First of many.

I have my first of four exams tomorrow morning.
It's a three hour exam on the cardiovascular and respiratory system. You'd think - that'd be like:
Heart pumps blood to keep us alive, heart stops pumping blood, we die = bad.
Lungs breath in air, air keeps us alive, so if lungs stop working, we die = bad.

I wish it was really that simple.
There's embryology, physiology, histology, pathology and pathophysiology.
There's an ABCD (and sometimes E) mnemonic which applies to post MI management, hypertension management. I'm pretty sure it could also apply to congestive heart failure, angina treatment and Aboriginal Health Care.

EEEE no longer reminds me of someone going down a really scary water ride, but instead reminds me of the way of dealing with confrontational parents.

And finally, parents that don't vaccinate their kids are stupid.
Herd immunity doesn't work if all the parents think the other parents will immunise their kids.
You can't expect other parents to vaccinate their kids, and take those risks, just so you don't have to with your kids.

I need to sleep now. This time in 3 days, I should be very drunk at one of the many pubs, bars, clubs in the gold coast and thinking merry thoughts about shopping trips later this week and the ideal place to vomit.

a haiku on tuna

tuna is good for lunch.
I wasn't a fan till med.
now i eat too much.

Med has taught me the value of several food groups.

Firstly - canned food. There are many foods that come in a can that you can basically eat as they come.
Tuna is one I've recently begun to eat a lot of, but only in the last couple of weeks. When I started medicine I noticed that so many people would bring tiny little cans of this smelly fish and mix it with various other food groups - crackers, salads, rice, macaroni cheese, etc. And I didn't understand it because a - it was smelly, and b - I'd never liked it in the first place.

Now I have a pantry shelf filled with various flavours. Are you aware that you can get nearly any flavoured tuna? I wouldn't be surprised if during one of my future shopping trips I stumble across a bubble-gum flavour or potato flavour. Not that I'd probably enjoy either of those, but I'm just saying that there would be little surprise.

Rice is another food group I took for granted until now. This past week I've probably had close to eight meals that contain it, and right now - I've mixed it with tuna. I can imagine a pathologist looking at my blood and being confused by what he sees.

PATHOLOGIST 1: *looks at blood* what the...
PATHOLOGIST 2: What is it?
PATHOLOGIST 1: Have a look because I wouldn't have a clue...
PATHOLOGIST 2: It looks like she's one quarter blood, three-quarters rice.

That's right, ladies and gentlemen, would you like some rice with that meal - because I've got plenty. Not to mention rice now comes in microwavable packages. What will people think of next?!

bermuda triangle

So today we were learning about acute renal failure. During PBL (weekly tute groups) we establish a list of learning issues which we go away, form answers for and then return the following PBL to educate each other with. Talking about the different types of renal failure fell on my fellow PBL Q-er, Joe today.
JOE: So Acute Renal Failure can be classified into 3 different causes: Prerenal, Intrinsic or Post-renal.
*He draws a little flow chart*
JOE: Pre-renal causes consist of...
*he adds to the flow chart*
JOE: Intrinsic consists of...
*adds more*
JOE: And finally post renal causes are...
*adds*
JOE: Essentially, I read that Pre-renal and Intrinsic consist of 75% of all cases of Acute Renal Failure, which you would assume meant that post-renal makes up the other 25%... It doesn't.
Shock horror that it turns out that medical researchers can't add.
JOE: Post renal failure does in fact account for only 5% of cases... which leaves some kind of bermuda triangle.
*Draws a triangle outline as an offshoot from the flow chart*
ME (thinking): Is this going to be on the exam?

Things that you should avoid saying out loud.

I was sitting in the group study areas of the library today, trying to email myself some work to print off later when a girl and a boy sat down at a table beside mine.

They were doing a group assignment and were randomly chatting most of the time but every now and then the girl would complain about itchy legs.

GIRL: God... my legs are itchy!
BOY: Keep them away from me.

Girl gets up to print off something and then races back.
GIRL: Can't forget those shoes.
BOY: Yeah, don't spread your fungus anywhere else!

Later.
GIRL: My legs are still really itchy!
BOY: Maybe it's an atypical presentation of an STD.

BOY2 (who's sitting behind me) laughs out loud.
BOY1: Oh, did I say that out loud.

I smirked a lot throughout this conversation.

I spend a lot of time at uni studying late into the night.

My uni has around two dozen tutorial rooms which are filled with the following items for individual and group study:
- A sink
- Tea cups
- Milo/Tea/Coffee
- A kettle
- Sugar
- Whiteboards
- Large tables
They also occasionally contain food, which is not meant for general consumption, since it is usually left there by the groups which study there routinely every week but whatever.

