Ritual

First you have to get through the negotiations. You introduce yourself as a student and exchange pleasantries and nervous jokes. You put on your shiniest Bedside Manner, perky and polite. Almost invariably, they consent with self-deprecating good nature. Everyone's got to learn some time, right? I'm happy to help if I can. Yes, thank you so much - I really appreciate it. If you feel uncomfortable at any time, please let me know and I'll stop. Your group and tutor are standing around you, sometimes participating in this exchange, but often just silent spectators at the show.

It's a shifting of power. Once you have given them the semblance of control, you proceed to command them to perform all sorts of bizarre manoeuvres. Could you take off your shirt, please? And would you mind if I pulled your pants down a little further? Is it ok if I put my hand here in your groin? This is someone who could be your grandmother's age, or your father's. In everyday life, you would perhaps nod at each other on a sidewalk, or if you met, you would defer to them as your elder and better. Now, circumstances have contrived that you both meet here, in this place of delicately balanced vulnerabilities. You have to get past your own anxious voices. Am I doing it wrong? Do they all think I'm a tard? Am I making it up, or do I really feel this? Am I hurting them? This is embarassing.

But when you're in the zone, when you've passed all the awkwardness and anxiety and come to focus, finally the physical examination becomes an oasis. The laying on of hands, the strict order of the tests and the calm solemnity recall the rituals of the ancients. Feel a pulse - make sure it is not your own. Put your hand on a heart. Listen. The room is quiet, the clatter of the hospital fades into the background, and all you can hear is the heart beat and breathing. A steady rhythm, almost music. One-two, one-two. It is a moment of strange intimacy.

Month

Was that really less than a month ago that I was considering failure and running away and hiding? Btw I PASSED I PASSED I PASSED!!!! Victory is a little diminished by the suspicion that they wanted to pass us all because of the change in the curriculum. Whatever. The hell of academic semester is over.

Global Health Conference was full on. I can't remember the detailed stats about climate change and AIDS and the exact Millennium Development Goals, but I'm left with the troubling sense of the enormity of the challenges facing our generation, and the necessity of finding out how my own small life can fit in with the solutions. Nelson Mandela, that old fella, has a nice turn of phrase. It's all a bit overwhelming really...fuel crises, food crises, global warming, conflict, epidemics. It'd be easy to throw up your hands and succumb to fatalism, but as one of our speakers said, "we cannot afford the luxury of despair".

After that was Convention...a little ironic, after the heady inspirational rhetoric of global responsibility, to spend a week in drunken stupor and mindless hedonism. You know those Clubbing Montages in movies with the DUBDUBDUBDUBDUBDUB music and the flashy lights and jam-packed semi-naked bodies writhing rhythmically and making out and you go "pffft I'd rather be reading Jane"? Yeah. A week of that. Don't get me wrong, those nights were a blast in a "what inhibitions?!" kind of way (slightly afraid of and slightly looking forward to what photos surface on Facebook), but it's definitely a one-off for me.

There were other things. GP week was good. I didn't want to stab myself in the eye, the work of a rural GP is actually interesting and the area is one I can envision myself working in one day...although occasionally I do panic at the thought of the vast as-yet-unexplored wider world out there, countries I've never seen, whole classes of people I've never come in contact with. The peaceful country life appeals, but so too the call of adventure and worldliness that once made me want to be a languages, politics and law major aiming for DFAT or the UN or whatever the pipe dream of the moment was.

Anyway. My grandma is wise. Whether or not 2008 is actually celestially destined to be a good year, telling me that makes me determined to make it so.

Brainhack

So my brilliant idea of cramweek, aka insantorium, was simply this: a blog about learning. One thing that I was procrastinating about leading up to these Exams O' Doom was how to do learn more efficiently and I came across heaps of different approaches - photoreading, memory pegs, holistic learning, etc, but there was no one resource collating all this. There are blogs for students, but I'd like to focus on the principles of learning and not crap like "sleep before the exam" (pshaw! overrated!). Interesting to me at least, and I'd hope to make it practical.

Will it actually happen? Perhaps. I'll check it out more carefully, see what's already in the field. Been reading up how to monetise blogs as well, and if I do venture out and do this, I want to start if off properly...and that involves learning about SEO (Search Engine Optimisation) and blog techie stuff (CSS and server management crapola) and marketing and all that.

I've recently realised that if I ever do write a book, it'd probably be non-fiction as, alack, I cannot plot and my visual imagination is pretty crap. This is a potential topic. And I've decided that writing a book is one of my life's goals. It doesn't even have to be published. I just want to have the satisfaction. That's the liberating thing about non-fic - it's not a matter of talent. Beyond being able to string sentences together and structuring things, which I believe I can do, it's just perseverance and discipline and finding the right questions to answer.

