Starting to resemble medicine, maybe a little bit. (Pt 2)


For most people, including myself, today is the first official day of fifth year. We’ve all been separated into clinical groups of either 14-16 students (mine is called 4A) and scattered all over different hospitals and rotations. My life has also officially been broken down into periods of either two or six weeks; the duration of a rotation and the amount of time between exams.

See one, do one, teach one, get comfortable, get inspired, write series of exams, move on to a new rotations and repeat. We should no longer refer to ourselves as medical students, but rather young doctors in training; It’s time to be on your feet the whole day, clerk patients, be on call, all the while trying to study, eat, sleep, stay healthy and maintaining a normal life too, basically doing all that Grey’s anatomy growing up stuff.

I had a hard time falling as sleep last night, I felt quite anxious and overwhelmed. I don’t like not knowing what’s happening and right now I’m as clueless as could be. The expectations and pressure is sky high and sometimes I forget that I don’t need to know it all, I’m here to learn and that’s kind of the all point. Change is uncomfortable, especially when it’s needed so I’m consciously having to remind myself to not be so hard on myself.

All I know is that today I start with Family Medicine, it’s a two weeks long rotation which probably means that my first exam and/or assessment is in two weeks. The overall break down is that the first two days comprise of a pre-test (based on contents I should have learned but probably didn’t in third and fourth year) and lectures with the HOD. You then get assigned to a general practitioner near you that you have shadow. You’re expected to go on a home visit, do a presentation, an observed consultation and as well as clerk as many patients as possible. I’m as excited as I am nervous.

Wish me good luck

Medicine (An abusive love story)

I must have been 6 years old when we first met. In a blink of an eye we became inseparable. You were that friend that always kept me out of trouble so I knew my mom loved you. I stuck around you because you understood me and never once judged me. Young, but I cherished the values you preached and represented. Even though our bond and friendship grew, life started to happen so we’d sometimes go months without talking but you were always there when I needed you. You were there for me through the awkward puberty phase and the overwhelming sex drive that came with it. I started to notice the curves off your body, the scent you gave off and just how beautiful you were growing up to be. As you grew so did your complexity, you started to learn foreign languages, you read a different book everyday, spent a lot of time in the library and carried yourself with such esteem. However, the older we grew the bossier you became too; you took advantage of my kindness, told me what to do, how to dress and even which subjects to choose at school, forced me to be good at maths, physics and to abandon the arts. I was young and naive so I complied to your every demand with the hope that one day you’d be mine. Completely mesmerized by the being you were becoming. You hated how much time I spent playing basketball and hanging out with friends, hated how close I had gotten to other girls. You felt unappreciated and so you punished me by playing hard to get, claimed that I wasn’t ready, I lacked drive, spirit and wasn’t mature enough. I wasn’t ready to have you, I wouldn’t know what to do with you. Broken hearted I had to survive through the confusion and hurt in the hope that one day it will all make sense.

Time lapsed and I met another, she had features that reminded me of you, and I hated that about her. I grew up, moved on and reinvented myself. Never really keeping tracks on who you had become but hearing stories through the great vine of some of your accomplishments from the friends we shared in common, physiology has always had a big mouth. 4 years since I had last saw and really thought of you, you creeped up on me without a warning. I couldn’t ignore the chemistry or the beauty in our interaction. The endless conversations and laughs as we caught up on life. I had grown crazier and you had become even more beautiful. I asked you out and you said no then said yes a few days later.

