Saturday, 12 November 2016

Rockpool or 6.21 AM

Light, high notes tik-tak against the shuttered sash window.
There's peace in the rain chorus with the woodwind
weaving and swelling in between
It's safe in this cavernous cocoon
from the mollusc shell of my duvet where
I sway in thought

It's a prosaic current at 6.21
A low thrum of contented consciousness -  rare and seeking
to pen itself in delicious words curling
my tongue around their impermanence

Seeking to be remembered when the turbulence comes
Or the dry hours - worse even with their dulling, numbing apathy
aping crassly this still-mindedness

It's temperate here with soft swells and slow eddies
stroking lingulates down through me - languorous, weighty laps - beneath the carapace balming
the core of peace I'd forgotten I had

Tuesday, 22 April 2014

Climbing back onto the face of the Earth

Well hey there. I'd like to preface this post with a summing up of the last year or so:


I don't think I've made this blog-writing enough of a habit yet. I guess when I feel like it it's usually to impart jolly posts about how much of a ray of sunshine I am (really I am, just...not for the last year). I have so many half finished posts on here I just wasn't in the mood to finish. I'd get started then FEELS and I'd have to stop writing.

There's been a running theme to my posts and my life for the last two years. From one painfully preventable, horrendously handled, catastrophically circumventable circumstance after another, it has been a year of hilarious tragedy. The volume of shit that went wrong was just amazing.

Hahahahaha it hurts so much I can't stop laughing. Help, the pain -
All the bullshit stars aligned perfectly, all the screw you planetary angles coincided and I'm pretty sure one or two Greek gods got involved - at least that incestuous whore, Aphrodite.

Lets go with the most blog-relevant. I failed my semester 3 exams by 0.8%.

0.8%. The pass mark was 60.8%.

Results, you funny.

It's not the failing I'm fussed about, seriously I'm not in the 90%-or-more committee. It's the reasons why I failed that are the source of the glass case of emotion. I won't go into them because god would we be here forever (refer to bullshit star alignments above) but I've discovered the amazing tag team that depression and anxiety can make when they join forces and you suck at fighting them. I'm in counselling, have been for quite a while now. In short I failed spectacularly at life and require professional help.

So proud. Much impressed.

Save for student support, the medical school has been nosy, bothering and smotheringly unhelpful. They're more panicked about the whole thing than I am, giving me all kinds of options like taking a week out (lol, no) or suspending studies for a year (lol, hell no). Consequently, I've gone back and forth about taking time out and decided this flip flopping is pretty much taking up any time I have to actually get my life back on track. So I'm sticking it out and hoping there's no damage the counselling can't help me handle and that the medical school backs off if I just quietly sod off and find ways to handle things. 

In fairness, most of last semester and a large chunk of the start of this one were spent trying desperately to get out of bed in the morning and face life. If I did make it out of bed I'd get as far as the living room and distract myself from being in my own head for roughly 5 minutes while I decided between calling someone to cushion the inevitable breakdown or curling up on the sofa to hide and ride it out. By then I'd have missed the morning lecture and was in more shreds than I could convincingly hold together. It was no one's business at university and, to make matters worse, there were people I knew would see through it and they were the last people on Earth I wanted to realise anything was wrong. So I'd stay at home where it felt less like my guts were spilling out while I scrambled to keep people from noticing. This wasn't most days, not even some days, but it was a number of days and that's bad.

Med school became a source of feelings of not being safe. My tutor would tell me 'once you start missing things we have a problem. You can't do this at work, your patients have to come first. At the hospital you can't just take time out and you need to go and do things to help yourself. If the counselling is only keeping you where you are you have to consider whether it's a good idea to continue.' etc etc. The general gist I got was 'your studies come first, get better, do it soon, or we're going to have some problems'. I get there was probably little else she could say in fairness and I wasn't informing her because I expected support. It was just to update the med school in case they accused me of being 'unsafe as a student doctor' by not notifying relevant people in authority about any issues affecting my studies.
I think she was trying the child-scaring approach with me - frighten someone enough into 'sorting their life out' and watch them do it. Spoiler alert: this does not work on depressed people who are neither 18 years old nor impressed with your affected sympathy and are legitimately doing everything they can to stay functional most days. And if you tell them to 'sort their life out' don't be surprised when they bitchslap you into empathy. For the love of god, you wouldn't say this shit to your patients, why would you say it to your colleagues?

