| Julian's profileLunasaBlogLists |  Tools  Help |
|
LunasaNovember 21 "real" Osces (RMH, exam 3)November 14 Long Case (St V's, exam 2) - lessons for a careerX = X' again. Today was wonderfully satisfying. I went into the exam calmly despite a poor night's sleep and little revision. I basically had a similar case to my sem 8-9 long case, bowel cancer. The patient was quite interesting, I can't hint at his identity for privacy reasons but definitely an interesting character with an interesting name. He mistook me for a man all the way through, asked me how old I was and thought I looked a few years younger than that, and then asked where I lived (ok too familiar). When I said I will take about 1 hour to talk to him, he said with a dramatic sighing plea, "I'm a sick man, I can't do one hour"...in fact he continue to talk quite enthusiastically in tangents about his life. He wasn't the best of historians but I got enough out of him. Impressive signs! I love heart murmurs. The lifts at St V's are so slow, took 5 min waiting for one and 20 min late for presenting, the shepherd having been stuck in a lift that morning for 40 min (she was glad there was no nervous med student with her haha).
I presented the case to two GPs, great combo cos they asked easy questions and were patient in waiting for the answers (greatest of all). One of them kept frowning at me but I didn't feel it get to me at all as I had expected it might, too engrossed in my presentation I was. The template I used was the one I forged for the RMH presentation, which they let me write headings for before I saw the patient, but then took all notes off me after I finished (legitimate move but I wonder if the St V's clinical dean doesn't sift through those from other schools for tips for their own students...I knocked off your manilla folder technique with my poor-man's version of an A3 sheet of reflex paper, ha!, but definitelly a good idea). My proforma worked a treat for me, and had I not practiced the long case that time at RMH, I would not have done as well today, I would have fallen apart actually with this patient.
I satisfactorially presented everything, missing a few minor things on the main system (e.g. negatives for organomegaly and masses, which would be relevant given the case), that was probably minor, and I talked very well with the questions. Not good to dwell on the minor negatives, but I thought I'd share this and record a lesson learned today for my own reminder. The questions are, exactly as our RMH teachers constantly remind of us, a conversation between colleagues. I was asked whether I thought a lesion was on the right or the left side. In my mind I saw the picture of the organ in question and the lesion, knew the answer and described my reasons fully, but then said "right" when I meant to say "left", and didn't realise at the time cos stress basically makes one "decerebrate". Then one of the examiners asked me if I was sure it is the "right" side. I started to think for a moment, but not really thinking enough, just the motions of "yes I should think for a moment", and then said "because of...(repeat my evidence as before), I'm sure it's the right side", then she stopped asking and moved on. Had I taken more time and care, I would have considered the evidence more, and reviewed my steps (e.g. it was obvious that the scars being on the left side gave more away in addition to my evidence in functional anatomy and surgical knowledge), and I would have checked my pronounciation of left and right. No detail is too small for any occasion for there is nothing so big as to not be made up of fine detail. Very important to be sure of left and right if I want to be a surgeon huh?
 This wasn't the first time I answered reflexively from the wrong motivation, but it is the first time I realised where I was going wrong. Now let's think about this for a while, what was going through my head when I did that. I was puzzled that the examiner, someone who I viewed would know what I was describing very well and was listening carefully to what I said, would ask me the same question again. That led to me thinking "this is one of those "trick" questions to test my confidence in my knowledge and logic and thinking. So my action? Stick to my guns and say the same things again, because I was sure of my knowledge (though I do think in pictures all the time yet sometimes without a conducting circuit to my verbal center, kinda like conductive aphasia or 3rd degree heart block, brain damaged I am). The main problem though, and the main lesson here, is attitude (i.e. angle of perception and reason for action). My mum just reinforced this gently, that it is rare that the examiner (yes even with the false horrid image we assign to them) would question your judgement in order to trick you with a view to expose potential ignorance. (And there ain't nothing wrong with ignorance or uncertainty my soon-to-do-very-important-things friends.)
What actually happened in that room was two doctors were having a conversation with another soon-to-be colleague, treating me as a colleague, and gently asked a question on a finding I made that they found inconsistent/questionable, without actually questioning my integrity as a doctor. Instead of being part of the team batting for the patient, taking a step back and think/recheck every step in the calculation and expression, I went onto autopilot and handled the situation as if it was a test of my integrity in my efforts of knowledge acquisition. But if it were a test of integrity, I would have failed (and indeed I did) with that defensive attitude. So, in future, for the good of the patient, I will take a humble breath, shift the focus off me and value my colleague's doubts with objectivity - even if they ask it less nicely than today; even if they come from someone below my rank where I may be tempted to presume inferior knowledge; or even if they are from someone of higher rank, from whom I may assume a question with a known answer is tantamount to an integrity-challenge in disguise and be tempted to treat it with return-fire). It's all for the safety of the patient's well-being and the integrity of my profession.
The contrasting scenario may be that in future I come across a patient where I have no idea of diagnosis or even findings, and be asked a question where there was no way I would have known the answer, where the questioner knew that fact and that it was unreasonable to ask that question of me with expectation of me being able to answer - in that situation, the only truthful thing and just thing to do is to admit ignorance, for there knowlege of ignorance is worth a lifetime of lies. And a healthy amount of doubt and humble consider that lead to positive action never hurts.
