Wednesday, 31 December 2014

2014

Normally on the last night of the year I write a post summing up how I've felt about the past year and what I hope for in the coming year. Last year I was unable to get to a computer on new year's eve so I didn't make one, but this year I have my laptop at hand, and despite the drink beginning to kick in, I think I can make it through this post whilst still sounding coherent!

Anyone who's read through this blog over the past few weeks will have probably picked up on the negative tone of the last few entries. Unfortunately that's pretty much the whole year summed up. I'm trying to be objective and fair about it all, and I don't want to cast a downer on things, but in all honesty, 2014 has been the worst year I can recall - trumping even 2010, because at least 2010 picked up towards the end. 2014 had it all - a relationship break-up, an inconveniently timed operation, an ongoing crisis of confidence in my own abilities as a med student...and that's not even getting into the longer term things I'm unhappy about. In general, it's just been a pretty rubbish year and I'm glad to see the back of it.

What do I hope for in the coming year? I'm not sure, but I think these would be my wishes and things I will try to work towards:

1) I want to pass my first examinations since starting clinical medicine (in March) with good marks - this would be such a boost to my confidence and would help me stop feeling so lost and adrift the whole time.

2) I want to reconnect with the reasons why I got into this thing - I love medicine, from the bottom of my heart, I really do. It is a tempestuous, mercurial mistress, but I have never wanted anything more than I want to be a good doctor. I want to go back to brimming with eagerness instead of feeling so angry and burnt out so often.

3) I want to hate my uni town less - yes, I miss my hometown, and yes I'm realistic enough to accept I'll never love it here, but at the same time, it would be nice if I could at least reach a state of cordial indifference, instead of outright loathing with the place.

4) I want to improve my social life - I don't have any great hopes for this one since I don't really have time to get out there and do new things...but still, it would be much appreciated.

5) I want to learn to differentiate between what goes on in the hospital and what happens in my private life. A rubbish day at the hospital should not mean that I should have a rubbish time when I get back home, and vice versa. I would say that this one is probably the most important one...and I would really appreciate any tips on how to achieve this goal.

6) I want to maybe get back on the horse, romantically speaking.



The cynic in me says that I probably won't reach all of these goals, at least not fully. The hopeful, optimistic side of me thinks that since 2014 was such a shit year, 2015 has nowhere left to go except up. I don't usually post "inspirational quotes" but for some reason, earlier today, I remembered a film I last watched some time ago, and I couldn't get the following quote out of my head:

"Let's drink to good times. Comic or tragic, the most important thing to do is to enjoy life while you can because we only go round once, and when it's over, it's over. And, perfect cardiogram or not, when you least expect it, it could end like that"

Happy new year to you all.

Wednesday, 10 December 2014

How can I snap out of this?

Block: Orthopaedics, week 3

My name is Grumpy, and sometimes I get angry.

The only problem is that as of late (the past three months especially) I have noticed that I am becoming more and more angry about more and more things, and it's really beginning to affect the quality of my life and my work.

As a person, normally (i.e. forgetting the past few months), I am quite calm and I don't have a particularly short fuse. I tend more towards being patient than impatient, and I'm not particularly prone to being over-emotional. Usually when I get angry, I don't show it at the time and I don't take my anger out on people around me (especially people who have done nothing to deserve it) - being prone to neuroticism, I tend to wait til I get home and then overthink it to death by myself. That's not particularly fun, but at least it means that I'm not perceived to be a dickhead by other people (hopefully).

Lately however, this is changing and I'm beginning to make it more and more obvious just how irritated and easily angered I am becoming. Matters came to a head earlier today when I ended up being short and quite rude with my consultant, something which I would never have seen myself doing before. The consultant, to be clear, had done nothing to deserve it - he just unfortunately happened to be on the receiving end of the past three months of my complete frustration and anger at so many different things. Luckily, I haven't completely lost all perspective, so a few minutes after being angry with him, I apologised and he was very nice about it. But that's not the point; this should never have happened in the first place. I'm not that guy. That's not me. That's not how I wish to be seen. But I can't seem to get back to who I really am.

