Dispelling the Myths

At around this time last year, I kept bumping into friends who were eager to talk about third year and tell me how awesome and easy and relaxing it was.

They lied.

Well, not quite. If you’ve just come out of second year, there are forms of mediaeval torture that sound as though they’d be awesome and easy and relaxing. I was irritatingly cheerful for most of last year — up ’til the weekend before the exams, when I made up for it with a four-day meltdown — and, now that I’m safely on the other side, even I can admit that it was a little bit like living through a horror film.

I love third year. Sure, I’ve been exceptionally lucky and ended up with a good hospital, a fantastic GP practice, and a comm skills tutor who’s totally bonkers in the best way possible, but even if I left all that aside, I think this year is still just better. That’s not to say that there’s nothing that makes me want to find an exceptionally solid brick wall to thump my head against. Integration Week was more dire than I’d predicted, and the Avoiding Plagiarism lecture wasn’t even the worst of it. My timetable is not totally devoid of pointless FRSs. But those things are the exception, not the rule. This year is all about the transition between the comfortable familiarity of pre-clinical medicine (because although we’d like to pretend otherwise, the divide between ‘pre-clinical’ and ‘clinical’ hasn’t been rendered obsolete by even the best of integrated courses) and the sheer blinding terror of fourth year rotations. We’re learning how to be clinical medical students. It shines through in almost everything we do these days, even PBL.

Awesome, yes. Easy and relaxing? Not so much.

On my timetable for just this week, I had two afternoons of PBL in hospital (which involves a commute), a full day in my GP practice (which involves a longer commute), a lab on respiratory anatomy, four hours of lectures, a three-hour comm skills session, and some clinical skills teaching on peripheral vascular disease. And somewhere in there, I still needed to actually do PBL. There was very little in there that I didn’t enjoy and even less that wasn’t worthwhile, but I was ready to fall down by the time Friday night rolled around.

The reason for this post was so that I could say this to my junior colleagues:

Right now, you’re in the medical school equivalent of purgatory. It’s brutal and exhausting and soul-destroying. So, you grit your teeth and push on, you take everything you can from it, and you take comfort in knowing that it goes by fast. You look forward to third year as a bright, shining beacon of hope and joy and blessed, blessed relief. It is all of those things and you are going to love it. But if any third year should try to claim that it’s a piss-take, you should feel free to smack them in the nose.

 

A whole new chapter begins.

Tomorrow, the first core block of third year begins with a day in my placement hospital.

It feels a little bit like the first day of school, except that I didn’t spend the evening before my first day at school doing a frantic recap of how to examine the cardiovascular system. It’s surely not been all that long since I was meeting my classmates for the first time, taking my first steps into the medical school, sitting down in my first lecture, brainstorming my first PBL. But tomorrow morning, the comfortable familiarity of that routine gets stripped away and something new — something that’s different and yet not — will begin. I’m a little bit excited and a little bit petrified.

 

Thoughts at the end of SSM.

This is my last week of Haematology/Oncology.

On Monday, I’ll be back at base camp for a week of lectures on topics both useful and useless — really, one has to question the wisdom of the faculty in scheduling a bunch of third years for an hour on How To Avoid Plagiarism, as though it’s likely to somehow be different from the way in which we’ve been avoiding plagiarism for the last two-and-a-bit years. From there, I go to Peripheral Hospital and Slightly Less Peripheral GP Practice, and ‘real’ third year begins.

The good thing about spending the next ten weeks schelpping out of the county for clinical practice/PBL is that I should theoretically have a more central placement in the spring, when I’m actually going to care about how much time I have to spend commuting. That doesn’t mean that I’m not going to moan pathetically at my alarm clock when it starts going off at zero dark hundred hours on cold, cold, cold mornings, but it’s something to keep in mind.

Before that, I have the rest of this week, which will be about tidying up my SSM essay and then truncating it into a ten-minute presentation, followed by a lovely lazy(ish) weekend.

My SSM has been busier, less lab-based, and more useful than I expected it to be. These are all good things. I’ve learned a lot. Not just about cancer (although that too), but about where my interests are, what kind of career I want to have, and what sort of doctor I want to be. The ideas that I have are ideas that may well change as I go through the next two years and onto foundation training, but I feel now as though I have somewhere to start. All in all, a massive improvement on the Drugs In Sport SSM that I was bitching about for most of last winter.

