Respect yourself, respect others.

My sister and I had an interesting discussion about what constituted assertiveness after I decided I needed assertiveness training. She’s a provisionally registered psychologist and knows something of these things. When she asked me what I thought assertiveness was, I told her her it was standing up for yourself in a polite and firm way, but she said no.

Assertiveness she told me, is respecting someone while respecting yourself. And ever since that conversation I’ve been trying to get my head around the concept. It assumes an equal power relationship. It gives you the right to an equal power relationship. And it’s a completely foreign concept to me. I’m sorry to say at some point along the line I’ve fallen into that awful way of binary thinking, the all or nothing approach. Either I have the power or you have the power – not you both have the power.

Since we had that conversation it’s like a lightbulb has switched on. The way I feel and interact with people has changed. And my need for validation is gone because I can give that to myself. Which brings me to my point.

My life is not public domain anymore. My thoughts and feelings belong to me and no one else, they do not need to be laid bare anymore because I’m a grownup, I can deal with them. It’s not to say I wont ask for help when I need it, because I’ve learned to do that too (a little more work in picking up the phone is required), but the time has come for me to have faith in the way that I do things.

The other part is that my medical education is not public domain anymore either. I know I can pass exams now. I know I have just as much right to be here as anyone, that I’m just as good. And now that I see patients on a regular basis, I can’t post about them unless I de-identify them to the point where I feel the value in the story is lost. And finally, most of you know me in real life or if you’re interstate, on Facebook.

This feels like the end of an era, something that started ten years ago and finishes here and now. I do feel like the Internet has saved me in so many ways, allowed me to develop connections with people in a time when I had none, allowed me to articulate the feelings I struggled so hard to put into words.

Part of me feels bad to leave you – but I write this because I respect you, and I leave this because I respect myself. Perhaps I’ll return after graduation, after a new set of challenges in the workplace present themselves, but for now (and I realise this is a growing tradition with med student blogs entering the clinical years!), it’s time to let my thoughts and feelings be their own again.

Thankyou all very, very much.

Not that person.

There’s an argument going on around the traps right now that interns should be allocated places based off exam results. This is inevitably from the high scoring crowd, those with past degrees relating to medicine or who spend every waking hour investing their self esteem in numbers.

And then there’s those of us who argue that exam results do not necessarily translate into good doctors. Everyone likes to do well – but when doing well comes at the expense of your work life balance, your relationships, your friendships, when suddenly all the surviving relationships you do have are on a superficial level – what happens when the day comes that you kill someone (and they say you’re not truly a doctor until this happens) and there’s no one around to listen to you? No amount of cleverly colouring in circles can help you with that. No amount of hours spent poring over books gives you the skills to deal in the workplace. You get factual knowledge yes, but that is all.

I’ll forgive you if you think my argument comes from being a low scoring student, scared about her place in the future. Nothing could be further from the truth. I just happen to have a touch more life experience than many people my age and I know how this goes. In my first degree I almost had straight HDs. Would have if not for some disastrous group work. I received certificates for getting the highest marks in three subjects. In one of those, I received the highest mark ever recorded for that subject. And I suppose that, if at the time you had of suggested that jobs be given out based on exam results, I would have been all over it.

But then came the workforce. My hours spent deliberating over the finer points of post-modern theory meant nothing. No one gave a shit that I could argue eloquently, that I was pretty damn good at 3D animation, and all that time spent on that imaging physics subject was useless. There was nothing in those high marks that reflected what my skills would be in the workplace. In fact the only use I got, was from the two subjects that weren’t as good because of the group work. The group conflict, for which my marks suffered, was the only inkling of what lay ahead.

I slowly and painfully learned the hard way. I might have had an HD for usability theory, but I got a big fat fail for Office Politics 101. And in spite of those amazing marks, I wasn’t any good in my first post-university job, because I simply lacked experience. And with that in mind, I would pick a consistently scoring credit average student with good relationships, living out of home, and some extra-curriculars over a top scoring kid who did nothing but study. I say this from experience. High marks in med school does not equate to being a good doctor, for the simple reason that med school exams do not reflect the work done. I get that people are proud of themselves when they do well, as they should be, but this is not licence for them to get everything they want, when they want.

As for me, well, I might not be the best of the best anymore, but I’m happy with my marks. I’m balanced – I have lovely friends, a wonderful fiance, and the best family in the world. I’ve had such a good time in med school, I’ve taken hold of the extra-curricular opportunities as they’ve arisen, and I would not trade that for top marks at the expense of all else, ever.