From then on I saw her very occasionally and out of duty to cover my ass should anything happen and the med school point a finger and say I was not doing everything I could to help myself and keep them informed.

Student support was the only place within the med school I felt remotely safe. They were more help than I will ever be able to repay.

It's weird. I'd have days where this was all very funny and I'd be pretty much berating myself for being a whiny little girl and then days (mostly counselling days) where it would be nice if life could just maybe slow down a wee bit to a possible halt please.

Eh. Whatever.

I'm not sure how to sign off this one so I'll just leave it hanging.

Saturday, 25 January 2014

A Review of My Learning from the People and Disease Course

This is a reflective post on my experiences during the people and disease course. From year one, we are assigned a patient whom we visit regularly then we find our second patient ourselves and follow up their progress also, reflecting on both their experiences holistically (which means we take into account social, medical, drug and family history as well as life impact on illness and vice versa. It's very good at teaching the importance of providing support to patients from all aspects of life that can be affected by illness). 

My first year of the People and Disease course has been an illuminating and challenging one. Before studying it I understood the definition of patient autonomy and the ethos behind it but I did not understand how deeply valued it was nor how essential it was to ensuring the best care is tailored to patients as well as possible. I also had less understanding of the roles of professionals in primary and secondary care, was less aware of the usefulness of patient feedback and was extremely nervous about the idea of house visits. 

The first greatest challenge was contacting my first patient, C. C presented with blackouts and was diagnosed with schizophrenia. I was also told that she was in her sixties and lived alone. The first thing I did, out of nervousness I’m ashamed to admit, was make assumptions about her character, socioeconomic situation and educational background - almost all of which were incorrect.

Where I expected someone reclusive, incoherent, difficult to speak to and disjointed in thought I found an articulate, open, intelligent woman. My knowledge about mental illness stemmed largely from societal beliefs and an A Level in Psychology, both of which served me relatively poorly in this instance. C’s strength of character, autonomy, management of her condition and utter refusal to pity herself or accept pity from others flew in the face of all the preconceptions I had.

I was touched by her matter-of-factness, her robust progressive attitude was obvious considering the many jobs and qualifications she had attempted despite repeat break downs. She made me aware of how badly her life had been affected by her illness but it was clear she valued her independence and resilience. She also seemed extremely self aware; she recognised that she could be ‘delusional’ and it appeared she understood her condition and her behaviour when not well-managed.

During my first visit, she was kind and welcoming, quite at ease with my questions. She told me she was happy because she finally had her own place and I found a comfortable rapport developing despite my nervousness. As our conversation progressed I felt increasingly confident with her dry wit and frankness and wondered what her opinion of the social stigma regarding mental illness was. She told me she does not associate herself with ‘those people who use the label to excuse laziness’ or ‘who wore the label as a badge of exclusivity’. I was a little shocked to hear this and have learned that no matter how ingrained beliefs are about groups of patients, I should reserve judgement of individuals.

Moving on to social and medical history, I learned that C had been sexually abused since childhood into early twenties, had been homeless several times in her life and had had very negative experiences in primary and secondary care. I was happy with the way I handled the conversation, apologising for bringing up such difficult topics and telling her she could decline to answer or stop at any time she felt uncomfortable.
When I asked about her opinion of the NHS and how she feels it has benefitted her, she told me the only thing the NHS has done for her is provide her with home medication and weekly Depixol injections at the clinic. She related poor, unprofessional treatment from staff during her time as a mental health in-patient on a mixed-gender ward with sex offenders and with her previous doctor. She told me her last GP talked over her and gave her little to no autonomy, that he tried to force her to re-unite with her abusive step family, that she was not told her diagnosis but found it out from reading her file, that it was not explained to her how her illness worked back then. She was obviously angry about it. I felt awkward with the information and found myself apologising for her experience and wanting her to know how much current practise valued patient autonomy and dignity.