 

If only it grew on trees

In academic terms, I’ve had a very chilled out start to the term. I haven’t seen any patients yet, but soon, and in the meantime, the lectures are really interesting and the it’s all been very well-organised. I’ve got enough on my timetable to keep me busy, but I’m not working like a maniac. I’ve got a good group. It couldn’t be more different from my last SSM. I’m ridiculously happy to be back to work. Perfect, right?

No.

For most of last week, I was sitting in third year classes and feeling my brain being engaged and, damn, having fun, but I always had a little voice in the back of my head reminding me that, although I might be sitting in third year classes, I did not know whether or not I was going to have funding to do third year.

A medical student from England pays somewhere around £3000 tuition per year. It’s a bit less if they’re studying in Scotland and a bit more if they’re in England or Wales, but roughly that. The students who came in as school leavers will have their tuition money loaned to them by the government, and they’ll pay it back once they start earning a decent salary. But for those of us who have come onto a five year course as graduate entrants, we’re not entitled to that loan and we have to find alternative means of funding our tuition. I’m in the fortunate position of having had my parents offer to pay my fees in first and second year, for which I offer them my eternal gratitude, but they couldn’t have afforded more. I’m paying for the rest of it. I also needed to find something that would cover my living expenses — graduates are entitled to the same government maintenance loan as school leavers are, but the increased length and expense of the clinical years together with the shrinking job market for summer temps have meant that that’s not enough to actually live on.

I’ve ended up taking out a professional trainee loan. It means that I’ll be living with a financial noose around my neck for seven years after graduation, but my choice was between that and dropping out. That isn’t a choice. I’ve worked too hard, I’ve come too far, and I love it too much. And it does help that I’ve known since before I even applied for graduate entry that this was something I would have to do one day. I considered it an achievement that I got to the end of second year without having to do it.

But there were a whole truckload of issues with the application for my bank loan and the processing of the application for my government loan had been somehow delayed, and that meant that for most of last week when I was sitting in class, I really didn’t know if I had any funding for this year. I would occasionally catch myself drifting off, pondering what would happen if I really did have to drop out. And, inevitably, I would get upset or start panicking. I may have actually shrieked ‘thank God’ in the middle of the street, when my bank manager called me on Thursday afternoon as I was walking home from the hospital. Having been swearing all week that everything was fine and that it would all work out, I was finally able to admit to my mum how worried I had been. “It would have been worse,” I said, “than if I had never got in in the first place.”

The stereotypical idea of a student is that of a rich kid, sponging off the government and not doing much work and using her student loan to fund nice shoes and lots of clubbing. I’m sure they exist, but I know they’re not the majority. I know that I’m not the only one who is literally scraping together every last penny just so that I can stay here. I won’t be unique when I graduate with a total debt of over £60,000 (having never, in eight years of university, bought a car or a pair of Jimmy Choos or an alcoholic drink). And I can speak for everyone in my year when I say that we work damn hard.

At some point in the not-too-distant future, the government is likely to announce its proposals to increase tuition fees to £10,000. If that happens, think about what I’ve been doing this week, think about how much harder it’s going to make an already Herculean task, and think about whether you want your doctors (and dentists and lawyers and nurses and teachers) to be chosen by the size of their wallet or by the content of their character.

 

The Joy Is In The Journey

For students at Glasgow, this weekend has marked the official beginning of term.

On the weekend that I moved in, my parents got lost. That’s mostly what I remember. They were driving from Newcastle to Glasgow in a two-seater van that was crammed full of all my possessions, and I was getting a bus from Newcastle and then changing onto a train at Edinburgh, and, when I called them from Edinburgh, they were lost. They claim it was the sat nav’s fault. I claim that it’s not rocket science to figure out that if you’re in England and you’re driving to Scotland, following the signs for The South is the wrong way. That was two years ago (and, no, we’re no closer to resolving that particular argument). It was my fourth year at university, my second shot at being a fresher, and the beginning of my first week as a medical student.

I’ve been trying to write down a bit of what I’ve learned and most want to pass on, but I’ve found that the most important things can best be summed up by the title of this post, and like this:

*

When you start on your journey to Ithaca,
then pray that the road is long,
full of adventure, full of knowledge.
Do not fear the Lestrygonians
and the Cyclopes and the angry Poseidon.
You will never meet such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your body and your spirit.
You will never meet the Lestrygonians,
the Cyclopes and the fierce Poseidon,
if you do not carry them within your soul,
if your soul does not raise them up before you.

Then pray that the road is long.
That the summer mornings are many,
that you will enter ports seen for the first time
with such pleasure, with such joy!
Stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and corals, amber and ebony,
and pleasurable perfumes of all kinds,
buy as many pleasurable perfumes as you can;
visit hosts of Egyptian cities,
to learn and learn from those who have knowledge.

