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Dispatch Eleven: Thoughts on Education

 “The mind is not a vessel to be filled, but a fire to be kindled.” ― Plutarch

It will not surprise someone to find - as I enter my 20th year of formal education - that I believe that education is one of the most vital, beautiful constructs of humanity. 

A wise man once said to be “if you wish to teach someone how to build a boat, don’t teach them about navigation, tidal currents, port vs stern, how to unfurl a sail or bang timbers together ... just teach them to long for the endless immensity of the ocean”.  The take-home message?  When you find what you love, you go the extra mile and what others would consider madness, you consider love. 

I love anatomy. I love neurology. I love people. And so, 20 years of education to me is not a vice, its a profound virtue and privilege.  One I am very happy, and proud, to be undertaking. 

“Study without desire spoils the memory, and it retains nothing that it takes in.” ― Leonardo da Vinci

Now its a fool’s game to try and place a precise quantitative value on education. But despite historic graduation rates, and the relative fall in wages/rise in cost of living, the best ticket of social mobility and the best determinant of earnings continues to be education.  The more you learn, the more you earn as they say. Now we can argue about whether those driven to get a PhD are therefore more likely to push for higher wages, which comes first?  Its a chicken vs egg argument, but its undeniable that a rigorous course - even non-vocational - instils tough hours, time management, problem solving, cerebral system two thinking unsurpassed in many - and most - disciplines. Higher graduates are very highly sought after. They are proven quick learners, hard workers and get the task done in an organised way. 

Take out that globe...and give it a spin. I challenge you to land on a region where education gains aren't translating to productivity and income gains. The highest-income countries have the highest rates of enrollment in secondary school and the smallest share of informal employment that is vulnerable to an economic downturn. There is a cost to not educating young people. The evidence is literally all around us.

Derek Thompson

But lets take those easy-to-gauge monetary values further.  Millenials with degrees are less likely to be in poverty than those with GCSE-level qualifications.  They are less likely to report that their “job is just a 9-5 to pay the bills” and more likely to report real meaning in their work and the pursuit of long-term goal behaviour in there career.   And whilst its undeniable that the value of a degree has monetarily fallen at the start of a career (graduate salaries have been flat for some years), the relative decline in wages to be claimed are significantly worse off at GCSE-level applicants. 

This TED talk from a few years ago is a brilliant example of education beyond the numbers. Education teaches you a developed, critical, systematic approach to acquisition of information, how to process that in a cognitively non-biased way and then come to a conclusion to maximise utility, morality and put in place the best approach/rules to do the most good for the most people. 

Education is a tool that affords a broader outlook on life, a deeper understanding into the patterns of the past, to the behaviour of ourselves and others, to the ticking of the biological clock, to the atoms of the universe, the great challenging works of humanity, the breathtaking architecture of the world and languages to converse with many types of people.  Education broadens you. 

So you made a good choice coming to University.  Use this privilege well. 

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Dispatch Ten: Books I’m Reading

The Water Dancer - Ta-Nehisi Coates

“Bored whites were barbarian whites. While they played at aristocrats, we were their well-appointed and stoic attendants. But when they tired of dignity, the bottom fell out. New games were anointed and we were but pieces on the board. It was terrifying. There was no limit to what they might do at this end of the tether, nor what my father would allow them to do.”

I am seriously enjoying this book.  Penned by Coates who is a prolific and brilliant essayist (see his famous piece defending reparations for slavery which has rekindled this conversation into the mainstream political discourse and forced several Democratic frontrunners for President to come out in favour), The Water Dancer is about an enslaved boy with a near-perfect memory save for his mother. Oh and he can teleport. He becomes vital for the Underground, but in order to harness his powers, he must reconcile himself with his maternal trauma: an interesting metaphor of looking “truth in the face” - something we must all do in order to become the best we can be - examine ourselves warts and all! 

There are so many lessons in life to draw from this, whether the inherent racism still prevalent in the world today, to abject poverty, to the simple normalcy of the slavers (termed Quality in this novel) - in short, environment and culture dramatically shape a person and, unchecked, humans can be capable of immense evil. Coates reminds us that any one of us could have been a slaver or a slave were we born in those times - there are no real moral absolutes, just relatively and beliefs of time. Just as we “grew out of” slavery, so too can we lapse into abhorrent slights of moral judgement. Something to bare in mind in the formative years of university as we enter a melting pot of many, many cultures and beliefs. A wonderful chance to challenge intrinsic in-out tribal mentality and broaden our horizons. 

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Dispatch Nine: “In Five Years Time ...”

Well first, this takes me back to a catchy Noah and the Whale song. 