 She was, however, happy with her current GP, which made me believe her claims about her previous doctor may have had some weight. During seminar 3, I related some of these negative experiences to the group believing they were mostly true. I had not considered that her illness may have distorted her perceptions back then and felt a little uncomfortable when I realised this. It has made me apprehensive about how to critically treat subjective accounts of experiences by patients, since viewpoints can be distorted by expectations, previous experiences and emotional/mental state.

My second patient, K, suffers from epilepsy.  I found her more easily and faster than I expected through a consultant in an epilepsy unit. The nervousness preceding the first call was there but I felt far more in control than I did when I contacted my first patient for the first time; I was more confident in explaining our respective roles for the module and making sure the patient had all the information she needed before agreeing to meet with me.

What I was not prepared for was finding out that her mother had recently passed away, less so that she was willing to make time for me if it was urgent. In the moment, I was afraid I would say something entirely inappropriate but luckily I managed to apologise and arrange a later, more convenient meeting for her and her family. Since then, I have had to rearrange the meeting due to constraints on the family’s time.

I came into the course with many preconceptions and judgements about illnesses, patients and care and I’m glad to say almost all have been challenged and improved upon

Friday, 22 November 2013

Messier 93

For Christmas, last year, I was given the most beautiful gift anyone had ever given me.

This year, on December 25th, I will see it again and every year on for the rest of my life. Rising above the horizon will be Messier 93; hidden in the sharp light of the cluster, is my star. My own part of the universe, 3600 light years away, 100 million years old and so precious.

My love of the stars was never a secret to anyone. Sure, all the books and research into aerospace medicine was a fanciful idea - I knew better than to think I'd survive medicine well enough to take it to space - but it was an idea I had, a little dream I could escape to and feel blissful in. Something between excitement and awe.

I talked about it to anyone who would listen long enough. I didn't care how ridiculous I sounded. And one person listened. He listened like he could see what I saw, like he could feel the joy I felt talking about it. I remember being so absorbed in whatever I was saying that I didn't pay attention to his expressions enough. They were love. Complete love and understanding. The kind you picture on the faces of parents watching their child get excited about the simplest things - not patronising, but content and blissful.

If I could steal those moments and live off the painful joy they bring alone, I'd die happy.

I understand that this all seems very overblown. People can buy a star and register it in anyone's name. It takes little effort to do.

That was not the point. That star represents so much to me. I was 'his star' from then on, he understood that it was not just some gift.
But still, I only wish he knew how much it means.

It is hope and love struggling through the fear and pain of that time. It is humbling, a reminder that I am imperfect next to something so perfect and yet someone loved me so deeply, despite my very un-celestial ways. It is almost permanence - when I die it remains, like an epitaph. An imprint, a tiny, insignificant reminder in a database somewhere that a girl with my name once lived and someone loved her so much they gave her a giant, light- emitting ball of pure energy burning through milleniae of history thousands of light years from where she lived her little life. I had hoped I would name another star in that cluster after him, so there would be two of us, as friends, as lovers but never separated. That, even if circumstances conspired against us, somewhere, somehow we'd be together.

I have never told him this, I don't know whether he would or could ever want to know now. When he gave me the star I hoped we would see it together a year on, that it would mark our time together. But this year, if I can manage it, I will be seeing it alone.

I never thought I could be capable of this much foolishness. Frankly this entire post is embarrassing, but I wanted to write it honestly, openly, so that in a few weeks' time, when I find out whether or not my heart will be broken for the last time by him, I am forced to look back on this and be grateful for at least this. That he loved me however brief that love was. That in my moments of complete desolation, someone thought I was as precious and beautiful as a star.

Tuesday, 4 June 2013

It's been a while...

I'd check when my last blog post was but I'm writing right now and too lazy to navigate to the page. It was probably sometime before the Triassic era anyway. I'd explain myself but, in short, life and medicine got in the way. That and my inability to find the energy, motivation or faith in my own thoughts to commit anything to the permanence of the internet. Which, you know, can be found, read, giggled at and never lived down should anyone at uni find it.

I had my second end of semester exam today - the paper today was great, yesterday's was a nightmare dipped in a bastard coating. The exams are designed in such a way you don't always know what they're asking you for, so you end up inventing medicine and hoping your answer isn't some absurd amalgamation of physics breaking down and all sense kicking the proverbial bucket.

