Another job offer

Well, interesting development. This time I was the one who was head-hunted. This time from a clinic I would be crazy to say no to. The standard of which hey operate is second-to-none. I could not fail if I worked with them. And they said they'd match anything the first place offered me. 

I guess I'll wait for the contracts to be written and decide which one to sign! Yikes!

Can't wait for 2021!

Job offer

 I have a verbal job offer for a GP job so I'm just so happy and cannot wait. It's at the practice of my choice and I basically head-hunted them and they believe we are a perfect match. They will hold my position until I can be released from the hospital.

One more week of psychiatry and then some annual leave for me hooray.

Tracy Anderson Method has been going really well for me. I'm stepped out of the subscription streaming training and back into the Metamorphosis workouts on the old DVDs, but it's still been good.

Psychiatry Resident

I love it. I could easily be a psychiatrist. It's just very interesting to me.

I will continue my GP training pathway though because I do want a life outside of work and GP provides the best work-life balance. I will do extra training in psychiatry though.

For the past two weeks I've recommenced my TAM (Tracy Anderson Method) workouts. This time I'm streaming! I absolutely love it. Tracy has really grown i the past few years since I've not done her method and I'm very happy with what she's up to. There is a lot more focus on paraspinal strength and functional strength and mobility. Also on the mind-body connectedness regarding not just movement but strength and health.

Already I feel brilliant. What i really wanted was the energy and strenghth to play with my kids more, both at home and at the playground. So often I get there and just want to sit down and have a coffee. Yesterday I finally got that motivation and energy back and went on the pay ground equipment and they climbed all over me and I felt good within my body.

MY aim is to do it daily, allowing a day or two missed a week if necessary (but hopefully not).

Pandemic!

The Covid-19 pandemic hit in full-swing during my ED term. It threw a few of our normal practices up in the air, including our training schedules, exam dates, rotations, and day-to-day operation.

We were VERY lucky at our hospital. We saw Covid cases but were spared the tsunami that has broken many EDs around the world. We were certainly stretched and patients did not get the highest level of care in the most timely manner during that time but I think overall we avoided major bad outcomes.

Considering Emergency Departments are normally stretched thin on a normal day, the pandemic was very difficult to deal with.

Many of my colleagues and patients were very anxious, stressed, and scared. The PPE was horrible to wear (hot, itchy, restrictive) but we were thankful to have plenty. We also had to homeschool our eldest daughter and my husband took a brea from studying law to maintain the home front.

The first wave is behind us now and at the end of this week I move into Psychiatry.

I'm so happy to be off shift work for a while and onto normal shifts but I will miss having weekdays off.

The pandemic also paused my progress on the WBA so I am not due to finish that in October instead of July. Many of my colleagues are in a much worse position with exams being postponed etc.

Overall, I'm looking forward to the next term, working my through this year and to General Rgistration, and seeing what next year holds.

Internship done!

Hoorah! I survived!

I feel SO much better now THAT is done.

My final term was in General Practice and I loved it. I got to hone-in on my passion which is Refugee Health, Obstetrics and Paediatrics, and Psychiatry.

Now I'm back at the hospital as a Post Graduate Year 2 Resident Medical Officer, or RMO for short. I feel SO much more relaxed, happy, and finally feel like the hard part of the transition from paramedic to doctor, and stay-at-home mum to working mum, is behind me,

This year I'm doing Obstetrics and Gynaecology, Emergency, Psychiatry, and Rural GP.

I'm still completing my Work Place Based Assessment for full (general) registration but that is going all well. I have been studying a half day on the weekends specifically for the WBA assessments and that is working well.

Home life is great, the kids and husband are great, I am still in love with our new home. Financially goals ar going well too. The two investment properties have really gained in capital value and we've been able to pay off those mortgages very quickly as they were so low. Now our next investment is probably going to be to be a partner in a GP practice from some time next year.

At hoe our personal goals are around health and environment, and a lot of what we do centres around minimalism.

Term 3 almost done

Yay!

Three-quarters of the way through internship.

I've been very busy indeed.

Term 3 (we do 4 terms a year here) was surgical for me and I was lucky and got ENT (ears, nose, throat).

