The Final Countdown

It’s raining today, a very grey world. And damp. Even though it’s bleak, shy patches of colour peek out. Purple flowers in my front yard. Pink and yellow flowers in the yard around the corner that I picked by L’s request yesterday. She’s been pressing them for two days under all four phone books in the house in preparation for a Fancy Manicure. Against my will, I will also be getting a Fancy Manicure.

There’s so much anxiety in the air, I can hardly make words. It’s like reaching the bottom of the slide at Margaritaville where you’re going so fast you can’t even take the deep breath you need for the plunge into salt water.

Breathe.

I don’t know what to tell you. My thoughts are scattered and dwindling, like the days until MBBS, like potholes on Kingston roads, like Riverton smoke some weeks ago.

There is news: local news, national news, international news. Heads of State visiting, vendor shacks being demolished, students massacred in Kenya. And there is life. Trips to Sovereign, fancy dress parties, clerkship exams and MBBS. I’m always struggling with how to reconcile external events with my internal life. How to hold on to emotional impact and evoke social and political feeling while still trying to find the perfect shoes. I digress, but I really wish I could find the perfect shoes.

It seems life is all about balancing nuances. I love nuances, but I’m terrible at eliciting them or acknowledging them or even realizing them most of the time. And even though the world is a million shades of grey today, and I like that, I spend most of my time imagining things as black or white, this or that, me or you.

Maybe because my life has boiled down to right and wrong answers. Even the calendar has been corrupted. For me May means sink or swim, June means pass or fail and July? July means life or death. Mine, and the patients’.

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Back to the House of God: some short reflections

1.

Final exams loom, a distressingly diminishing number of days away. Calendars are the enemy now and every sunset inspires a mixture of awe and resentment. Days and weeks and months are finite, fickle creatures.

2.

I reread Samuel Shem’s cynical exposé on medical training in North America because I needed to remind myself what I was working toward in the weeks after exams. House of God isn’t a particularly encouraging novel, but throughout the story hope rises like the Wing of Zock: unstoppable and overpowering.

3.

In this season of fasting (not Lent) I will have to give up so many of my vices: novels, writing, the internet, sleep. Oh, sleep, I will miss you. A fourth year student asked me what I would do come June 3 when the last of my exams are over.

“I’d run naked,” she suggested. Oblivious to our incredulity, she continued. “As I walk out of the exam, I’d be unhooking my bra, pulling down the straps.” She trailed off in slow-motion speech, lost in a fantastical daydream.

I intend to sleep the sleep of the guilt-free. It’s been so long since I had guilt-free sleep, I’m probably going to get an ulcer. Just one time I would like to put my head on a pillow and not have the voice in my head (which sounds uncannily like one of my friends) demand that I cease this nonsense and get on with studying.

4.

This morning while waiting on the bus that shuttles us to the hospital, I stared across the expanse of sea and horizon, thinking.

I feel like I’m being wound-up, I wrote in my journal, like an old-fashioned wrist watch. Will I fall apart when the time comes, or spring smoothly into action like some well-oiled gears?

Do any of us know how we will perform when we need to? I think everyone feels some tension at this point, regardless of ambition. Even those of us who are certain of passing (there are always some) are still anxious about graduating with honours or distinctions.

There’s so much at stake, so much at risk. I calm myself by remembering that this too shall pass.

*

P. S.

Thursdays have sort of turned into book sharing time, so I’m sorry if this wasn’t what you expected. But! If you read this far, know that I have been reading way more fiction than I should, and if you want a recommendation Neil Gaiman’s Trigger Warning is absolute soul-disturbing perfection and you should go read it now (Also, he and Amanda are pregnant so yay).

It’s so rare that I recommend a newly published book – am I doing it right?

UWI Bites Off More than They Can Chew (What Else is New?)

2015 will see the graduation of the largest medical class the University of the West Indies has ever produced. In the face of dwindling economic resources and rising costs of health care the 2015 cohort is a case of too many crabs and not enough barrels.

Last year the government struggled to find positions for the new batch of interns, having to stretch the usual quota of four basic rotations in internship year to include sub-specialties. This year, we have almost twice as many students graduating, provided we all pass final MBBS (and given our propensity to surpass the expectations of our administrators it’s very likely we all will). It’s begging the question: what are they going to do with us?

Rumours abound of strategies the government is trying to put in place to catch us all. But the catching will be clumsy if the rumours are to be believed. Some people murmur that a number of interns will be deferred from taking up posts until January of the following year. Others whisper that a shift system will be implemented allowing each intern to work for eight hours a day – this comes with the abolition of duties and (distressingly) the abolition of duty pay. But it’s all he said, she said, Chinese telephone.

