It wasn't mine. Of course.

It was a cold Melbourne day. I'd been waiting for the St Kilda tram for half an hour. Or thereabouts. My memory seems to whirr and grind more than it used to.

Eventually, whirring and grinding up the tracks came the tram. Ding! It breezed to a halt, and I climbed on.

I think the young man behind me was being impatient, but I took my time. Stick. Steady. Left foot. Right foot. I tried to get to my seat before the tram took off. Sometimes I fall over if the tram moves suddenly.

This time, it didn't and I went to a seat near the front with a "Reserved for the elderly" logo. I sat down. The tram still hadn't lurched forward, and I looked around.

There were few people on board. Not surprising for a Tuesday lunchtime, I supposed. There was a young mother with her swaddled progeny sitting two seats down. A couple of Asian students were sitting close to each other, talking quietly and using their mobile phones.

Near the back, three youths with heavy Lebanese accents were energetically reliving their football game from the previous night, their grainy, jubilant voices echoing around the cabin like the corridors at the G. Nearer the front, one of the local homeless men sat with his collars pulled up around his ears. He was shivering, and the newspaper insulating his torso poked out around his neck as he moved. He talked to someone unseen.

The tram still hadn't moved, and I looked around to see the driver gesturing at me animatedly. He shook his head and rolled his eyes. I didn't hear very well anymore. It seemed like he'd been trying to get my attention for a while. He said something loudly about there being a "Good kid trying to help."

The young man was standing just next to me. His clothing was too small; a white t-shirt clinging to his sinewy shoulders like a drowned rat. He had white headphones jammed into his ears, cord twisting and trailing into his black jeans pocket. A black, red and white chequered belt saved his sparse pants plummeting to the depths of his ankles. The arm, his left, replete with angel tattoos reached out with a bag.

"You left this on the street."

I looked at him, confused.

I did? Oh. How embarrassing. I do that sometimes. I get forgetful. His tattooed knuckles and leather-bound wrist awkwardly, delicately, put the bag on my right knee.

The bag was brown, hessian. It was squared and had two handles. Like those new fangled green things that Coles and Woolies try to sell us. The hessian was moulting a bit.


The tram trundled off forward. I looked up to the mirror, the Arabic driver still shaking his head in frustration.

The bag was quite heavy; I couldn't remember what I'd put into it. I couldn't remember if it was my bag, actually. The heaviness felt like some cans of food. I like to make spaghetti, so I thought maybe I'd picked up some tomatoes at the supermarket.

I tried to put my hand inside the bag, but the opening is zipped closed. I fumbled with the zip. I was unsure; I didn't think the bag was mine. Why would they give it to me if it wasn't mine? My old hands don't open zips very well. Maybe someone kindly closed it for me. I must have forgotten about it. My memory had been going with age. I felt perplexed.

The creaking of the breaks whispered through my hearing aid like a ghostly shriek as the tram made a stop. We were still for a few seconds, and a young girl alighted. She had long black hair, porcelain skin and a forlorn look about her. Her midnight lips were pierced by a silver ring, her eyes surrounded by inky colours. She, too, had white headphones and angel tattoos. She moped to the back of the tram as it moved, and took out her mobile phone.

The bag was still on my knee. It felt cold through the hessian. I shoved my smallest finger into the small gap near the zipper's end and wriggled it. It moved open a few inches, but I still couldn't glimpse the contents.

I squeezed my hand into the bag. Maybe there was a small can of baked beans in there too. I liked baked beans. If it was a small one I could give it to the homeless man. It didn't feel like there was anything more than maybe three cans inside. Perhaps two big ones and a small one.

I'd been shopping earlier, but I couldn't remember what I had bought. I went to the newsagent for the paper, still under my arm. I wracked my mind for which cans I'd paid for. Still, it was nice for the driver to wait for the young man to get my bag for me. The young man was sitting a few seats down from me on the other side of the tram, nodding his head and white headphones.