We work 6:30am to about 6pm plus some occasional weekend shifts. It's a lot and I've become burned out at times and needed a day off here and there. Luckily the admin people are very supportive if you let them know what's going on and just take a day here and there and otherwise keep pushing through.

I took a Gen Med assessment of my WBA and completely bombed it. It was not prepared to the standard that was expected of me and I really just didn't have the time to prepare adequately. It really threw me and I wasn't sure I could manage internship, having small children, AND the WBA so I took a small break from it wiht the support of the hospital.

I have decided to attempt my surgery assessments though as I've had a full surgery term and think I can manage it. I only have a week to prepare which is difficult with this schedule but I've decided to sacrifice the next week to make it happen, hence I'm still at the hospital library now after work and though I'd take the opportunity to quickly update here.

I've to do:

1. Prepare three Case Based Discussions and present one
2. Physical exam for head and neck
3. Patient counselling

I think I hit my low a couple of weeks ago and cracked. Strange thing is I came back to life and am more relaxed at work; its almost as if I had an epiphany but what has actually happened is I don't care as much as I did before. Although that sounds bad, its probably what I needed to do. I was too uptight about everything and not relaxed. I still do care about my patients but I don't care as much about whether the other doctors are judging me, or if I don't know as much as everyone else, or I'm not as good as my peers, or what would happen if I missed something (theres safety nets for that and I don't have to protect all the patients by myself).

Well that is all I have to report really. I still miss ambulance but not as much as before. I started to feel more like a doctor than a paramedic a few weeks ago finally.

Just about half-way through internship

Oh, wow, I'm almost half-way.

I've been THAT busy that I haven't even had time to blog. I have no idea whats happening in the world either.

So I completed 8 weeks of Gen Med which means I have to do two more to meet the minimum requirements as set by the Medical Board of Australia. I've just done 11 weeks of Emergency Medicine (minimum 8) and have two more weeks of this term then I'm half-way through internship! That is if you include the first 5 weeks which I wasn't technically officially working (see previous posts) as my "leave". (I'll take paid leave after Jan 14th 2020 so I can finish internship on time).

I have learned  A LOT. It has been really difficult. I've struggled a lot as well. There's nothing quite like feeling stupid all day, every day, and working you butt off to only meet minimum requirements! I'm not sure I'm even meeting "average".

Luckily for me though, my Home life is amazing. We have bough the most beautiful house that I'm totally in love with and is like a "dream house". The kids and husband are great too and living in this area there is so much to do and so much beautiful nature that I'm so happy when I'm not at work.

Anyway, I have to only write a short post as I've come into work early to sit in the library and prepare for a WBA assessment today. I have passed the first 3/3. I need to pass 16/20 in total to get my full "general" medical practitioner registration.

The completely terrifying life of a new intern medical officer

Oh..wow.

So, anyway there was a delay with getting my medical practitioner registration through. It got submitted lat due to a late job offer and I had to wait for it to properly start work.

I did a couple of observing shifts and realised this was actually going to be hard.

Then, tonight, this is my second proper shift. And it's a night shift. And the nurses are asking me stuff I don't really know and its terrifying.

I feel like the stupidest intern to ever walk through the front doors of this hospital. I may well be, or maybe I'm not and this is what most interns feel like, I'm not sure.

My goal at the moment is to survive internship. It's difficult because I don't want anyone to find out I know nothing but you have to ask for clarification and help to do your job safely. Simple decisions I have no problem making in class are causing paralysis by analysis in reality. Simply prescribing paracetamol or eye drops has me second-guessing absolutely everything.

I am SO thankful for my paramedic background. I honestly don't know if I could do this without it given I did not attend the local medical school like every single other intern here except for 3 others. I feel like if I went to a "normal" medical school then I would know I was up to scratch by doing the same course with everyone else.

Sitting and passing gate AMC was mildly reassuring at the time but that has all gone out the window!

As I write this my shift is progressing and with every repeat of the same condition/management/prescription my confidence goes up about 1%. I suppose by the end of the year that will get my confidence from the current 0% to above 50%.

My calls tonight so far have been:

1. Two spiked fevers. One already had blood cultures and urine analysis, and the other did not so I ordered them for him. Both patients already had CXR. Otherwise observing stable.