What's even at the root of all of this? I would guess it's to do with the following factors (in no particular order):

1) Having had to work, since February, with a student with whom I have had a major personality clash (God, I hate that phrase) - genuinely, every time I see this person (almost everyday) my mood instantly dips and I don't perform as well as I want to.

2) Still not feeling like I've fully settled into clinical medicine - feeling stupid and behind virtually all the time. The lack of comprehensive feedback on one's progress definitely does not help.

3) The general negativity of the hospital environment as a student.
 
4) The usual longer term complaints: lack of a satisfying social life, no decent stress relief, missing my hometown, slowly hating my uni town more and more, feeling broke, etc.

5) Not having anyone to talk to about all of the above - apparently I have a "personal tutor", who I met once, nine months ago, with ten other students, for 30 minutes. I doubt he would recognise me if he passed me in a corridor and I certainly can't imagine talking to him about any of this crap. Never mind the fact that he doesn't even work at the same hospital which I'm on placement in and getting hold of any consultant as a student is the devil's own job at the best of times, let alone when you're based ten miles away from them.

Regarding point 1, thankfully I don't have to work with this person any longer after this term (i.e. next week). It's been a painfully long ten months, but at least it's coming to an end. But as for points 2, 3, 4, and 5, I genuinely have no clue what to do...and I don't see any of them changing anytime soon.

I just really wish I had someone to talk to, someone who's been through it all before, or who at least understands what I'm talking about without having an agenda of their own. I don't want to talk to anyone at the med school because I don't want to gain a reputation for being a "complainer" or "difficult", and even if I did, what exactly would I say to them? That I'm really tired of constantly feeling so stupid and that I wish I had a better social life and that I was back in London?  I'm struggling to come up with a suitable answer to those problems myself, so what chance would a complete stranger stand?

Alternatively, if I can't change any of the above points, I wish I at least had a better way of coping with them...but at the moment all I can come up with is counting down the months til I finish here and hopefully move onto something better, but that strategy doesn't feel like it's working particularly well at all.

Deep down, what really disappoints me the most is that it's even come to this. I did not envisage feeling like this when I got into med school or when I first started here. Comparing the optimism and excitement of my first entry on this blog (a month before I started) with the general tone of my past few posts and how low I feel pretty much every day now, I just want to go back to 2012 and start over. Or at least apologise to that guy and tell him I really didn't mean for it to turn out like this.

Wednesday, 19 November 2014

Miscarriage

Block: Anaesthetics, week 4

(Not sure if this counts as a trigger but uh...if you don't want to read about miscarriages...don't read any further).

It's the middle of the night and I have to be back at the hospital in less than 7 hours, but I can't sleep. I tried and I lay awake in bed for about 30 minutes, but I don't think I'll be able to drop off until I get this off my chest.

Firstly the positives - anaesthetics is so awesome. I've really been enjoying this block so far - it's the perfect mix of practical procedures, applied pharmacology and physiology, and patient contact. You get to do something which makes a massive difference to the patient's experience but you don't have to sit through the grinding dullness of four hour medical/surgical outpatient clinics. Great specialty, great placement, great teaching - seriously, at the moment it's my number 2 specialty choice (after emergency medicine).

I like doing practical procedures - in the anaesthetics room as a med student you can insert cannulas and take part in basic airway management so you can do more than just hang around like a spare part. Until today I'd seen quite a few spinal anaesthetics (where the patient is sedated but not fully knocked out), but today I was excited to see that the list was to include several general anaesthetics. This would finally be a good chance to hopefully get to insert an airway device, which until now I'd only ever done on plastic mannequins.

The first patient came in and was due for knee surgery. I got to have a go at putting in an LMA, but due to the patient's difficult airway I didn't get it in so the anaesthetist put it in instead. Still a decent experience though and at least I got the cannula in on the first attempt.

