The Day I Cried in Hospital

Yesterday was a bad day.

It’s been a bad couple of weeks, emotionally; me being weaker than I ever thought I could be. I’ve been able to retain my composure mostly.

However, during ward rounds our consultant looked up disinterestedly while I was presenting a rather interesting patient and said, “Today is your last day, isn’t it? So why is it that you can’t calculate the feeds of these children?”

© Jill Greenberg, “End Times”

At the beginning of our rotation my partner and I had asked the sixth years to teach us the formulae for feeds. They tried kind of half-heartedly and told us that it wasn’t part of our outcomes. The registrar  agreed.

So I responded, not in a sarcastic tone, “I’m sorry – I was under the impression it was only part of the sixth-year outcomes.”

And she responded, “I’m sorry, how old are you?”

She then went on a tirade of how even if it wasn’t in our outcomes we should have learned it. Her tirade consisted mostly of personal insults.

We committed to reading it up and moved on to my next patient. And then my eyes started tearing. And my voice got all husky.

“Sorryitsbeenareallybadday canipleasejustgocalmmyself”

And out I went. In tears. They were big violent sobs.

It was kind of embarrassing. I don’t let people who don’t know me get me down. I’ve never cried in a clinical setup, not even when a patient died. I wait for the privacy and security of my room.

I don’t know why this affected me so much. I guess it doesn’t help that for the past two weeks, we have been mainly ignored by the rest of the team. Our (valid) questions go unanswered. Our input into difficult diagnoses is ignored. We had three OSCEs today, and not once were we told what to expect. Not once were we tutored in anything except breastfeeding and X-rays.

So after really going the extra mile for a team that seemed to be inconvenienced by our presence, I guess I didn’t feel they reserved the right to scold us for not sniffing that we were expected to know something.

I managed to calm myself down, but every time somebody made eye-contact with me the hot tears welled up. I have cramps in my jaw today from clenching my teeth so much.

It didn’t get better after hospital. I was teary for the rest of the day.

It was weird for me. I don’t cry a lot. Ever.

Consultants are mean, and often. I don’t mind being grilled for answers. I find it thrilling, actually. But personal insults in a professional environment are just so… unprofessional. Here’s hoping I’m stronger next time.

Ectoparasite Infections in Art, Literature and History

Because today is a study day (and I would like to study, for once), today is a quick post.

One of the chapters in Dermatology is about ectoparasite infections of the skin. These include crabs (Pthirus Pubis) and fleas (yes, humans can get fleas).

And, just to show how relevant these are, here is your daily dose of fun, in two portions.

Med School: The Reaping

They supposedly do this thing at the beginning of medical school:

Look to your left, look to your right. Only one of you will graduate in the allotted time.

I don’t remember them doing it for our class, three years ago. I used to think it was because they were committed to getting us all to the end of med school in one piece.

Nowadays, I think I may just have bunked that lecture. Or fallen asleep during it.

Of my original clinical group, only two of us remain. One person may not even be in my year anymore, soon.

I have seen brilliant medical students not only fail, but get excluded from their course. These are students whose notes I have used to study for exams. These are people who taught me to draw blood or put up an IV or resuscitate a patient.

I understand that medicine is a tough field. I understand that doctors hold the lives (and livelihoods) of their patients in their hands. But I have to wonder if we are assessing whether one is a “good doctor” correctly – if people like me get to stay, and people like them have to leave.

This is South Africa. We cannot afford rotten doctors. But nor can we afford to produce so terribly few doctors.

I am seeing some of the best doctors being removed from this profession before they are even part of it. And there is nothing I can do about it.

I am now half a doctor

I suppose it is appropriate to share the good news on Thanksgiving, even though we do not really celebrate the holiday in South Africa: I passed my third year final examinations.

If you have been following this blog, you will know that I started the year with the will to be a “better student” and it did not always work out too well. Third year ended up being a little tougher than expected. Regardless, I am thankful that I get to enjoy my short summer holiday without studying for a rewrite, and I am thankful for the myriad of people who have supported me throughout this year.

When on holiday (or procrastinating), I like to pretend that med school hasn’t swallowed up all of my creativity. This was the product of my recent dip:

I am thankful for all those who stood by me and told me that no, I wasn’t an idiot.
And I am thankful that the first three years of med school are over.
Now, on to the next three.

