My Quest To Get Into Clinical School And Become A Real Doctor
Aaron Singh -- And so it finally begins. After three long years of sitting in lecture theatres having obscure biochemical minutiae stuffed down my throat and reassuring myself I'd become a doctor someday by watching 'ER' and 'Grey's Anatomy' with my drooling tongue somewhere in the vicinity of my carpet; after three years of moaning about medical school to everyone who'd listen (including your lot, my landlady, the homeless dude across the street and his dog) resulting, so far, in the grand total of two hemorrhages, one death due to bleeding out of the ears, and a great reduction in applications to Cambridge; after all this, it's finally time for clinical school.
I know I've moaned a lot about the medical education system at Cambridge (heck I've even been quoted in the local student newspaper –- some of my friends wonder why I haven't already been expelled) but really, I can see the point of the huge emphasis on science and theory taught at traditional universities like mine. Not only does some of it actually come in handy in clinical practice, it also helps us understand why we do the things we do to patients (arguments and fistfights not included, of course). Perhaps more importantly at a science-heavy university like Cambridge, it sets you up for the third year, where you do a BSc year in a course of your choice (it's weirdly called a BA at Oxford and Cambridge, for historical reasons, as well as to confuse the heck out of potential employers).
But now it's finally time for that stage in my medical career that I really signed up for -– the clinical part. And another one of the myriad oddities of the Cambridge system is that you have to go through another whole round of application forms and interviews –- you don't get to march into the Cambridge hospitals, you have to APPLY there. ALL. OVER. AGAIN. The perk is that you can also apply to Oxford (shudder) or to a London clinical school. About half choose to stay, and the other half choose to get the heck out of there (or are kicked out, depending on their exam results).
There. I've explained the whole Cambridge sytem in a nutshell. Still with me so far? No? What's that you say? You're on the floor bleeding out of your ears? Send me your name, I'll add you to the tally.
I don't think I'll stay at Cambridge, because I might want to do surgery and people say you get more experience and a wider range of cases in London. Plus, of course, I expect to see an increase in the number of Cambridge dons sneaking into my room at night with chloroform-soaked handkerchiefs after they discover that newspaper article. Lock your ward doors and hide your IVs, patients, here I come!
If Life Was A Circus, Medical Students Would Be (Commitment) Jugglers
Aaron Singh -- It never ceases to amaze me how medical students can have so many commitments on their plates and yet manage to do everything at once. Sure, I’m studying at Cambridge University, ostensibly home to some of the world’s most intelligent students (a demographic I am sadly not part of myself, having gained admission due to my unusually attractive eyelashes -- but that’s a story for another day) but still. The number of times I’ve met medics who manage to balance other pastimes and yet still score high marks contributes more to my hair loss than my barber does.
I’ve blogged before about medics who realised that their true passions lay somewhere else, and became big names in those other fields. But now I’ve discovered a whole new subspecies of medic: those who excel in sports, music, theatre, literature, etc. and yet still manage to score highly in medical exams. These people seem to be able to maintain (and in some infuriating cases, combine) their different passions and juggle the time needed to pursue these seemingly incongruous pursuits, yet still show up for lectures on time with all their homework done and not a hair out of place. I swear these folks must have a personal secretary, private helicopter pilot, and make-up artist hidden away somewhere.
Unfortunately, multitasking is as alien to me as talking is to a dog, thanks in no small part to an incident during my childhood involving me being born, a doctor’s slippery gloves, and a rather unfortunate collision between my infant head and the operating room floor. But as I’ve said before, medical school is somewhere you’d expect to find smart people who have been multitasking all their lives, and as much as I may sit and gripe about them, there exists a certain pressure to be just like them, to do more with my life and my time here at university. So I suppose meeting people like this is good for you from time to time, as it drives you and shows you just how much you could accomplish yourself if you just got off your bum, turned off that episode of ‘House’ and actually did some revision. (Metaphors not from personal experience. Cough.)
Take some time to look at yourself and ask: what type of multitasker are YOU? Are you Everywhere-At-Once-Dude, bending the laws of physics to do everything and be everything at the same time, thereby creating hundreds of jealous would-be assassins with your every success? Are you Slide-Projector-Dude, focusing on only one thing at a time but giving that one thing your all? Or are you
Aaron Singh Hopeless-Ritalin-Overdosed-Mess, trying your best to do several things at once but inevitably ending up on the floor with all your juggling balls around you?
If you answered Types 1 or 2, good for you; we know why you’re in medicine, and you’ll probably make it big. If you answered Type 3, hey, wanna form a club?
Recipe To Destroy A Medical Student's Will To Live
Aaron Singh -- Easy peasy. Step 1: Get said medical student's laptop to die, preferably under mysterious circumstances and without warning (bonus points if you can squeeze in one of those head-poundingly irritating “illegal operation” error messages). Step 2: Make popcorn. Step 3: Watch, laugh, and eat popcorn as said medic goes crazy and bounces from one IT department to another like a pinball flicked by Mike Tyson.
I know it sounds weird, but anyone who's ever lost a laptop will know exactly what I mean. It's like having a part of your life ripped out of you, dangled tantalisingly in front of you whilst you jump through hoops to get it back, then pulled away just as you make a final leap for it only to fall flat on your face to the sound of canned laughter. (What's that you say? If you have to read any more of my metaphors YOU'LL lose your will to live? Okay, okay. Sheesh.)
Seriously though, just like in many other places, laptops become indispensable in med school. Remember Kendra's old post about having her notes stolen and literally combing the entire town for them in a panicked frenzy? Well, my notes are on my laptop, along with my dissertation drafts, my 'Productive Mode' study music (hey, I'm terminally lazy, okay? don't judge me) and three years' worth of photographic memories. But one day it just goes on the blink without explanation, and I spend the next few days shuttling it between the College and University IT departments with enough desperate efficiency to get a job at FedEx. To cut a long story short, in the end my laptop came back to me with its hard drive wiped and no explanation of what went wrong (sneaky buggers, these laptops). Fortunately for me, I had all my essential data backed up, but a week without my laptop made me realise just how dependent I am on this thing.
Lesson learnt: back up anything important. And for heaven's sake, buy a Mac if you can afford it.
Psych Me Out Too
Aaron Singh -- (To those of you who have noticed: yes, I did indeed just steal the title of this post from my colleague Anna’s earlier post, because a) it had something to do with my post and b) I couldn’t be bothered to think up a new and original one. Amazingly lazy? Yes, but hello - this IS me we’re talking about.)
As I mentioned in a previous post, one of the idiosyncrasies (and attractions) of the highly traditional course at Cambridge is that in our third year we’re free to do whatever course we want, even non-medically related ones, and earn a BSc in that subject. After throwing around a few options (including Pathology, Neuroscience, and the curiously popular that’s-it-I-can’t-stand-medicine-anymore option Law) I settled on Experimental Psychology, partly because I really enjoyed the Psych lectures last year, and partly because one of the lecturers is Professor Simon Baron-Cohen. If the name sounds familiar, it’s because he’s
the most handsome man in the world OMG I love his eyes the cousin of Sacha Baron-Cohen, the actor who plays ‘Borat’ and ‘Signor Pirelli’ in the new film ‘Sweeney Todd’. Professor Baron-Cohen is sadly more well-known for this fact than for being amongst the world’s foremost psychopathologists and a leader in autism research, as well as a damned good lecturer. I’m doing my dissertation under his supervision this year, as well as trying hard to avoid getting slapped with a restraining order trying to be more disciplined and organised with my work this year to avoid last year’s fiasco (and the subsequent death threats from my tutors. It’s nice to be alive, you know).
Next year however, we get to go to clinical school, also known as the ‘OHMIGAWD I’M FINALLY GONNA BE A DOCTOR!’ stage of our medical education. Yes, ladies and gentlemen, for those of you just starting to read my posts (you have my sympathies – run whilst you still can), the Cambridge system means that for the first three years of medical school we get to park our butts in lecture theatres all day getting biochemical minutiae shovelled down our throats and seeing patients an average of 2 times a year. Next year however, we get to apply to clinical schools (yes folks – another round of application forms, interviews, and chewing your nails whilst harassing the postman every day for results letters – even when you’ve ALREADY gotten into med school! And you wonder why I’m deranged?).
I’ll write more about where I applied to after the results come out (so that anybody already studying there can immediately apply for transfer on grounds of fearing for their mental health). Wish me luck!
Everyone Deserves a Second Chance (On Both Sides of the Stethoscope)
Aaron Singh -- At the risk of dashing the hopes of everyone out there who prayed that my long absence from this blog meant that I was finally dead and gone and wouldn’t be causing any more brain haemorrhages with my dreadful writing, I would like to take this opportunity to confirm that yes, I am indeed still alive, and the rumours of my death are greatly exaggerated (despite the fact that they're featured on every "Top Ten Prayers of All Time" list in every church, synagogue, mosque and pagan altar from here to Reykjavik).