Then there is the idea of the flexi-week. Recently decried by the Jamaica Medical Doctors Association, the flexi-week is a modification of the 40 hour work week that would allow employees and employers to come to individualized agreements on the distribution of working hours. The government wanted to implement this bill on April 1 but JMDA cried foul, admonishing Parliament for not holding discussions with key stake-holders (namely, doctors).

It is strange that on the cusp of entering the workforce, so much of the dialogue about the changes affecting that workforce is happening over our heads. We have a right to information that will affect how we live, work and do business in the upcoming years and it isn’t fair to withhold this information on the basis that we have not yet passed exams (if that is indeed the basis). Transparency is key or else, much like our transition through medical school, our transition into internship will be a rude awakening.

No one in my year batch knows just what awaits us on July 1, 2015. There are so many questions that need to be answered. Where will we be placed? How many hours will we have to work? How will we be paid? How will we afford to repay our loans?

UWI answers these questions with: We need a new hall of residence. We need a new faculty building. We need a new administrative building. We need an extension to the university hospital. As long as the input (students) generates revenue, the by-product (doctors) can muddle along as it pleases. Or doesn’t please, as the case may be.

Can we have the health ministry intervening to put a cap on the number of medical students the UWI can accept in any one year? There are so many disadvantages to large medical classes it would take an entire post to enumerate them all. Suffice to say the risk far outweighs the benefit.

I came, I saw, I survived (4th Year Part 2)

You didn’t think we were done, did you?

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The offsite clerkships conclude with Ophthalmology (10 weeks), Anaesthesia (5 weeks) and Orthopaedics (5 weeks).

Ophthalmology

Goals:

  1. See/do every last thing on your procedure card. Seriously. They will send you back to the clinic to see/do things.
  2. Learn when to refer (all the time).

Opthalmology at KPH was a fair experience (I’d give it a 5/10. Anaes gets an 8). There are a lot of patients but you don’t really get much guidance. The lectures are good but the consultants disappear right after and the residents are always too busy to teach. Bonus: they will tell you which patients have pathologies that you can see.

Ophthalmology at Cornwall was my saving grace. The consultant takes you around the clinic on your scheduled day, looking for interesting conditions, and she teaches ophthalmoscopy technique at the same time.

The bonus of UHWI is that the clinic is more organized with specific patients attending at specific times (eg. retina clinic) but the residents are not as . . . easy-going as those elsewhere.

Penultimately. . .

Anaesthesia

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Goals:

  1. Read all the time so you can present your topics to the residents (the only way to learn)
  2. Learn how to manage an airway
  3. Know Basic Life Support like the back of your hand. Know it better than the lyrics to your favourite guilty pleasure song.

I did Anaesthesia at KPH and liked it. Everybody was willing to listen (on Anaes they don’t teach, you have to read up a topic and talk about it) and the consultants were nice. Probably because there were a lot of them so no one felt too pressured (take notes, every other specialty). There is a wealth of OT experience because KPH is basically surgery central. As long as the elevator is working. Seriously, can we get some foreign investors working on our hospitals instead of our roads? At least if accidents happen on the bad roads the victims will have somewhere to go.

And lastly:

Orthopaedics/Ophthalmology

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Goals:

  1. Learn the theory behind the common orthopaedic problems
  2. Learn the practical management of the same i.e. reducing, casting, splinting fractures etc.

I did Orthopaedics at (can you guess?) Cornwall. It was a half-and-half experience for me because despite getting good lectures and clinical teaching, there wasn’t a wide variety of patients presenting during our stint. That and you have to remember to go looking for procedures. Nobody’s sitting around waiting for you to come put a plaster on them. Unfortunately. But the residents and consultants were more than willing to teach and grill you to death and talk you out of ears.

Bonus: Orthopods, as a hazard of the trade, are really, really good looking. That is total objectification, but I’m just saying – if you’re a girl (or guy, no judgement) who’s into shoulders and arms this clerkship is the ultimate viewing experience.

*

Hope you liked the mini-series. (See Part One). If you found it useful (or amusing), please (do me a favour and) leave a comment saying so. Feedback makes one feel so appreciated.

We’ll do this again when I graduate med school. :)

Been there, Done that (4th Year Part 1)

Here it is. Finally. I know you’ve all been waiting eagerly for this. What?

The ultimate guide to surviving (nay, thriving) in your fourth year of medical school at the University of the West Indies, Mona.

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Ha. Ha. We are better doctors than you. :|

It’s a harrowing year. Five blocks of thirteen clerkships, some of them running concurrently. Where will you find the time to eat, sleep, live a little? But don’t despair. You can actually enjoy fourth year here.

*Disclaimer: You will see the golden seam of my bias toward Montego Bay (home) and the Cornwall Regional Hospital running strongly throughout this post. Just embrace the fact that Cornwall > UHWI.

