Before I began medicine, I did a Science Degree at one of the universities near my parent's place. As far as science degrees go it was probably quite good but I retained basically none of the information in the years following and I remember worrying that my lack of retention may pose ominous for medicine. I needn't have worried.

Medicine is taught primarily through case (or problem) - based learning. Whereby the students are issued with a case and through that particular scenario you learn about relevant physiology, pathology, diagnostics and examinations. In the first two years of medicine I've covered most of the topics that I'd learnt about in science but where I had lost the information immediately following the exams, I have found that what I've learnt seems to stick and that I enjoy it. That for the first time in my life I leave the grounds of a university (or school) and actually smile about the things that I've learnt.

It's what's made me realise that medicine is the place for me. Every block I've struggled to overcome hurdles in my learning and I've struggled to come to grips with the realisation that this is what I have planned for the rest of my life. That this all-consuming, intelligent and engaging world is what I've had my sights set on since I was ten and I'm scared in more ways than I can count about losing my chance. But I've also learnt that this is one degree where hard work, motivation and a genuine enjoyment for most of the content is rewarded.

These holidays...

Today is the first day all holidays that I've felt a certain degree of calm. I began this blog in order to keep my readers (the very few of them that there are) up-to-date with my life as a medical student; to put it simply, I've kind of failed at this task. But yesterday I received my marks from the last set of exams for second year and I have passed everything, which ultimately means I have passed second year. It was the most amazing feeling and when I got home and told my parents that I'd passed, I proceeded to dance in the kitchen for a good five minutes.

Passing second year doesn't just mean I will begin third year in mid-january next year, it means: that I will be permanently living back in Brisbane; that I no longer have to live on the Gold Coast; and that all my study paid off.

Next year I'll begin what my now-graduating housemates describe as 'the worst year of their life'. I always nervously laugh when I think of it because I remember what they were like last year and it wasn't the most pleasant of experiences sometimes. According to the staff at the university I will be expected to be the hospital or clinics or doctors privates surgeries at least 35 hours a week. I'm not sure when I'm meant to earn an income around this when they also expect another 15 hours study on top of that.

I am going to try and write a blog about my experiences in the hospital and studying a much more practical medicine every couple of days next year and then maybe at the end of it all I can write a book from it.

But for the next month I plan on enjoying myself and seeing these people in Brisbane who I adore and have missed dearly since living away. I am going to bake, drink plenty, exercise, write, watch all the TV shows that I love, read all the books I've put aside since beginning med and find the perfect little house to live in next year. I am going to sleep on the beach and go for drives on hot summer days with the windows wound down and the music playing loud.

... I'm going to do things.

I'm faced today with the realisation that I'm incredibly unmotivated. Anything, anyone distracts me from medicine at the moment and I welcome it.

Boys are my current thing and distract me they do.

My car also needs its exhaust fixed because at the moment it sounds like a revved up speed-racer. It's rather embarrassing. If only I had a boyfriend, I would tell people it was his car and that it was compensation for his tiny weener.

The point of this blog was to think of something amusing to write about and thus provide me with a good excuse for not studying. It seems I have failed.

Only four more hours till I'm basically home free.

Had a mad panic about 20 minutes ago when I looked up a book to find out the action of a muscle and it told me the wrong thing. Then looked up three other books - thank god they told me what I already knew. Phew!

I just need to breathe. Breathe. Breathe... zzzz...

She's been eating my cupcakes while I've been away studying at uni. SO. NOT. IMPRESSED.

... these were not communal use muffins!!

So, as well as adding unnecessary amounts of stress to a life, which I probably make considerably more stressed then it need be, medicine has also seen me become a hypochondriac.

Take for example, my friend and I were talking about a guy who had been in our first year of medicine but had had to drop out because he developed bone cancer. My friend was explaining the situation to me:

ME: So how exactly did he find out he had cancer exactly?
FRIEND: Well supposedly, after a chronic experience with back pain, he finally had an x-ray performed and it turned out he had cancer.
ME: Is it just me, or did your back just start hurting. I swear I have cancer... that would just take the cake for this week.

Speaking of cake, I baked cupcakes yesterday and they are delicious. As my housemate assured me, the icing, which I at first disliked has grown on me and is now strangely addictive. I think it's like that cheese bread at Sizzlers, obviously they add some form of drug to it because nothing that simple could be so addictive.

