contentment - what a novel concept

its the day before the exams and i'm feeling pretty content, actually. strangely i'm not overwhelmed with anxiety, but i know this will come around 10pm, and i had a terrible sleep last night. i'm listening to the beatles at the moment, something very unusual for me, as their happy-sad tunes usually irritate me. lou came over to study with me yesterday, and it was really nice, and we got quite a bit done, and had a good chat over lunch. we have spent quite a bit of time together in the last few weeks, studying and talking. i guess we must not irritate each other too much, which is more than i can say about most people in this world. what a miserly hermit i am. the day before lubie and baz also came over for a swim and osce practice. that was pretty relaxing as well. my whole weekend has been an interlude from the hectic week beforehand, what with the tb clinic and all that, and sorting out my electives. the only thing that really worry me is the electives itself, traveling on my own, and wondering if i'll be able to cope with my limited mandarin. i suppose it's the same as before i came down to melbourne and when i first started out at the mac. new experiences scare me shitless, it always has. i suppose when i'm 30 i'll be afraid to go out the door. *sigh*

annoying little things

got my mantoux test read today and its 20mm. huge. ddx tb exposure from patients or good response to BCG vaccine. the problem is mum's not sure if i've had the vaccine before last time i asked her. and i thought my previous mantoux tests were normal. so i call her tonight and now she thinks i've had the vaccine. so my previous mantoux tests might have been false positives. or something. the problem is now i've got to go and get an xray and get the reg to check me out at the tb clinic at the rmh. and i cant be bothered doing this, because of exams and all that. it's just fucking typical isn't it? when you're under stress things always go wrong. and little things which normally just annoy you now fill your horizon, stuffing up your studying mentality, replacing it with irritability and worry. not that i had much of a studying mentality thing happening in the first place. at least i don't have to take isoniazid for six months, i guess. fuck going overseas. maybe i should've just hung around melbourne, went to the mac, and work with the oncology patients there or something. bloody hell.

the reality of paediatrics

read an article in the good weekend about the families whose baby were taken away from them because doctors reported their baby's injuries as NAI. it makes it so hard - sometimes you just can't tell if the baby's injuries are accidental or not. it's easy to see doctors as overzealous crusaders out to take away babies away from their evil parents; or parents whose lives were torn apart by incompetent doctors and DHS people who didn't really know everything and therefore did the wrong thing. All too often doctors have to act on insufficient information and lack of knowledge, but parents sometimes think doctors should know everything, fix anything, and put all their fears to rest. sure it's vulnerable when you're faced with a big institution and you have no idea what to do with your sick baby, but sometimes doctors don't either. sure some doctors pretend and act like they do, but in truth, many doctors are just as scared, especially in this age of medical litigation. i asked my electives hospital in taiwan about medical indemnity and they told me they don't need medical indemnity. i guess the patients in taiwan haven't clued into that one just yet. but getting back to it - we have to do something. the best we can. and sometimes it's not enough. sometimes we make mistakes. sometimes those mistakes are fatal, or tear families apart. but it happens. if, based on what we know, we think the child's injury is due to an NAI, but the parents look harmless, and the story doesn't fit the injury, we've still got to report it. the law's made it mandatory, for god's sake.

watched when harry met sally last night (i was procrastinating majorly, and meg ryan: oooh). i think man and woman can become friends. just because i'm friends with a girl, why does it have to mean i can't be attracted to her? and vice versa - if i am attracted to someone, why can't i be friends with them? sex complicates the friendship, true, but you've just got to work around it. and if it doesn't work, there it is. i can't help being attracted to someone even if they're not. but why does it mean i can't be friends with them? i think that's bullshit. it just makes it harder, when you finally work up the courage to tell them, and you've been friends for so long you forget how to be their boyfriend. actually, maybe i've just got the point of the movie. heh.

steppenwolf

i went to bed tired and woke up exhausted. caffeine is doing bad things to my body. cigarettes are doing awful things to my throat. i feel like i am in one of the skits in coffee and cigarettes (heyyyy! you're bill-ground-hog-day-ghostbustin-murray!), sitting around doing nothing and wandering around in my head. but i dont dream faster - i just cant fall asleep. put on some joy division to coax my uneasy restless mind to sleep (but it didn't work), and before that was top gun and its 80s cheese. this morning its the white stripes. been listening to a lot of music lately, trying to distract the distracting/procrastinating part of my mind while i study. oasis (cigarettes and alcohol), led zeppelin (going to california), simon and garfunkel (seven o'clock news/silent night), silverchair (pure massacre), jeff buckley (lilac wine), the cure (friday i'm in love), tori amos (china), the clash (lost in the supermarket), the velvet underground (pale blue eyes), the whitlams (unreliable), jet (move on), and, of course, pink floyd (careful with that axe eugene).

