I think I've got it all figured out!

Okay, so a big claim to make... but at times, amongst the choas and confusion that comes with having to make a million and one choices about life, career, holidays, etc, there are moments (probably short-lived) when one feels like they've got it all figured out.

For starters - application for medical internship positions in NSW opened yesterday. It's been a horrendous task deciding how to preference the 15 or so networks on offer because really, at the end of the day, you could end up with preference 1 or preference 9 (for the past 3 years 100% of first round allocations were within the first 9 preferences). So you have to be realistic about deciding which places you'd be happy working in, even if they're not your first preferences. I chose to preference based on geography (hospitals close-ish to where I live), but also taking into considerations places that have accredited vocational (specialist) training programs that you're interested in. At the end of the day, I wouldn't be thrilled getting preferences 7, 8 or 9, but it wouldn't be the end of the world either. I haven't put in my official application yet as I need to get a letter from the university confirming my enrolment and potential graduation status, so hopefully will do that in the next couple of weeks. Beyond the anxiety and stress of this completely random allocation system, it's so exciting to be applying for a "real" job (and really, for me this is the first job that I have applied for since getting my job at the pharmacy 10 years ago!).

Next up - thinking seriously and realistically about specialities. Still a bit early, but it does help to have an idea as it could influence where you preference higher for internship hospitals (ie some hospitals have better a reputation than others when it comes to certain specialities). So I've been going backwards and forwards between emergency medicine and O&G; but since starting my anaesthetics rotation 2 weeks ago, I've disregarded both!! Anaesthetics is it, really I just know it! A few years ago, at the end of my first year of medical school, I went on a 2 week elective to Fiji where, while on a surgical rotation, saw anaesthetics in practice for the first time. It was then that I thought anaesthetics could be for me; but with little exposure since, I hadn't really considered it to any great deal. Having just finished gynae surg in the rotation prior to this, I'm now fair sure that at least the G part of O&G is definitely NOT for me. I was so disinterested and just plain bored by the end of the rotation; even though I applied myself as much as I could (I really did!!).. but it got me thinking and moving away from O&G in light of this. Also didn't help that I went to Phuket straight afterwards, which then got me thinking even more about how much I value my holidays and travelling, that I truely appreciated how offensive a career in O&G would be to one's leisure time :-S Anyway, this rotation couldn't have come at a better time. It's been priceless having consultants and registrars on board to talk to about the training program and what is involved in the way of time commitments during and after training. Also the rotation itself has been a good mix of the practical and theoretical. I got my first ET intubation this week! I tried 3 times without success but can now proudly say that I have done a few (4 in fact!) successful intubations. I've also gotten some invaluable practice in other skills (more essential for an intern) such as supporting an airway and ventilating in the correct way using jaw thrust, sealed mask and bag; as well as some much-needed practice in cannulating. Between cases, my supervisors have all gone out of their way to give me tutorials on the basics of anaesthetic theory which have helped demystify what is otherwise a potentially complex area of medicine. I wish this rotation was longer than just 4 weeks - I would love to go into greater detail with the theory and learn new skills.

This brings the third area which I've (sort of) finally organised - my elective term. It'll be my last elective as a medical student, I always thought I would go somewhere totally out of this world; picturing in my mind an imagine of my hands buried elbow-deep in someone's open thoracic cavity, heroically performing a cardiac massage (I have no idea where I even got this image from - I don't even want to become a surgeon let alone a CT surgeon!). Lots of people from my year are going to Africa, some even braving the likes of Bara in Jo'burg - but now that it's come to it, I've found myself not really that ready or compelled to take on such an adventure. So I thought long and hard (well, not that long and hard as you will see) and have decided to return to Fiji one more time, to where it all began, and complete an elective in anaesthetics - this time with a little bit more knowledge and wisdom than last. I'm very excited actually, it almost feels like a home-coming. I made a lot of friends and met some wonderful characters when I was there last, so it will be nice to see them all again. Another thing, this time I plan on travelling around and experiencing Fiji culture away from Suva. I've set my sights on booking a 7-night diving trip with Tui Tai expeditions, to venture out away from the tourist tracks that tend to be quite numerous around Fiji.