Why then, you ask, have I deprived my long-suffering readers of my suicide-inducing rants for so long? Rather than telling you a tale of murder, intrigue and derring-do culminating in a rainswept showdown with the Senior Examiner for Medicine on the roof of King’s College Chapel, I have decided to tell you the truth instead. I made some very bad academic decisions last year (read: I slacked off. BIG TIME.) and have been spending the intervening months trying to repair the damage. Luckily I was given a second chance, which is why I’m here instead of in a shallow grave somewhere with an axe buried in my head attached to a note saying "With love, Mom."
But as I sat pondering my good luck, trying to figure out what went wrong where, something my old A-Levels college headmaster once told me came to mind. "Don’t be afraid of being imperfect. After all, isn’t the whole point of medicine to deal with human imperfection?"
And the more I thought about it, the more I realized what a wise man my old headmaster was. Medicine does indeed function to give humanity a second chance. And as I found out from some of my doctor friends who wrote in to show their support, many of them had stumbled in their careers, too. But they all got a second chance, and were now successful practitioners.
So is it wrong that we on the other side of the stethoscope get a second chance, too? It’s a cliché that failure is a better teacher than success, but it’s a cliché because it’s true. I got my second chance. And I intend to make the best of it. So break out the vomit buckets, folks - I’m back!
Coming up: what I’m doing for my BSc this year, where I’m transferring next year, and how I drove both famous actor Sir Ian McKellen and famous autism expert Professor Simon Baron-Cohen mad. Stay tuned!
No Patients Please, We’re Academic Doctors
Aaron Singh -- These past few weeks I’ve been helping give "Cambridge Access" talks at various locations in the country. These talks are an unofficial initiative to improve access and encourage applications to Cambridge from those who might not otherwise apply, believing the common image of Cambridge as a place where stuffy old dons in robes sip champagne, eat caviar, grant each other’s children admission, and slap each other on the back for being so great. So I’ve been going to some pretty far-out places to speak on what it’s like to study medicine in Cambridge, and why more students should apply.
I remember back when I was an applicant myself, when I listened to some of my seniors speaking. And to prepare for my talk, I asked myself, “What do I wish those guys told me back then?” After rejecting the initial answer that rose reflexively to my mind (“Apply to Cambridge? What are you, nuts? RUN BOY RUN!”) I had to agree that the most important thing was conveying just how different studying medicine here was compared to the rest of the world.
Anyone who’s read my posts before will know that the system of medical education here isn’t exactly my cup of tea, and many of you have left encouraging comments, ranging all the way from “Chin up, dear, it’ll get better” to “Stop whining and get on with it, moron!” Other universities in the UK and throughout the Commonwealth (though not in America, as far as I know) teach scientific medicine alongside clinical medicine, making sure students understand the relevance between the two, and giving medics enough of what they want (read: blood, gore, billowing white coats and hot nurses) to keep them hooked. But in Cambridge the first 3 years is hardcore science, with patient contact only twice a year. So after 2 years in Cambridge, I’ve realised that medicine here isn’t for everyone. Being an old, traditional university that’s big on research, it aims to inculcate a love for research in its students and a scientific curiosity that, whilst a necessary asset for doctors, is a lot more useful to academicians.
And yet a lot of students who want the usual method of learning medicine apply to Cambridge (and other research universities) anyway, for the prestige and the big fat crest on their degrees, completely unaware that for the first 3 years they are nothing more than glorified natural scientists rather than real medics. So in the end, what did I tell the eager beavers who turned up with their wide eyes and their faith in humanity as yet undamaged?
“Every university teaches medicine in its own unique way, so whichever one you apply to, for Pete’s sake, do some research on the course there.” (And here I bit down hard on the little red horned voice in my head urging me to scream “RUN PEOPLE RUN!”. These voices can get so irritating. Maybe I should tell my therapist about them sometime.)
Those Who Can, Do; Those Who Can’t, Teach?
Aaron Singh -- Teachers. We all have them, we all know them, and sometimes we all spend class time daydreaming of creative ways to kill them horribly. But like ‘em or not, teachers are a lifelong part of medical teaching. From the sadistic professor grinning evilly on your first day at med school to the slightly more senior professor who actually helps, teachers play a big part in medicine because of medicine’s very nature as a profession where learning is lifelong.
And so it should come as no surprise that many of us medics choose to do some teaching in our lifetimes. All doctors do some teaching and guiding in their careers, of course, but not everyone likes it; some choose to give vent to childhood nightmares, leading to tales of horror (such as those sometimes heard on this blog), and some become like those subatomic particles you hear about in quantum physics: they exist only theoretically. But still others like it so much that they choose to make careers out of it; they go into academia, teach doctors, do research, and are often inspiring enough to spur many other students on to greatness. We’ve all encountered one of those teachers, as I said in a previous post.
But only recently did I see that there was a difference in attitude towards teaching in medicine. Studying at a research university in a country where academia is respected and even rewarded, I had been taught that academia is a respectable profession, no less desirable than surgery or internal medicine or any other medical specialty. I enjoy teaching*, and had been seriously considering a full-time career in academia, far off though that choice may be. But while I was back in Malaysia for the summer, I asked some of my fellow medics what they thought of it, and first I got silence. Then some of them actually started laughing.
“What, don’t you have enough stress already?”
“What are you gonna live on for the rest of your life, peanuts?”
Then they all laughed heartily, slapped me on the back right as I was swallowing, and admitted none of them knew the Heimlich Manoeuvre as I sat there gagging.
But they’re not alone. In many countries, academics are seen as weaker versions of the professionals they help to teach. If you’re in a teaching job, it’s automatically assumed that you’re there because you couldn’t land any other job. Whereas in Western countries, academia is seen as a proper profession, even venerated, and thankfully a trend towards this is being seen in more and more developing countries (Malaysia included) as they realise the importance of research. I actually spent some time as a part-time teacher helping out in my old school, and I enjoyed the experience thoroughly. I’m definitely going to spend some time teaching in my career too.
*And no, not just because I want to pass on all the slaps, kicks and textbooks thrown at me by my supervisors, okay.**
**Okay maybe just a few kicks. Okay knuckle raps only, I promise!
Let Me Heal You, Comrade: Part I – The Quirks of Socialised Medicine
Aaron Singh -- With the release of Michael Moore’s controversial new documentary ‘Sicko’, lots of debate has been going on about socialised medicine all over the world, including here in the UK where the National Health System is simultaneously the reward at the end of the long years of medical school and the bane of most doctors’ lives. I haven’t watched Sicko yet, but when I do, I’m sure I’ll have something to say about it as well, which is why I’ve written this post as the first one in a series.
One of the things that HAS happened recently and caused a lot of aggravation, press coverage, and mass suicide of doctors’ brain cells, though, has to do with the whole Modernising Medical Careers (MMC) fiasco I bored you with a few months ago. MMC, the disastrous online application system for junior doctors put in place earlier this year, has been scrapped, leading to deities of all types across the UK being inundated with prayers of thanks. However, before it finally rolled over and went off to the Great Recycle Bin in the sky, it had time to cause one last scandal. Turns out that the security on the (now-defunct) MMC website, where all applications were made and results were handed out, was so low that practically anyone could have marched straight in and accessed applicants’ details. A prominent British medical blogger dug this up and went to the media as well as the government, and Channel 4 News cracked it wide open, leading to the website being taken offline within minutes of the news announcement being made.
Of course, junior doctors were up in arms when they realised that their details were freely available online, and it remains unknown who might have accessed the details, though the government denies that any unauthorised access happened and piped soothing music through public broadcast systems all over England to make it all go away. (Okay, maybe not, but you get the picture.)
Another point of contention in socialised medicine is loss of autonomy. Doctors are a sticky bunch, and we like our autonomy, especially after slogging through years and years of training to get it. Most doctors around the world have enough autonomy to keep them happy and yet in line with public health objectives, but in Britain’s NHS the government has a far bigger say in doctors’ lives and careers, as can be seen with the above MMC exercise, and the reduction in power of the Royal Colleges of Medicine, traditionally responsible for postgraduate medical teaching in Britain.
But ah well. With the good comes the bad, and luckily for us, vice versa. Coming up next time on Let Me Heal You, Comrade: the GOOD bits of life in the NHS! Now all I have to do is go find some…
What Is This Passion Thing Anyway?
Aaron Singh -- I’ve blogged about passion before, and it got a lot of responses. Everybody talks about it; from the half-dead old professor who gives the introductory lecture in first year and then disappears back into his coffin until next year, to the tough-love-doling quasi-military doctor who first takes charge of you when you start work at the hospital. Every book on medicine contains at least a chapter on it; old doctors swear you’ll never make it through med school if you’re just in it for the money (just before they get into their chauffeur-driven BMWs and drive off sipping champagne, the old coots), and young doctors credit it for keeping them going (besides truckloads of caffeine, of course, but that’s another story).
