The average week so far.

An average week of life in the Gen Med rotation...

Monday: 6am to the UWA gym, 8.30am to SCGH for ward rounds and interview patients, 1.30pm - 4.30pm PBL tutorials, 5pm dinner then study

Tuesday: 6am run or rest day, 8.30am ward rounds, 12.30-1.30 Lunch time Grand rounds OR neurology tutorial, 2pm Outpatient clinic with Registrar or consultant, 5pm dinner, then study or netball :)

Wednesday: 6am gym, 8.30am ward rounds and interview patients, 12.30-1.30pm lunch clinical case, 2pm tutorial with consultant, 3.30-5pm communications tutorial or academic mentor tutorial

Thursday: 6am RPM class or run, 8.30am ward rounds and interview patients OR morning with consultant in AAU, possible lunch at Trinity (yay!), 2pm-5pm QEII lectures, dinner then study

Friday: 6am run or gym, 8.30am ward rounds with consultant, 11am tutorial with consultant, afternoon to study or do research project, do something social at night :)

Saturday: 7.30am gym or run, study/assignments, social at night?

Sunday: 8.30am gym, study, washing, 4-6pm Radiolollipop (if not too much study/assignments)

On the Home stretch.

Only 4 more days of General Med rotation to go. I think i will miss it, it has gotten to a point where we are clicking with our Registrar more and developing more confidence in what we can do in the hospital. I would like to have more time to learn about conditions and tests rather than trying to focus on assignments, Maybe i will be back interviewing patients throughout other rotations looking at general medicine aspects when i have time :) Our new intern is scaring us with how much work she is doing and how tired she is doing her surgical and now gen med rotation, something to look forward to in the future! But she appears to stress herself to go the extra mile which while good to take the challenge can be an extra challenge in medicine!

It was the first time i saw someone who had passed away the other day. It was a man we had been treating with dementia and other comorbidities and he was deteriorating so it was kind of expected. I watched our doctor check his signs and give the consent that he had passed away. He looked peaceful yet even though he was so still i was just waiting for him to jolt awake. I didn't really know what to think. I also saw my first lumbar puncture on Thursday! It was amazing to see such clear fluid coming out from the spine! Our reg was an expert although he was a little nervous having not done one is a while but you could only tell by a small shake in his hand, he sounded so calm and professional and got it first go :) I congratulated myself for not fainting although i did start to feel a little dizzy (it was a longer needle!) but i wasn't the only one. I also felt my first spleen in a patient with Chronic Lymphoid Leukaemia and did a cardiovascular exam on a man with a mechanical aortic heart valve, very cool hearing the click like a clock and realizing it was his heart beat! Unfortunately he was an intravenous drug user and had infective endocarditis, some people never learn.

We had a tutorial on how to look after ourselves as doctors and medical students on Wednesday. It is scary that we are in the profession with the highest rates of depression, suicide, divorce and basically stress! Why? If you are a brick layer and you lay the brick wrong, you can always knock the wall down and lay the bricks again. In medicine we are dealing with humans and life, if we do something wrong it is likely to be something we cannot take back and redo. The man talking to us was amazing and gave so many life experiences for us to learnt from :) Basically he was teaching us how to make medicine our friend and not our enemy and used a representation of a Pie chart for us to picture the proportion of our lives we should dedicate to each aspect. They were divided into Work, Self, partner, kids, family/friends and community where each aspect had an equal share in our emotional energy and should therefore have an equal share in life balance. He told a story about a doctor he knew who was so loving and kind to his patients and staff and everyone loved having him around. Then he met his daughter and told her how loving he was to everyone and always there for people, and her face tightened as she said 'yes but he was never there for us'. He neglected his family for his work, i never want to do that. He also gave us simple things to do in the future like take your children on conferences, have designated dates with your partner, just time for the two of you and make sure you have a hobbie or something you do for yourself that is not part of work. He mentioned how some people balance life through kids and work. But they are obsessed with both and still do not look after their partner or themself. It was interesting the man said that he would take his daughter to basketball and she would shoot a goal and always look to him to see if he was watching which he was. But then he realised he didn't want her to play for him, but to play for herself and the team, so although he loves to watch, one day he didn't and explained to her he wanted her to play for herself, her own enjoyment and her team, that would be a hard thing for a child to understand but is so important. Did you know that apparently if you have dinner with your family at least 4 times a week you reduce the chance of being an IV drug user? Family is so important, as is a balanced life.

