Ten Things I've Learned about Medicine // 6 months

Long time no post, sorry! Life has swept me away. Kangaroo Island posts will come soon, I hope.

With the six month mark passing a few weeks ago and inspiration hitting me after a really great talk by Dr Ranjana Srivastava at the S.B. Dowton Leadership Conference today, I've decided to do a bit of a reflection on the last six months of my life. Mostly focusing on the medical aspect of things, because I've realised that I've been neglecting writing about that aspect of my life for a while.

So, on the hour long bus ride home, I opened my laptop and wrote down some thoughts into my medical journal. I've taken the time and effort to put some here, too.

So here, a reflection on the last six months of medical school.

This is my 'reflecting-on-life' face.
Just kidding.
Taken at Kangaroo Island, actually!

I remember at the start of this degree I was confused. I was excited, unsure what to expect, and felt completely and utterly lost.

It’s only been a period of six months but I’ve felt like I’ve learned so much already. Looking back at the start, we've all come so far already, and I'm sure there's an unimaginable more amount of things to learn that are looming in the very near future.

About this time last year, a UNSW medical student held a seminar for budding medical students to offer us some advice about medicine at UNSW and inform us. It helped enormously, but something he said on that day stuck with me. He said that “medicine was not what I expected it to be like”, and at the time it made no sense to me because:

1. I wasn't even sure what one would 'expect' of medicine anyway
2. I had no idea how anything in a medical degree could be ‘not what you expected’. To me, a medical degree seemed pretty straightforward.

I thought medicine would be so simple. It would just be ‘walk in, diagnose, treat, done’. Of course, this isn't the case. A lot of the things I’ve learned in the last six months are things that no one ever told me about. Complicated things.

No one ever told me that a medical degree would involve so much, and require such a broad range of skill sets.

No one told me about the difficult decisions that would have to be made, the immense pressure placed upon medical students, the competitiveness, the time-constraints and the mistakes. The consequences. 

All the negative side of things that were swept under the covers and left to be discovered by ourselves once we all made it into medicine. How was I to know that 1 in 5 Doctors would be diagnosed with or treated with depression sometime in their lives? 

Beyond Blue, 2013. National Mental Health Survey of Doctors and Medical Students. Taken from this.
"Approximately 21% of doctors reported having ever been diagnosed with, or treated for, depression"

Medicine was difficult for the first six months. It still is, now. It’s been a constant uphill battle, but along the way I’ve learned that there’s no other course that I’d rather be doing. Medicine excites me, it gives me purpose, and it has developed into a part of my life. If you had the time, I could go on about my medical career for hours, and to be completely honest and realistic, my career hasn’t even started! I’m still on the journey to developing a career.

The science side of things have been relatively easy. Note that I say 'relatively' easy. Don't get me wrong, the sheer amount of content is more than I'd have ever expected, and it's difficult as heck, but there are far more intensive problems besides the theory component. 

The most difficult thing I’ve encountered thus far is time-management. And maintaining a healthy balance in life. As a medical student, health is on the foreshore of our minds, and so we understand that health is not limited to physical health.

Most medical students, myself included, want a balanced lifestyle. We want something more than just a life of studying, and that might be because of the fact that we’re constantly surrounded by high achievers and have grown up with (or are surrounded by people with) high ambitions. 

As if being accepted into medical school isn't good enough, every day we’re faced with medical students who have an incredible wealth of extra-curricular activities and leadership and talents that we can’t help but compare ourselves to.

We are never really truly satisfied with ourselves, and we think we can do so much because the mentors and idols and figures in our lives all are incredible people who pass their exams, complete their assignments, are championships in one sport, are at an AMUS level for some musical instrument, are trilingual, run in marathons, and volunteer for a charity three times a week. They probably also manage to sleep more than seven hours per day, and have time for their family, friends, and themselves. And meditate on a daily basis.

Taken from here 

Of course, this is not always true, and a lot of them will actually tell us that life can be a struggle when you have so much on your plate, and they too feel the stress. But to us medical students, they seem like they have their lives together, and it places so much (self-)pressure upon us to be the same. 

And, by all means, we want to be able to be like them. I wish I could have so many talents. And as driven medical students, we tell ourselves that we can be like that -- if they are ordinary people underneath it all, then we should be able to achieve that too, right? And it's that notion that 'I should/could be as great as them, but I'm not' which eats at us.

The very nature of the medical field and criteria to be accepted into medicine means that everyone in our degree is driven, hard-working, and intelligent. We are curious minds with determination, and a very high level of competitiveness.

Anyway, without further ado:

TEN THINGS I'VE LEARNED IN THE LAST SIX MONTHS OF A MEDICAL DEGREE (FIRST EDITION)

1.  Your 'To-Do' list will never be finished.
I’ve learned in the last six months that your ‘To-do’ list will never be finished. ‘Being on top of everything’ is just not an option. There are an endless amount of tasks to do, but only a limited amount of resources and time to allocate, and to top it all off, a seemingly impossible set of expectations to satisfy (for others, and for yourself). 