Just as I was getting used to the nightmares where I'm frantically reading exam questions written in Chinese out loud (either I'm secretly fluent or I'm offending a whole country and its ancestors with my frankly racist dream-Chinese) my written exams are happily over. OSCEs next week.

They went ok overall. I mean they didn't justify the super-depressed-ness exhibited consistently over the last few months in the run up, but hey.

I'm a little disillusioned to be completely honest. I really wasn't expecting to struggle so much or find it so hard. The hardest part of being in medicine is when the initial glittery lights and rose tints fade and you realise your heart is not 100% in it. Don't misunderstand, I worked hard for this and I'm privileged to be here. What I mean is I'm starting to realise it really isn't the Great Happening you expect it to be after you've been at it for a year. The realisation follows that you hung up your entire life on something, defined yourself and your worth by it, only to find out that when you got there it was a degree not completely unlike others. Sure the job spec is different but, ultimately, medicine is a vocation NOT your representative as a person.

And that's the healthy way to think about it. I was obsessed with being 'perfect' for medicine, that I had to have all the traits and be like my friends on the course, that it should be my life. That there was some crazy list of attributes we were all aspiring to that would change our entire being. I'd cherry pick the best traits from people, put said people on a pedestal and bewail my relative stupidity, slowness, idiocy, weakness, lameness, how the med school must have made some mistake because who would ever think I could be a halfway decent doctor etcetc...
This relentlessly, as though self-flagellation would appease some medicine god from raining his perfection-demanding fury on me.

I slowly realised the pressure of believing there was some ideal medical personality to aspire to was draining and removed all joy from the subject. Not that the membranes and receptors unit isn't euphorically fun...in a parallel universe where its permanently opposite day.
I expected myself to be perfect and prepared for medicine so much so that I would not struggle - this despite being told repeatedly that I and everyone else would find it difficult because it really, really is. When I struggled it impacted so negatively on me because I believed if I were not already primed and breezing through first year then I was 'not good enough'.

Which is utter crap.

I think I'm a masochist - I repeatedly make life difficult with unrealistic expectations of myself and ridiculous pedestal-ing of other people's pretty achievable traits.

Self esteem, evaluation and awareness of worth are so important in this career because it literally has the capacity to chew your ego up and spit you back out. I'm starting to appreciate the personal professional portfolios we do with all the reflective writing a hell of a lot more.

So here I am, at the arse-end of year one in medical school and I'm a little more battered than before but hopefully wiser.

On a final note, watch The Great Gatsby especially if you've read the book - I spent most of the first hour and a half hoping it wouldn't end like it did in the book which is silly, I know, but damn it I wanted it to end on a happy :(.
Anyway, it's amazing and, even if you don't think so, there's Lana Del Ray's Young and Beautiful as part of the soundtrack which is one hell of a song.

Wednesday, 26 December 2012

I think it's time for this.

I'm barely focusing on revision. When I do it, I do it. I get it done and I'm happy doing it. But I'm not really motivated. It's not laziness or apathy. It's just not my focus.

I feel fragmented. I've felt out of touch for so long, like I'm in a waking dream. And it's insular and safe.

I feel like I'm in a bubble and everything in it is safe and slow and measured. It's fragile and naive but it's static and just outside it is something that isn't. Something that's going to hurt. I'm waiting for it to hit me actually and I suspect it dances to the tune 'life goes on'.

I made mistakes this semester, personal ones, that have fragmented my life into pieces. Falling apart doesn't even begin to describe how the last three months have been for me. I worked so hard to get into medical school, sleepless nights, scary nights, lonely ones where I couldn't imagine a life where I was not a doctor. I built my life around it and made it the centre of my universe, suffered for it and earned it. So when I say that I lost all interest in it on and off for three months solid I want it clear what that means, how bad it was, how badly I needed help.

I wanted to leave. I wrote up course withdrawal letters and deleted them. I told next to no-one. I stopped talking altogether. It wasn't the course, the course is fine. Excellent even, brilliant, amazing, one of the best in the country. It's tough but it's wonderful as a course. I want it clear that it wasn't medicine, it was my life.

