The end of one year, the start of another

I don't know where the days have gone but i am now looking at my last few hours of being 21. I don't feel like i should be 22 as it sounds so much older than i actually feel, i always thought i would feel a lot more independent and grown up, have more confidence than i do now. It's not that i don't like who i am because i do, but when you are younger i use to look at those who were 21/22 and think how mature and grown up they looked, i don't feel like that at all! Do i look like that to other people? I have grown (on the inside at least :P) quite a lot over the past years at uni and my year of 21 has probably been the biggest year of my life, i think in that case i am kind of glad to be turning 22 tomorrow because each year is like another chapter and is what you make of it as you take in what you have learnt form the past year/s and make this new one how ever you like, it can hold what ever you want it to hold :)

I'm not quite sure what my next year as 22 will hold exactly, it is open for me to take each day as it comes. What i do hope is that i will continue to learn and to overcome my fears, increase my confidence in myself and what i do and to take every opportunity that comes my way. I will work hard but i will also have time for myself, my friends and my family and i will believe in myself, mu hopes and dreams and those around me. No matter what comes my way i will give it my all and i will not give up.

Thank you 21 you have given me so much experience, i am ready to take on 22.

Learning :)

General medicine is exhausting! If it wasn't so interesting and exciting we all would have crashed by last week. I had my phlebotomy session in Monday and felt so relieved afterwards! I was in the out patient pathology clinic from 8am to 12pm with Lali from RPH, it was nice to have a familiar face there as we were both a little nervous! The man in charge (Vishnue) was really helpful with a sense of humour which eased our nerves a little and he took us through a few of his patients as we watched his technique and listened to his tips. Then it was our turn to try out on a fake arm first.... then real patients!! I felt confident enough but was still trying not to shake, these patients aren't necessarily the healthiest and some had come from upstairs where nurses could not take the blood because they had tricky veins. I did 8 bleeds in total and got a vein each time!!! I had a little trouble switching tubes as i would draw the needle out ever so slightly which caused a little superficial bleed but only enough to be mopped up by a cotton wool ball. I will remember that if no blood comes out at first, withdraw ever so slightly in case you are on the wall of the vein (i did that once) then pull/anchor the vein inferiorly with your other hand. If blood does not still come out, pull out and try again. One man was worried i would miss but the staff member watching me said 'if she misses you can punch me'... no pressure there!! But i told him i would get it and thankfully i did! It was a good experience i hope i can practice again soon while it is all fresh enough in my mind :)

Tuesday 4 of us had a really good morning following an endocrinologist in the outpatient clinic called Dr Walsh. He specialised in thyroid disease and first took us through the thyroid examination, i learnt about Pemberton's sign, how to assess the eyes for thyroid related pathology and also about squatting to test for myopathy - a few additions from last years thyroid examination. I was amazed at how common Grave's disease is in the population, we were able to palpate some goitres too and see what they feel like.

That afternoon I also had a good chat to a really nice older man and his wife and got a history from them. They were both in their 80's but so lovely and positive, i hope i can be like them when i am older, apart from a minor problem bringing Mr into the hospital they were quite fit and healthy :)

Today we had a trip to the ICU... first impressions made me feel uneasy it is such a scary place seeing the patients so out of it with tubes coming from every direction with nurses just watching them in case anything changed. We met a man who was alert and looking quite well compared to the others, you could tell he wanted to get out of there and was feeling uneasy and thankfully he was moved down to the wards where he came under our doctor teams' care, i look forward to chatting to him he had a nice sense of humour.

Unfortunately we faced a sad moment when we met a patient we have been seeing for the past week with aggressive cancer. We have watched him deteriorate quite fast and seeing him today was quite a shock, i don't know how long he will last.