So I’ve learned to adapt. I really don't get an option, really. When you get thrown in the deep end you've got to learn how to swim or you're going to sink.

I’ve grown into a person who is no longer bogged down by imperfections or anxiety because some trivial thing in my life isn’t going the way I planned. I’ve had to learn how to prioritise and accept that things don’t always go the way you planned them to. There are endless examples I could list right here. 

'To-Do's are supposed to be done, eventually. But that will hardly ever happen completely because there's always more things to do.

Scott Adams, Dilbert.
http://dilbert.com/

2.  Medical students have huge personalities.
I’ve also noticed that everyone in medicine here has a very big personality. In a sense, it makes it very interesting to get to know people, but simultaneously, it can become difficult to work with people, and it can be mentally exhausting, particularly for introverts. And it also means conflict happens, on quite a regular basis. You should see our ethics lectures.

Thankfully, most medical students have some capacity to think laterally and consider the 'other side of the story', so it makes some form of compromise possible.

It's a bit mixed bag, really. On one side, it's great to get to know people with such amazing and unique personalities, but on the flipside, it can also be too much sometimes and difficult to form a consensus or achieve efficient teamwork.

3.  Endless knowledge.
I’ve also come to realise that in a medical degree there is an endless wealth of knowledge. There are countless opportunities — many that you will miss because of time constraints or stress. There is so much to learn and so many useful people and opportunities around you, and although it can be sad sometimes (classic case of FOMO), it’s great to know that there’s always something new around the corner.

You'll never learn everything.

That statement can be interpreted both positively and negatively. I try and take it optimistically.

4.  Face it, you will never be the best. Ever.
I’ve also learned that it is almost impossible to be the best. 

With the nature of medicine, I believe that it’s almost literally impossible to be 100% satisfied with your efforts.

Coming from a background of education where I always pushed myself to be ‘the best’, it was a big and radical change to awake in a place where ‘the best’ was unachievable, and I was competing with hundreds of other people who are all thinking along the same lines. 

I’ve learned to lower my standards for myself, and accept myself as long as I've given it the best shot. Because if you don't do that, then you'll never be happy or satisfied with your own efforts, and that's just a slippery slope to a loss of self-confidence. And I think that's a trap that a lot of medical students and Doctors fall into, especially when their friend who studied less than them manages to get a HD, whilst they're stuck with a bare pass. It can be hard on the self.

They say 'P's get degrees' but a lot of medical students aim much higher. And many struggle to accept themselves when they fall short of the bar, which is a common occurrence.

5.  You'll be thrown into the deep end on more than one occasion. I.e., no more floaties.
I still remember my first interaction with a real patient. My tutor had thrown us into the deep end, and in hindsight I realise that his teaching style was quite different to the guidance that a lot of other tutors give.

Taken from here

We were thrust into the room to take history, and it was daunting, it really was.

The first patient I talked to was a great person. In retrospect, she was extremely easy to talk to and I shouldn’t have been as afraid as I was. Nonetheless, I stood there in line with my group, trying to plan out how the conversation would go, what questions to ask, how to word things, whether I looked presentable, and thinking "oh shit oh shit oh shit I'm next and my colleagues have already asked all the questions I was going to ask" as I felt my palms crying out an ocean of sweat.

Walking up to the patient I could feel my face flushing, the nerves racking up, and feeling a bit sense of inadequacy (or, at least, the fear of being inadequate). This was a real patient! This was the real deal! 

This was a big deal.

But, at the end of six months, although I can’t exactly say my patient interaction has been extensive (I’ve seen about eight patients now), I can say that I feel like it’s improved a lot. Talking to patients seems much less daunting now, and even abdominal examinations are alright.

So you'll be thrown into the deep end, and there's really nothing you can do about it. One thing they teach you in medicine is that sometimes you'll be handed shit and you'll just have to deal with it.

Again, again, and again.

6.  Communication wasn't as easy as I thought it'd be.
We, as budding Doctors/medical students, can often feel so isolated and distinct from our patients. Especially as a new medical student, I couldn’t help but feel like they were another species. 

A species that we had to be extensively cautious of when we interacted with them, careful with our actions and how we behaved, how we looked, how we spoke, how we smiled, and even how we moved. 

I felt vulnerable. I felt like the entire situation was fragile. I felt the weight of the demands. 

And that led to a great sense of fear because there was such an immense level of pressure placed on this interaction. We were brought up to know that the Doctor to patient interaction was pivotal to being a successful practitioner, and surrounded by colleagues with such great ‘people-skills’, it placed a lot of pressure on us. 