A number of things contributed to the events of the last few months. Being completely away from family who were depressed by their own problems as well as the imminent war in Syria (have now lost an uncle leaving behind his widow and six children, lost a ten-year-old cousin; another three uncles injured, one of whom is in a coma and the other two shot in the chest and arm), away from friends, somewhat burned out from three years of biomed, somewhere new, somewhere relatively lonely and scary for me, accommodation miles away from the university, bad and barely-there diet that I couldn't find a way to control, things that happened whilst I was on holiday in Syria, meeting someone wonderful and involving them in the biggest mistake of my life, the daily schedule, the bitter cold, the feeling of inadequacy, of stupidity and redundancy.

I have been depressed for over three months now. Unfortunately I'm the type of person to self-punish. It's stupid and accomplishes nothing but I did it anyway. After the mistakes I made I became ill. I refused to go see anyone for help, I refused medication, refused rest and sympathy. My immune system was in shreds, I wasn't sleeping. The nightmares didn't let me rest for more than a couple of hours. The sleep paralysis came back; I was having hypnogogia episodes up to three times a week. When I woke up there would be a terrible pain, like something had been ripped out of you from your throat down to your gut and where it was was an empty pit with boiling walls. I would run every excuse in my head to not go into university. I'd look through the lectures and tell myself I knew it from biomed. I'd ignore calls, texts, e-mails and facebook messages from family and friends. I wouldn't eat, I didn't care what it did to me, I ended a very short term relationship - if you can call it that - in Syria.

Worst of all was the feeling of rejection and abandonment. My mother couldn't forgive me for or help me with what had happened; in fact she made things worse, unbearable. During and after every phone conversation with her I felt like my heart was going to stop beating, like my muscles would collapse and I'd suffocate to death from emotional exhaustion. My friends often found me like that, having a panic attack. Countless times I wondered that it would hurt less if I just stood in the middle of the road and waited. I felt like I had turned my back on my faith and in turn my God had rejected me, like my faith didn't want me, like I wasn't good enough.
I'd beg not to be left alone. It was pathetic and I said so when I was finally made to see how bad things were and to go see my personal tutor and student services.

Naturally little work was done. I functioned well at university but pretty soon everyone on the course noticed things weren't ok, everyone was talking. I was lost.

Week after week I'd cycle through depression and something vaguely resembling normalcy. By the end I'd tried everything; cutting myself off, being around people, avoiding people, talking to family, talking to friends, talking to student support, asking to move groups, begging for respite from my mother's inability to cope whilst begging her to help me feel like half a human being again. The things I said, the thoughts I had, they felt and sounded like complete break down.

It's over now of course. I've done what I can. My father helped me, gave me peace again and forgiveness despite my going against everything he's ever taught me. My mother was never very good in a crisis.

The saddest thing is the wonderful person involved in my mistake, the person I have to ignore my feelings for and vice versa. He stayed with me and he is still with me, with more understanding and integrity than anyone I've ever met save my father.
If you ever read this, if you ever see this, I want to thank you. I want you to know that without you I would not be recovering so quickly. The things you did for me no one would have expected you to do and anyone would have understood had you walked away at any point. Thank you for not leaving when I or anyone else tried to make you, thank you for being more human than anyone I've ever met. And you're right, we'll be the greatest friends we can be, as close as we can and it's not second best, just another way to be with someone.

Sometimes you know what lessons you learned from your mistakes, sometimes they leave scars or memories you wish you could un-sully. For me it has been all of the above. What I did did not come from a bad place, it wasn't rebellion or malice. It was love. Irrational and naive - stupid, even. But it was love.

I'm idealistic enough to be sorry that that's not enough and old enough to understand why.

Thank you, to anyone who read this.

Monday, 24 December 2012

Compartmentalising - A summary of Leicester Medical School

I suppose I'm trying to break up all the events of this semester at medical school into little pieces so that they make sense to anyone who didn't live them. I wonder sometimes whether I'm writing for myself or the people who read my posts and find my writing becoming less personal and more people-pleasing to ensure no one is bored to tears by someone else's foreign experiences. But if I did that, if I wrote purely with readers in mind, I'd get a job as a writer instead of as a future doctor with a cathartic repository for a blog.