We met a nice man this afternoon who was really nice to us med students and let our consultant take a tutorial using his case for us. The man had the first case of jaundice i have seen, he was literally yellow!! We took turns doing part of the history and i

started the physical examination, i am always uneasy doing it in front of people watching me let alone doctors but did OK. It was also the first time i had palpated an enlarged liver so now i finally know what it feels like and what to look out for. The man had Crohn's disease which was related to his symptoms now causing an autoimmune primary sclerosing cholangitis where the biliary tree becomes inflamed and scarred blocking the bile duct and causing obstructive jaundice. The man is on the waiting list for a liver transplant, i hope to follow him up and see how he is going! It is quite rare though as only 4% of people with inflammatory bowel disease develop this condition.

I have managed to fit in some exercise in the afternoons as we are starting too early to fit in in the morning. Today we started at 7.30 and finished at 4 so i went for a run but felt lethargic! We are starting to get a little ill from being exposed to all the bugs in the hospital as well as running around tiring ourselves but hopefully we will pull through :) I better get back to some study all the same!

The start of something new.

Wow, what a week it has been! I don't know where to start... all i know is i have survived my first week in the hospitals and it was such a hectic/exciting/overwhelming/challenging week to start with! I had a nice weekend last week, Kyle and i went to Bunbury and to a friends 21st birthday at Barbados. It was really nice to see her again and a few other familiar faces who i haven't seen for so long, some i didn't even recognize before half the night was over! I left before it started to get very rowdy when the others got into the dancing and drinking mode, i have never really understood the enjoyment of trying to dance when you barely recognise the person next to you in a drunken state and nor do i think i ever will and nor do i want to. I'm not one for the parties and drinks and i'm not going to be... give me a catch up with friends over coffee any day! I had a really nice chat to Kyle in the car though, it was nice to have company driving and we hadn't had a good chat for a while. We talked about our hopes for the year and where our lives would take us. I am usually a very goal orientated person but i realised over the past few months i haven't really set any and i feel a little lost. Maybe its because i no longer have the responsibilities of working at College or because i'm not track running which i have missed this season. Sure i have things i need to work on for med and improving my studies for the year but otherwise there is a little blank spot. I still mentioned my goals for my fitness and running wherever they will take me, i would just love to run in an Australian competition what ever that may involve but feel like life is getting more hectic and challenging to do so, have i used up my opportunities? But Kyle is so positive and helped me get the feeling again and the fire inside to believe that anything is possible, thank you Kyle :)

I have taken a gym appraisal and set up a weights routine to help build up my muscle tone and increase my strength. Funnily enough the guy who made it for me was called Kyle! He seemes a little lost when i told him what i wanted as most girls want to lose weight and do cardio work, but i wanted strength and tone. But i am excited to get into the weights! (so long as i can fit in the time to). I have been set 4 days of 40 minute workouts - 1. shoulders and chest, 2. legs, 3. back and 4. arms. I have almost done a full set of each in the past week but it'll take a few weeks to get into a good routine and balance it with my runs and classes. It is exciting though i have always wanted to do weights!

So Monday.... i was nervous but excited! We had an orientation morning and prety much ran laps around the hospital and got our Sit Charles GairdnerID cards. Then we met our team of doctors - MU3 with Dr Ayaar and Dr Devapaar. They are really nice and informative and ask you questions which doesn't feel so interrogating! We followed them for ward rounds and i suddenly realised how much i have forgotten or do not know, i felt so naive and out of it!! The days are basically ward rounds of Acute Assessment Units at 8am then self directed history taking and physical examinations with patients, tutorials and lectures in the hospital teaching area and home by 4 or 5. I am exhausted by the end and hungry as we barely have time to eat! So trying to fit in exercise i had a few 5.30/6am wake ups, no wonder i was exhausted by Wednesday!

We went to out patient clinics and had tutorials besides the patients beds. Hospitals are a scary place, there are so different to GP settings where we have been before, we are looking at the sickest people in the population and they have all the signs we have only read about for severe diseases and conditions. We had a neruological tute with patients and conducted neurology examinations on them, most could not talk, were confused, some could not coordinate their movements or feel pin pricks. It is amazing on a medical learning side but i feel so sorry for the patients. Unfortunately quite a few have advanced cancer and secondary metastases to the brain which is causing their neurological symptoms. Unfortunately one man we are following is deteriorating fast, i wonder if he is still with us after the weekend.

