Planning and bullet journaling

If you want to multi-task, maximise efficiency, and generally succeed in life: I reckon it is a lot easier if you're good at managing your time, and managing time is easier if you plan ahead. I like to use my planner (I've been using the ManifestationPlanner.com this year) for planning.

I have recently discovered a system of planning called Bullet Journalling. This morning I spend a few hours planning out the coming weeks and months to juggle placements and work (and running a household, paying tuition fees, and looking after a toddler, etc).

This morning, I also listened to the first half of the Audible book "The Miracle Morning". I have actually already read it before but it was so good that I have decided to listen to it again. 

Not much to add

I don't really have much to add at this time to the blog but I thought I would post seeing as Bubby is napping and I have the laptop open.

I downloaded the Grammarly app, which I can thoroughly recommend. The free version is good.

I have been nominated for the OUM Students Association. I'll update how it goes over the next week or so. I don't really have the time to do it but there is a group of Australian students that are very driven to improve the course and circumstances for students. That requires people to put their hand up for nomination and to represent the other students There was a hole -> I stood in it.

I'm HATING having Bubby in full-time care atm, but what can I do? It's only for another 6 months this year so really I need to keep a good perspective and devote myself to making the most of the time I do have at home and to make sure this investment in my education pays off long-term.

I'm still using my Law of Attraction planner and can thoroughly recommend it, or at least, the Bullet Journal method (please Google). Maximum time efficiency is what is required in med school, especially if still working and/or raising children.

IM placement

I'm in week 2 of my IM placement and it's going really good.

The others (students, interns, registrars, consultants) have been very friendly and accepting of me as an "outsider", or "elective" med student, especially seeing as they rarely get international electives at the particular hospital where I am training.

My knowledge: there are gaps, but they're not HUUUGGE huge. Just bigger than I'd like. Not so embarrassing that my position as a final year medical student is questioned. Not at all. Well, not to my face.

Some things I have been doing have been seen as more advanced than expected for an average medical student and that has made me feel a lot better about myself. Those things include: writing the progress notes during ward rounds, reading the obs/drugs charts, placing IVs, and being eager to learn more than the bare essentials. Some med students do that, but it's not expected until intern year.

Some things that make me look a bit behind include my lack of in-depth knowledge on certain pathophysiology and pharmacology questions. Some of the rarer diseases, I also don't know as well as the local medical students. When it comes to the more common stuff, I think I have a really good grasp on the basics, thanks mostly to my paramedic background. For example, the Intern asked the Consultant why she didn't start her Type 1 Diabetes Mellitus patient on metformin (a Type 2 DM drug).

I am learning a lot about how ward rounds work, I went to an M+M session (morbidity and mortality), am generally keeping up with the discussion about patients and their management, and generally not looking TOO stupid. Whew.

Apart from the hands-on and clinical observing experience, this rotation has (so far) given me the boost in motivation that I really needed to get me back into the books and focused on up-skilling myself in the areas I need to improve. The first half of med school is all about keeping up with the pace of the course; been told what to study and when. The second half is all about (finding and) attending placements, consolidating knowledge, and filling in the gaps as you go along.

So, today is exactly six years since my first day of medical school! Wow! So I always knew it would take me five-and-a-half to six years to do a four year course. The reason being: the first two years I did part-time. This was always my strategy from the beginning (financial, mostly). It turns out that it is probably going to take me seven to seven-and-a-half years! GASP!

**Goes into cardiac arrest

Killing 17 birds with one stone - my current study plan

Here's my current plan of attack:

• study all day at work. Also, catch up on rest, sleep, meal prepping, and laundry and work. Also, clean car at work. Also clean boyfriend's car at work. 
• do placements when not at work. Try not to look like you've had no days off. 
• tell placements that placement is your priority. Tell work that work is your priority. Family is actually your priority.
• make sure to go through all the points you jot down in your mini-notebook while on placement in case you get asked the same question again. Looking dumb once is forgivable; looking dumb twice for the same topic is embarrassing.
• cross-reference the topics you need to study for IM exam with AMC MCQ prep material, Tally and O'Connor, and OUM set readings. 
• try not to cry.