Damn it's uncomfortable to air ambitions in public, even with, what, 2 readers? This is idle speculation at this stage.

66.66% done!

Today I...

• Had 3 hours sleep before my exam
• Sat one of my first OSCAs where I had to actually TALK to PEOPLE which I was scared about because a) I have not talked to humans for like a whole week and b) my sex counselling video was a total disaster and c) hello I'm an INTP! I hate people! hehe
  
• Was so nervous at some points I wanted to spew my Weetbix
  
• Counselled a fake patient about their herpes test results. I am in love with my tutor right now, because she STRONGLY HINTED that Breaking Bad News would be on the exam, so I actually looked up how to do it and had a framework for what to talk about and was practising "sorry, I'm afraid the HIV test is positive" last night in fact (aloud to myself). It went better than I thought it would. Was grinning all the way out, probably just the adrenaline. But it was like....maybe I'm not actually not as inept as I'd thought. I can do this stuff. I can do people. I listened reflectively! I empathised! And it didn't feel too fake!
  
• Completely blanked on how tiredness would relate to indigestion. Well actually the question was, "how would this change your thinking?" but I was too stuck on reflux to expand to cancer and systemic diseases and haemorrhage. STUPID!
• Had to scurry from the main exam room to the counselling rooms twice. Felt so sorry for the year manager because it's a huge logistics nightmare..they had to shuffle students up and down the corridoor like ten times, and sometimes people were too dumb to realise it was their turn, or went over time. There were walkie talkies involved and they had to co-ordinate timing and stuff.
  
• Took lollies from a stranger
• Took free tea
  
• Got into a car with an acquaintance on a whim, cos he asked if we wanted to go to lunch. The food was semi ok though we did have "what meat is this?" *taste* "I still can't tell" issues, but it was fun talking to people I don't know well.
• Told a guy he reminded me of my seedy uncle. hahahaaha he so does. He's our The Todd...a wannabe beefcake, real Alpha Macho "I like beer and cars and guys who don't are faggots" type. So closeted. Hilarious though. He smokes! We just did lung cancer, emphysema, ERECTILE DYSFUNCTION, diabetes and osteoporosis, and he smokes!
  
• Had to amuse myself on blank OSCA stations. I did half a sudoku and some word thing, but that somehow made me more stressed when I couldn't think of a three-letter colour ending in e, so gave up. Then I made a paper plane which I really wanted to fly, but that would probably be against the rules or something. So lots of the time I sat with my eyes closed and played air piano. That was calming. Also this breathing technique I learned from Mind Performance Hacks...you take deep tummy breaths in for 3 counts, hold for 3, out for 3. Stops the hyperventilation.
  
• Surprised myself at being slightly disappointed that this guy I know has a girlfriend. I never thought of him as potential! Not that he's that attractive, he's just the nerdy semi-weird but nice type I'll probably end up with.
  
• Wondered if the faculty made the questions less demanding this year because they don't want to fail anyone since they're changing the curriculum next year. They're dropping the Regional Rotation would you believe?! This is "We Need YOU to be a rural GP!" Newie we're talking about! And it's entirely for logistics not educational rationale. What a shame. The clinical stuff is, I hope, what will make us think of ourselves as Doctors to Be for the first time, and prepare us more for the real world than this "sit in a room for a week and cram" bit. Shame on you, Newie! This is partly a result of government policy I think. Making new places in med school sells well politically - "look, new doctors on the production line = totally the solution to the shortage!" - but there's the small matter of the hospital system accommodating for the extra training that we wide-eyed wet-behind-the-ears types need. And seriously? GP community placements won't cut it.
  
• Practically danced out of the exam. Such a weight off my chest. The written parts were ok, and regardless, having the two OSCAs out of the way means this hell is almost over.
  
• Asked someone how they coped with failing last year. I'm surprised at who fails. Some of them are obvious slacker "I accidentally got into medicine" types, but then there are also the really studious and serious Malaysians, as well as the outgoing and at least verbally impressive types who teach anatomy and stuff.
  

Ahhh. Such a turnaround from last week. Some of the conclusions I drew then are still true, but I'm on less of an emotional hair trigger now. There is hope. There is life beyond Wednesday. This career is not a trap.

Holyfuckingshit, if I pass these exams, I am HALF A DOCTOR. Or at least half an intern. Dr T-Dizzle. Snort.

Rosebush

A portrait of a nervous breakdown. In the past week, I....

