Academic rankings

The Oaf had set himself a target when he started medical school, a seemingly simple one yet one that demanded an awful lot of time and effort. That target was to be a good medical student. Specifically, the Oaf not content to be just above average wished to finish medical school knowing he was "a top quartile student".

For those readers who may not be all that familiar with the current job application system, 40 of the 100 points that the job applications are scored out of are based upon a students ranking. A top quartile student receives the maximum 40/40 points for that element of the application.

So it was with great delight that the Oaf logged on the other day to find himself in prime position for a junior job, as he was informed he had made the cut! A sense of relief and achievement fell upon the Oaf as he mused over the hard slog and many late nights he had spent to reach this. Then rather curiously, he felt something else - a dulled sense of shame. In retrospect, far too much time was wasted with angst of 'not being good enough' and far too much pressure placed upon his shoulders by himself to reach such an arbitrary target.

So the Oaf although pleased with his performance, shall take this upon board and will think more carefully in future, allowing himself to know that it is important every so often to give himself a break.

Misspellings

Sat in an out-of-hours clinic and about to send for the next patient the Oaf scans tentatively for the booking details which read "62-year old female with virginal bleeding, brought in by her daughter".

The Oaf laughs to himself at the irony of the error and sends for her, pondering whether he should later explain to the receptionist the key differences between a virgin and a vagina.

Becoming the consultant

Part way through a busy morning of deliveries on the labour ward the Oaf is called over by the professor of obstetrics and gynaecology, a brief welcome precedes the following conversation.

Prof: 'So, there is one question you must answer if you want to become the consultant in obstetrics and gynaecology'
Oaf: 'There is?'
Prof: 'Indeed. Now, tell me. What is the difference between a midwife and a terrorist?'
Oaf: 'Erm..?'
Prof: 'You can always negotiate with a terrorist'

Sweeping generalisations aside, the Oaf is also finding that there is some truth in humour.

Behind the curtain

Recently the Oaf has found himself on frequent forays into the hospitals and general practices waiting rooms. Shamefaced, sitting quietly on a chair and staring at the floor. Initial impressions may be misleading and one may be forgiven to think he had been told to leave for misbehaving. But, the truth it transpires, is not as a punishment for bad behaviour, nor for his status as a medical student. It is because the Oaf is a man.

Needless to say, he is not overly enjoying some of the obstetrics and gynaecology placement. Placed with just one other medical student - a female student, the experience has quite brutally demonstrated the divide between man and woman in the world of medicine. The Oaf has in fact been keeping a tally, and to date has been ejected from just under half of all intimate examinations on female patients. His colleague hasn’t been declined once. Indeed, she has even been invited to practice on said patients, leaving the Oaf feeling somewhat more wounded.

It is fair to say, that had the roles been reversed and the patient a man undergoing intimate examination it is unlikely that they would ever object to having a woman present. Upon re-entering the room for the next consultation the Oaf is offered sincerest apologies from his colleague and the female nurses and doctors for the exclusion. This is somewhat baffling to the Oaf - for would it not be say, entirely inappropriate for the Oaf to personally apologise for every time a builder had whistled at their passing, for every inappropriate chauvinistic comment they may have received or indeed, for the overall oppression of women by men throughout history?

But instead, he smiles and insists everything is fine. He had in all honesty preemptively resigned himself to this treatment prior to the placements. Trying not to take it too personally he is disturbed to hear that a medical student at another hospital had been refused for entirely different reasons all together. The patient, of asian descent had allowed one male medical student to observe but refused the other on the grounds of being white. Whether or not this should be tolerated, the Oaf does not know. He rarely wishes to stray into such culturally and socially sensitive discourse.

But as the gender division is just an unavoidable fact of life, the Oaf is glad for those women who tolerate his presence even though quite obviously uneasy by it. And, perhaps above all, he is thankful that it will never be his genitals on display as a weary medical student steps forward with speculum in one hand and cervical brush trembling in the other.

The bottom rung

Recently, the Oaf has felt his patience wearing thin. Not content with various changes in curriculum that has seen some of the already scantly taught bread and butter medicine sacrificed for what many would consider as less pressing issues - farewell ENT, make way for yet more medical ethics. As the fourth year marches on the Oaf finds himself on his Easter break. Yes, a whole four weeks prior to the rest of the country. It has so far been a rather lonely affair, with both friends and family working as per usual.

This break has provided the opportunity for some reflection on the year so far. The Oaf feeling rather deflated for once has been troubled with certain attitudes that have worn his character down recently. With the novelty of being a fresh, eager clinical student long gone and with a more concerted effort to grow a professional persona, the clinical attachments have not been without a growing disdain for the student status.

At the lowest rung of the ladder students can expect a certain degree of condescension. We dutifully pull rank and generally respond positively to occasional verbal flagellation. But it does take its toll, and often spills over into the realms of outright patronisation and unpleasantness. Perhaps we should not be shocked by such frequent unkindness, for medicine is not a soft subject. With the Oafs skin thickening he has been wondering at what point such attitudes might change. As a junior? registrar? consultant? The smart money suggests the latter.

A recent experience on the wards highlighting this involved the handling of faecal matter. The Oaf was assigned the role, primarily due to his status as the sole student present. It was a brief task and not particularly pleasant but on this occasion he was not unhappy to comply. Besides, who needs friends when you’ve got enemas?