The second patient was brought in for an "evacuation of retained products of conception" - I read this on the list, but I wasn't fully sure what this procedure was. It was obvious that it was something gynaecology related, but I wasn't sure and I still haven't done my O&G block and I didn't want to ask about something potentially personal or embarrassing in front of the patient...so I made a mental note to look it up later. I figured that since the patient looked generally well and it was a very short operation it probably wasn't that serious. Reading this now, hours later, having looked it up, I can't stop feeling exceptionally naive.

The patient came in and her airway was much easier than the previous guy's. I got the LMA in and I felt pretty good. I observed the operation...from where I was standing, I wasn't really 100% sure what I was observing, and I was also being quizzed by the anaesthetist, but it was all over very quickly and I was riding high on the fact that I'd done a cool practical procedure.

Honestly, I felt pretty damn good whist on placement today. It was only hours later after I left the hospital and looked it up that I realised "evacuation of retained products of conception" is a procedure carried out after a woman has suffered a miscarriage - and I witnessed the whole thing without batting an eyelid, completely oblivious to what was going on. The thought didn't even cross my mind that this might be something related to miscarriage - I was completely and blissfully oblivious.

I don't think being super-sensitive or overly emotional is a particularly good thing for anyone, let alone a doctor. This isn't about being macho by the way since I don't believe in any of that alpha male crap - and I'd be saying the same thing if I were a girl too. Terrible things happen in life and I can't get upset or emotional over all of them, otherwise it would be impossible to function. But when it comes to my work, I want to, for a few moments at least, fully understand the gravity and seriousness of any given situation involving a patient in order to better appreciate what they're going through. As it stands today, I feel like I've watched something quite sad but without fully appreciating it and paying it the necessary respect which it's due - and this is leaving me feeling quite guilty at 3 o'clock in the morning.

Sure, I can sit here and say that it's not my fault (because to be fair, it actually isn't), or I'm just a young guy, what am I supposed to know about miscarriages, I haven't done my O&G block yet, it's not my damn problem anyway, I'm being too neurotic as usual, etc, etc...and I'm not saying that I should have started crying in theatre or whatever...that's definitely not my point...but what I am saying is I wish I'd been completely aware of the whole story behind the procedure. It's perfectly fine for me to be happy about learning a new skill and getting an LMA in...but equally I should have felt sad for a few moments that I was witnessing an "evacuation of retained products of conception". But I didn't, and that leaves me feeling guilty, slightly stupid, and unable to sleep.

But I have to try because in the time it's taken to write this out, there's now less than 6 hours left before I'm due back at the hospital...goodnight.

Tuesday, 7 October 2014

Criticisms

Block: Nephrology, week 2

Right, so I'm currently on a general medical block and attached to a renal firm and a cardiology firm. I'm not massively keen on renal medicine but I was very glad when I got this allocation because I felt my renal knowledge was severely lacking and during these 8 weeks I'd actually learn something. So thanks to this block I now know the difference between the nephrotic and nephritic syndromes (probably-maybe-hopefully).

There isn't any formal clinician led teaching as part of the renal block. Instead, each student has to run one teaching session during the course of the placement and make a presentation on a given aspect of renal medicine to the other students. This isn't a bad idea actually - teaching is an important part of the work of a doctor so why not start it early. A cynic might say that we're paying £9000 a year so that someone with more than 6 months experience of clinical medicine can do the teaching, but I am not a cynic. Grumpy, miserable sod perhaps, but not particularly cynical about the education I'm fortunate enough to be receiving.

So I spent this weekend making my presentation and reading around my topic - I would hesitantly venture to say that the presentation I wrote was, in my opinion, actually pretty okay (considering my stage and all that). Giving the presentation didn't go too badly either. But what always seems to happen is that I unravel a bit during the grilling afterwards. Is it nerves? I don't know, maybe, but whatever it is, that bit was shaky to say the least.

