No time

I think it's fair to say if you're working full-time and studying med, you have no free time.

I got called out for work until 3am this morning.  I got up early at 11am to do a bit of urgent house work (dishes) before returning to work at 1pm.  After an hour for shift change-over, lunch, doing some work-related admin, management dropping in etc I got so little actual study I'm starting to feel stressed. In 4 hours I read four pages from my textbook.  Where on Earth did the time go?

It's now Friday night. I just got home from work and I've done the rest of my urgent house work which included vacuuming.  I'm on-call again tonight so who knows what the night will bring.

So I have to end this post cause I need to get a few more pages done now before watching some Kaplan videos tonight.

One of the worst things is, I've just realised the readings I was supposed to do last week, and the references I have been given for both weeks are for a different edition textbook, that I figured I'd better read the whole endocrine chapter of Robbins Pathologic Basic of Disease but I'm making the mistake of back-pedalling.    Feeling overwhelmed.  I've gone against my won rule.

And I so need to wash my hair tonight.

First endo quiz down

I did my first "weekly quiz" for endocrine just before - I think I fluked it.

I had obviously spend too much time focusing on the case study and things surrounding hypothyroidism that I didn't cover-off on some of the additional readings of other endocrine hormones.  I figured we'd cover them as we went along in the module.  Not so.  Not so at all!

Well I got some very good advice from a fellow classmate and which readings to focus on for the exam.  Ok.  I think I might know what I'm doing now.  I swear half of the difficulty of studying med is trying to figure out what you're supposed to do and when.

So, in a nutshell, it seems the case studies are all well-and-good but I need to make sure I'm doing the additional readings.  For example, there was a questions about the hormones of the anterior pituitary gland. Well, silly me thought we'd cover that in more detail later in the module as there is a case on pituitary disease.  Yah I'll have to remedy this and thankfully I've got away with an ok grade this time.

As I've had four days off work this week I was feeling pretty good about my progress, but that quiz has shaken me up a little.

No time to dwell.

Back to the books!

Masters grades are in

I got my grades for that Masters subject I did and they are good.  I'm so relieved.  I wasn't sure how I'd go because I wasn't happy with my work, but then again I'm never happy with my essays.  Whew - one less stress.

I also looked through my transcript and that subject I "failed", well I think I should have been given a "withdrawal - late" grade instead so I've emailed about that.  They gave me "fail - insufficient" instead.  Cause that grade is a real bummer.

I have one more "easy" subject of Masters, Ethics, so I'm now considering doing it - hahahaha.  Now that I'm on the other side of the pain of juggling Masters and med school and basking in the glow of achievement.  After that easy subject comes two research subjects and two research projects.  Yuk.

Well back to studying med.  I have this new routine where I reward myself for completing a reading by doing housework!  I think I need a doctor.....

My dog

I love my darling dog, and he loves going for car rides. We don't go far without his proper safety-harness seatbelt thingy, but to tell the truth, he really only likes short trips around the town centre where we can drive slow and smell all the wonderful smells.

I got told once that talking your dog for a walk is like them getting to read the newspaper.  I guess my dog just got a quick scan of the headlines today.

It seems to make people happy to see a giant dog in a small car as well.  His head sits up higher than mine. Sometimes when I come out of the supermarket I see him sitting in the drivers seat behind the wheel, which looks really hilarious. It's well-worth the hairs he leaves all over my car seats.

Another one of the most amusing yet simple things in life, I think, is how much dogs love car rides and how much cats hate them!

Remote proctor

I got lazy and distracted yesterday arvo.  I just couldn't do it.  I needed to chill and rest my brain.  At least I got in a few hours in my mentor session and about an hour at home on the new case study, but that was it.

This morning I'm happy to report I've got my mojo back and I'm nearly done with the case before lunchtime, which is great.

I've also installed my Remote Proctor, which is a weird camera thing and finger print scanner as now our end of term exams are done from home, rather than in the testing centre in the city.  This is great for a lot of people who have to travel great distances to testing centres.  I kind of liked having the day off and going into the city.  I think I was less likely to be distracted by my pets, phones, whatever.  I suppose I can turn my phones off but try telling my dog and cat to amuse themselves for 2 hours when I'm just sitting here in my study ignoring them!  Believe me I've tried reasoning with them: "I'm doing it for us so we can have more plants to sniff, more toys to chew, and the expensive pet food". LOL

Back to finish this case study now....

MD vs MBBS

I just read an interesting article in the Medical Observer, and it's the not the first on this issue.

University of Melbourne began their graduate entry MD course this year, and the full-fee places cost over $219,852!  The debate is whether this MD has been designed purely to circumvent the Federal restriction on Bachelor degree fees.  Melbourne argues it is to reflect the postgraduate-level of the degree in-line with US med schools, versus undergraduate entry MBBS which has been the traditional stream for Commonwealth countries until recently.  Masters degrees apparently don't have these restrictions.  The MD is seemingly being marketed as a Masters.

You can read the full article via the link below.

What do I think?  MBBS and MD as medical degrees have always been considered equivalent (not to be confused with the Commonwealth "Doctorate" much like a PhD).  Whether you do a 5-6 year undergrad MBBS or a 4 year grad-entry MBBS, you still end up graduating at the same level.  As will the new Melbourne MDs, and US MDs, and even me as an MD from OUM.  We all start out as interns, PGY-1.

I personally recently decided to change to the MD stream at OUM because now MD students sit a separate assessment in basic sciences which is supposed to make sure they (we) are prepared for the USMLEs.  I wanted to make sure I was also prepared for the USMLEs as I intend on sitting them.  My friend doing the MBBS stream, for example, is not intending on sitting the USMLEs.  Why?  Because they cost over $2000 to sit, and the similar exam OUM provides is for free, and she is intending of working in Australia (or Samoa or NZ).  She will sit the USMLEs if and when she decides to apply for residency in the US.

Also, if the University of Melbourne thinks "MD" is more appropriate and better than "MBBS", then they must be right? Right?

What does all this mean?

I don't have a clue, but I do have a sneaky suspicion Melbourne's trail-blazing may indeed create a sort of two-tiered graduate system (as was mentioned in the article).  I hope not because I don't like tiers.  There are tiers in ambulance and I don't think they provide better outcomes for the patient at all, but that is a whole other post.  If the MD course wants to be a Masters, then be a Masters, or a dual MBBS/Masters.  If it wants to have a semester of research, that's great, but that's what OUM is wanting to do too based on recommendations from PAASCU.  And I'm sure there's other med courses which also have a strong research focus.  (But how dare I compare the University of Melbourne to OUM, right?)  Will "MD" be a more desirable set of letter to have after your name than MBBS in a few years...?

What does this all really mean to me?  I'm not really sure and I don't think I really care.  I just want to learn how to be a good doc, to graduate, and to find myself a job.

I just thought it was interesting, that's all.

Enjoy.


Fear MDs will lure students into specialties

University of Melbourne MD degree

Mentoring

As part of my course, I have to see a mentor for two hours every week during my pre-clinical modules.  Today was my first mentor meeting for this term.

I am so lucky to have the mentor that I do. She is a top emergency consultant and works at the local major regional hospital.  So, basically, she is doing the job that I want one day. (Emergency medicine is still my first preference, with paediatrics and general practice as my other top preferences). She is very optimistic about my prospects of finding a job once I graduate, despite me being an IMG (International Medical Graduate) and the surging medical student tsunami in Australia.  Geez I hope she is right.

So today we had a double session and we went through the first two cases - hypo- and hyper- thyroidism.   It went well.  It even went better over a pot of jasmine green tea and eggs florentine.

That was my morning.  Now I'm home and my afternoon will be going through the second case study.  I believe I can finish it today as I don't have work to interrupt me.  I like to get the case study read and out of the way before moving on, although after each Learning Issue there is the associated readings, but I prefer to do those all at the end.  I liked my method last week of reading the case study (and looking up any unfamiliar terms along the way), watching the associated Kaplan videos, and then doing the readings.  The readings were easier to digest with a quick overview first from the case and the videos.