Anyway, much to look forward to! On a toned-down note - I have a mid-year exam in about 10 days that I have done absolutely no study for. So on that note I will leave you, and probably check back in again before I head off to Mudgee for my third John Flynn Placement.

Review: The Pavilions Phuket

Several weeks before departing for our week-long vacation to Phuket, one of my well-travelled mentors at work gasped at horror that I would want to venture anywhere near the well-beaten tourist track that is Phuket. This made me somewhat apprehensive before our departure; but luckily all this melted away (making room for some much needed rest and relaxation) within minutes of arriving at The Pavilions. Perfectly situated somewhat north of the island of Phuket, it is well-clear of the chaotic touristy areas surrounding Patong Beach - but relatively close enough of a commute if you still wanted to go there. Also, this hotel does not cater for families with young children which - and don't get me wrong, I love kids! - makes it an ideal setting for those looking for a spot of tranquility and maturity that only a child-free setting can provide.


Our Villa was wonderfully spacious, very well-appointed and tastefully furnished. We had an infinity pool with breath-taking views of the ocean and the weather was perfect for taking a dip any time of the day or night! The open-air breakfast lounge provided an amazing soul-lifting back-drop to enjoy the very tasty breakfast each morning. Although not as extensive as your average 5-star hotel breakfast buffet; each item had been thoughtfully selected, providing guests with a "best of" range to choose from, with the main items (e.g. eggs, waffles) offered from an la carte menu and thus made fresh to order. The French toast and green mango smoothie made a particular impression on this foodie's tastebuds! We ate at their signature restaurant 360° twice - again, spectacular views of the surrounding hills and ocean provide a wonderful ambience to sample a fusion of traditional and modern Thai food. Other culinary delights of note are the Pavilion Platters that can be ordered to your villa to enjoy as a snack by your pool or on your sun lounge - we tried both the Savoury and Chocolate Fondue Platters and highly recommend both!


I also tried two of the spa treatments: a traditional Thai massage and an Aromatherapy Oil massage - both of which sent me to a completely different, blissful place; I cannot even find the words to portray the experience with justice! Le sigh!

The staff at The Pavilions are extremely professional and discreet; but still manage to genuinely portray the hospitality of Thai culture with their warm smiles, greetings and interactions such that one feels like they are returning home every evening, rather than as a guest.

In conclusion, a word or two on Phuket as a destination. It's easy to see how a well-travelled continental drifter may view Phuket as a predictable destination, not worthy of exploration - particularly if you do go to areas that are jam-packed full of tourists and families that have obviously come on one of those "kids stay, eat, and play for free" budget holidays (nothing wrong with that at all - just company who may not be to everyone's taste). I will be the first to admit - we came to Phuket specifically knowing that we would get more for our dollar than travelling virtually anywhere in Australia - and would be able to stay in luxurious accommodation at a fraction of the cost. Herein lies the challenge for you as a traveller, to create your own unique experience away from the beaten track. I believe that staying in a boutique hotel away from the main tourist areas, like The Pavilions, will serve an ideal setting to help you appreciate this beautiful part of the world. I also highly recommend hiring a car and Navman while you're there to get around - it's so easy to drive here and it means you're not tied down to doing set day-trips with tourist companies. Drive to a fishing village to meet the locals; or have a picnic on a secluded beach - the staff at The Pavilions are more than happy to give you directions. Another activity that I highly recommend is learning how to scuba diving and taking a diving trip out in the Andaman Sea - there are some gorgeous diving sites, the water temperature is warm all year long and the big bonus of course, there will only ever be a handful of other people joining you on these trips!

Scuba diving

This weekend and last, my dad and I completed an Open Water Scuba Diving course. This is something we've both wanted to do for a long time, but I've kept putting it off because of time constraints, plus I had an inkling of reservation about the (lack of) sense and sensibility involved in plunging oneself deep into the vast, vast sea....