But that's not what pisses me off. Clearly I'm not meant to be an expert on renal medicine, and we're all here to learn anyway and that includes not knowing the answer to questions. Whatever. What pisses me off is when the clinician in charge of supervising the teaching session doesn't actually give you a complete appraisal of your presentation, but merely lists what was wrong or lacking with it. Including, at one point, telling me that I hadn't included something which I very clearly had.

I am not a precious flower. I don't need a pat on the back and a smiley face stamp on my report sheet to keep me going through medical school. What I do need however, is something other than criticism once in a while. I'm not asking for anything grand, just the merest acknowledgement that at least the bits of my presentation which weren't criticised were actually up to scratch. Because when all I hear is that I missed this bit out and I don't know about that other thing, I'm left with the impression that actually, I'm not meeting the standard expected for someone at my stage, my presentation wasn't very good, and that I might as well have spent the weekend getting loaded and re-discovering the meaning of life instead of sitting in the library.

Or am I supposed to assume that your silence means that you tacitly approved of the rest of my presentation? Or is "approved" perhaps too strong a word for you? How about "tolerated"?

Clearly the only way to learn is for someone with a great deal more knowledge and experience to point out where you're going wrong. But when all you hear day in and day out, whether it's in a teaching session, on the wards, in the clinical skills lab etc is that what you're doing is all wrong and lacking in this and that, it really begins to grate after a while. Fair enough, on the ward you don't have the time to give me proper feedback - but in a formal teaching session that's not really the case, is it?

Medical students are already way more prone to neuroticism, perfectionism and self-criticism than the average population - this sort of thing only serves to encourage it.

Friday, 26 September 2014

Third year and the rest of second year

Block: Cardiology, week 4

So...I'm not really sure how to get back into the swing of this thing after 7 months. I don't even know why I stopped posting on here...I think it's because things just became a bit overwhelming in my personal life a few months ago, and I just couldn't figure out my own thoughts well enough to attempt to put them across on here. I had a bit of writer's block essentially...it's not that anything I have to say is particularly meaningful or deep, but I don't want to just post for the sake of posting, if you see what I mean.

Right. So. What's been going on since February? Well I finished that community medicine placement and was launched into my first clinical rotations. Here's what I think of them so far. In general, I've found them all (with one notable exception) to be interesting and engaging, but I can't imagine doing any of them for a career.

Gastroenterology

The description given here is very apt - the range of conditions is interesting and wide but I couldn't spend the rest of my life doing endoscopy. It was during this block that I first realised how much I dislike outpatient clinics and my non-existent attention span.

Ophthalmology

Kill it with fire. I hated this particular specialty with a venom I've never felt during medical school and having to attend the million and one boring, endless clinics for it each week (complete with a sign in sheet, of course) made me experience Vietnam style flashbacks to the torture of attending first year biomed cell biology labs hungover week after week.

Urology

Generally very interesting stuff. I had been apprehensive about this one before starting it as I hadn't really enjoyed my renal module during pre-clin, but the surgery side of it was good. But during this surgery block I again realised how limited my attention span is - I don't think I would be very suited to being a surgeon and standing still in one spot for hours each week getting through operating lists.

Vascular surgery

The triple As were a lie, it's all about the triple Fs: feet, feet, feet.

Psychiatry

Genuinely very interesting patients and conditions, but Jesus, so much talking. I'd miss the practical aspects of medicine too much (as well as the basic science which I spent nearly two years trying to cram into my head). Also...a bit too..."social work-y" for me at times.

Now

At the moment I'm back on another medical block...but again all that's being confirmed to me is that I just don't have the fascination or interest in any single body system or organ to wish to devote the rest of my working life to it. I also really dislike the routine, sedentary nature of outpatient clinics, something else which is putting me off from a lot of specialties.