I'm making my own hand-written notes and if I'm successful, I'll upload them somewhere.

OUM student conference Melbourne 2016

The conference was amazing. I really enjoyed meeting my fellow students. I am so proud to be a part of this group of extraordinary people. Now when I say I am n OUM student, I hold my head up high with pride.

The keynote speaker was Dr Johannes Wenzle and he is an expert in the Australian Medical Council exam that IMGs need to take to practice in Australia. I learned so much from just one weekend.

I took my daughter along for the Sunday session, which was a significant distraction, however, I still go a lot out of it.

That's all I really have to comment right now. Maybe I'll post about it later.

OUM Students Conference 2016 - pre-reading

Just some pre-conference pre-reading.... About 50 pages.

The students conference is on this weekend in Melbourne. 

Finance secured

Woohoo.

I've just received a phone call from the bank notifying me that I have been approved the money I need to pay for the remaining fees for the course!

Yay!

The financial stress of medical school has, overall, been more intense than the study load, job uncertainty, and placement-finding combined.

This is great news.

The repayments are completely affordable (spread over five years but I hope to have it all paid off within two years) and is a major milestone for me.

Australians are not entitled to any sort of student loans for overseas courses. Australian-based courses, such as medical degrees, are supported with either Commonwealth Supported Places, FEE-HELP loans, or a number of other government-supported schemes.

Studying medicine at OUM, for Australian students, is a huge financial commitment. Students cannot continue with their study unless they are up-to-date with their dues, paid module-by-module. I'm not sure how much I have paid in total (the fees changed - decreased, in fact - half-way through), but I think I have just bought myself a $136,000 degree over the past six years. Very competitive in the realm of medical degrees, but scary when I think of what else I might've done with that sort of cold hard cash.

I am very proud of myself for earning, and borrowing, that money over the past six years. Who knew I had that sort of economic potential.

Anyway, I have said before and still firmly believe that education is the best form of investment one can make. It's an even better investment if the odds are that that education can increase your earning potential enough to recoup the financial investment and even have greater returns.

So, I'm going to divulge some slightly personal information to you to show you how I did in the hope of assisting others:

• Completed the first two years of tuition over 4 years. Paid a monthly payment plan of about $1800 for 4 years (about $86,000)
• Refinanced my house for the first half of the clinical placements (about $25,000)
• Loan for final clinical fees ($25,000)

So, you need to bear in mind that I have continued to work full-time for the majority of my degree. The first four years we tough but I managed. I was also paying a brand-new mortgage off at the same time. Also about $1800 per month. I earn about $4000 per month, so simple maths shows I was pretty short on cash. I worked overtime whenever I could and got pretty burnt-out in the process. I also travelled and managed to make a bit of extra cash here and there to maintain a lifestyle I liked. 

I actually took a personal loan out at one point to help as I got behind. I paid that off about two years ago. When I took maternity leave, that is when things got really financially tough. I was able to refinance my home which increased my mortgage repayments which I am still, literally, paying for now. The best thing about this FINAL loan is that this is it. No more tuition fees coming next year to compound on the top of the financial pressure. I can take the full five years to repay it if I want. 

Ok, I hope me telling you all my personal financial business helps someone. I remember when I started I thought to myself that I had NO IDEA how I would afford everything but I just took a leap of faith, and worked really hard, got a little creative, begged, borrowed, and...refinanced. Somehow, it happened.

(I never did win the lottery, though...)  

Preparing for clinical placements

Here are some tips from University of Newcastle:

https://www.newcastle.edu.au/about-uon/governance-and-leadership/faculties-and-schools/faculty-of-health-and-medicine/resources/for-students/student-placement-information/the-placement-experience

HOW SHOULD I ACT ON PLACEMENT?