Yesterday, FYI, I had my first online lecture for the term.  It went for three hours and covered the first case study.  I was so glad I had done the pre-readings as you need to have done them before class to be able to answer the questions the lecturer asks.  There are about 10 students in my class so we all get asked questions in turn. I felt pretty confident about most things, but once again I feel inferior to the nurse practitioners and osteopaths - they are already seeing primary presentation of hypothyroidism, for example, and ordering and interpreting tests.

My mentor told me every time I have a patient from now on, after I've finished all my paperwork and other duties for work, I should sit down and go through all the possible differential diagnoses for that patient, write them all down, and then write down how I would work that patient up as a doctor and what tests I should order.  I will definitely do that from now on.

To be honest, I didn't realise until this week that thyroid problems could cause arrhythmias.  I will look at that more closely now, although my mentor did say it's not exactly the most common cause (of bradycardia and AF).

Ok off to get cracking on this hyperthyroidism case study.  My dog is already crying at my because I'm at the computer and ignoring him.

PS  My iMac is going really well.  I think it is one purchase I can definitely say has made my life better.  Loving the iPad too.

Today's routine

Today I was so tired.  By the end of my working week the sleep debt has accumulated so much I feel like I've done an all-nighter... I tried to fix it by going to bed at 6.30pm last night as soon as I got home from work - but I could only sleep for an hour before my body said "Hey, I'm normally woken by a loud beeping noise at this time so I'm just going to go ahead a wake-up now anyway".

I got up and watched Paramedics: Recruits from the night before which was 20 minutes with fast-forwarding the ads.  I was happy to see this week they showed a patient that vomitted all over himself and the ambulance as that is what the job is really like.  I have become good at pre-empting emesis with my four years on-road experience (plus 3 years ambulance training and 7 years army medic experience).  I was watching the tv thinking "He's gonna spew!  Get an em-bag!", but, no, they were insistently trying to put a Hudson's (oxygen) mask on him.  They nearly wore it too.

All I wanted to do was watch tv last night. Instead I got to finish the physiology Kaplan videos for all of endocrine, which is excellent.

Today at work I watched the whole pathology section for endocrine as well.  I have now completed the videos for endocrine in the first week of the term (except for pharm because its thyroid section is so small - I will watch it at the end of the term for revision of the other endocrine drugs)!  Excellent!  The videos took me about 1.5 hours today.

Retention of videos - probably about 75%, which isn't bad considering they are designed for revision.  For me, I found them handy as an introduction to the topic.  I think watching them again as revision would be better.  The biochemistry I watched the other day is probably my weakest area (as usual) but I think I could do well there if I spent more time on it.  I think being in the MD program now this is something I'll certainly have to look at.

We went out on jobs for most of the day, and I managed to scrape in the endocrine section of FA over about 20 minutes.  I took my Guyton and Hall in the ambulance with me, but my partner finished his paperwork too quick and was done before I had refurbished the ambulance.

At work I'm always looking up anything I don't know, especially patients medications, and revising things like diagnosing left and right bundle-branch blocks, and when I return to the ED cubicle with my finished paperwork, often the doctor has ordered his initial tests and management and I can check what they are.  At triage I'm on my phone Googling everything while I wait that 5 minutes.

Tonight I have to prepare for tomorrow's lecture.  I have to make sure I've done those compulsory readings, which is a massive task.  It will take me all night, and that's if I don't get any call-outs.  It's also my baby-sitter's 18th tonight so I promised I'd drop in if I could.

That is where I'm up to.

In other news, my dog hates thunder and I felt so sorry for him today as we were stuck at the hospital and it was a big storm. He got into the rubbish bin yesterday, but it was my fault as I left chicken bones in there andI guess the smell was just too irresistible. He once did that when I first got him last year but he got the bin lid stuck on his head.  Enough time has passed now and he has regained his courage towards the bin.  I must remember to put such smelly-delights straight out into the big bin in the garage where he can't get to it.

Study pattern

For those who are interested in the day-to-day study pattern of an OUM med student, I will try to continue to give a daily description this term of what I'm doing.

So, yesterday....was almost too long ago to remember.  We were quite busy at work and I was feeling really tired.  I think I probably managed about 4 hours study (it's a 12-hour shift, but we had a break for the first 2 hours, so 10-hours at work yesterday on-duty) and I first revised the second half of my case study notes (from the day before) which took about half and hour.

Then I started back on one of the readings - Kumar and Clark's Clinical Medicine.  I had done a few pages on Intro to Endocrine so I revised them, then finished the intro section and went to the section on Thyroid Axis, which is about 3 pages, and then I started on Hypothyroidism.

I managed to borrow the Guyton and Hall Physiology text from the hospital while I was up there with a patient.

That is all I got to do in four hours (!) because it was so interrupted.  Maybe it was more like three hours.

When I got home I watched the last 15 minutes of Send in the Dogs which is about the Police Dog Squad in Australia.  I had started watching it the other night (for about 15 minutes) when I decided to record it and study.  I then recorded Paramedic: Recruits so I wonder if I'll get a chance to watch that any time this week.

I also had dinner.  About an hour had lapsed since I got home and I started watching the Kaplan videos again.  I think this will be my new nightly routine.  I revised the notes from the night before, and got about 30  minutes into the video when my pages went off at about 8.30pm.  I was out until 2am working.

Due to being out so late, and working basically from 9am to 2am, we got a break until 12pm today.  So now my day is cut short.

Today I started studying back at work with the Guyton and Hall Physiology assigned reading.  So, I thought it said to read pages 74-76, but it is in fact chapter 74-76!  It's about 40 pages!  Also I need to accomplish about another 15-20 pages of Kumar and Clark and a few pages of anatomy (but I'm not going to stress too much about anat).  These are the three that are listed as this week's syllabus, but in the case study there's manyt other readings, such as embryology, histology, and pharmacology, which makes me think the syllabus are the most important.  But obviously I'd like to achieve all of the required readings.  There's even more recommended readings and links to websites, but I can't see it happeneding.  Maybe if I have spare time after Sunday's lecture I'll scan the weblinks.

Normally, I highlight my textbooks and try to mentally retain the knowledge as I go.  Obviously, I can't highlight the library book, so I started to make notes instead.  I'm not sure which will be more effective for me.  I'm starting to think note-taking, which goes against my normal way.

Probably a combination of reading, highlighting, note-taking, and watching the Kaplan videos is ideal.

Ok, there goes my 15 minute blog break.  Back to it!

Study-buddie

I got my confirmation email today that I am indeed in the endocrine class this term.  Yay.  And even better, my friend from first term in Samoa is in this class with me too.  Double yay!  It will be great to have a study partner this term.  We have decided to have weekly Skype sessions before our lectures to compare notes and what we believe are the key points for the week.

I am making good progress through my first week's case study, although it's now the end of Wednesday and it took me two days to read the case study.  I now have three days to read all the assigned readings from the core textbooks which is far-and-away much more than 50% more reading, if you get my drift. 

I started my morning by doing housework before work, then revising yesterday's stuff before moving on, which was extremely effective for retention (I believe).  I also Googled and Wikipediaed any words or terms I didn't know or fully understand as I came across them before moving on, which I think worked well.  I underline the word and then label it with its definition.

I make notes in the margins of the case study and go back and edit and adjust anything as necessary.  Being critical of the case notes and my own notes works well for me.

If things are listed within a paragraph, I relist them in a bullet-point list as my mind digests this form of list easier.  Anatomical things I generally draw pictures, and especially for microscopic anatomy such as, for example in this case, the structure of a thyroid follicle.

Thyroid follicle

I also draw chemical, molecular structures.  I have now chem background except my own self-study for the GAMSAT, but I still can visually appreciate the difference in structure between thyroxine (T4) and triiodothyronine (T3) (see below):

This helps my brain remember information about T4 and T3 as I picture them in my mind when describing their actions and interactions with iodine and thyroxine binding globulin (for example).

I also did the end of case quiz (which is different to the new graded weekly quizzes) and was satisfied with my progress and retention thus far.  I think they were perhaps a little easy, and I think I need to look at some USMLE-style questions from somewhere at some stage.  I normally don't get my USMLEWorld Qbank 30-day subscription until the last 4 weeks of term, but this term I might start early, even though you can't choose just "hypothyroidism" questions for example.  Hmm... I'll decide when I get paid next week if I can spare the $100.

