Day of Reckoning

This is it: the result of four years of formal medical education all hinges on our performance in three hours this afternoon. The sixty or so of us taking the exam this afternoon get to the hospital and wait around the lobby to be called in. We are then herded into another room, wait some more. The room is humming with anxiety; some of us chit chat to distract ourselves while others flip through pages of notes. Psychogenic diuresis kicks in, we drink more water; the toilet is in constant demand. After an eternity, we are lead out of the holding room to our respective stations. At the sound of a buzzer, the exam is officially started.

Three hours later, the last buzzer is accompanied by a collective sigh of relieve from all of us. We stream out of the hospital, some recounting the points they failed to make, some swearing they will be blind drunk tonight. I am just happy the whole thing is over.

In the evening, I join my fellow classmates at the Royal Exchange Hotel, the local watering hole frequented by college students, for a night of celebrating the end of medical school and, for many people, to say good-bye to each other. Soon enough, we will all head our separate ways.

We greet each other by a hearty “Congratulations, Dr. [insert last name]!” and point out the novelty of being called doctors. When used in front of my name, it still sounds so oddly formal. With beers in hand and over the amped up guitars by a cover band, we talk about where we will be next year, what specialties we want to go into, and the possibilities the future might bring. The buzz goes late into the night.

We have done it! I have done it! It feels surreal – to not being a student anymore, to not having to worry about studying tomorrow, to finally have a job again.

One Day More...

Until this is all over! The big, end-of-medical-school-and-must-pass-to-graduate exam is spread out over today and tomorrow. Our class is split into four groups: Saturday morning, Saturday afternoon, Sunday morning, and Sunday afternoon. As always in this kind of situation, I have the misfortune of being allocated to the Sunday afternoon session, just to ensure that the agony of endless waiting is prolonged. The exam is the live, face-to-face type consisting of nine live stations in which we are given scenarios and are instructed to talk to or examine or device a management plan for the real or volunteer “fake” patients.

By now, half of the class has already finished their exams. I am sure they are all appropriately in an altered mental state, but continue to quaff large quantities of alcohol in various disguises which, for many, has been the one constant through the four years of medical school.

While those half of the class are blowing off steam and generally engaging in wanton revelry in ways that may potentially be career-enders should they wish to enter politics later in life, this half – well, me at least – is trying to use our psychic power to predict the questions and topics that will be on our exam tomorrow. They had a cardiovascular system examination station today? I think it might be respiratory or gastrointestinal system tomorrow. They had an O&G station consisting of contraception advice and placenta previa today? It could be pre-conception counseling and pre-term labor tomorrow. Today’s ophthalmology station had patients with glaucoma and retinitis pigmentosa? We’ll probably get a couple of patients with macula degeneration and diabetic retinopathy…

No more studying. I am as ready as I will ever get. It’s time for some sleep.

Turkey of a Day

Happy thanksgiving! Hope your turkey is delicious.

Because I’m not having any.

I’m getting used to doing nothing for Thanksgiving now. For one thing, in Australia, today is just the fourth Thursday of November and nothing more. Secondly, we have our big, end-of-medical-school-and-must-pass-to-graduate exam this coming weekend. Any holiday would have to take a back seat to studying. For the last few days, I have set up shop in the library with my study group, pounding the past exams. And today was no exception.

So I came back in the evening, cooked up some quick pasta, and called it a day.

Maybe I can do some kind of Thanksgiving dinner next year.

Ten for Ten

In the early afternoon, I walk out of the children’s hospital with the other student in the rotation, feeling tired but relieved. Now that the exam for pediatrics is behind us, what are we going to do?

First, a beer is essential. Then, I am just going to enjoy the sunny afternoon.

Next week is study week for the big exam: everything we have learned over the last four years will be fair game. The diploma is going to be hinged on whether we pass this exam. So, the pressure is on.

But for this afternoon, I’m not going to think about it. Maybe I’ll even go see that new Bond movie tonight.

All Studies and No Exercise

Ugh, I feel like my body is atrophying. This is the last week of the rotation, which means serious study time, which is encroaching on my exercise time. For a whole week now, the only exercise I have been getting is my bicycle commute to and from the hospital. At a measly seven kilometers roundtrip, the commute is long enough to make me break a sweat, but not long enough to make me feel like I got a workout from it. Well, it’s better that than nothing.

Halelujah

I guess I can say "Halelujah!" that it's almost the end of medical school. But this halelujah actually refers to one of my extracurricular activities - the Queensland Choir. We are singing Handel's Messiah this year and this is the final week of rehearsals. Last week, with my unlucky viral infection, my voice dropped an octave and I could only sing about two notes. Singing then would probably get me kicked out of the choir. So, with my voice recovering over the weekend, I feel like I should join the last two rehearsals before our concert at City Hall this coming Saturday.

This will be my final performance with the Queensland Choir. The Messiah is always fun to perform. It was one of the first concerts I had performed in during my undergraduate years with University Singers. In the following ten years or so, I had performed it with other groups a few times. The complexity and intricacy of the masterpiece makes it a challenge but also a joy to perform each time. And each time I gain a new appreciation for Handel's genius.