By Tuesday afternoon i felt so overwhelmed and was having a little panic not knowing anything, but i refused to let that get in the way of valentines day and had a wonderful night out with Kyle! He said i choose where to go for dinner and i thought of Giardini's in Leederville as my friend Lexi likes it there, and it was funny but awesome to see Lex was there too with her dad!! Kyle and i also went to Green and Co where we went on our first date and had a coffee, then he surprised me and took me bowling as he remembered i had wanted to go for a while. We had so much fun and both got 2 strikes!! Needless to say i felt so much better afterwards, a great night in great company wins everytime :)

I feel like i have not done the week justice, i cannot explain how it has been in detail, but i hope this next week goes well, i want to do well. I have a phlebotomy session taking blood from patients tomorrow morning 8am which i am a little nervous about, but hopefully after a few i will be able to do it with my eyes closed (maybe :P). Wish me luck!

Worries and Hope

For those truly important people around me and for anyone else who reads this entry.

I have been thinking a lot lately about those around me, most of the people i am around have similar traits, we are hard working, dedicated and passionate about what we do particularly our studies, but we are also able to have a good time, take time for ourselves and our friends and most of us try to balance our lives. But i have also found there is a sort of possessive trait which we share, particularly seen with our studies. It's like the curve of stress and performance where there is a balance between how much stress or possessiveness is actually beneficial and how much is detrimental to our life and general well-being. I find we are more prone to tip the 'optimum' level, myself included, whether we realise it or not. It is often hard for those around us and especially ourselves to realise when we go too far and start to take actions and have thoughts that we think are doing good but are actually bringing us down. Sometimes all we need is one other person to notice and tell us before it gets out of control and our behavior changes so as to make it harder to reverse it. Other times we may notice what is being detrimental to our lives ourselves and either be able to fix it ourselves or most importantly have others around us to help us get back on the right track.

The right track does not have to be what is 'normal'. Normal is such a confusing word, what exactly is normal? what does it mean? Apparently it is conforming to the standard or common type, the usual or regular, serving to establish a standard. While we tend to define ourselves as normal by those around us, it takes all types to create this 'normal' definition. In reality we are all different. Unfortunately 'normal' eating these days tends to be guided towards take away foods, foods from packets and high in saturated fats and sugars. I value healthy foods and a balanced diet, i love carrots, celery, avocado, wholegrain breads, muesli and yoghurt, blueberries, strawberries, apples... fresh foods, foods with spices, colour and flavour and home cooked! So am i not normal? No i'm not by the standards of society but i am eating what i know i enjoy and it also happens to be healthy in terms of a balanced diet of fresh and wholesome foods which help me feel full of energy, satisfied and happy from the taste and smell of the food i eat. I swear in another life i would be a cook/chef. I believe in flavours and the enjoyment of mixing and matching spices and foods but also in a way which ensures you are getting your nutrition you need in terms of macro and micro nutrients. Sort of like a challenge to see how the food you eat is the most flavorsome and beneficial :) I believe in the 80/20 rule, 80% fresh wholesome foods and 20% indulgence such as a cupcake or a muffin in my case. I love how sweet foods can bring people together and make me happy. A cupcake can brighten anyone's day. Apart from diverting a little, i guess what i am trying to say is these days i am not classified as 'normal', but i am enjoying what i am eating and how i eat and i know it is beneficial for me in terms of my well-being so i will not change.

Eating disorders are sadly too common these days, they can be triggered by social, physical and emotional circumstances. Those of us who tend to have a more possessive nature are at a higher risk in particular life situations and environments to develop these disorders. I'm not saying the quality of being possessive is bad as it can show desire, passion and determination to areas of our life which enable us to go far and get to where we want to in life taking many opportunities that come our way :) It is only when it has the opportunity to be turned into a possessive obsession that is actually harmful to us when it is bad, particularly with food.

