical school: it's not okay.

InAustralia, the Australian Medical Association (AMA) is in damage control. A leading vascular surgeon has come out and stated that female surgeons should endure sexual harassment in order to protect their careers. A junior doctor in Melbourne has spoken up and described the harassment she’s faced by being a talented but female registrar. One of my idols has written a piece about the lack of female specialists in Australia.

Unfortunately, this issue isn’t confined to the workplace.

 About halfway through medical school, we started doing short cases. This is one of the key assessments medical students face, and involves performing an eight-minute examination of a patient, followed by a summary of the key signs and list of differential diagnoses.

Naturally, my colleagues and I, new to the wards, were petrified.

We went to every tutorial on performing examinations, formed study groups, did trial run after trial run. After ward rounds, between clinics, we were practicing listening to heart sounds and percussing lung bases on one another.

One day, we were examining the respiratory system. I was the patient, and a fellow med student was examining me, and another was acting as the assessor.

He had forgotten to examine my chest. The medical student, providing feedback, mentioned this.

“How could I have forgotten those beautiful breasts?” He said, staring at my chest, pretending to squeeze them with his hands.

We just sat in silence. We didn’t tell him off. We didn’t say that such language was inappropriate.

I wish I could say that I’d spoken up and given him a piece of my mind. But I didn’t.

It took more of the same and the prompting of a friend to tell someone. I was scared. I felt dirty. I felt that I was blowing things out of proportion, making mountains out of molehills. I didn’t want to ruin his medical career… or mine.

I did speak up. I was supported by the hospital and made to feel safe within hospital grounds.

But outside of the wards, I was made to feel like the perpetrator. I was forced to see the person that had made me feel like an object. I was made to attend mediations with this person, despite my desire not to, wanting to move on with my life. A black mark was recorded against my name, as if to say that ‘this woman is a troublemaker’. I was forced to rehash this incident to other clinical deans, encouraging that voice in my head that reprimanded me for speaking up.

Unfortunately, this wasn’t an isolated incident, and I know that I’m not the only female medical student out there who has gone through this. I know of women who have gone through much worse, and it’s not acceptable. Every medical student, regardless of their gender, should be allowed to feel safe in the presence of their peers. This culture of misogyny begins young. We need to educate students on what acceptable behaviour is, and that the gender of a medical student has no bearing on their ability. We need to cultivate an environment where women are supported to speak up. We need to change.

I was sexually harassed in medical school, and that’s not okay.

[mylifeasamedstudent]

a few notes on leaving work at work.

A fewnights ago, I found myself wide awake in bed. I’d left work about 5pm, but just before I’d clocked off for the day, one of my patients from the previous day had returned to the emergency department.

I remember hearing her voice from the triage station.

I remembered how I felt the day before, intermittently offering her hope and making her cry.

As an intern, perhaps I was out of my depth with such a complex patient. But that notion was quickly pushed out of my head by a more worrying one: maybe I’d messed up.

Maybe I should’ve asked for help sooner. Maybe I should’ve referred on sooner. Maybe I should have been more careful, consulted the past medical history… maybe I should’ve been better.

I wish I could say I’d only lost sleep over this one patient. But there’s many. The re-presentations. The not listening to my instincts. The patients who I felt I could’ve done better for.

But here’s the truth: you will have days like these. You’re not going to stop having days like these when you become a resident, a registrar, or even a consultant. But you have to trust that you made it this far. You have to trust that you’re doing your best and that you’re asking for help when you need it.

Don’t beat yourself up. Learn from your mistakes. Grow from your errors. And most importantly, leave your patients at work – they need rest and so do you.

[mylifeasamedstudent]

surviving internship: the first four weeks.

Congratulations!You (and I, I might add) have made it through medical school. But this is the beginning of a career in medicine, and it's nothing like what medical school told us it was going to be. Here's my list of tips for surviving the first month of being an intern. 