So, this is my space and I don't know why I'm apologetic about it. 

Last time I mentioned that this semester has been difficult. I'd start by talking about the academic side and then the personal side but they're so heavily interwoven I'm not sure how to separate the two. I'll have a stab at it and talk about the university for now, at least that way I'll feel less guilty about more personal, less relateable posts. 

Leicester is an excellent medical school. Our medics committee is second to none giving medics separate clubs and events to fit in with our timetables. The med student events are the envy of Leicester let alone the university - the locals join in during introweek :)
Leicester Medic's Pyjama Pub Crawl: http://www.youtube.com/watch?v=n-jRF1Vyb7I
Leicester Medic's Introweek: http://www.youtube.com/watch?v=IAUnc-5gDrg

The teaching and integration of clinical and pre-clinical years is seamless. OSCE training starts early in semester one with regular practise sessions at Leicester Royal Infirmary for history taking and consultation, the dissection room for taking BP etc and assignation to one surgical and one general practice patient whom we visit either in their home or the hospital. 
The older years offer excellent peer-peer help, organising clubs and support groups for anyone who needs it. We have medic family revision sessions, there's a real sense of community. The competitiveness is palpable but non-threatening so far. 
Pastoral care is phenomenal, from personal experience, with lecturers and other qualified doctors giving their time to offer anything from academic assistance to a patient, kindly ear - this on top of your personal tutor who acts as first port of call for any concerns. There's a welcome lack of elitism, most fellow medics are down to earth and almost everyone is exceedingly friendly. 
We're given booklets containing pretty much everything that needs to be covered for each unit with learning objectives so we get used to structured, ordered learning very quickly. The emphasis on integration is heavy ensuring you always know or at least ask why you're learning something. Spoon-feeding is there but you're expected to look at the information synoptically, putting it all together during group work sessions. 
And there's no learn-it-for-the-exam-forget-it-later - we have end of semester exams called ESA1 and ESA2. If you attain a satisfactory in both of these you are exempt from the end of year exam called the Year 1 Exam (previously known as The Qualifier), get less than satisfactory in any one of them and you have to take the Year 1 AND redo the OSCE. A satisfactory in LMS is 70%.

I laughed nervously too when I first heard this but, apparently, it really does sound a hell of a lot worse than  it really is (I'll let you know after my ESA1 in January). Its also justifiable - a doctor with at least 50% of the knowledge or a doctor with at least 70%?

To top it off, most of our professors have a very different approach to teaching than I experienced in biomed. Some are very personal with us and you are treated as though you were a fully qualified FY from day one. Some are amazing orators taking you from fits of laughter to sobriety within an hour several times. One thing you will never forget as a first year (and will be grateful for for probably the rest of your medical career): Dr. Hsu and his Health and Disease in Populations unit - statistics would never be half as funny and exciting while still managing to teach you sobering cautionary tales without his lectures.  

And the societies! We have a Quidditch team which has to be seen to be believed. There's also the Assassin club where you're given a student target to assassinate and you have to find out who they are and get to them before they get to you - this involves pretend-stabbing them in the back with a plastic spoon/spork/knife or anything you have handy. Its much cooler and less loserish than it sounds. I promise.
There's the AstRoSoc too who meet for sightings at the on-campus observatory. They build rockets too - I've missed out on all the fun because I'm usually all funned out after a long day. Plus there's The National Space Centre which I'm going to attempt to inhabit at some point.
Medics' Badminton, Hockey, Rugby for men and women, Football, Cricket, Tennis, Wilderness Expeditions, Running, Walking, Bridge. Book clubs at each hall, pub quizzes every Sunday, events at the O2 Academy every day, different medic society meetings, conferences and training events - literally lost count of all the things you can do.

I'm clearly trying to sell it.

No but really, its a great med school, you'd be fair to call bias of course but I fell in love with the place on sight. 

You've heard that medicine is tough, long, harsh, demanding, unrelenting and it is. Having a host of things to keep you sane and a dedicated support network makes you feel like you have a much better chance of taking the hits as they come.