These study rooms are lit by movement-sensory lights, which means that if you sit in the same position for too long the lights begin to dim. Imagine the following two versions of a scenario:

Girl and boy are studying quietly in a room.
No movement for some time
... Lights begin to dim.
*boy thinks: oh yeah, mood lighting too.*
Flight of the Concord's 'Business Time' starts to play.
Boy and Girl get it on.
Girl quits med school.

OR

Girl studies quietly and without movement in the room.
... Lights begin to dim.
Girl: ARGH! SOMEONE IS OUT TO GET ME! KILL EVERYONE...
Security carts girl off to the hospital psych ward across the road where she leaves med school and is begun on an anti-psychotic.

This is perhaps a third option, which is probably more amusing to an onlooker who stands outside.
Girl studies quietly and without movement in the room.
... Lights begin to dim.
Girl: Oh crap.
*Girl begins to frantically move her arms as if possessed and calling on some demon cult to grant her wish*
Insert: which would be to pass medicine, if she (read: me) chose to undertake such a task.
Other med student walks past the room and sees bizarre spectacle: WTF?!

There is a guy in med called... Stan and we call him Creepy Stan because he is, to state the obvious - creepy. And Creepy Stan used to have a terrible haircut which only added to his creepiness. I was met today by a friend in the hallway, I will call her Agrabah.
Agrabah: Crazy Stan got a haircut!!
Caitie: Crazy Stan? Who's Crazy Stan?
Agrabah: It's Crazy Stan... you know, crazy stan. Stan?
Caitie: Oh! You mean Creepy Stan!!
Agrabah: Crazy, creepy, whatever. I must show you... it's odd.
We don't get far before we realise that walking along the hallway only to peer in tutorial rooms, will appear a little odd.
... Later.
Caitie passes the room containing Creep Stan and sees the new haircut.
Caitie: I saw Creepy Stan's haircut. I've got to say it definitely is an improvement on his last haircut. It makes him look less...
Agrabah: Creepy, I know, doesn't it.
Caitie: But still crazy.
Agrabah: Definitely crazy.

Currently I am surrounded by masses of paper in various piles which I'm sure at one stage were organised but now I can't be so sure. They're meant to be divided into various topics - tute papers, lecture notes, assignment notes, clinical skills notes. They're not - in fact, such organisation could not be further from the truth. My current organisation consists of a green environmental bag that contains all my university work and that all my cardiovascular and respiratory notes are bound. That is the extent of it.

I think I should be more worried about this complete and utter lack of organisation but currently I can't seem to think of anything other than the fact that exams are in five weeks. I always considered the pressure on me in the few months leading up to getting accepted into med school was horrendous but I've recently decided that maintaining this position and being proud of the work that I complete during med school is so much greater. I enjoy my time in this degree and the things that I learn so much more than anything else I've ever studied; obviously I get bored sometimes but for some reason I find myself smiling about the things I learnt in a lecture or a tute, and that is something I've never experienced.

Procrasinating from procrastination.

So part of medicine is completing a list of tasks for every weekly case called 'Learning Objectives', which we have shortened to yet another acronym - LO's. A friend of mine was commenting that she's beginning to hate those two letters, which I immediately agreed with before realising that my surname starts with both. *Face-palm*

This past weekend I have been doing the list of LO's for a case about a woman with a heart attack. One of the LO's reads like this:
8. Experience in a simulated form how to answer a request by a critically ill patient for their prognosis.
My thought process went a little like the following:
- I think I need to watch a film on this.
- How does one put video on paper?
- What does simulate mean? And why would I want to experience it?
- And why would I want to experience telling a critically ill person they're going to die?
- Would the correct answer be: Yell and point at something behind them and then make a quick getaway while they're looking away?

The next LO was almost as bad:
9. Experience in a simulated form how to ethically and legally request post mortem permission from next-of-kin, after a patient’s sudden death.
- Ask and then duck as the family member takes an almighty swing at your head.
- Deligate, deligate, deligate. If you're a consultant, shaft the responsibility to the registrar, if you're a registrar give it to the intern, if you're the intern give it to a medical student. If you're a medical student... well, remember that everythings for the sake of learning and unless you actually kill or maim someone, you're probably good to go. Or just run and hide.

A third year medical student (3YS) who I work with was telling me a story about her day in the surgical ward of our local hospital.
She had recently run into a registrar earlier that day and was committed to not getting noticed for the rest of the day. So picture this:
*3YS stands flat against the wall, believing that in no way possible can she draw attention to herself*
Other student: Hey can you lend me a pen? (or some other meaningless question)
3YS: Sure
She lifts her elbow slightly away from where she had them stuck to her sides, just in time to have a Consultant race around the corner, run into her still form and spill coffee all over his expensive clothes.
Consultant: WHAT THE HELL DO YOU THINK YOU'RE DOING?!
*3YS flinches*
Consultant: WHAT THE HELL AM I MEANT TO DO NOW?!!
*Storms away*
Intern: If it was going to happen to anyone today, it was going to happen to you.