Food is always available to us in Australia and food of all types. We eat to keep ourselves alive, to provide fuel and nutrition to our bodies, but we have also been accustomed to eating for other reasons such as when we are stressed, depressed and anxious or when we are happy, celebrating an event or just being social. At the moment the world is having an obesity crisis as people are not getting adequate nutrition and eating too much fats and refined sugars with a combination of not exercising enough and it is sad. The human body is made to live, not to watch TV and drive the car, and it needs adequate fuel to do so. But on the other side, controlling food can be a way to cope with life, it can be something we know we can control and so some of us can do so in a way which is also detrimental to ourselves. Obesity increases all cause mortality, but so does inadequate nutrition. Everything in life is about balance, but there are so many factors which can alter the balance or persuade us to take a lean to one side.

While eating disorders are high in females they are also increasing in males in different forms, yes males can also be anorexic and bulimic, but they are also more likely to be obsessed with their food for its nutritional value such as proteins for 'building/bulking-up' . I hope to those important people around me that you see the enjoyment of food for its flavours, colours, smells and preparation, i hope that you balance yourself yet treat yourself to those food you love. I hope obsessions do not hinder the potential you have in your lives and that the only voice which tells you what to do and which choice to make is truly you.

"Normal fear protects us; abnormal fear paralyses us. Normal fear motivates us to improve our individual and collective welfare; abnormal fear constantly poisons and distorts our inner lives. Our problem is not to be rid of fear but rather to harness and master it" - Martin Luther King Jr

Nursing Attachments - entering the hospitals!

And we finally enter the hospitals! Not for our official rotations but for nursing attachments to see how the nurses work, what they do and how the hospitals work in general. 7am starts meant we were up at 5.30am as we made our way to Charles and found out exactly where our wards and nurses we follow are. I was in the Respiratory ward on the 5th floor. At 7am we get to see the nurses handover their patients from the night staff to the day staff, this is basically where they a ll sit down with a printout of the basics of the patients condition and then update the printout and include any personal information or specific things to follow up on throughout the day. I felt a little out of it as we were bombarded with abbreviations and terminology i hadn't heard or become accustomed too but i felt so professional even just sitting there pretending like i knew what they were talking about! I had a mountain of questions afterwards which i asked the nurse i was following, a lovely lady called Hazel and learnt so much throughout the morning.

I started off in the high dependency ward in a room of 6

patients who needed constant monitoring and care. There was actually 7 due to an overflow from the ED department so one poor lady was on a bed in the entrance way but another man was being discharged that day thankfully. The morning mainly consisted of following Hazel as she prepared all the morning medications for the patients, both IV and oral. I saw a subcutaneous injection of clexane and the next time one was given i gave it!! Tick! my first injection :) it was done in the stomach of my patient, i was a little nervous because clexane can sting but it went well.

learnt about capillary blood gasses or CBGs which are more popular than ABGs as they are less invasive, but they are tricky as you use a diabetic prick needle on the earlobe and have to 'milk' a small amount of blood out and collect it in a tube, and it has to be done with precision or else the BG machine will not register the blood and the blood gasses will not be read.

Apart from observing the nurses work the other thing i actively did was help showing a patient, i wish i could have done more such as the routine observations or 'Obs' the nurses did to every patient - blood pressure, respiratory rate, oxygen saturation, temperature and pulse i was quite keen to get involved! This morning was a difference experience, i was able to see a patient who had terminal cancer which had metastasized from his lungs, he is a rather lively and intelligent man but is refusing palliative care. It opened my eyes to how different patients come to terms with these situations where they are facing their own mortality. He would open up to the nurse i was with this morning, you could see he was almost battling in his mind what to think of his situation. His wife died of the same condition (please no one smoke!!) 2 and a half years ago and that was when he said his life ended. He was refusing medication such as strong pain killers, but talking to a doctor he is now in the mindset that he regards his body like the military. His symptoms are like the opponent, when they attack is when he wants to act and now that he is becoming symptomatic he is willing to take charge and fight the cancer with radiotherapy. It is the mindset that is helping him deal with his condition and ultimately his decision, in other cases the doctor could use this view and say that sometimes we need to take the opponent by surprise and hit it before the symptoms/attack comes to prevent the effects of the symptoms. I was a little disappointed that the doctor did not try to relate to the patient in his views of the disease but rather diverted what he said back to symptoms and the biological point of view, there is nothing wrong with that but it is important to see the whole picture and take into account the patients perspective and thoughts more to guide treatment decisions, i thought this doctor was lacking this but who am i to judge as a medical student. I know when i am a doctor i want to make sure i spend time to sit down and talk to my patients and MAKE SURE i have the time.