After this concert, the choir will break for the summer and next year, I will be far away from Brisbane. During the three years that I had been able to sing with the Choir, I had a lot of fun learning new music and making new friends. With no formal music education and not able to play any instrument, I can count on singing as the artistic complement to the scientific side of my life. Being able to sing with a dedicated group of enthusiastic singers and lose myself in the music is incredibly stress-relieving, even during rehearsals when we get yelled at by the conductor.

Halelujah!

Downed by Germy Kids

Everyone else on the pediatric rotation has been getting sick. It seems that whatever virus the sick kids have been coming into hospital with, it is now being passed around our group of med students. A few of my compatriots have already been feeling miserable as of late. Amidst the constant sniffling, I have luckily avoided getting hit - until last weekend. A hint of a sore throat on Friday brewed over the weekend and, by today, has become a full-blown case of viral upper respiratory tract infection. This has got to be the worst time to be sick. There are only two weeks until the end-of-rotation exam and then another week until the final exam. I really can't afford to be sick this close to two important exams. I know it's probably viral and I just have to let it run its course. If it's caused by what the kids have been spreading around, I should be feeling pretty sick these couple of days but I will be fine come exam time. Let's hope it's that and nothing worse.

A Historic Day

After lunch, I am on my way to the ward to find more information from a patient's chart for my case presentation when I decide to stop by the staff tea room for a cup of coffee. As I enter the room, I hear the TV on with sound at full volume. A couple of nurses are organizing charts while looking up occasionally at the TV. The local TV channel is carrying live coverage of the US election. I make my cup of coffee and see Barack Obama on the screen getting ready for a speech. At the bottom of the screen flashes the designation: "President-Elect." As he starts to speak, I sit down with apt attention and sip my coffee absentmindedly.

Earlier in the day, I looked up the election returns online whenever I could. As I watched one swing state after another going to Obama, first Pennsylvania, then Ohio, then Virginia and Florida were starting to look more and more blue, I became increasingly hopeful even though the results were only based on exit polls. It almost sounded too good to be true - what, no "too close to call", no outcries for recount? I wasn't going to get my hopes too high; I was almost anticipating that some of the swing states would turn yellow, and then we'd get bogged down in yet another round of law suits for recounts and countersuits to stop recounts. I was telling myself that I wouldn't be convinced until the official counts were confirmed. Now that McCain has made his congratulatory phone call to Obama, I am relieved that the drama that had followed the last two elections won't be repeated this time.

I watch as President-Elect Obama speaks in his trademark soaring oratorical style. I notice that my eyes grow moist as his infectiously hopeful speech goes on, his eloquence a stark contrast to what we have had to suffer through in the last eight years. Images of his elated supporters crying, singing, and celebrating flash on the screen. Obama's election has brought hope to me and to many people who feel the country is heading in the wrong direction. But this is only the beginning; we can't expect Obama to fix everything. The things that are going wrong in the US are beyond what any one person can do to fix. He is inheriting a country with its economy in the dumps, a health care system already running over the cliff, and the only thing constantly going up is the national debt. These problems won't be solved overnight, but I know the one thing Obama can do as soon as he takes office is to repair the United States' image internationally. To paraphrase a popular credit card commercial - one economic bailout package: $700 billion; fix the health care system: $50 gajillion, to have the United States regarded around the world as the beacon of freedom and democracy once again: priceless.

With Obama's speech over and the local station switching back to its regularly programming, I dab my eyes dry and start my way to the ward again. I walk out of the staff tea room with a slight spring to my steps; I, as an American, am standing taller today.

Burning Out

There is a recent article on the New York Times about medical students in the US feeling burned out and depressed that contains some alarming statistics: 11% of those surveyed have had suicidal thoughts from depression, almost half of medical students surveyed suffered from emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Among the factors cited are the constant lack of sleep, the pressure to excel, the hazing from senior students and residents, and having the firehose of information aimed at them non-stop. In the article, the author, an accomplished specialist herself, recounts her years in medical school when she felt miserable but unwilling to admit it because she did not want to admit to failure amidst the fierce competition among her fellow students. The article paints a picture of cut-throat competition and every-man-for-himself mentality in the US medical community.

After reading that article, I feel especially fortunate that I had decided to go to medical school in Australia. Now in the final month of medical school, I can say that I have not had any reason to feel burned out in the four years of medical school. Perhaps being a few years older than the average medical student has given me the emotional maturity to better deal with life's ups and downs, but if this article is an accurate reflection of the system in place in the US, I think my coping skills might have been pushed much closer to the limit there. Sure, the firehose of information has always been there, as was the pressure to excel, but to a much lesser degree because internship placements in Australia has nothing to do with one's rank in medical school. Any lack of sleep I have had was due to things unrelated to medical school; I don't remember any incidents of hazing by senior students and residents. In general, I never felt that I was alone in the course. Everyone I know has helped one another the whole time, whether it was to discuss the finer points of some intricate metabolic pathway or to lean on another's shoulder for emotional support. I would say camaraderie and cooperation are the better words to characterize the last four years.

I am not saying the medical school system in Australia is better than that in the US. The competitiveness of US medical schools is the impetus behind the constant innovation, for example. But for my own sanity and mental health, I am glad that I have been able to enjoy the relative tranquil four years in Australia.