2. Three patients who can't sleep. Temazepam for all, one with a reduced dose due to poor renal function and concurrent use of opioids, one phone order.

3. Patient wanting to self-discharge. Was able to talk to her about it and convince her the hospital is the best place for her right now,

4. Rechart regular medications.

5. Rechart insulin chart.

6. One spiked fever patient became hypotensive. Needed med reg review. Requested albumin (blood transfusion protocol required).

7. Patient with runs of VT and sleep apnoea with decreasing haemoglobin. Called in pathology service for urgent bloods. Another med reg review.

8. One maintenance fluids order.

9. Two discharge summaries completed (poorly but whatever)

10. New intake list updated.

11. Ward list updated.

And its not even over yet! It's 4:22am and I'm on until 9am. Wish me luck!

Additt:

It is now the next day.

At 0422h I had no idea of the shit-show that was to come roughly between the hours of 6am and 9am.

6am - I try to update the ward list and new admissions list for the 8am handover as this is one of my primary roles and to do this I need to physically go into the ED to confirm patients and bed numbers. I get asked by my reg (who has been dodging helping me all night) to help him admit a patient who as it turns out is quite confused and takes a life time to answer my questions. Oh and I've never working in ED before so I don't know where all the correct forms are. I fail to get anywhere.

MET call goes off and its part of my role to attend every MET call. Severely hypotensive man with confusion, and as it turns out is having an Addisonian crisis.

Phone call from ward for one of the patient's I'm covering for the night who I have not yet met whose haemoglobin has come back dangerously low at 65. I commence ordering packed red blood cells for transfusion, a process that require a registrar to co-sign.

Another MET call, this time surgery, Is is APO, is it asthma? Whatever the patient is sick, One med reg still at the last MET call and now the other stuck wiht this one, I get called back down to the low haemoglobin patient who is likely bleeding out into his abdomen. I hadn't finished filling out the paperwork for the transfusion. I know this because I can't do it without a reg. Nurses ask me questions about units and speed of transfusions meanwhile I don't even know how to order the bags of RBCs.

By this time the day shift nurses come on and they've started to pick up on things that need doing: this medication doesn't have the total 24 hours dose, this medication is illegible can you please re-write it, this patient is hyperglycaemic, this patient needs a daily prednisone dose. All while I'm trying to handle a blood transfusion on my own. And geez I thought I had all 28 patients completely covered at 4am.

I call for help. My reg instructs me to call the consultant. I don't want to. Its' early on a Sunday morning and it doesn't feel right. I mean, you're only supposed to call them if you absolutely have to.  The consultant as kind as he can be and informs me I should've called the specialist registrar. I regret the phone call and call the specialist registrar who isn't too bad but I don't leave the conversation feeling very good about myself. This is bullshit.

All the while, one of my sole purposes of the shift, to have the current new patient admission list ready for handover, has not been done. It's a gapping hole. Day shift do not care that all the new patients were admitted at the exactly the same time a patient was bleeding out and others were stuck in MET calls. Great. I look like a failure. Great.

The intern taking over from me is lovely but I can't help but feel like a failure. I leave him two simple tasks to do which were sprung on me by the nurses last minute, but I feel it is reasonable. I hope he agrees. Next time he tells me to call him to come in early to help. He is so kind but I leave feeling completely inadequate.

I can only hope that this is what most new interns describe as the steep learning curve they experience in the first few months of the job. And I can only hope that it will get easier but I found last night really challenging and I'm back for more tonight.

First week as a doctor

Oh wow my first week is done.

It was mostly powerpoint-style orientation. You know, the boring stuff such as fire/emergency procedures and how to fill out your timesheet.

Everyone has been so friendly and welcoming so far. I am sure there will be moments ahead of me when people are not so kind, but so far I am enjoying it.

I am having a lot of trouble sleeping though as my mind tends to worry about the calls I may have or not knowing something I clearly should know.

Just a short post as I am flat-out juggling my new job (so so busy) and being a mum as well.

Medical Intern 2019

Woweee..... What a couple of weeks!

The moral of the story is to be prepared for when an opportunity comes along so you can grab it with both hands!