It started out with us spending everyday together and staying up till the early hours of the morning talking on the phone. I could never forget the electricity in our first kiss. The sex was heaven, the journey was poetic and we seemed something rather magical. In love, yes I was. This was new to me and quite indescribable. The more time lapsed, the more of you started to become revealed and the more of me fell for you. Life happened we got busy but still managed to talk though. Sometimes you were clingy, moody or seemed emotionless, I equated that to the possibility of PMS. We fought more and laughed less, you hated how much I’d spend on my phone and claimed that I didn’t give you enough attention. I did not take you seriously enough and my efforts were limited. You needed more romance, more time, more sacrifice. You started driving me up a wall and frustrating me as I was already giving you all I had. How dare you say I don’t give you enough time, I couldn’t recall the last time I saw my friends and family, the same way I couldn’t equally recall the last time I wasn’t with you. You’re my life and I’ve admitted that, you own my heart, thoughts and body but still have the audacity to say it’s not enough. I’ve given up my friends, my job and even my family for you. Must I die for you before it’s enough. You control my life in a way that is frightening to me. I want to chill and watch a movie, but you want me to study – so we study. I want to see my family over the weekend but you want to me revise – so we revise. I want to sleep in and recover from last night’s study marathon but you want me to attend lectures and PBLs – so we attend. This is so toxic and yet I can’t walk away, the sex is too good, the love is too deep, we’re too intertwined. I couldn’t escape you if I wanted to then again I don’t really want to. What have you done to me? Why do I hold on so damn hard to you. You’ve become a part of me.

I love how you say my name and talk of a future with me. It’s quite clear that I love you more than you love me. Another fight you’re too jealous and controlling, I can’t take it, I’m out, I’m done with this. Frustrated and angry I refuse to think of you, it’s been two days now, I miss you but a man’s ego is a lot. You call me crying, you want to make up, I’ll come see you, I really hope your neighbors aren’t home, they’re really starting to hate us. It’s loud, it’s passionate, it’s messy. We get high, we eat and repeat. I stay longer than intended. Cuddles and booty rubs, love bites and endless talks. I wonder how long this peace will last.

This is abusive, you’re terrible, an horrible lover, but I’ve never loved anything the way I love you and so I’ll stay. It’s simple, it’s complicated, it’s messy. I hate you but I also love you, you’re my soulmate so we might as well get married.

Medical School in South Africa (Interview with a matric pupil).


How far along are you in your studies?

  • I’ve just completed my fourth year.

Why did you choose to study medicine at Wits?

  • Medicine has been my passion since I was yay high, I did an entry on  why medicine a few weeks ago. My choosing of Wits was based on personal preference and it made the most logistical sense, I live in Johannesburg, they offered what I wanted to study, and it’s a great university.

How many university offer medicine in South Africa?

  • There’s 9 in total; University of the Witwatersrand, University of Cape Town, Stellenbosch university, University of KwaZulu-Natal, Sefako Makgatho Health Sciences University (previously known as Medunsa), University of Pretoria, University of the Free State, Walter Sisulu University and University of Limpopo.

Are all the courses identical?

  • No there’s no standardization in the curriculum, every university teaches it differently. The amount of time spent on core subjects, clinical exposure and even labs differ. We are however expected to know more or less the same things by the time we graduate.

How are the years broken down?

  • First year is devoted to basic sciences (Biology, chemistry, physics). There’s also Psychology, sociology, and Medical Thoughts and Practice (MTP).
  • Second year is an introduction to medical sciences; Anatomy, physiology, molecular medicine and MTP II.
  • Third and fourth year is integrated basic medical and human sciences. Each blocks focuses on a specific system. It introduces clinical concepts such as pathology, pharmacology, immunology, bioethics, microbiology, anatomy and physiology.
  • Fifth and sixth year introduces clinical rotations, most of your time is spent in the hospital, you get to play doctor and interact with patients. You’re expected to go through the following rotation; Internal medicine, OBGYN, surgery, Paediatrics, family medicine, urology, ENT, psychiatry, ophthalmology, forensic medicine, Trauma, emergency medicine, anesthetics and community medicine.

Which university offers the best medical degree?

  • I’d say Wits, we have the biggest teaching hospital on the continent as our classroom so we have a broader exposure spectrum. We’re also the only MBBCh in the country (although I think that’s just Wits way of being spicy). I’m obviously extremely bias because I’m a product of Wits. However I’ve heard that Tuks, UCT, SU and SMU have really good programs too. It’s very hard to compare because the teaching styles, the academic hospitals, exposure and resources all differ between universities. For example, Wits focuses more on theoretical training whilst Tuks focuses more on practical training, which of the two produces the better doctor is based on the students themselves (this is a non-ending debate between very bias parties, one you should stay away from.) In the end it’s really the reputation of the university that counts.

