Remote and Rural

I forgot to say, I’ve applied for the Remote and Rural option for 4th year. If I get it, it means I’ll be spending the whole of next year in Inverness.

I got an email on Friday telling me that I would find out if I had an interview for it this morning. Interveiws will be held tomorrow, which is a fine bit of notice since I need to travel back to Aberdeen for it. I need to travel back to Aberdeen from Inverness to be interviewed by people who have travelled down to Aberdeen from Inverness specifically to do these interveiws. It’s madness.

I’m getting very twitchy. I wish they would hurry up and let us know.

Complex regional pain syndrome type 1

I apologize for the lack of posts over the last few weeks. I was trying to compose something decent to fill you in on what I’ve missed, but really don’t have the motivation right now. My flatmate has just come home with a couple of friends and put some music on. It’s 11pm and I really want to sleep, but I just feel a bit shit. I hate to moan, but I equally hate feeling so up and down without telling anyone. I have been feeling slightly sick almost all day. Sort of a background of indigestion overlaid with the vague notion I would like to vomit. It peaked after meals and fell away as time went on, but was ever-present. I was still hungry and still ate three times, even if that did make it worse.

I had a second pointless visit to my community course patient this morning, so I had to get dressed up. It wasn’t a chore, she was very nice, just didn’t really have much to tell us. Then a couple of lectures in the afternoon from a doctor who had very fun slides, but a distinctly un-fun lecturing style. Admittedly it wasn’t the most riveting of content, but I found his voice pretty soporific. The two best bits of my day were both jammed into the space between 4pm and 6pm. I finally got the cheque from the girl who drove into my car in the hospital car park, which means I will shortly not be driving round with a huge dent the size of New York in my car. And then I had coffee with Becky. It was nice to geek out for a bit, I mean, in the grander scheme of things, does it really matter which theatre is the emergency theatre? Probably not, but it’s fun to delve into the (at times barely functioning) system that keeps our hospitals running from 5pm Friday to 8am Monday. I sincerely hope that living together next year will let us spend more such ‘quality’ time together; hell, we might even talk about something other than medicine, although it seems unlikely, there’s still a whole lot of that to cover. I always come away from our coffee meets enthused about medicine; they’re good for me. Then of course I came back to the flat and had a huge revision slump, so instead I had dinner, felt sick and spent 45 minutes wrapped up in my duvet on the sofa watching Star Trek to cheer up again. Like I said, up and down kinda day, like the weather.

Serendipity

So I’m ironing at 11pm, as you do, and my flatmate gets back from work. He goes into his room to change, and shouts through to ask, “How’s life?”

“Fine,” I reply.

“What are you going to do when the lease expires here?” he enquires, quite out of the blue.

Serendipity: n. The faculty or phenomenon of finding valuable or agreeable things not sought for.

I did not intend to discuss this until I had a firmer plan for where exactly I was going to live next year, but I could hardly lie and say I wanted to stay, when in truth I was actively planning moving elsewhere. So I simply told it like it is. “I’ve got a couple of other places in the pipeline,” true, I have 2 options right now, “other medical students, you know.” Turns out Jason intends to move when the lease expires too. He wants to go further north, towards his work. I want to go further south, towards the hospital. So, now I have my two choices, both better than here, but neither exactly perfect.

One is probably a good idea, it has a fair chance of working. The other is probably not a good idea, it could go either very well, or very badly. I don’t know if it’s crazy enough to work. I have a rule of thumb: when life gives you two choices, take the riskier path with greater potential rewards. That is what I would like to do here, I would like to be able to say, “to hell with the risk, I’m going to try.” But I don’t think I can, not yet. I’m not reckless enough.

I know what my parents would say. I know what my friends (the sensible ones at least) would say. I agree with them. Why then do I keep having the same though, “but what if it did work?”

This blog

I would like to share with you, my readers, some thoughts I’ve been having about the future of this blog.

When I set it up, it was always meant to be a medical student blog. All the other blogs I read, nearly 40 of them now, are medical, with only a couple of exceptions. It is from them that I got my inspiration, and my desire to write one of my own. In fact, I’d like to share with you how I discovered ‘weblogs’.

The very first blog I found was Random Acts of Reality, by Tom Reynolds. I can’t remember what I was searching for, but I came across it and started reading. I’d never encountered such a thing before, I didn’t know what it was or that there were so many out there. How ignorant I seemed then, looking back on it. I don’t really know how long it’s been, but I checked some posts from back in 2003 and I remember reading them, I might have gone back though the archives though.