But I assume thats not the point of the dispatch today - ha! 

Speculation about the future is a fickle thing.  

On the one hand, the fabulous Eleanor Roosevelt had a point: 

“The future belongs to those who believe in the beauty of their dreams.” 

Of course it makes total sense that “without a goal, and the passion to pursue that goal, you cannot score”. Without this, success is incidental, a fortunate chance encounter. 

But equally so, a key root of human suffering is depression about past mistakes, and anxiety through speculation on the myriad future options.  Drawn quite readily from the teachings of Buddha, author John Green wrote this: 

“You spend your whole life stuck in the labyrinth, thinking about how you'll escape one day, and how awesome it will be, and imagining that future keeps you going, but you never do it. You just use the future to escape the present.”

And one more quote, summed up wonderfully by a certain Kung Fu Panda character Master Oogway:

You are too concerned about what was and what will be. There is a saying: yesterday is history, tomorrow is a mystery, but today is a gift. That is why it is called the "present.” 

Now, I admit, its not often I draw divine inspiration from an animated ageing tortoise, but boy did he make a good point.

I could say to you “oh I plan to be a junior doctor, with a great booming website of MCQs, a podcast, a rippling six-pack and money worries long discarded.  But I just don’t know.  

What I want, broadly speaking, is good health, good friends and a fulfilling job with traction that is drawing me closer to the neurologist I want to be.  

The question isn't “oh my word, why am I not there yet?”.  Rather it is a case of No More Zero days. 

Huh?

Well, no more days where I don’t do something for this goal.  That can be anything from reading a page on neuroanatomy, editing some questions on my website or meeting a friend for coffee.  And the latter is just as important as the former.  Without strong mental health and social connections, how can I nourish my body/mind sufficiently to have the resilience to become an awesome doctor?

Be present to the future, but not at the expense of the presence.  Its all we ever have - a series of succeeding presents. 

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Dispatch Eight: Healthy University Habits

To all returning and new Warwick students - Welcome (back?) to Campus!

I want to talk today about a few important things I’ve been working on to optimise my time and happiness here in Cov.   I call these things the “5 S’s”.  

Stasis

It is SO easy to get stuck in your dorm room.  First you sleep there, then you eat there, you socialise, Netflix, study, pre’s and relax there.  That duvet is a burrito.  A burrito that you should probably send to laundry a little more … am I right?

But bad news.  It may be cosy and warm … but its really a TRAP.  

If the priorities of that space become entangled, then the use of that space for each is diminished.  A room associated with all the above is not a haven for sleep, it isn’t a restful retreat with friends and it may seriously affect your health.  

Go to the library, coffee shop (don’t let anyone tell you there aren’t a tonne of places on campus to relax and study beyond the library, there are some real gems!), meet friends in the park or spread the “load” of room time - it seems churlish, but “room hygiene” is vital for a compartmentalised life.

Sleep and Screens

Following on from this, one of the most effective mood boosters, concentration drivers and mental health wellbeing tools is 7-8hr sleep.  I know you’ll be clubbing, bingeing Rick and Morty, but more often than not observe good sleep hygiene.  What does this mean?  Charge your phone in another room/end of the room, bed at a set time (and be strict), kick out people when you need to look after yourself and try to limit time in sleep space when you’re not going to bed!  You’ll only be swiping insta stories under the duvet for an hour as your brain moans “just let me zzzz”

Slow Down and Focus on the Now

Keeping your environment itemised and your sleep regimen strict are major boosts to your mental health.  What does this allow?  Better concentration in class, better energy to have fun, more awareness of the fun when its happening.  You're more likely to rise early and hit books/the gym if you have a good sleep pattern.  You’re more likely to be energised in the kitchen to avoid another cheeky Dominoes.  

SMART

We’ve all seen some glossy mag talk “SMART goals” aka specific, measureable, attainable, relevant and time-sensitive.  Try jotting down a few goals you want to achieve in the next week, month, year and see how you can make them SMART.  These goals, when categorised with a clear path, are more motivated for and more likely to be achieved.

Finally just make sure that the biggest driver of your success at university is a resilient self.  All of the above makes you more resilient, but you have to want it. You have to push for it.

Welcome to the Warwick Family - you’re going to do great :D

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Dispatch Seven: Explain a Fear

When you start a degree, moving away from home for probably the first time, there is an avalanche of newness and challenge. It is quite common that when your parents, friends or significant other drop you off in halls and the door closes for the first time you get a sense of Prisoner Syndrome.  The walls close in, this is too much change, too rapidly. 

