Having a Bad Day?

Medicine is a constant reminder of how fragile and unfair life can be. Life can throw curve balls and do some pretty unexpected things. I was in clinic and met a lady who is 40 years old and have been getting treatment for cancer. Unfortunately, it has been found that it has metastasised to other parts of her body such as her bowels and her lung. What really struck me was that as I entered the room, having read the notes before seeing her, I was expecting a frail lady who would look quite ill. Instead, I was greeted with a very healthy looking lady. If I had seen her in the hallways, I would not have guessed she had been battling cancer for almost 2 years and now facing another fight against the metastases. While going through her medication list, she was on high doses of analgesics and one can imagine how much pain she is usually in. As we got further into the consultation, what once was a calm looking lady turned into a nervous and worried person. She is supposed to undergo radical surgery in a few days and I really do not blame her for her nerves. I was taken aback by how calm she was at the beginning. It really puts things into perspective. I had a bad week last week with back pain, but after hearing the patient's story, my back pain seemed like nothing. It is nothing compared to what she's going through. And it really amplifies the fact that if you think you're having a bad day, there are people having a much worse day than you. It's easy to forget how fragile life can be. 40 year old woman - most are fit and healthy. Cancer is something still seen as a disease that affects the older population. It was inspiring to hear about her fight and her courage. Pretty sure I didn't whine/complain about anything for the rest of the day.

Life can throw curve balls affecting you physically and your health. But I wanted to talk about mental health. By being in a stressful job, it is important to keep your mind "happy" and not allow work overwhelm you. Your emotions can greatly alter your way of  functioning. Recently, there has been a lot of mental health awareness campaigns going on especially back home in Canada. I personally know quite a few friends affected by mental health issues such as depression. I thought it would be worthwhile for me to write a mini blurb here and raise awareness to those who read my blog. Statistically, about 1 in 4 students are affected by depression and approximately only 1 in 4 people seek help. The main reason for the lack of seeking for help? Stigma. Mental health is still a "taboo" subject and it shouldn't be one! It is a common problem affecting many people. Not many people want to speak up and get help. You can't just "laugh" off depression or mental health illness. I know way too many people suffering with this. What bothered me was how even in the health service, health professionals are almost afraid to ask about psychiatric illness. The number of times where I've seen various professionals very quietly ask if there is any history of psychiatric illness or if he/she suffers from depression. We ask about heart/lung/bowel problems loud and clear, but when it comes to mental health it gets all "hush hush". If there wasn't this "stigma" surrounding mental health, will there be more people seeking for help? I would like to think yes. I've had friends who suffered in silence and I have nothing but praises for those who gathered enough courage to seek help. From what I hear, it can get very dark and lonely. There is so much help out there. People shouldn't be suffering in silence. Stigma is unacceptable. The reason for raising awareness is to eradicate the stigma associated with mental health. 1 in 4 people are affected. That is common. Look at your group of friends. Live in a house with 3 others? Do your part and raise awareness.

Request: The Future.

There was a request from one of the readers here asking:

"What are you planning to do after medical school? It would be great to get some insight to what Canadian medics plan to do after their studies in the UK."

To be honest, the future can always change directions and I know I will have to be prepared for anything that life throws at me. My first choice is to stay in the UK and do my specialty training here as I know the system,   and I have gotten to know quite a lot of doctors who can give me advice for the future. I will try my hardest to stay in the UK, but laws do change. Hopefully the law won't change to prevent international students who study in a UK medical school from practising in the UK. In my eyes, I have spent 5 years in the UK. Moving isn't easy. The last thing I want to do is moving back and forth between countries. When I set my mind to something, I like to stay on that track and I am a very determined and ambitious person. In a way some people see it as stubborn, but I set goals for a reason - it is something for me to look forward to and to work towards to. I used to be quite a high level athlete and giving up is not an option. I do not like to stray away from the goal and when I do, I do get disappointed. I set high standards for myself and yes I know staying in the UK will not be easy, but I have set my mind to it. I have moved my life over to the UK and I personally don't see much of a future for me in Canada.