I grasped the smaller can, it felt odd. It was small for a can of food. Still, it was cold and metallic and has a ridge at one end. Perhaps it was a can of beer. I couldn't think why I'd by a beer, except to give to someone. I turned the can on its side in my hand, so my thumb could hold it, just so. Then, I pulled it out of the bag.

Something beeped. Everything hot. Everything white. Someone, a scream. Everything red. Everything cold. Silence.

It wasn't my bag.

.

There's an old joke about the mechanic and the surgeon, in which the mechanic mentions that he does the same job and the surgeon says "Try doing that with the engine running."

Patients often compare their bodies to motor vehicles, an idea I've recently developed it to point out how stubborn people are when it comes to seeing their GP or generally seeking Medical advice.

It's that point of a consult when the Pharmacist asks if the patient has seen their doctor... or even thought about it. I'm going to put a mechanic's spin on each of the four usual responses;

1. It's too expensive.

A visit to the doctor, during the week is going to cost you a maximum of thirty bucks as a gap payment. Many people use bulk-billing Medical Centres. You remember, the free ones.

A service for your car? That's $220, without blinking. Money well spent?

2. I have to wait for too long, it's inconvenient

Sure, medical centres and emergency departments can make you wait. Sometimes, you might be an hour behind your scheduled appointment, other times you'll sit in the ED waiting room for six hours, or more.

Last time you got your car serviced, chances are, you changed your entire day around. You had someone meet you at the mechanic's to give you a ride to work, or you shelled out for a cab. All that will add up to at least an hour out of your day. Worse, though, think about the last time you broke down. When your engine started smoking or the radiator blew; did roadside assistance get there in half an hour? How about two hours? And the whole mess, took what, about five hours...?

3. I can't get an appointment.

It's true, doctors are busy; the good ones seem to have appointments booked for at least the next three weeks.

I'd also warrant that you're willing to wait that period of time to book your car in. Why is that?

4. By the time I see a doc, I'll feel better. I don't want to go when I'm healthy.

I recently met a bloke who hadn't seen a doctor in forty years. He was fifty five. He'd had some very worrying symptoms for the last three months, and was just happy to push on.

Pretty sure that he would have his car looked if the engine rattled or the brakes creaked for that length of time, even if they sounded fine before he got it into the shop.

What's more, the motorists just love getting their cars serviced at 10,000km, 20,000km and so on until, at 90,000km, when the car can still be sold, the ad reads "Full service history."

-

In short, people will devote time, money and energy into getting their pride and joy seen by a good mechanic. But for some reason, they don't devote the same amount of energy into looking after themselves. Please, don't wait for the engine to blow. Go and see your doctor.

Despite a slow start, I'm enjoying Psyche Rota more than I thought I would. I haven't posted much about it, because although I've a penchant for good tales, humourous anecdotes and fresh perspectives, I'm not going to be posting any Psychiatric patient related stories.

I just don't think it's cool; Psyche patients are a particularly vulnerable population, and mashing together individual delusions for the purpose of a story would, I feel, over-emphasise 'wackiness' without either giving due creedence to their serious disability, or helping to reduce the seemingly insurmountable social stigma that comes with chronic mental illness.

I will admit I've heard patients describe delusions and hallucinations that are, on the surface, funny. I'm ashamed to say that the first time I listened to a patient report some of their delusions I couldn't maintain my poker face. At least, not for the first thirty seconds. As the patient continued, a feeling of deep sadness washed over me.

The thoughts were this person's reality.

A student arrives at the scene of a car crash. It looks as though the crash ahs happened a few minutes ago, as there are small crowds around the occupants of each of the cars. There's no smoke, but one person is lying on the ground, looking unwell-ish.

The student pulls out of the line of traffic, screeches to a halt and gallops over to take charge...

"Nobody move him! I'm a MEDICAL STUDENT!"