Do I need to be very smart to succeed in medicine? 

  • A certain level of intelligence is required to understand tricky concepts and reason your way to diagnoses but in my opinion resilience and disciplines are qualities that will take you further.

What are the pre-requisite coursework to get accepted in medicine?

  • From a high school level; physical sciences & pure maths. However doing life sciences is also quite helpful. From a tertiary level, most schools would ask that you have completed physics, chemistry and biology at least on a first year level.

How long is a medical degree? 

  • A medical degree in South Africa is 6 years (5 years at the UFS, I stand to be corrected). Wits offers a 4 year program but you need to be a degree holder to qualify for that.

Tell me more about the 4 year program at Wits.

  • Basically there’s an entry point into 3rd year. You get to skip the first two years but you will need to have completed a degree first. There’s quite a complex selection process and entrance exam. Details on the course can be acquired here.

What is your average day like?

  • as a fourth year student, my mornings would comprise mostly of lectures or labs, it was quite rare to have afternoon lectures but they did happen every now and then, especially towards the end of a block. I’d be at Varsity Mondays, Wednesdays, Thursdays and Fridays. On Tuesdays I’d be in the hospital so it would be morning rounds, clerking patients, presenting to the registrar in charge then going to clinical skills in the afternoon.

Is medicine difficult?

  • Yes and no, There’s a lot of work to learn in a very short period of time. Each block is different, so you need to adapt really quickly. It’s a really taxing degree and requires a lot of strength. You will need to be disciplined and work hard. You’re studying to save a life one day, that is not something one should take lightly.

Do you have a social life?

  • What’s that? I’m kidding, yes I still have a social life, mostly with my classmates though because of the similar schedule and location of residence. I rarely ever see my other friends though, after your third year most of them graduate from their respective degrees, start working etc so dynamics change. It’s important to live a well-balanced life so having a hobby, playing sport and hanging out with friends is very therapeutic.

What happens after 6th year?

  • You become a medical doctor. You have to go through 2 years of internships at a public hospital (which you apply for in your final year). You’re the most junior doctor in a team of doctors, you go through different rotations and teach medical students if you’re at a teaching hospital. You then have to do a year of community service, usually at a clinic where you’re now considered a senior doctor. Once that’s completed you can choose to either specialize as a registrar or become a general practitioner.


This is based on my personal experience and conversations that I have shared with friends at different university.

FIN

It was an ordinary Tuesday morning.

9:15 AM on a Tuesday morning, a man in his mid 30’s is brought into casualties on a stretcher by 4 paramedics. Victim of a mob attack, he’s unconscious, has multiple laceration to the face and torso, possible damage to his cervical spine and a fracture on his right leg. There’s no registra on duty, she left 5 hours after her shift last night because of the evening patients influx after an accident on the M1. The other registra has been called off to another hospital for the week. There’s only two doctors in the wards; one is a second year intern who is now 3 hours post-call and the other is first year intern who started her rotation two weeks ago. A third intern has been called in from the surgical unit but he hasn’t arrived yet. There are too many casualties coming in that no one notices the 10 year old child who’s having a seizure in the corner or the crying mother with the 3 months old baby who has now become unresponsive. Sounds like the introduction to a Code Black episode right? sadly this is more or less an ordinary morning in the trauma and emergency unit at any large public hospital in South Africa. The lack of resources and the shortage in medical staff in comparison to the patients that require help becomes a reality you experience upon the early days of clinical exposure. It’s not a story that is told to scare us, it’s a reality. There aren’t enough healthcare professionals in the country.

But back to this ordinary Tuesday morning, a sigh of relief as the Nurse in charge notices us, “students, great.” She quickly calls us over, “Hi guys, as you can see we’re having a busy morning” she said before she started instructing us on what to do, “Can the two of you go help in administration and triage patients, can you follow this doctor and assist her” she instructed my friends. She then turns to me, “bad day to wear a white shirt my boy, follow those paramedics and assist the doctor with that man they’re carrying.”