Anyway, at the end of last year, while on holiday in Jordan's coastal town of Aqaba (on the Red Sea), we took an excursion on a submarine boat with a glass hull that allows you to have a sneak peak at what lies beneath in the comfort of a dry and controlled environment. The submarine boat passed by a group of scuba divers on its course and I remember thinking to myself, "Far out, that's where the real fun and adventure are!!". It looked so free and liberating that I resolved to get my diving licence the first chance I got.

Watching divers from inside our submarine boat in the Red Sea, Aqaba Jordan

We booked with ProvDive in Coogee literally the week before starting the course as they had a one-off half-price offer. We were given a book and dvd to work through before starting the course - I found it really quite useful and informative learning about some of the theory of diving principles before even trying it; and the prac components made sense quite easily after that. We hit the local swimming pool for our first session in scuba gear to familiarise ourselves with some important safety elements like how to breathe using the scuba system; finding your regulator (breathing device) if it falls out of your mouth; sharing air with someone using the second regulator if you or they run out of air; clearing your mask if it fills up with water while you're under, etc. It was weird at first, that's for sure! Nothing was difficult per se, just a matter of adjusting your body, equalising pressures, and the number one rule: remembering to never stop breathing!!

Our first open water dive was out at Gordon's Bay last Sunday - I couldn't have picked a better day or site for the occasion. The weather was absolutely gorgeous both in the water and out; and the visbility was a fair 20 metres or so. It's difficult to describe the sensation in terms other than "like flying through water". I was warned by the guy who booked our places in the course that it's an addictive hobby - I can vouch for that! It was just as I imagined it would be and better. The silence, tranquility, and sheer beauty of the underwater world made me feel so calm and at peace; corny as it is, I kept humming Nina Simone's "Feeling Good" in my head.

Gordon's Bay, Sydney

The other thing that I loved was the commraderie among our team and enthusiasm of our dive instructor. There were nine of us in total: my dad and I; a law student about my age and her mum; a cute young Ukrainian couple; a cool surfy couple and a guy of New Zealander Maori background who wanted to learn to spear fishing while diving. We all came from different backgrounds; but between us a common desire to travel and explore the world around us, epitomised by our dive instructor - a young, hip Danish guy who left home in his twenties to travel, got his diving instructor's qualifications, and never made it back to Denmark. Le sigh! The life of the young and free! I mean, I'm young right (turning 25 this year); but by God, let me just say that the further along medical training I go, the more restrained and tied down I feel. Once upon a lifetime a ago before starting medical school, I just wanted to travel, drifting from place to place - taking my skills with me wherever I went. I was always going to be either a teacher, doctor or nurse for this vision to work; as these professions would equip me with portable skills that are universal across all borders. Fast-forward to the reality that is medical training and my prospects of continental drifting any time in the next 10-20 years are looking quite grim. I'll leave a complete and unabridged rant on this topic for another day; but let's just say, although I thought I could rise above and conquer this long-held silly dream of mine, it's getting the better of me and I am presently giving a lot of thought to what I'd like to specialise in based on it. Anyway, another thing I was also quite surprised by, was the inclusiveness and unpreteniousness of the diving community and their culture. They genuinely want people to learn to dive and be excited about the underwater world - and it's not financially driven either. When the costs of equipment, staff, insurance, licencing, etc are factored in, I doubt much if anything at all is made on leading a diving trip or teaching a "learn to dive" course. I could explicitly spell out a comparison to the culture of the medical community at times; but you all know where I'll go with that one. Hmmm...

So after our first weekend of diving, this weekend couldn't come sooner. We had another geat couple of dives, this time out at Camp Cove. The weather this weekend was a bit miserable, but when you're underwater, you're going to get wet anyway! We finished our course and I have to say I was sad at having to say good-bye to my diving buddies. Le sigh, such is the nature of transient friendships; but who knows, it's a small world and our paths may cross again on day, on land or in the sea.