From there I found I Am Not a Drain on Society and The Paramedic’s Diary, both excellent, if very different. Then it just blossomed exponentially. You can see my eight favourites over in the side bar. I cannot move on, however, without mentioning Trauma Queen, written by Kal. My absolute favourite blog, written by a Paramedic (EMT until not too long ago) in Edinburgh. Everything is beautifully written, interesting and overall a joy to read. It’s funny how if you read a blog for long enough, you feel you know one side of the author so well, but there’s still so much you don’t know about that person. It always brings a smile to my face when I remember that I read TQ for more than 2 years before I realised Kal was gay. I mean, it’s not like the (old) pink based colour scheme and the word “queen” in the title was a give-away or anything. I wasn’t until I read Flitting, with the phrase “there were some vile gay jokes thrown at me”, that the penny dropped. Live and learn, as they say.

Back to my own blog; trouble is, I’m only a first year. It’s not like I’ve got many medical encounters to talk about. I can count on one hand the number of patients I’ve met since I started Jedi school medical school (my iPhone auto-correct replaced a misspelling of ‘medical’ with ‘Jedi’, I thought it made for an amusing typo). The sorry truth is, I saw more patients, and spent more time talking to them, when I was on my work experience in hospital than I have since actually becoming an official med student. I guess back then I was something special, I was a potential student, I had to be encouraged and nurtured so I would ultimately choose to take the plunge and study Medicine. Now I’m locked in to it, now I’m just a nameless, faceless number, part of a bigger institution that has to be tolerated, but not necessarily liked. Incidentally, I’m more than just a number, I’m two numbers! There’s my exam number, currently 73, but it’ll change next year. And there’s my student number, but I think it would bit a bit silly to tell you what that is.

Without interesting tales of car crashes and LOLs in NAD (little old ladies in no apparent distress, from House of God by Samuel Shem, a classic hospital novel), what is there for me to write about? I know I’ve always claimed that I write this blog for me and not for you, but truth is I’d rather write something a bit more interesting that a clichéd ‘teenage angst’ saga. Too many appalling American movies destroyed what credibility that genre ever had.

Luckily, next year I’m on wards once a week, so I should be able to bring you stunning bards of COPD and UTIs. That in itself beings a whole set of new problems, namely patient confidentiality. When I decided to stop being anonymous and blog under my true name, I made it rather more likely that I would write something that people could identify. I guess I just have to be careful.

My only other option is to start a new blog, anonymously, to write about medical things, but I don’t think I could keep up with two blogs, it’s hard enough with one. So here it is, I’m going to try and write more medically related posts, when I can, and cut back on the ‘my life is so difficult’ ones. Not because it isn’t, but because it’s the one I chose; and really, you don’t care!

Right, enough procrastinating, back to the revision, exam in 65 (and a half) hours.

I saw the best minds of my generation destroyed by Google

Los Angeles, 2026

Ted got busted because we do graffiti. Losing Ted was a big setback, as Ted was the only guy in our gang who knew how to steal aerosol spray cans. As potent instruments of teenage social networking, aerosol spray cans have “high abuse potential”. So spray cans are among the many things us teenagers can’t buy, like handguns, birth control, alcohol, cigarettes and music with curse words.

I tried hard to buy us another spray can. I’m a street poet, so really, I tried. I walked up to the mall-store register, disguised in my Dad’s business jacket, with cash in hand. They’re cheap, aerosol spray cans. Beautiful colours of paint, just screaming to get sprayed some place public where everybody has to see what’s on our minds. The store wouldn’t sell me the can. The e-commerce system simply would not allow that transaction. The screen just went gray and stayed grey.

That creepy “differential permissioning” sure saves a lot of trouble for grown-ups. Increasing chunks of the world are just… magically off limits. It’s a weird new regime where every mall and every school and every bus and train and jet is tagged and tracked and ambient and pervasive and ubiquitous and geolocative… Jesus, I love those words… Where was I?

Right. We teenagers have to live in “controlled spaces”. Radio-frequency ID tags, real-time locative systems, global positioning systems, smart doorways, security videocams. They “protect” us kids, from imaginary satanic drug dealer terrorist Mafia predators. We’re “secured”. We’re juvenile delinquents with always-on cellphone nannies in our pockets. There’s no way to turn them off. The internet was designed without an off-switch.

So my pal Ted, who stupidly loved to tag his own name on the walls, got sent to reform school, where the security is insanely great. Me, I had a much higher grade-point average than Ted, but with no handy Ted to steal spray cans, the words of the prophet have vanished from the subway walls. So much for my campaign to cover the town with graffiti street-stencils of my favourite teen pop stars: George Orwell and Aldous Huxley.