I was very sneaky and took a picture of the corridor i walk to get to my ward (which looks the same!) luckily no one was around but i did not turn the flash off so may have scared a few patients into thinking they are seeing flashing lights! But i want to remember my first rotation in the hospital as much as i can :)

I met Lexi and her new puppy Tilly who is adorable! It was lovely to see the, Till absolutely loves Lex and follows her everywhere and Lex is in love with Tilly, i'm so glad she found her perfect little girl :) We made yum pizza's with Megan, Mel, Murph and Dim which was nice! I had to leave early to finish some online questions but was so glad to spend the evening with them. I will put up some photos of the night soon! I can't believe three years has gone to quickly and Lexi has graduated from psychology! I am so proud of her she has put in lots of work through ups and downs and is amazing, i never doubted she would graduate she will be an amazing psychologist!

Happy graduation Lex :)

Re-evaluation

I did my trial run, i was almost not going to but i decided i had nothing to lose. It was a lovely morning and so nice being at the oval with only one other person and running as the sun rises! I have missed the track. So i warmed up and ran my 1500m in... 5 minutes and 25 seconds. It is not a fast time but i felt as ease and strangely relaxed after trialing myself! It was all i wanted to do and it was the deciding factor to not put myself under stress of competing at the states, i wish i could of don't get me wrong, but my time was more on the slower side than i would have liked to compete with. I think in the situation i could be able to get to 5 minutes which is quite good with no actual track training! i have to commend myself on that at least :) Friday night came and went and i felt uneasy and a little list not competing honestly but it is gone now. I will be back somehow. Next year i may be in a rural area and not able to get to states but i will somehow compete in a track competition in the future. For now i will set new goals, i will look at the cross country and winter season which is something i haven't really done before!
That makes it quite exciting :) usually after the athletics season finishes i rest injuries and never focus on long distance, but now i am determined and almost ready to go now! I'm waiting for the winter program to come out, but i know i have a few runs in sight:

1. Gallipoli run on the 22nd April

2. HBF run for a reason 27th May

3. CITY TO SURF!!! 28th August

And my goals? The city to surf one is easy - break 50 minutes. But i would also like to break 19 minutes for the 5km and maybe there will be a competition at the end of the year i can aim for, we will see. I was excited looking up rural places to go for medicine next year and i found Broome has a little athletics track that runs over the winter season due to the heat. I would LOVE to do my placement over there and help out at their little athletics centre! I could help them train and also train with them and get experience up North with both medicine and the local community - it sounds amazing if it could happen :)

I had a nice time at a 21st last night and met some people i hadn't seen in a while. It was a cartoon theme and although i wasn't sure what character i was i enjoyed being some sort of flower fairy, but i loved some of the costumes there!

The Highs and Lows

I have to admit i had a few days of stress and exhaustion last week. The low days of being in Gen med rotation, but the good thing about lows is the only way is up! I was exhausted after netball Tuesday night since we played at 9pm, but picked up after the game even if it meant i couldn't sleep from the high of sports afterwards! After surviving a busy week complete with research
tutorials, talking to an inspiring Aboriginal patient (who turns out to be a famous footballers grandfather!), having tutorials with our registrar and consultant and fitting in exercise it was nice to have a break over the weekend even with large assessments coming! The truth is it is hard to know what to study for them, and if we have the feeling of not knowing what to study then maybe it is a good sign that we are ready for the assessments and in actual fact need a break and time out to recuperate before them.