Now I’m also thinking that it was a really bad day to wear a white shirt. I run off after the paramedics. “Here help us get him on the bed on the count of 3. Careful with his neck. Hi sir, can you hear me?” said the doctor in charge, let’s call him Dr. X. “What’s your name?” He says, looking at me, “okay, Yannick I need you to get me two bags of Balsol, ask the nurse over there to show you where to get morphine.” I did not completely understanding what he said, it was hard to concentrate; there was a lot of blood, I had never seen so much blood before. I run off to the nurse who helps me find the Balsol and morphine. As I return, Dr. X says, “pupils are reactive to light, he opens his eyes to and flexes away from pain stimulus, his speech is slurred and inappropriate. What’s his GCS score?” before he goes on to insert the drip. “GCS score, uhm I should probably say a number, any number” I thought to myself before guessing 7/15. “He saw right through that, he knows I guessed”, still thinking to myself. “No, it’s actually a 9/15, you need to revise your notes. A fifth year student should know these things” he says, looking rather disappointed. “I’m actually in fourth year Dr.” I corrected him, but deep inside I still felt as though I should have answered that right. He pauses for a second then says “Oh my bad, well today we’re going to treat you like you’re in fifth year. I’m gonna need you to draw blood, syringes are in the orange basket, after that you’re going to need to put a cast on his right leg, I think he might have fractured his tibia. I’ll suture his face while you put the cast on. I’ll talk you through it.” Now my mind is racing and my heart is pounding, I’m feeling dizzy and a little nauseous but I can’t  differentiate between a hypoglycemic attack because I had skipped breakfast or a panic attack. I’ve drawn blood maybe a handful of times, I have sweaty hands now, what if I puncture right through the vein, what if I get a needle stick injury, what if I precipitate the formation of a thrombus and kill the patient. Seeing the look on my face he says “You’ll be fine, I’m right here to help now get going, this man needs your help doctor”
I had been called doctor by my family members and friends, since before I had ever filled out my application form to med school. Somehow it felt different having this tired intern call me that. I followed his instructions, spoke out when I needed help and the rest is history.

I had learned two important lessons on that ordinary Tuesday morning; never ever wear a white shirt to a Trauma/emergency unit (I mean why would you?) and to always be prepared. That ordinary Tuesday was my first day of fourth year, I didn’t even know the ward we had been assigned to and while I was still on holiday mode, the patients I was suppose to serve that day needed the best version of me. There’s no days off, there’s no excuses, you can’t be slacking off; if you’re going to show up, you’ve gotta be ready, you never know when you’ll be the deciding factor between life and death.

FIN

Why medicine?

Why medicine? It’s the ultimate question and the simple and rather expected answer is that “I want to help people.” It can’t be the money, I mean we really don’t make that much for the work we do; but then again I don’t understand why there would be a simple or expected answer to such a question.

I was a sickly child, so I spent a lot of time in hospital surrounded by sick people, many of were often alone and scared. I remember going from bed to bed chatting to people and telling them that they’d get better and that everything would be okay. I kept getting in trouble with my grandmother because she kept telling me to stay in bed but I couldn’t help myself. From that grew an overwhelming passion to want to help people, even it meant that I got yelled at for it. As a child I remember being asked what it is I wanted to do when I grew up. My answer each time was that I wanted to make the world a better place, helping one sick person at a time. If people felt better than the world would be better too.

I was cute and innocent, but that sentiment remains true till today. Truth is that medicine is the perfect combination of all my passions. It’s where science meets art, facts meets faith. it highlights the imperfections of humans and yet promotes and teaches to never give up on them, it is the best representation of humanity. It’s a practice that encompasses my passion for people, my love for God, my understanding of nature and it excites my being. Let’s face it, medicine is awesome. I remember the first time I stood in the dissection hall, that first incision, that paralyzing moment, how could one feel so alive in the presence of death. How could one be so much, so complex and yet so simple. The human anatomy, I don’t understand how you could not fall more in love with what it is to be a human being. I remember my first interaction with a patient, I didn’t know enough to diagnose, let alone help her, but just talking to her and making her smile. I’ve never felt more in the right place. How could I ever do anything else. I want to be use as a tool by God to aid others heal, to bring life into the world, to guard and to serve that very life. I’d practice medicine even if I wasn’t getting paid for it.