And Shakespeare. I used to hate Shakespeare, because the teachers would park us in front of the webcam terminals, turn on the Shakespeare lessons and leave the building. But then, somehow, they showed us Macbeth, a play which actually MEANS something to us. Grown-ups don’t understand that (or they wouldn’t be teaching it) but Macbeth is the true authentic story of my generation. This is Macbeth’s world, and us teenagers just live in it. Dig this: those “Three Weird Sisters”, who mysteriously know everything? They can foretell anything, instantly, like Google? Plus, the witches make it all sound really great – only, in real life, it totally sucks? Well, those “Three Weird Sisters” are the “Internet of Things”, they’re “Ubiquitous Computation”, they’re “Ambient Findability”. The truth is written all over the page (or the screen – my school can’t afford to give us any “pages”). Just read that awesome part where they’re boiling pseudocode in their witch-cauldron! They talk like web designers!

Macbeth stumbles around seeing ghosts and virtual-reality daggers. That sure makes sense. Every day of my life, I see people with cellphones yelling eerie gibberish in public. The world of Macbeth is totally haunted and paranoid! You can’t get one minute’s privacy, even inside your own bed!

So, I did my class report about Macbeth, and every kid in my English class instantly agreed with me. I’m not the most popular guy in school, but they started CHEERING me. And Debbie, this wacky Goth chick in my class who identifies with Lady Macbeth… After my class report, Debbie sleep-walked out of the classroom and pretended to hang herself! Of course the teen-suicide subroutines in the school jumped onto Debbie immediately. Debbie broke the software rules, so Debbie is toast, just like Ted.

My Dad – he’s still alive, apparently – he sent me an email from China and said I ought to “recruit” Debbie into my “social group dynamics of online identity production”. My Dad always talks like that. I haven’t seen Dad face-to-face in six years. Look: I am a 17-year-old male, okay? I don’t want to send Debbie any hotlinks and digital video. I want to take Debbie out! Maybe we could take some clothes off! But there isn’t any “out” for me and Debbie. There isn’t any “off”, either.

Okay, I admit it: Debbie is insane. The fact that Debbie really likes me, that just proves it. Debbie ACCEPTS this sick state of reality. She EMBRACES it. We are doomed.

Imagine that Debbie and me somehow go out together. We want to network with our peer group, teenager-wise. I need to figure out what’s hip and with-it and rebellious, and Debbie needs to know what the other cyber-Goth chicks are wearing. Is that okay? No!

It’s not that we can’t do it: it’s that all our social relations have been reified with a clunky intensity. They’re digitized! And the networking hardware and software that pervasively surround us are built and owned by evil, old, rich corporate people! Social-networking systems aren’t teenagers! These machines are METHODICALLY KILLING OUR SOULS! If you don’t count wall-graffiti (good old spray paint), we have no means to spontaneously express ourselves. We can’t “find ourselves” – the market’s already found us and filled us with map pins.

At our local mall, events-management sub-engines emit floods of locative data. So if Debbie and me sneak in there, looking for some private place to get horizontal, all the vidcams swivel our way. Then a rent-a-cop shows up. What next? Should we go to Lovers’ Lane? There aren’t any! They eliminated all those! They were tracked down with satellites and abolished with Google Maps.

Okay, sure: I know I sound pretty depressed. Us teenage poets depress easily. You know what they tell me whenever I rant like this? “Get a hobby.” Play imaginary fantasy computer games! That is allowed me! Wow, thanks! When she nursed me as a baby, my Mum dropped me right on my head to play Wonder-World of Witchcraft. I sure know where that story goes. If “religion is the opiate of the people”, then immersive multiplayer 3D virtual worlds are hard-core Afghani heroin. My Mum will never make it back into the labour force: Mom’s way too busy building herself up to 146th-level SuperMasonic Tolkien-Fantasy Ultra-Elf Queen. Like that helps! Look, I can show you Mom’s gaming environment, right on the screen here. My Mom’s a Welfare Elf Queen (CR) (system crash) (hard reboot)

Debbie: why do you access me, when you know that makes things hard for me? Why do you tag, and link to me? Why do you telephone? And why, why, why do you write me silly notes on paper? I am so sick of you, Debbie. Why, why do you hack me? It is just to see the things that you know I am writing about you…

Debbie, you believe in us. You think we are the future.

I am so miserably happy, just now.

© Bruce Sterling, 2006. All rights reserved.

Another day…

I think I've lost sight of why I'm here. Right now it feels like I'm doing a science degree, only speeded up. I don't think I could hack the traditional type medicine course; 3 years science then 2 years clinical. Luckily Aberdeen run a modern course, ie there is early clinical contact. I'm hoping the community course, despite all it's faults, may well spur me on again.