So on Saturday Kyle, Emma and I drove to Mandurah in the afternoon for a lovely afternoon of High tea for a friend in medicine's 21st birthday. They had a lovely house and outdoor undercover pool! Her family did an amazing job cooking so many delicious foods! it was wonderful to chat with her family and people from medicine :) We were about the first ones to arrive and the last ones to leave getting back around 8! I loved spending more time with Kyle too as we don't get to these days being so hectic. There is a photo i took at the Mandurah beach before we went to the High tea of Kyle doing taekwondo, I insisted on taking his picture with my new camera he got me for my 22nd! :)

Sunday i always do washing and the gym in the morning and had a catch up with Kyle for a quick coffee at a lovely little cafe in Dalkeith at Lo Zucchero cafe, it is a little Italian one with award winning wood fired pizzas! Kyle and i have made it our mission to try find little 'hidden' cafes around and find the best coffee/chai latte we can :) mission accepted!

I was looking forward to this afternoon... i now have behind me 2 assessments which i passed. One was an observed case presentation. What it involves is seeing an unknown patient, taking their full history and doing doing a relevant clinical examination then presenting the findings and differential diagnosis and your next steps/investigations to your examiner/doctor. I was really nervous and had studied lots of differential diagnosis and possible outcomes i could get! I passed, i talked to a lovely lady who had vomiting and diarrhoea which in the end was due to a campylobacter infection from chicken. However my examiner was so 'chilled' and relaxed about the exam that he left the room when i was taking the history and didn't want me to do an examination! So although i passed i feel a little cheated, i didn't actually do the whole thing! He said he looked through my log book of patients i have seen in the past 5 weeks and feels i am on the right track and didn't need to do one... very trusting and relaxed doctor he is! I was a little deflated after being worked up about it so much but in the end i know i can do the examinations and i did feel accomplished by coming to the correct conclusions of an infection causing the patients symptoms and said the correct diagnostic tests. So a pass is all i needed. The doctor did said i had a great rapport with my patient and mentioned i would be a good physician which was nice to hear :) Its good to have those little comments to lift you up and on-wards!

We also had a ward case presentation with our consultants, they were really interesting listening to each others presentations and learning from our cases and the questions our consultant would ask us. I learnt about Pancoasts tumour which the neurology case i mentioned beforehand has been diagnosed with and a possible metastasis further down the spinal cord. I also need to look up farmers lung and bird fancies disease related to interstitial pulmonary fibrosis. We all passed those though... double ticks for the day!!

I feel relieved, now with 2 and a half weeks of Gen med left i just have one more ward case presentation and an Aboriginal case study to do and i can just focus on my practical skills before it is the end of gen med :) i do feel like i have progressed so much in the past few weeks already!! It is almost a shame to not continue with the diverse learning we are getting but i think a slower rotation is needed for next one, fingers crossed i get a good placement!

In the back of my mind i am still contemplating whether or not to be a late entry to the state championships 1500m this Friday?? I could go to the oval tomorrow morning before the hospital and do a trial run. I can't get it out of my mind but honestly don't think i am fit enough to run it against the others. I haven't even been training!! Maybe its because everytime i go to Kokoda i speak to people who say i inspire them when i run up and down the hill, one lady suggested i go to Malaysia and do a 4.5 hour hill run!! I'm not that fit :P but they motivate me and i do miss track running. Soo... reasons for and against trying the competition:

For: I miss and love track running, i want to feel the adrenaline rush of running as hard as i can with my spikes and feel like i am flying again. I should take all opportunities that come my way and not be afraid of making a fool of myself. I don't know what next season will bring (even though i want to focus on the track next season!) so should just try.

Against: I don't know how fit i am, i would make a fool of myself, i will hurt my foot again with my spikes and bring about an injury (which will heal in a week), i am putting too much pressure on myself, i won't be allowed to compete entering late and not competing throughout the year so am wasting my time.

Which side is stronger?? So plan... do a trial run at MacGillivray oval tomorrow morning and if my time is OK i will email Kylie Wheeler to ask if i can still compete and go as a late entry for Friday night. My fitness is the deciding factor so i will let it decide tomorrow :) easy...