So when you ask why medicine? It’s really simple but it’s not; I am medicine, Medicine is me. It is an extension of me, in as much as I am an extension of it. We’re in a love hate marriage, a complicated relationship but we’re definitely soulmates. We fused when we met and became one being; it’s my thoughts, my heart, my passion, my dream and my calling. So that’s why medicine.

FIN

My textbooks are racist.

Being a black male medical student (yes we do exist), you quickly realize that you’re not just there as you, you are representing your entire race and gender. One that continues to let you down in every way possible but you continue to boldly represent. Being a black male medical student, you’re continuously interacting with teachers and consultants you cannot relate to, not culturally, racially or any other forms of -lly. White consultants assume that you’re there based on a quota system and the few black consultants want to make you believe that you need to work thrice as hard to be worth standing where you are, continuously telling you stories of how hard they had it during their “time” and how we should be grateful to have it the way we do now. Both completely out of touch with reality I suppose, it’s 2016 I cannot be grateful to the fact that I’m given the opportunity to have these specific set of struggles, I need change and accepting things as they are isn’t something I think I can do. Being part of a group of about 30 black males in a class of 314 students puts your race and gender into perceptive. How did we get here? People look at you and applaud because it seems as though you’re one of the lucky few who have managed to survive this far in a system that is in no way designed for you. As though we should still celebrate being a minority in 2016.
In the spirit of peace and ignorance I had accepted this and learned to deal with it to a certain extent; accepted the pressure that it came with and the shock on people’s face when I tell them that I’m a medical student or when they see me walking around the hospital in scrubs or with stethoscope around my neck. The constant “you don’t look like a medical student” or the confusions that all my black female friends MUST be nurses, because there’s no such thing as black female doctor right? I guess this fits right into the #WhatADoctorLooksLike problem; there’s are some physical criteria and we either have too much melanin or two X chromosomes with too much melanin to fit in. I had learned to deal with the look on the face of a white consultant when I was able to answer a question my white counterpart could not. Learn to politely smile when they felt the need to compliment my accent by telling me how well spoken I was, something I had never heard said to my white counterpart, it almost as if as a black man, I’m not suppose to articulate my words right, my knowledge of the English language is suppose to be limited. As a black man, my level of education and intelligence isn’t measured in the degrees I may have, the distinctions I continue to get or my ability to reason but rather my ability to flawlessly speak the English language in an European accent. To walk in a ward without a name badge on and everyone automatically assuming that you’re a poor black patient & not a medical student or young doctor. I dealt with it everyday I was in the ward, seeing consultants continuously asking my white counterpart as to what we’re suppose to be doing because the possibility that a person of color could know what’s happening is beyond understanding. I had to learn to keep quiet and not take offense when subtle racist or sexist comments were made in my presence.

But it was when I felt this very racism in the comfort of my bedroom that I lost my ability to cope. Like a shock of white while reading my clinical examination textbooks in preparation for an OSCE; I realized there was a lot of descriptions on how to identify jaundice, cyanosis, xanthelasma, pallor, hyper-pigmentation and hundreds of other diseases presentation, but these descriptions explain how to identify these on white patients, the images in my textbooks were all of white patients. I stood there in disbelief, thinking maybe I’m overthinking this, I’ve been studying for too long I should take a break. My discomfort, however, was too overwhelming to ignore as I put down the textbook to quickly pick it up again and go through every image in it never once seeing a person of color.
This is the prescribed textbook by an African university, a textbook used to train African doctors for African patients, but it had no African images or descriptions, not once in the hundreds of pages that made the textbook. My OSCE will be conducted on black stimulating patients, the wards where I will spend the first 5 years of clinical exposure is made up of 99% of black patients but I’m not studying for black patients, I’m not being taught for black patients, I mean how would I ever identify any these on a black patient? The author of my prescribed clinical examination book must have never heard of sick people of color. Maybe black people don’t suffer from jaundice, maybe it’s a Caucasian thing, maybe we don’t suffer from anaemia, cancer or anything that has the ability to alter our appearances. Maybe it’s all infectious disease with us, maybe I’ve had this all wrong, nah it can’t be – I took to the google streets to confirm my curiosity.