In the end I was offered two internships and a third interview (which I declined when I accepted the second offer).

I actually now start January 7th 2019 which is three weeks from now! :O

It's also interstate so I need to pack up the whole house and move my entire life and family as well as prepare myself mentally and clinically for the year ahead of me which by all past accounts will be challenging.

At this point in time I feel really grateful for all the help I received along the way from my mentors, work colleagues, and especially my husband and children. My parents have been great and my friends. My paramedic boss was so good about it when I gave him under the minimum notice to resign. I'm actually going to remain as casual paramedic and see how the year transpires.

I'm also really proud of myself. I was reflecting back on all the crazy stuff I've done to get to this point. I drove past the McDonalds I studied in on Easter Weekend because the library was shut. I remember the guy next to me saying I'd be better off studying at the casino, given the incredible noise and busyness of the restaurant that particular day. He was probably right!

All the double-shifts, driving hundreds of kilometres, staying up late and getting up early to study around the kids, how my first was born the week after. my final pre-clinical exam and my second the morning before I received my diploma. I'm really proud of my stoicism during this time. And its no wonder I feel burnt out right now.

But there is no time to rest now!

I'm on might shift tonight on the ambulance but I have a million things to do today. Grocery shopping for one because I still have two children that need heathy, or any, food in the house. I also have to declutter my possession s as I don't want to be transporting interstate junk that I don't need or want.

Then there is the clinical revision I really want to do. I've submitted all my AHPRA paperwork which took about 5 hours to complete. I want to print some "cheat sheet" cards covering common meds and common physical exam points (especially neuro).

I also need some doctor clothes. What I currently have won't cover me on a full-time roster. I was my own version of a uniform which consists of opaque black stockings, black knee length pencil skirt (not tight), house, and cardigan with pockets. Hopefully I won't start in ED because that required green scrubs and I only have one set.

Ok that is my very exciting update for now! What a journey it's been to get to this point!

No longer a med student!

Internship offer!

I just got my first offical internship offer! I start Jan 14th 2019.

I'm so excited about my future in medicine.

Not much

Not much has happened since my last post. We have been away on a family holiday before I commence back at work (ambulance) next week.

Australian internship prospects have not changed.

Being away on holiday helps to find the time to sit back and reflect on what you truely want, and to find the adventurous spirit to brave through the tougher times (such as these).

I have been researching possible alternative locations of internship and I hope to have something sorted out in the coming months. Until then its just getting back on road as an ambo, preparing for AMC2, preparing for internship, and saving in case we have to relocate (yet again).

AMC1 pass!

So, so, so happy to report I passed the AMC part 1 on first attempt in May.

The 6 weeks had off to study was all I had really. And we moved in the first week and holidayed in Tasmania for a week as well so it wasn't exactly 6 weeks full-time. I ask had the kids to think about so my days wherefore like 6 hours of study, not 12-14 hours or anything crazy like that.

I think my ambulance experience, my clinical placements and med school course work, and then my study strategy is what got me a passing score on the AMC. I also recommend AMCQBank.com (no affiliation) as that really prepared my mind for the skill of the test taking. I also learned some clinical knowledge along the way, although I'm sure its not the most reliable or authoritative source available! However, it helped me gauge where I was in terms of readiness for the exam. I recommend scoring at least 50% in the AMCQBank.com practice exams before attempting the real exam.

It also helped me realise that I can study for and pass standardised Australian medical exams. Even if in the beginning things seems tough, or I don't know everything, I can still be "good enough" to continue wiht my career. I'd love to know more and be more comfortable as a junior doctor so now I begin the processor preparing for internship.

I have applied for internships in Australia for 2019 and am waiting to see what happens. We are also considering Samoa 2019 to be able to give us a sense of predictability for the next few years, rather than just waiting another 12m months to see what happens. I'm not sure on that one.

Next month I am returning to ambulance work at a new branch. I am very excited to be back doing the job I love, getting my clinical game back on after 18 months of not seeing a single patient since having my son, and regaining my Authority to Practice. We are also a registered profession now so I look forward to paying $500 for that honour lol

So for now I'm studying my ambulance stuff, preparing and applying for internship, and just figuring out a good routine as a mum so the kids grow up happy and healthy.