Confidence

If only i can bring my confidence up, it is coming slowly but i still find myself a little too hesitant for my liking! Even just chatting to a patient and taking a history from them in the hospitals, what am i afraid of? Is it that i will make a fool of myself? Is it that i might upset them somehow? I always seem to have a feeling of uncertainty or that i am doing something wrong lingering in the back of my mind. I know confidence comes with time but there are days where i feel pathetic not even bringing myself to talk to a patient! I will work on it, if i go in pairs more then progress to interviewing someone by myself at least once every 2-3 days then that will be good too!

I gave the birthday card to the lovely girl in the ward with anorexia. Her mum was there so i didn't get to chat but just drop it off. I saw her again today and she thanked me for it and said she gave it to her mum to read and it made her mum cry! We had a little chat this morning, i hope she doesn't think it is strange i chat to her just as a friend but i hope i can see her more, i always end up visiting at odd times or when she is asleep in the afternoon unfortunately. Maybe i'll bring some cards and just sit and play them with her :) But even chatting to her i want to but i still get skeptical like with other people that i am doing something wrong, but i am not! I need to overcome this feeling i really want to.

I learnt today about the Indian flowering plant called Henna, it is used to dye the skin, hair, fingernails, leather and wool. The paste of the plant is applied to the skin for a few hours overnight to stain the skin like a temporary tattoo and it also acts as an anti-fungal :) The staining is due to the lawsone protein released from the henna leaf. It is said that henna has been used to adorn young women's bodies as part of social and holiday celebrations since the Bronze age in the eastern mediterranean. The earliest mention was in the context of marriage and fertility in the Ugaritic legend of Baal and Anath as the women would mark themselves in preparation to meet their husbands. The night of the henna is even now celebrated by Jews, Muslims, Hindus, Christians and Zoroastrians all celebrating marriages by adorning the bride and often the groom with henna. Henna was regarded as having blessings and was applied for luck as well as joy and beauty with complex patterns.

Recipes

10 Recipes For A Beautiful Life

Imagine Life as an amazing kitchen where all ingredients can be found to make the most amazing recipes without ever failing at creating.

10 Recipes For Life

1 – Friendship recipe:

Two Friends, one heart, two Souls, One world. ~Soul

2 – Challenge recipe:

Every couple that has lasted has once or more thought that it wouldn’t until it found enough Love to work it through. ~Soul

3 – Connection recipe:

Tweet for two: Melted with essence, Stirred with sweetness, Seasoned with spice and savored with You. ~Soul

4 – Love recipe:

Place a thought in the center of your heart and let it infuse for a moment before sharing it with another. ~Soul

5 – Peace Recipe:

The greatest way for life to flow is to give it some Love. ~Soul

6 – Success recipe:

Take your greatest passion, wrap it in Wisdom and serve with humility & gratitude. ~Soul

7 – Wisdom recipe:

Life is a fruit to which Wisdom is the heart. Always keep the heart in the center of your Life and it will always get a flavor of her Truth. ~Soul

8 – Unity recipe:

It takes all differences to make a world look beautiful just like it takes all ingredients to make a recipe tasteful. ~Soul

9 – Compassion recipe:

Love is to Life what creativity is to cooking, it takes a lot of it to make it remarkable. ~Soul

10 – Chef recipe:

The Man who finds enough strength to show his gift is the artist who finds enough Love to share it. ~Soul

Crossing lines.

Just as there are many choices in life, there are equally a number of lines which can be crossed. The trick is to know whether they are lines of boundaries which should not be crossed or another step to a brighter and more welcoming side.

We have crossed the half way line through our General medicine rotation and i am looking forward to seeing the home stretch! As amazing and exhilarating as it is, a slightly slower and less intense pace would be just fine with me atm. We interviewed and examined an awe-striking neurological man today who was really nice. It was such a complicated examination we were all left a little baffled by what was happening! The man had signs of horners syndorme on his face, his right arm had muscle wasting and he was very weak mostly distally, both arms were hyperreflexive excpet for his right triceps and he had decreased sensation around C7 and C8.