Studying for one more 271-module…

I do not enjoy the Cardiovascular System. Which is a bit of a problem, seeing that I’ve been told The Boy’s father is one of the best paediatric cardiologists around. Pray he never sees this blog then.

The problem is that the CVS is just not interesting. You may remember previous posts when I was studying for previous exams – subjects that were a real struggle for me – but there were tonnes of interesting tid-bits. Cardio, not so much.

And that says a lot, coming from someone who, when she was younger, often thought she was dying of a heart attack or some arrhythmia.

ECGs are quite a big problem. I always knew I should pay more attention in physics at school, but I never imagined it would come back to bite me in the ass in this manner. Electric stuff especially was never my favourite.

I have acquired an awesome little booklet called Making Sense of the ECG by Houghton and Gray (wonder if he is related to THE Gray? Or was that Grey?). This booklet has been a life-saver. I am actually beginning to think that ECGs are perhaps not so bad. Not interesting by a long shot, but not so bad.

I have also been trying to study the work in an integrated manner. It is the way a patient will present and also a way that makes understanding much easier. Like: Atrial Fibrillation is the failure of efficient atrial contraction, resulting in fibrillating waveforms on the ECG (a saw-tooth appearance). Can lead to haemodynamic instability and thrombus formation. Possible prescriptions include Beta Blockers and anticoagulants. If the patient is asthmatic, try cardiac-specific agents like Atenolol.

By the way, a lot of the above is probably only half-true. Don’t judge, I’m still studying and I have a week left. Like at the moment it seems like it is not actually the Myocardial Infarction that kills, but the often-resulting arrhythmias, like ventricular fibrillation. Maybe when I study a bit more extensively I will find that this is not completely true.

At this point, a message: attend your classes, kids! I definitely didn’t attend enough of them, which is why I am struggling so much. In 2011 I will be a better student!

My mom bought me some awesome coloured pens in a really cool pencil case made entirely out of a zipper. Man, I love being home for the holidays. I have quite enjoyed making pretty notes and my family has offered much support. Shame, I have been quite a grouch towards them…

I am a little bitter at having to write this exam in January, but it was my own decision. I attended International Rotary Youth Leadership Awards in Montreal, Canada in June and in order to attend, I had to request a deferred exam. It was totally worth it though, but I really need to pass!

Tomorrow (Friday 31^st) marks a week to the exam. I cannot believe I almost need to return to Cape Town. I definitely need to find some enthusiasm (or enthusiasms, as a dear teacher of mine used to say) within the next week.

Mobile update

I am going against everythong I stand for and posting a post from my Blackberry.

I have been meaning to write for the past ten days, but I just don’t get to it. One must be sociable when on holiday, you see.

Oh, I am home and it is amaaaaaazing.

Anyway, I PASSED MY EXAMS!!!!!!!!!!

I found out on Monday. I didn’t do great but they are all definite passes. Also, I ALMOST cum laude’d my OSCE! Next year I want to Cum Laude them all.

I shall add more news soon, but thoight y’all should know I passed.

Also, I think my cats may have organophosphate poisoning.

We fumigated the house today and the pestmaster said all would be fine in two hours’ time. But they were froting at the mouth and they have midriasis. Although midriasis is consistent with adrenergic and not cholinergic poisoning.

I am worried. Also about the people here at home….

An awesome video, some humerous insight into my exams

So I wrote Urogenital System on Friday and Reproductive System today and I think that I now know everything about urology, gynaecology, nephrology, genitalia, reproduction, neonates, genetics, pregnancy and breastfeeding. I have Endocrine System left on Friday and I am exhausted.

My friend introduced me to “Amateur Transplants”. They are hilarious! Check out this video, it rings so true. Be warned that it’s not 100% clean though.

Today I went to Parliament…

Today I went to the South African Parliament. The student governments from four Western Cape Universities were invited to participate in a discussion with the Committee for Higher Education (which in turn advises parliament and Blade Nzimande, Minister for Higher Education).

The Parliamentary building is really beautiful. It has an air about it that still makes me wonder about politics and law as a career direction. Then again I think I’ve proven that studying medicine need not restrict your interests.

Accessibility of Tertiary Education by poor, deserving, undergraduate and postgraduate students.