I could probably do with two or three new textbooks too.  The library at the hospital was shut today when we took our first patient there, so I'll try again during the week.  I need this week just Guyton and Hall's Textbook of Medical Physiology.  I have the others already which is great.

So that is all.  Yes, I'm super-dooper motivated this term for some reason.

I hope it lasts.

Endocrine

I'm back at med school finally and it looks like I'm doing the endocrine system this term (I haven't had a confirmation email yet but it's the only one I can access and in my profile it is listed as one of my courses).

Endocrine is not exactly an area of expertise for paramedics (compared to my previous modules of cardiovascular, respiratory, and musculoskeletal) except for perhaps diabetes.  So this should be interesting.  At least I know where the thyroid gland is.....

So this week's case is hypothyroidism.

It also looks like I have my lectures at a humane time, albeit on a Sunday at 8am, and the three one-hour lectures are back-to-back which is really great.  I mean, it's difficult trying to sit still for three hours, but it's easier when trying to plan the other parts of my life around the lecture times and I'm less likely to forget them.  Morning is also the best time because at work most of our jobs seems to come in in the afternoon and evening.  Saturday nights can be a killer too, but I am happy with 8am after last term was 5am!

The weekly online quizzes are open for 22-hours on Thursdays, so that works out well for me too.  They are fine because I can find 10 minutes in a 22-hour window on any day of the week (usually).

So, yeh, I'm happy to be back studying again.  I'm a year and a half into the course now and I want to ramp up my performance a bit more.  Well, actually my grades have been good so far, but I want them to be excellent.

------
Sunday was my sister's wedding.  I am officially free of MoH duties now.  It all went really well and it was a total credit to my sister who organised such a wonderful event.  She hand-made a number of decorations such a pin-wheels and mini-noodle boxes for the lolly-bar which put such a lovely personal touch to the whole thing.  It was simple and classy yet elegant.  Bravo to her.  My Mum knitted a wedding cake (just for show, not for eating!) that was super-cute and sat on the gift table.

The day before the wedding we picked up the flowers from the florist.  The flowers were my contribution to the wedding, a gift from me, and OMG I can't believe how far a fairly decent amount of money wont go when buying wedding flowers. Yikes!

It was probably the best wedding or event I've ever been to!


And now all it right in the universe once again......

Back into the routine

I'm back into the "study at work" routine.  I watched the first of 14 hour-long lectures on immunology by Albert Einstein School of Medicine on You Tube and started the immunol chapter of First Aid for the USMLE Step 1 (which I often call "FA").  I did so much study today that I rewarded myself with housework when I got home. lol

That is all.

I wish I could motivate myself to revise last term but I cannot.

I want to start preparing for the Step 1 but it's so hard when you're struggling to keep up with the term's curriculum.

No more Masters

Today I finally submitted my final assignment for this term in Masters of International Health. Woo-hoo. I hope I pass because it was pretty average work.

I've decided to take a leave of absence from my Masters and to concentrate on med school. Of course this all makes obvious sense to anyone sitting on the outside.

Well, again it happened today. As soon as I decide to take a break from masters, I see something about the health crisis in poor countries. Today I was checking out Dr Najeeb's video lectures on YouTube, and he had these "other" favorite videos so I watched one and it had the most horrible pictures of really skinny little children in Africa. It was quite alarming and moving. It was all photos I've seen before, and I have experience first-hand with this sort of thing, but it's so easy to forget "those" people way over "there".

I haven't decided to give up my goal which is to work for MSF, but I have decided I really need to put more focus, time, effort, etc into med if I'm going to get the USMLE scores and therefore hopefully residency that I want.

In other news - I'm settling back into work ok. I'm loving my new twin-Apple purchases of the iMac and iPad and they have indeed made my life better (it's not often a purchase can fulfill that promise).

And I start my new term of med school on Monday.

So I'm feeling particularly motivated right ow, which is probably due to the modest break I have had away from med, but I put in one of my Kaplan videos tonight, read a page of my Davidson's, flicked through my Murtagh's, scanned a bit Standford Mini Med School, and now I'm feeling a little lost and without direction. I suppose the best thing to do would be to revise or look at those "additional" modules from OUM once again but I wasn't expecting to have completed my masters assignment by tonight.

I did watch about five minutes of the Kardashians wedding special before I started having delusional thoughts of sticking chopsticks through my eye-balls. I'm just not that integrated back into the western world yet.

The Wheel of Life and how I got into buddhist philosophy

I'm really stuck on this Wheel of Life.  I find it absolutely fascinating and amazing that it almost so perfectly describes the human experience.

I keep thinking about it because I've already learnt so much from it and situations continually arise in which I can self-reflect and use the Wheel to help me kind of self-analyse what is going on.

Wikipedia actually (as usual) has a nice summary (search Wheel of Life and it will take you to "Bhavacakra which is the real name for it).

So someone asked me the other day how I got into buddhism.  I'm not sure.  I think I really started thinking about it in first year uni when we got taught about mind-body connectedness and we were given an example of a mouse entering a room full of people and how all the different people might react differently to the mouse.  The mouse is the same mouse, but our perception creates our reality.  From understanding this concept I was able to understand the Four Noble Truths (which I have blogged about in a previous post). But basically it's about finding happiness by dealing with your own inner perceptions, not the outside world.

Then, I had a question about karma.  I kind of intuitively knew karma was real.  I mean, whenever I've done something good to someone or been nice to them I've always felt better and then seemed to have people be nice to me too.  Then I thought a lot about Newtons Third Law, which to summarise, that all actions have equal and opposite reactions.  Therefore, if I'm putting positive actions and words out into the universe, I therefore must get positive actions and words back to me.  But that's a little difficult to prove outside of physics.  And some people have karma from past lives they have to deal with first.  This is why you might feel you have to work a lot harder to begin with in life.  All I know is the more I show kindness and generosity to people, the more I seem to get it back in return.

Then, I had a big question mark about reincarnation.  Seriously?  I used to be a cat?  Or Joan of Arc?  Then I read somewhere that reincarnation can occur in your current life.  I explain it like this to my girlfriends: "You know how you seem to date the same guy over and over again?"  That's reincarnation. You haven't learnt how to deal with your attachment to assholes, and that the nice guy is the one you should go for.  This is the reincarnation of the lesson in life you need to learn before you can move on.  It's obviously not just limited to dating.  It's also in your career progression, dealing with personalities, dealing with money, etc etc.

And somehow, over time, I've come to accept that life reincarnation is possible.  If I think back I think that started to happen as I started to practice meditation.  And by "practice" I mean "put into practice" rather than "try hard to learn how to do it".  Like enlightenment, meditation happens when you stop trying and start simply being.  But that's another lesson.  When I first started meditating I felt a connectedness to the universe.  When all my thoughts, fears, and worries settled back down into the background, the "mad monkey" (which is what they call the constant and continual chatter in your mind) hushes for a second or two, you honestly can't help but feel connected to the universe.  Like the soul feels strong again, and the soul feels connected without time or space barriers.  This is how I really knew the soul existed.

Incidentally, I've been reading Stephen Hawkins The Universe in a Nutshell recently and he talks about time perhaps having no dimensions.  Being infinite.  Like space.  But, again, I think that is for another conversation or this post will become it's own book.

Then, I asked on this recent trip, "What about the problem that 90% of all the humans that have ever lived are living now"?  Where do all the souls come from?  Well, I got explained by my Bhutanese guide that we might have been a tree or just a seed.  We don't know.  But we were and always have been part of this universe and we will be yet again reborn into samsara (this is the sanskrit word for the cycle of rebirth, which, is not ideal!)

So, samsara.  Samsara is what is depicted in The Wheel of Life in a symbol form.  Which I like, because I believe I am introverted and I therefore find pictures really helpful as my mind thinks in pictures.  I was interested to read that historically they think Buddha himself drew the first Wheel to help explain ordinary people understand his teachings.  I'm ordinary I guess.  And further on in Wikipedia it says it was put on temple walls to help teach "more simple-minded farmers and cowherds"!  Well, I wont be too insulted. I happen to like farmers.