Now I may be determined and ambitious, but I'm not going to shoot myself in the foot. Always have a back-up plan. Things can go wrong. Life can throw a curve-ball at you. Rules can change. Who knows. The future is unknown and the most you can do is to be ready. Yes I have my mind set to stay in the UK, but I am still planning to take the Canadian MCCEE so if push comes to shove and I have to go back to Canada, I can. Nothing worse than ending up jobless and stuck in that awkward grey area.

I know quite a few international students wondering about taking the USMLE. (Note: I am not trying to start an argument/debate with this topic - just a personal opinion. Sorry in advance if anyone takes this persona/finds it offensive...) Who doesn't want to live the "American Dream". So why am I not taking it? Because I am not seeking for the "American Dream". To be very blunt - I do not care for working in the US. Some people see it as a great opportunity to make some good money. Some people just like the environment more. How I see it - if you are looking for the "American Dream", I'm sorry to break it to you, but in today's economy - there isn't much of an "American Dream" anymore unless you become a very famous doctor. The US is a very competitive place. Remember not only do you have to take a sickeningly hard exam, but you also have to score well in it. There's no point in just scraping a pass - you have to have a competitive score to get a desirable job in the US. I personally have my mind set on a specialty and it is a very competitive specialty. If I wanted to go the US, I would actually have to ace the USMLE. I don't want to end up working in some small southern town in the states in the middle of nowhere. The UK schools aren't geared to take the USMLE. UK medical students are geared to become practising doctors...not to take a US registry exam. That means students who want to take the USMLE, have to spend a lot of extra time to study for the USMLE alongside with their UK course work/exams. It is a very tough thing to juggle and you really have to be determined to go to the US and be committed to do well. So do your research.

Having said that, those who are determined to go to the US and have their eyes set on the prize - will probably do well in the USMLE. These people would probably take the exam seriously and study hard for it. Some might not really care what specialty they want to go into. These people will probably get a job in a desirable location. I'm sure I wrote a post about priorities before. Personal preferences and priorities - what is important to you, may not be as important to the person sat next to you. To make your priorities work, you will have to make sacrifices. At the moment, my #1 priority is to get into my desired specialty. This will probably require me to make quite a few sacrifices as it is a competitive field. The most likely thing I will have to sacrifice is: location. Someone else who wants to do the same specialty may see location as a huge priority. He or she may rather stay in London than do specialty X or he/she may not mind doing specialty Y in order to stay in London. It is all down to you.

All in all, the future is a personal thing. Everyone has his/her own path. No one path is the same. Know your priorities and stick with them. Don't let someone else alter your priorities or talk you out or into things. It is your life at the end of the day.

Old Age.

Had quite a weird week...weird as in a week which really made me change my perspective on things.

I got to go visit a nursing home for people with dementia. I had previously volunteered in a nursing home before medical school but I didn't work with patients with dementia. I went to visit a 75 year old man who has vascular dementia and had just moved to this new home. The nursing staff were worried about him as he had spent the entire night pacing up and down the hallways continuously for 15 hours non-stop. I went into his room and sat down in front of him. His room was fairly small. One single bed. One small wardrobe in the corner. 1 night stand. 1 cabinet. This man just sat in his chair, hunched over. He wore a baseball cap so I couldn't see his face. As he sat there I saw him dribbling on to the floor. It was almost like he wasn't even there and was staring at his shadow. I looked over to his night stand and saw 2 pictures of him and his family. In the pictures, he was middle-aged and appeared to be a very proud man. He stood in the pictures full of confidence. He looked very happy. Then I looked back at the patient, still dribbling and staring at the ground. He looked quite frail. I eventually said hello to him and he didn't reply. I moved his hat a bit so I could see his face. He still stared at the ground. I asked him what is his name and he replied me without looking up. I tried to carry out a very basic conversation with him, which proved difficult as midway through he started mumbling. I couldn't quite understand him and he quickly stood up. He walked to his wardrobe and was very unsteady on his feet. He had a very unbalanced waddling gait. I asked him where is he going and he replied: "Home". I kindly told him this is his home and to sit down again. As he came back to his seat I looked into his eyes and he didn't look happy. He didn't really even look like the man in the picture by his bed. As he sat down, he went back to staring at the ground and stopped talking to me. I just sat there looking at him. I thought to myself: Is this how residents here pass their day? I found it pretty sad as they just sit in a fairly tiny room. This particular man, if he isn't pacing up and down the hallway, he is sat in his chair almost lifeless. Really made me think that people need to live their life to the fullest. Appreciate the things and people around them. I felt bad for this man. His life seemed pointless. He was confused. Ageing is a scary thing. Just comparing this man to the man in the pictures - it is almost like night and day.

