A post for anyone sitting any exam in medicine.

I have a dear friend sitting a fellowship exam in a few months.  Said friend is brilliant – we’ve known each other since first year of medical school, and when she’s passed this exam, she’s qualified to be far richer than me.  Her specialty is so safety-critical (there are varying degrees of this depending on what field you choose), that it has an exam when you start training, and an exit-exam at the end.  And like all medical exams, they’re a curious mix of vague multiple choice exams, essay questions on things you know nothing about that you’ve never heard of in your day-to-day job, and face-to-face arrangements where you either stand in front of a bunch of serious looking guys who are all much bigger than you, answering questions on scientific obscurity, or, getting 6 minutes (in front of same bunch of guys), to examine someone and confidently make a diagnosis, usually obscure.  FUN right!

The BEST part, is that there is no real curriculum.  It’s not like university where, for the most part, if you show up to lectures and do your readings you’ll do alright, and if you’re really interested you’ll get HDs.  Or you do the easily-available past papers and your lecturers write questions based on the semester material.  There’s ‘the curriculum’ they provide you, which is really just a list of all medicine. (Hot tip; there are now over 7000 drugs you can prescribe, let alone all the diseases, genetic mutations, crazy new drugs, diagnostic procedures – I could go on!).  There’s also the part of you (especially when you’re a woman, occasionally one of your examiners might be a woman but that’s it), that just isn’t used to the idea of being a specialist doctor.  You think, ‘who, me?’  because ten minutes ago you were playing beer pong in a seedy bar in medical school thinking you were the coolest ever because you’d never been cool until that moment you played beer pong.  But specialists don’t play beer pong, they wear suits and have serious faces and Know Everything.  Their juniors are scared of them and scramble at the slightest hint they’re coming to make sure everything is ready and beat themselves up for a good week if they haven’t gotten to something, longer if the specialist gives them grief about it.  And you’re a junior for so long you don’t know what it is to be a boss.  Does anyone?

One minute you’re in medical school playing beer pong even though you don’t like beer, thinking you’re the coolest ever, hiding up the back of the lecture theatre with your friend hoping no one asks you a question while your friend does the crossword, or standing in the path lab being told about the special tubes in some machine when really you just want a nap – and suddenly you’re sitting fellowship exams?  About to become a boss??  Really?

And yet, here you are my friend.  Yes you, about to become a boss.  And here I am bursting with pride, watching you jump into that black hole of study.

Studying for these exams is like being blindfolded and tied up and straightjacketed and asked to swim in a straight line across a lake.  Nothing you do is every enough.  Everyone is better than you.  Everyone studies better than you, and magically is going to do better than you.  It is mandatory that you beat yourself up for not understanding statistical theory they offer whole degrees in.  If you’re a guy, you grow a long beard and it’s not movember, out of some strange time-marking ritual.  You can’t speak to anyone.  You don’t want to do anything but study but you can’t study because you’re exhausted from your 12 hour shifts that usually go much longer if you’re a caring doctor.  You walk outside and the light blinds your eyes and you see regular people doing regular things and they feel like aliens.  You do really badly on your practice exams.  So badly sometimes, you can’t even talk about it because if anyone found out The Truth, they would know that you don’t deserve this.  You don’t deserve to be a boss, what are you doing here?  You get 35% on a practice exam, how dare you even dream of it?  Most people would give up, surely?

Except you do deserve it.  And here you are.  Dressing up and showing up, in one way or another, at that study desk days in and days out.  Doing good some days, badly on others, not enough on some, too much on others.  Trying to find that balance that can’t be found.  Falling down that rabbit hole that has to be gone down for success.  Entertaining the idea, that subversive, dangerous idea that maybe you can.  Maybe, just maybe, all that learning and forgetting and learning and forgetting, and failing and succeeding is just exactly what you need.  On the day you’re going to see that question you failed a thousand times over and you’re going to remember the answer.  On the day you walk into that room and there are 5 guys in suits, maybe a token woman, you’re going to remember every single guy in a suit who gave you grief over the last 6 years and know that they can’t hurt you.

And because you’ve passed all of your exams with high marks so beautifully before (or maybe you didn’t but regardless, you still got here), you’ll know that you can do this because you’ve done it before.  You know that all those study sessions, the long ones, the short ones, the failed ones, the successful ones are all just coins in a bucket and you’ve filled the bucket up a thousand times over.  On the day, you’re going to walk in there and everything will just kick in, you wont be you anymore, you wont have control over what you say because your training will take over and the fancy, suit wearing specialist will take over and choose the best answers for their patient.  The safe answers, the caring answer, the non-experimental answers, the ethical answers.  And even if the roof caves in and the exam is cancelled you know you’re going to be okay and that the sun will keep rising whether you want it to or not, and all of your friends and family will be cheering on the other side, roof or no roof.

All of this is a process of shedding your skin and growing a new one.  It takes time, and it’s painful and it doesn’t necessarily go smoothly.

