Monday, 29 February 2016


Fourth year med school.
OSCE [objective structured  clinical examination].

Max and I were practising one of the many role play scenarios that could come up in the exam. This one was post-natal depression. He was playing the doctor. I was playing the patient.

Him: do you ever worry that you might harm your child?

Me: I don't know.... it just won't stop crying, and sometimes I just don't know what to do...

Him: do you have any hobbies or interests that can take your mind off it for a while?

Me: well.... I used to love playing tennis, but I just don't feel like it anymore....

Him: what about your intimate relationship with your partner? Is that OK?

Me: well... My husband and I used to be quite active, but I just don't feel the desire anymore. And besides- I've just given birth. I probably shouldn't be having sex, anyway....


[looks at me quizzically]

[shrugs his shoulders]

He suggested an alternative.

Now, I won't say what that alternative was, but I'm pretty sure you can guess. Needless to say, I was laughing so much I could no longer continue with the study session.

To be fair to Max, we had done so many practise sessions that we were both starting to get a bit delirious. But even so, I wasn't ready for that.

Max, man- you kill me. You take out a knife and kill me.

That was a tough year for the two of us, but through our extensive preparation, we actually bonded very strongly, and it's one of the main reasons we're as good friends as we are today. My approach to exams has always been very structured and methodical. I really don't like taking risks with exams. My ethos has always been: there's a syllabus. So learn the syllabus. At age 15 for my GCSEs, I came up with a revision timetable for myself. It took 2 weeks to make, and detailed my intended subject matter every day for the 4 months leading upto the exams. My good friend and bandmate, Munawar did something similar, and we collaborated to make timetables for the other boys in the year, selling them for 5pounds each. Almost none of them actually used them. But we did. And we got straight As.

Max was more than happy to come with me on my journey, and to the table, he brought a wealth of exam experience, having already qualified as a dentist, and then doing a medical degree en route to becoming a maxillo-facial surgeon. The symbiosis worked very well. We passed the exam with ease.

Within the constraints of getting the work done, I'm very serious. But when there's room, my inner child comes shining through, and to be honest, my inner child isn't very inner. He runs very close to the surface, and sometimes it takes a lot of conscious effort to keep him under control. However, it's because of that that during the lead up to those exams, Max and I laughed more than we'd laughed in a long time. It's something I've noticed repeatedly among a lot of my close friends. Max knows that around me, he can act like a child and still look like an adult in comparison. He knows I won't judge him. Which is why he can make jokes like the one above. Nobody else believes me when I tell them, though.

Being a kid is important. No matter how old you get, or how serious life becomes, don't ever stop being a kid.

How is everyone?

A few editions ago, I made reference to a written exam I had just done, and was waiting for results for. This was the written component of the fellowship of emergency medicine, which entitles you to become a consultant. I actually took 6 months off full time work, and was doing brief contracts to stay afloat financially, as well as keep in touch with clinical medicine while studying. It was a tough time leading up to it, as in emergency medicine, you see literally everything, and there's no limit to how much detail you can go into any one particular area. It took a lot of self discipline to study each subspecialty to a depth that I thought was reasonable before moving on to the next one.

There was a pre-set timetable of mock exams organised by the college in the build-up [NSW Fellowship Course], which I attended, and actually caught up with some former colleagues from a previous hospital. Most peoples performance was highly variable, with emotions soaring and plummeting at high frequency. Some of my former colleagues had been doing that same exam twice a year since I started advanced training four years before. And they still hadn't passed it. These are smart people. I looked at them and thought "Victor- people smarter than you fail this exam. What hope do you have?". Which didn't do anything for my confidence at all. However, by the same logic, I could reasonably argue that people less smart than me pass the exam. Clearly there's more to this than being good at medicine.

I just kept plugging away, trying not to get too phased if any one particular exam or question didn't go too well. The strange thing was, though, that the study wasn't the hardest thing about it all. This was the first exam since the age of 22 that I've done while being single. The loneliness was crippling. I hated it. I really hated it. I went to Wellington in NZ for a couple of days for the salsa congress where I saw a lot of my old friends. They're like a family to me. On the final night I was almost tearful, as I knew I'd have to get back to studying again.

The thing I tell myself to keep myself going during prolonged study periods is 'It's not forever, and it's not for nothing'. If either of those were to change, then I simply wouldn't do it.

Exam day came, and I wasn't actually that nervous. I'd done all I could reasonably do. It was just a case of getting through the day. Two 3-hour papers with lunch break in between. The morning paper was free response, and the afternoon paper was MCQs. The first was incredibly pressured, with a great need to answer as quickly as possible, as running out of time was a very real danger. Maintaining that level of concentration for 3 hours straight was really draining, and it took all the endurance I had.
There were thirty questions in total, and for 3 of them, I specifically remember turning the page and thinking




I have never heard of this thing in my entire life.


Keep it together. Think logically, act sensibly. Do what a reasonable person would do in this scenario and move on to the next question. Don't let it affect the rest of the exam.

Afterwards, I spoke to the other candidates and asked them "Had you even heard of that????" Thankfully almost none of them had, which made me feel a lot less like a sheep. Retrospectively, though, work life in emergency is like that: you can get presented with the most random things. You can't know everything, and you definitely can't have experienced everything. You need to be dynamic and flexible, and handle unfamiliar situations with a sensible approach. I guess this is what they were testing here. Not so much the medical science. They wanted to see who would keep it together, and who would crumble. Some people do crumble. Thankfully, I didn't. But whether or not that would affect the outcome, I would have no idea.

The afternoon MCQs were much less pressured time wise, and even if they weren't I've done so many for my US exams and MRCP [UK] that I think I would have handled them reasonably well, anyway. The questions were very broad, and I found myself thinking right back to medical school to answer some of them. I came out of that one feeling nothing like as traumatised as the morning exam.

My brain was fried by the end of the day. I took the ferry back to Manly and took a friend out to dinner to have a very quiet celebration of  it all being over.

It was a 6 week wait for the results, but I wasn't going to stress about it. It wouldn't make any difference. It takes a couple of weeks at least to recover from these exams, so I was just focussing on getting as much rest as possible.

The announcement would come  via an emailed link to the colleges website with a list of candidate numbers. They were 2 days late with it, which made everyone quite anxious. It was a Wednesday morning. I was on duty in the intensive care unit in Wollongong [the greatest job in medicine, by the way], but got permission to sneak back to the doctors residence to check on my computer, as the site is not mobile friendly.

I clicked the link. It took me to a page titled "The following candidates have successfully completed the written component of the fellowship examination 2015.2:".

Then there was a list of numbers in single file.

I scrolled down.

My heart was pounding.

They appeared to be in numerical order [which was nice of them].

My eyes started watering, which didn't help.

I saw my number.

I lost it.

I was literally out of control. I completely lost it- I was jumping up and down and screaming and shouting. I made that scene from When Harry Met Sally look like a minor disturbance. I just went mental.

I couldn't believe it.

I cried.

You may have seen the Facebook status:

I ran into the intensive care unit with my arms in the air, and my colleagues gave me very warm congratulations- they all expected me to pass, although I wasn't quite so sure. 

Anyway- that ugliness is behind me forever. I will never do another written exam as long as I live. However, it's not quite over yet. There's still the matter of the practical exam [OSCE] this May. I can't prepare for this by myself, though- I need a practise partner. 

Now, where's Max...?