But what is this passion thing all about anyway? People talk about it as if it’s something big and fiery. Go to an Anthony Robbins motivational lecture and he’ll have you jumping around in the aisles thumping your chest and singing uplifting songs. So, are passionate doctors supposed to bound into the hospital every morning with big goofy Cheshire Cat grins on their faces, kiss the nearest nurse, hug the nearest patient, scream some cheesy overused cliché like “Let’s save some lives today, people!” and get down and dirty with more energy than aging hippie rock stars on stage?
I’m still not sure what passion in medicine is all about. But I may have uncovered a few clues. The top students here at Cambridge, some of the most gifted medics alive, are all very quiet people. Most are so soft-spoken you can’t hear them in a crowd, but they know enough to convince you that they work diligently (and that they’re not human, but that’s another story). Is that what passion is then? Is passion really a flame, but not necessarily one that burns brightly and loudly? After all, the noisiest medics (the ones who seem to have a pathological need to show off just how much they know to the lecturer and inadvertently make you think of situations involving them and lots of sharp knives) in my year tend not to be the brightest.
Another totally different kind of insight may have come when I was on one of my shadowing assignments. One doctor in the general surgery ward was performing what must have been her 55th rectal examination that day, and me having watched enough episodes of Scrubs to know that my role was that of the annoyingly eager medical student, decided to chime in with a question exactly when half her hand was off exploring territories that had never seen the light of day.
“So, uhm. What is it that keeps you going? You must have loads of passion to do this kind of thing all day.”
She turned, gave me a poisonous glare that must have set off half the radiation alarms in the hospital, then smiled with the kind of black humour that only a doctor performing her 55th rectal examination of the day could muster. She inclined her head towards a window behind her, overlooking the high street.
“It’s what keeps me from jumping out right now.”
What Type Of Post-Exam Person Are You?
Staggering out of the last exam, which just happened to be a lab full of stinking bacteria, some of which is probably still stuck up my nose and which came from sources disgusting enough to make a cannibal blush, I somehow didn’t feel the fatigue that I should have felt, having stayed up the whole night looking at slides that showed coloured mush and trying to make sense of histological features that looked more like glorified paint splotches to me. Adrenaline, ladies and gentlemen, is your friend. Ever seen a car crash patient who’s sustained horrible injuries but is lucid and seems fine? Seasoned emergency physicians know that it’s all adrenaline, and once the adrenaline rush dies down, bad things will happen. Especially if it’s on a TV show (each show has at least one episode with an Adrenaline Rush Patient nowadays, but unlike real life, the patient can’t be JUST a patient, that’s not enough … she has to be pregnant! Or the main character’s father/mother/secret lover/retarded cousin! Or the President of the United States!).
Exams are hell, folks. Especially if they’re held every day consecutively for over a week, including Saturdays. I know Saturday exams are nothing new to many of you hardcore medics out there, but I’m a lightweight. I prefer my exams well spaced out with plenty of time to cram in between, not a marathon session that leaves you feeling like one of the extras in ‘Dawn of the Dead’.
But no matter what sort of exam-taker you are, one phenomenon unites all of us, a single common experience that affects all of us, whether nerd or slacker, rich or poor, good or bad, Jedi or Sith:
The post-exam crowd outside the exam hall.
Excited chattering, whoops of joy and relief, and sobs of grief, both from the people who just didn’t revise enough, and from the anal-retentive nerd who’s beating his hands against the wall because he forgot the alternative name for the radial groove and lost out on a bonus mark. Personally, I don’t like discussing the exam afterwards and prefer to concentrate on the next exam, but there are plenty of those who do.
What kind of post-exam person are YOU?
P.S. If your answer to the above question is ‘the kind who dances around other students whooping at them about how well I did and how easy the exam was’, send me an email but give me a few days to respond. I’ll need about 3 days to order an extra-large sledgehammer and find your address. Public transport these days…
Letters From Iwo Jima (And By Iwo Jima I Mean The Examination Hall)
Aaron Singh -- Okay, so exams are almost over, and I’m about to commit the grand mistake of saying the Most Famous Line Ever To Medical Students, the one that ALL of us say at some point or another, usually right after walking out of a particularly disastrous exam:
Never again will I cram for exams. From now on I’m going to be a good boy, compile all my notes well before exams, look through all the past-year papers available, highlight and colour-code my lecture notes, dot my I’s, cross my T’s, and generally work like one of those anal-retentive quasi-military nerds we all hate but secretly want to become (oh come on, good grades and thick glasses are sexy, and you know it).
Seen any flying pigs yet?
We all go through the phase; we don’t work as hard as we’d like to for exams, don’t perform as well as we wanted to, then we make these promises to ourselves out of guilt and a desire to do better. In my experience, these promises tend to last until about 24 minutes after your last exam, when you’re in a pub somewhere having a celebratory drink (or a few hundred), that jukebox near the door is starting to look REALLY attractive, and ‘levator labii superioris alaeque nasi’ sounds like something your grandmother would slap you for saying out loud.
But hey. We try, and we try again. Medicine is all about not giving in when you fail repeatedly. And hopefully each time we get better. Hopefully.
I’ve just got one more practical paper to go, and then I’m free, FREE!
See you all then for more thoughts on the horrors of Cambridge exams. And no mention of jukeboxes!
Borat Week at Cambridge Medical School
Aaron Singh -- Jagshemash! For those of you who haven’t seen the cultural phenomenon that is the film Borat: Cultural Learnings of America For Make Benefit Glorious Nation of Kazakhstan, that’s what naïve Kazakhstani reporter Borat uses as a greeting. (It’s not really Kazakhstani, it’s Polish, as I found out when I gamely yelled it at two bemused young Kazakh girls who are now on my List of People Who Will Stare Intently At Their Own Navels When I Pass By. But that’s, um, a story for another day.)
Anyway, stay with me; I actually do have a point. What has Borat got to do with medical school, you ask? Am I, with my unique ability to utterly waste 10 minutes of my readers’ lives as they read the drivel I spew out, about to spout tasteless jokes about Kazakhstani doctors screwing up surgeries and accidentally murdering patients in the most comedic ways possible? (No, we’ve got the British health authorities for that. Bada-bing!)
Last week was christened Borat Week by Cambridge medical students doing Experimental Psychology. This is because, in addition to having weird senses of humour, we had lectures by the world-famous psychopathologist Professor Simon Baron-Cohen, who in addition to being one of the world’s foremost experts on autism, is also the cousin of Sacha Baron-Cohen, the comedian behind Borat.
And so I stepped into the lecture with this great man with a sense of trepidation, partly expecting to see an insanely-grinning Kazakhstani reporter dressed in a white coat speaking in broken English and telling bad jokes about autistic children. But boy, was I surprised. Professor Simon Baron-Cohen turned out to be almost the polar opposite of his more famous cousin; he was quiet, articulate, and had the same soft-spokenness I’ve noticed in good doctors who work with children. What’s more, to receive a lecture on autism from the man who practically wrote the textbook was inspiring in a way I consider myself lucky to have experienced.
In my last post I talked about heroes. Professor Simon Baron-Cohen is definitely one of them. Every year he is invited to give talks to the general student population, and they are always hugely popular. Students not doing Psychology sneak into his lectures just to hear him speak. Part of his appeal is of course his academic star quality, which he has achieved without any help from his cousin, but part of it is also that he is, very simply, a good teacher. He doesn’t have any airs and will readily answer any question, even from a starstruck medic who went up to him after the lecture and asked a random question simply to get near to him, and then started giggling like a schoolgirl when he replied. (Not that I’d know anything about that. Cough.)
I guess I’m lucky to be part of a profession where heroes are readily available and can be found on the frontlines, diligently working away for the betterment of humanity. Every university has its own academic stars; the ones who inspire you in the best way possible: through example. I’d love to hear about yours. I need all the inspiration I can get to resist the urge to go jump off the nearest bridge… OHMIGOSHEXAMSAREINTWODAYS!
Beyond McDreamy: Real Medical Heroes
Aaron Singh -- The previous post by our dear nearly-graduating fellow blogger Kristen got me to thinking about heroes. (No, not the new American TV series, you addicts.) We all need heroes. I could go on and on about why, but then I’d just be ripping off Aunt May’s speech from Spider-Man 2, so suffice it to say that we need someone to look up to and to show us that things can be done. Call it the "4-minute mile effect," if you will, named after Roger Bannister who ran a mile in 4 minutes and showed the world that it could be done, after which a bunch of other runners perked up and said “Hang on a minute, maybe it IS physically possible after all” and started doing the same thing themselves.
