Let’s GRADUATE together (Useful tips that have saved my clinical year thus far)

Here are some useful tips I've picked up on that have truly saved my clinical year thus far.

1. Take a deep breath, I know clinical years are intimidating but it is going to be okay. It's a new space, there's a lot of pressure and a lot is expected of you. But what you need to remember is that you are there to LEARN and learning means that there are going to be days where you won't know the answers, there are going to be days where you're going to make mistakes either with a patient or paper work, there are going to be days where your consultant is going to be annoyed with you. It's all part of the learning process. Some days you'll love medicine, some days you'll hate medicine.

2. No man is an island, for every rotation you go through thousands have gone through it before you. Put your pride aside and ask for help, ask which consultant, registrar, nurse or intern is very helpful and eager to teach, which textbook did they use, helpful resources, summaries, what was the exams like etc. I cannot tell you how many times just talking to my friends has calmed me down, motivated me and saved me throughout the last 8 months. 

3. Share! Your textbooks, your resources, your tips, your knowledge and your time. At any given time I'm chatting to a friend or colleague who's going through a rotation I've gone through before. Sometimes I get a little frustrated, I may be stressing with my own issues or struggling with my own work but I always offer help. A few texts, voice notes, emails, maybe meeting up and even tutoring them, anything is better than nothing. I know exactly what they are going through and the type of help they need, so if I can offer it, why not? I have a list of who has which summary or textbook of mine. I'm lucky to be on a bursary so they provide the prescribed textbooks for each rotation but what good is having an Internal Medicine textbook when I'm busy with Obstetrics and a friend is in Internal Medicine without one. So SHARE. Also your network isn't limited to students in your university or students in your year, make friends with medical students from all over. I'm always talking to the final years, I study with final year students because they're able to provide that insight and refer me to good summaries or notes. They can test me right there and can simplify concepts I'm struggling with.

Also share good series websites, eating out spots, movies to watch, events, hobbies etc.

4. Food, sleep, exercise and family/friends. You need at least a support system that is both an escape and/or a place you find motivation. Clinical years are busy and tiring, so always make sure that you're eating, even if it's a snack in between tutorials or seeing patients, EAT. Try to get some sleep, some days you've just got to clock out and postpone the reading to the next day, REST. Go for a jog, do some push-ups or go hard at the gym, it helps keep your energy levels high. It may seems as though you'll be using up the little bit of energy you have left but it actually has the opposite effects after a few sessions, EXERCISE. Spend time with your family and your friends (especially those who aren't in the medical field – don't hang out with people that are going to ask you about exams when you're trying to relax). My family loves hearing about my experiences, my crazy workload and they're always around to motivate me when I feel low, and believe me you'll feel low. So having a good and reliable support system is EVERYTHING. Especially when life outside of medicine starts falling apart, we unfortunately or fortunately don't live in a medical bubble, life happens and it has to go on.

I am quite a spiritual person so going to church, praying and reading the Bible is also a very important part of my escape list.

5. Find a mentor, I reached out to one of the current final years late last year. I just needed someone who had gone through it to walk me through it, especially right in the beginning of the year. She's been such a blessing, she's always available to help me out with information, cheer me up with random stories and remind me that I can do this when I'm feeling doubtful. She advices me on which material to use, approach to rotations etc. She's also the main reason why so many people come to me for advice because I've been learning from her since before 5th year started. She's good people and has my best interest at heart plus she's really smart so I trust her, even more than I do some of my consultants.

6. This may be a tad extra for some, but teaching one. One of the organization on campus asked me to conduct a GIT bedside tutorial for some of the junior students in third and fourth year a few weeks ago. It was a really amazing experience; the benefit in this is that you find yourself a leader's and teacher's position, it forces you to be on top of work, it's great for revision and it also allow you to remember or be taught a few concepts you might have forgotten from the junior years from the students you're tutoring. It's such a fulfilling feeling when you can see them understand a tricky concept simply because you've taken the time to explain it. It's a really worthwhile experience, shout out to Wits BHPA for putting together this initiative.

No man is an island, let's graduate together.

I am yours and you are mine (A letter to my unborn child)

I thought I had discovered all the different forms of love until you. I thought I had felt the purest form of joy until you. I thought I knew what life was about until you. You're nothing more than a seed tossing and turning making your mama sick and yet you already mean the world to me. We were never ready for you but we are over moon now that we know you're coming. Never in my life have I felt the need to be better then the way I do now. I'm already in love you and you're not even a person yet.

I am yours and you are mine.

I don't know why but deep down I know that you're a girl, maybe I'm just hoping but it doesn't mean I'd be any less excited if you were a boy. I hope you have your mama's eyes, nose and forehead. I hope you laugh, give and share just like her. I hope that as I look at you grow as a small bump on her I'm able to appreciate that it's our love that has been conceived. I swear my heart skipped so many beats I thought it stopped when I first heard yours.