You want to socialise, but you’re also tired from overstimulation of the newness.  You want to just lie down in bed, but the mattress is bare and you haven't unpacked anything.  Or maybe you want to just jump up and knock on the door of your neighbour, but they’re still staring at the unsheathed mattress, wondering how exactly they are going to do laundry and study for a degree in something. 

Change, especially those first few hours/days, can really be something.  We don’t tend to trust or like change as adults. We want comfort and a known quantity. Its more predictable, less scary.   We are told “life begins at the end of your comfort zone”, but almost all life is familiarity: same car, same route, same job, same friends, same home.  Now you have no friends here, have to budget seriously (probably) for the first time in your life, have to cook for yourself, have to study something at a higher intellectual level than ever before and all in a city you probably haven't explored too much. 

So what do you do about this?

The answer is complex, and certainly not the same for everyone: 

First, what you are feeling is absolutely fine. You can feel anything you want to feel. Take a moment to sit with a closed door and think about how you're feeling. Are you homesick?  Excited?  Confused?  A mix of all the above and more?  Great: you’re human. 

Second, can you make this space of yours comfortable quickly: is there a shop around the corner where you can get some staples: a pizza for tonight, some milk and tea bags - do you have a cup?   Make your bed first. Its a snug place to sit and you can always just put on some YouTube for free on your laptop if you need some familiarity. 

Third, sociability. Even the most introverted person in the world needs social intimacy on the regular. Isolation is considered torture, and loneliness is a big cause of depression, anxiety and death in the elderly.  We all need human connection.  So shyness, whilst common, cannot be allowed to rule here.  You need to accept a degree of social anxiety - certainly don’t beat yourself up for it - but move past that. 

A few nice ideas: 

- get a bottle of cheap wine to share with your housemates

- keep your dorm bedroom door open (prop it open with a wedge or a chair) so people know they can see you 

- put some music on - just the charts on Spotify 

- sweets, go get some and share them out 

- introduce yourself to friends 

- try saying “yes” to things. I know that just doing things that might make you uncomfortable can suck, but equally there are many things at university that are so foreign to what you've done before.  If you never try, you simply will never know.  Our unknown unknowns are some of the most dangerous, and critically missed, opportunities. 

Fourth, patience.  We have all been there, it gets better.  There are likely tens of thousands of people at this university. Tens of thousands of potential future friends.  There will be a myriad of societies so that even if you don’t find a housemate to watch your favourite Netflix show together, you will find a society full of like minded peeps. Theres everything from politics, archery, BME, medical, charity, comedy, photography ... the list goes on and on.  You will find friends.  But only if you do go looking for them.  Allow yourself the luxury of time. The societies will be there when you are ready. 

So there’s a fear.   Social isolation and newness. 

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Dispatch Six: Favourite Songs

Aretha Franklin - Chain of Fools 

One of these mornings The chain is gonna break But up until the day I'm gonna take all I can take, oh hey

The Beatles - In My Life

There are places I'll remember All my life, though some have changed Some forever, not for better Some have gone, and some remain All these places had their moments With lovers and friends, I still can recall Some are dead, and some are living In my life, I've loved them all

John Lennon - Mind Games

So keep on playing those mind games together Faith in the future, out of the now You just can't beat on those mind guerillas Absolute elsewhere, in the stones of your mind

Nina Simone - Aint Got No, I Got Life

I've got life, I've got my freedom I've got life I've got the life And I'm going to keep it I've got the life

Bon Iver - I Can’t Make You Love Me (a very specific cover version)

Turn down the lights Turn down the bed Turn down these voices inside my head Lay down with me Tell me no lies Just hold me close, don't patronize Don't patronize me

Billy Joel - My Life

I never said you had to offer me a second chance I never said I was a victim of circumstance I still belong Don't get me wrong And you can speak your mind But not on my time

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Dispatch Five: Explain a Fear

I fear many things - as I think we all do deep down.  

Most profound is failure. I fear that my sense of self will be disappointed.

Failure is a tricky business. It can be a monumentally powerful driver to goals and progress, or it can instil paralysis. In postgraduate studies, failure is omnipresent - there is always someone better than you at any modality to journey into. What you have to do is foster a unique set of skills and interests and pursue them. 

Life is not about the pursuit of happiness, or even its attainment, it is about realising the things you want to do and being content with the journey. Mindful gets a wishy-washy time - which is sad as I do enjoy meditation - but ultimately you have to accept that you won't get everything done, and thats ok. Small goals and small victories are nothing to make you assume you have failed. 

Be thankful for what you have.  There’s a former you who would love to be in your position now.  

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Dispatch Four: The Dream Job

This is not too hard.  I originally wanted to be a history professor, but dropping out of that course, I started anatomy.  This made me fall in love with medical education, and neuroanatomy in particular.