It's like heroin... disguised as bread. It keeps making me sick, but baby I keep going back for more.
ME (and the bread): Please Sizzlers, replenish your plate for the sixth time. Though I feel bloated and fat, I can not say no.

I recently went to Splendour in the Grass - a massive rock festival held in Byron Bay for 3 days every July.

It was stupendous.

Alas, dancing for hours in the cold, winter air doesn't make for very healthy living and I have alas come down with a persistent and quite annoying cough. I can forgive my cough however, because my weekend was so great, and despite being a little bit cold and sometimes disappointed with the arrangement of Splendour, everything turned out really well and I got to dance a lot.

I don't know why, but I used to hate dancing and now I love it. I just found that I could dance for hours, without thinking about Medicine or about any of the other stresses in my life. And now I am back at uni, studying till 10pm at night and I've already had my first cry of the week and argument with a family member.

Time to go swig me some cough syrup.

Security guards.

I think I write a lot more on this blog when it's leading up to exams. I like to think it's because my life is so interesting and jam-packed up until this moment that I don't have the time to write, but I really think that this is the time when I become a professional at procrastinating.

The time leading up to exams is also the time when I like to bake. Today I made an apple crumble from scratch. I stewed the apples, I made my own crumble, I covered not only the apples with the crumble, but the whole counter-top, the flour and butter containers, the floors and my clothes.

I've also discovered that I probably have an unusual acquaintance-like friendship with the security guard at my university, because I like to study at my uni till late in the lead up to exams so often when I'm leaving my uni and walking towards my car I'll turn around to see the security guard watching me leave.
At first I thought "Creepy man! Run!"
But now, after getting to know the place where I've chosen to live till the end of this year, I realise it's "OMG! Security guard rescue me!"

See I have a theory about my neighbourhood which I was explaining to a friend when she was planning on staying late at uni.
FRIEND: I think I'm going to stay late at uni but I need to get my car first so I can drive home afterwards.
ME: What time are you thinking of staying till?
FRIEND: About 7pm.
ME: Oh, you'll be safe to walk home then. The rapists don't come out till after 8pm.
People turn and stare at me.
ME: What I mean is, rapists don't come out till after 8pm.
FRIEND: I think that's the same thing.
ME: Surely not. It's a tried and tested theory.
FRIEND: You've walked home before 8 and not been raped and walked home afterwards and...?
ME: What me? No, no, no.
FRIEND: Then how do you...
ME: Well surely rapists know that there are people about and cars about at 7pm. It's like prime-time on tv. Nothing bad ever happens during prime-time. It's all Fraser and How I Met Your Mother and Home and Away.
FRIEND: Pretty sure two kids got molested on home and away last week.
ME: What type of world is this that we're living in!?!

So as I was saying. Me and the security guard. We're tight.

Tupperware.

I bought pyrex tupperware today with the money I probably should have spent on bras. Albeit pyrex is made from shatter-proof glass; which I proved today when I took my tupperware from its packaging and proceeded to drop one of the small bowls on the ground. Luckily it didn't break.

But I still require bras and was thinking about that today as I realised that exams are about 4 weeks away. These two things probably don't seem connected but unfortunately that means that here starts the downward spiral into failing medicine and thus living in the gutter; which I think I should prepare myself for. I will take to wearing shopping bags around the apartment and wearing only a thin scrap of material for clothing.

However, because I brought tupperware instead of bras, it is very likely that I will not only be living in a gutter but I will be bra-less.

Good thing I brought tupperware to wear (as a fashion statement my friend told me).

Bad thing it's see-through.

Sugar Free Icecream

I've recently started doing sudoku puzzles again.

I used to be pretty obsessed with them; so much so that my mother bought about six different books filled with various sudokus. I quickly became less keen about them, but as I mentioned, I've become significantly more into them again. I'm starting on a book of 400 and making my way rather quickly through them. For some reason the answers are coming more easily and I'm not sure what to think about that.

Perhaps my way of thinking has shifted slightly.

I like to think that over the last two years (maybe even three years) I've become more mature. Which really isn't hard if you knew what I was like before than. I have a really good grasp of my faults these days, but that doesn't seem to stop me making them known to people.

My Par-Par (my dad's dad) recently admitted himself into hospital after feeling very short of breath (dsypnoea). A little bit of history on my grandfather makes it rather evident that he has himself a set of risk-factors for some of the most common and serious diseases. He has Type 2 Diabetes, high blood pressure (hypertension), he was overweight (but has lost a lot of weight in order to control his T2D), he had 3º heart block which led to the application of a pace-maker, and as a result of complicated cataract surgery and macular degeneration - he's now legally blind.