Down his trunk he had weak sensation below T5 on his left and his left leg had reduced sensation. His right leg was weak mostly distally again and he had right foot drop and a babinski sign but his left leg was OK. He also had hyperreflexia on both legs with no muslce wasting (his knee reflex was so big!!). So it was a mixture of LMN and UMN signs but we think he has a lesion around C7/C8 and another or multiple lesions between C7 and T5 causing the UMN signs in his lower body but they don't know the cause yet... sound confusing??

I put in my little diagrams of explanation :P

I spoke to a lovely girl today who i wanted to speak to for a while. You can tell she is so bright and smart and a lovely person when you enter her room, if anyone should not be in hospital it is a bright 18 year old. She has anorexia and it makes me break inside to see. Maybe it is because my best friend has suffered the same illness for years and it hurts to think what she is going through? But she reminds me a lot of my friend and also a lot about me. I went in to talk to her and she was a little reluctant and asked how long it would take expecting more interrogating medical questions, i just said a few minutes and thankfully she agreed. As students we always start off asking 'so what brought you into hospital?' but most of the time the patients look at us funnily because they know we already know. Still its how we start from the start to get their perspective and work on from there. I didn't want to ask interrogating medical questions, i just wanted to know a little about her and it was strange how much we had in common! She has done athletics for years and even came down to Bunbury for a competition when i was there too.

We chatted about running, sport and had some good chats about baking and cooking and she loves cooking shows too. There were some issues which came up which she didn't feel like talking about with me which i completely understand! But i would love to keep chatting to her but just as a friend, i hope she doesn't think it is strange. They say in medicine you need to keep a distance between getting too involved in your patients, but what if it is a moment of fate in your life where you meet someone who you are meant to, as though you have a gut feeling that you should do what you are doing whether it is regarded as 'appropriate' or not? I can't let an opportunity go where i could be there for someone and make a new friend, is there really a line in this case? It makes me think about my future though as a doctor, when i work in a rural area and possibly be a pediatrician i also want to run or be part of a youth mental health organisation.

I took myself to McGillivray oval on Monday to test out my running and fulfill my craving to sprint! Crossing that finish line after each run I knew I was a little sore from the gym the day before but my times were OK, not the best but possibly enough to at least compete in a 1500m event and not make a fool of myself. If i have time maybe i will go again this week and do a 1500m time trial... if i have time. But even after one track run with spikes my injury from last year played up in the arch of my foot so the next 2 days it was a little painful! We started netball again for social games on Tuesday nights which was fun! I love netball too, i love the speed and agility and the challenge of reading the play and it it is such a nice way to see friends you don't too often anymore.

I just wanted to put in a picture of my breakfast i love! Apricot and almond muesli with nuts and cranberries mixed in natural yoghurt, a little vanilla protein powder, a drizzle of honey and strawberries (or blueberries and banana!) perfect start to the morning, yum :)

What a week, What a world.

I couldn't have asked for a better start to being 22. Kyle got up even earlier to come to trinity at 6.30am and play 'mum' and gave me some presents mum had passed on when i saw her on the weekend. It was so nice to still have that and felt more like home :) I was quite nervous for my birthday on Tuesday for all the activities which were happening throughout the day in the hospital. Those of us in my group had to do a little presentation on patients at a multi-disciplinary group, we were all a little nervous and had a page of notes until we got to the meeting and our doctor told us to cut it down to a few sentences!! not as big as we thought then :P We had a great tutorial in the morning where our consultant actually took the time to just sit down with us, tell us how he approached patients and diagnosis and answered questions we had. He took us through ECGs which i was happy about - they are so confusing!! We also had a meeting over lunch with doctors giving presentations and a clinical tutorial in the afternoon. The tute was on cardiology and we found a lovely lady who had an aortic stenosis. It was amazing to hear the murmur on the stethoscope and i learnt so much in that session!

That night a few good friends came out with me to the

Buddha Bar in Subiaco, it was such a nice place, great atmosphere and the food was amazing too! I had chicken vindaloo and was spoilt with a sticky date pudding from Kyle which he ordered with a candle to sing happy birthday for me :) i loved the company it was such a good excuse to catch up with people too :) The day was not complete without a skype to mum and dad at home and i blew out a cupcake and candle over skype! Welcome to 22!