With heroes including Prof. Diamond (See previous post), Oliver Sacks and Robert Sapolsky, the commonality is the brain.  Currently, the dream job is neurology with a teaching role at a local medical school for the neuroscience of medicine.  

But as important is a profound sense of self-worth and ensuring that I can thrive both professionally and personally.  A dream job will not remain a dream if it sacrifices everything on the altar of its success.  

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Dispatch Three: Four Favourite Quotes

“Competence: be really good at the basics.  Caring: “people don’t care what you know until they know what you care”.  Conviction: what does that leader stand for?”

- Three C’s of Leadership by Gen. Mattis

This is a wonderful list of traits for leadership.  Mattis, a ret. four-star US Marine General, was often described as a “warrior monk”, as prolific on the battlefield as he was in academia.  That he is a deeply admired and conscientious leader of hundreds of thousands is beyond reproach.  I really believe that the Three C’s are something to emulate and demand of yourself for your team - by nature of the beast, a doctor will be a leader in their niche.  So this is important to instil early.

“Life is what happens to you while you're busy making other plans.”

- John Lennon

A wonderful song, from a wonderful album.  Lennon penned this lyric - which is so true it hurts - for his son, who he would tragically never see grow up.  A fitting message of both carpe diem and the limits of long-term forecasts beyond the Met Office.

We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty.

- Maya Angelou

I challenge you to find a more insightful, powerful and intelligent woman than Dr. Angelou was.  We spend so long talking of the CEO, the professor, the billionaire, we rarely talk of their bildungsroman.  Angelou does a wonderful job in many works documenting her harrowing life at times, and how she weathered through resilience to push for change and strengthen those around her - including, importantly, herself.

“Which organ does the blood from the heart supply first?  It supplies itself first, its a lesson in self respect which we will learn. It takes care of itself first so it can take care of others.”

- Marian Diamond

My all time hero, Professor Diamond was a UC Berkeley Neuroanatomist for six decades.  The subject of an emmy-nominated documentary, feminist and pioneer of neuroplasticity, she won too many national and international awards to count, opened orphanages, sponsored children through college she met on her travels and in her latter years became a YouTube star with her “introduction to anatomy” course watched by several million.   Marian was rejected from medical school due to the sexism of the 1940s, and yet despite feeling “it destroyed her”, had sufficient emotional intellect to turn that into an MA and PhD in the brain - studying neuroendocrinology and phantom limb syndrome variously.  Supporting herself through grad school, she demonstrated anatomy, falling in love with education.  But she also swam every day, waged a war against junk food, and insisted that non-science majors take her course to “understand the anatomy you may call home for the next 100 years … who knows?”.   To look after others, to thrive with others and make a utilitarian difference in this world - whatever your field - you must first care for yourself.  

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Dispatch Two: Explain Your Blog Name

Welcome to the second dispatch, and already I’m behind schedule.  No surprises there looking at the rosta of content from the previous year.

First Fact: I am in grad school

Dominating my life right now is medical school (as a graduate, which is rare in Britain). I have just passed the first phase and am entering year two (MS2).  Whilst I did, technically, enjoy the preclinical year, it felt quite … familiar.  I have a degree in A&P so basically this was a chance for refresh at a more superficial level - even the bedside teaching and community home visits seemed liked old territory: I worked in the NHS full time for three years before starting MS.

So I’m looking forward to entering the hospitals each day and starting clinical medicine.  The way we think in the decision-making process is endlessly fascinating for myself.

Second fact: Brains

I love the nervous system.  It is simply the best, most ephemeral, anatomy available to human study.  Cells have ideas.  What more is needed to be said really?

Third fact: Water

I love water.  I dream about water.  I get grumpy when I don’t swim.  I’m an advanced open water PADI diver and really, really need to get back under the waves soon.

Fourth fact: Botany

I wish I’d done botany as a BSc.  I would still have come to medical school, but I would have an even more profound appreciation for nature.  Ferns are just … well better than most people.

Fifth fact: Pseudo-veggie

I was raised a veggie (basically) and thus cooking is hard, conceptually, with such a preponderance of meats in most all recipes.  It is not innately easy for me to cook meat, though I do eat a lot more of it now - something I’m thinking of going back from though …

And so there you have it, five wee facts about me.

What I’m Listening To: “baaaad guy” - bite me, its catchy.  Though when the 17 year old talks about being dominated in a song her mummy would otherwise sing along to, well … yeah, that’s different.

What I’m Reading: Still Hat.