We’ll start with the offsite clerkships. First up:

Obstetrics

Goals of clerkship:

  1. Deliver babies
  2. Learn as much as possible about common gestational problems and emergencies.

You definitely want to aim for Cornwall Regional Hospital or Mandeville Regional Hospital, which excel at the practical aspect (i.e. catching babies). Lots of babies, limited baby-catching competition. You can easily complete all your deliveries  on site. At Kingston Public you’ll be competing with midwifery students (scary!) and at UHWI there are comparatively fewer babies to catch.

Bonus! Kingston Public has a super-dedicated, totally great post-DM resident who loves students and will teach you everything under the sun if you can pin him down. Like a leprechaun, only instead of gold you get good grades.

Next up . . .

Emergency Medicine/Radiology/Medicine and Humanities

Goals:

  1. Fill your procedure card.
  2. Learn how to site IVs like a boss (and read ECGs with more than passable competence)
  3. Not fail Radiology

This rotation was only offered at UHWI and CRH in my year (2015). Hands down, Cornwall was the better choice. You end up competing with six students instead of thirty, and in one morning you can see a kajillion times the patients UHWI sees in a day. Procedures are endless, the teaching is superb (dedicated, nice consultants. Not that the UHWI consultants are mean. It’s just that, well, Cornwall rocks), and you don’t have to fight to the death over catheterization sets. Mostly because there aren’t any. Ha.

I only wish I had stayed awake for at least one of my Radiology classes because we got some great teaching from one or two people while I was catching z’s. Medicine and the Humanities is pass or fail so the most I can sell is the sheer entertainment of listening to one of the lectures ramble on about the history of Rome. Which is hilarious now, but later on in another clerkship you will wish he would teach the subject at hand. Less hilarious at the time, but still pretty hilarious in retrospect. (I really hope I passed).

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Part One of a two-part post on “Hey, look what I did!” To be continued . . . later. Do you agree, disagree? Tell me in the comments!

Housekeeping (and an apology)

I missed posting anything last week, which I feel guilty about. I’d like this place to have a kind of regularity, like a bar. Except less seedy. But if you’ve been reading my friend Tricia’s new blog then trust me, you would have gained way more than you missed out here. Go check her out.

My computer has been having issues, probably due to me having put the fancy new Windows 8 OS on a considerably old model. Imagine your grandmother in fishnet stockings. It’s not quite so accurate an analogy but you’ve now been scarred for life. You’re welcome. K suggested I try Linux’s Ubuntu which is what I’m going to do. I’ll let you know how that works out. So far I haven’t pulled my hair out, but I’ve had a few close calls.

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I am stuck with my idea for the JCDC creative writing competition. I have two vague ideas that I don’t trust myself to do justice to, even though anyone else could probably run with them straight into an honorary mention, at least. The dealine is April 30 so I need to get a move on.

What’s holding me back is my problem with writing Jamaican. It is such unfamiliar territory for me, and I’m always afraid of being called out as a fraud. It sounds silly but I get that all the time just by living here and being myself. I’m afraid the minute I put pen to paper about any of it people will dismiss it and me as pseudo-Jamaican Americanized rubbish.

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LIAR.

I am a week away from starting my fifth and final year of medical school. The general response I get from people about that is “Congratulations!”, “One more year!” “Excited?” and so on. No, I’m not excited. Yes, there is one year left (and a half!) and I am batting away terror over the whole business. I am not ready to wander off into the world and be partially (minimally) responsible for people’s lives.

This is not a thrilling prospect (maybe in the sense that movies like Scream and I Know What You Did Last Summer are thrilling). Fifth year is a whole new kettle of fish as it pertains to grades. I’ve heard our clerkship exams are actually harder than final MBBS (on purpose) and if you fail any of them you can’t graduate. Yeah. I’m totally excited about that.

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This will probably mean less time for blogging. But I’m going to try and keep up with things here. Or not. We’ll see how it goes.

Speaking about blogging, there’s going to be a shift in focus for Well Read Robin because I have a fancy new theme. Mainly, I’ll be discussing things I’ve read – newspaper articles, books, magazines (yeah right, I haven’t read a magazine in years) etc. I will still have the occasional “This is My Life Now” post and tidbits of writing here and there, but those will be bookends and bookmarks for the Real Stuff.

Thank you for reading thus far and I hope you continue to enjoy WRR!

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Pax.

It’s that time again

In exams our lives get reduced to bite-sized segments.

We slow to 5 minute crawls, pivot on a handful of marks then stretch to 60 minute sprints of alphabetized glory. We live and die on the sound of the bell; we cliff-climb without supports, swinging frantically from question to answer to question. Hesitation is death. But is that not our calling?

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