AMC Prep Week 5/6 - on the road

I am in Week 5 of 6 weeks AMC prep and I am away from home visiting my parents in Tasmania. So far they have been very supportive of my study including looking after the children and cooking meals etc. I wish I had this much support all the time.

This week I have dedicated to the AMC Anthology of Medical Conditions book, specifically the images within the book as I hear they appear on the exam, and AMCQBank. There is probably about 100-150 pictures in Anthology so I think it's reasonable to at least learn the conditions/diseases presented.

I have also been told the images in Tjandra Surgery textbook are worth knowing, however that is a much larger textbook. I will have a flick through when back at the hospital library. My colleague also said each topic that appears in AMC Handbook to look up the answers online in the RACGP guidelines. That makes total sense. And is probably a better way for me to study than using Murtagh's.

I am really enjoying QBank. I was around 70% average but I've dropped to 60% since doing the normal distribution of questions, that is more adult medicine, whereas before I was focusing on obstetrics and gynaecology and psychiatry questions to supplement my study last week for which I seem to do better on exam questions. I have done about 400 questions out of 1795 so far. Actually, I think part of my drop in percentage is doing the questions at home and on holidays because the distraction level is extreme. I find I lose A LOT of marks because of simple errors such as reading the question or answer choices incorrectly. I will have to take my time on the day.

My colleague just informed me she passed the AMC with a 60-65% average on QBank so that is a little reassuring, however I would like to improve my scores over the next few weeks before I sit the exam. Of course, I'd like to do really well on the exam, and not just pass it, but I need to sit it next month as I don't have any more full-time study time available to me, plus hoping to have some results for internship applications mid-year.

I have now booked my exam for Saturday the 19th of May. I will be staying in the city (without the kids) the night before so I don't have to travel as far to the testing centre. I need to be there at 8:30am.

My current level of confidence has improved to where I can see I can possibly do this (hence I booked the exam) but I am not very confident at all. And it feels shit.

Overall, though, this prep has made me feel much more confident about possibly being an intern soon. As a supervising doctor once said to me: "You don't have to be the best, you just have to be average." Love it.

If I pass AMC then I will feel the right to feel average :)

Improving

I have been intermittently taking practice exams to see where I'm at and I'm happy to report my confident and marks are improving.

I think a lot of it is just activating my brain in this way again after such a lengthy break with the kids, not thinking about much else except nappies, formula, and whether Iggle Piggle is an appropriate role model for the past year.

I started out with an embarrassing 45% correct average, now it's around 70%. I would like to be hitting 75% consistently (or even greater) before I attempt the real exam.

So I've almost completed 4 weeks of full-time study prep, but in that time I did miss some days due to moving, Easter, illness etc. I plan to have another 4 weeks of part-time prep when hubby goes back to work but I would absolutely love another 6 weeks full-time study (to make 3 months total) but I simply do not have that option due to childcare.

Anyway, no time to lose worrying. Back to the books.

I'm currently doing AMC QBank as well.

Week 4/6 of AMC1 prep

Today I start week 4 of my 6-week Australian Medical Council exam for International Medical Graduates prep. I can't believe I'm already half-way.

Week 2 was a write-off due to moving. Last week I had a massive migraine with neurological signs that landed my in the Emergency Department with a CT Brain. I'm all fine but it took the wind out of my sails.

Weeks 3 and 4 have been a much reduced study load than what I set for myself in weeks 1 and 2. I really should've given myself an extra week for adult medicine at least.

This week is Obstetrics and Gynaecology. I am doing the O&G questions from AMC Handbook of MCQs, and cross-referencing them with Llewellyn-Jones Fundamentals of O&G. Some of the gynaecology questions from AMC Handbook are in the adult medicine section so I saved them for this week when I came across them in week 2 as there are only about 28 obstetric questions.

A lot I know from just having a baby myself. Some I learned at med school and from my in-hospital clinical obstetrics placement, but seeing as I was pregnant with my first during the reproductive system module and then with my second during my O&G placement, I can't say I was really on the ball during those times at med school. I definitely learned more by simply being pregnant myself. Of course its very much augmented by the fact I read O&G textbooks to supplement my own experience as a patient. I always say that its easier to remember things when your brain deems them important. What is more important than the health of your unborn baby?