Anyway, where was I ......?  Here's what Wikipedia says:

The meanings of the main parts of the diagram are:

1. The images in the hub of the wheel represents the three poisons of ignorance, attachment and aversion.
2. The second layer represents karma.
3. The third layer represents the six realms of samsara.
4. The fourth layer represents the twelve links of dependent origination.
5. The fierce figure holding the wheel represents impermanence.
6. The moon above the wheel (top left in the image at right) represents liberation from samsara or cyclic existence.
7. The Buddha pointing to the moon (top right in the image at right) indicates that liberation is possible.

So, in my own journey of understanding things, I get the "hub" of ignorance, attachment and aversions.  In fact, I think its a lovely neat summary, rather than all the other twelve deadly sins and the like.  Everything comes from ignorance, attachment, and aversion.  And, in fact, attachment and aversion are due to ignorance and vice-versa.

Karma - ok I think we accept that now.

The six realms of samsara (or segments as I described in my last Wheel of Life post) are interesting.  Very interesting indeed.  Especially the jealous, lucky, and greedy realms.  They call these realms the demon, god, and hungry ghost realms, but I think my translation is a bit more accurate for everyday English.  So it's interesting that the lucky realm is the most "comfortable" life but it's not the way to enlightenment.  The "human" realm is, which I thought previously (as I wrote in my last Wheel post) that is was the enlightened segment, but actually it's the human realm where one can work towards enlightenment.  This is better than the :lucky" realm because people in "lucky" are so preoccupied with their comfortable life and defending themselves from the jealous realm, that they forget to practice the path to enlightenment.  And according to The Buddhist Society, these people are in serious risk of being reborn not as a human, but as a lesser being such as an animal where it will take a very long time to work up enough karma to get back up.

So, yes, the realms are transient, day-to-day, minute-to-minute depending where in your life you currently are.  And the Wheel, held in the mouth of death or "impermanence" is a mirror to remind us humans what it's all about, the bigger picture, and not to get distracted for too long.

I have thinking about this Wheel a lot.  About my jealousy towards the privileged people that got to go to a top school, got into med school straight away, and haven't had to work as hard as I have to get to the same place.  And then I have been thinking today a lot about the current Occupy Wall Street movement as there is an Occupy Melbourne movement gearing up.  Are we in the jealous realm?  We did, afterall, help plant those seeds in which those big Fat Cats now eat the fruit.  And, are we also in the lucky realm in Australia, the top 0.5% of the wealthiest people on the planet?  Have we forgotten?  Are we preoccupied?  Or are we the "hungry ghosts" that just want more and more?  Is one flat-screen tv per household no longer satisfying?

Many questions.  But the main thing is, when I feel jealousy or hatred towards the lucky people, I know where I'm coming from.  I'm coming from jealousy realm.  And that is born out of either ignorance, attachment or aversion.

And finally, the outer circle.  The twelve links of dependant origination.  The "human activities" I think I described it as, as that's what it kind of looks like.  Well, I have just learnt today that they are actually:

1. Lack of knowledge
2. Construction volitional activity (I think this is work or crafting stuff)
3. Consciousness
4. Name and form (I think this means physical being)
5. Contact (ie with other humans)
6. The six senses (the mind gets its own sense)
7. Pain
8. Thirst
9. Grasping
10. Coming to be (this is the coupe having sex, ie conception)
11. Being born
12. Old age and death

These twelve sections are part of what makes the wheel go round, but I have to study this outer layer a bit more in depth before I can fully understand its pertinence.  I believe that the six realms are internal causes of suffering, but the outer twelve are external causes.  This is why I thought they were simple activities of daily living.  Mmmm so much more to learn.

Ok I think this concludes today's lesson.  I'm teaching myself, rather than trying to preach so I hop ethis doesn't annoy anyone too much.

Just part of my "about stuff' in which this blog is supposed to be about.  My life and stuff.

Now to cease avoiding this friggin essay.....

Mac time

Well, I did it.  I finally bought myself an iMac.

I've had my Lenovo mini-laptop for about two and a half years now, so I think I got my $500s worth.

I was looking and umming and ahhhing over an iMac before my trip, looking at refurbished models, secondhand ones, the student discount, the finance options, etc etc.  In the end I was trying to write this friggin annoying assignment yesterday and thought "I've had it".  Coincidentally it was the same day Steve Jobs had also had it.  RIP Jobs.

So I generally pride myself on not getting too swept up in the hype.  I've managed to resist an iPhone all this time, and an iPad.  I finally succumbed to an iPod a while ago when my cheapie MP3 just wasn't making the grade.

I have also found my recent computer habits are quite confined to the desk therefore a desktop makes sense, that and also I spend a LOT of time at my desk at home thanks to that little medical degree and masters degree I'm trying to work my way through.

My smart phone is doing very well for internet browsing the odd thing here and there.  The ebooks I have on it serves me well for a bit of study squeezed in where I can at work or the traffic lights.  Perhaps the only gap I could find is those times I want to sit on the couch and do a bit of uni work, or at work when the work computer is occupied..... And then they invented the iPad.

The iPad was initially only interesting to me because it is yet another in a long line of technologies which seem to have been developed straight from Star Trek's vision of the future  And they called it a "pad" which is what the Star Trek one is called ("PADD").  So that's cool.

But now with my whole going back to the desk top thing I though there was room in my life for an iPad, so, well I was already in the Apple store anyway, so that's how my credit card got a nice workout today.

And what about my Kindle?  I still think it;s superior for reading comfort and probably suits us older people who don't like reading from backlit screens.  But I haven't really used it.  I have friends that use their's all the time.  Hmmm.  Not sure what I will do with it now I have the iPad.  I can't imagine carrying both around.  Stay tuned for more on this.

So that's about it.  I have the weekend to do these assignments and I really can't wait to get back into med school.

Back home

I'm back home now.  I arrived late Sunday night and was pretty much a zombie for two days, which seems to make sense as I hadn't slept for two days thanks to my flight schedule.  I go back to work Sunday night.  Have have two assignments due on Monday for my Masters which I haven't even looked at yet.  OMG.

My house-sitters left my house in very good order so I don't have to stress about housework at all, which is so wonderful.  But I have a lot of mail to go through, bills etcetera, but that's fine.  There's nothing scary in there.

I start my new term at med school in two weeks and I'm anxiously looking forward to it.  I just want to progress through this degree already.  I'm a bit nervous about the MD program I've switched too as I am already expecting it to be more difficult for me as my basic sciences are my weak point.  I have also heard from other students that the new exam system is not user-friendly and there has been a lot of complaint that it adds more stress and is not a fair system.  Great.

So I am still to transcribe the posts I wrote in Tibet and was not allowed to upload due to the censorship by the Chinese government.  I also have some cool pictures of my trip, but that too will have to wait until I do these assignments.

Looks like I'm back.

Last day

I can't believe this is my last day on this holiday. I fly out tonight and should reach home by tomorrow night.

I can't believe what I've done in only 4 weeks. Its crazy! It feels much longer than 4 weeks, more like 4 months!

This morning I used the hotel spa facilities and had a nice go in the steam room. Yesterday I had a lovely pedicure. I ALMOST feel human again.

Yesterday I went to buy some thangkas. I got the Wheel of Life for myself. It matches the Buddhas Life one I already have. Two of my friends had a requests; Medicine Buddha, and one where a monkey and elephant slowly change white (representing the path to enlightenment). Now I have three pictures to get framed when I get back (the other is a panoramic photograph on canvas of Potala Palace taken in 1916).

Today I have to fun task of packing! I searched online to find out my airline allows 20kg of check-in luggage total, and there is no "piece" system, ie I can check-in two bags for no additional charge as long as the total weight is less than 20kg. Sweet. I have an extra bag now but they are both small(ish).

I love it here but I also can't wait to get home.

Female traveller

I'm back in the relative comfort of Kathmandu. Despite its dirtiness and craziness, for some reason I feel more at home in Nepal than I did anywhere else on this trip.

The flight was delayed due to weather in Kathmandu. You can imagine my surprise when they made their boarding announcement and the only aircraft I could see out on the tarmac was a twin-propeller plane!

At first I was scared, then a bit happier because I thought it should do better on the shorter runway at Paro and in and around the mountains which flank the airport.