There's one person knelt by the injured person's head. Let's call him Frank. Frank is holding the patients head straight. The Med Student addresses him with a tommy-gun barrarge of questions;

Did you see what happened?
Have you called the ambos?
Did you move him?
Is he breathing?
Does he have a history of seizures?
Has he been talking?
What is he allergic to?
Is he bleeding from anywhere that we can't see?
Is there family around?
Where are the other passengers?
What's the formula for the area of a circle?
Does he have a fever?
Is anyone carrying a defibrillator?
What's his pulse?

The student frantically begins to examine as much of the patient as possible, without moving him or touching him, making Hmms and Ahs at each graze or scrape.

To which Frank responds, calmly. He was in the care three behind the accident, and saw everything happen. The patient is breathing by themself. As the ambulance's sirens come into earshot over the hill, he quickly answers all the relevant questions, and mentions that he suspects the patient is on drugs.

The Medical Student is somewhat surprised by this last statement. He looks up sharply at Frank and says, "That seems a bit harsh. Just because he pranged into the car in front doesn't mean he's on drugs."

Frank shrugs as the ambos roll up and start triage. The patient on the ground is being loaded up, and Frank explains to the Ambos what happened, how the scene has been treated and managed

The Ambos listen intently, and thank Frank for his help, before heading off "Seeya later, Frank

Meantime, the Medical Student is confused, and standing around with his hands in his pockets. Talking to the crowd, trying to give them advice about their problems and what to do next. Evidently, not used to being utterly useless.

As Frank goes walks to his car, the student jogs over and says, "So, are you a nurse or something? 'coz you did really well to assess that guy and call the ambos."

Frank mentions he's an intensivist at the local Tertiary Metropolitan Hospital.

Medical Students don't often talk about failure.

They talk about the idea of failing, the fear of failure or, in hushed, disdainful tones at the front of lecture theatres, about someone who didn't pass. Some medical students have never flunked anything in their lives. They are wholly unfamiliar with the bitter taste, the anguished self-reflection or the smell of raw failure.

Earlier this year, I failed a rotation.

Shock.
I eagerly looked up my marks and was hit by a bus. I hadn't just failed one component, I'd failed a bunch. I felt sick to the stomach. I wanted to call someone; to talk to someone, but I was on rural and thoroughly isolated. Not all bad, I thought, I can wallow in shame and self doubt for a few days. Which I did.

I sat in the house at SQuIRT in shock. I went over each exam in my head. I clearly remembered each patient, what they looked like, their names, their differentials.

Analysis.
I recalled the facts of the long case; I'd presented it pretty weakly, and the examiners hammered me for questions. Of this I was least confident, I mean, I knew the patient had Congestive Heart failure, but, well, I'd made a hash of the presentation.

I knew I'd made a Zebra diagnosis for one patient which was wrong; I'd had the actual diagnosis in my list of differentials. The presentation was a deforming polyarthropathy of the hands.

The last chap had a pleural effusion. I skipped vocal resonance, but asked for a CXR when I got heard decreased breath sounds, and noted the opacity's menisceal appearance in the appropriate hemithorax.

Fear.
I hadn't felt particularly confident at the time; they were clinical exams with Professors and I was intimidated and nervous. Really nervous. Frankly, I thought that I'd done poorly, but not this poorly. And not in all of the exams. I could recall several exams I'd sat in the past where I'd had that 'just enough to scrape through' feeling, and I'd had that same feeling afterwards.

I'd never failed anything before. I felt empty. And dumb. And scared. My underlying sense of academic invincibility had been smashed over my head like sugar-glass bottle in a kung-fu movie. Dazed. Scared.

Frustration.
I called my parents and vented frustration; I was still too proud to admit that I'd made a hash of things. I didn't want to do eight more weeks! I wanted to graduate on time, with my mates. I sure as hell didn't want to go through the 'special application process' for intern jobs, and start the year late. I am not the person who fails! I don't fail.