Interesting Reads Online:• I’m quite the fan of Gen. Mattis, the “warrior monk”, and this profile does a great job General Mattis Talks Trump and the White ... - The Atlantichttps://www.theatlantic.com › politics › archive › 2019/08 › general-james…

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Dispatch One: Explain Your Blog Name

For my first “Challenge Blog” thing, I thought we’d go with explain the blog name.  Well, as a blog mostly aimed as a journal of sorts about my time at Warwick Medical School, and an homage to my past life (anatomist), I chose a geeky name: the latin nomenclature for the main (principle) artery or the thumb.  I think - like a Facebook like - it was supposed to be a thumbs up to medicine.

Yes, that’s awful isn’t it?

Truthfully, you could go six layers deep into the translation of why … but the honest answer was my lazy quest to find a unique URL!

Anyway, I am one day away from moving into my new house.  

And boy have I moved a lot of houses in recent years - more than a dozen at last count. 

There’s an interesting essay in my mind somewhere about the effects of transient roots on the formative young graduate student. But considering the insane Deanery system for decade-long medical training (often necessitating broken families, isolation and commutes as long as the hours worked) of junior doctors, I guess I should be used to being a traveller. Maybe a caravan?  Or tent?  Maybe just a canvas strapped about some trees.  

Phase II of medicine begins this coming Monday.  Like many clinical medical students (oh my word, I’m a clinical medical student), I’ll be working to supplement the funding (which really is shockingly poor for GEM), having secured a job over the summer for the new term.  So expect my future blogs to contain some more realistic advice about funding GEM, and how flexible working works with an inflexible onslaught of essential GMC-mandated sign ins.

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What I’m Listening To: “I,i” by Bon Iver. Not my fav album by him, sadly, but still chill affff. 

What I’m Reading: The Man Who Mistook His Wife For a Hat - I’m doing a select module this semester in Medical Humanities and this is essential reading.  Though I’d argue for any doctor wanting to think more sympathetically and compassionately about their patient, it’s desired reading. 

Some Free Things to Read Online: 

• Yet another study mentioning the gut-brain-axis in Parkinson’s disease origin https://dx.doi.org/10.1007/s00401-019-02040-w

• A great read about Chronic Fatigue Syndrome https://www.newyorker.com/culture/personal-history/a-town-for-people-with-chronic-fatigue

• How student debt is just monstrous for this age https://www.newyorker.com/magazine/2019/09/09/student-debt-is-transforming-the-american-family

• An interesting read on unsettling things being found in vaping patients https://www.nytimes.com/2019/08/31/health/vaping-marijuana-ecigarettes-sickness.html?action=click&module=Well&pgtype=Homepage§ion=Health

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Blog Challenge

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Reflections on Phase I of Medical School

Well, a year of Warwick Medical School is over and, mercifully, I’ve passed to Phase II!

I thought I’d take this opportunity to write down some frantic reflections of the year.  Wish me luck!

A great memory of the year was …

The realisation that, despite what I had convinced myself, I had made good friends.  Far better than I thought, and arguably deserved.  This year was notable for a descending, stress-induced veil of introversion that is quite unique to my outward, usual self.  But, again, we all contain multitudes and must care for each facet.

A bad memory of the year was …

… relationship stress approaching Christmas.  I reverted to old habits that were not fair to other people.  Fortunately, I am now closer than ever.  It is worth stressing that gains can be replaced when consistency and mindfulness is not brought to your actions.  

Practice conscientiousness in your interpersonal relations - don’t be a dick, basically.

One thing you learned about yourself this year was…

I love teaching, but I also struggle with the boundaries of a teacher.  In that my “extra mile”, can be “too extra”.  I have to work more on self-care and determination.

A memory of Block I …

The end of non-mandatory lecture attendances brought two things: much more freedom and a reduction of academic stress.  But directly ushered in a time of self-isolation.  

A sad reality, and one that I will have to better balance next year.  

The fact is simple: each lecture is recorded, and invariably a direct recitation of PowerPoint bullets to the tune of 3-5 a day.  

I don’t work well in such passive, didactic environments.  And to attend these lectures is, sometimes, to write off whole days/weeks. But in doing so, its also writing off an interface to interact and be known by your peers - to grow friendships.  I didn’t know it by block one, but I had started a train of negativity in myself with that isolation.

I was not prioritising academia as much as writing off the rest of life.  A bad move.  A bad move.

A memory of Block II …

This was a very disorganised block taught - objectively - terribly.  

I realised that CBL isn’t for me in the slightest.  Far from being useful, it was harmful.  It detracted from my learning and took me away from study, often revealing inaccuracies with very (sub-professional) IT packages and facilitation from PhD students.