Here’s the best part though.  You’re not going to be that specialist.  You’re not going to be the one in the suit with the five other serious looking ones who gave you grief when you were an intern.  You’re going to be the one with the kind smile.  With the twinkle in their eye.  Who tells their intern not to sweat it if they didn’t follow up on something non-critical within 3 hours of being asked to do it.  You’re going to be the new breed, the next generation of specialist.  The dynamic, friendly and brilliant kind who are currently just sprinkled about like little oases of relief in a world of so much stress and anxiety.  That’s who you’re becoming right now.  Try it on.  You’ll probably find that it fits better than you ever imagined.

No matter where you are in medicine – first year, or pre-fellowship, this post is for you.  All the very best of luck.

Perfect motion.

9 years ago my husband and I got in an old Magna and moved our entire lives to this state so I could go to medical school.  That day, driving away from my childhood home is forever etched in my memory.  It was burning hot, and as we drove away I cried and told him to turn the car around.  I couldn’t imagine a world without my whole life in it.

How do I put 9 years of my life into a blog?  How do you even begin?  All I know is that the pace of my life increased a thousand percent and didn’t stop until now, 9 years later.  Years and years of the most amazing journey that’s shaped the person I am today, so profoundly different from the one that arrived.  9 years of the most solid friendships I’ve ever made.  Transitioning from terrified arts grad through the incredibly rigorous physician training program to the mostly self-assured doctor that I am today.  I have my moments.  I have a million photos of the things I’ve done.  I have the scars from the tragedies that have fallen in the duration, and the strengthening of those friendships as a result.  The beliefs I entered with are not the same as the ones I exited with.  That breathtaking naivety that you enter medical school and internship with, that you have to enter with otherwise you would never survive, replaced with a gravitas that comes from the things you have seen and a gentle patience for that breathtaking naivety in your juniors that you cultivate for as long as humanly possible.

How do I describe that life in which I had a baby, the one that came at the end of a rainbow, who irrevocably took my heart and put it outside of me in the form of fat little arms and legs?  Who slept while I studied and cried while I slept?  Who broke my heart with every 15 hour shift, endless weekend and evening teaching, and those single days off where I was torn between wanting to sleep so hard and being with her?

How do you put a decade into a single post?  I don’t think you can.

And here I am, in my final 15 hour shift as a basic physician trainee, in my last ever shift at this hospital that I’ve been at for 3 years, the hospital that broke me and reshaped me over and over.  The residents are buzzing about the wards, I’ve got some downtime after seeing some very sick patients.  That panic that used to consume me at arrest calls replaced with that sense of calm that comes with experience.  That knowledge that there’s always someone you can call, and the sense of achievement you get when you lose the fear of calling anyone!  I feel no fear about starting advanced training.  I should.  But after everything, god, after everything that has happened, I have no fear left.  I’m here to learn my craft.  I’m here because I want to be.

Right now I’m wrapping up my last ever med reg job.  I’m moving interstate.  I’m sorting out daycare.  Reading my orientation timetable.  And I’m saying goodbye to this wonderful state that has given me so very very much.  There are no better friends than the friends I have.  No better job.  No better husband and no better child.  I’m exhausted from a sick daycare petri dish baby, I’m not sure when I last washed my hair, and my husband and I haven’t had a moment alone since before she was born and my house would almost qualify as squalor but, here I am, okay with it all.

Through it all, like golden threads woven through my time, shine my incandescent friends with whom we have laughed and cried every step of the way.  Thankyou so very very much.

The perfect set of circumstances.

It’s December.  The sun is shining but I can’t feel it.  I live over the road from the sea but the water feels like it’s a million miles away.  My body feels a thousand years old and the baby has been asleep for no longer than an hour at a time over the last few days.  My exam notes are on the floor in a corner and I’m staring at the wall, asking my mother, through a veil of coffee-tinged fog, what craziness had entered my head that thought I could sit a five hour written examination with a newborn?  My mother shrugs and says “you can spend your whole life waiting for the perfect set of circumstances”.

And there it is, like lightning.

And here I am again, 3 weeks out from exam number 2, horribly horribly behind, with a small baby, the loving and long suffering husband, and us, just us, in our tiny place, with all our family interstate.  My colleagues put in hours and hours and I come home to see my little girl who gets a new superpower every day without me being there.  She is always happy to see me and my heart lives in various stages of broken.

I cry at work almost daily, mainly out of frustration.  Too many patients, not enough time, I don’t really know my colleagues, I have no little group.  They walk around the hospital in their study groups, diligently seeing cases.  I have no courage.  I present cases, I’m told things like “you need to work on your knowledge, your confidence, your face, your eyes, your words”.  I cry some more, and keep going.  The circumstances are far beyond ideal.  I’m incredibly close to failing.

And then I come home, to my loving and long suffering husband, to my smiling baby and my tiny apartment near the sea.  I talk to my friends via text because phonecalls in the evening are pointless with a baby and they cheer me on.  I think how lucky I am to have everything I have, exam or no exam.

I have the perfect set of circumstances.  Maybe not for a huge exam, but I’ll do my best.