A couple of times, starting in my first block, when there was been nothing happening on my ward I went down to A&E and clerked in some patients there. Before starting med school I had thought of doing A&E, then during pre-clin I went off it and pretty much picked a new specialty each week...but now I think I want to do A&E again. That's not to say it doesn't have its own disadvantages...but each time I've been down there I've never experienced a dull moment. In fact, I enjoyed it so much I'm currently trying to arrange my elective in emergency medicine...so hopefully once I've done that I'll have an even better idea of whether or not it's for me.

I think that's all for now, I think I'll have to be a bit more regular at updating this thing (if anyone's even still reading it!).

Sunday, 23 February 2014

Chorea

Block: Community medicine, week 2

"Chorea, or St Vitus' Dance, is the occurrence of short, purposeless, involuntary movements of the face, heads, hands and feet. Movements are sudden, but the affected person may hold the new posture for several seconds..." - Black's Medical Dictionary, 42nd edition

So last week I was based at a stroke unit in a hospital for the first week of our community medicine block. Each week I move to a different location and setting so for my second week (of three), I was sent to a centre for adults with neurological disabilities to observe the care provided.

I have to be perfectly honest here, this week was not much fun. It was tiring, both emotionally and physically. The latter is something I am familiar with...the former is something I have been fortunate enough to have never really encountered before in my personal life.

I have worked with adults with acquired brain injuries before, back when I was applying to medical school and I wanted to do some volunteering. The centre which I volunteered at back then was rather different to the one I was based at this week however in that the adults I met on volunteering, whilst disabled, still maintained a large degree of independence. This was in complete contrast to the residents I met this week, nearly all of whom depended on the carers to assist them with every aspect of their personal care.

This alone was fairly eye-opening. I had never really given much deep thought to the work which carers do. I was aware that it's an invaluable and demanding job which isn't well paid at all, but I suppose until I actually saw the nature of the work first hand, I didn't really and truly understand just how very personal it is and what a difference it makes to the lives of the patients, most of whom (due to the nature of their conditions) are also completely unaware of the care which they are receiving.

Observing the work of the carers was physically tiring as it meant long hours and early starts, but it was nothing compared to the emotional impact of seeing the effects of long term neurological disability. What had the most significant impact on me was seeing a patient with Huntington's disease on the second day of the placement. Huntington's disease is something which is taught to any GCSE biology student as a prime example of an autosomal dominant condition. Back then, all I remember was constructing Punnett squares and learning that because its signs and symptoms manifest later on in life, many of the sufferers have already gone on to have children who will also be affected before they themselves realise they have the condition.

At medical school this basic understanding was slightly expanded upon with the inclusion of some facts about CAG repeats, PolyQ tracts, and mutant Huntingtin protein. I dutifully memorised the definition at the beginning of this post in case an exam question came up asking me to define the main symptom, chorea (no such luck). By this point, I felt I had a pretty good understanding of this condition.

All of the above however, as scientifically fascinating as they may be, are completely useless at actually getting across the severity of the condition or indeed, for preparing you for the physical reality which the patient faces on a daily basis. Based on the dry definition from Black's, I had somehow assumed that chorea was basically like a more severe form of twitch...but not something which would make the patient look like they were receiving an electric shock to their entire body. None of my notes on the genetics of Huntington's disease prepared me for the sight of the patient lying in a bed with raised, padded sides, with weakened, wasted limbs, unable to understand what's going on in the room around them - the carers preparing the liquid breakfast...the shouts coming from another patient's room down the corridor...the medical student standing in the room trying to connect the dry textbook definition which was rote memorised months before and the three-dimensional evidence of a condition which someone else has to live with everyday for the rest of their (shortened) life...

It was a steep learning curve to say the least. By the end of that second day, I was feeling pretty down indeed. I suppose I should mention at this point that I don't normally get very emotional; usually I'm quite composed and in control of my emotions. That's not to say that I don't care or I don't have human empathy...but in my personal life I'm not very prone to shouting, crying, etc. It's just not me. But by the end of that second day, and for the first time in nearly 6 years, I felt the full force of my emotions.