I am yours and you are mine.

I've been talking to God about you everyday since we found out about you. I'm terrified by you, I'm afraid that I may not be the best father as I may lack the example and so I've been praying; asking God to teach me patience, resilience, understanding but above all things to teach me love. I pray that you're okay, that you're healthy and I pray for your mama too. I pray that you may inherit both our graces and that the Lord's angels may never leave your side. And as you grow inside the womb so does the love I have for you. 9 months is too long, I wish you were here now.

I am yours and you are mine.

I've been talking to your mama about you, we discuss what your name will be, who you'll look like more and all the things we need to get for you. We discuss how much we love you and how we can't wait for you. She still makes fun of me for crying the day she told me we'd be expecting you. She's a little jealous because we both agree on how much like me you are, all her new cravings are my general cravings and I laugh at the fact that all of a sudden she cannot eat what I don't eat without throwing up. She's feeling a little self-conscious though because you're making her gain weight but she loves you, sometimes I think even more than I do. To be honest I'm a little jealous that she gets to spend her every moment with you, even with the morning sickness and cramps, I'd give anything for that.

I am yours and you are mine.

I talk to you everyday which is funny because you're still but a cell growing in your mama's womb. Everyday I tell you that I love you. I can't wait for you to show me who I am, I can't wait to hold you, I can't wait to look into your perfect eyes and discover the meaning of life. You are my blessing, my gift and I'm already so in love with you. I can't wait for you to wrap your fingers around my thumb and change the person I am forever. I can't wait to have you fall asleep on my chest, I can't wait to be woken up by you at 3 in the morning. I can't wait for you to cry for me. I can't wait to see God every time I look at you.

I am yours and you are mine.

CONVERSATIONS

I had a conversation with an old friend. The more we spoke the weirder it felt as we realized how close we once were. She once knew everything there is to know about me, I was an open book with her, I shared all of me never doubting or second guessing myself. Never in my life had I felt so free, so real, so safe and so naked. She knew me better than I knew myself, she understood my fears, guarded my dreams and kept my insecurities secret. She was my safe space and my escape.

As I stood there remembering all of the things she once meant to me I just couldn’t recall why we had drifted apart so much, it couldn’t be distant. I couldn’t recall why we spoke less and less, it couldn’t be that we ran out of things to say. I couldn’t understand why we both had our guards up, I couldn’t understand why I felt the need to protect myself from someone I once considered my protector. What had happen to us? Who did this to us?

As I questioned her, she paused in confusion wondering why I couldn’t remember. They did, she said, they broke us; first into 2 pieces than 4, then 8, then 16 etc. They lied to us, they used us, they abused us, they cheated on us, they manipulated us, they disappointed us time and time again. And we allowed them, we allowed them because we wanted so badly to see the best in them, we allowed them because they made us believe that we couldn’t be without them. We allowed them even though we knew better. They broke us and when they tried putting us back together the pieces just never fit quite right. What made it worse was that after every shatter, pieces of us got lost and no matter how hard they tried they just never managed to recover it all.

We haven’t been together since and that’s why you haven’t been yourself. Look how doubtful you’ve become, listen to how paranoid you now sound, this isn’t you and it was never intended to be. The saddest part isn’t that you no longer believe in them but you’ve also stopped believing in you. You’ve stop believing in what you could bring to the table, in what you could achieve, in what you could become. Even though I hadn’t seen her in awhile she made so much sense and provided a clarity I didn’t even know I needed. I asked her could we be together again? how we could be us again?

She told me that I needed to realize that it is more about me than it is about them. They can’t heal us not even with their effort or honesty, only I could heal us. Although there’s no secret formula to finding my way back to her. Forgiving them and more importantly forgiving myself for allowing it to happen, learning to prioritize and take better care of myself would be a good start. This will take time and effort. I would need to step out of my newly found comfort zone. I would need to stop using her as a protective mechanism, stop using her as an excuse to hold back. For as long as I have human interactions we will be tested, we will be stretched and maybe even broken again, I will be hurt and disappointed but I need to learn how to differentiate between who’s worth us and who isn’t. Find faith, find insanity and find courage then I can come find her.

“It isn’t unfixable, yes it is going to hurt and yes it is going to be feel uncomfortable. I know that she hurt you and she hurt you and he hurt you and she hurt you again but she came back and he apologized. She begged you and he tried making it right. Life will hurt and disappoint you but it doesn’t mean you should stop believing in the journey. Humanity is flawed but no man is an island, find me my friend, find me.”

My friend’s name is TRUST and I didn’t realize I had lost her. I needed to trust Trust before I could learn to trust anyone else.

TRUST | FIN

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