Then when I went back to the GP practice, I met another lady who desperately needed a total hip replacement. Her x-rays showed severe osteoarthritis (OA) as in it was bone on bone. The patient had a shortened right leg as well due to the OA. On palpation of the greater trochanter...it felt like you were running your hand over a bag of marbles. You could feel the osteophytes! Range of movement was severely decreased and the patient had pain on extension and flexion. Actually any movement made the patient jump. It was fairly remarkable that she doesn't need to use any aids to walk, but you can tell she is struggling. Unfortunately, the surgeons do not want to operate on her due to her health and as well she does not have anyone at home to look after her. She told me that she has outlived her entire family and there was no one left. She explained to me that she tries her best to get through the day, but usually just stays at home to avoid any hassle and because her hip hurts too much. She has tried all sorts of analgesics and even tried topical treatments (which doesn't work, which is no surprise as her hip was bone on bone). I asked her what does she do every day if she doesn't really go out. She told me she just sits there and read and told me that her life has become very boring and that there isn't much meaning to it any more. She talked about how active she was when she was young and gradually as her hip got worse, she couldn't go out for walks in the park or even do her gardening.

If you think about it, when I start reaching the peak of my career, the majority of my patients will be the elderly. In general the population would be quite old as the current generation of "baby boomers" are starting to reach retirement age. I think it is key for medical students to learn how to deal with the elderly. It is frustrating to hear students go: "I don't like old people. I hate talking to them." I sometimes can't help but say back to them: "Well start liking it as the population ain't getting any younger." I'm sure I have said this before,  but I quite enjoy talking to the elderly. They always have a great story to tell or have some pretty wise things to say to you. They are all so strong as they have been through so much. They seriously need a heck load more respect from people of my generation and the younger generations. Ageing is the fact of life and there isn't any way to avoid it (well unless something really tragic happens to you at a young age...). Sometimes it is just hard to see what the future lies for you when you see so many elderly patients.

Doh!

Interesting and short week of paediatrics. Had Monday off as I was in for 9-5 lectures. Tuesday..can't remember what happened...obviously nothing exciting as I would remember. I was on-call again on Wednesday so I was in the hospital from 8:45am - 9pm. It was also my SHO's last day and to be honest I think he was really great. Probably the few doctors that really made us medical students feel very welcomed and a part of the team. He's also really good at teaching too. Really smart dude. As a medical student, the biggest worry is being left out from the team. It's already nerve-racking to step into an unfamiliar environment and have no clue what you're supposed to do, so when a doctor welcomes you and teaches - you feel much more at ease and it really makes a huge difference to your experience at the hospital.  It was also nice that he could remember our names and it really helps with making us feel welcomed. Great thing about this SHO is that I understood him. I knew when to bother him and when not to. And it seems like he too knew what I was like. Seriously, some of you may think I'm really hard working, but I am definitely not the hardest working student to have graced medical school. In fact, I'm quite lazy (blushes). It was interesting how my SHO could tell that there are times where I don't want to do anything and he lets me be. It was like we were on the same page so it was good we had this mutual understanding.

Took quite a few "tea breaks" during my on-call so I got to talk about life as a doctor with the SHO as the ward wasn't too busy either. It was eye-opening. But the conversation soon led to a massive "DOH!" moment. Out of no where I was asked: "You don't like Paediatrics very much do you..or this attachment in general right?" I was actually left speechless. My face was probably a mix of a dead pan with a "DOH" moment. Secretly inside...I haven't really been enjoying this placement very much as in general I'm not very interested in Medicine. I really miss going to theatres and watching surgeries as I find it much more interesting and exciting. I have tried my best to put on an enthusiastic/keen face during this placement, BUT apparently it is fairly obvious I don't really like paediatrics. Another interesting bit is that the SHO could tell what I wanted to do in the future. Haven't told him what I was interested in and he randomly was like: "You're definitely going to do surgery. It's written all over you." And for some of the followers of this blog, you probably know I want to do Orthopaedic Surgery in the future so it was nice that people can see I want to do surgery. On top of that, the day after, another doctor went up to me and was like "You don't like Paeds very much do you. It's like written all over your face." Cue another "Doh!" moment. I even asked if it was that obvious and everyone around me was like "Yes." Soooo....it probably means my supervisor/consultant can also tell I'm not really enjoying the attachment. Honestly though, I'm not HATING it, but I don't love it either. I'm quite indifferent about it and I do realize I'm quite awkward around kids as I don't know what to do with them. Guess it's something I have to work on...and I am trying quite hard though...guess that's what matters.