• Attempted to cram: dermatology, ophthalmology, diabetes, endocrinology, hepatology, nephrology, orthopaedics, immunology, infectious diseases, cardiology, neurology, respirology, rheumatology
  
• Burst into tears multiple times, including weeping at the piano
  
• Seriously contemplated skipping the joint and running away to do volunteer English teaching in South America, to Find Myself and fucking rebel for once.....to the point of wondering how I can get a debit card and what kind of camping gear I need
• Stayed up til 6-7am
• Studied in bed, in the bathroom, in the kitchen, on the dining table
  
• Did not do any exercise beyond going downstairs for food
  
• Read about 1000000 pages of notes and realised just how many lectures I napped in...the handwriting would start off impeccable and then deteriorate to scribbles by the end, heh
• Relived some of my and Ru's intra-lecture exchanges via our margin graffiti
  
• Thought about what I wish I'd told my first-year self: 1) from the beginning approach med as if you were gearing up for the physician's exam, to be a Real Doctor...rather than studenty "I just wanna know enough to pass" or "this isn't on the curriculum" attitude, 2) COLOURFUL PENS and highlighters make a world of difference to how much you feel like studying....typed notes in table format are boring, 3) reading up BEFORE the week starts makes you feel smart and feeling smart makes you study more and studying more actually makes you smarter.
  
• Drank a LOT of Irish Breakfast, English Afternoon and Earl Grey tea
• Obviously peed a lot
• Wondered if I should take the USMLE boards just to solidify my knowledge in the basic sciences
  
• Learned that apparently bee venom is good for fatigue in MS
  
• Wore the same clothes for about 4 days straight
• Undressed to go to shower only to realise that my mum had set the house alarm and had to run downstairs, redressing on the way, to turn it off
  
• Practicised that Granados Oriental piece a bazillion times. Still got to do the middle bit, but am getting pretty good at the first bit except for that fiddly trill
• Did not leave the house for an entire week
• Drank about 12 boxes of lactose free chocolate milk (not that I'm intolerant, it was just free at the GP convention)
• Hit my head against desk
• Snapped at my mother
  
• Talked to myself, a lot
• Ate a lot of mandarins and bagels
  
• Wondered if Jerry blogging was a three-year cry for help
  
• Invented retarded mnemonics like "quatre femmes sit on your lap doing high kicks" (quadriceps, femoral nerve, anterior thigh, extension) (ok, I'm actually proud of that one. the stupid ones are the ones that I make up and then promptly forget)
  
• Realised that I hate medicine and the only things stopping me from ditching it are 1) debt - this bonded thing is a MORTGAGE ON MY SOUL, 2) all these textbooks going to waste, 3) my grandma would be really sad
• Realised I actually enjoy some of medicine and want to be good at it and in my dream "running away to S. America" scenario I'd bring my OHCM
• Discovered that I like pathology (though not the microscope aspects, the mechanisms) and microbiology (cos bugs have identities) and immunology (very logical, fits warfare metaphors well). I hate rote rote rote learning anatomy and drug names
  
• Went outside at 5am, thought about jumping in the pool with my pyjamas on
  
• Considered my extra-academic marketable skills and came up with...diddly squat. Well I can type, write ok, speak French halfarsedly.
  
• Prayed to, and railed at, god...who, by the way, hates humanity, going by some of the horrendous diseases I've seen
• Did nothing but eat, drink, poo, pee and study for days on end
• Told myself I'm a fucking idiot because I'm 22 and all I've done is study and I'm going to fail at that which means I fail at life
• Realised that failure could be liberating and motivating and a Life Experience because I've had it all my way til now...a test of character
  
• Napped on the floor of my study
  
• Decided I need a life: closer friends, diverse interests, a job, LOVE SWEET LOVIN'
• But decided I'm not really ready for the latter til I'm totally happy with who I am, which is not yet
  
• Realised that I have never strayed from the path of least resistance in my life -- never made an autonomous choice, never acted against the destiny set out by my milieu (school, uni, make money, consume)
• Was cheered by reading silly forum posts on the internet
  
• Helped a friend do her job application letter
• Wondered, in the darkest depths of 5am self-pity, who I could call for Listen&Support at such an insane hour...but as always, kept myself to myself
  
• Got really excited about a potential new blogging project and procrastinated for a bit drafting up ideas and posts and thought about how I could even maybe turn it into a book
  
• Woke up the next day and reconsidered it and thought it's probably stupid
  
• Wrote half a post about how my family is totally fucked - >80% divorce rate, some multiple. Also realised I have no blood aunts! Well only one, but she's estranged.
  
• Tried to meditate
  
• Realised that this is all bloody self-indulgent and melodramatic because I have had it so damn easy: parents and grandparents who love me, money, education, health, opportunity...a giant big fat cushion of privilege...not that it was much comfort at the time
• Realised that one day I'd look back and laugh in disdain at myself for thinking that THIS was stress
• Was told by my grandma that according to astrology this year is meant to be a good one for me....hahahahaahahahaha right.
  

Phew. Catharsis.

Earworm

And possibly fingerworm as well, I just spent an age digging up a free score for this piece. Tis Granados, Danza Española No. 2, Oriental. It kills me.