Steppenwolf: most men will not swim before they are able to. isn't it witty? naturally, they won't swim! they are born for the solid earth, not for the water. and naturally they won't think. they are made for life, not for thought. yes, and he who thinks, what's more, he who makes thought his business, he may go far in it, but he has bartered the solid earth for the water, all the same, and one day he will drown.

reading handholds

went shopping last night with thommo and taisia, and i noticed the way she held his hand. it declared: he is mine. taisia has been giving us homework, leaving around cleo and cosmopolitan magazines for us to read, so we can pick up a few tips on how to treat girls right. well in one of the issues there was an article about couples handholding and what it meant. well, i must've been paying attention because her hand was over his, leading him along, her elbows and body snuggled in yet a smidgeon ahead. aha! i thought to myself, she's got his dick in a noose! then again, we all know those magazines are full of shit.

found out on saturday jim also has a blog. interesting how everyone around me seems to be declaring their views to the world, wanting to share their thoughts, to be heard. i wonder if anyone actually reads them? i wonder if anyone reads these words? does it matter? it feels therapeutic just to get it off your chest, so i suppose i matters not whether anyone else knows them. but i suppose if somebody does write back in a sympathetic way, one of these days, i will be over the moon.

exams are in less than two weeks. stress kicked me in the gut this morning. yet procrastination inevitably wins and at the end of yet another day i am shackled with self-inflicted guilt. taisia's friend claire came around and they're watch sex and the city in the living room. oooh the last episode. who cares? we've got a charade going on - me pretending i hate that show and the only worthwhile purpose of giving in to her tv viewing on monday nights is because claire comes around (a very nice, blonde, buxom scottish lass with a killer accent i can only half understand); her pretending to set me up with claire and trying to win me over to her tv show. sheesh, the games we play to pass time, so we don't have to do any thinking and actually talk about or do meaningful things with our lives.

my new medical curriculum

the quality of medical students teaching is something many of us complain about and there is nothing we can do about it. at least not until we are ourselves teachers. but it is could be such a great experience, and all it requires is some thought and a little preparation. teachers like debbie amott at ballarat base and danni bao at the kids prove that it is possible to make medical students love you (although being good looking helps too, i don't deny). here are some tips to keep in mind:

1. turn up. on time.

2. planning is the key to success. simple things such as rounding up a few patients before hand goes a long way.

3. free coffee not only make us love you, it also means we are awake enough to listen.

4. teach us things that are actually important, not just interesting. make sure your monologue has a point.

5. finally, pay the tutors, give them a medal, add FMS after their names (Friends of Medical Students). Whatever. Just recognise them for the top blokes and sheilas they are.

here are a few of tute structures that i think should be adopted immediately:

a. history taking: line up as many patients as there are students. give us half an hour each with the patient to interview and write up. then listen while we give five minute presentations, paying attention to the opening sentence, our proposed list of issues and plan; NOT the patient's list of thirty drugs and how we mispronounce them. this will pay back big time we become interns and ring you at the middle of the night. peer questions are gold. for a bit of variety, try focused interviews such as psychosocial history or lifestyle and ADLs. a tute with six to eight students will take about an hour and half.

b. short cases: pair us up and send each pair to do a short case. one student will examine while the other observes. fifteen minutes later, get the examiner to present his/her findings, and the observer to comment on the fluidity, patient manner and differential dx. not only do we learn to do systems examinations this way, we actually see signs properly, and get to clarify them with you instead of guessing. this tute takes about an hour.

c. disease presentations: divide the specialty into core conditions, and assign one to each student. for example, in respiratory disease, asthma, COAD, DILD, pneumonia, lung cancer, infections, PE, etc. ten minute presentations and one page handouts essential. this will become the bible come SWOT vac. repeat for other specialties. each tute may take an hour and half.

long case case are useful, but they take a loooooong time and often there aren't that many patients suitable for long cases. the traditional bedside tutes are next to useless - you never observe a sign properly when there are eight of you trying to have a go, and i'm sure the patient feels terribly like a guinea pig. what about dignity? what about privacy? out the window they go. and this process certainly doesn't endear them to our presence.

true meaning of procrastination

had a busy weekend without meaning to (again). saturday was sunbaking and making sandwiches and group a barbie (nick cave versus crazy town). sunday was reading a book about physics so i didn't have to study (did you know there are six types of quarks? up down charm strange top bottom). monday was gal's birthday (more roast? yes please!). tuesday was mucking around at jim and pete's (and monty python's meaning of life). its so hard to study for exams. and when you actually sit down in front of your messy notes (or lack of), you are suddenly filled with a strange desire to know absolutely everything about where oestrogen is produced in the pregnant woman and how that feeds back on the pituitary, then realising that you don't have time to learn this in detail, that you should be memorising risk factors for PROM, then try to draw up a new medical curriculum so you didn't have to do exams, then watch a bit of tv, then make another cup of tea, and call mum, and all of a sudden its dinner time. then bed time. then time to wake up. there just no way i'm going to learn all this in time. mmm time for a smoke.