Part of the issue I had such a terrible migraine, I think, was from studying at the library. The public library has only one study room and it is often booked by group of old ladies chatting about knitting or baking or some crap that really infuriates me. The other "study" section of the library has been so unbelievably noisey and distracting lately. I am a mum and a paramedic so I can work under pretty awful noise conditions but this library situation has been horrible.

Then I realised I really needed a particular textbook that I really didn't want to have to purchase so I rang the local hospital library to see if they would allow me an outsider membership. It took a week to organise and $135 for an annual membership but I am so happy to be able to borrow at the hospital library AND study in a lovely quiet space. So stoked.

Its been the Easter long weekend so neither library has been available to me and my husband had arranged some (urgent) landscaping to occur at our new house and our babysitter kind of feel through so I was unable to study which really sucked. Always, always obstacles for me. But...I just have to push through.

So far I am sticking MOSTLY to my plan of completing AMC Handbook cover-to-cover and referencing topics in Murtaghs, as well as Llewellyn-Jones O&G, Practical Paediatrics by South and Iaasacs, and I think I'll also use Foundations of Clinical Psychiatry by Bloch. A few other clinical guidelines online, and I'm really going to try and go through the photos in AMC Anthology of Medical Conditions because that's where I heard a lot of the images in the exam come from.

Ok back to the books because I have no time to waste.

The AMC prep continues

I'm in week 2 of my 6 weeks full-time AMC study prep.

We moved house last week which threw a massive spanner in the works. I sacrificed my study time to unpack and set up furniture to be able to live. It's so much more time consuming with kids, plus our new place needed a number of immediate renos. I love it though, so much character and oh boy was it a bargain for where it is. All I see is the potential. I just want to stay there but who knows where I'll get my internship next year.

I'm still studying AMC Handbook of MCQs against Murtaghs as my primary focus, then looking at some other topics that are known to come up in the AMC part 1.

My colleagues have been doing well passing their exams which makes me more optimistic, although they are a lot smarter than I am!

That's all I have to update, I have to reach my set daily study questions quota in the library before I go home. Luckily I moved just around the corner so I can go home for lunch break. Today I want to do 20 questions which should take 8-10 hours.

AMC prep

My AMC prep is now in full-swing.

My 3yo has started kinder two days a week from 9-2 and I put the baby in daycare the same times. Then I go to the library and study.

I was also doing Sundays at the library (6 hours) which was fantastic but hubby was feeling the exhaustion a little too much so I decided to drop the Sundays and hope and pray the kinder hours are enough.

Hubs has 6 weeks off starting week after next. I will be studying full-time during that time. I have broken the AMC handbook down into 6 weeks and will complete all the questions and do the necessary back-reading in Murtaghs etc. This will be the bulk of my prep.

I am still intending on taking AMC1 mid-year. I would LOVE to postpone it to end of year but I'm not sure how much more benefit I would get as I'm wanting to return to work part-time as well as my long service leave pay is about to finish.

Happily, my brain is finally able to switch into student/doctor-mode the times the kids are in care, which is fantastic. I finally feel like myself again. I'd personally prefer twice as many hours to study but that is not my current reality. I'd love to stay up at night an study when they go to bed but to behest, I am exhausted by then and bubs is still waking twice a night. I don't think I can do it. Maybe closer to the exam I'll caffeinate myself eve further.

In the past I'd watch a doctor show like ER to get me motivated when I'm feeling like a professional student and not a doctor but seeing as I haven't really watched TV since the kids were born, now when I do-so it just seems so lame. BUT, someone did recommend I read When Breath Becomes Air and that definitely sparked some motivation within me. I think I should try and get another medical memoir to read.

Having kids...it's just such a huge obstacle for mothers wanting to do anything else than be a mother. I am so thankful to have this current balance. The kids are loving kinder/daycare so mum-guilt is not very strong right now. Baby smiles and waves when he sees the educators at daycare. He happily plays with their toys and naps better than at home. I think he is benefitting from the daycare as much as I am.

In my vast experience as a mother (lol), I believe that finding the right balance is unique to each family, takes trial and error to find, and is immensely dynamic require readjusting the sails as you voyage.