Then I started to get scared again when I questioned whether a twin-prop should go OVER the Himalayas. Agh.

Obviously, I survived in one piece.

-----
Being a female traveller can be interesting. Of course there's the extra male attention, extra caution when out at night, but then there's the fun of trying to find tampons...

I came with extra tampons on this trip because I knew from previous experiences how difficult such a luxury item can be to find.

Trying to explain to housekeeping, the pharmacist, and the taxi driver what it is I'm after, and even showing a tampon as an example, became very not fun very quickly.

I suppose I can last two more days without the luxuries of home.

Life and great expectations

Life can be funny. When I first arrived in Bhutan I was so impressed but the rooms and food. But I had just come from Tibet and my expectations were low.

Now, five days in, I'm not impressed. Infact, i'm slightly disappointed.

I managed to find an atm yesterday that accepted Visa (it said Mastercard too) which was not easy. It's in Paro. Thete-s rumours of one in Thimpu as well, and I saw one at the airport but it was out of service so I'm not sure if it would have worked.

Tigers Nest today... I'm nervous! It's a 5 hour hike to 2000m. Can't wait to go back to work for a rest.

Thangkas

So ive started to become slightly obsessed with Buddhist thangkas. They are these painting depicting different things, sometimes a buddha or a tara, but my favourite ones are The Wheel of Life, Buddha's Life, and the Mandala (Kalachakra Mandala).

The picture is The Wheel of Life. The detail and craftmanship alone is amazing. It takes a master with 15 years experience around 40 hours to paint one around 60x90cm. Using a single yak hair, the add the gold paint carefully.

Looking into the paintings, there's always something to see. The Wheel of Life has a number of components, but to summarise, the six segments represent the six states of existance in life. There's the hell-like experience where I just noticed a man with a rope around his neck and another man coming at him with an axe!

There's the animal-level which I believe literally represents being an animal (reincarnation, remember) but i'd guess it might also represent humans living like animals as well, in a sort of unconcious state, perhaps,driven only but basic emotions like fear and anger. But I see no humans in that segment.

Then there's the area which I think is like greed because all the people arw fat. I heard it described as the people that are never satisfied and spend all their time consuming. I think that could translate into the capitalist West easily.

Then there's the two inter-related segments where one is the "sowing" and the other the "reaping". The people who sow are jealous of those who get to reap. I see the sowers have their bows and arrows out against the reapers. The reapers seem to have a luxurious segment, like the rich, but they have to deal with the jealously from the sowers. This diachotomy would well represent the rich versus the poor.

Then finally there is the heaven-like segment. I assume one needs to achieve enlightenment first.

By the way....

.... I'm back from Tibet.

There is so much to say. I saved a post every few days on my phone app as Blogger and Facebook are banned there. I'll try and post them when I can and write a bit more about my trip when I return home.

For now I still need to survive this week in Bhutan.

Kathmandu Hyatt

So last night I decided to stay at Kathmandu Hyatt. It also upgraded myself to a Club Room which cost about $200. It was well worth it. I had a nice hot bubble vath, washed AND conditioned my hair, had all my laundry sent out and returned within 3 hours (they even repaired my travel pillow), and had a decent meal. I may have also had one or two glasses of Australian wine.

I had good wifi but was still unable to upload my blog posts for some reason. I will post them back-dated asap.

Now i'm waiting to check-in with Drukair at Kathmandu airport for my flight to Paro, Bhutan.

Tibet

I go to Tibet tomorrow for two weeks and I'm not sure if I'll be able to publish my blogs from there or not.

Standby....

Kathmandu valley

I took this photo yesterday from "monkey temple" (that's what the tourists call it due to all the monkeys which live there). It overlooks Kathmandu valley.

Altitude (12/9/11)

I'm having my first experience with altitude as I write this. My driver guesses we are about 2500m. I estimate this is probably about right as the effects have just begun to take effect.

I feel the hypoxia. I'm dizzy, a little confused, and a bit tired but overall ok. I feel a little hard to breathe also, and I liken it to being in a suffy boardroom with bad jetlag.

We've stopped for lunch at a local restaurant in the mountains in the hope the clouds will move so we can see Mt Everest and the Anapurnas.

Punjabi dress (11/9/11)

I bought a punjabi dress today. Very happy.

Power (10/9/11)

Just experienced my first Kathmandu blackout. I'm so glad I got pre-warned about them. I have my trusty dynamo torch and the room comes with a candle and box of matches - nice.

So, Kathmandu apparently has government-controlled, systematic (but not predictable) blackouts in regions due to there not being enough power. Interesting solution.

Slumdog

So my tour guide today wasn't a real tour guide. He was a dude I met while walking through Thamel in Kathmandu.

Firstly, you should know I got a lot by vibe and gut feeling. I liked Rakesh from the get-go.

The tour was excellent, but the highlight for me was having tea at his "house" which rivalled any refugee-camp i've ever seen on tv, and surpassed the slums i've been to in Cambodia.

Rakesh lives under a tarp on a woven bamboo-sliver frame he made himself and houses him, his wife and four children. I'd say it was 3-4 metres squared. It's pretty dismal but I tried really hard not to show it.

Instead I complimented him on his handy work, his beautiful family, and thanked them all for the priviledge of being welcomed into their home and their life.

Below is a photo of his son. I did the thing where you take a photo of the kid and show it to them- they love it.

I'm so lucky.

Kathmandu

This place is friggin insane. It frenic, noisy, colouful, and slightly overwhelming.

I took a walking tour today which was interesting, hot, sticky, a little scary, and mostly amazing.

I saw bodies being washed and openly cremated by the river. I saw Hindu and Buddhust temples. I saw leppers and beggers of all kinds. I walked right through on-coming traffic, and travelled on public transport called "micros" which are small Suzuki mini vans.

I even had a retailer drop his price with haggling - I think he felt sorry for me - because I agreed to pay $15usd for a shirt without argument.

Overall, its been an amazing day.

Karaoke

(From 2 nights ago in Hong Kong)

Goodbye Hong Kong

I had the best fun last night with some locals and some expats drinking cocktails, shots, dancing, and singing karaoke!  I'm so glad I had a late check-out this ornign as I really needed it!

My breakfast included green tea which, along with 1g of Panadol, really helped the hangover. I feel ok to fly tonight.

Budget hotel

After a long bus ride from Hong Kong airport to my hotel in Kowloon, I missed my stop and had to walk not far with luggage, i'm here.

I wasn't expecting much. Like Singapore, $135AUD gets you what I'd consider 3-star. But that's all ok if you're prepared for it. However, the food and transport is cheap. My 2-course lunch with tea or coffee was $10 AUD. It wasn't overly tasty, but that's ok too.

It's a bit insane here in Kowloon. It's not how I remembered HK from '99. Apart from it's reputable excellent shopping, I see no advantage in stopping here over Bangkok nor Singapore, and in my opinion KL remains superior. Indonesia should get themselves a good airline with stop-overs in Bali. Who wouldn't want to stop-over in Bali? And geographically-speaking, it's in the right place.

Anyway, I got a late check-out at my HK hotel which is the best thing that could've happened to me today.

Accents

I used to feel really self-concious of my Australian accent when I travelled. Now: not-so-much. Except... When people are having trouble understanding what I'm saying and they repeat the word back to me in my accent!

Example: this morning I was asked which airline I'm flying (for the shuttle bus to get me to the correct terminal). I said DragonAir. I got parrotted back to me "DraaaagounAir" in the most horrible faux-Australian accent.

(Incidently, I'm actually flying Cathay).

Taiwan

I leave Taiwan this morning after a good 3-day stay.

I'd recommend more than one day in Taroko as getting there is an effort. If I lived in Taiwan I think it would make a great weekend-escape.

Everyone has been extremely friendly. This is my general experience while traveling which restores so much needed faith back in the human race (sometimes all the stupid things our species does gets me down).

I'd recommend the Novotel Hotel at Taiwan International Airport (Taoyuan) for late/early morning flights for sure. It's very new here and I'd give it 5/5. It's about 30 mins from Taoyuan and 60 from Taipei so it's not suitable for any other reason.

Goodbye Taiwan! I had a great time!