As for my dad and I; our holidays have just gotten all the more exciting and fun!! Our first chance to put to practice some of our newly acquired aquatic skills will be this upcoming week. My mum, dad and I are off to Phuket for a week over the Easter long weekend and I can't wait to get into the water and check out some of the amazing tropical reef and sealife up there. Hopefully will get a chance to take some photos while down there too! In closing, I'm going to highly recommend y'all get out into the water and try diving for yourselves. You'll be amazed, I promise!

Break-it-up

I have a load of uni work that is quickly piling up into a mountain. 11 weeks into the (17-week) semester, I'm thinkin', "crap! what have I been doing all this time?!"

Doesn't help that, mentally, I just want to cruise through this year and put in the bare-minimum of effort required to scrape through. Still, it's dawning on me, "scraping through" still requires public health assignments to be handed in; journal club papers to be presented; and short-cases to be reviewed. Urgh!

One of the habits I've had to get back into practicing, is breaking tasks up into bite-size chunks, and chipping away at a seemingly overwhelming workload one bit at a time.

God that I wish for this year to pass painlessly! Pleeeease!!

In other news, today as I was walking to the train-station, I found myself becoming a nosy-onlooker at the scene of a car vs pedestrian accident. I watched with much apprehension as the ambos scooped up this poor semi-conscious woman (who was just innocently minding her own business, crossing the road at a pedestrian crossing, as you do..) and whizzed her off to hospital. I considered for a brief second running back up to the hospital (I assume they would have taken her to my clinical school hosp; which was only a few hundred metres from the scene of the accident); checking out her management in the ED and seeing that she was okay. But the sight of the pool of blood that was left on the road from her open head injury made me feel quite queasy.. and honestly, I decided that I preferred not to know the outcome, if there was a chance that it was going to be a bad one. *Shudder!* Anyway, I now have a renewed sense of utmost respect and admiration for ambulance officers.

Okay, enough said - time to hit the books!

Inspirational: Dr Susan Downes

I came across Dr Susan Downes' story as I was browsing the net this evening, searching for some career inspirations (as you do). She is a GP-Obstetrician who delivers services across a huge expanse of land in Western Australia (extending as far out as Christmas and the Cocos-Keeling Islands in the Indian Ocean!!).

The following is an article that was featured in Medical Forum WA Magazine (April, 2006). I hope you enjoy reading about her story and find her work as inspiring as I do!


Multiskilled - Dr Susan Downes
Written by Mark Thornley
Saturday, 01 April 2006

They say the genes for multi-tasking, negotiating skills, spatial awareness and acceptance are carried on the X chromosome. Dr Susan Downes is living evidence of these inherent skills, plus more, having pursued a varied career in primary health care while raising three children. Her ability to thrive on diversity, adapt, and break down boundaries has positioned her as an every day pioneer in primary care. Susan was a wide-eyed epidemiology research assistant before she took up medicine at the age of 35. She has excelled since, undaunted by family trauma, and this year her remote GP work in the Pilbara and on Christmas and Cocos Islands earned her the General Practice Prize for Excellence in Population Health, conferred jointly by The Public Health Association of Australia and the RACGP.

Dr Susan Downes on her RFDS run

A self confessed travel junkie, Susan has always had a curiosity for new cultures.

"When in London I was working with many epidemiology doctors who inspired me with their stories of different countries and cultures. One in particular had worked in New Guinea and told me how he had to do a caesarean on a tribal chief's wife who had obstructed labour with twins."

"The tribe was cannibalistic and he was thinking, ?if this doesn't come off, I'm on the menu for dinner'. He'd never done it [a caesarean] before and was reading the medical book and was on the pedal radio trying to get instructions."

Flicking through an international medical journal and drooling over jobs for medicos in exotic locations, she decided to enrol in medicine as a mature age student.

Her actual medical career began as a family GP in Fremantle where her strong connection to people meant it was not long before she knew the names of her patients' budgerigars and was "burying their grandmothers".

The multicultural Fremantle mix of Greek, Italian and Portuguese provided a solid grounding for her transition to the Rural Women's Female GP Program that now sees her consulting Malay, Chinese and Muslim communities throughout Christmas and Cocos Islands.