Piano: the first one I found was by this 11 year-old girl. While it's prolly a bit less polished than this other woman's version, I love how she's really into it. Also, dudes, 11.


Geetar:

It's great being able to compare versions on different instruments. I reckon the guitar one is more romantic and soulful, cos they make up for the instrument's relatively limited dynamic range with sensitive phrasing and flexible timing. Or something. I'm only just beginning to work on my classical ear after x million years/dollars of music tuition. The slides on the guitar make it more lyrical as well. Sigh.

Why is this piece so familiar and haunting? I have a feeling it's from a movie. Godfather? I've definitely heard it before. Only came upon the title by chance, listening to ABC Classic FM: Up Insanely Late. Digging that channel lately. In my car I've got it programmed along with Triple J and Today FM. In company the cooler ones are chosen; alone I wind down the windows and blast me some harp action.

PS for Chris: I SAW A MOUSE IN MY ROOM!!! The first time it was exiting. The second time it was coming in. Errrr.

Candles and other obvious metaphors

So, radio silence.

What I haven't been saying here, or rather what I've been saying by not saying anything here (are we following?), is how I'm terrified that med is not my One True Vocation and that I'm going to turn out to be a incompetent doctor, bitter and resentful at how it's taken up my life.

I think it's partly because of our lack of clinical stuff this year so far, with hardly any patient contact. Buried beneath the books, the weekly grind of Working Problems, it's easy to lose sight of where it's all leading. I fear that I still don't own medicine; being a student doctor isn't part of my identity. Compare this with learning French- it is a part of me, it was my passion (at least for a while). Whereas with med, part of me is standing to the side, half amazed at what knowledge I have managed to pick up, half bemused and terrified at the thought of one day being Dr Tina. Who, me? What a ridiculous notion. With my heart not really in it, I was afraid that I would be a half-ass doctor, knowing just enough to get by, fooling the less critical of my patients. And that's just not what I want out of life; I want to be brilliant at what I do, passionate, absorbed. Sure there are doctors who can do other things at the same time, like my hero Oliver Sacks, the great neurologist who's written about things as diverse as music and botany. But I don't have that kind of protean genius; I know that just getting to grips with the mountains of med knowledge will take up most of my efforts, leaving my other interests by the wayside.

Also, med frustrates my desire for creativity and Making a Difference. You're at the coal face, applying other people's technologies and research, with your impact being limited to the patient in front of you, basically working as an algorithm-churning machine. Yes, it is a noble and important job and satisfying in its way, too. But it's constrained. The scientist who invents a new vaccine, the politician who brings in universal health care, the teacher who shapes a class-full of young minds...that's how you multiply your impact. Yeah I realise how grandiose and naive that sounds. I know my limitations, but I want to use what I've got for the greatest effect and satisfaction.

In short, I felt trapped. Trapped by the 5 years I've already spent at uni, the $100k debt, the expectations of family, the 5 years of Bonded practice and at least 7 years of advanced training awaiting me. So I've been idly surfing for alternative lives. An English-for-foreigners teaching diploma, a correspondence course for a Grad Dip Psychology.

These worries have been sloshing around for months now, and I never thought to speak them to anyone. It's taboo. Then yesterday had a chat with Chris. A light of hope! She told me that she too has doubts about clinical med being her life's work. I'm not alone. She's interested in business, finding a niche to fulfill future healthcare needs. Now that is exciting stuff, where new ideas are possible. She wants a non-profit branch to her biz too, and suggested that I be part of that, doing some kind of travelling medico-journalism kinda thing. What a pipe dream, what perfection! It's so obvious. One of my main objections to Being a Writer (ooh la la) is that I'm crap at making up stories. But lo, there are many stories in med. As I was reminded today- we had a palliative care placement, and oh how it was lovely talking to a patient. With 10 years of cancer but still seemingly well, he told us about his love for the bush and his career as a forrester, his worldwide travel, his passion for Schubert and art. In fact he's going to Sydney tomorrow to buy a Schubert CD of the most beautiful piece ever, he says. So among my notes about his medical history of hip replacements and diabetes is a citation for Piano Sonata in B flat, D960. Have a listen (I downloaded the Lipkin one). I dunno about "best evah", but it sure is beautiful, especially the second movement. For Friday I've volunteered to be the one quizzing him about the psychospiritual stuff (what a silly term for "what do you think about dying?").

Whether or not these are impossible dreams, suddenly the trap seems less deathly tight. The inevitable bitter end - haggard repressed half-assed GP - doesn't have to be that. There's something to work towards and hope for. I'm reminded how I convinced myself to get into med in the first place and it doesn't seem quite so self-delusional- that people and their stories are pretty damn awesome.

Now for the "study and pass" bit.