Dear Talley’s and O’connor

Black, colored, Indian, latino, Asian people with jaundice, cyanosis, anaemia, and hyperpigmentation do exist. I’d be more than happy to forward you images I found online for your next edition.
Sincerely
a disappointed BLACK MALE MEDICAL STUDENT (yes, we do exist) forced to used your textbook.

DSM 5 criteria for Medical Student Disorder

Fast forward 18 months from my last entry to Block 11B (or Block 12). Psychiatry, I felt a strong urge to write something about it after having spent the last couple of days trying to understand the difference between delirium, delusions, dementia, depression, bipolar disorder, schizoaffective disorder, schizophreniform and schizophrenia all the while diagnosing myself a few times with each of the previously mentioned conditions. Psychiatry was pretty interesting, the lecturers weren’t the most exciting people in the world but at this point, anyone who gives off too much energy is annoying so I’m not complaining. It was a little too philosophical which was quite a new experience. I’ve learned a bunch of cool new stuff too though; like I finally understand what Alice Grey had, (Alzheimers) or why Rajesh Koothrappali can’t speak in front of women (persistent selective mutism). I can also say things like Pseudologia fantastica which is a really fancy way of saying pathological liar.
All in all 2016 has been a long year and it just doesn’t seem to want to end. People talk about the taxation of medical school all of the time, I hadn’t been able to fully relate to that till recently. I’ve been running on fumes for the better part of two months now. My studying efficiency has reduced quite drastically, having a hard time focusing, remembering things I’ve covered and I’m just always tired (I could sleep standing up tired). To make matters worst I’m having mini breakdown and anxiety attacks on the daily now. I get random tension headaches (yes I can say that now, I’ve covered some neuro) every second day so I literally have to continuously take pain killers because the traditional “take the night off to rest” is not an option right now.

In the mist of all this I’ve made what I consider a noble prize winning discovery. I have discovered a new mental disorder, I call it MSD which stands for ‘Medical Student Disorder‘. After almost two years in this place I’ve concluded that we’re all suffering from MSD.
It has an insidious onset, taking months to years to manifest, varies between people. It’s exacerbated by stress, sleep deprivation, constant studying and a bad coping mechanism. There are many risk factors but the highest is a successful application and enrollment into a medical school. Symptoms start off quite subtle; change in eating and sleeping pattern. Followed by exaggerated curiosity that turns into paranoia. The paranoia is manifested in the form of self-diagnosing and diagnoses of others with the rarest conditions. Every tall person must have acromegaly, every chubby person is suffering from Cushing’s syndrome, if they’re limping its Trendelenburg. In this block alone I’ve suffered from a bunch of psychotic, affective and personality disorders and such and such.
DSM 5 criteria for MSD requires one major and at least three minor symptoms;

– Major symptom – Be a medical student

– Minor symptoms;

  • self-diagnoses of every condition known to man
  • change in sleep pattern (insomnia or hypersomnia),
  • decreased or increase appetite,
  • abnormal relationship development (Naming a cadaver Sam and sharing your life drama with him in the dissection hall because he gets you),
  • desensitization (Thinking about having a fatty pizza for lunch while removing the subcutaneous fat from Sam abdomen’s)
  • social cognitions (difficulty to relating to normal people),
  • everyday you tell yourself you will get your life in order and everynight you tell yourself that tomorrow will be that day.
  • A random urge to binge drink (either before, after or during an exam).
  • Apathy towards your textbooks followed by intense guilt for not studying which you still ignore because you have apathy towards your textbooks.
  • Having an overwhelming amount of knowledge but thinking you’re immune to most pathologies (e.g. educating your mates at the local pub or the bartender serving about the effect of alcohol on the body while drinking your seventh round of the night).

It’s still too early in my studies on MSD  to confirm but I wouldn’t rule out signing all diagnosed patients to a mental asylum, I’m teasing but to be honest yes we’re all a little loco. We see the world in our own weird way – tell me this isn’t textbook psychosis.

FIN