Things improved slightly after that. Once I got my initial emotional reaction out of the way, I gradually got more used to the nature of the centre and began to accept that it was what it was. So the third and fourth days of the placement were a bit easier to deal with. At the end of the week, I went out and got extremely drunk (I think I spent about £30 on Jagerbombs alone)...that too also helped, though admittedly, the following morning wasn't much fun.

Before starting medical school, I knew that before long I would encounter emotionally demanding situations...I didn't get into the profession with false impressions or delusions, but I suppose actually being faced with the situation for the first time was bound to be tough to deal with, no matter how prepared I felt for it in my mind. I guess like the long hours, endless exams, increased student debt, etc it'll be something which I'll get more "used to" as time goes on, as callous as that sounds.

Finally, here's a nice song from the legendary Woody Guthrie, who also had Huntington's disease:

Friday, 14 February 2014

The start of something new

Block: Community medicine, week 1

So yeah, further to my last post I'm going to be trying a new way of doing things on here...there'll be less focus on academic worries and exams, and I'll try to concentrate more on reflecting on what I've seen on placement about the nature of being a medic itself. Ultimately being a medic is more about being able to understand and work well with the job on a day to day basis rather than simply passing exams, so I think it'll be useful to reflect more on my experiences rather than just posting a list of grades every few weeks.

I'm not exactly sure how this will work just yet, but for this week at any rate I have tried to organise my thoughts into subheadings and I'll just try and write a bit on each...here goes...

Finally growing up?

I'm in my 6th year of higher education. For the past six years or so, life has been pretty much exactly the same. I've gotten up in the mornings, gone to lectures/group work (if I've felt like it and if they weren't too early), panicked over exams, gotten results and moved onto the next stage of the degree. Lather, rinse, repeat, term after term, year after year, as I finished my teens and meandered my way through my twenties. The university and location has changed, but the actual routine has been pretty much the same since 2008.

Things are different now...I've finished pre-clinical medicine and what I will be doing from now until 2016 is completing a variety of different placements in medical and surgical specialties. I have no Easter holiday and a two week summer holiday in the middle of August. I have to get up each morning, make sure I'm shaved and presentable, put on some smart clothes and go to placement.

Basically...it feels like I'm finally a less of a conventional uni student and more of a grown up being trained for a real job. Of course...I don't get paid and I'm still not qualified, and even though it's only been a week, already it feels like the endless sequences of lectures-group work-revision-exams was a million years ago and this new way of doing things is going to be more similar to what the rest of my life will be like.

Despite feeling pretty tired this week (there have been early starts each day and a fair amount of traveling around), I feel happy with finally being able to do something a bit different and more grown up-ish. Being a clinical student feels a lot more like what I want and need at my current stage in life, although I can hear the cynics out there saying that this optimism is merely the honeymoon period. They may be right...but I very much doubt I'll ever really start yearning to return to group work.

The difference between this term and last term

Put simply...this time 3 months ago I was panicking about trying to remember exactly what the Loop of Henle does and earlier this week I was taking breakfast orders from patients and helping an elderly gentleman with his washing and dressing. 'Nuff said.

Ward rounds

So this week I've been based on a stroke unit...the hospital is small and friendly...there's a consultant and a registrar based on the ward and one morning I found myself joining them and a few nurses on the ward round as they went from bed to bed checking up on the patients and reviewing their medication, listening to their concerns etc.

This definitely felt like what being a medical student should be like...though it became slightly more demanding when the consultant asked me some questions and I got a few of them wrong. This was especially annoying since they were questions which I'm sure I knew the answer to deep down...perhaps it was a case of nerves and being felt like I was being put on the spot? At any rate, I feel that clinical medicine will involve a lot of instances of getting things wrong in front of my seniors and having to go away and make sure I learn it properly for future reference. Unlike before, there's no immediate exam pressure, only the desire to not appear lazy and/or incompetent in front of doctors and patients...which in some ways is more motivating than the threat of failing exams.