An uncomfortable in-between.

Once upon I knew my shit. I’d go into work, there’d be problems, I’d solve them. Once upon a time people asked me to help them. Once upon a time I was top of my class at university, got certificates for that, and generally got pretty used to being awesome, which of course I completely took for granted.

Never, ever, take being good at something for granted.

Enter medicine. I got pretty used to knowing nothing and needing everything explained to me. But now that I’ve been in this for three years, I know something, but it’s all still very preliminary baby steps, and at the same time, I am de-skilling in my old trade, and finding my knowledge completely obselete. And I don’t have the time to stay up to date, nor the need. It’s awkward. I feel completely mediocre at everything. I liked being awesome at something. It was a good feeling. That said, it took me at least five years to get awesome so I’ll go easy on myself.

This is one of the pitfalls of a career change where that change doesn’t build on the original choice. Med sci to medicine is a nice compliment. I know they say they are forgetting everything, but they speak the language and that’s a massive hurdle. I now speak the language – awkwardly. I still find myself searching about five seconds too long when asked a question. The answer is there but still not familiar. I long for the day when the answer comes in the correct syntax. Where I can speak this language fluently. I think next year will be my year for this, I really do. My goal for this year was more or less just to stay afloat which I have done, but now at the end, I want more.

But it’s the end of the year. I am burnt out. I am cereal in the fridge, keys in the freezer burnt out. And no matter how much I want to be good, I’m actually kind of crap thanks to my burnt out apathy. It’s taken me all day to open up Word to do my homework. Hours lost. So here I am at the end of a shockingly difficult year for many different reasons, burnt out, and spectacularly, shockingly mediocre at everything. Where once I was really good, where two years ago I was also really crap. It feels strange and uncomfortable, and I’d like a holiday now please.

On returning what doesn’t belong to you.

“How do you cope with the tidal wave of someone elses emotions?” I ask.
The psych reg looks at me sharply.
“What do you mean?”
“That manic patient right now” I say, “I felt worse and worse and worse and then when he felt better I felt better – how do you control it? How do you block their feelings out?”
“It’s not something that happens to most people.” she says slowly.
I’m feeling crazier by the minute, and explain that I find it overwhelming, especially in psych patients.
“Then,” she replies, “you are far more attuned to peoples emotions than most med students. I don’t believe in magic, but there is some instinct there, and somewhere along the way you’ve become very very good at reading people. And you can use that. If you’re talking to a patient and begin to feel those overwhelming emotions, say for example, sadness, you can ask them if they feel sad today. And you’re likely to get a yes.”
We talk more, more on projection, transference, counter-transference. She stresses again that not many people can pick up emotions like this. I ask her again how I can switch it off, but you can’t. You can only use it to your advantage, once you can identify that those feelings don’t belong to you.

And looking back, so much of my behaviour is influenced by emotions that often I can’t understand why they’re there. Now I do. They’re not mine. They’re of everyone around me. I don’t know how I came to be this way but when she said that it struck a cord. I’m an introvert for a bloody good reason. Social gatherings are just way too much data. Sometimes I can handle it, sometimes not. And I wish upon wish I wasn’t like this. I never understood why being around people never seemed to bother most people that much. I always assumed everyone could pick up on emotion and was frequently confused when people displayed astounding lack of insight or empathy into others. Once again I’m the abnormal one. It explains why I get tired so fast, why I’m always trying to escape and get home to where there are no people.

Not very helpful for medicinie. Very good for me to know about it though, much as I wish I was a normal unfeeling, disaffected sort of person. I’m not really comfortable with the idea of realising other peoples emotions and using it to my advantage either. My psych rotation is making me feel quite uncomfortable about a lot of things. I realise I’m very guilty of projection too – in that I don’t feel safe enough to talk openly about how angry I’ve been, so I’ve communicated that in ways that have made others angry on my behalf. I don’t like that and now that I know it has a name, I can stop it.

I can’t really talk about the rotation too much because confidentiality is of utmost importance in mental health. But it’s doing wonders for me. I’m crystallising my own personality better than ever before, and being empowered by all these wonderful words they use to describe behaviour. And I’m returning peoples emotions to them. They’re not mine. It feels wonderful to know that, and be able to give them back. It’s good to know I can perhaps recognise when they’re not mine, and be less affected, less tired by people. And suddenly feelings I’ve had around people in the past have made me realise so much about those people too, and explained them for me. It’s exciting. I couldn’t be a psychiatrist for the reason I’ve just talked about, but I’m really glad I’m doing this as a rotation.