The scenario tied in well with a lecture we then had this afternoon on 'End of Life'. it was quite heavy in the sense that we were asked questions about how we perceive death and our thoughts on how we would like to die - acute and quick or chronic over time. I put my hand up for chronic but 60% said quick and acute. I know you can suffer more in a chronic condition, but when it is my time to go i don't want to go unless i have a chance to fight what is taking me down and a chance to choose my treatment and how i spend the last part of my life. I would want to make sure i can say goodbye to everyone and if i have anything i need to do or say before i was to go then i would do them to 'die peacefully' as they say. I know i tend to be a bit of a fighter and take challenges to try get the most out of my life and that is how i would want to go and with those i love around me. We watched an interview of a patient with pulmonary fibrosis who dies 2 weeks later which was emotional for everyone and made us think how strong the person was to come to terms with his mortality.

The nursing attachments have been a great experience but i have no doubt the rotations will be even more experience which will leave us both exhilarated and overwhelmed at the same time! There is so much in medicine and life to learn.

Shakespeare, Birthday's and Baking expo

I had a lovely past few days! I have to admit our lectures were not the most thrilling but were still very useful for the hospital setting. Thursday night myself, Emma and 2 other girls from medicine went to the Shakespeare in the park 'The complete works of William Shakespeare' in Kings Park. It was such a lovely atmostphere, everyone had picnic rugs and food to sit on the grass, the show itself was awesome. It was so cleverly done t
o make the stories of Shakespeare all in one show as a parody, i laughed more than i thought i would watching Shakespeare! I would definitely see it again, we even got rain in the last half but that could not make us miss the show! I also made it to the

6am RPM class that morning,there was more people there than the 8am class i went to and once again the atmostphere was very motivating and i loved the class :)

Friday afternoon i went home for my sister Sarah's 18th birthday. I had an off day Friday for some reason, i think i was down about missing out on spending time with my boyfriend and missing out on a medicine girls movie night along with female issues but once i was home the feelings went away :) Saturday i had a great morning run to Marlston Hill and ran up and down the stairs, i felt tired but i had a great run and was so excited i feel like i am getting stronger again! I ran a little faster and did some more stair runs than i had before and i felt great! I did some jobs in town then caught up with Lexi at muffin break, i love catching up with Lex and muffin break always has tasty muffins to satisfy our taste buds :) The afternoon was filled with cooking for Sarah's 18th birthday dinner, i didn't know why mum was cooking so much until i realised we were having the Smiths over as well as pop from Esperance, Nicole and Daniel. It was a great night, i love when the 5 of us girls get together it always makes for funny photos and conversations!

Sunday i went for another run in the morning and went further than i did at home 2 weeks ago, i know i was fighting Dengue fever still then but i felt so much better :) Then we gave Sarah her gifts, mum made a wonderful quilt for her with beautiful colours, pop gave her an open that looks like it has the world inside it, it is so colourful and even more special as it was Nan's opal, nan died from Ovarian cancer about 12 years ago. Pop has given each of us a piece of jewellery from nan for our 18th. I have a lovely nugget on a chain and some gold earrings to match, i only wear them on special occaisions. Then as part of her birthday gift Sarah was off with her friends to Perth for the Big Day out concert! I headed back to Perth and met Kyle and Lex at the Convention centre to see a baking exhibition. First Kyle and I went into Wilson street parking which was open from someone going out, but we and 2 other cars thinking we had a parking spot got trapped in there, so the next hour was trying to find a resident to let us out. I will follow Kyle's advice and take the bus next time!! But we made it :) there were some wonderful cakes on display that people had made they were amazing! Unfortunately we were a little late to do a cooking and decorating class but we watched a demonstration of making cupcakes. I learnt...