The bigger picture

Last week my (fairly new) phone broke. I was a bit gutted about this since it was my first smartphone (yes, I know I'm late to the game) and I'd barely had it a few weeks and it was already being sent off to repair at god knows what cost. I'd been enjoying using Snapchat and WhatsApp (it's like free text messaging, don't cha know)...and now I was phoneless for no good reason.

Then I turned up to the ward over the next few days and saw some of the pressures patients and their family members were under. Things rather more difficult and trying than a new phone breaking e.g. uncertainties over the future, housing, money, and so on. And that's not even considering the very obvious and serious medical issues which each of the patients and their families are facing as they attempt to adapt to life following a stroke.

I know that as a future doctor I can't negate all the annoying things in my life simply by remembering that the patients may have it worse. If I did that, I'd never be able to complain about anything ever again and it would probably lead to a lot of unconscious pent-up frustration...but at any rate, on this occasion, considering the bigger picture did bring me back down to earth slightly. I got myself a £10 phone to use in the meantime until my current phone gets repaired...I just hope the warranty covers whatever's gone wrong with it as I really don't want to end up spending loads on it.

Conclusion

I've been blogging for over four years now and this feels like a very different way of writing about things...but it's been good to get these things off my chest. Until next time then...

Monday, 3 February 2014

Future directions

Okay so it's been a while since I last updated this thing. This is for several reasons. Firstly...not much has really been happening lately: I got my exam results towards the end of December, had my Christmas holiday then came back for a week long introduction to clinical medicine and our first community placement block. I've since had three weeks off, which will be coming to an end shortly.

The three week community medicine placement seems fairly laid back - the purpose of it is to become better acquainted with how disability and impairment can affect patients in their daily lives and to understand the ways in which our health and social care system can help them (or in some cases...what could be done better). I think we have to do a report and then we begin our first "proper" hospital based placements at the beginning of March, something I am obviously very excited about!

But yeah...there hasn't been much to think about lately...or at least...not much in the way of the typical things I normally think and write about. This kind of makes me wonder about the future direction of this blog. For the past four years, my blogging activities have mostly been a way for me to do deal with my own personal uncertainties and mostly academic neuroses; my struggle to do well in my BSc, my anxieties over getting med school interviews/offers, and more recently, my attempts to try and handle the pressure of accelerated pre-clinical medicine and to get through to the bit of the course I've been looking most forward to.

But these things are now largely in the past - I won't have any other major exams until March 2015, things should start becoming slightly less pressurised during this phase of the course, and I can't even moan about how useless I find things like lectures and group work...because that's all over now.

However...that said, I don't think that means that it'll be plain sailing for me from now on. Based on the knowledge I have of myself, my personality and my way of dealing with things, I still think I should blog as a method of stress relief and to make sense of things (even non-exam related things). Clinical medicine might be slightly less intense compared to the basic science onslaught which is years 1 and 2 of a medical degree, but I have no doubt that there will still be long hours, deadlines and (potential) emotional and personal uncertainties which might crop up as I finally ditch the lecture theatre and begin to learn how best to get to grips with the most fundamental and human aspect of the job: understanding and treating patients.

I think, therefore, I need to start becoming more comfortable with reflecting about non-academic matters on here. Up until now, I've talked about standard studenty things like exam pressure, results etc, and whilst I'm sure I'll still do this throughout the next 2.5 years, I think it would also be good if I attempted to think and reflect a bit more on here about the day-to-day aspects of being a medic, as opposed to being a student.

At the moment, I know I can talk to my friends, parents, etc about what goes on...so it's not like there isn't anyone who'd listen, but at the same time, there's nothing quite like sitting down, considering my thoughts and feelings over the course of an hour by myself, and then getting it all down in print. And then looking back on it weeks and months later to see how far I've come along. Spoken conversations just don't allow for that...so I suppose that's the reason why I'm keen to carry on writing, in one form or another.