Textbooks, as we know, can be both goldmines or empty shells. They can be full of biblical prose, disjointed, ambiguous, verb-less sentences of verbosity, or witty, concise, razor sharp and, most importantly, informative.

We're familiar with the cinematic line "open your books and turn to chapter...", or "we'll start at page...". In the world of academic texts, this is often the way. We pick up the tome with a question in mind, flick first to the index and then directly to the focus of our attention. Be it to describe the conflicting pressure gradients of the nephron, or the capital of Kazakhstan, we seldom languish in the remainder of the text.

Recently, I've made an effort to read the first few chapters of a textbook, particularly the introduction. I suspect that this is primarily because I'm reading specialty texts, and I'm keen to learn the basic approach. That is, how the author (and by extension, their specialist colleagues), approach their field.

How strange that, after nearly eight years of tertiary education, I'm reading books with fresh eyes. Not the fact-seeking ruthlessness of exam-study precision, nor the trivial style of someone looking for a tidbit to impress their consultant. Instead, before diving headlong into the finer points of the Pathologic Basis of Disease for another round, I'm trying to see how Drs Kumar, Abbas and Fausto think about their field.

Pointedly, page 2 of the Oxford Handbook of Clinical Medicine tells us;

"Decision and intervention are the essence of action: reflection and conjecture are the essence of thought: the essence of medicine is combining these realms in the service of others."

The Coast Hospital has a new scenario based learning suite that Med Students, Docs and the rest of the clinical staff have been having some training sessions. The aim of the sessions is to more accurately replicate the real world; a challenge that anyone who's given Rescue breaths and chest compressions to a plastic shell will fully appreciate.

One of the real beauties of this kind of learning is the chance at a 'do-over' or as golfers say, a mulligan. Moreover, the ability to analyse and critique our reactions in a stressful 'real-time' environment is extremely helpful in future decision making.

For Med Students, the analysis unfailingly emphasises two key points; that a) we can recognise an unwell patient and b) that a systematic approach will yield positive results.

In many aspects of life, we are not afforded the chance to analyse an instantaneous decision; the situation progresses, and all hindsight is, of course, 6:6. We rarely, if ever, get a 'do-over'. To combat this, cricketers have net-sessions, rugby union players have tackling practices, and soccer squads practice penalty kicks. All those hours for one shot. To take the extreme, the intense, the unimaginable and have the brain convey normality.

I'm yet to be involved in an arrest situation; I'm hopeful it runs like in the scenarios. For those ones, there are no mulligans.

His fluoro shirt was visible a few seconds before the automatic doors whirred open, and he entered from the long dark night. As he stumbled across the shop floor, I almost reached preemptively for a sharps kit. As he reached the counter, he fumbled for his phone, dark eyes searching the screen. His gaze lifted to mine, focusing some seconds later.

"I... need... some... formula. ... For newborns." He slurred, before squinting hard at his phone and naming a brand.

Unfazed, I toddled over to the baby section and fetched the request, with a "No worries". Meantime, he'd begun to rant. About his girlfriend. About two hours of text-messages. About the baby crying.

"Plus, " he says, clearly now with a full waft of XXXX assaulting my nostrils and eyes, "I'm maggot."

"This is the one you're after?" I confirm, gently.

His pupils accommodate to the shelves behind me, and then to the behind of the leggy shopgirl, as he dumps the cash on the bench.

"Sooo, theeen... what time does your lady friend... get off?"

"You'll have to ask her yourself," I say with a wry smile. I'm met with a forty-five second string of abuse littered with F-bombs, C#$&'s and racial slurs.

I can be pragmatic about abuse; it happens in the health services. The sick feeling, biting like an ulcer in my gut, wasn't because I'd been sworn at, nor because my assistant had been abused. It was for the girlfriend, and the newborn.

Bob bounced back, his Troponin sky high, for the third time in as many months.

Under sixty and full of modifiable risk factors, a jolly round fellow, reclines relaxedly in his bed.

The cardiologist tells Bob he's in serious trouble, his angina's unstable but his risk factors for surgery are gargantuan, especially his fifty a day smoking.

Bob's round face bobs with laughter, he drives the speed limit and he doesn't chase the women, he says. There's no drama with half a dozen each night, eh doc? And what's a few smokes too, he says.

Objectively, his prognosis is terrible. The cardiologist tells him - in numbers - the chances of death, and when.

Bob bobs some more, "At least it's not cancer.", he smiles.

And the cardiologist pauses, looks square into Bob's eyes and gently says, "With most cancers you'd have longer."

And Bob, kindly, round, red-nosed, white bearded Bob, just doesn't get it. Because it's not cancer.