Always keep Ithaca fixed in your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for long years;
and even to anchor at the isle when you are old,
rich with all that you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would never have taken the road.
But she has nothing more to give you.

And if you find her poor, Ithaca has not defrauded you.
With the great wisdom you have gained, with so much experience,
you must surely have understood by then what Ithacas mean.

(KP Kavafis, translated by Rae Dalven)

 

And the cry went up — SSMs are out!

I’m doing Clinical Haematology and Oncology.

After the disaster of my last SSM (those who were around in January will remember the Drugs in Sport debacle), my main objective was to get something clinical. On the one hand, this meant that I chose things a little more carefully and made absolutely sure not to choose anything that I wouldn’t be happy to actually do. On the other hand, it meant that I took some really stupid risks with the form, like not picking anything with more than about 12 places and not ranking things in my actual order of preference. Therefore, I’ve spent the last six weeks worrying that I would end up being assigned to something awful that I hadn’t even ranked.

But it worked! I’ve got the one that I wanted to do, in a specialty that I’m really interested in but isn’t a core component of fourth and fifth year rotations, with lots of clinical content mixed in with some lab stuff, at a hospital that I can walk to from my flat! Hurrah!

 

It ain’t over ’til it’s over

I’d guess that for the people whose A-level results came out on Thursday, the dust is beginning to settle.

For some, it’ll have meant waking up with a celebratory hangover. If that’s you, my heartiest congratulations. The only thing you need to do now is to enjoy the last few weeks of your summer holidays, let yourself get excited about what comes next, and not argue with your parents when they try to stock you up with bedsheets and twenty pence pieces and a month’s worth of groceries (trust me, you’ll be grateful for it).

For others, there will have been tears. There are many, many options open to people who didn’t make their conditional grades — re-sits and graduate entry, to name the most popular, and what’s right for one person might very well not be right for another. But when I got my A-level results, six years ago, I was in the tearful group, and to you, I offer this story.

*

(Note: A number of readers may have seen this story before. It was one of the first things I posted, back in August 2007. It disappeared with the reboot of my blog, earlier this year, and this week felt like an opportunie time to put it back up.)

I’ve submitted three separate UCAS forms with twelve applications to ten different UK medical schools. I’ve sat the MSAT and the GAMSAT and the BMAT and the UKCAT. I’ve had nine interviews, clocking up hundreds of miles and a gallon of GNER coffee en route. I’ve spent my summer holidays bringing up the tail end of ward rounds and sitting in clinics with doctors who’d had the misfortune of getting stuck with the work experience girl. I’ve learned many things since I clicked ’send’ on that first application in my final year of sixth form, and the most important is that getting into medical school might be about the grades and the experience and the interview, but it’s also about wanting it enough and being pig-headed enough to keep going even when it feels as though it might never happen.

In the 2002/2003 application cycle, I received conditional offers of ABBB from St George’s and ABB from Kings. I was shitting myself an appropriate amount when I headed into school on A-level results day, but in spite of being nervous, in spite of knowing that my synoptic Physics paper belonged in the Edexcel Bloopers Hall of Fame, the idea that I would ever end up with anything less than exactly what I needed had never occurred to me. I was eighteen, you see, and therefore invincible. I don’t remember opening the envelope or exactly what went through my head when I saw my grades (although I do remember, with startling clarity, the look of utter panic on my form tutor’s face as I proceeded to thoroughly fall apart on him), but I know that I knew that BCCC was not going to get me into a UK medical school. I also know that I rang both Kings and St George’s, just to check, and that they very politely didn’t laugh.

The first thing I did was get on the phone to the Czech Republic. In addition to the two places I’d had through UCAS, there was an offer on the table from Charles University in Prague, and in that first half hour of not knowing which way was up, I rang the admissions office and accepted it, but I later called them back and unaccepted my acceptance. I might have been eighteen and invincible, but part of me realised that Prague was just too far from Newcastle and that maybe I was going to have enough challenges without throwing in the additional complication of a new culture and a new language. It was the right decision; I would go on to meet hundreds of international students and realise that I would never have handled it with anything like the grace that most of them did. I also turned down an offer from my school to stick around for a year and do resits, knowing that I’d be miserable and that in any case I would have trouble pulling those grades up to straight As. So, having not had the sense to use one of my spare places in UCAS to apply for something else, I took what seemed to be the only option left to me and I entered Clearing.