I am very, very nervous about AMC, but each day I study my optimism grows a fraction. The honest truth is, I am not confident because I am simply not ready, I haven't studied enough and my knowledge is not where it is expected to be. I will overcome this by studying more and improving my knowledge as preparation is the best cure for nervousness.

AMC prep and worry, worry, worry

Hi,

I'm back!

So...what has happened since my last post...

I had my second baby. A gorgeous baby boy. He's just so sweet and handsome, calm and very very strong! Wow! We call him Hulk Baby or Bam Bam. He's just perfection. I received my medical school diploma the day after he was born. It was a strange and amazing week!

He has only just started sleeping well at 6 months old, and with having a 3-year-old on top, it means I've been the perfect example of exhausted. Complete baby-brain has prevented me from attempting any form of study, revision, AMC or internship prep, until now. Given this situation, I have deferred my internship until 2019. I hope I get something next year.

So I will be focusing on AMC prep now. I hope to sit AMC Part 1 before May/June in case any mid-year offers become available (unlikely). I think I might need longer to pass it. I'm now dealing with the consequences of only putting in minimal effort at medical school basically since my first child was born. I had a feeling I'd need a catch-up year but having a baby on top means I'm practically having two catch-up years. I worry this won't be good when I apply for a job. I plan to try and do some observer shifts in the second-half of the year to accomodate for this. I worry I won't be able to fit everything in as I also want to go back to work casually for some extra money.

My daughter commences 3-year-old kinder next month, just two days a week, 9-2. We have arranged for our infant son to attend daycare on the same days to allow me time to study. Currently, I get not more than an hour or two per day, and that is highly interrupted and unproductive. My kids sleeping patterns overlap in the middle but it means at least one is awake for 16-18 hours a day. You don't need a PhD in mathematics to figure out I'm already running on empty and can't stay up to study when they are asleep. I'm ok to live day-to-day as a mum like this, but as a doctor preparing for registration exams and needing my brain to fire on all cylinders, this is less than ideal.

My husband will take care of the kids solo on the weekends this year so I can go to the library but the opening hours are limited at only 9 hours for the entire weekend. So, to do the maths, if all goes to plan, I will have 19 hours per week allocated to study. Most people study full-time, as in 40-50 hours, for 3-6 months to pass AMC. This makes me even more worried.

So I'm worried. In a nutshell. In a worried nutshell.

Then add on top of that "mum guilt." The fighting of the biological desire to be there for my babies 24/7. The wanting to play Lego and make snacks above medicine is a strong force. Intellectually I know better. I know they can thrive on two days paid care a week, I know they can thrive on hubby being the stay at home parent while I kick-start my medical career. I know this because I've done it already with thee lest child and she is just a fantastic kid.

I know they kids will have amazing opportunities as they grow with my income that medicine can provide.

My daughter's kinder is also the school both children will attend until they are 18 (graduated secondary school). It is a very good (read: expensive) school. It makes the worry about everything worth it. I follow the school on social media and when I see the older students are in Spain or France on exchange, participate in sports such as equestrian or cross-country skiing, travel to Ireland to learn traditional dance, and that half of the students graduate with scores in the top 20% of the country (i.e. admissions access to the majority of university courses), I know it is all worth it.

Done!

On the weekend I passed my final exam for medical school. It was a 16-station OSCE formatted to resemble the AMC part 2.

All assignments submitted and tuition fees finalised (I owed for library access).

Now I sit as a medical school graduand waiting my diploma in the mail and also waiting the arrival of my second child who is due in 4 weeks!

I am off work on paid maternity leave and long service leave until May 2018. The next few weeks and months I will be concentrating almost solely on being a mum. I have decided to defer my AMC prep until Baby 2 is sleeping a bit more and I have caught my breath after the first few months of infanthood.

I intend on completing my 12-month medical internship next year. Applications are open now.

I have been so overwhelmed with everything over the past few weeks that I haven't properly processed what this journey has meant for me or all the people  who have supported me on the way. I thought I'd do a big Oscars-style thank you speech here and on social media but instead I'm just sitting here a bit numb, a bit relieved, and mostly in the fog that is late pregnancy.