Basically, we need someone to show us that it can be done. Someone to inspire us; someone who gives us strength, makes us noble -- no wait, hang on, that’s the speech from Spider-Man 2 again. Um. Okay, never mind. Anyway, we in medicine are no different -- we look up to famous doctors, teachers and role models. Unfortunately, if you ask anyone nowadays to name a famous medical role model, the answer will most often be:
“Why, Dr McDreamy from Grey’s Anatomy, of course!”
Or Dr House. Or McSteamy or McSleepy or McCreepy or whatever. The point is, the deluge of medical dramas on television has changed the way people view medicine. There is some evidence that medical school applications have risen as a result of popular medical shows like Grey’s Anatomy and House. And while the actors' portrayals of doctors are commendable, they're not very realistic. Wanting to be like them is all well and good -- until you actually GET into medical school.
Then you realise it’s not possible to have a “hunch” and be correct in your diagnosis every time despite overwhelming medical evidence to the contrary. You realise that not every patient who goes into cardiac arrest is going to survive after you thump his chest a few times. You can’t treat patients and nurses like crap and get away with it. And no, every time you burst through double doors the E.R. theme is NOT going to play, and your white coat will NOT be billowing heroically behind you. (Dangit.)
Thankfully though, one thing medicine has no shortage of is real heroes. These are usually the unsung ones, the kind of hero that you find in everyday life, whose efforts usually go unnoticed. Like the specialist who actually treats students nicely and who doesn’t mind teaching you a little bit extra. Or the nurse who stays behind after her shift to make sure her patients are okay. Or the professionals who go above and beyond the call of duty because they are truly dedicated to their jobs, and who do their jobs well despite knowing they won’t get any extra recognition for it.
Being a preclinical medic, I haven’t seen many of these heroes (but I’m told they’re out there in almost every hospital; all of my medic friends have someone they look up to. Do you?) Those that I have had the pleasure of knowing have touched me with their dedication. I’ll talk about one of the more famous heroes here at Cambridge in my next post. In the meantime, I need to get to the library before all the spaces are snapped up -- people actually queue up waiting for other people to vacate their seats. The sheer madness of it all.
See why we need heroes?
My Head Is Full of Drugs
Hello. This is Aaron’s brain writing. Unfortunately, Aaron is unable to blog this week as he has passed out from repeated slamming of his head against his desk after the 53rd consecutive mock exam he has had to undergo this week. I, however, am still able to pass on his thanks for the many constructive comments his astute readers posted on his last blog entry, and as you can see, I am also able to make extremely lame jokes like the one above. I am also glad to report that I am intact, though my frontal lobes are a bit sore as a result of the trauma from head slamming (Aaron’s desk is quite hard; bad for me, but good for losing consciousness in the shortest amount of time, as well as making a loud enough sound to alert his neighbours, even if they do spend about 20 minutes howling in laughter before someone recovers enough to call an ambulance). Certain segments of my cortex have also been fried as a result of an intensive pre-exam period of cramming 300 drug names into my limited neurons, some of which proceeded to protest and commit mass suicide to avoid being forced to memorise anymore. However, I estimate only a few hours before Aaron regains consciousness and can repeat the whole cycle again in preparation for the next round of cramming for exams in three weeks’ time.
I also anticipate further physical trauma to other parts of Aaron’s body quite soon. As soon as this evening, in fact, when his tutor announces the results of his last mock exam, we are expecting quite some trauma to his rear end. Boot sole fragments were found in his gluteal region the last time mock exam results were handed out.
This, of course, is all conjecture. Some of Aaron’s tutors are so esteemed that they have written several large tomes of knowledge, and in addition to brandishing these tomes during tutorial, they are quite apt to hurl them at their students’ faces, particularly Aaron’s. Facial trauma may also be on the menu. We shall see.
Until next time, may your hemispheres be as one.
Is Medicine Really My Passion?
No, really. Do you? Is what you’re doing now exactly what you want to be doing for the rest of your life? Is it what, in the innocence of childhood, you saw yourself doing, in the rose-tinted FutureVision™ that we all see our future selves in?
No, this is not one of those self-help ads you see on TV. As I’m sure any one of you has discovered if you've ever been forced to sit down and spend ridiculously long hours concentrating on ingesting material (read: cramming), revising tends to make you all deep and introspective. Along with the “I’m-never-doing-this-last-minute-cramming-again” promises you make to yourself (promises that inevitably tend to last until 24 minutes after your final exam), you tend to start asking yourself whether it’s all worth it. With the increasingly difficult financial situations of medical students, the long hours of work, and the sheer agony of being forced to stay in and revise whilst your friends doing other courses are out playing Frisbee and chatting girls up on the University lawns with the spring flowers out in full bloom (not that I’m bitter or anything), doubts begin to creep up in your mind about whether you’re truly doing what you’re passionate about in life.
Donald Trump’s cardinal rule is “Love what you do”. Almost every self-help book written by successful people includes some variation of this. And the medical profession is no exception to this: there are many, many doctors, nurses, and medical students out there who are truly dedicated to their art. Some of them, including my fellow writers on this blog, are your dream doctors: kind, not money-minded, genuinely caring about their patients. They are missionary-like in their zeal (and some of them ARE missionary doctors, come to think of it). Whilst some of them might come off as being ultra-competitive nerds, like Cristina Yang on Grey’s Anatomy, underneath the whole must-win medical-junkie image is a true passion for what they do.
Then you have the other extreme: medics who got into medicine not because they wanted to. Some of them were forced in by their parents (“we know what’s best for you, honey” sound familiar?), some of them just didn’t know what else they wanted to do, some of them want the money, and some of them watched an episode of ER and went “Hey, that’s so cool!”
Then there are those of us in the middle. Those of us still going through the motions, still unsure of whether medicine is really right for us. Some of us stuck in this limbo will eventually come to our senses and leave for new pastures that really excite us (Jonathan Miller, Che Guevara, Deepak Chopra and Michael Crichton were all trained as doctors). Some of us will find something about medicine we love, and stay. Some of us, the really talented ones, will do both.
But for now I count myself in this limbo. I know I really like medicine, but I have other passions too. Maybe I can find a balance. Or maybe I should listen to my lecturer, who when consulted said “The more you do something, the more you realize if you like it or not. So shut up and get back to work, you lazy bum.”
Yes sir. I’m going, sir. Straight back to the library, sir. Please put that whip away, si— …ouchies!
Final Exams Provide a Reality Check
Aaron Singh -- It’s 6 am, and I’m sitting by myself on the top floor of my College library. The sun’s first rays are beginning to peek through the modern glass ceiling, and I’m still plowing through a series of Pharmacology lectures. In recent days I have earned the dubious honour of being the biggest customer at the College coffee vending machine, being too lazy to crawl all the way back to my room to make my own, and I’m now on a first-name basis with the College janitors who come in at 4 am to clean the library and prepare it for another working day. The librarian doesn’t bother cleaning up my books when she finds them anymore, knowing that wherever I’ve run off to, I’ll be back soon. Sigh.
So why am I working so hard, you ask? Well, firstly, it’s out of sheer panic. You see, ladies and gentlemen, just recently, about the same time I cracked my first textbook open a few days ago, I discovered an urgent truth that (I like to think) many medical students (just not the ones around here) probably discover around the time they sit down and begin hardcore revision (studying) for final exams:
I have forgotten how to revise.
No, really. All year I’ve been frolicking around on stage (which explains the death threats from my tutors) and making half-hearted attempts at studying (which explains the death threats from the lecturers who mark my essays). Now I’m getting death threats from my neurons, as I overload them in a last-ditch attempt to prepare for exams in 2 months.
So why this last-minute studying? Well, taking inspiration from Kendra’s last post, I could go on about how I signed up to be a white-coat-wearing, patient-seeing doctor hungry for clinical experience, and didn’t expect the hardcore academic training we get in our first three years.
But nope, the reality is simply that I'd lost myself for a while. I’d forgotten how hard I had to work to get into medical school in the first place, and how hard we all promised ourselves we’d work once we got here. But fortunately for me, a combination of caring tutors and overly competitive manic coursemates has opened my eyes while there’s still time. I may have to work overtime for a bit, but it’ll be worth it in the end; if I get my choice of third-year course, I may finally get some clinical exposure! But that’s a story for another post…in the meantime, I have a far bigger question looming on the horizon:
Black or white coffee?
Update on UK Doctors' Situation
Aaron Singh -- Since my last post, an event has happened that has had doctors cheering in the wards and medical students taking time off revision to go to the pub with their comrades to drink in celebration (not that I’d know anything about that. Cough). Right after I sent in my previous post, the National Director of Modernising Medical Careers (MMC), the administrative nightmare that has been plaguing British junior doctors for the past few months, announced his resignation. In his announcement, Professor Alan Crockard stated that he thought “the principles of MMC are laudable and I stand by them. More patients should be treated by trained doctors, rather than doctors in training."