At all times you should demonstrate professional behaviour and comply with all attendance requirements, actively participate in learning experiences, and demonstrate respect for peers, supervisors and patients / clients. You should:

• be punctual
• dress professionally for your placement and adhere to any School or Facility specific dress codes (like uniforms)
• demonstrate cultural awareness and sensitivity
• display UON student identification card (with photograph) or School-specific placement cards (with photograph) as directed by your School
• adhere to the rules, regulations and by-laws of the placement facility
• show consideration in regards to the rights and properties of others
• meet the statutory and / or facility requirements regarding privacy and confidentiality
• refrain from any form of misconduct such as:
  • inappropriate behaviour and /or language
  • knowingly performing procedures beyond your level of learning
  • demonstrating intimidation
  • argumentation and disrespect

In some placement facilities mobile phones may interfere with the effective operation of electronic equipment. Just in case, make sure your mobile phone is switched off before attending a placement facility unless otherwise informed.

WHAT ARE THE PATIENT / CLIENT RIGHTS?

All patients/clients have a right to free and informed consent. You must always ask a patient/client for their consent to see them, talk with them, undertake a physical examination, access their patient/client notes or be involved in their care. You need to make sure that the patient/client understands that you are a student.

While most patient/clients are generous and will allow you to interact with them, some patients/clients may decline consent. It is expected that you will respect this decision.

It is an expectation that all students obtaining consent are familiar with the process and are aware of particular circumstances which influence the provision of informed consent. These include the patient's culture, language barriers or impact of medical or psychiatric illness. You should review your course notes for specific guidance or discuss the relevant issues with your Course Coordinator or placement supervisor.

Patient information is confidential. You should not identify a patient in any documentation or assignments. Any form of copying or photographing of patient information is not permitted. Each Health Facility will have a policy about the process of accessing a patient's record.

From RCH:

http://www.rch.org.au/studentorientation/2_preparing_for_placement/Preparing_for_placement/

Preparing for Practice

In order to get the most out of your placement at RCH it is important to:

• Be prepared - have a good understanding of the situation and gather as much information as possible. E.g. read the Unit Record; speak to other professionals involved; know the names of the parents and patient; know the medical condition of the child; organise an interpreter if required.
• Know your role - negotiate with your supervisor prior to meeting the family what your role and responsibilities will be: e.g. are you there to observe, should you contribute etc.
• Be respectful - Demonstrate respect and give your full attention in the meeting. Be aware of how your presentation, (Nonverbal behaviours) is perceived by others.
• Have a purpose - So that you can feel confident in the questions you ask; know what information you are trying to retrieve and what you can offer the family; don't feel embarrassed if you don't know the answer or feel that the topic requires a higher level of experience/knowledge - let them know you will find out and then check with your supervisor. 
• Be honest - introduce yourself as a student and don't be offended if the family would prefer to work with a qualified professional. This is a teaching hospital and most of our famlies are aware of that.
• Respect confidentiality and privacy - read, understand and sign the confidentiality and privacy agreement given to you at the beginning of your placement. Close the curtains or doors when discussing personal information with families; utilise private spaces where required and possible and obtain consent to share personal information with other agencies.

These are the videos I'm watching for IM:

https://www.youtube.com/watch?v=4YkHXtiSsuc&list=PLpy31mWaA4A4YVv4uIo11P8mA8tScc6SJ

plus my OUM ones on Moodle (same topics but far more boring).

Updates

I've just added an email address (profile) so people can contact me if they have any questions.

I've also added a FAQ page (tab at the top) and will add to it as people ask me questions.

Internal Medicine pre-placement panic

My heart sank just now as I see in my calendar that I begin my IM rotation in 2 weeks. I really do not feel prepared. If it wasn't the local hospital I'm trying to impress, and the home of my mentor, then I wouldn't care so much.

I asked my colleagues what to read before I go in and they said:

• pneumonia
• diabetes
• hypertension
• COPD/asthma

Maybe a few others.

When I read this topics I think of yeh, I get it, but my mind isn't in driving mode. It's in passenger mode. I'm not in the midst: oh what would I prescribe and how much. I don't know how to explain it. It's past my bedtime.

Ok another post about my pre-placement panic and what I'm doing about it tomorrow (I hope).

Can having a baby make you smarter?

It turns out YES!

Mothers often complain about baby-brain but I wonder if it's simply sleep- and rest-deprivation, and not being used to multitasking to such a high degree, dealing with stressful events, and having your routine (including sleep) completely out of whack. There's also the skill of being interrupted ever 5 seconds and remaining sane. That's a tough one.