Would not recommend CBL.  To such an extent, its a factor in my advocating for not going to Warwick.

A memory from Block III …

By this point we were well into the swing of Brain and Behaviour - which I adored.  Community and Bedside teaching were up-and-running and, once we were acquainted, it was fantastic.  A real change to the academic, powerpoint pace.  So lovely to be in those environments so early.

A memory from Block IV …

This was the block run by the anatomy department.  So, academically, I was in my element.  This allowed me to have a lot less cognitive capacity run through studying, and much more time for education.  I really found that I was enjoying the Friday teaching sessions, which showed medical education as a passion I must pursue.

A memory from Block V …

I was surprised to really enjoy this block.  Sadly, very sadly indeed, the examination was not representative of the content of the course itself.  

Depsite this, I found the content gripping.   I had no idea this would interest me so much!

Now, am I about to drop Neurology for OBGYN?  Slow down.  I think the work/life balance would always preclude me from such a thing - See Adam Kay’s book(s) - but fascinating nonetheless.  

A huge mistake I made this year …

Physical health.  I have been stress/comfort eating and BOY does it show.  My BMI is now a worrying 27 - aka midway between ideal weight and obese.  Classified, for the first time since 12 as overweight, has been disorienting.

I have not had 5-a-day for a long time.  Rather, I’m drowning in chocolate and processed food.

But I will change.  I have given up chocolate in its entirety - as I did for three years in high school, successfully - and will soon purchase a slow-cooker for a new diet rich in vegetables.  

Its simple, you cannot outrun a bad diet.  It affects all things.  

This I am committed to address, and in a quick, evidence-based way.  

Two things I’m proud about this year …

An appreciation of the good, and bad, are so important.  Often we don’t celebrate our successes sufficiently, as we reach a baseline with achievement and want the next thing.  That five year quest for medical school, once achieved, is ignored and not appreciable because its the “next test”, or “making rent” etc etc.  90% of applicants to WMS fail to get in, and I just passed the first year in the top decile recorded.  Not bad ey?

The other thing I’m proud about is the project started: MedGuide.  This is not an advertisement, but I hope its going to be great for generations of Warwick students.  Watch this space and watch (medguide.uk) itself.

The scariest thing this year was …

Heartbreak.  Though managed better than ever before, which - for me at least - is huge in my personal development.  

An example of self-care was …

Something conceived by a dear friend of mine, Autumn.  Its called “Pumpkin Time”.  

At 9:30pm my alarm sounds and I turn, quite literally, into a pumpkin (think Cinderella).   I go to my room, lock the door, AirPlane mode and meditate.  

After this, I will have a wash, brush my teeth and review a quick 15 question self-reflection of the day.  Questions range from “how do you feel?” to “an instance you made someone smile today”.  

When I go a few days without Pumpkin time, or with answers I’m not proud of on the self-reflection form, I know that I’m not leading my best life - not prioritising myself sufficiently.  Which is itself a poisoned chalice.  

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One Block Down

What I’m Listening To: AM - Tranquility `Base Hotel and Casino

What a lightning month its been.  Paradoxically, I feel this was the shortest - and longest - four weeks of my life.  The friendships I’ve made feel deeper somehow … maybe a result of pressure and solidarity?

We are ending the first block at WMS “Health, Metabolism and Homeostasis”. That is week 5/26 done.  

In this brief time, we have covered an awful lot of stuff from all MBChB-required GI and abdominal anatomy, to thyroid physiology, introduction to inflammation and infections, microbiology, pharmacology of the kidney, urinary bladder, thyroid, stomach, small and large intestine, hepatic drug metabolism, community days, multiple sessions of teaching fellow students and about 6-10 full days in the Clinical Skills wing (general history taking, systematic review, abdominal OSCE complete, BLS, First Aid, Infection Control) and UHCW Surgical Training Centre with prosections (plastinated, fresh-fixed), medical imaging and surface anatomy model drawing/palpating.  That is a truncated list.  Madness.  

Relationships are becoming quite, well, close on the course between many people.  The intimacy, uniqueness and isolating nature of this degree does tend to lead to … interesting situations to say the least … say no more …

For myself, I’m loving the review of A&P.  Whilst the level is quite below that of my undergrad, its nice to see practicable points to my knowledge.  Its great to have the time to teach my friends (who all seem very grateful) and explore the common-sense of pharmacology (once you know your physiology sufficiently).

I am also signed up for, and on lesson 3 of, Intermediate Adult Swimming lessons.  Whilst nothing to do with medicine, a holistic life is the name of the game - its the journey, stupid!  Overcoming issues with swimming and asserting a new confidence is a major goal of mine.  I can’t wait for the next session!  Butterfly and tumble-turns soon.