This week, one of the Intensive Care Registrars popped his head into the CCU to check up on a patient he'd been asked to see overnight. Luckily, they'd been well enough to avoid transfer to his unit. The patient's story was interesting enough to keep the ICU reg, well, interested, and he's the kind of compassionate fellow to actually follow up on consults.

In addition to his obvious empathy, one thing struck me about this Registrar. He had a textbook in the crook of his arm. Not the typical ICU fodder, nor a voluminous tome such as Harrison's latest offering. No, he had Guyton & Hall's Physiology, firmly within his grasp.

Somewhat surprised, I asked if he was sitting exams soon. "No," he replied, patting the red spine gently, "it's just that I like to stay on top of this stuff." He finished his observations and trotted off to the ICU.

I think every Pre-clinical Med student wishes for the day their textbooks are permanently burned into their brains, knowledge available for instant recall. Similarly, the clinical years instill in you a sense of simplicity through structure - all that basic, history based stuff. It's easy to draw the dots between chest pain and myocardial infarct. Dredging out first-year physiology, engineer-style, to explain symptoms and progression is another string to the bow.

The reg, unspeakingly, reminded me the books we use, at every level, remain relevant in every clinical context. That's why it's called life-long learning.

On two consecutive days, in two consecutive areas, I've been reminded that I'm not at 'the next level'

Yesterday, I had a bicycle race, and the organisers put the top two grades together. I'm a pretty solid B-Grade rider, and rated my chances at finishing with the (relatively small) peleton. I lasted barely two of the five laps before getting dropped like a lead balloon, before riding alone to the finish. Don't get me wrong, I'm fit, riding pretty well and can flog almost anyone else I ride with for a good forty kilometres. But I'm not at A-Grade level, and I won't be for a while

Recently at the Hospital, it's been a similar thing, sort of. I can hold my own in discussions with medical students and interns. I have a pretty good 'clinical approach' to most things, I'm more systematic and I'm better at presenting. Today, though, I got schooled on rounds. It got me thinking about progression;

The phrase 'taking it to the next level' is well overused by hip-hop artists, film-makers and sportspeople alike. And usually, it's nonsense, garbled trash talk. Until, of course, you're the one who can see both sides of the level - what you can do comfortably, consistently and repeatedly, and what you cannot.

Since mid-year, this is what Med School's been like - both sides of the junction. Some days above, holding on to the peleton, making good plans and diagnoses. Other days, dropped, agog, out of my depth. The next few months I'm going to use to get comfortable. To consolidate knowledge and skills. To prepare for the Next Level.

Last night, I lost it. A meagre 48 hours earlier, my Mum asked if I ever felt like crying. I've just finished a month of oncology. Throughout the rotation, I felt like I had my emotions under control.

Last night, I watched a movie. Inside the first ten minutes, I was sobbing, fetal on. In a moment, all the pain, the hurt and overwhelming sadness I'd seen in the last month was draped over me a veil. Too heavy to cast off, to black to see through.

Last night, I remembered. Faces of terminal septuagenarians, stoic and brave. The disfigured faces of a few with head and neck tumours. Grieving families of comatose patients, one foot at the threshold.

Young mothers. Mothers searching for a way to explain death to their toddlers.

Sadness, incomprehension. Death.

And when I stopped crying, Batman and I watched the rest of the movie together. And the patients, those who are still alive, continued to live the rest of their lives.

Last night, the movie I watched was about Love.

My boss asked if I'm counting down. A few months ago, we had a chat and I said that I'm not yet at the stage of counting my remaining shifts in Pharmacy. I'm not.

As I walked into the Hospital around 7:30 this morning, the laboureres at the adjacent building site were singing, whooping and laughing as they worked. They'd started dismanting the four stories of scaffold concealing the hospital's new building several hours earlier. They shouted to eachother and guffawing at their humour. Smiling at life.

Below, a trio of tired nurses and an Admin officer trudged through the main entrance in silence. Their heads slightly bowed and gaze fixed on an indeterminate point some hunderd metres through the wall. Their day was just beginning.

In first year, my drive to uni went through downtown, usually at peak hour. In the snailled traffic, dark suits and skirts would weave their way through, en route to white, starched-collar monoliths. I didn't see laughter, and rarely smiles. Mondays were the worst, for them.

I love Mondays. Shiny, new, rested. On Mondays, I'm reminded about direction change. That I made a conscious choice to go back to Uni. That I love learning about medicine, life and people. That feeling of 'something new' that you get on the first day of school, or a new job, that 'fresh start' feeling, is always there on Mondays.