I'm at once very bitter about residency training, but so grateful to get to be a resident in my dream specialty.
I'm increasingly frustrated by the insane work hours, the low hourly wages, the lack of support for residents... but simultaneously grateful to have a car that I can drive to work, a condo that I own, a steady income that I can support myself with, and so much more.
It's hard to reconcile these two people (sometimes one side gets way stronger), and I often feel alone, like no one understands how I can be very bitter but equally as grateful, all at the same time.
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Random thoughts while rounding
Always have to swipe ourselves into the internal medicine wards. Swipe access in, swipe access out. It's to prevent patients with dementia from escaping.
One comes up to us, as we're discussing a case in the hallway. Some of them will just randomly join the walking part to rounds. He patiently waits for us to finish then asks if we can open the door for him, he needs to go home. Ask him where his nurse is, best to ask them, he goes, 'bloody useless" and walks off.
It's not entirely uncommon to get a call from families sometimes (usually disgruntled and frustrated) to go, so Mum or Dad's just escaped from hospital or the ED. Shall I ring the ambulance to bring them back? At the extreme, I've had patients barricade themselves in random rooms.
Mr H is still making his laps around the wards with his walker, if he bumps into something, he some how manages to troubleshoot it or wait for a staff member to move it. Usually a Wow (Workstation on wheels).
Another patient confidently walks past us to an alcohol hand wash/purell/hand sani. Picks up and tries to drink it, when her bedside nurse runs up and stops her. She goes, aww I was only going to take a sip.
Reminiscent of the woman who drank the perfume sample on tiktok. Addiction is hard.
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38 days till my 2nd internal exam. And I'm freaking out here because I'm left with entire syllabus.
So, made some plan today to complete everything (includes making notes/mark in book)
Week 1 : Lower limb (notes), Protein metabolism (notes) , Fats metabolism (notes? , Excretory system (study+notes)
Week 2: Abdomen, TCA cycle, ETC, GIT
Week 3: Abdomen, Fat metabolism, CVS
Week 4: Abdomen, nucleic acid metabolism, CVS, CNS.
(Will be covering Xenobiotics, ECM, embryo whenever I have time)
Week 5: Revision + Internal examination
Week 6 : Practical exam.
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8 noviembre, 2022
Mi nombre es Sophie, estudio 2º y 3º de medicina, aunque debería estar en 4º porque este año decidí hacer un año de recuperación y así empezar el año que viene con todo limpio.
Tengo muchas ganas de utilizar Tumblr para encontrar la motivación que me ayuda a estudiar todos los días, ya que a veces me es difícil encontrarla pero poco a poco lo conseguiré!
Ahora mismo estoy estudiando microbiología y luego intentaré entender 2 temas de epidemiología que se me atragantan mucho. Este cuatrimestre también tengo farmacología, patología y bioquímica clínica.
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When Breath Becomes Air
My favorite quotes and moments from this magnificent book by the late Paul Kalanithi.
"What makes life worth living in the face of death?"
"You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! then make time, while you be,
But steps to your eternity."
~ Baron Brooke Fulke Greville, "Caelica 83"
"Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor."
"The neatness of medical diagrams did nothing to represent Nature, red not only in tooth and claw but in birth as well."
"Maybe life is merely an "instant", too brief to consider. But my focus would have to be on my imminent role, intimately involved with the when and how of death -- the grave digger with the forceps."
"I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking. (…) In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun."
"Technical excellence was not enough. As a resident, my highest ideal was not saving lives - everyone dies eventually - but guiding a patient or family to an understanding of death or illness."
"In these moments, I acted not, as I most often did, as death's enemy, but as its ambassador."
"If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live."
~ Michel de Montaigne, 'That to Study Philosophy Is to Learn to Die'
"Had the confirmation of my fears -in the CT scan, in the lab results, both showing not merely cancer but a body overwhelmed, nearing death- released me from the duty to serve, from my duty to patients, to neurosurgery, to the pursuit of goodness? Yes, I thought, and therein was the paradox: like a runner crossing the finish line only to collapse, without that duty to care for the ill pushing me forward, I became an invalid."
"If the weight of mortality does not grow lighter, does it at least get more familiar?"
"She asked. 'Don't you think saying goodbye to your child will make your death more painful?'
'Wouldn't it be great if it did?' I said. Lucy and I both felt that life wasn't about avoiding suffering.
Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristics of the organism is striving."
"Shouldn't terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it?"
"Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward."
"I can't go on, I thought, and immediately, its antiphon responded, completing Samuel Beckett's seven words, words I had learned long ago as an undergraduate: I'll go on."
"That's not to say that if you believe in meaning, you must also believe in God. It is to say, though, that if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn't have any. In other words, existential claims have no weight; all knowledge is scientific knowledge."
"And the New Testament says you can never be good enough: goodness is the thing, and you can never live up to it. The main message of Jesus, I believed, is that mercy trumps justice every time.
Not only that, but maybe the basic message of original sin isn't 'Feel guilty all the time'. Maybe it is more along these lines: 'We all have a notion of what it means to be good, and we can't live up to it all the time.'"
"Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete."
"Doctors, it turns out, need hope, too."
"Conversely, we knew that one trick to managing a terminal illness is to be deeply in love -to be vulnerable, kind, generous, grateful."
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A house in virginia.
House in Virginia clinics are hard. Just emotionally. A couple of my patients joke about it in the way you have to alleviate the pain, "let's call it a house in virginia"
All the history particularly of the older patients who lived this crazy experience in the 80s epidemic days before the age of HAART (highly active anti retroviral therapies) can be particularly soul destroying - if it wasn't for their upbeat outlook on life having survived. I had a hard time but an illuminating one watching the Dallas Buyers Club. Because now we treat it like we treat any other chronic disease, it's mostly manageable, liveable. So long as you take that one tablet a day.
Think about my LGBTQIA friends all the time after these clinics. How different everyone's lives are now compared to 30-40 yrs ago. We are the lucky ones. Would my friends have survived had they been born in another country or another decade. They have access to PrEP if they need it. I try not to contemplate this. But these clinics do hit me in the face from time to time.
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