For the uninitiated, Clearing is like a rugby scrimmage with more paperwork. I spent two days on the phone. Kings had offered me a place on biomedical sciences almost in the same breath as they’d told me that my offer to do medicine had been rescinded, but, since at that point I had been planning to move to the other side of Europe, I refused it on the spot and I wasn’t surprised to find that all of their biomed places had been filled by the time I called them back. I got a tentative offer for biomed from St George’s, but they wanted to re-interview me and I turned them down because I was worried that I would be rejected and that everywhere else would have filled their places by then (and I would later discover a handful of institutions that had filled their places just in the time it took me to make that decision). I reluctantly called Durham, a university that seemed too close to home and too cliquey and wanted to send me to the middle of nowhere for my degree. I did it because my best friend, who performed a hundred miracles that week, dialled the phone and put it in my hand. I still don’t know what made me agree to their offer, but it was an impulse that I’ve never regretted.

I went to Durham with the intention of getting my degree, not getting noticed by anyone, not embarrassing myself, and getting out. I had no expectations other than that I would be able to use it as an alternative route into medical school. I couldn’t have predicted how much I would come to love it, or how different a person I would be when I left. As an A-level student, I’d regarded science as a necessary evil and was prepared for a degree in biomedical sciences to be more of the same. I was taken completely by surprise. It was interesting, and it was exciting, and I was having fun with it. It sucked sometimes, too, like spending an entire Saturday in a library with a case history and a set of lab values and a precariously stacked pile of books that all added up to a disease that did not appear to exist, but, on the whole, the good days outweighed the bad days, and even the bad days weren’t so bad, not when they ended with the satisfaction of everything finally clicking into place. By the end of my three years, I had turned into a scientist.

And then there were all the things I learned that had nothing to do with biomed. I grew up, I worked out how to function as an independent human being, and I learned who I was and who I wanted to be. Those are things that are worth more than any degree.

It wasn’t planned… but I wouldn’t change it for the world.

At the beginning of third year, I submitted a second application through UCAS, and, by April, I had been summarily rejected by all four of the medical schools that I’d applied to. I put it to one side and got on with the business of getting through finals, and graduated from Durham with an upper second class honours before disappearing for a month of travelling across America. When I landed back in the UK, it was to a room at my parents house, a desk job in public transport admin, and yet another UCAS form.

A few days before Christmas, Kings turned me down for the third and final time. I was shattered and my faith was starting to wane.

I was interviewed at Glasgow on an exceptionally windy day. A complicated story involving trees on the line, the wrong kind of snow on the line, and power cables on the line meant that my journey was delayed and then rerouted. A series of frantic phone calls to the admissions office were made, and, in the end, I arrived with three minutes to spare and had no time to get nervous. Unsurprisingly, I have no coherent picture of it in my head. I remember being asked about my dissertation and recent developments in medicine and why I had chosen to ‘leave’ biomed, and that we digressed at one point into a conversation about Sebastian Faulks. I had no idea of how it had gone and I had months to wait for a decision. I logged onto UCAS Track at 7.10am on the morning of March 15th 2007 to see that my status at the University of Glasgow had changed from a blank space to my favourite word in the English language — unconditional. I screamed the house down.

It had taken five years, but I was going to be a medical student.

 

FYI

There will be a citizens’ rally in Grosvenor Square, London at 5.30pm on Wednesday 19th August, kicking off in front of the statue of President Roosevelt. The aim of this rally will be to send a simple message to the American people via a banner that will read:

GO FOR IT AMERICA.

OUR NATIONAL HEALTH SERVICE IS A BLESSING FOR ALL.

Pass the message on.

 

We Love The NHS

If you’ve turned on the television or read a newspaper or, really, been alive in any way at all this week, you’ll know that there are NHS-related rumblings coming from across the pond.

I was sixteen before I knew that there was a fundamental difference in the funding of the American healthcare system compared with the funding of the British healthcare system. I’d lived my whole life in a country where we have universal healthcare. I had experienced at first hand the systems in Malta and Germany and Australia, where they also have universal healthcare. I was aware that no such thing existed in most of the developing world and that the economic divide would mean world-class healthcare for the rich and, very often, nothing at all for everyone else… but I had no idea that healthcare in America operated under the same basic idea. I mean, why would I? What possible reason could I have had for thinking that the world’s only remaining superpower wouldn’t make sure that all of its citizens were able to access medical care when they needed it?