Safety ideas

This (sign in picture, taken at Hualien train station) is a good idea. I think "safe zone" would be slightly less discriminatory. There are other vulnerable persons around.

Unless they decide to serve cocktails in this female-friendly zone...

Lunch

I love bento boxes. I wasn't expecting to see them in Taiwan's train stations.

The picture is my lunch. The box,was 65 NTD which is about $2 AUD. I also got a cute skinny can of coke and three Ferrero Rochers for 115 NTD total. That's about $4 AUD. Sweet.

Silks

I check-out of Silks Hotel Taroko this morning - I'm currently stuffing myself with the free (included) breakfast to prepare me for the 4+hr journey back to Taipei today.

I've already had my swim in the amazing roof-top pool which over-looks the gorge. There's a pagoda on the top of one of the peaks, and swallows, dragonflies and butterflies seem to enjoy the pool as much as the guests.

Taroko

Today I spent the day hiking Taroko Gorge. My legs and feet are sore. I was so glad to make it to Silks which is 5-star luxury. I started with a lychee martini in the rooftop spa. There were 4 elderly Taiwanese people in the spa with me who were all very interested in my tattoos. Noone got out in disgust though, so I think i'm fine.

The room is gorgeous, but the bed is as hard as anything. Typically Asian. I'm sure i'll sleep well anyway.

First faux-pas

So I accidentally mentioned the Dalai Lama today. My tour guide was talking to me about the different religions in Taiwan, he asked me if I was Buddhist because I' vegetarian (I'm only a part-time vegetarian but I guess asking for chicken and not porj put me in some-sort of vegetariab category), and then I mentioned how the Dalai Lama eats meat sometimes. The response I got was "He's not a Buddhist. He's something else" in a kind of stern tone. Oops. Sorry I forgot that the Chinese hate him, and I guess the Taiwanese are strongly influenced by popular Chinese ideas. I'd love to delve deeper into the anti-HHDL psyche, but I haven't founf the appropriate time/person as yet.

The photo is from my taxi. Those small koalas bloody make it everywhere - it's unbelievable. I saw 3 westerners all day, yet I see 2 Australian koala keyring thingys.

Hualien night market

No Westerners here... Loving it. Luckily my taxi driver ordered my meal for me as everything was in Chinese. He was a bit stressed about what I would like but it worked out well.

Chicken coffin

Here's a picture of my chicken "coffin" sandwich from last night at the Hualien night market

Cool

Cool things that have already happened to me on this trip:

+made all flights, buses, trains (even though I didn't pre-book as recommended), visas and have retained all luguage
+standing-out like dogs balls as the only round-eye in Taiwan has been an advantage as people been super-friendly and helpful
+free wifi in many locations
+used a squat-toilet on a moving train
+girl next to me on train took photos of me while I was (sort of) asleep
+confimed my first night's accomidation, emailed the homestay in Hualien and got picked up from the station
+at a sandwich called a "coffin" which was a hybrid between french toast, toasted sandwich, honey chicken and lettuce
+confirmed my suspicion that travel adaptor plugs are way over-priced in Australia (1500%)

HK

Made it to Hong Kong after a fairly reasonable 9+ hour overnight flight.

Just had to walk about 2kms to my connecting flight's gate. But I have food, iced espresso mocha, a seat, free wifi, and the gate in eye-sight.

Taiwan, here I come!

Packing

Leaving in 3 hours....

Overdue

My masters assignment is now one day overdue.  It just didn't get finished yesterday.  It's now 7.30pm in the evening and I've only just started looking at it now.  It really wont take long as I only have the referencing to clean up, checking the 1.5 line spacing and correct font, and finding the coversheet etc to go.  Should be done in an hour.  A day late is about -5% I think.

I spent the earlier part of the day mowing my lawns (got a new lawn mower yesterday!) and installing my washing machine (got a new washing machine finally today).  I also had much fun doing the "preliminary"pack for my trip which is where I lay out everything I'd like to take, and then secondary pack is where I divide the preliminary number of clothes by two. 

Things are getting more exciting now as I was checking the weather in Kathmandu, Lhasa, and Paro.  I already know Taiwan is hot and humid (yay), I wasn't sure about Kathmandu (average of 23oC in September) and Lhasa and Paro are fairly mild at about 18oC.  Of course I got Mt Everest Base Camp which I can guess with much accuracy will be cold to very cold.

I'm also trying to hook up with a fellow ambulance person in Nepal as he has much to do with a few clinics over there despite this trip supposed to be being a "tourist-only" trip as I haven't had a pure "for pleasure" holiday in three years due to study and volunteering.

My work vehicle is a Mercedes

Writing assignments

So I have to finish writing this assignment for my masters by tomorrow.  Tomorrow I want to just be referencing, proofing, and submitting so I want to finish it today.  It's much more difficult than I first thought due to all the statistics I need to find.  I'm at work today and tomorrow.  I only just came back on from my fatigue break at 12.15pm as we were out until 2.15 am this morning.

Anyway, seeing as I have so much to do I must go now.

I other news, I went to a city hospital last night for work and there were about a dozen small children in the ED and I thought to myself that I really want to do paeds, which is another reason to be pursuing the US residency path as you can go straight into paeds there, but in Oz you do Internal Medicine first then a fellowship (I believe).

Emergency paediatrics with a sub-specialty in tropical medicine would be my ultimate.

Op-shopping and my life update

This post is so massive it needs sub-headings.....(I need to lay off the RedBull....)

Op-shops, animal welfare, and the environment
So I've been getting into op-shops lately (that's "opportunity" shop which is like a charity or thrift store for all you foreigners).  I was so stoked today to find a long black down-filled jacket for $3.50!  At first I wanted to get a North Face one for over $500AUD.  Then I was horrified to learn they are only $250 in the US and I couldn't get a new one online and sent to me.  I saw some on ebay a little cheaper - around $200-250.  Then my friend just got back from Tibet and she scored one for about $30AUD.

I got a good new silk-blend sleeping bag liner from ebay for $12, so even if I have to hire a sleeping bag I will feel ok in my liner.  I'd love to buy a good -20oC one though cause I get so cold and I want to do some camping this Summer - I already have a light one and a medium one, so a heavy one would be great (I know -20oC sound too wam for Summer, but for me it's a real comfort knowing I wont be too cold).  I also need a new swag, but that's for another adventure.

Other things - I also picked up a pair of cargos, a short skirt and short shorts (for over legging), and a longer, flowy skirt for my modesty especially in Nepal - all were less than $3.50 each.  Apart from saving money, time, and recycling (well, reusing I suppose, but anyway...), I'm mainly most happy about the down jacket because I've been battling a moral dilemma bout it.  I normally avoid leather, silk, and sheep skin, and I only eat meat once a day - and only free range chicken, beef once a week, and some seafood (mainly fish and mainly the ones which aren't being over-fished which you can find a guide here for Aussies, and here for worldwide), avoid dairy, I only get pets from the pound etc etc.  I try and consider the animals in my choices.  I'd love to be vegan but it's really impractical and quite difficult to make sure you diet is full of the essential amino acids and omega-3s etc.  Anyway, I am happy I could at least get a recycled down jacket - those little geese didn't give up their bodies for nothing.

My upcoming trip
So my trip is finally coming together.  It looks like I have most things if not everything already.  I hope to tread lightly as possible and eat locally.  Mainly backpacking so the souveniers will have to be minimal and thoughtfully chosen.  My last leg of the journey is thorugh Bhutan so I;m hoping to pick up a traditional dress.  Through Tibet I wouldn't mind some prayer flags, althogh you can get them here in Australia quite easily.  Those spinney prayer thingys (I just Googled it - they are called hand prayer wheels) will be good too.

Medicine
Now, study.  I have requested that OUM transfers me into the MD program.  I am currently in the MBBS, designed for Aussies and Kiwi following the traditional Commonwealth model.  The difference is only a matter of a few weeks extra clinical placements in which I would do a sub-internship, hopefully in the US and hopefully in emergency, family, or paediatric medicine.  However, recently OUM has decided to examine MD students on the basic sciences separately as they were finding students were having difficulties in the USMLEs in these areas.  So, seeing as I want to sit the USMLEs, I asked to go into the MD stream which is apparently more difficult, and is definitely more expensive.  Some people would avoid these two things like the plague.  Not me!