Regardless of all these issues, at almost-90 years old, my ParPar is a very intelligent man and despite the occasional loss of memory that's pretty common for a man in his ninth decade he has full control of his mental capabilities. In fact, he has a photographic memory (of what he can manage to see) and still remembers information and poems that he learnt as a child. He also likes to think of himself as somewhat of a medical information connoisseur because he worked as a medical supplies salesman for many years, and to his credit he does know a lot about the profession for someone who just sold the products.

When I went to visit him in the hospital today we had the following conversation.

PP: So I don't think I have diabetes any more.
ME: Oh... you sure about that?
PP: Well I had my blood sugar taken the other day and it was 6.1 (normal) and then this morning it was 4.5 (normal again)
ME: Well the hospital knows that you're a diabetic so all of your food is going to be sugar free to avoid the obvious problem.

Random medical insert: Diabetes, regardless of type, is characterised by increased blood glucose levels as a result of reduced glucose uptake into the cells. We get glucose from most foods, primarily sugars, and our body's cells use it to make energy in order to keep use functioning as normal as possible. The high glucose levels have many problematic effects and unlike Type 1 which can be maintained by insulin injections, Type 2 patients tend to be resistant to insulin and therefore their glucose levels need to maintained by their diet and exercise. The disease despite total management, is incurable and a life-long problem.

Story continues,
PP: Oh I know that... but I think they must have made a mistake in the first place. Because my glucose levels couldn't be that low if I was diabetic.
ME (thinking): they could if you weren't getting any sugar at all.
ME: Pretty sure they're holding all sugar hostage from you like pirates!!
PP: And I think that the only reason why my levels were 28 (Very very high!!) -
ME (interrupting):THEY WERE WHAT?!?!?
PP (looks at me oddly as I splutter)
PP: As I was saying, the only reason they were so high was because I've been eating all that icecream recently.
ME: Well that could definitely do it... Hang on a minute, isn't that ice-cream sugar free...

The point of my opening about my own faults is that my family brought up this conversation and tried to tell me that obviously my grandfather didn't really have diabetes. Then, when I tried to explain that my grandfather's sugar levels could be managed at a completely normal level by the right diet and exercise (which obviously the hospital was doing), I was told that I wasn't always right and that when I explained medical things I shouldn't act like a 'know-it-all'.

I don't think I'm a 'know-it-all', far from it in fact, but I do have slightly more information about things like this than them because it's what I study and think about ALL THE TIME. Just like I don't question my sister's knowledge of english literature or grammar because she's a teacher, or question my dad over different laws and their interpretation because he's a solicitor, or try to explain an engineering sequence to my older brother since he's an engineer, or think that I could ever understand art and painting better than my mother. I find it absolutely infuriating that they think have the right to shut down my knowledge because I may in fact speak with slightly more confidence than them.

I know my faults, but I also know that my strengths are talking about medically-related topics because I study hard enough to be confident in some of what I say.

Patient presents as a...

- 17 year old young man
- For the last 9 months, has spent his days alone in his room
- Listening to loud music
- Not hanging out with his friends
- Getting into fights with his father
- Untidy bedroom
- Does wash or shower regularly

CASE: What are your hypothesis for the problem with him?

ME: Well despite the fact that you just called a 17 year old male a man, instead most obviously A BOY! Perhaps just good old-fashioned adolescence... just maybe. Possibly.

The mother is concerned... just like every other mother of a moody, pubescent male adolescent.

dysphasia.

So I'm currently studying the brain block and in the hospital the other day, our Reg told us about an interesting set of syndromes which all come under the setting of 'Dysphasia', which generally describes an impairment of speech and/or comprehension of speech.

Speech is controlled by two different areas on the dominant cerebral hemisphere - Broca's Area, which is found in the Frontal Lobe, and Wernicke's Area which is found in the Temporal Lobe. Broca's area is associated with the muscles and movement of the body involved in forming speech, meaning that any lesion, disorder or disease that affects this area results in upset or dysfunction in the formation of words and the repetition of words, known as Expressive Dysphasia; usually comprehension of language is preserved with this dysphasia. Wernicke's area is the 'Auditory association cortex', where auditory information is further processed and interpreted, and then acts upon Broca's to provide the accurate spoken word in response to auditory cues. When Wernicke's area is disrupted or a lesion forms there, an individual loses their ability to comprehend spoken word and to understand a conversation or questions and presents as Receptive Dysphasia.