I really feel that being a paramedic has prepared me for being a mother in all of the above ways.

And, as I think I blogged about in an earlier post, after having my first baby I felt I had gotten smarter and did an online IQ test where I scored much higher (about 10 points) than in previous attempts.

I also have a reduced requirement for sleep, a more profound sense of being present, and the ability to  make more rationale decision to prioritise (such as saving versus spending on things I don't need). My home is much cleaner and more organised.

They negative effects of becoming s mother, for me, is the deep feeling of fear. If anything happens to my child, it scares the absolute crap out of me. I suppose that is somewhat normal, especially for someone who has seen way too much scary shit at work.

Retrain your brain to find Netflix boring and textbooks interesting

^^This is what I have done.

Today, I'm at work. I have a mild headache from working on-call. I want to just relax, so I watch a little Netflix on my laptop. A few minutes in and I'm bored. I find it SO hard to find a show I actually like. I'd rather be reading textbooks or intellectual articles on the internet.

Dammit.

I never used to be this way.

However, if you take enjoyment from activities that ADD VALUE to your life, then I reckon you're onto a winner. Learning for enjoyment has got to be one of the best ways to spend leisure time if you are after an investment into your future. Investing into your mind, health, and spirit are the best investments that can be made (in my humble opinion).

Today I'm reading Cecil's Textbook of Internal Medicine and the Oxford Handbook of Clinical Medicine in preparation for my IM rotation coming up.

I have also been reading articles about Justin Wolfers, the Economist, and trying to think of how applying economic principles to my everyday life may be of benefit.

What is an ILIan?

So, I posted a few weeks ago that I was going to try and raise my IQ.

It is actually really difficult to find 20 minutes a day for something you're not very passionate about; that is not in your Top 3 goals for the day.

Sadly, so many competing priorities get left behind as I am busy with being a great mum, a great partner, and maintaining the household and providing 3x daily nutritious meals for the three of us. Oh yeh then there's work, med school, and other pursuits.

Anyway, I was decluttering some more (I can totally recommend Marie Kondo's method) and stumbled across an old test I did for special university entrance and it has allowed me membership with Intertel! Yay! That is the high IQ society for people who score in the 99th percentile or above.

So, anyway, it's not Triple Nine Society (aka TNS, 99.9th percentile) but it's a double nine society lol

Taking little wins where I can.

A member of Intertel is also sometimes known as an ILIan.

The test score I used placed me in the 99.8th percentile. Just a small 0.1% increase would be enough for TNS membership. It correlates with an IQ of 143. My goal was for 146 for TNS. I think this is a reasonable gain I could expect from proper nutrition, hydration, rest, sleep, and brain training.

From Wikipedia:

Some societies, including widely known societies such as Mensa, accept the results of standardized tests taken elsewhere. Those are listed below by selectivity percentile (assuming the now-standard definition of IQ as a standard score with a median of 100 and a standard deviation of 15 IQ points).

• Top 2 percent of population (98th percentile; 1 person out of 50; approximately IQ 130):
  • Mensa International – as of January 2014, ~110,000 members from ~100 countries; annual dues for American Mensa are $70 (dues differ by country).
• Top 1 percent (99th percentile; 1 out of 100; approximately IQ 135):
  • Intertel – as of January 2014, 1,300-1,400 members; annual dues are $39.
• Top 0.1 percent (99.9th percentile; 1 out of 1,000; approximately IQ 146):
  • Triple Nine Society – as of January 2016, 1,700 members from 50 countries; annual dues are $10.
• Top 0.003 percent (99.997th percentile; 1 out of 30,000; approximately IQ 160):
  • Prometheus Society – as of January 2014, ~120 members; annual dues are $50.
• Top 0.0001 percent (not reliable with current tests):
  • Mega Society – as of January 2014, 26 members

Life lessons

A couple of interesting things happened to me this week. One is that I bought my first Louis Vuitton handbag and first pair of LouBoutin shoes. If you are like my boyfriend and have no idea what this means, well it means that these are luxury items. Think of Mercedes in the car market and transpose that into handbags and shoes.