(Now, how exactly he thought that we could get trained doctors OTHER than letting doctors-in-training treat patients, I don’t know, but hey, I am but a humble brain-damaged drone slogging away in the academic backwaters of Cambridge, not some head honcho at MMC Central. That sort of job probably requires more brain cells than I have left, especially after most of mine committed mass suicide (apoptosis?) after about 3 hours of continuous pharmacology.)
However, he ended with a nice acknowledgement of the profession’s opinion of the whole fiasco: “But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system.” Now that is a refreshing change from the government’s official stand. So far, doctors have not received a single apology or acknowledgement of the medical profession’s dissatisfaction with the system. If Professor Crockard stepped down in genuine protest against the failures of the system, then he truly deserves to be applauded.
The review of the whole process that the government promised, which was supposed to be jointly carried out by representatives from the government as well as the medical profession, has also suffered a setback. The British Medical Association (BMA) has pulled out of the review in protest.
I have no idea what you all think of me now for spamming this blog with MMC updates, but I hope some of you have found this informative. (The rest of you, hold your rotten tomatoes! Let me get my flak armour on first.) Back to the library!
Small Comfort for UK Doctors
Aaron Singh -- After the hullabaloo of the past few weeks regarding the new government policy on UK doctors’ training (see my previous two posts), all the ruckus that has been raised by doctors appears, amazingly, to have finally penetrated the dense corridors of bureaucracy in the labyrinth of red tape that is the Department of Health (DH).
They have finally agreed to scrap the previous system of interviews under the Medical Training Application Service, which brilliantly ignores doctors’ CVs, research accomplishments and extracurricular achievements in favour of their creative writing abilities, i.e. how well they can imitate John Steinbeck in describing moments where they showed ‘decision-making ability’ or ‘proper team-building etiquette’. What’s that you say? It sounds like this new system was dreamt up by hospital janitors instead of top hospital consultants? Well, funny you said that, because it’s not so far from the truth. Recently the Health Minister came out and apologised to the House of Lords after discovering that the only people selecting candidates for interview (and by this I mean DECIDING HUNDREDS OF DOCTORS’ LIVES AND FUTURES) were, surprise surprise, not only doctors, but also “senior non-medical clinicians or senior deanery human resources staff”.
He forgot to include “and one big mother of a PC”. Because the entire system was online. Hundreds of thousands of doctors’ livelihoods were fed into one giant computer, and it reacted exactly as every cynic on the planet expected it to: by crashing. Repeatedly. And losing applications. And delivering others with the accuracy of Elmer Fudd on dope. There has since been much amusing debate over what exactly the Right Honourable Lord Minister meant by “non-medical clinicians”.
Under the new system, however, all candidates will be granted one interview at their deanery of choice. So there. All these lousy doctors taking time off their duties to march on the streets and whine in the papers (and in the case of this medical student, to blog) can stop their noise, we’ve given them one interview. Does this make things better? In the language used by the MTAS panel, oh yes. The conciliatory noises they make are enough to deafen a herd of stampeding rhinos. But if you take a closer look at just what they have promised (as more and more doctors and bloggers are starting to do) you start to see that things perhaps aren’t as rosy as the DH wants you to believe.
But like I’ve said so many times before that I suspect it’s starting to get old (is it? Tell me and I’ll stop saying this. Nothing stinks more than a stale blogger), what do I know? I’m only a medical student. I’m trusting the wise minds elected into government to know what’s best for my future. And it’s time for this medical student to go hole himself up in the library for another desperation-(and caffeine-)driven 24-hour revision marathon. Wish me luck.
It Takes a Debacle to Incite Doctors
Aaron Singh -- Thousands of doctors marched on London last Saturday, stirred to action by the huge injustice that is the Medical Training Application Service (which I blogged about in my previous post). The march, organised by medical protest group Remedy UK, saw 12,000 junior doctors, consultants, professors, medical students, general practitioners and supporters (and even a few nurses out in support of their medical brethren) marching from the Royal College of Physicians to the Royal College of Surgeons, two of the oldest medical regulatory bodies in the country (who are, incidentally, also having their decades-old autonomy interfered with by the government simply for not acceding to their requests for a greater say in their affairs). Another march took place in Glasgow on the same day that also attracted hundreds of protesters.
Even opposition politicians dropped by to take advantage of the government’s mess. Conservative Party leader David Cameron made a stirring speech in which he talked about “treating doctors like human beings” and giving respect to the profession. Applause and cheers greeted him. It has been a long time since anyone, especially politicians, spoke about doctors that way.
Doctors are not easy to incite. We are not rabid militants who jump up and start burning effigies at the first sign of our rights being infringed upon. It takes even more to get us on the streets, away from our wards and hospitals. But when that happens, it is a serious sign that something is wrong. Very wrong.
All throughout the week little else has been spoken about in London hospitals. There are whisperings of doctors leaving for Australia, New Zealand and the United States. Still more are planning to leave medicine altogether and take up an MBA course. One colleague told me the interviewer for a London MBA course had himself been a doctor years before!
But here in the academic backwaters of Cambridge, all the protest and hullabaloo has not reached us. The Easter vacation has begun, and for us that means it is time to buckle down and do some hardcore revision. Thanks to the lack of clinical exposure here, most medics are blissfully unaware of the chaos that will greet them upon graduation. What do we know? We’re just medical students. Now excuse me while I go enjoy some blissful ignorance by burying my head in Neurobiology.
UK Medical Profession Dips Into Chaos
Aaron Singh -- This past two weeks, the UK medical profession has been in turmoil. Senior doctors have been outraged, junior doctors have been driven to tears, and medical students (including yours truly) have been filled with fear for their futures. All this because a storm months in the brewing has finally hit us. It goes by the benign-sounding name Modernising Medical Careers (MMC).
MMC is the brainchild of the Department of Health, and was proposed to reform the training of junior doctors in the UK. It culminated in the Medical Training Applications Service (MTAS), which required all junior doctors, regardless of the jobs they currently held, to fill out an application form more akin to a Communications Skills exam. They weren’t even allowed to submit their CVs or portfolios. The method has since come under heavy fire for its many flaws, chief among them allocating a tiny percentage of marks to applicants’ academic grades and experience, and mainly being a test of creative writing. I provide a sample question for your amusement:
Describe a recent example from your surgical experience of a time when you found it difficult to make an effective judgment in a challenging situation. How did you overcome this difficulty, and how has this experience informed your subsequent practice?
Based on your answers to questions like the one above, you are then offered interviews by the four deaneries of your preference. But the total number of jobs available through this system means that, come August, 8000 junior doctors will find themselves without jobs.
On results day, the MTAS computer system crashed multiple times. Junior doctors in hospitals throughout the country found themselves without answers and had their suspense prolonged. Doctors found themselves with interviews for jobs they didn’t apply for. Some application forms went missing. All in all, the system was a huge letdown; as the British Medical Association put it, “a shambles”.
Entire careers. Jobs. Families. Dreams. Ambitions. All dependent on whether you can write waffle well enough in answer to those questions to get the job you want, where you want it. Since then MTAS has come under heavy fire from the medical profession. Newspaper headlines have highlighted it. Members of Parliament and prominent politicians have spoken out against it. Most of the medical Royal Colleges have criticised it. Indeed, several deaneries involved in MTAS itself have withdrawn in protest. And some of the countries’ best doctors and researchers, including a few of my lecturers here in Cambridge, have signed a letter to the Department of Health expressing their disgust with the seemingly carefree way MTAS is messing with doctors’ careers.
This Friday, a white coat ‘March in March’ has been planned, where doctors from all over the country will march from the Royal College of Physicians to the Royal College of Surgeons in London to protest this treatment. Over a thousand doctors are expected to attend.
As a medical student, most of this is still over my head. But it makes me fearful. Very fearful. Imagine all that work, all those years of slogging through med school, all those years on the wards, all going down the drain. Reports of junior doctors bursting into tears on the job this week have been all over the news. Fortunately it seems that the government is starting to back down after all the uproar.
There might be a light at the end of the tunnel after all, but for now it seems quite dim.
Cane and Dis-Abel-ed
Aaron Singh -- In the madness of life at Cambridge, you have to take time out. That is, if you want to avoid becoming one of those nerds so ubiquitous here, who walk out of lectures at 2pm, into the library, and out again at 7am the next day to go to lectures, and who survive on nothing but bread and Sainsbury’s sandwich filler, and who raise their noses from their books only to clean their thick-as-Biochemistry-textbooks glasses once in a while. That, or a lecturer. (Seriously, some of them look like they’ve been buried in their labs so long they haven’t seen the light of day for months. At least, that’s what their dress senses tell me. Ever been lectured by a rambling old man in an Edwardian suit?)
