The warmth of the quilt enveloped me, as a blaring cacophony erupted in the background. It was 5:45am and unlike the four days prior it took everything to leave  my sheltered cacoon and step out into the world. Practically inhaling breakfast, it was another day I left my watch behind as I raced to make the bus. It was running late. Predictable.

Now doe eyed and eager, I brushed past the worried faces at the hospital elevator, racing up four flights. Can’t be late. Empathising with our COPD patients, I puffed into the empty doctors’ office. Drat. Why didn’t we start at the same time every day?

‘So what did the physiotherapist say?’, the registrar asked. Illegible, more illegible writing. It was already 2:30pm and we’d barely seen half the patients. ‘It’s just one of those days’ I told myself. ‘Just keep smiling’.

3pm. ‘Isn’t that your patient in Bed 5?’, the nurse yelled, as we finally sat down to lunch. It wasn’t my first MET call. It wouldn’t be my last. Plastering myself to the wall I watched the herds flocking to the scene like sheep. ‘Can’t breathe, can’t breathe,’ the patient gasped.  Only yesterday she had been telling me how upset she was her son hadn’t visited her in hospital yet. A moment I had cherished, congratulating myself for finally finding the time to truly get to know a patient. She remained surrounded. Lines, masks, leads.

‘Increase the oxygen, why isn’t there an alcohol swab here.’ With doctors and nurses engrossed in their individual roles the patient’s eyes moved to me. It took everything to muster my courage and give her a smile. We both knew, but neither said a word. Silence. Flat lines on the ECG. A life lost. My eyes darted over to the corner as her young son and his wife ran into the ward. A single tear trickled down his face. A missed oppurtunity.

 

Within moments I was rushing to grab a progress note as we moved to the next patient, the only remnant of our previous encounter being my quivering hand as I began to write. It was funny how I forced a smile.

‘Hey, hey, what’s wrong?’ I heard. It had only been a few hours; couldn’t I have smiled a little longer? How did they know? I felt angry. Why was I staring into space whilst the rest of the team continued to deftly craft intricate management plans for our complex patients?

My colleague stood me outside the room, as the team proceeded to see the next patient. ‘You have to learn to forgive yourself’ I heard her say ‘We all knew you knew her better than any of us.’ ‘It’s ok, you are allowed to feel this way’.

Maybe I had needed to hear that a few hours ago.

Maybe the smile wouldn’t have been so forced.

My hand may not have quivered.

We always expect ourselves to work at our best, despite the circumstances. We compare our responses and reactions to others, often more experienced. We feel guilty about taking our own time to process our emotions. Why? Maybe it is our internal drive, maybe we learn it from our environment and peers. But can we really bring the best care to our patients unless we are functioning at our best?

So…

 

Forgive yourself.

Take your time.

Realise.

You don’t always have to keep smiling.

In February 2014, I was on top of the world. I just received my offer to study medicine. My life’s hard work had finally paid off. The rest would be a breeze; studying medicine is easy, a bit of memorizing, that’s all, and everyone gets a job at the end. My life was sorted! I became the model student, everyone’s goal, everyone’s dream.

I went into medicine full of joy and excitement, absolutely confident that I had more than what it took to ace this course. I was ready to live the dream, ready to become an excellent doctor…

I am still unsure when the turning point happened, when the dark hour of self-doubt began to settle in. It might have been sometimes before my first end of year exams, when I realised that I could simply not study enough to cover the scope of what could be tested.  It might have been outside the door of many OSCE stations, where I was paralysed by topics that I was not prepared for.

Or it might simply have been the daunting realization that I was not as dedicated, gifted and hardworking as I had thought…As I sit in front of my laptop, too tired to concentrate on studying after a day at placement, I think of my many fellow medical students who achieve higher grades than me, and who through their dedication to juggling uni with extra-curricular and research activities, also enjoy the benefits of having glowing CVs. As I struggled to answer my consultants’ questions, I resigned to the fact that I simply did not have the knowledge to impress doctors and build the social connections that everyone seem to value so highly.

Now, edging towards the end of my time at medical school, I have more questions than ever. Would I be able to cope with the demands of internship next year? How do I determine which one of those multitude of medical specialties suits me the most? Would I ever be good enough to overcome those increasingly difficult challenges that stand between junior doctors and training programs?