Last week we spent some time in the community.  I can’t say when, where or what happened, but I’m so grateful that my university prides itself on this aspect of medicine.  Too often, courses hide students from patients for as long as possible and force rote learning of dry, non-correlated scientific facts (sure to desert forever as soon as summer arrives).

To do a “walk around” of the area, with simulated patients in mind - finding accessible routes, pricing up groceries, looking for public transport, seeing social areas, finding alternate schools in catchment areas really demonstrates the mantra that the physician is more than the extender of life.  A really great insight for many on the course I’m sure. Health is not reducible to pharmacological/knife-wielding outcomes.

I’ve been loving my CBL - the group are fab.  We seem to challenge each other, but create a laid back, open surrounding.  Everyone is clearly very smart and attuned, but also willing to speak up when they aren’t sure.  Its great to see the comfort setting in … a nice bunch!  

Well, that’s enough from Insomniac Mercer,

[princepspollicis]

Week Zero - “Welcome Week”

What I’m Listening To:  Egypt Stations - Paul McCartney

What I’m Reading:  Guards! Guards! - Terry Pratchett

-

OK!  So I am now a medical student!  

We’ve had introductions, completed a full CBL case, debated medical ethics, been introduced to pharmacology concepts/routes of administration, attended a black-tie Ball and been inundated with AS level cell biology (which duly terrified the non-biomedical UGs).

I am so happy to see wellbeing a core curriculum component.  It is well known that healthcare professionals, including medical students, suffer higher rates than the general population of burnout, stress, exhaustion through to pathological development and/or suicidal ideation.

Paramount importance thrust on physician’s health is really inspiring and powerful a message to send from week one of our medical careers.  

Look, its tough.  Of course it is.  People die, people suffer, families grieve, the unexpected is expected.  And in the middle, a squishy blob of organic matter: the doctor … me soon.  However the science of decreased performance, productivity and physician health on long hours is in.  The way we have trained juniors in this country is inefficient, against tenants of neuroscience of health, wellbeing and education.  

Medicine is stressful, but it shouldn’t be stressful because you’re working yourself to death.  That old guard idea must end.   We are evidence-based people, who will be evidence-based doctors.  

This can’t be excused.  

What is good for our patients we must demand for ourselves. PAs, AHP ascensions and increasing doctor intake/funding is essential and affordable.  Doctors are humans too.

“I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard”

The Declaration of Geneva

We had mindfulness sessions, discussed the neuroscience of the process and I led the group in some definitions and understandings of what was going on.  The group has asked me to carry out a few mindfulness sessions during future case-based learning classes, which I’m more than happy to be doing!

I wrote previously about mindfulness in this journal, so we will leave that there.

On Friday I went to UHCW, the mammoth local hospital where we shall be based for each friday in first year, undertaking anatomy workshops in the surgical teaching centre, drilling all the clinical skills and surface anatomy exercises.

I was blown away by the UHCW Anatomy professors - exceptionally bright, enthusiastic and somehow made PowerPoint engaging (I know!).  I found myself on a hike the day very excited for anatomy teaching, and longing even more for an Anatomy Teaching Fellowship (I did a BSc in Anatomy and Human Biology).  The DREAM job!

That will do for now, I’m hanging from the Medics Ball (I’ve become a cliche medical student tragically).  Busy week meeting the society committees I’m to be a part of - so v excited!

Later!

[princepspollicis]

One Day More

In one hour - at writing - I will be a day away from becoming a medical student.  This is a very weird concept to grasp: both a culmination of a dream, and the start of an arduous, exciting career.  

Many hours of blood, sweat and - definitely - tears have formed this opportunity.

From an unsure history major, switching to Anatomy and working in the NHS frontline for several years, to finally deciding on medicine.  

Revising and taking the UKCAT, chasing references with old professors, writing a personal statement between night shifts alone, submitting UCAS.

Waiting on interviews, prepping and attending selection centres, waiting for offers/rejections, getting offers - plural!!! -  working a further six months full-time, moving to Warwick.  

And now one day more.  

I am keenly aware of the paradoxical nature of pursuing happiness.  The grass is always greener - ergo routing contentedness from goal seeking is impossible.  

In short: its the path, not the end, that’s the life you fool.  

Saying “once I become a medical student I will have fulfilled my goal and be happy” is crap.  

That application path sucked.  I had fun with real superb friends, family, but it sucked.  The process is stressful, arbitrary, weirdly non-evidence based, discriminatory, elitist, expensive and time-consuming.  For me, I’m in the Old Boy’s Club now, and “paying it forward” will be an essential component of my time at WMS and in latter practice.    Any teenager, young-adult with the agency to ask me for a shadow has my vote.  