So we all find ways to cope. Mine is comedy acting. I take to the Cambridge stage at least once per term, to the laughter and applause of drunk students too inebriated to throw rotten tomatoes at my lame jokes, and to the consternation of my tutors, who tell me I should stop prancing around on stage and concentrate on becoming a doctor. And so it was that last Saturday I was on stage as Romeo, and during the final dance when I had to lift Juliet onto my shoulder, something in my leg pulled. And when I woke up the next morning, my leg was NOT happy.
So this past week I’ve been hobbling around on a cane. It’s a borrowed cane, belonging to another medic who, for whatever reason, thought it would be convenient to jump off the Bridge of Sighs onto a punt floating past underneath (true story). It’s a nice cane, too, that bears no small resemblance to the cane made famous by Hugh Laurie’s Dr House in the TV series.
We’ve all seen patients on canes. But they usually hobble into the clinic or teaching area, get checked out, then go back to their lives, and that’s that. We never stop to think about how their lives must be.
But now I had my chance.
The first thing I learned about walking with a cane is that your walking speed is considerably reduced. Here in Cambridge everyone walks fast, and the first few days I was late for lectures, tutorials, everything. But eventually I got the hang of it. I started twirling my cane whenever I stood still, and used it to do all sorts of tricks like open doors, press buttons, and hook objects to drag closer (Warning: Do not try this with a full glass).
But the thing I wondered about was: would people give me more space? Are we as a society still sympathetic to disabled people, or have we decided that they don’t deserve sympathy simply for being disabled? To ascertain this, I decided to try the most daring experiment, the ultimate gauge of public civility, that most time-honoured test of sympathy: The sidewalk test.
*dum dum DUMMMM*
It’s simple. You hobble along a sidewalk (and here, the sidewalks can be incredibly narrow) and see if people give way or if they simply stare ahead and continue to walk, in which case you can either squeeze past, give way yourself and step off the sidewalk (which I do for ladies anyway, this being Britain) or, if you’re in a particularly nasty Dr House-ish mood, beat them out of your way with your cane.
And the verdict?
Idealists rejoice, for most people are still nice. On the really narrow sidewalks everyone stepped off for me when they saw my cane. I didn’t get treated any differently either, and some of my friends were very nice and helped carry my stuff (there are always some perks). And whenever I bumped into an elderly person using a cane, they’d smile kindly at me, or give me a knowing twinkle (as if to say “get off that cane whilst you still can, youngster”).
Thankfully now I’m almost off my cane, but still … I’ll never look at a person with a cane the same way again.
A Moment of Truth for Every New Doctor
Aaron Singh -- There comes a moment in every medical student’s life, when he realizes that all he’s learning is not just for exams, that one day he will be out there on his own, with real live patients and no medical professor leaning over his shoulder to guide him.
I knew it would happen.
And this week it did.
I have blogged here before about being a first-aider, and here about my University having a highly theoretical premedical course without much clinical skill development. Back before my encounter with an epileptic woman aboard a plane, I wouldn’t have hesitated to rush forward during a medical emergency and volunteer whatever help I could. Then I read the comments under the first-aid post, advising me not to rush into situations. I also heard horror stories from other medical students about medics and doctors getting sued by people who didn’t want to be saved. And I hesitated. All that I had believed about medicine was challenged. You couldn’t just rush in and save someone if they didn’t want to be saved. And if you didn’t know EXACTLY how to help and what to do in that situation, it was better perhaps not to step forward at all.
It was a normal Monday afternoon. I spend my afternoons in Pharmacology lab sessions with about half the medics in my year. This particular afternoon’s practical was a laid-back, slow one, and I was at my table, mixing drugs up, when behind me I heard a loud crash.
I turned around and saw that the whole lab was still. Whatever had happened was hidden from my view by another table, along with the medics sitting at it. Other medics were craning their necks to get a good view, but no one seemed to be moving. Nothing seemed urgent. I assumed someone had dropped another test-tube or beaker, or some apparatus had fallen to the floor, and everyone was taking advantage of the interruption to take their minds off their work for a while.
But people kept staring. I got that feeling you get in your stomach when you know something isn’t right. No one was moving, not even the demonstrators. I asked around, “What’s happened? Did someone drop something?” but no one answered. They just kept staring at the floor.
So I crossed the lab and came around the table. And lying on the ground before me, in the middle of a slowly growing crowd of onlookers, was a student. Passed out on the floor.
No one moved. A lab full of some of the brightest medical students in the world, and none of them had any idea what to do when someone fainted in front of them.
Then it kicked in. I was a first-aider. I was a MEDIC. I could DO something here. Go forward, you fool. She could be hurt. I started to step forward…
And through my mind flashed a single question, a question I am ashamed to admit ever crossed me now, especially at such a critical juncture:
Will I get sued?
Seems ridiculous in retrospect. She was just a medical student who had passed out in the lab. Not a patient going into cardiac arrest or requiring complex surgery. But that’s what flashed through my mind.
I was afraid to practise my art. Afraid to accept responsibility.
Everyone kept staring, myself included now. Finally a grad student raised his voice, “Is anyone here a first-aider?”
I started to reply, “Ye—“
Then a long white coat flashed by me. A tall handsome demonstrator, exactly the kind you’d expect to come zooming out of the sky to save you in a crisis, rushed past and bent over the girl, carrying a first aid kit. I blinked. A senior first-aider! Now maybe I could help.
So I joined him and introduced myself. The girl was already recovering consciousness; she had just fainted momentarily, probably due to tiredness. In a few minutes she could stand, and we sent her home. The tall demonstrator clapped me on the back and went back to work. No harm done.
But the incident is still ringing in my mind. I’ve got a long way to go before I’m out there on my own, but it scares me. Both that I hesitated, and that I was afraid to perform my duty. The first duty of a doctor. I’m safely ensconced in preclinical medicine now, with supervisors looking over my shoulder to clean up any messes I make, but it’s only a matter of years before I find myself in a white coat and having to tend to real patients. And when that time comes, I pray I do not hesitate.
"I Was a Doctor for the Taliban"
Aaron Singh -- Thanks to all who commented on my last post. Whilst some of you misunderstood what I wanted to convey (I was not, repeat, WAS NOT insulting surgeons, I was commenting on a minority who do the profession no good by flaunting their egos beyond reason), I found the comments enlightening, especially since I harbour dreams of joining the ranks of surgeons myself someday. My curiosity piqued, I was driven by the reaction generated by my post (and by the crowds of angry surgeons baying outside my door) to delve deeper into the world of surgery. This opportunity presented itself when Mr Philip Henman, an orthopaedic surgeon, came to Cambridge to deliver a talk called "Conflict Surgery: The Great Game from the Sidelines." (By the way, in the UK surgeons are referred to as "Mr.")
Mr Henman has a special interest in providing surgical care in war-torn areas and has served with both the International Red Cross and the British Territorial Army. His most recent assignment, and the one that formed the bulk of his talk, was in Afghanistan, where he served before the war broke out. At that time, the Taliban were seen as bringing modernisation to the country, and indeed he found that whilst theoretically his camp was there to treat and augment the British forces in the area, many of his patients came from the local population.
In fact, he was essentially a doctor for the Taliban.
After a long, harrowing bus journey to the Cambridge hospital (which is some distance away from the University) involving a delay of more than an hour, a huge angry Scottish bus driver, and a storm intent on blowing my umbrella away, I stumbled into the lecture theatre just as Mr Henman was being introduced. He started off with gory pictures of injuries sustained from landmines, a step-by-step run-through of the types of injuries caused by projectile weapons and different calibres of bullets, and some weapon-related operations he performed. (It was at this point that I realised it was probably not a good idea to be stuffing your face full of the refreshments provided when a picture of a blown-off leg flashed onscreen.)
Then came the part everyone was waiting for: tales from the frontier. Mr Henman gave us a firsthand picture of what life really was like out there in war zones: the lack of proper resources and First World operating theatres, the eventual desensitisation to gunfire in the distance, the need to keep yourself going with simple pleasures like taking a walk in the hills. The patients weren’t the only ones at risk of dying out in the field hospitals.
Working with the locals also gave him an insight into their ways and lives. Mr Henman put up a picture of a smiling Afghan man with a flower in his mouth; this playful-looking dude with a huge beard was, in fact, the local Taliban commanding officer. He explained that whilst today’s world might view this man as a dangerous terrorist, back then he just wanted to open a hotel. "All the Taliban wanted to do was to start from scratch, restore order to Afghanistan, settle down and then, you know, open some hotels," he told us, grinning widely.