On moving forward.

This year highlighted to me some changes I need to make. I need to ask for what I want. I need to say what I don’t want. I need to stop hanging back and waiting for someone to show me the way. I need to be, dare I say it, proactive (are you playing corporate buzzword bingo yet?)

I need to use the phone and stop relying on email. I was talking my fledgling psychologist sister about all this, and she was saying that on some level, there is still some core belief somewhere that says what I have to say is not valid. It’s hard to reconcile because I feel pretty good about myself these days. But she’s right – somewhere in there something is still a bit broken and I can’t quite get to what it is.

My psych rotation is helping in a way – it’s teaching me to name things. And it’s showing me illness. I know you’re supposed to say mental illness – but when talking about a sick person do you say cardiac illness? Neurological illness? No. You say they’re sick and they’re in hospital. And the people I’ve seen are so very, very unwell and they can be treated. I don’t like how mental illness has been separated out as something different from medicine. The wildly confused man I saw who truly believed everything he saw, who hadn’t eaten for days, who stood in the sun for hours unable to feel the heat….that is ill. I hope he’s alright. He was violent and angry and confused but so lost. The fear in his eyes was there, he was so frightened by all that he saw. But I digress.

I keep dropping the ball. I never study as much as I want to. The house is never clean. I look like a hobo half the time. I can’t keep up with my extracurricular stuff, honours, the society and all that entails. And there’s a wedding in there. I find myself beating myself up for not being on top of it all l but I think it all is just a bit too much. Next year there’ll be no wedding but there’ll be a long case and another barrier. I wanted to work on our yearbook but I’m really thinking of not doing it now. Sometimes you just wish someone could sit you down and say, this is how things work, and I’ll start you off so you know how to continue.

But even that wish goes back to that core belief. I’m struggling to even exercise of late. I feel frozen in headlights. I feel unable to do any of the things I really need to be doing.

I hate this shit. I’d love to be well adjusted with a solid sense of self and the confidence required for the unknown.

For Christmas please?

Two minds.

I’m in two minds over whether I should delete my previous post. For all of it’s whining, most of the time now that’s not me. I have these blinding moments of self-doubt but they are becoming so much fewer as I get through medicine. And I realised too that when you walk away from a conversation feeling that way, perhaps the others are feeling that way to some degree and if there’s one thing I’ve learned, it’s never to take on another persons negativity as your own. This was most evident in my first grad job – I walked into a very unhappy workplace with little experience of such things and rapidly started bitching with the rest of them, even though initially the stuff they were complaining about didn’t faze me at all. I’m glad I’ve learned that lesson prior to entering the hospital system because that is going to be the mother of alll tests in that regard. Resilience of personality is something I’m still working on. I hate disagreeing with people, I hate proving them wrong, I hate that they feel bad because of it. I’ve at least graduated from silence to diplomacy.

I also realised that yesterdays post was not me at around 3am this morning on my 7th or so trip to the bathroom thanks to a completely inexplicable bout of gastro which had me throwing up all night. Fortunately it stopped a couple of times after my stomach was completely empty – nothing worse than continuous hurling of an empty stomach. This realisation came after I had leaned back against the cold wall, shaking and red faced. I almost laughed. I probably would have if my stomach had let me. Nothing brings you back to reality like how bloody horrible you feel when you have gastro. Really, everything is fine. Everything is fine except I’ve been exhausted by this year and need to take some time and do things really slowly.

Next week however, I would like no illness at all. I think I’ve learned my lesson, even if it did take three weeks.

Mute.

I haven’t felt like talking much of late. My psychiatry rotation started a week ago and while interesting, doesn’t hold me. Usually I spend the first two weeks of a rotation in a magical daze, convinced this is what I’ll do – psych did that for me for about ten minutes. I saw an overdose followed by Narcan (the heroin overdose reverser) this week. The patient nearly died. Someone mentioned to me that must have been pretty confronting but strangely it wasn’t. O&G tore me to pieces, that didn’t. I’ve been in similar situations with friends before I guess, a long time ago now (and don’t worry, it was never me – I was always doing the rescuing – as much as a lay person can), but it wasn’t totally unfamiliar. It’s becoming increasingly clear to me though that the familiar worlds in medicine are the ones I’m pulling away from.