I am living in the moment by making a beautifully minimal room that energises and inspires me to simplify and prioritise.   I undertake daily walks.  Am enjoying the company of some lovely new coursemates at home.  I am listening to music.  I read fiction every night.  I meditate.  I take pictures on a real camera, of people, moments and landscapes.

I am thankful to those that read my applications.  To those that read my personal statement.  To those that encouraged, listened to rants, patted my head.  

I am thankful to my undergraduate professors for their excellent preclinical science tutelage that was a key part of my application.

I am thankful to WMS for accepting me.  

I am preparing diet plans, swimming lessons, bike routes.  I am keen to focus on both physical and mental health - particularly in the immediately challenging preclinical year.

I am thankful for the Daniel Mercer that worked his arse off to have me sat typing on a 2018 MacBook Pro, on a comfy bed in Warwick a day before becoming a Warwick Medical Student.  

I am alive.  I am healthy.  I am a conscious, critically-thinking individual with good music, food, interests and company.  It is a good time to be alive.  Complacency is not allowed, for sure, but appreciation of the present is important.  

Right now I feel the transient satiety of achieving the start of a medical degree.  I feel rested and prepared to start not only preclinical lessons, but swimming classes.  I am excited for clinical skills, challenging concepts and a new systematic direction of thinking with peers in Case Based Learning each week.  

I am eager to get on home visits in the community, debate ethical quandaries, have access to phenomenal anatomy resources and further my clinical correlate knowledge.  

In short: appreciate the achievements, be aware of the new and, yet, say “what’s next”?

[princepspollicis]

On Mindfulness

“For who would bear the whips and scorns of time,

The oppressor's wrong, the proud man's contumely,

The pangs of despis'd love, the law's delay,

The insolence of office, and the spurns

That patient merit of the unworthy takes,

When he himself might his quietus make

With a bare bodkin?”

Stop. Phew. What is this?

Our ancient nervous system is hard-wired for the “pursuit of happiness”.   Satiety is evolutionarily dumb, we crave accumulation.

A complacent cavemen ended up in the bellies of tigers.

We are wired to edgedly require more of a dopaminergic hit.  This sucks.

Nothing is enough. We are rapt with anxiety drenching past and future losses.  Our goals never suffice a paleolithic hunter’s mind.

To enjoy satiety, through a sort of transient contented appreciation, we must practice grounded non-judgemental awareness.

Now mindfulness sounds like wishy-washy, Eastern philosophy, voodoo bs. It did to me once.

But stay with me.

This is present awareness - absent aberrant thought pulled through conscious loci.   To focus passively on your breath, or other sensory modality, drifts one from conscious tumult. This is nonspiritual, logical, factual.

Most suffering stems of fearing an imagined future, or reliving a suffered past.  

In observing an anxiously churning abdomen - permitting sensation to neither define or dictate - but accepting its presence passively, liberates.

You are not your emotions.  They can’t control you if you detach and observe nonjudgmentally.

Recording gratitude is another route to appreciative living. Write down something:

You’re thankful for that happened in the past

You’re thankful for that is with you right now

You’re thankful for that is in your immediate future

Write a brief thank you note to someone who has done something for you. Show gratitude. You don’t need to send it.

Write of your gratitude of God, karma, fate, spirituality or sheer atheistic happenstance and luck that you’re a sentient creature on the planet today and why that's so incredible and awe-inspiring. [*1]

Even apical dreams last moments.  Earning a place at medical school delivered brief celebration ...

... followed with fear.  

Fear of imposter syndrome, finances, moving, new friends etc.

Madness, but totally logical. The sated caveman is yummy.

In short, take a moment to be appreciative of the present. Relish the present.  Its an instant mood-booster and prevents us from taking the small things for granted.

Whether you're a medical student, doctor, lawyer, butcher, baker or candle-stick maker, there is life in you and there are present/future opportunities too.

Realise them now. Realise it’s hard, and that’s ok.

FOOTNOTE:

*1 - I’m thankful for 1) my determination of three years work to get to where I am 2) to my mother for giving me a rent-free life before grad school 3) to the opportunity to study in such a resource-rich opportunity, and at such a resource-rich time for medical knowledge. Thank you Granny for believing in me, for listening to my piano playing at the end of my bed, when no-one else would. Its your birthday on writing this, and we all miss you.  I’m also awed by the dumb luck of being on this Goldilocks planet, at this time of antibiotics, internet, meritocratic gender-neutral entry to medicine. A long way to go, but mindful of the progress.