1.       Have a (healthy) vice. Let’s be honest. Internship is stressful. I’ve spent hours awake at night wondering if I’ve missed something, or if I did the wrong thing, or if I handed over properly, or if I upset my consultant… the list goes on. That’s what makes it paramount that you have something at home that makes you happy and relaxed. For me, it’s a long bath with my special oils. I come home, and after I’ve pottered around, I get into the bathtub and spend as long as I like there. It’s a much better idea than reaching for a bottle every night, and every year, a number of junior doctors sadly take their own lives. Please look after yourselves.

2.       Have a plan. Every time you see a patient, you need to do one thing: decide whether the patient is likely to deteriorate in the next ten minutes. If you’re worried, get help straight away, even if it’s just a gut feeling. No one will be upset if you seek help. But if they’re stable, make a plan for that patient. Come up with a likely diagnosis. Order some basic bloods. Think about what treatment you want to start and look up the protocols. Go re-examine the patient if you think you missed something. And then go to your senior and present your workup. You might be wrong, and that’s okay. But you’re thinking like a doctor.

3.       But ask for help when you need it. You’ve been a doctor for a month. You don’t know everything. Heck, most of the time, I feel like I know nothing. But if you’re out of your depth, or you’re not quite sure, ask for help. If you’ve looked at the x-ray and you’re 99% sure there’s not a fracture, get someone else to look at it anyway. If you’ve put a plaster on a patient, and it’s your first one, get a senior to review. It saves time down the track and it’s an opportunity to learn. Asking for help is not admitting failure, promise.

4.       Nurses rock. Nurses are incredible. On the wards, they know the patients better than you. In ED, they’ve seen a million patients – always ask for their opinion. They’ll often give you the diagnosis. They know where everything is and how to treat most conditions. Ask them for help, learn their names, be friends. It makes a huge difference.

5.       Take everything you’re told with a grain of salt. If your registrar tells you that a patient is coding and needs CPR, don’t question it. But if they start advising you on future pathways and which hospitals are good and what battles you’ll face, listen closely but don’t take their word for it. Pathways in medicine and surgery are changing all the time. Respect the experiences of others but don’t take them as gospel.

6.       You are not as dumb as you think you are. I spent my first three weeks convinced I was the stupidest intern to ever come out of medical school. I was convinced that I made mistake after mistake after mistake. But then I realised: I’m not that bad. Every intern struggles. Just because you think your colleagues are better than you, it doesn’t mean they are. My co-intern today told me about her panic with a patient re-presenting – an exact feeling I’d had a week ago. You’re doing fine.

7.       You are not alone. Reach out to your support networks. Debrief with your fellow interns and leave the house occasionally. Call your parents and your partner. If you’re struggling, talk to social work. Most hospitals have someone to look after staff wellbeing. You’re protected by confidentiality, so talk without fear. And if you’re feeling at risk of suicide or self-harm, tell them that too. They can’t keep that confidential, but they can put you in contact with support people.

8.       Use quiet time to study. Make use of night shifts and lulls to use hospital resources to catch up on study. But do most of your learning on the job – that’s the stuff that sticks. And if your colleague has an interesting patient, go see them as well. Keep learning.

9.       Be nice to the med students. Give them interesting patients. Don’t make them write all your notes. Learn their names. Let them cannulate and take bloods and suture people. They’ll be doctors soon too.

10.   Listen to your patients. Sometimes, patients are exhausted and fed up with doctors. They know you can’t offer them much, but you can offer them your ear. Find out what’s really upsetting them. Acknowledge that you wish there was a magic pill you could offer them. Learn the names of their visitors. Keep them updated about their care. Be a person first, and a doctor a very close second. And social history matters. Social history should be done for every patient, not just in OSCEs.

11. You will have to break bad news. Telling a patient that she's miscarried or that they need to go to hospital never gets easier. Just make sure you have someone to talk to and a way of being kind to yourself afterwards. It's okay to cry and be sad or be angry. It's normal. 

Keep plugging along with internship. We’ll all make it through.