And then, as all surgeons do when speaking about surgeons, he got onto the surgeon’s ego bit. Just like any other surgical specialty (or indeed any other part of medicine, for that matter), conflict surgery can be dangerously addictive. Many surgeons volunteer for missions abroad to add a little spice to their careers, and maybe to tack a little glory onto their CVs. But then you get the adrenaline junkies, the ones who relish being in control and having so much power, the ones who go out repeatedly on missions to the most dangerous locales, risking life and limb. Often these were surgeons who had no families to speak of, and many were also disillusioned with medicine in their home countries (here in the UK the culprit is often the National Health System).
Mr Henman also added, however, (and here I completely agree with him) that these surgeons, whilst demonstrating personality quirks like a massive ego and obsession with their work, were also tremendous assets to international aid organisations, simply for their willingness to be sent out into the field repeatedly.
His talk was enlightening in more than just a medical way. Many of the questions he fielded after the talk were about Afghanistan, and how rather than being a nation of bloodthirsty terrorists as painted by the media, it contained ordinary people living ordinary lives, just like anywhere else. But the medical aid worker’s perspective is unique. Often medicine is not so clear-cut out in the field as it is in a hospital.
Why Do Surgeons Have Such Big Egos?
Aaron Singh -- Last week I went to hospital. (pause for collective gasps!) I know, I know, I study in a university famous for being strictly traditional and hence not allowing pre-clinical medics anywhere near patients for the first three years. How then, you ask, did I get into a hospital? Did I, in a moment of sheer desperation, dress up as a nurse? Did I slip on some scrubs and do my best J.D. impersonation? Or did I, completely fed up of mindlessly stuffing obscure biochemical details into my brain, walk into the middle of the street, get hit by a car and get sent to A&E (the British version of the ER)?
I wish I could say that I did (it’d certainly increase the hit count on this page), but nope, the answer is much more mundane. In an attempt to pacify clinical-exposure-hungry and whiny students like me, the University has introduced a Preparing for Patients component of the course, which allows us to go interview patients in hospital once a year. It’s to improve our communications skills, and seeing how fantastically excellent I am at communicating my feelings without launching into a full-blown rant, it seems like a very good idea to prevent deprived students from beating up (or more likely getting beaten up by) patients in their 4th year.
So it was that at an insanely early hour, we were sipping coffee in the hospital cafeteria, waiting for our consultant to show up, and being given a rare opportunity to just sit back and observe how a hospital operates. There we were, so ridiculously well-dressed that any half-starved idiot sauntering by could’ve told that we were medical students. (I mean seriously, how many doctors do you see walking around hospitals wearing suits?) It was then that I noticed you could actually tell what sort of doctor the person walking by was, simply by the way they looked at you. Some of them walked past and smiled when we caught their gaze. Some of them were staring off into the distance, lost in thought, and didn’t even notice the crowd of curious well-dressed medics gawking in the cafeteria.
And then there were the surgeons.
These were the ones who walked past you with a sense of purpose, with an expression that sent lesser medical personnel scurrying out of their paths in terror, and with eyes whose gaze could physically melt medical students if you weren’t careful. Several walked past us, instantly recognizable, and those who bothered to look at us did so with a disdainful expression, dismissing our existence as being too trivial to bother their exalted minds. They were Lords of their Domain; entire operating theatres were built as shrines to their greatness. Why shouldn’t they walk around as if they owned the place?
I’ve always wondered why surgeons seem to be more affected by the famous God complex that seems so prevalent in the medical profession. Recently, my cousin brother underwent surgery, as I talked about in my previous post, and the surgeon who operated on him, whilst perfectly competent, also demonstrated this uppity demeanour. She strode into the OT (fashionably late) without seeing him pre-op, and didn’t even check on him post-op. During the surgery she didn’t bother to reassure him; it was the nurses who did this.
Now don’t get me wrong, I’m not slagging surgeons. I know many fantastic surgeons, and hope to be one myself someday. I just think they could tone down their ego sometimes. Not all ego is bad; I’m a Donald Trump fan and he’s known for espousing the belief that a healthy ego leads to a higher quality of work. And this is true as long as it drives surgeons (and indeed any other worker) to perform better, but it’s completely unnecessary when it causes them to ignore patients, shout at nurses and look down on doctors from non-surgical specialties. And abuse medical patients. ESPECIALLY when they abuse medical patients. But that’s an embarrassing story best saved for another day…
Nurses’ Effect in the Operating Theatre? What Effect?
Aaron Singh -- The waiting room was cold. I remember thinking to myself, why the heck are all hospital waiting rooms cold? If I ever become a hospital bigwig I’m going to make sure there are MORE than a few heaters installed in my hospital waiting rooms.
I sat on the edge of the bench looking straight ahead. It was only after a few minutes that I noticed that the rest of my family members there were looking at me with an odd expression on their faces. Then I remembered. Here I was, a bigtime medical student, studying at a top university. Knowledge coursed through my veins, and I was sitting in a hospital. I was supposed to be in my element. Master of my realm, all that jazz. They clearly expected me to be the picture of calm. The source of reassurance. Not this quaking, sweating, nervous wreck sitting on the bench unable to make eye contact with them.
On the other side of the wall, in an operating theatre, was my cousin brother. He was undergoing surgery in an operation which I was told was quite routine and from which "he probably won’t die," or so said the surgeon with a smile. Someone needs to tell surgeons that sarcasm isn’t exactly what family members want to hear right before you slice their loved ones open.
Pull yourself together, man! Time to play genius medic. And so I forced myself to stop worrying, plastered a silly grin on my face, and turned to my family members. I tried to think of something reassuring to say, mentally digging through all those Communication Skills classes I’d slept through, when she came.
A shimmering vision of beauty and kindness, holding a cup of steaming tea, with a kindly understanding expression on her face. She sat down with us on the bench, introduced herself as the head nurse on duty, and started talking, and before long she had the whole family calmed down and raptly paying attention, myself included.
On the other side of the wall, my cousin brother (being a plucky medical student himself) had elected not to have general anaesthesia so he could experience what it was like to undergo the operation. He later related to me how cold it felt, and how the surgeon was rather impersonal, humming away without so much as an "are you okay?" It was the OT nurses who kept him reassured and made sure he was comfortable. He told me they were really professional and concerned, and made up for the surgeon’s lack in communication skills several times over.
Some doctors have told me that nurses play a very small role in a patient’s stay in hospital. I beg to differ. Whilst it may be true that the doctor’s role is far bigger, it should be remembered that there are some things a doctor can’t do that nurses can. I hope I still remember this when I grow up and become some impersonal drone mindlessly chipping away in some ward somewhere.
We Interrupt This Blog To Bring You An Earthquake
Aaron Singh -- The earthquake near Taiwan that occurred on the Tuesday after Christmas, clocking a 7.1 on the Richter scale, meant many things to many people. To Taiwanese residents, the earth under which they had walked all their lives, secure in its fixedness, suddenly betrayed them, shaking buildings, killing two people and injuring at least 42 more, according to this BBC report. To people all over the rest of Asia, the severing of underwater communications cables meant they were cut off from one another. Businesses went into panic, governments scrambled to contain the crisis, and banks rushed to make sure their foreign trading activity was not affected.
And in the midst of it all, somewhere in a sleepy town north of the capital of Malaysia, one lone medic was typing away at his computer when suddenly an error message popped up and ruins his day.
"Connection Lost. Retry?"
Naturally, the hapless medic retries. Of course he’s going to. In fact, he retries some 30 or 40 times. But the modem isn’t even listening. One of its distant cousins somewhere on the floor of the South China Sea is in trouble, possibly even severed, so it’s definitely not going to stick around so some medic can update his blog. Oh no. It’s already packed its bags and rushed off onto the Fibre Optic Superhighway to see what it can do.
And so it is that my blog entries are a little late. Whilst Malaysia wasn’t directly affected by the earthquake, Internet connectivity in some areas was disrupted, and sluggish at best. My thoughts go out to not only the people directly affected in Taiwan, but to those around the rest of Asia who suffered more serious consequences that I did due to the loss of communications. Just goes to show how we’re all connected in this day and age, and how we don’t need to be physically affected by a disaster for our livelihoods to be disrupted anymore.
How Much (or How Little) Should Doctors-in-Training Work?
Aaron Singh -- It's funny sometimes how raw materials at the beginning of a process differ so starkly from the end product. One of the most well-known examples is of course the diamond-making process; raw carbon isn't much use to anyone, but throw it through extremes of pressure and temperature, and you get one of the most sought-after gems in the world. And any medical type can tell you that faeces looks quite different before it goes through the process that makes it faeces. Another process medical types can tell you about is the process that made them medical types in the first place: medical school.
The beginning of the whole process is actually quite fun to watch (especially if you're one of those sadistic medical school professors prone to rubbing your hands together and cackling evilly). You've got these triumphant, smells-like-teen-spirit types fresh out of the long slog of school, waving their successful applications about and actually believing in those big terms they used in their personal statements; terms like 'vocation' and 'calling' and 'service to mankind'. Full of bravado, they march eagerly through the gates of med school, completely oblivious to the fact that said gates are painted blood red, ominously tipped with barb wire, and are held open by grinning succubuses in white coats.