Here's the thing: the bag is good, but not THAT good. I like it. I bought it preloved and I'm so glad I did because there is no way it is worth the original $1800 price tag. Also, I am so bloody self-conscious carrying it. I don't like leaving it lying around just in case someone thinks its worth more than it is. Then there's the worry that people will think I bought it new and was so wasteful with my money.

The shoes: they're not that good either. I prefer the ones I got from the opshop. I don't know what brand those ones are but I like them. I'm reselling the shoes as they don't fit properly anyway. I am also glad I bought them pre-loved and not the original $1500 price.

So far my experience of these items is not what I thought it would be.

Then, today, I saw a post on Facebook that asked you to "choose" any one of a number of special gifts. By far the most popular was the ability to know the number of every scratch card (to get rich), and the second-best popular was to have the worlds highest IQ. Now, being in Mensa (and potentially Triple Nine Society) and knowing some super-dooper intelligent people with genius IQs, I know that having the world's highest IQ is not the "magic bullet" that people think it may be. People think they would be able to learn everything, to know everything, and to therefore make really good decisions and figure everything else out to get what they want. Not so. People are more than just rational thinking machines. And having the world's highest IQ doesn't necessarily make learning things about life simple.

That got me thinking about whether being rich isn't actually as good as some people think it might be.

So I Googled it. Turns out that being rich isn't the "magic bullet" some people think it may be.

Once I heard a saying that went something like: Money isn't important unless you don't have any.

I have being participating in a manifestation course (like the principles of The Secret). I am an avid vision-board maker. I bought a Law of Attraction Planner (I think it helped me secure my latest clinical placements).  I know people think it is a bunch of mumbo-jumbo, but what it does do is make you really focus on what you want. What you ACTUALLY want. These exercises made me think about whether I wanted to manifest that mansion on the hill nearby. The truth is: no, no I wouldn't want to live in that mansion. It's too big, too much maintenance, and draws too much attention. I already feel the house I live in is more than big enough for the three of us. Any bigger and I'd need staff. I don't want "staff" in my personal home. AS it turns out, I LOVE my house that I currently am in. I want to do more to the garden and buy new curtains, but overall I love it.

After I manifested my Louis Vuitton bag and LouBoutin shoes, I have realised I need to be careful what I wish for. I am grateful for them as they have made me realise the joy I thought they would bring me didn't happen. It makes me able to imagine if I did have that expensive luxury car: would I be constantly worried where I parked it? I heard a surgeon's Audi got keyed at the hospitals. It drew too much attention.

So, where to from here?

I truly believe that sometimes you have to go off course to know when you're on the right one. I think that's how heat-seeking missiles and sniffer dogs work.

I was manifesting 2016 as the year of luxury and celebration. I may need to rethink what this means to me.

Anyway, no big conclusion or pearls of wisdom; just some rambling.

Placements booked!

So, very exciting. I booked a 4-week IM placements and another 4-week EM placement (which I will do as an elective "rural emergency medicine").

I start IM in 4 weeks. I have been on annual leave and at home with the baby so not studying happened for me. I can get that done at work. I have 16 work days until my placement commences so in that time I need to get well enough prepared to make the most of my placement, feel more confident in myself as a medical student and future doctor, and not make a fool out of myself.

EM begins after a 4-week break between the two.

Both are local hospitals! YES! That means I can juggle being a mum and a paramedic without having to travel away from home.

Both hospitals have hinted that they can potentially give me more rotations. Both hospitals have internship programs that I'd LOVE to get once I graduate and pass AMC.

After these placements I still, therefore, have to find another 24 weeks of hospital placements before I can graduate.

Trial OSCE

I had a trial-OSCE a couple of weekends ago. Three students were taking their final OSCEs, and three students were having their trial run.

I hate to admit this but I did not prepare. I was in complete denial about what I was going in to. I figured it was a trial run so learning from mistakes is ok. I relied entirely on my paramedic background.