Our reg, Clare, then gave us a way to differentiate between the two.
Doctor and Patient with Expressive Dysphasia
Doctor: Can you describe this room to me?
Patient (with ED): The room is sideways, the rain is in the light, the coffee cup is on a pen, the chair is on a table

The patient is capable of speaking normally and it is evident that they're describing something.

In a patient with Receptive Dysphasia.
Doctor: Can you describe this room to me?
Patient (with RD): Super-cala-fragilistic-expee-alidosis, super, expee, hoot hoot.

It is evident that their interpretation of language is wrong.

Therefore in order to further discriminate between the two, you would give them a set of instructions such as 'close you eyes', 'touch the window', whereby if the patient is capable of doing these it is expressive dysphasia (comprehends instructions), and if the patient is incapable then it is receptive dysphasia (incomprehension of instructions).

Further, the corresponding area in the non-dominant Cerebral hemisphere to Broca's provides musical tone and quality to the voice when speaking, so that if there is a lesion in this area the person presents with a monotone voice.

Studying medicine is...

sometimes like those times when you sneak up to the christmas tree on christmas eve. All day you've been eye-ing off that huge present that sat wrapped beneath the tree like an elephant in the room - you just can't take your eyes off it.

Night rolls round and everyone's a sleep and so you sneak out to the christmas tree and open your gift, see what it is and then wrap it back up and go back to bed. The next morning you're sitting round the tree and your mother hands you the huge gift with a big grin on her face - sure that you'll be excited when you get past the wrapping. But the more paper you unwrap, the less a surprise it becomes and the less excited you are because you've ruined the surprise, you've ruined the adventure.

That's what medicine is like sometimes.

You want so desperately to learn about every thing in the body that there is to know. Every organ, every function, every tumor, every disease that can disturb that vital calm that regulates our health, but more we learn and the more we study the less exciting it all becomes, the less 'new' everything is and more it seems like we're unwrapping a gift that we've already caught a glimpse of.

Is it wrong to wish I still had rose-coloured glasses on?

Being drunk is like...

reading a book for the second time; you skip over all the things that gave the story a plot.

I like to think of getting drunk as a bit of fun.

Occasionally it's fun you can't remember a lot of, and occasionally it's fun which gets you into a bit of trouble.

Over the last week I've been drunk 3 times - post-exam party, friend's birthday party and a wedding. During these nights I've realised that I'm seriously lacking in something that other people seem to have, and that I was sure I didn't need. That person.

Since I was little (10 years old, to be precise), I've known exactly what I wanted from my future. I knew that I wanted to be a doctor and as difficult as the exams and study were to get there, there were definite steps that I could take in that particular direction to achieve that particular goal. But, I also wanted a family - that dream guy that every girl wants.

I have no idea what steps to take. I can't fathom dedicating another part of my life to another person, when I can barely dedicate enough time to looking after myself, but at the same time I'm desperate to.

I keep getting these chances with boys, who seem genuinely interested and run a mile in the opposite direction. I keep expecting to feel immediately at ease and comfortable in their presence from the word go and when I don't, it bothers me and makes me doubt the future with them.

I hate being drunk because I miss the things that usually distract you from realising what you don't have.

First exam tomorrow and...

there is so much to know!!
Have decided it's time for bed, because I can't cram anything more into my brain.

The problem with being a student...

is that my hand really, really hurts.

I don't mean, just a little cramp but I mean serious aches and spasms that are running through my hand and causing typing to be somewhat difficult.

Obviously i should never be a surgeon.

I'm sure there are other things that are problematic about being a student, but right now - this is all I can think about.

How to investigate Uterine Bleeding

Patient History:
Menstrual cycles: regularity, menarche, duration, abnormalities
- establish their idea of normal/abnormal, regular/irregular
- presence of clots, pain, swelling, discharge, postcoital bleeding, dyspareunia, clots, premenstrual cycles
- Family history of 1º relatives - cycles, menarche, regularities.
Use of contraception: type, duration of length, side-effects
Obstetric history: previous/current pregnancies; complications; ante/post-partum haemorrhage; miscarriages/abortions; previous infertility.
Pap-Smears: results/regularity
STD-checks.