So as a much needed break, the Oaf is glad to be back home and able to forget medicine for a time. The absence will hopefully refresh both mind and character, ready for the next intensive term of hospitals and exams.

At your cervix

With legs forced wide apart, screaming ferociously as is humanly possible as a catheter funnelling between your legs runs straw-yellow. You shit yourself, with the paracetamol suppository making an untimely cameo – hello old friend. Finally your most intimate and sensitive area rips under pressure, all to the tune of “Grade-I tear, we’ll stitch that up in a moment!”. This taking place in front of a crowd of midwives, doctors, husbands and of course, students. Yes, that’s the miracle of birth alright.

I was woken at some ungodly hour after about thirty minutes of sleep, my scrubs covered in meconium (bilious-green newborn baby shit to the layman) and blood from the earlier emergency c-section. “Come quick! Her cervix is about 10cms dilated and she’s about to push!” I’ll be the first to admit, there are a lot nicer things to wake up to. Bleary-eyed I made it to the delivery room to see another mother go through what looks literally like a living hell. I think todays modern society has sanitised just how disgusting, painful and undignified child birth really is.

In fact, I’d go as far to say that none of the deliveries I witnessed had anyone particularly elated for the best part of twenty minutes after birth. The fathers looking fairly pale were exhausted from several hours of relentless screaming and hand-crushing culminating in what could be literally described as a bloodbath, as their loved ones are torn in two. The mothers being told “come on now, just one or two more pushes and it’ll be all over”, which sounds about as comforting as being told to expect just one or two more hits to the crotch with a sledgehammer and it’ll all be over. Anyway, in reality that isn’t entirely true as it’s then followed by a second, fairly disgusting ‘miracle’ of afterbirth as a sizeable placenta is gently teased out.

I did get the opportunity to scrub in at 1am for an emergency c-section. I’ll almost shamefully admit that I got a kick out of the added drama of rushing to theatre. The actual process of getting the baby out was over in minutes, and as the uterus was cut open a torrent of blood, amniotic fluid and meconium covered me whilst I stood there retracting and suctioning up blood. At which point there were a few screams from the cyanotic bundle of joy and everyone gasped a sigh of relief. The surgeons stitched her up as I continued to suction whilst trying not to get in the way, and I held a kidney dish catching rhythmic spurts of blood from the vagina as the surgeon pressed down on the belly after closing.

Another time during that night I was taking observations for the midwife when I got asked about the CTG (a clever machine that monitors foetal heart rate and contractions simultaneously). Yet I found myself in an uncompromised situation where I could reassure the mother and tell her that the reading was completely normal (which it was) or worry her by running off after the midwife, because we as students are not supposed to give out medical advice. So I settled for both options, saying I was almost certain there was nothing wrong and getting the midwife to double-check. I’m not sure if it was because I was the only guy on the ward that evening, assuming that everyone has this 19th century Dickensian attitude, but a lot of people assumed I was the doctor that night (which I corrected, over and over). O&G is probably the most disgusting specialty I’ve seen so far, and also amongst the most fun. So much so that it’s one I’d seriously give consideration for as a potential career.

One fell into the cuckoo’s nest

Recently, the Oaf has been spending his days on a psychiatric ward. I shall refrain from making the somewhat predictable and tweely made remarks I received upon arriving at the unit for the start of the placement, “whose more mad, us or the patients?!”. I smiled politely and died a little inside. The Oaf was certainly here for business, or at least one would think so. However, the lines between patient and student had started to blur already. As to begin with I had not been provided with an access card, instead having to plead with whichever mental health nurse was nearest the door that I was in fact, not under section and was allowed to enter and leave the unit, each day, for several weeks.

For safety reasons, students are paired up and provided with personal safety alarms. Unfortunately for myself, it later transpired that my partner had swapped hospitals prior to the placement with no replacement. ‘Well, at least I have the comfort of an alarm’ I foolishly thought to myself during the induction. Not so, a rationing of alarms meant allocation of the last alarm went to a pair of female medical students on another ward. Despite humorously yet somewhat truthfully pointing out that they could put up more of a fight than the Oaf if such a situation arose, it was clear I was to be alone. I was told that such situations did not really occur and that I should just keep in view of the other professionals working around me. All very comforting to hear, but they refrained from mentioning a patient had stabbed and killed another a few months earlier on a different ward in the unit. “Don’t worry though, they’re most probably in Broadmoor now.” I was eventually told.

Despite the constant, ebbing concern which left the Oaf looking rather paranoid and consequently the unfamiliar nurses ever suspicious as to my role there, the placement passed uneventfully. During ward rounds the Oaf was conscripted for notational duties, and at times was amongst the busiest individual on the round oblivious to the multiple psychologists, nurses, occupational therapists, clinical pharmacists as he frantically scrawled the important points into the files.

Meeting the patients proved to be a rather unique experience. From those who were convinced I was in fact, the consultants son to one individual who casually told me they were ‘a weapon of god with the power to turn off the sun’. Truthfully, the Oaf had not been looking forwards to this particular placement. The ambiguity of psychiatric disorders is something the Oaf is not comfortable with, and in retrospect still is not suited towards. It did however, change certain preconceptions of conditions only previously known through textbooks and lectures.

It is in all honesty, not a career suited to the Oaf. This was made especially evident as what proved to be one of the highlights of the placement being overhearing a consultant telling a nurse who had been on the phone, “just say that we’re busy, not that ‘it’s like a madhouse’ in here.”