Personally, I feel I am most lacking in the basic sciences so I kind of like the idea of being pushed more in this area.

I had been considering residency in the US since the get-go, and with recent developments in Australia it seems like IMGs are going to have a hard time getting internships.  I am also fond of the idea of internship in Samoa, however I didn't realise until yesterday that the wage for interns is only AUD$15000pa!  That's less than 10% of what I earn now.  It's really only a problem in I have a mortgage that needs contributing to, or other Australia-life commitments.  At least it is a good incentive to get my finances well-and-truely in order by then.  So, that new car I was thinking about getting is not going to be got.

I am friends on Facebook with an American OUM student and she told me the US OUM grads have been really successful at gaining residency.  I must ask her in which discipline.  The OUM curriculum advisor told me the sub-internship clerkship is really important for getting one's foot int the door for matching into their residency programs.  I think I will be good at this after going through the paramedic clinical placements and then graduate program - be super-dooper friendly, seem intelligent and thoughtful and competent but not over confident, work your butt off, be the first to arrive and the last to leave, have no other life outside of the placement/grad work, offer people drinks and food and make their life easier not harder, and most importantly, did I mention food?

Masters
Yep, so I'm supposed to be finishing my assignment right now (I'm at work again) which is why I drank the RedBull but instead I sewed buttons and holes up on my new opshop purchases, made a healthy lunch (to try and prepare myself for the diet of lentils coming up), discussed MoH things with my sister, and chatted to my work partner for today who is an IT guru about using my mobile phone as wifi for my laptop at work (we only have one PC and it can be inconvenient) and using wifi instead of internet roaming data stream while overseas.  Whew.  Oh, and blogging.

Ok must finish this essay.  I've done 1100 words out of 2500 and it's due in 2 days.  Wish me luck!

Satisfied

I finally got my term results back and I'm "satisfied" on my happiness scale.

My bosses got the sack

The executive board of my ambulance service got the sack today by the health minister.  Initially I thought this was a good thing until I realised the CEO has remained.  I don't want to get the sack by expressing my thoughts here, but in my opinion I'm not happy with the way the current CEO has steered us since coming into power.  The word "service" was literally dropped from our name, and the ambulance business model as been attempted to be implemented.  I might be a bit of a tree-hugging hippie, but even the extreme right-wingers must see running the public health service as being fundamentally different than that of running a profit-making business.  I'm confused.

Anyway, today at work I got stuck into my masters assignment.  If I can make that kind of progress every day this week I'll be very happy.  Now I'm getting into it, I'm getting into it.  I think I might even be learning something valuable for my future career and life's education in general.

Still no reply in regards to my missing term grades from med school.  Still my happiness factor cannot be measured.

Grades and happiness

Here is my formula for happiness using the end of term grade:

2(End of term grade - 50)/10 = happiness score

Use the happiness score on the following scale:

0 - devastated
1 - very very unhappy
2 - very unhappy
3 - unhappy and considering a career change
4 - consolable
5 - trying to remain positive
6 - slightly relieved
7 - satisfied
8 - happy
9 - very very happy
10 - massive ego mixed with questioning the integrity of the course

Here is an example:

I get 85% for my end of term grade

2(85-50)/10 = 7

I would therefore be satisfied with a grade of 85%.

Sunshine makes everything better

Another glorious day of sunshine here.  I think I have survived another icy winter.  My mood and energy levels are improving exponentially.

I spent the day doing housework and gardening.  I'm now at work waiting for the day shift to return - they wont be long - in order to take over their (better) ambulance rather than take home the "spare".  Of course I was also suppose to write my assignment today but with the weather and the number of chores that needed doing, I couldn't resist getting out there in the garden.  I'm quite pleased with how things are coming along (slowly, slowly).  I feel even better to have done something physical to counter-balance that terribly boring day I had yesterday in the lectures.

I'm still waiting for my grades from last term.  Samoa time yet again is dragging on.  I paid on Thursday.  I allowed a lag of 24 hours, that's fine, for that information to get to all the right people.  Then there was the weekend.  Then Samoa is a day behind.  But today is Monday there.  Oh, I know, I bet it's a public holiday there today.  They seem to have a lot there compared to here, however their culture is a lot more focused on lifestyle than getting ahead.  I think that's why I love it there so much.

Training day

I had my annual training day for work at the regional head office today. It was ok as the first half was clinical. After lunch was a struggle in the stuffy boardroom. I swear I was hypoxic all through the medico-legal session.

Hens

Final MoH duties

Hole

This is the holey dog escaped through today. He's 40kg.

At work

Seven working days left until holidays!  Yay!  And that includes a training day, so only 6 left on the road (with six nights of call, unfortunately).

I just looked at my ambulance station's stats this morning, and our workload has more than doubled since changing onto this new despatching system.  This could be a very good thing if we want to get funding for a proper night-shift here and stop doing call... Ah... a girl can only dream....  The good thing with more call-outs though is more money.  It seems to be getting a bit easier to meet my tuition fees right now.  Feeling fairly good.

Masters - Essay one of two has been commenced.  I'm giving myself until the end of Tuesday to complete it.  It's about the epidemiology and burden of STIs and HIV in India and the second part requires me to decide on priorities for programs in the prevention of STIs and HIV.  It feels strange to write an essay again seeing as I don't do them in med school right now, but I'll just work through it systematically as usual.  Start with the heading and subheadings, collect data and references, and mould it into a coherent piece of writing.

Easy?

Fitness update - it has totally been sacrificed for everything else in my life.  I had a great conversation with a guy at work that is the perfect picture of good health and fitness and I watched him throughout a working day and he had already gotten up really early for a run so was planning to do not a lot after work, then spent the rest of the day preparing and cooking meals every few hours, shopping for more fresh groceries etc.

My other friend at work that works out every day puts all her energy into getting a workout done that everything else gets done second.  She eats fairly "normally" though but is not a high performing athlete like the guy from the first story.

So, what I'm trying to say is I haven't found that perfect balance for me yet but I'm still searching and I wont give up because right now I feel soft and sluggish.  Yuk.

Ramped

I'm currently "ramped" at the hospital, which means my patient is stuck on our ambulance stretcher at triage because there are no hospital beds available.

Not good at after midnight. Not good out of our catchment area. Not good when I haven't been able to complete an 8-hour rest break in over 24 hours now. Not good that I've now been up for 18 hours and am probably going to be past the 20 hour mark by the time we make it back.

But it's all ok because tomorrow is my last day for the week.

Overheard in a patient's house

OVERHEARD IN A PATIENT'S HOUSE

Paramedics attend the house of a very sweet, very elderly yet sprightly lady living home alone in a fairly remote rural area.  She had earlier called her doctor to tell him she felt unwell. The doctor then called for an ambulance to attend.

After assessment, the patient refuses transport to hospital.  The paramedics try to educate the patient on the phone number to use in case of an emergency.

PARAMEDIC

"So, if we leave you at home, and if you ever feel unwell, do you know the number to call the ambulance?"

ELDERLY PATIENT

"No..."

PARAMEDIC

"It's 000"

ELDERLY PATIENT

"Oh, is that it?  Just 000 and I can get you two to come to my house?"

PARAMEDIC 

"Yes"

ELDERLY PATIENT

"What if I feel well?  Can you just come over for a cup for tea?"



Peters Projection World Map

Spherical map (winkle Triple projection)

Spherical map laid flat (Mercator projection)

Lat/Long map

Peters Projection Map ("an area accurate map")

I just got my new, laminated Peters World Map.  The Peters map is interesting because it depicts the world in an "area accurate" form, meaning 10sqkm of land will take up 1sqmm on the map, for example, whether it is in North America or Africa.  A regular, more commonly found map would look more like the first three, where you can see, for example, Africa and South America appear much smaller in ratio to the land mass of North America and Europe.

When I first came across this map I was horrified to learn I'd been exposed all my life to what initially seemed to be a deliberate attempt of the "west" and the "north" to make their countries seem geographically more superior, thus inferring greater political significance on the world's stage.