A consultant told me off on my second day and demanded to know who my lecturers were because I couldn’t name the mechanisms of action of the alcohol craving suppressant drugs. I politely told her it was my second day and that the lectures we’d received were only introductory but she kept going on about it, shaking her head, that old I can’t believe you don’t know that chestnut. And while I feel quite justified in my lack of knowledge on the subject, I just can’t quite shake that niggling feeling of “you don’t know enough, you should know more, one day everyone is going to see you for the big lazy impostor that you are”.

In my head I know that’s incorrect. Serp tells me I work my arse off – but it never seems enough. I feel so different to most of my cohort and it can get lonely. I watch them systematically work through things, study for defined hours – they are so stable. When I talk of my life with my friends at uni, the stories of theirs they share by comparison seem so straightforward, balanced and structured. And of course suddenly I miss what I’ve never had, I wonder if the job I’ve done teaching myself all this is really any good, that perhaps it’s like ballet, you’re only good at it if you’ve had it from a young age.

I know that’s not true. And I’m tired of these feelings of doubt. I’m 30, not 3, and it’s up to me to build these things into my life. And I have to learn it anyway, for my children’s (should I have any) sake. Sometimes it’s hard to sit there and watch them talk about parents, homework help, fathers coming home at the same time every night, tutors, dinner at the same time. A family table. But spare me the “look how far you’ve come without it” speech – this isn’t about my achievements or what I’ve missed out on. This is about me really badly needing to let those feelings go. I don’t want or need to feel like that. It doesn’t help me to think I can’t be as good as them because of my upbringing. I’m a fighter, I know that much.

I’m beginning to crave structure, organisation, regular study times – yet I vary so wildly in how I feel from day to day that my best laid plans…well you know how that line goes. But we know about the road to hell too. Perhaps it’s just baby steps as always. This self-doubt doesn’t belong to me. It’s not mine and I don’t have to keep it for that reason. And if I can quit smoking I can sure as hell quit self-doubt (frankly if you can quit smoking you can quit anything.)

None of this has a damn thing to do with that consultant. I know she was wrong (and abusing the power relationship). I just need to ditch this habit, kill this monkey on my back, and step forward with the rest of them in the knowledge that I’m just as good as anyone else.

Lessons learned.

Decide.  Decide if it’s money you want, or time.  And then regret whichever one you choose because each comes with it’s own challenges.  To save money, I decided to make my own wedding invitations, but I lost so much time!  Would I prefer to lose money?  I don’t know.  It was a huge learning curve, and took me right back to my days in design and media coordination.  And it reminded me why I left – the epic frustration.  At any rate they’re all down now.  And I learned some valuable lessons which I thought I’d post here in case anyone who reads this is ever remotely interested in making cards of any kind.

1. Wear gloves.
2. Guillotines go blunt.
3. Score the card before folding it.
4. Use an awl to poke a hole in the card before inserting a stud.
5. Wear gloves.
6. Don’t let a paper store tell you that inkjets wont print onto metallic paper – they will, but you need to use matt or inkjet fixative spray to stop it smudging every time you touch it.  Do this in a well ventilated area, not your one bedroom flat.
7. Buy extra paper.  I bought extra and still ran out.  After all, guillotines do go blunt!

Onwards.

I passed.  Being deemed ’satisfactory’ feels pretty good.  We don’t learn how we went for a while but it’s just nice to know I’m through.  I really hope I’m not sitting on the borderline, that would really suck, but even if I am, it’s a year to the next barrier and I really learned how to learn this year, far better than in the previous ones.  I’m learning how to gauge my own knowledge too.

A guy at the beginning of the year challenged us to summarise Davidson’s, a sort of bible of every disease.  I tried at the beginning of the year and got too bogged down in detail before giving up.  For the first time in med I have some resolutions.  These are borne out of me wanting to be really good at my job.  I don’t want to get the top marks, or be some kind of gunner, I just want to know my shit.  I know that’s a process that takes a lifetime, but why not start now?  I also made a promise to lose the inferiority complex if I passed this one.  So for my final year of medicine, here are my resolutions

1. Summarise, or at least read, Davidsons from start to finish.
2. Ditto Essential Surgery.
3. Lots of long cases and reading of the two long case books I like.
4. Do all the UNSW vivas (now that I have them).
5. Lose the inferiority complex – it’s held me back for way too long.
6. Do a study plan once I get my timetable, every rotation.  This really worked for me in O&G.

I know that sounds heavy and hopeful, but I have a year to do this, and it will comprise the majority of my non-rotation specific study anyway.  That same person that told us to summarise Davidsons also said to stick to one text – that’s been part of my problem, and one I’m happy to fix now.

Phew.

Man…

Food sure tastes good today.