Taken from the Sydney Morning Herald, Weekend Edition. February 25 & 26th, 2012. Cartoon by Michael Leunig.
Actually spent five minutes struggling to remember the name of this artist (Leunig) because I kept thinking his name was 'Leydig' instead #medstudentproblems.

Another interaction stands out from the rest. There were a lot of language barriers and confusion, misunderstanding, and uncertainty during this interaction. We were all afraid to speak up, afraid to clarify things in fear of offending the patient, afraid of bringing up certain taboo topics, afraid to even speak clearly because we were so unsure of what ‘was allowed’ and what ‘wasn’t allowed’. 

We walked in there not knowing what to expect and really just feeling in the dark, especially with an elderly patient like this man who spoke poor English. It was difficult to interact with him and I couldn’t help but feel some barrier forming between us.

Communication, I began to realise, was not as easy as it seemed.

Watching my colleagues approach this man — who definitely was not in the slightest bit intimidating — with such cautious steps and look of worry in their eyes, I distinctively remember thinking ‘Thank god I’m not them’, which in hindsight was a terrible thing to think, but I was most definitely scared shitless of the idea of interacting with a patient, especially one where communication was so difficult.

But, things get better.

I've only got a few patient interactions under my belt but I'm starting to improve. The fear is subsiding and a sense of determination is replacing it. Patient interactions are growing to be one of my favourite things of medicine, let me tell you that.

7.  Difficult situations lie ahead.
How does one go about discussing something so controversial as death, or organ donation, or life support, or terminal illnesses, with a patient? 

What is the correct way to walk up to a patient and tell them that they have terminal cancer and there's nothing you can do?

How do you tell a weeping husband that his wife is brain dead?

How do you decide whether to turn life support off or not?

There are no answers to these questions. Go figure.

8  Tread carefully. But if you miss-step, it's okay too.
The second hospital session I had, something happened which I will remember for a long time. 

My colleague and I were talking to this female patient and she had said her age. She was nearing her 80s, and she had also mentioned that her birthday was coming up in about a months time. My colleague had remarked “Oh haha, not long left, hey?”, initially what they thought would be a seemingly harmless comment in reference to their upcoming birthday, but we all realised that it could have been interpreted the wrong way.

Needless to say, they were roasted by my tutor afterwards, and we all realised the significance of every word and sentence that we uttered when we were interacting with a patient. They were almost grilled alive and in that moment, I felt immensely terrified of the responsibility that we were so quickly handed as medical students, only a month or two into our degrees.

I had also made a bit of a blunder that session, accidentally asking about 'living conditions' instead of 'living arrangements'.

I left that hospital session fearful and with a sense of shame and anxiety. I was unsure if I’d ever improve. It crossed my mind that ‘maybe I ought to just drop out of medicine.’ as I found talking to patients so difficult, so demanding, and so impossible — there was simply too much pressure, and I didn’t think I’d ever improve enough or get it right.

But, I sucked it up and kept going. Because mistakes are inevitable in medicine. 

I anxiously await the day that I miss a diagnosis. I anxiously await the day that I mis-diagnose, or prescribe the wrong drug, or forget something vital. I anxiously await the day that I witness my first death. 

I anxiously await the the day that a patient dies because of my mistake. 
(If it happens, that is. Though I am fairly sure that this will happen. It happens to the best of us).

9.  Things weren't as simple as you thought they would be.

I started to realise that some of these patients have conditions which are not as simple as I thought they’d be. No simple 'prescribe this and they're all good to go'. 

Let's face it, there's a reason why they're in hospital and not at their local GP.

There were conditions that required continuing care, that grew more complicated (with medical complications), that would happen over and over again, and were most definitely difficult to treat. I never had anticipated that patient cases would be this difficult — a simple and easy miracle cure was simply not possible.

10.  Medicine is difficult. But you will adapt. 
I guess most of all, over the last six months, I’ve learned that medicine is difficult, and not as straightforward as I had expected or hoped. Things are messy, and a mile away from ‘perfect’. Things won’t go the way you expected them to be, and your life will be flipped on its head from time and time again.

But as Doctors we adapt. That’s the most important thing I’ve had to learn -- the need to adapt. To change yourself and your life as the environment around you changes — that’s the only way you’re going to make it through medical school.

Things do not go the way they planned. They probably never will. 

There will always be something unexpected, and the ‘ideal situation’ rarely ever comes to fruit.

The times are going to keep moving and you will have to keep rolling with them.

In the last six months, I've learned a wealth of things that no one ever told me about, and needless to say, my view of medicine has changed completely. 

I'm certain that the next six months will bring even more knowledge.

The half year has been a roller-coaster of events. Despite the struggles, the uncertainty and the anxiety, I have to say that at the end of the day, there’s no other degree I’d rather be doing.

Because despite all the lows, there are a wealth of highs. These are the things that convince me to keep going.

This video sums it up. (Ignore the fact that it's an ad). It's beautiful. It'll only take two minutes of your time.