Then I thought maybe it's just the way the spherical map "unrolls" that makes the top-heavy northern hemisphere stretch out further.  I think this might be partially true.  Then if you look closely at the third map, the Lat/Long map which has the latitude and longitude marked out, you can see the southern hemisphere has been ripped off.  The latitude lines not only "cut-out" before they make it all the way to -75o, the spacing between the most northern latitude lines is much greater, thus distorting the northern hemisphere an making it appear larger (this one doesn't have Antarctica in it, but if it did the space between the lat lines would still be compressed).

So apparently a lot of people were outraged when this Peters map first got released in the 1970-80s.  I've only just found it.  I'm fairly outraged on behalf of us southern hemispherians.  Not us wealthy Aussies, but the poverty-stricken south with whom I feel I identify with so much.  Outraged to learn my mind has been tricked all it's life with such an optical illusion of ?political motives.  It initially seems so benign, but I can't help thinking "What about all the other more subtle things we can't prove objectively with a tape measure?"   All the subliminal racist images regarding those people with dark skin.  A 3yo baby with a massive tummy, retracted incostal ribs, eyes bulging out (imagine images from the 1980s Ethiopia famine) - I can hardly imagine that image on a white child.  Oh but "they" are over "there".  Yeh, over there on that massive friggin continent called Africa.  Are the numbers so overwhelming (what's a few million child mortalities?) that we shut off now?

I just don't get it.

But then again I do.  I'm doing it right now.  In a way.  I'm sitting in my house that could home about 50 Burmese refugees.

I must confess, I was driving in the ambulance today past a windfarm, talking with my coworker about why people are blocking windfarms in our town (one wind turbine could power our entire town).  We decided it was due to jealously and greed, and people not believing/caring about climate change (under the guise of other arguments of course).  I then thought to myself "Well, if us humans die out then so we should.  We friggin deserve it we're so selfish and stupid."

Then I remembered that humans by nature would rather be right (as in correct) than have a favourable outcome, as unintuitive as that sounds (that's why pessimism is so addictive - you're either always right or pleasantly surprised).  So I should probably try and change my mindset.

So, I try and think like an optimist.  I believe every problem has a solution.  I'm not a defeatist yet.  What can we do?  Well, I think we can only do so much. 

Firstly, I try and wake up each morning and think about how I can be generous to others. My co-workers, my family and friends, and of course my patients.  I also have a job which contributes to the greater good of humanity (I think) and I try and utilise my work time in this way, to cultivate a more harmonious world by showing compassion, even when I really don't want to.  But even the Dalai Lama only has so much time and so much attention span.  I've seen him live, and he did get distracted at times.  I like that he's only human.

I try to lobby for what I believe in.  On this blog, with my election vote, with the occasional Facebook status update, and with the way I generally live my life.  Sometimes I even fill out a petition and I've even written to my local Member of Parliament on occasion. 

I vote with my consumerism power.  I believe the consumerist dollar is one of the most powerful things in the world.  You don't like a product because it's not Green, then don't friggin buy it.  Speak in actions rather than words.  Say you would prefer Green, Free Trade, and Cruelty Free over cheap by only buying those products.  Of course, consume LESS, but when you do, make good choices.  We can't always be perfect, but strive for 80/20 (80% "good" choices).

Inform and spread the word.  Tell people about what you do.  Sure, don't ram it down their throats.  Noone likes that.  Lead by example.  Make it attractive and "normal" to be a conscientious world citizen.  Like an add that's on the radio atm, "be enviro-normal, not enviro-mental". Show that it's not a strain to care about things.  You're not a "bleeding-heart", or a hippy tree-hugger without a job.  You're intelligent and you've got a good, strong character.  Every wants that.  Character is power.  Even the shallowest of people want that.

9 days (of work) left....

I'm back at work after my tonsils have begun to quickly retreat thanks to good ol' penicillin (thank you Alexander Fleming).  My sister suggested I should get a box to take with me on my trip just in case, and perhaps take a double-course this time due to these two attacks being so close together.  No, she's not a doctor, but she has had tonsillitis many times before she finally went under the knife (well, diathermy actually). 

I have to see my GP about high-altitude medication and overseas vaccinations anyway (I have finally found a good GP for the second time in my life).  The Australian Government website Smartraveller is pretty good for general advice.  I like to look at it before I go anywhere and also register my itinerary plans "just in case".

Apart from that, I feel as far from a medical student as possible.  This is a good thing in one respect, but generally very bad as there is so much to cover I should be reading every day.

Sick. Again.

Apologies for the lack of posts but I've been battling tonsilitis AGAIN. Yep, I can hear the sound of the ENT surgeon's diathermy machine already.

Status quo and spark of motivation

Yes, same ol', same ol' here.  Just working, enjoying freedom from med school, looking forward to holidays, got lots of social plans on my days off etc.

I think my brain is already on holiday.  I don't want to do overtime, I'm finding every excuse to not do my Masters readings, and what PT course?  My house is looking tidy though and I've been flicking throough House and Garden magazine, and I have heaps more energy at work.  I feel sorry for my work colleagues as I've been operating in a constant state of  half-dead, but I didn't really notice that until now.  It's funny how you accept that because you're a med student you just automatically have no other quality of life.

I've been reading the Mothers In Medicine blog a bit lately.  Not because I'm a mother (unless you count my dog and cat), but because other blogs link back to interesting articles about juggling home life and work, choosing the right partner, and some other interesting aspects of being a female that is successful in the workforce.  Anyway, it's given me a bit of much-needed inspiration.

Just had a really sick acute pulmonary oedema patient.  I haven't had a full-field APO for ages.  It was good to do someone that was actually so acutely and time-critically sick.  I was sure he was about to arrest.  Thankfully he didn't and our treatment brought him back in the right direction.  We picked him up from the bush nursing hospital where they rarely do sickies and the staff need a lot of paramedical direction.  I was the treating officer and it kind of felt good asking the other paramedic to do this, the Div 1 nurse to do that, the nursing student to grab me this, and the doctor (GP) on scene if it was ok for her to give a drug that we dont' carry but he needed.  It went smoothly, efficiently, and I caught myself mid-IV cannulation drawing parallels between that situation and what it would be like to be an ED doc running an arrest or similar.  I really think emergency medicine is for me.

And it was just what I needed.  More motivation to continue studying this long, long (and expensive) journey through med school.

Void

Nothing much is happening right now.  Just working, occasionally reading something for the Masters, doing stuff around the house and garden now the weather is improving.   I'm sewing this weekend on my spare time - just making a skirt/dress/wrap/top thingy (convertible for travel) by hand as I find it extremely therapeutic. 

Hence, I haven't been chained to the laptop and I haven't posted for awhile.

Mensarian

Just went to my first Mensa lunch today. It was very interesting and fun. I'm glad I went.

School fee blues

My massive med school tuition fees are starting to get me down.  I know I'm really lucky to be able to travel and afford things like a new fence when I need them, but it's frustrating to work my ass off and not get ahead at all.  I really noticed it when I just took two weeks off work sick and only got paid my base wage (no overtime or call-out allowances).  Another 4 years of this it going to hurt.  I'm going through a phase of doubt while sitting here going through my miniature bank accounts. 

Ugh.

Well only 4 1/2 weeks until I go away. Geebus!!!  That is totally scary.

Well I haven't done my workout today yet, despite sitting here in my trackies.  I think I'll go do that now to try and lift my mood.  Maybe I'll have an epiphany or at least more optimism in regards to the financial situation.

So unfit

After just 2 days of manual labour around the house I am so sore, so tired, and feel like the most unfit slug/blob in the whole world. So horrible enough to friggin do something about it.

In bed now resting my aching body.

Must find trackies in the morning. Actually looking forward to it. I have all day spare at home while my fence gets finished.

Goodnight.

Maintain-ence

One of the problems with working full-time on an on-call roster and studying medicine is there's not much time for anything else, including house maintenance. So, now I'm on a break from med school I'm busy busy busy with all those jobs I've been putting off around the house.

Finally the weather is improving! Just when I thought I was going to get osteomalacia.

TV for pets (part 2)

This morning's show: Strange car pulling up in neighbours drive way

Affluenza

I learnt a new word today.