Next week there will be new SHOs starting on the job and meaning starting back at square one with trying to get on with the new doctors. Life is always full of changes and you just have to keep adapting. Also being a medical student you constantly have to remind yourself that you're at the bottom of the ladder and you really have to work hard to get noticed. Note to self: Stop making it so obvious that I don't like kids.

Summary of my 5 weeks at Medical School

Sorry for the long wait!

First I want to say good luck to all the 2010 medical applicants! Hopefully you'll be hearing from your universities soon!

So far medical school has been A LOT better than I thought it would be. I always hear that medical school is EXTREMELY busy and tough. I cannot confirm the tough bit...yet, but so far the work load has been pretty moderate. I have seem to already enjoy Surface Anatomy lectures and practical activities in the dissection room. I always get excited when I see either of these on my timetable. At the moment I have seem to found a new enemy: Biochemistry and Histology. Biochemistry because I felt like we went through it way too fast but I think we are going back to it later in the year to study it in more detail. I was told that the first eight weeks are still like module introduction, where we cover almost everything that we will be doing this year. Not too fond of histology, not because it is hard or anything, but this is where we have to do online practicals at home. I have been finding them quite annoying as it is quite a challenge to find the answers to the questions. Plus it takes a really long time to complete like what...ten questions? We are allotted two hours to do the histology practical so that kind of gives you an idea why I find histology slightly annoying.

Social wise I am loving it! I am glad I have made lots of friends who are very nice. We hang pretty often and we usually go have lunch in the union or something after our morning lectures. So far I have went to all the medic socials:

Freshers Foam Party
Medics Fancy Dress Pub Crawl

Yes there has only been two events for us medics BUT the two events were AMAZING. The MedSoc really put a lot of effort into these events to make sure we all have loads of fun. Plus who does not like a nice discount at the bars during these events. From time to time I do go out with some of my friends at night to go sit at a bar and play some games. Pretty fun. Great bonding time too.

So far I have learned to keep up with your lecture notes and do your recommended reading (especially before practicals such as dissection)!!! Every week I would type up all my handwritten notes and merge them with the lecture powerpoint that is always posted up on our med school website. I guess I just want to do these notes for the future as when it comes exam time I don't want to be trying to remember stuff I did in September. But yes do your recommended reading so you don't get lost! Feel really dumb at dissection when you don't even know what topic you're learning about for the day...so avoid it by reading!

I shall end this post as it is getting long...and boring...but I will try to update more often. Maybe sneak in a interview tips post...which I should have done quite awhile ago.

Officially to be a Med Student!

Right...I'm a total newb at this blogging thing so please bear with me. Anywhoooo, earlier today I have officially been given an unconditional offer to study Medicine in England. I was so relieved to finally see the word unconditional crammed in the decision section of my UCAS.

So I just want to give a brief introduction of what my blog will be about. For the next few weeks, before I officially start university, I will be blogging about the process of applying to medical schools in the UK and the experiences I have been through. Hopefully the tips I'll be giving out will be helpful.

Later, once uni starts, I will begin to blog about my life as a med student and the ups and downs of my uni life. As the title says: "The Crazy Life of a Med Student", I will probably be bogged down with work and essentially will be pretty crazy. Hopefully first year won't be too bad.

If you don't know me well here's a quick and brief introduction. I'm from the great land of Canada and specifically live on the beautiful West Coast. Why did I choose to study Medicine in the UK? Well I really enjoy the course that they offer and how it is so direct and pertained to medicine while in Canada you will have to do an undergraduate degree first and learn about general science/any other thing. I am pretty passionate to study medicine so I felt that studying in the UK is what suits me best.

Anyways I don't know what else to keep typing about...but I will start doing up uni tips probably tomorrow if not the day after.