My paramedic background served me well. There were one station in particular where I felt uncomfortable (it involved a CT image), and one I completely lost the plot due to a reason I know but won't go into now. That particular mistake won't happen again. I think I might try and do a separate post about it.

So, anyway, it was actually good. I saw that I can so accomplish this with effort. There are things I need to do to get nowhere I want to be but it is very achievable. It was probably the best outcome I could have gotten from the experience.

I have being avoiding med school and pretending I'm not a med student since returning to work. I was so tired of the stress of it all, and with moving house and a new baby and returning to work, and no placements to go to, and with OUM pausing the clinical exams until the new year: I had little to motivate me to care to study in my free time. The little that I have.

Anyway, I'm trying to get back on the horse. At work I go the extra mile to learn about the cases we attend but not much else is happening. I hope to start some IM placements locally soon but I wonder how many timesI can harass my contact for a spot.

Fingers crossed for the new year.

Raising my IQ experiment

Ok so here's something that may come off as, I dunno, strange or silly or egomaniacal. But I'm going to blog about it anyway.

I want to see if I can raise my IQ.

I believe I'm in the low 140's, and at least in the high 130's. I'm in Mensa so that's minimum of 132. Maybe I just scraped through, who knows. I've only ever done the online tests.

I joined Mensa before starting med school and having a baby, where I think my IQ went up a bit just from using my brain a bit more than normal. I just did an online test that claims to be within 4% accurate, under heavy influence of sauv blanc, and still scored a 139. I think I'm better when sober and well rested. Dehydration alone reportable decreases IQ by 10%.

So, anyway, I'm conducting an experiment to see if I can raise it and get into my goal of the Triple Nine Society.

TNS requires an IQ in the top 0.1% of the population, whites approximately 145. I think I can do this.

I need to sit a proctored exam to gain evidence of my IQ. They are generally expensive, however I have quickly Googled and there is something called an ACT and I think its for College admissions and is only $40. There is one nearby in April 2016.

What I really need is A GOAL. I am lacking something to strive for. I have med school, sure, but I need something new. My proposed regime for increasing IQ will surely benefit my studies.

I have one hard rule: no nootropics except caffeine. No messing with my brain chemistry and relying on stimulants. I even want to quit caffeine. When I was really clean with my diet I experienced heightened mental clarity and I want it again.

At the very least I want to know my IQ, my best possible effort, and hopefully it is enough to get into one of the Top !% societies. Mensa is the biggest, oldest, and most well-known high IQ societies but somehow I feel like Top 2% is setting the bar bit low. There is The High IQ Society whites easier to join online and is the Top 5%. I am with them as well. I joined them before Mensa as I was more confident.

I'm aiming for high 140's.

Here's my rough wine-induced plan:

• no alcohol
• eat clean
• train mean
• early nights
• meditation
• dual N-back training
• common IQ test question familiarisation
• more research this subject

No wine will be hard. I've become to rely on it due to having a toddler.

Wish me luck.

Two essential textbooks

Here are the two textbooks which I believe are essential (for Australian OUM students anyway):

1. General Practice by John Murtagh
2. First Aid for the USMLE Step 1

AMC MCQ prep

I am beginning to prep for the AMC MCQ exam. I said I wasn't going to start yet, but I am not feeling confident in my abilities of an almost-doctor that I want to have a focused kind of "revision" of actual "what to do" when treating patients so I figured AMC prep might help me have some sort of plan.

I've been looking around the net and I think I'll do the HEAL bridging course, but not yet. It's 6 weeks so that it a trouble in the first place as I only get annual leave in 4 week blocks.

RACGPs has a 10-week fully online course but it's really only a MCQ question bank and I resent having to pay $2000 for 400 questions. Maybe I'll do it once I graduate. For now there are plenty of free resources around to keep me occupied.

This is my current strategy:

I have John Murtagh's General Practice text book that I'm using as my core text. There are 141 topic it! Too many to tackle cover-to-cover.