The next day i was up early and fitted in a run through kings park and to Kokoda trail. It was one of the best runs i have had so far, the sun was beautiful through the trees and i felt quite energised! At the stairs i met a lovely older man who inspired me. Well at first he said to me 'you are inspirational you go up the stairs so fast, are you a sprinter?' and i was a little shocked and told him i just aim to keep up my fitness. He was an inspiration himself as he said he tries to keep himself fit and more people his age should. I hope to be as fit as him when i am older :) his name was Conrad, it was so nice to chat to someone as it gets lonely running by yourself all the time, i hope to cross paths running again! I had to have a laugh as there was another middle aged couple going up the stairs and as i passed they made a comment about being shown up by a crazy 15 year old... i just turned 22 but i still look 15! :P it is a year older than in December where a customer thought i was 14 in my all too big pharmacy uniform, but i can't see anything bad about looking younger :)

I was a little stressed by mid week as i had an assignment

to finish but a trinity commencement dinner on the Wednesday night and by Wednesday i was exhausted!! I managed to get up at 5.30am Thursday for an RPM class but that just about did me for the week. I made sure i got enough sleep Friday to go out with Lexi! We went to...... Taylor Swift yay!! I brought tickets for Lex and I for her 21st birthday last year, it is almost 6 months ago but we have extended her birthday celebration and she is such a special friend she deserves it! I was running late as i was stuck in peak hour traffic and the normally 20minute drive to Burswood took an hour!!

We almost didn't have time for dinner beforehand but managed to get kebabs which were really nice actually. The concert itself was amazing, Taylor is such a down to earth person, extremely

nice and an amazing live singer. She came into the crowds and it was lovely to see her hugging and shaking hands with the younger girls, they all looked gorgeous dressed like Taylor with flowers and headbands in their hair and dresses. I stayed the night at Lexi's and it really enjoyed having more time to catch up!

And now it is Sunday night again... i had so much work to catch up on and managed to do quite a bit but there is still lots to do. I needed a break and to write though. I got back from Lexi's good friend Shannon's 24th birthday get together in Cottesloe which was nice, it was great to chat to Shannon and a girl Chelsea, they are both lovely people i hope i can see them more! The couple of hours that followed i wasn't really expecting. I saw a good friend at dinner and she didn't look well so went and said hi to her in her room to find her upset. Its never nice to see her or anyone upset so i'm glad i took the time to go see her. It turned out someone from her course may have committed suicide on a project down in Albany, she didn't really know them but the thought of it being someone close and in her course made her upset. Unfortunately she has had a rough time the past few months which would have triggered it too, i want to catch up more often and make sure she is OK, i worry about her sometimes.

My room mate had afternoon tea with a friend from medicine to talk about her decision to quit. She is now studying biology and botany and is happy with her decision. My room mate was a little distressed about an assignment due, boy troubles and the thought that we are getting ourselves in very deep with medicine. It is hard and it controls your life. I asked her if she still has the passion for it and she says yes. It is just a harder time atm as her consultant is not the nicest and she starts to doubt herself and her abilities and think 'i could be as happy as the girl who quit, be less stressed and do something else i enjoy with my life'. She said she would be a teacher, i could see her being a teacher when she said it but didn't want to say given her unsteady state. But i can also see her being an amazing doctor which i did say and which is true. We will get through it. It will be tough but as long as we learn to balance out lives we will get through. Me, i would probably be a physiotherapist or manage a sporting club or be a personal trainer. Or i would go live overseas for a while, live in a little Italian village and learn Italian fluently, take cooking classes and open up a wonderful little bakery or a restaurant... how wonderful does that sound :)

There are so many choices in this world and life throws us so many possibilities, how do you know which one is right? You take a chance, follow your heart and believe that it will lead you in the direction you are meant to take and follow it with confidence. I will get to Italy one day, i will do a cooking class and i will one day have a bakery or cafe. And i will also help out at a gym or who knows maybe own a gym too? I will one day have a family and my own house in a country town, and i will do that while also being a confident, trusted and a good doctor.

Anything is possible.