It's exam week. Actually, this year every ninth week is exam weeks. But still.

Apparently Internal Medicine is the hardest rotation. You have to learn everything that's not surgery, pediatrics, O&G, mental health, General Practice, anaesthetics, Rural Medicine. So, pretty much everything.

My colleagues and I have been pulling roughly 10 hours days at the hospital for the last seven or so weeks, and for me, it's been great. Involved, intense, insightful, the works. The 'long' hours were starting to get to me a few weeks ago, then two things happened.

Firstly, I read through the latest AIHW report "Health and community services labour force 2006" (released March 9, 2009) about the hours that health professionals pull. Of the 57,019 doctors in Australia in 2006, the average working week was 45 hours. The lowest average working weeks were scored by the pathologists(40), radiologists(41) and rheumatologists(41). Worth mentioning are GPs(43), Residents(48) and Physicians(46). The most hours all went to surgical specialties (average of 54), most notably paediatric surgeons, who worked on average 61 hours a week. Which, I think, all seems to make sense. There's not really part of me thinking "Wow, that's waaaay to much hard yakka", or finding it wholly unreasonable. Demanding job, long hours. Makes sense to me.

Secondly, I arrived early one morning, about five past seven, and find that the Med Student common room has been overrun by half a dozen registrars. They're handing around printouts to each other and going through old exams to prepare for their Part Ones. I was impressed. They'd been there since about 5.30am. Studying. Now they were packing up to start their twelve-hour shifts. As doctors. Where they were actually responsible for patients and decision-making and teaching juniors and medical students. I was awed.

There's loads of talk around about the tough hours that interns, junior doctors and docs work, but they don't really approach the issue of 'study time'. The next time some pissant 20-something medical student complains about how hard it all is, how study wrecks their social life, how they can't play sport anymore, just think about the registrars. Their only study time comes between twelve hour shifts.

Now that's Hard Yakka.

Possibly the most relaxing afternoon's solo study I've ever had.

One of my most nervous days in Pharmacy was the first day I worked as a registered pharmacist. I still remember the first 'script I handed out.

But what was different? I'd worked my 2000 hours, I knew my stuff and I could run the day-to-day workings of a pharmacy without having to think about it all too hard. I could dispense safely, I'd passed my reg exams. Why was I nervous?

That first 'script was Augmentin Duo Forte - the common cure-all antibiotic - which further pushed the point home.

"This one's twice a day, ideally with food, but it doesn't matter. Have you had it before? No? Okay, are you allergic to anything? Penicillin?" and on I went. I counselled until the lady wanted to leave. But I was safe.

I was responsible. The line.

That morning on the way to work, I'd thought about the doom and gloom legal lectures from Pharm school, about pharmacists, either incompetent, hapless or nonchalant who'd dispensed without thinking, or counselling or practicing pharmacy. How they'd hurt patients. How they'd been sued. Or deregistered.

Responsibility hit me. It wasn't a sudden thing; my preceptors had ensured that over the 11 months of pre-reg that I'd been accountable for my actions, slowly but surely, and that I was safe and aware.

That first day (or week, in all honesty), was like getting my P-licence for driving. I was aware of the ramifications of my actions (or inactions). It reminded me of the whole learning to drive process;

1. Aged five. You don't know that you don't know. Cars drive around the streets. Mummy or Daddy sit behnd the wheel and do stuff and you go places.

2. Aged fifteen. You know that you don't know. The engine's on, why aren't we going? What does that pedal do? What's a clutch? This is hard.

3. Aged sixteen. You know that you know. I can drive. Check my mirror, into first and takeoff. Indicate at the roundabout. A policecar! Brake on the straight before it's too late.

4. Aged twenty-five. You don't know that you know. Off to work. What's on the radio? This station sucks. Which CD? I hope I can find a park. Yurgh, this traffic!

In the same way that drivers are not immune from accidents, Pharmacists are not immune from errors. But, when conditions get tough, the good driver lets their training kick in and reverts to basic principles. Same goes for pharmacy. Every time.

This line of thinking was triggered by a conversation I had today with one of the interns at the hospital. She mentioned that she found it hard to relax and switch off during the prolific downtime afforded during weekends 'on call'. At first I thought that this was a bit silly. I mean, if there's no work to do and everyone's healthy, you can relax, right?