Some really interesting points were highlighted by the different SRCs for this debate. These included:

1. Encouraging public-private partnerships to make university-funding more accessible
2. Revising the National Student Financial Aid (which is actually currently being done)
3. Standard of Secondary Education in terms of retaining university students
4. Accessibility to middle-income sector students (something close to my heart)
5. Entrance requirements for university

Short explanation of point 4: High-income families aren’t really affected by increases in fees (yes, generalisation), while low-income students can get bursaries (scholarships) rather easily, at least in South Africa. Middle-income families, however, are not poor enough to get financial aid, yet not rich enough to afford tertiary education without a struggle.

Short explanation on point 5: In South Africa, in order to correct the inequities of the past, students compete in racial profiles for entrance to university. In other words, the top portion of each separate race group will receive admission to their preferred course. However, this means that black students who attended rural, disadvantaged schools without enough teachers and in many cases without sufficient infrastructure, are competing with wealthy black students who went to better schools than even I attended. The question was whether it would not be best to compete in groups determined by the scholastic opportunities you had as opposed to race in this setup.

We then sat in the gallery while the actual Parliamentary proceedings began. It was my first time ever and I found it very interesting – and rather shocking too. Members are rather rude and personal towards each other. It seems like a more honest microcosm of South African society. That was not really a pleasant event to witness, but apparently British Parliament is even worse.

Members of Parliament participated quite intensely in the debate regarding Higher Education and the Minister was taking notes quite avidly. That is something, at the very least.

I am unsure whether we have contributed to potential change, but it was definitely worth the hours out of my study timetable. There was talk about inviting SRCs again in the future.

Afterwards I walked through the Company Gardens – they are BEAUTIFUL. I want to spend more time in that area of Cape Town. It is beautiful and historic. The planetarium and national museum are near there as well. And I thought, “I could actually make some good memories here.”

Also, I have actually studied today. I am now pretty clued up about all genital infections and their diagnoses. I know that Candida is not sexually transmissible and that “Bacterial Vaginosis appears not to affect men” (well gosh, I wonder why that is so). Unfortunately one of my books says that the partner must be treated and the other says that it is not necessary, so I shall have to check up on that. I can classify and grade different genital prolapses and I finally understand Leiomyomata. I even studied PMS, dysmenorrhoea, rape and sexual dysfunction.

Personally, the sexual dysfunction chapter is my favourite because the authors obviously tried to keep things professional. “A hardworking husband coming home from work to find a frustrated mother with crying children is not in the mood for sex” – it goes without saying, but the fact that it is written in academic literature is kind of cute.

Tomorrow… more studying. I can do this. I have to do this.

2010-11-08

So my first exams today went alright. Okay I lie, it is the best exam I have written this year. But truth be told that doesn’t say much, seeing as this past year has been terrible, in the academic sense. And in other senses too, but let us not go there.

So today – it had some thumbsucking, but I am so sure that it will go extremely well.

On Friday, however, I write Urogenital System, which comprises Pre-Clinical, Nephrology, Urology AND Gynaecology. I am scared. With that, I should go. I can still get two good hours of studying tonight. Thanks to those of you who are keeping me in your thoughts.

Also, tomorrow I am attending South African Parliament for a discussion regarding the cost of tertiary education. I am very excited, even though it will take five hours from my studying.

Finally, according to Google’s pretty logo, today is the 115th birthday of the X-ray. I hate X-rays, but I suppose they are quite awesome for health and diagnosis and all that.

Okay, as my Friend would say, I am procrastinating now. A-studying I must go!

Tata.

Exam hell [well, hopefully not]

Tomorrow I start my end-of-year exams. My Schedule:

• 8 November: Introduction to Clinical Medicine
• 12 November: Urogenital System
• 16 November: Reproductive System
• 19 November: Endocrine System

Then I just have Cardiovascular System to write at the beginning of January. I attended International Rotary Leadership Awards in Montreal, Canada, in June and couldn’t write the exam then. Then I will be done with all my 271 modules…

The problem with studying medicine is not so much difficulty as it is volume. Okay, embryology and CVS are difficult, but for the rest I have done so far it is just pure volume. It is a mission to get through everything in time, nevermind to remember everything. Especially if you are like me and you like being involved in things other than just academics.

These next two weeks are going to be really difficult.

Pray as if you haven’t studied. Study as though there is no God.