"I felt I was becoming a bit narrow in the suburbs and just filling out forms and sending people off for blood tests. When you're out in the sticks you're doing everything yourself. You're reading your own x-rays, and doing your own bloods and ultrasounds."

She now incorporates Chinese medicine and Aboriginal bush medicine into her consulting, where she can. She thinks any GP who takes on a rural locum might regain some of their inspiration, especially away from bureaucratic hoops.

For example, she recalls one confronting incident on Christmas Island, which is so remote even the Royal Flying Doctor Service cannot attend patients unless they charter a special plane.

"We had a fracture-dislocation of the cervical spine. No plane could come and the paralysis was getting worse as we watched him. A community plane that used to go to Jakarta happened to be on the island so we took the seats out and a nurse and I got on with the patient and the pilots, and set out into the Never Never and flew to Perth via Learmouth in the dead of night. We really felt we weren't going to make it but eventually we got the patient there and he went into theatre straight away and is now walking."

Susan has been attending the health needs of adolescent Aboriginal women in the desert communities of the East Pilbara for five years. She visits these communities for 2-3 days every two months where she confronts sexually transmitted infections, unplanned teen pregnancies and cervical cancer.

To do this she must gain the trust and confidence of these shy groups of women, where she helps deliver education programs at medical centres, schools or even creek beds and swimming holes.

By preventing STIs, future infertility and its expensive solutions are greatly reduced. By encouraging pregnancy-free years, young Aboriginal women mature physically and mentally and attain higher levels of education.

Susan's involvement as Liaison GP at Woodside Maternity Hospital has ensured the hospital's status as the last inner suburban hospital to retain a thriving public obstetric service run by GP obstetricians. Deliveries have risen 12.5% and she assumes a senior role in a team delivering over 700 babies each year. Susan now performs her own caesareans and can offer the full obstetric service in remote locations such as Derby where she does obstetric locums.

Twenty-one years after entering medicine, she had recently completed an obstetrics research project and hopes this, plus her work with the WA Centre for Rural and Remote Medicine, will help others providing obstetrical services in remote communities.

Enjoying bush walking and bee keeping as hobbies, she has a long term goal to work for Medicine sans Frontiers or Oxfam - when she gets enough money in her super fund.

(http://www.medicalhub.com.au/, accessed 30 March 2011)


I'm trying to locate her contact details so as to send her an email and ask if I can do an elective with her at the end of the year! Would be amaaaazing!!

Full-time all the time

Random rant that I feel strongly about, so just put up with me for a few minutes here.

Dear Stay-at-Home Parents (who think that only they can exclusively call themselves "Full-time Parents" and feel that they have the hardest and most important job in the world),

I'm sorry to break it to you, but you don't. In fact, you only have half the job that some others do. Because - believe it or not - parents who participate full-time in the workplace, do not come home to part-time parenting. No, in fact, they come home to full-time parenting: the same job that you do all day, they do when they come home. So they essentially have two full-time jobs. It's called "Time Management".

I understand that you may be frustrated by the lack of recognition and financial reimbursement of full-time parenting, but here's the thing: it's even less valued and recognised as an occupation if you are a full-time participant in the workforce, because there is the assumption (by a select few) that you cannot be a full-time parent AND a full-time worker. So they take claim to the title of "Full-time Parent" and take it to define only those who do this exclusively.

Oh, and another thing, if full-time parenting was financially reimbursed - I bet you anything that parents who are also full-time participants in the workforce would be excluded from that payment. And you'd all be okay with that. So go figure.

Anyway, just putting it out there for the next time someone starts giving me their spiel about how exclusive full-time parenting is "the hardest and most important job in the world".