At the pharmacy, if there's actually no work to do then I relax. I'm not a 'newspaper pharmacist*', but if there's not work to be finished then, well, it's okay to chill out; the patients will come to you. Meantime, grab a glass of water. Have a bathroom break for the first time in ten hours. If something happens, no worries, you'll handle it. Worst case scenario you have to call someone else. You've seen plenty. Your basics are good.

Then I remembered that feeling of responsibility. It doesn't surprise me in the slightest that three months into the term, an intern still buzzes through the whole shift on call.


*Newspaper Pharmacists will get their own wee post in the coming weeks.

Most people have had the odd sleepless night. The feeling of tiredness washing across the senses, without sleep taking control. The grittiness that comes with opening the eyes at half three and not being able to return to the world of slumber. Or the rolling, kicking, turning just to get comfortable. When a night is too hot, too cold, too light, too dark, too loud or too quiet. Sweaty feet or cold shoulders. Mind racing about the frustrations of today or the anticipations of tomorrow. And, eventually, that feeling of exhaustion as you plead with the night to allow a few hours, or moments of all encompassing, resting sleep.

Unsurprisingly, not a shift goes by when someone asks me about sleeping tablets. "I just haven't been sleeping well", they say, "and I, well, I just want something to knock me out."

Of course, there's no chance of getting benzos or other hard sleeping tablets; the limit in pharmacy is a few sedating antihistamines. And, yeah, quite a few people like to chow them down. If it's essential, I usually go for the smallest pack size of an agent that'll work.

I don't like recommending 'sleepers', because for most patients it's overkill. The key, I reckon, is a good sleep routine. Plus, making any tablet part of your sleep habit unnecessarily is likely to be, well, habit forming, right?

If you're a glasses-wearer, it's pretty simple; you take off your glasses and you can't see. You're used to not seeing a) when you're sleeping or b) at night. So your brain twigs that it's sleep time and off you go to the land of nod.

Clearly, the not seeing equals sleeping is a tad idealistic. I've heard of several effective techniques, on top of the good old routine that is (roughly); close curtains, pyjamas on, wash face, brush teeth, snuggle down, fall asleep.

An oldie (+/- goodie) is a warm glass of milk. Not so hot if you're lactose intolerant though. I'm not massive on late night milk, myself. I much prefer the quiet, relaxing music, with a bit of a beat to it. A few examples of bad would be; Nirvana, AC/DC and The Rolling Stones. A few ideal examples would include Moby, Coldplay, Enya and The Postal Service.

Obviously you're not trying to blast your ears off, just loud enough that there's something to hum too if you need and a enough base to sense. The same as for wee puppies when you use an alarm clock to emulate the mother's heart beat. That kind of thing.

But, most importantly, if you're not getting good, regular sleep then see your doctor about it. It compromises your ability to work or learn and it's generally bad for your health. And because feeling exhausted, sleepy and frazzled, as a part of a regular day, well, it sucks. Time for bed.

Anyhoo, I've had in my mind for quite a while which specialties are definite possibilities, as well as those which are definite no-go zones. Since I've only done internal med, I consider many of my views to still be a bit on the theoretical side, but hey, that's how it goes.

At the moment, Radiology and Pathology are well out. I get that they're good fun for interest's sake but not every. single. day. Plastic surgery is made noble by a few, but there's a bit too much... plastic... around that neck of the woods. I'm not a big fan of Gastroenterology either (insert poo joke here).

Strongly within the realms of possibility are; Cardio, Respiratory, Psychiatry, Emergency Medicine and General Surgery.

My current 'Hot List' is (in alphabetical order only);

• General Medicine (It's better than knowing a little about a lot. It's knowing a lot about a lot, right?)
• General Practice (The appeal of womb to tomb, maybe not so much at the dawn of my career, but that work/life balance I'll want. Eventually.)
• Oncology (It's intense, caring, evolving, fascinating and isn't what I'd call 'for fun' medicine.)
• Obstetrics (& Gynaecology) (Yeah, blokes can still do this; it's got good amounts of public health, medicine and surgery. Rockin'.)
• Paediatric Medicine (Make a big difference to a wee human's future, yeah?)

Undoubtedly, the next few months, years and so on will see this list change, shrink and generally morph. Oncology wasn't even a consideration at the start of Med School, but I find it making the above top five list quite comfortably.

This morning's quiz, though, made a suggestion completely out of the box; Aerospace Medicine.