1. Use eggs and butter at room temperature

2. Use unsalted butter and add a pinch of salt as normal butter has i think she said 22 teaspoons of salt??

3. Beat eggs and butter for 5-7 minutes

4. Add 3 eggs one at a time to not let it curdle

5. You should only add milk if necessary, usually only butter and eggs are enough

6. Cake flour is better but expensive, a 'cheat way' is to add one cup of flour, take out a tablespoon and substitute it for 1 tablespoon of cornflour.

7. Mix gently so as to not over mix

8. You can use an ice-cream scoop to scoop

mixture into patty pans

Tomorrow we have our first of 2 nursing attachments from 7am at Sir Charles Gardiner Hospital followed by lectures in the afternoon. The work is slowly building up, I'm a little nervous but it should be a great experience!

February :)

February! :) I'm not sure why i like February so much, i think its a combination of liking what February brings and being happy that January is over. I do like January in the sense that it is the start of a new year and you feel like you can be a new you and start afresh, but i always seem to get ill in January and i don't like how it always seems to be so higgledy piggledy (i have never actually written that out before it looks quite funny!) and i can never get a routine which i like to have. I like how in February a routine comes into play where you can truly incorporate what you are working towards this year. I also like what it brings, valentines day i have always liked whether i had a boyfriend or not, i love the feeling and seeing people happy together and celebrating being with each other. I have always wished my friends happy valentines day too as i think it should be about celebrating who is around you who you love as friends and family too and not just for couples. So i hope my boyfriend doesn't mind me saying happy valentines day to a few people including him :P There is also my sisters birthday, she is 18 this year wow!! an my birthday on the 28th. It is scary to think i will be 22 this year... where has the time gone! i don't feel 22 and don't feel like i act 22. Here i am still studying when my close friend has a house and having her second child in May. Such different lives for the same age, but there is no fault in following a passion or working towards a goal in life, the time for settling down an
d families will come later there is no rush. So i still like birthdays even if i feel strange to be turning 22, its nice getting calls from family and friends, we would be much more isolated without birthdays and special events!

This week so far with lectures has been slower than i thought, i have had time to go to the beach, meet people from medicine out for coffee, do lots of exercise and enjoy myself while learning, i am enjoying it! We finally got our hospital allocations for the 8 week rotations. i am doing General Medicine which has been regarded as the hardest one but good to get out of the way first. I am at Sir Charles Gardiner Hospital which i am happy to have so close! My flatmate Emma ended up in Royal Perth Hospital, she is happy with the hospital but not happy with the fact we put in preferences to have a few friends in the same hospital but we are all separated! Em has actually ended up in the same hospital and the same group of 4 out of 239 students as my boyfriend, at least i can exchange stories with them. I have no doubt the 7.30am-4.30pm days will start to take its toll once we get started, but the excitement of the rotation and practical experience will hopefully keep us all going with our heads held high :) Its good to brace myself but i'll just focus on the days as they co

me for now. This week our lectures have been on infection control (so many lectures on how to wash our hands!!), taking a sexual history and Practice in the Clinical Setting and tomorrow we have Aboriginal health, research methods and writing in patient records sessions on Friday.

We finish by Friday afternoon so i am looking forward to having a few days home for my sisters 18th this weekend! I feel like my fitness is getting back again so i might try some track runs when i am home to see if competing at the Strive competitions before it is over is possible... i'm not getting my hopes up but i like getting my fitness back all the same, no matter how sore a pump class can make your muscles be ;) but i have been enjoying my runs through kings park and up and down the Kokoda stairs (picture on the left), i'll see if i can get up for a 6am RPM class tomorrow, i have never done a 6am class before! I better make sure i head to bed so i can get up... wish me luck! :)