Things to do this week:
- LOs
- Practical revision
- DHC report
- Hospital report
- Go to the beach
- Go to an engagement party on Saturday
- Pay bills.
- Don't get distracted by reading, writing, new episodes of Gossip Girl, House and Grey's Anatomy

... Easier said than done.

I have a dream.

Or rather, I had the first of what is likely to become many dreams.

There was no preemptive attack of stress, nor any particular moment that I could pinpoint as the reason that I woke up about a week ago from a terrible dream.

In my dream I had just finished my final case in the renal block of PBL. To anyone who doesn't attend my med school, this probably seems like no biggy, but what I should probably mention is that renal is the final block of cases prior to exams. So in my dream, I've finished renal and realised, "holy crap! I have a week until exams, and I'm sure I had only just started respiratory a couple of weeks ago and how exactly did I skip forward to this point in time."

I woke up the next morning feeling distinctly unsettled. As a result I am starting to feel the stress of exams which begin in six weeks.

One of my exams is called an 'OSCE'. Don't ask me what that stands for, because medicine is all about the acronyms and mnemonics. For example, a way to diagnose the psychological development of an adolescent is by using HEAADSSS (Home, Education, Activities, Affect, Drugs/Alcohol, Sexual history, Suicidality, Safety). Notice the multiple A's and multiple S's, this is a common thing in medicine and entirely destroys a doctor's future hope of winning a spelling bee.

But back to an OSCE, this basically examines a students ability to perform clinical skills. A first year's OSCE consists of history-taking and using our stethoscopes to listen to different sounds. A fourth year's OSCE consists of giving needles; I wish I was one...

My two housemates are both third year medical students at my university and one of them (HM1) offered to run me through a cardiovascular examination. It went a little like the following:
HM1: Where would you start?
Caitie: Well I guess I would start with a general inspection of the patient.
HM1: Which would consist of?
Caitie: Oh GOD, the pressure, is anyone else feeling hot in here?
Caitie: I would look at.... (and I listed several correct answers)
HM1: Then where would you move to?
Caitie: The hands, where I would look for janeway lesions and osler nodes
*Caitie beams proudly as she regurgitates terms she heard the other day in the hospital.*
HM1: Which are indicative of?
Caitie: Janeway lesions are because of... congestive heart failure?
HM1: Not likely.
Caitie: One of them's because of congestive heart failure. Osler nodes, for sure.
HM1: Nope. Can you think of what is?
Caitie: Splinter haemorrhages, they're definitely because of congestive heart failure.
*Looks hopeful*
HM1: Er...
Caitie: Then what do they all mean? These is like jeopardy but without the prizes!!
HM1: They are all because of infective endocarditis.
Caitie mutters: ... same thing.

The rest of the conversation went a little like that and so I rewarded myself by watching the new House episode. A prize I believe can only aid me in my future career choice.

Realisations about med school.

So med school started some time ago, and we've already passed the quarter mark of first year.

I've learnt several things since going to med school:
1. Old Doctors who are your tutors - will hit on you.
2. Med School is all about the food that you bring to your tute groups. It's not spoken openly about, but you can tell that every tute, when a new person has to bring food that they're trying to beat the last group.
Example, number 1 - The first rotation of bringing food, male #1 brings KFC... unbeatable, one thinks? But no! female #2 brings baked goods, male #2 brings increased amounts of KFC... and so on, and on.
3. Med school involves a lot of alcohol and a lot of drinking of said liqueur. It's in my belief that when they built my med school four years ago, the developers thought to themselves, now where would be the best location to put a medschool (read: where is the closest pub that students can frequent)?
... The medical students pay for every single one of the bills that the pub probably accumulates.
4. Med school is all about budgeting your fortnightly income around where you want to go out from Friday night to Sunday night and how much you want to spend. On Thursday nights I receive a fortnightly allowance from the government and my income from my job, I then think about what I have planned for the coming fortnight and how much of my income I should set aside. It's very organised, I think.
5. Med School is also about cooking elaborate dinners, which take a long time to make and therefore act as a method of procrastination that isn't obvious. Read later on for photographic evidence of my dinner tonight.
6. Tetris is addictive.
7. I've reverted back to highschool where I spend way too much time on MSN, Skype and Facebook.
8. Tuberculosis shots are gross - they don't hurt much but they do other things... like ooze and explode
9. Houses full of med students get messy when said students get stressed.
10. Even when you're stressing so badly about exams that you have nightmares, there's always spare time for curry.
11. It's not just me, other med students spend too much time watching medical dramas.

More realisations to come.