November 13 FEU Clinical Osces (Day 1)Of 5 years of going to the same place for osces and assessments in general for my lifetime, I have not walked into an osce with so low a level of anxiety and heart-rate before. I'm pleased to have finally (and firstly) acquired this calm for an exam, which I had been training myself to, however, whether I actually performed well is yet to be shown. I certainly did not prepare for this set of exams as pressingly/desperately as I have for the past. I've been distracted during the revision period, emotionally and geographically wrestled with for the semester, and can claim legitimate identity confusion from a number of transitions. However, the semester has been filled with great moments of learning and realisation, leading to willingness to step into roles and positions previously reluctantly touched and dodged. (X = X' is what's actually tested here I think). Today, I flew entirely on my own knowledge gleaned over the experience of 6 years rather than any study I have done in the last few days, yet I did _learn_ in the way I wanted to learn in the last few days (also a new-found achievement). I was surprised that I remember how to do a pap smear (despite realising how I must have done a few steps imperfectly), experience from the Women's semester where I pushed myself with enthusiasm despite the lack of incentive. I'm quietly pleased with what's happening, just hope I pass. Achieving old goals I had given up hope on in the face of repeatedly being thwarted - it's rather satisfying, there's a degree in that in my degree I think. ;)
Another realisation....I'm a person who take strength in doubting, as doubt is an action that has served me well in finding out things that no-one else sees or one does not see at first glance and that which people try to hide or deny, seeing into the hearts of things and people, seeing what I thought was the truth. However, recently a friend told me to "love myself", possibly cos of my pre-exam cries of hopelessness, and got me thinking. In combination with the senseless attacks the feral kids on my street continue to hurl at my family and my anger towards such unchecked behaviour and the lack of community action against it, and also in combination with a recent episode of Dr Phil on bullying where he encouraged the bullied to find something that they feel good doing, that which no-one can take away their self-esteem from, I'm starting to do just that - love myself, seeing all that I have failed or refuse to acknowledge out of shame, regret or denial, under the guise of being modest. It's hard to find truth sometimes, but truth is not necessarily what people tried to hide (needing probing), it could also be the things that we fail to acknowledge (which we just need to see and say they exist).
I give myself too little credit. Why is it that I can't except a complement from people who are honestly giving it and has nothing to gain from lying? Why is it that I find it hard to not look away when someone's gaze fall on to mine? Why is it that I continue to insist that I know nothing, when I can give reasonable answers consistently most of the time and am reassured of my adequacy from legitimate critics? It's all inconsistent and forged from years of what Dr. Gijespers phrased as self-"shame and blame - a poor motivator". I can spend the rest of my life looking for external sources of this phenomenon, but the reality is that I am the one who permit it and encourage it to continue (regardless of who kindled it) and I am the one with the power to look for a better motivating mentality.
In a word, I think I'm onto something. November 12 Changing the subjectThe Chooser
The choosing of a subject
To the chooser a dilemma doth bring.
Once chosen, alone in option he becomes,
Needing to make good on way of his own choosing;
For if we perish, satisfied are we to look beyond for the doing,
Yet the chooser has been his own noose-maker and executioner, in one body for the dwelling.
Ugh! I got to stop writing stuff that has death in it....
November 11 A Poem - no idea why this image pops into my head at this timeThe Falling
I woke up at the bottom of a pool,
Eyes open to rippling blue and sunshine.
So calm and peaceful the morning, nobody awake,
Nobody can find me nor ask things of me.
The figure of a beautiful woman appeared on the roof-top,
Back-stepping carefully to the edge, stood there a while.
Soft, golden hair floats on strong shoulders,
Caressed by loving tenderness of soft breeze,
Reluctantly let go to fall on her smooth back.
Lady of mystery turns her head.
Seeing me, she smiles,
Lip-corners dancing, eyes glistening through water.
Why so high? Is the board set by others' expectations not conquest enough?
Withdrawing her gaze came her reply.
She opened her arms - invitation to challengers I cannot see.
I imagine her face: she closes her eyes and draws breath deeply;
Then, lets herself fall.
Her beautiful body enlarging in slow motion in my vision
Until it filled all that I could see.
A moment less for silence, her weight came crashing onto my chest,
Crushing my body, as I break into pieces for her.
Her golden curls, now caressed by turbulant water,
Wrap their hold around my face, pulling it towards hers
Into a kiss.
What means you by this sweet lady?
She opens her eyes,
Flames hotly dancing inside of them,
That which water cannot quench.
My heart races, and tries to push her away.
Our pair of bodies struggle as one in the water -
One to merge, one to part.
In the grips of her embrassing arms and tangles of hair
I am entrapped.
Smothered in one kiss,
Oh, how long doth a single breath last!
My fragmented body begins to disperse piece-wise like drowning tiles.
Into my form she sinks - her body into my shell.
Doth thou likest me so much for the taking?
Yes, came her answer finally, 'ere the last dispossession of my hearing.
She has everything now,
And, now, my fragmented tiles caress and dance around her.
Waves settle and people see.
DreamAnxiety must make dreams increase in activity and darker in content. I woke up from a terrifying dream...not the most terrifying and rather recurrent theme. I'm in my room/my house, but of a different architecture because there's a window from my room to the next room in this dream, which there isn't in real life, and there's no house in the back where there is in real life. I'm alone in my house at night, guarding it, (And I'm convinced that "there is never enough sticks or a strong enough lock" so I have about 3 sticks as weapons). It's dusk, and I lock all the doors and windows, as I am in my own room, I see through the communicating window someone intrude through the next room. I lunge at my bedroom door and push my back against the door and my feet abbutting the bookshelf to keep up the strength, stick in hand, terrified. Then I woke up and couldn't not get back to sleep cos I was aching all over (probably from acting out this fight in someway). 90% of my dreams these days tend to be me fighting or running away from someone chasing me to avert danger, when I was young I enjoyed my dreams because they were themed on me exploring new places and feeling rather safe in the wandering. I want those back.
Oh, and I hypnotised myself before going to sleep, trying to get obsessions out of my head, but fell asleep before I gave any instruction....kinda dumb. |
|||||
|
|