The current ruckus in America was quite neatly summed up on last night’s Mock the Week, when Russell Howard said: “Barack Obama is trying to get free healthcare for 46 million people in America, and this has made him unpopular in America.”

This is completely illogical and downright stupid, but also true. I suspect that under normal circumstances, we would quite happily have left America to get on with it — having lived through eight years of the Bush and Blair Show, most of us have come to expect stupidity from the American government and to simply be grateful when that stupidity is aimed at domestic policy and therefore not the sort that gets us dragged into a war. Except that in an attempt to demonstrate the evil of universal healthcare, the Republicans launched an attack on the NHS. This has included the branding of the National Institute of Clinical Excellence as a ‘death panel’, the claim that Senator Kennedy would be thought too old to be treated for his brain tumour, and, of course, the piece de resistance, an editorial from the Investor Business Daily stating that Stephen Hawking “wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”.

It’s been referred to as ‘a beautiful hypothesis destroyed by a single ugly fact’.

And once we had stopped laughing at the Investor Business Daily for its inability to use Wikipedia, we turned our attention to the NHS. In the last few days, the NHS has been defended by the Prime Minister, Professor Hawking, and the BMA, and, more significantly, by the great British public.

This is what I believe:

The NHS is a national treasure. I got into this because I wanted to be a doctor for people who need doctors. I want to work in a system that — with all of its flaws and annoyances and red-tape — still believes that we’re here to treat a person, not a social status or a bank account or an insurance company. I am alive because my father lived for seventeen years longer than he was expected to, because he was given dialysis and transplant surgery that didn’t cost him a penny; because my mother’s emergency caesarean was necessary and so it was done, without a phone call to an insurance company ever needing to be made; because in this country we see it as our responsibility to look after our youngest citizens, especially if that means keeping a very premature baby in intensive care for four weeks at no cost to her parents. I have a grandfather who is 81 years old and has every comorbidity imaginable, but the NHS has never given up on him and he’s still going strong. I see patients who get better and go home, having never had to make a choice between looking after their health and making sure there’s still a roof over their family’s head. I’ve met a remarkable man who will be on thrice-weekly dialysis for the rest of his life, but who is so full of joy, living a full life and feeling good, and never, ever needing to worry about where the money’s coming from, which is exactly the way it should be. I believe that the grounding principles of Clement Atlee’s NHS have never been forgotten: a universal service for all, based on clinical need and not on ability to pay.

I look at the patients I’ve seen, the people I’ve met, and the family I’ve got… and then I look at the NHS, and I think, all of this is here because of you.

 

A bit of breathing space

After getting my exam results, I needed to take some time to do something other than eat, sleep, live, breathe, and blog medicine. I might have insisted that this year I wasn’t going to neglect my life for the sake of my exams, but, as the hazy memories of a lovely Easter weekend faded and the days between it and the beginning of June started to race by, it still happened. I’d known for months that I would be missing a performance of Rossini’s Petite Messe Solenelle that was scheduled to take place on the night before Paper 1, so, because I wouldn’t be singing anyway, there were a few evenings when revision ended up taking precedence over choir practice, and then other things started to drop off the radar… In the end, the only non-academic commitment that I was keeping was on Sunday mornings, and even with that, on the last couple of weekends I was going into the library at the crack of dawn on a Sunday so that I could get an hour or two in before heading up to the cathedral.

So that’s where I’ve been for the last six weeks or so — recharging my batteries.

I’m still in Glasgow. I’ve cooked good food and spent time with friends and caught up on sleep and read books, and, after two years in the west of Scotland, finally found the time to go to Loch Lomond. This past fortnight I’ve been doing some very temporary work for the local bus company in a role that I’ve dubbed The Weirdest Job I’ve Ever Had — and I’m the girl who used to make her living from fixing boilers and unblocking toilets and providing condoms at three o’clock in the morning, so that’s saying a lot — but that job has now ended, so I’m hoping that my temp agency will find me something else soon. For a little while, it’s been nice to just be.

This week, I started to get excited about September. I had coffee with a friend who is just reaching the other end of third year, and talking to her has really made me begin to look forward to it. I’m starting to make plans for my junior elective and to think about what I might be able to do for my SSM next summer. I’m helping to write the Glasgow chapter for a new medical school admissions guide. If I don’t have any temp work for next week, I’m going to get in touch with my old VS tutor and ask if I can come sit in on clinic for a couple of days. It’s come to the point where I want to be a third year because I want to start doing third year, which, when compared to the frame of mind I was in in May, when I wanted to be a third year because I wanted second year to be over, is all the difference in the world.