Self doubt.
But I had. And not in a small way. Self-doubt nibbled at my toes, then ankles and wrapped around my knees. I felt like medicine could be tackle me to the ground at any second. I was, of course, still seeing patients out at SQuIRT. I started asking basic questions that I knew the answer to. I wanted to know that I had some clinical acumen. Late at night I'd stare at the roof, thinking about becoming a doctor. Was I smart enough? Did I have the skills?

Determination.
About 2am, something clicked. I am smart enough. I do have the skills. Of course they're not perfect. This is a learning curve. I need to know more. I will learn more. I thought long and hard about what I'd done wrong, and what I'd do differently. I had a bloody long list. I will be a doctor, and I will be a bloody good one. I will learn from this setback and retake my medicine.

Frustration, again.
The next morning, I rang my clinical school, and arranged to meet with the Prof. I wanted feedback so I could see exactly where I'd gone wrong. I had some ideas, but I needed confirmation and some direction. He was honest, brutally honest. We discussed both my clinical and professional shortcomings. He reassured me that I'd be able to stay at the Coast when I resat the rotation. We talked through some styles of clinical thinking, and he reassured me that my rationale was sound, that I was safe. There was still a nagging, frustrating feeling in the back of my brain. It wouldn't go away. I wanted to have passed, and couldn't change it. Grrrr!

Relief.
Back out Rural, I bided my time, I had a list of deficiencies in my knowledge that I felt were too glaring to be ignored. I corrected and ameliorated the obvious holes I'd established, and focused on the exam block. At the start of the subsequent rotation, I got an email from the SOM. They'd done an audit, and they'd goofed. Turned out I'd passed everything but the long case, barely. I didn't have to repeat the rotation, provided I passed a Supplementary exam. It was in six weeks' time. I felt back in the game, barely. I wasn't drowning, but I felt a swimmable ten kilometres from shore.

Determination, again.
I wrote down my long list and began to study; I wanted a structured approach. I put together a plan. I had a timetable. I planned to see patients. I would join in remedial classes. I asked for help from previous clinical mentors. I read and read. I consolidated. I did a practice exam with the Prof. He gave me a solid pass, with some pointers and tips. I was studying for two rotations at once, and by jove, I was going to bust my chops to past that supp'. I'd been given a chance, and with knowledge, practice and determination, I'd take it.

Self doubt, again.
I sat the exam. It went better than the first time. I was less intimidated. I was methodical. Two aspects in particular I was unhappy with; one of which was time management. I fluffed away my post-interview planning time, and my structure suffered. After the exam was finished, the markers casually requested I attend for feedback a few days later. I blanched. I wasn't sure what to think. Had I completely blown it? I'd constructed a solid list of differentials, and was able to discuss the key pathologies at play. I felt like I knew my stuff, that I had a well-rounded plan for the patient and a good grasp of their situation. Oh no. This was starting to feel bad. I had a sleepless night. Or two. Self-doubt was back. I considered that I might have failed. Seriously considered.

Relief, of a sort.
I showed up for the feedback session prepared to discuss, and learn. I'd rationalised that if I had to re-sit the entire rotation, I'd lost only pride, and gained the chance to learn again. I passed.

The relief wasn't that total, complete weight-off-shoulders feeling that usually comes with passing "final" exams. It was partial; I had achieved the mark, I'd learned much about myself in the process. This rotation wasn't a final anything; it was a checkpoint. Amongst else, I learned to be more systematic and logical. The lessons are still raw.

I still get whiffs of the smell of failure. I'm not intimate with the scent, and nor do I want to be. Until a few weeks ago, I couldn't have told you what it was.

I've heard flagrantly ridiculous stories about Medical Students doing and saying silly things. Sure, everyone does silly things, but these ones are all a result of a student's inflated self-perception and their lack of humility. Or perhaps plain arrogance. This is the second in a series of three. (You can find the first one here.)