 

Through all my doubts and uncertainties however, there is one thing that I am confident about: I have had struggles and self-doubts through medical school, yet I have overcome them. My lists of achievements through medical school may not be less glowing as it was back in high school, but through each and one of them I have learned to strive to be a better version of myself, and these moments of personal growth would allow me to overcome the bigger challenges to come.

My achievements in school have given me confidence and pride, but I was so sheltered that I believed I no longer needed improvement. Medical school has allowed me to know that there is always something to aspire to and strive for, and that is a great feeling.

The journey as a medical student and doctor is long and meandering. Self-doubt and uncertainty are often intertwined with this path. If you ever find yourself feeling doubtful about your abilities, please remember that you have all accomplished so much to get to where you are today, and there is no reason why you wouldn’t continue to do so. Additionally, the greatest achievement is a journey, not an endpoint and I wish you all the best on this amazing journey.

It always starts small – like a ripple – before slowly welling up inside. You know what’s coming next, so you brace yourself.

 They’re all just temporary feelings that will pass right?

The tachypnoea, chest pain, palpitations, vision changes, paraesthesia, depersonalization, flight of ideas, and that sense of impending doom. No amount of knowledge can prepare yourself for the wave that comes. It surges through every fibre in your body, filling every nook and cranny, relentlessly striking at every insecurity with more precision than a stressed medical student trying to cannulate a delirious dehydrated patient while trying to decide whether to call a code grey amidst a cacophony of beeping alarms. Its icy grip tightens round your chest, clinging to every breath as you struggle to maintain focus. Through ragged breaths you use every rational thought you can muster to counter your worries and overvalued ideas. And just when it seems you’re not going to make it, you do. You remember to breathe. The waters finally recede as you shut your eyes, inhale deeply and shake it off before ‘resetting’ and picking up where you left off.

 

Five years have passed in a flash and with the end of medical school in sight comes a barrage of different emotions: Joy, relief, sadness, dread. I would be lying if I said it was easy. “Peaks and troughs”, they said. Yet that one line cannot surmise all the obstacles one faced: Mental health issues, challenging colleagues and supervisors, social isolation, insomnia, 4-hour sleeps at night to study for the VIA, the list goes on. One that I found particularly troubling and persistent was anxiety. Here are some tips I found helpful.

 

Seek Help When You Can– You are never alone. Sometimes mates are good and all, but there are times when things can get too overwhelming. There are always avenues for help like Headspace and getting a mental health care plan from your GP. The student services at our clinical sites are also very understanding and always have our best interests at heart. Knowing when we are in over our head and seeking help is a good step in a positive direction. No matter how big or small your problems are, there is nothing wrong with saying you need help.

 

Take Time For Yourself– Never underestimate the power of taking some time to focus on you. Take a break from the books, get out there and take some time to relax. Exercise, treat yourself to brunch (not UberEats), hang out with your friends, visit a familiar haunt (or somewhere new). Remember to pace yourself and not burn out. So… Treat yo’self! J

 

Surround Yourself With Friends and Family – It’s easy to get caught up with work and rotations and lose contact with friends and family. Try and make it a point to spend some time with them. Grab a coffee, have brunch together, share your troubles, or just kick back and binge on Netflix. If not, drop them a call. Sometimes all we need is just for someone to talk to or laugh alongside with.

 

Mindfulness Works– We have all spent time savouring that tiny piece of chocolate, trying to focus on every taste bud as it slowly melted in our mouths – I wouldn’t know, I practically inhaled mine. A chocolate fondue fountain with strawberries would’ve worked better, but I digress. If you ever feel tense and unable to relax, meditation has been a great go-to for me. Taking a couple of minutes to regulate your breathing and doing a ‘body scan’ is a good way to reset and start over. If you’re like me, lacking imagination and would rather not type ‘relaxing music for stressed out medical students preparing for final year exams’ in YouTube search bars, then I would recommend the Smiling Mind app which is completely free and has several pre-set programs to select from (no, I do not have shares in the Developers’ company).

 

I hope these tips are useful for those who need it. Good luck for the rest of the year everyone!