End rant/

GAMSAT Version 2.0 and "meh" talk

Weekends always go so quickly. What's with that..?! I had a very bizarre experience this weekend. I did St John First Aid duty for the GAMSAT exam (Sydney Venue). It was so weird right. Last time I was there was four years ago when I was sitting the exam myself. It's funny how even the memory of a high-stress situation can provoke the same sympathetic response as the original event. I so vividly remember not being able to sleep the night before the GAMSAT - I kept dipping in and out of consciousness, checking the time on my mobile phone next to me every half an hour for fear of sleeping-in and missing the damn thing. Not to mention the drum-roll palpitations on entering the exam hall. It's such a b*tch of an exam and I honestly see no correlation between passing the exam and success in medical school. It really is just a high-attrition tactic to wipe out > half the med-school hopefuls so that the bureaucrats and admin people don't have to deal with the effort and paper-work of going through all the potential applications that would come through. Meh. Anyway, thing of the past, can comfortably put it behind me and was oh-so-very relieved to be there as a spectator at the Australian Technology Park in Redfern (venue where the exam is held) this time.

On the med-school front, I finished my rotation in Neurology last week. It was a really good rotation; made all the better by the team I was with and my supervisor. I definitely could have been more pro-active and involved, but I seemed to always find the temptation to go home after lunch too strong to resist. So basically I'd attend ward rounds in the morning; then tag along with the registrars on their consults (usually in ED); there would always be a meeting of some sort that was worth attending (especially the radiology ones where they go through scans of patients on the wards); some days there would be a clinic on in the morning or afternoon; and the rest of the time was spent seeing patients on my own or with another student. I tried to see at least one patient a day and do a long-case type assessment of them. Sometimes the interns would ask us to take bloods or put in cannulas which I'm a bit over doing now because the novelty has worn off, from doing so many last year. Anyway, there were four medical students on the team - one of whom was a bit annoying because she would always hang around until really late into the evening with the team. She's interested in pursuing Neurology as a speciality, so I understand that she wanted to get as much out of the placement as possible; but still, it made us all look unmotivated and less-than-keen. It was a bit frustrating too because she would never explicitly answer my questions on what she would get up to in the afternoon/evenings when we weren't there; so it was hard to gauge whether it was worthwhile staying behind or not. Of course we could've just stayed behind ourselves and found out, but I don't know that it would have really been useful as most of the activity seemed to happen during the day, and she would always slip off and do her own thing anyway. Meh. I'm sounding a bit like sour grapes now, so I'll stop. I am actually happy that she's thrown herself into Neurology. Two reasons: (1) every speciality and its patients deserves to have a keen-bean enthusiast who will throw themself into their work - these people turn out to be the movers and shakers of the specialy; (2) last year she was set on pursing O&G, so she would have made some very stiff competition if we were going for the same registrar-level training position. Okay, official freak of sour-grape I am today - will stop! So, um, yeah.. I always assumed I'd fall into a career Neurology myself, because I have a degree in neuroscience - so it seemed like a natural progression. I have to say though, the fascination and general awesomeness that drew me to the theory of neuroscience back in my undergrad days; is numbed by a sobering overtone of helplessness when it comes to the actual clinical practice of Neurology. There really isn't much that can be done for a lot of patients under the Neuro or Stroke-Unit teams, curatively - with the majority of management aimed at stopping disease progression or rehabilitating the body back to a functional state, post-event. The true hero(es) in my eyes, are the clinical research teams that are working on preventing and/or curing neurological diseases. I hope that I can see their effect of their studies in my life-time. It really would be an amazing contribution to society.

Tomorrow I start the last of my medical/surgical "selective" terms - Gynae Surgery. I had initially been timetabled for Haem Oncology, but I heard it was a fairly average term to do as a med student, so I swapped out of it. The person who was assigned to Gynae Surg has no interest in this area at all, so she was happy to take anything else. I'm thinking again about going into O&G, so I guess it was a win-win situation. I've heard the supervisor for this term is really nice, but he grills his students on their knowledge of the anatomy of female reproductive organs. So I spent like maybe half an hour (if that) trying to memorise the ligaments that hold various different things up and stop them from falling, if you get my drift. I think I'm okay getting grilled for the first week, and then getting the swing of things by the second week, because I'm honestly finding it too hard to just stare at diagrams of the uterus and ovaries without a clinical situation to slot things into context.

Anyway, it's now midnight and I'm wishing I had more weekend time to catch up on sleep, chillax, watch some DVDs and do some uni work. Meh.