I guess I need to try and remember why I worked so had to get here in the first place. I need to relate where I want to be with where I am right now. Because at the moment?

There's no motivation at all.

The Doctor is in the house

NHS Blog Doctor is back.

Head over there for some candid insights in to “GP land” the the lunacy of Today’s NHS.

Just some of my thoughts below, Dr. Crippen at NHS BlogDoc will explain them far better than I. (If you don’t really care, which is fair enough, it’s only going to be you and everyone else who ever needs to see a doctor in this country who suffers, read this article for an example of what exactly it is we’re all going on about.)

The trouble is the Labour Government…. what? Too much? Ok, the trouble is the Government, regardless of party.

The NHS was for a long time run by the people in it. Doctors were professionals i.e. they regulated themselves. There were the Royal Colleges and the Academy of Medicine and the GMC. All run by doctors, and those doctors were chosen by other doctors. The same was true of the nursing profession also. These two groups came together to run the NHS. Matrons ran hospitals, assisted by admin staff. Almost everyone was scared of Matron, everyone respected her because she had more experience than anyone else.

Now, was this system perfect? Of course not. Maybe somewhere in all that self regulation I was talking about there was some mutual back scratching. I have no doubt that mistakes were made and covered up because ‘that’s just how you do it’.

The conservative government came along and crippled the NHS by introducing the ‘internal market’. Basically, each Primary Care Trust was given a set amount of ‘funds’ to spend on sending patients to primary and acute secondary and tertiary services (that’s “GPs”, “hospitals” and “fancy hospitals” to the rest of us). This was supposed to stimulate competition within the NHS as hospitals competed to provide services at lower prices. The trouble is half the time these same hospitals are trying to work together, on research projects, on patient transfers and on specialty services. It is a bit difficult to stimulate a competitive market one minute then expect seamless cooperation the next, but that’s what the Thatcher government did.

When Blair came to power in 1997 it was with the promise that he would abolish the internal market. However, in his second term he changed his mind and instead decided to strengthen the market.

That is really only a taste of today’s modern NHS, there are thousands of other things going on. Nobody has the answer, and no system is going to be perfect. But I can tell you one thing for certain: The NHS is have more money poured in to it than ever. It is providing care now to a standard far below that seen since its conception in 1948.

What will happen in the years to come, nobody knows.

Because we all need something to believe in?

On of the reasons I watch Casualty on BBC 1, apart from the blood and guts and drama, is that very occasionally they hire some top quality writers and do something incredibly powerful. Usually it has a different format than your average episode. Other medical shows have done it. There was that episode of ER that was filmed in real time with a steady-cam; the whole episode, and it was brilliant. The other casualty episode I’ve seen that was a bit different was the one after Ruth hung herself. We lived her life, through her diary. It was an unbelievably moving piece of drama, acted brilliantly. Well this week’s episode was similar, a lot of flash back, with the episode ending where it began (not an hugely different editing practice in itself).

It examined the stress of working on the front lines of the NHS, and what it’s like when you make a mistake that seriously injures someone (in this case leaving them in a wheelchair for the rest of their life). Watching these programs, reading all my favourite medical blogs, it makes me wonder why I want to do what I do. Now don’t get me wrong, this isn’t me changing my mind, I knew what I was getting in to from the word go, I knew the sacrifices I was going to have to make. You have to say that to the interview panel, but the truth is, regardless of how much I knew, I don’t think it is ever possible to understand; to truly appreciate exactly what’s in store.

Why then?
Why do we put ourselves through a gruelling 5 year university course we’ve agreed is the second most difficult one there is.
Why, when we know the pay is crap, the lifestyle will actually damage our health, we’ll never see our kids (if we even get round to having a family)?
Why, when I know that the speciality I’m most interested in is going to involve me getting abused, forced to work in illegal conditions, fill out endless forms for ‘whiplash’ (aka compensation hunting) injuries, and be working to entirely clinically pointless and impossible to achieve targets?

Because it’s a calling? Because I know I’d never be truly happy doing anything else? Because some one’s got to do it? Because I want to make a difference?

I don’t know the answer to the question. I give opinions without truly believing in them.

Some would be worried I don’t know why.

I’m not.

Because it’s just what I have to do, no matter what.

I guess it’s faith; belief without evidence, belief without need for evidence.

Faith that it’s right; faith in yourself; faith in your friends and colleagues; faith that people will do the right thing, in the end…

Sometimes, I feel like my faith is the only thing that keeps me going.