I have the RACGP list of top 30 conditions treated by GPs. I will list them for you:

1. hypertension
2. immunisation
3. acute URTI
4. depression
5. diabetes
6. lipid disorders
7. general check-up
8. osteoarthritis
9. back complaint
10. prescription
11. oesophageal disease
12. female genital check-up
13. acute bronchitis/bronchiolitis
14. asthma
15. anxiety
16. test results
17. UTI
18. dermatitis
19. pregnancy
20. sleep disturbance
21. sinusitis
22. gastroenteritis
23. vitamin/nutritional deficiency
24. malignant neoplasm of the skin
25. abnormal test results
26. atrial fibrillation/flutter
27. oral contraception
28. solar ketosis/sunburn
29. ischaemic heart disease
30. virus

So, I think knowing the top 30 conditions is essential, but also are the rare but life-threatening conditions.

Murtagh's has clinical boxes with an asclepius listing medical conditions which are important to know so I hope to go through those too.

On Facebook, I've liked the https://www.facebook.com/AMCprep page. They put up free AMC MCQs, only one every few weeks, but if you go to their page all the old ones are listed so you can work your way through those before you pay the $100 a month or whatever it is on their website.

So I'm beginning with that and hope to complete by the end of the year.

There's also a few things on YouTube if you hunt around.

I also have to hunt around for my next lot of placements.

Stress and motherhood and placements: the update

I wanted to quickly update on where I am right now with my stress, motherhood, and my clinical placements.

Stress: much, much better. So it turns out that after 8 years as a paramedic I do have some PTSD which motherhood and an unfortunate incident triggered. I was also living in a place where I felt unsafe. I will NEVER put myself or my children in that situation again. I have returned back to work and MY house now and things are so much better. The stress at work is completely manageable, but if something happens that makes me feel the personal security of my child is threatened, I have a strong, physiological response (shaking, racing heartbeat). I know I have some work to do on this because I'd like to do some travel etc and I can't always control my environment. It has been a horrible time in my life and it has made me realise the safety of my nest is paramount.

Motherhood: It's getting easier now Bubby is 13 months. She's a bit easier to manage these days. Being back at work has helped me feel more "normal", and I schedule one day a month for myself where she goes to daycare and I do my own thing. She's in daycare 2-3 days per week which is perfect for all of us. This won't be the case when I do my next clinical placement, which I'm a bit worried about. Today, for example, I took the day off work sick (I was really crook yesterday and a bit better today but still sent her to daycare). I am getting everything done in one day lol. I also get everything done at work in my downtime between jobs.

Placements: I have 32 weeks to go. I need: O+G (8 weeks), surgery (4 weeks), IM (12 weeks), and 8 weeks of electives. I am currently speaking to four local hospitals that all sound promising. I have until March 2017 to complete all these plus my final MCQ exam and OSCE. Then I'm done! I am hoping to be done next year though and then look at internships.

Internships: so, if I do my AMC in time I can apply to Australian hospitals for internship. If not, I have to wait until the following year. I am HAPPY to take an extra year to prep for AMC and get a good score, also to work a bit longer as an ambo and maybe save some money before I drop down from senior paramedic to junior doctor. I'm looking at internship in Australia, Samoa, or NZ at this stage.

Here's the thing: I'm 8 years in my job. We get 4 months long service leave at 10 years, which you may take early (from 8.5 years) if you intend to stay until 10 years. I am thinking about potentially doing my internship in Samoa (or elsewhere) while on LSL (8 months half-pay, plus accrued annual leave). That's the game plan atm. I will also see what is around in Australia and what is best for the family. My partner loves the idea of living overseas for a year. I, however, "like" the idea of a sibling for my daughter and there's no way I'm going to be pregnant or have a baby as a medical student (again) or in Samoa. And as I'm 37, I'm running out of time (and for anyone who says I can have a baby at 42, I think they're mad).

Goals: visualise with me here please! (Hey, I wanted to add you really need to write down your goals so you can work towards them, otherwise who do you know here you're going...?)

• Graduate from med school mid-2016
• AMC exam early 2017
• Apply for internships in 2017 for 2018 start
• 2018 first year as a doctor, Bubby will be 3-4 years old and in kinder. I will be 40!!!
• I will be 40, but look and feel 30! 
• Internship local and do a year as dr overseas after, or the inverse