Presenting Complaint:
- Pain, Hirsutism, virilism, male secondary characteristics, abdominal bloating, vaginal bleeding, discharge, weight changes, temperature intolerance, galactorrhoea, nausea, vomiting, constipation, signs of blood loss (shock, anaemia), psychological/mental changes

Medical History:
- Coagulation disorders, bleeding disorders, Endocrine disease (Thyroid), Previous cancers, Previous STDs (PID), IBD (Ulcerative Collitis), Liver/Renal disease

Surgical History:
- Hysteroscopy, laparoscopic salpingoscopy, salpingectomy, hysterectomy, caesarian birth.

Medications:
- anticoagulant medication; OCP (Oestrogen/Oestrogen+Progesterone); IUD; HRT (MP/Contraceptive based)

Family History
- Bleeding disorders
- Endocrine disorders
- Previous menstrual history of first degree relatives

Social History
- Smoking, alcohol, drug use; exercise; diet; occupation; relationships (how many partners/current/past)

Physical Examination
- General appearance: pallor (anaemia), signs of endocrine disease
- Thyroid inspection
- Abdominal examination: uterine, masses (faeces, fat, flatulance, fluid, foetus, tumor), pain, colour abnormalities

Vaginal Examination (only used on currently/previously sexually active individuals)
- Cervical swab (infection - cervicitis)
- Pap-smear
- Examination of vagina (masses, colour, abrasions, bleeding, rashes)

Haematology
- FBC, Iron Studies/Anaemic studies, Blood glucose - normocytic (blood loss anaemia);
- Coagulation studies (INR/PTT)
Biochemistry
- Serum ferritin
- LFT/RFT
Hormones
- Pituitary Hormones (TFTs, Prolactin, LH/P (Ovulation), FSH(PMP/MP), Oestrogen (PMP,MP), testosterone (PCOS)
- Serum b-hCG (pregnancy/ levels indicative of intra/extra-uterine pregnancy)

Pelvic US (if not virgin - Transvaginally and transabdominally)
- Visualisation of polyps, fibroids, uterine bleeding, adenomyosis
CT/MRI
Hysteroscope
- Saline-infusion sonohysteroscopy - use of saline infusion to fill uterine cavity and show any filling abnormalities
Endometrial Biopsy
- Dilatation and Curettage

wizzle

I'm tired, exhausted and feel like all the salmon and tuna i've been eating recently is no longer giving me energy and brain food like all the ads say. Damn omega 3.

In fact, I think I'd find (if I was awake to notice) that all it was really doing for me was giving tuna-smelling wee. No, not infection wee, but literally tuna (possibly with sun-dried tomato flavouring). It seems that stuff goes literally RIGHT through you.

I've almost finished my first run-through of studying. That's my aim by 10pm tonight, when I leave uni and head home for a nice big nap.

Today is a sad day for me and I really just feel like lying at home and watching Bones and not thinking about what happened a year ago.

Tomorrow I'm driving back to Brisbane and buying flowers at the Markets for my mum (who's birthday it is).

I hate the reproductive system. And I hate palm cards. And the chips I had for lunch have made me sleepy. Drat.

a week off...

As usual, I pick up this blog in a similar fashion to how I left it - stressed, late at night and procrastinating from either sleeping or studying. There are probably three important things I should do throughout swat vac, all of which you would expect to come pretty easily, but are in fact easy to not do:

1. Studying
2. Sleeping
3. Eating

The first one, I'm pretty good at, but I tend to get pretty easily distracted at home and usually have to spend most of study week locked in a tutorial room at uni to avoid being distracted by my housemates who enjoy wandering into my room and having half-hour chats. I also have to quit facebook and MSN, or risk being distracted there as well.

The second one, is something that I have no problem doing but can't ever seem to do it at the right times. Don't get me wrong - there's no insomnia on this front - it's just, when I'm studying I always want to sleep and when I'm going to bed I always find something else to do. Like right now, it's 12.20am and I should be fast asleep - but I'm writing this blog.

The third one, well that's the procrastinating tool of geniuses. See, one has to eat, so if one really wants to procrastinate but appear to not be, they just go out and cook an elaborate meal under the guise of 'starvation'.

Tomorrow i'm heading up to the uni at 8am and studying there till 10pm. God I can't wait for this week and a half to be over.

Music I'm enjoying currently:
Friendly Fires
One Silver Astronaut
Sia
Frou Frou/Imogen Heap
Phoenix.