A girl in the year ahead of me, Sonya, related the following incident;

Sonya was out on the town in Brisbane, having a big Saturday night along with her good friend and classmate. They wandered to the bar for a drink and got talking to a good looking young chap. Tall, clean cut, big smile and nice eyes. Sonya is most clear about these features.

He was a Medical Student. A charming one, initially, and he regaled them with stories of just how hard medical school really is, and the dedication required to become a doctor. He was in first year, and the second semester had just begun. Nonetheless, the lad was charming.

It's just that he didn't ask anything about the women he was 'chatting up'. Well, not for a while. He was, however, very emphatic about discussing the joys and rigors of Medical School.

The conversation continued for a good ten minutes, and the chap eventually asked what the girls did for a living. They informed him, good naturedly, that they were several years ahead, in the same programme.

He recoiled in disbelief. "No you're not." he said, "That's bullsh1t!".

The girls gently assured him that they were, indeed, at the same university, in the same course. He didn't take it well at all. His body-language changed, the look in his eye went from 'dreamy and flirtatious' to panicked and floundering. He'd said some quite arrogant things, and was now feeling a pinch of humility. He had to prove himself. He said;

"If you're in medical school then, then, then... tell me about the bilirubin pathway."

The girls looked at each other with surprise. They smiled politely, and began to leave. Sonya swears she heard the young man expounding his knowledge of stercobilin, conjugation and the like as they hurried past.

In her own words, she was just "Having a moment"; an insignificant yet highly embarassing lapse of concentration, one of those Rabbit in the Headlight moments;

Deep in sonorous conversation with her peers, Alacoque was unwittingly just a minute or two late for the morning's meeting. She wandered into the auditorium and, finding it to be quite dark inside, unhesitatingly flicked the lights on;

The radiologist presenting the case halted, mid-sentence, as the image behind him disappeared.

Fifteen consultants and their respective teams turn and stare at Alacoque. Some are squinting, but most can clearly see her outline at the back of the theatre.

She stands alone. Guiltily, her hand lingers by the switch, her notepad over her open mouth, agog with surprise, eyes filled with terror.

An eternity passes. Someone clears their throat.

She blanches, exclaims "Sh1t! Sorry!" several decibles louder than her previous chat, and hastily exits.

Without turning off the lights.

An awkward pause ensues as the consultants and junior medics giggle amongst themselves. After a few seconds, the radiologist runs to the switch at the top of the auditorium, turns the lights off and resumes his presentation

Alacoque, having regained some colour in her cheeks, was, of course, gently ribbed by her team for the duration of the morning rounds; She is recovering, gracefully.

I've heard flagrantly ridiculous stories about Medical Students doing and saying silly things. Sure, everyone does silly things, but these ones are all a result of a student's inflated self-perception and their lack of humility. Or perhaps plain arrogance. This is the first in a series of three.

A good friend recently relayed to me the following story;

We were at this ball, it was a ball for all Victorian Medical students, and a bunch of us Deakin-folk had gone along to enjoy ourselves. The blokes among who had suits wore them, the girls dressed up nicely, and we caught the buses there expecting a good time. We did indeed have a pleasant evening, soured by only one nefarious incident.

Bob's in his early thirties, and was being his usual friendly self, engaging new and different people in conversation. He found himself having a chat with four immaculately groomed seventeen year-olds, in what were visibly expensive tuxedos. They mentioned that they were in their first year of medical school, how fantastic it was, how smart they are and several other arrogant missives.

The clincher was the point of the conversation where they took the time to stop focusing on themselves, and asked which Med School Bob was at.

He replied "Deakin" and they laughed.

Bob, quick as anything, says, "I wouldn't laugh if I was you; Deakin's a four year programme, and yours is six. I hope, for your sake, you're not the intern on my service in six years time. Think about it, chumps."

And he walked off. The tuxedos stood there looking dumb. Until they remembered how awesome they were and went off to find some chicks.