Fast forward five or six years and you see the end product. Call them what you will, interns, F0/F1 doctors -- I'm going to call them housemen because that's what my local hospital calls them. The housemanship years, the formative years of every doctor's career, often are also the most abusive and overwork-filled years. The treatment of housemen varies from country to country. Let's look at one end of the spectrum by starting with Malaysia, one of the more advanced Third World nations, a country gaining more and more international prominence for its medical standards.
For years, housemen here have worked 34-hour shifts without much remuneration and not even the reassurance of having the next day off. They are expected to work these hours whilst being given the most menial of tasks and being treated with less respect than the average hospital janitor. This whole baptism-by-fire approach tends to be supported by old doctors (who of course had to go through it themselves) and by young doctors whose parents are old doctors. "You'll gain invaluable experience", they say. "No better way to learn the trade." And when pressed with persuasive arguments, they go back to the old favourite, "We went through it, so you bloody well can too. Knuckle down and stop complaining, you young upstart".
Now let's look at the other end of the spectrum: new doctors with too light a workload. For this, of course, we return to Glorious Britain, Motherland of Political Correctness and People Who Sometimes Just Whine Too Much. Here the European Working Time Directive has doctors working only 56 hours per week, with plans to reduce this to 48 hours in the next few years. And yet still you get protests; predictably from old doctors but also from some very worried young doctors. "How are you young whippersnappers ever going to be as good as we are when we worked hundreds of hours longer than you did?" ask the old doctors. "How are we ever going to be as good as them when they worked hundreds of hours longer than we do?" ask the young doctors. The authorities, of course, sidestep the whole issue by feeding an easy-to-understand analogy to the people. "Just as you wouldn't want a pilot who hadn't slept for two days flying your plane, you wouldn't want a doctor who hadn't slept for two days treating you", say they. And they have a point. But can housemen's workload be reduced so drastically? Will this impair Britain's ability to compete with the rest of the developing world when it comes to healthcare? And just how much (or how little) should junior doctors work? Where is the balance between experience and overwork?
I don't know. All I (and countless other junior doctors like me) can do is look to the Powers That Be to decide what's best for us, and keep our fingers crossed when we graduate.
Saving the Day at 30,000 Feet (Or Not)
Aaron Singh -- It was all quiet on the plane. The lights were dimmed; most passengers were asleep. The dashing young medic was in his aisle seat, talking to a hot young air hostess who was crouched in the aisle next to his seat, eyes wide in admiration at his tales of medical derring-do.
Then, suddenly, a cry from the opposite aisle! Flailing arms could be seen over the heads of snoring passengers. The hostess rushed off whilst the medic stood up and, with his keen diagnostic eye, spotted the unmistakable signs of a woman having an epileptic fit.
Gallantly he stepped out of his seat, mentally prepared himself, and strode over to help. The woman was in spasms, being held by her beautiful teenage daughter. The hostesses didn't know what to do and stood around with pillows in their hands. All their faces, with worry in their beautiful eyes, now turned to the medic standing authoritatively above the woman.
The medic, realising he was the woman's only hope, stepped down to take charge. As his strong powerful arms moved in to stabilise the woman, her young daughter's doe-like eyes turned to him, and her quivering lips parted for the words to stumble out:
"What the heck do you think you're doing?"
The medic stopped. Surely she hadn't meant to be so abrupt. Surely she realised one of the world's finest medical students was now bent above her mum trying to help. So he replied in a manly voice:
"Why, I'm going to try and stabilise her, of course." Brilliant smile.
The stunning hostess from before glanced shyly at him from out of the corner of her eye. He flashed her a confident smile for good measure. Then, with an adoring expression on her face, the daughter spoke again, uttering words in a tone he was sure would be nothing short of reverent:
"Get your hands off my mum!"
It was about then that I started realizing how big an issue patient consent was in this country. All those years I'd watched chiseled-jaw TV doctors rush over to help inexplicably beautiful women who collapsed before them on the street led me to believe you could just rush over and administer first aid to whomever you liked. In Malaysia that's certainly the case; merely being a medic meant people would be happy if you volunteered your services in an emergency, and would almost always let you take over. But in Britain the situation is different, as I learnt on one of my first-aid assignments; you can't simply run over in slow-motion with a first-aid kit whilst the theme from E.R. pumps in your mind. The patient would be well within his or her rights to tell you to sod off (especially if, like me, you can explain all the ionic receptor interactions that cause epilepsy at a molecular level but don't know jack about treating it. See my previous post for why). Just another manifestation of the Eastern reverence for (and the growing Western mistrust of) the medical profession.
But I've been thinking about whether patient consent is just another bullet point in the long list of things that have been caught up in the tide of political correctness whitewashing the country. Surely it serves as a safeguard to protect patients from quacks and incompetent practitioners (not that I'd know anything about that, of course), but where does it stop? At what point does the patient's ability to choose actually start to endanger him? Before going on a first-aid assignment, we are told to introduce ourselves properly to any patient, reminding him or her of our limitations as first aiders and asking permission to treat. However, this power that patients wield over us also lets them nitpick, going so far as to demand a specific type of plaster or bandage simply for cosmetic reasons.
All I know is that I'm going to make sure my first aid kit is well stocked with medium-sized Hansaplasts before going out on my next assignment.
I'm a Medic -- Get Me Out of Here!
Aaron Singh -- Making the decision to become a doctor is easy. It probably happens one lazy afternoon, when you're sitting in front of the television watching one of those hunks or supermodels playing doctors on TV burst through double doors, white coats billowing behind them in slow motion as the theme music plays. You see them save patient after patient whilst having time to form lasting relationships, sleep with one another, get into and out of prickly situations, and still show up on time for work the next morning. And you think to yourself, "Hey, that looks like something I'd like to spend my life doing." It is one of life's great sadnesses that at that moment, an angel does not appear in a glow of heavenly light and smack you on the head with a mallet to bring you back to your senses and make you choose a different career.
In my case, this particular tale took a surprising turn. After going through all the years and years of school, after sitting through all the exams they could throw at me (and there were quite a few, as Cambridge makes you endure quite a drawn-out application process), and after burning enough midnight oil to single-handedly raise the global temperature a few degrees, I found myself finally in university. After the senior medics had taken us wide-eyed eager beaver freshers on a tour of the medical school, I realised something was wrong and piped up.
"Um, excuse me, but -- when do we get to the hospital?"
A blank look. "What hospital?"
"Well, we're medics, aren't we? Where's our teaching hospital?"
They looked at me and blinked. Then the sniggers started. "Hospital? Riiiiiiight." Full-blown chuckling now.
See, my university is one of the last bastions of a purely traditional medical course. This means that while other universities hold lectures in hospitals and their students get patient contact in the first few weeks, we spend our first three years sitting in lecture theatres having obscene amounts of scientific detail shoveled down our throats. In fact, we enter the local hospital a grand total of about two times a year (barring any serious accidents, of course, and there are few serious accidents associated with lugging around huge textbooks from room to library and back again). I knew I was giving up some clinical contact when I applied here but I didn't appreciate the full extent of the sacrifice.
A few weeks ago, I was on first-aid duty at a sports carnival at Nottingham University. I was the only first-aider there not from Nottingham. I received my first hint that it was going to be an interesting day when I dabbed a bloodied gauze into my bottle of antiseptic. "What the heck do you think you're doing?!" came a shrill cry from the senior first-aider next to me. "Don't they teach you sterility where you come from?!" A very basic mistake, and one that, in retrospect, makes me cringe, but one that I simply hadn't been taught about.
For a while after that I felt sorry for myself. I felt as if I wasn't getting out of medical school what I'd gone into it for. Then came a chance meeting with one of those passionate genius book-toting medics that we all want to kill at some point in our careers. She was in the year below mine but knew stuff I was still learning in my lectures. In the midst of pummeling my self-esteem into the ground, she told me why she chose to come to Cambridge to read medicine; to her, the traditional system was a safeguard, a way of ensuring that when she came into contact with patients, she really knew her stuff. Everyone who enters the medical profession has some desire for excellence and hard work, and to her this meant knowing her stuff inside out, even if it also meant she'd know needlessly obscure molecular details about how the drugs she was dispensing were acting.
It made sense. It didn't immediately solve my crisis of confidence, but it helped. The University Prospectus warns you that there are many ways to learn medicine and that "by choosing Cambridge you have declared your choice." Personally, I'd like a little more blood on my shield before I go out into the arena that is the medical profession, but hey, every method of learning medicine has its pros and cons, and I get some reassurance that at the end of the day we'll all be on even keel. Even those of us from PBL (Problem-Based Learning) universities.
Theoretically, at least.