Long overdue update

A lot has happened since my last blog post in August.

Too much, so here’s a quick summary in bullet points (as usual)

02/07/18. I set up an instagram account for my brush lettering! It will serve as a  safe space for me to keep track of my progress… with time, hopefully my account flourishes and my work gets acknowledged… some day, when my lettering skills have been honed and are much improved, I hope to sell my work.

19/08/18: Decided to take Holy Communion for the first time. This has been something that I have abstained from for the longest time… mainly because of teaching from the church of my childhood that we should abstain from the sacraments until we have “confirmed” our faith. For years I have let the bread and the wine pass by me… until I was challenged about it again by the pastor of my current church. Now, Christ Church doesn’t insist on people needing to attend catechism classes and publicly declaring their faith before we are encouraged to take communion… they teach that if you believe, you can and should receive. Recently, my pastor found that even after 9 years at CCL I have still not partaken in communion. He challenged me about it. He was clear that he did not want me to do anything that would sin against my conscience, but he also encouraged me to think about it more seriously. He wanted me to share in the joy and the commandment that is communion, even if I didn’t take it every time… he was keen that I partook in it. So after some deliberation, I realised that my hesitancy all boiled down to legalism. “I can’t do it because the other pastors said I shouldn’t.” But the bible doesn’t say no, does it?  Jesus’ disciples did not wait for a catechism class before they took communion. Am I following the bible’s words? Or am I blindly following the “laws” set by men? I decided that there was no TRUE biblical reason why I should not take communion as a believing Christian so I took the plunge. I ate the bread and drank the wine. And it was good.

20/08/18. Received some of the worst news I have had in my lifetime. Bad day. Tears. Sorrow. Desperation. More about this some other time…

Since then I have tried fasting and praying for the first time in my life. I fasted for 20 hours once a week. It has been an interesting experience. The hunger reminded me each time that I had to pray. And the fasting reminded me that “man shall not live by bread alone, but by every word…” It also kind of helped that fasting helps me to reduce my daily calorie intake… (though my weight didn’t really budge much- it has pretty much plateaued out, which is frustrating!)

12/09/18- 15/09/18. Went to the ESRA conference in Dublin. Killed SO MANY BIRDS with one stone. 1. Sat the EDRA part 1 (And passed!!! Woohoo. Scored 74.6%. Honestly, I didn’t think I would manage that at all as the exam was a lot harder than I had expected or prepared for, so I am very thankful!) 2. Attended the cadaver workshop and “all blocks in one go” US scanning workshop (They were so GOOD and useful. I learnt a lot of anatomy that I was unsure of/ didn’t learn in med school. Also, it felt so good to have experts who actually know what they are doing/ talking about teach me and answer my questions. I actually trust them when they tell me how to do infraclavicular blocks… versus at work, when I sometimes get the sense that some consultants are just “winging it” and don’t really know what they are talking about either… At these workshops, I was getting real experts who have sat the EDRA before and who practice thousands of blocks regularly hold my hand and say “hold the probe this way…” “look for the clavipectoral fascia…” The teaching was so good and well-worth the euros. Highly recommended!) 3. Did my first ORAL PRESENTATION at an INTERNATIONAL conference. Yep, another win for the CV! My free paper wasn’t nominated for competition, so I was pretty relaxed about it. There weren’t many people there (I think I presented to only about 15 people in a small room max), and there was no judging/ strict time-keeping. No difficult questions and the feedback on my work was really positive… so I was very pleased! 4. Visited the Republic of Ireland for the first time. Didn’t do a huge amount of sight-seeing as the conference was pretty much 8.30- 1700 or 1800 daily, but the couple of hours after “work” was pretty good (esp since the days are long in the summertime).

26/09/18. 25 weeker. 32 weeks corrected. Paracetamol OD. 5 times. milligrams confused with millilitres. Acetylcisteine. HDU. Apologies and duty of candour. 3 days terror. No sequelae. Now innovation for change. Let’s see how this goes. May be good for the CV and cons interview eventually as a “critical incident” to discuss. Department  supportive. SRob texted the next day “Hi Just checking you are ok. No one thinks any worse of you. Personally I would appoint you tomorrow!” Made up that my favourite consultant thinks this way.

Positive feedback. Been receiving some really lovely feedback from consultants. Especially SRob. I personally really like him and respect him as he is really good at his job and attentive to minusci. He’s the block guru and as you know I am interested in regional anaesthesia. Also, he is open-minded and not quite as resistant to change and innovation as some other people can be. I didn’t think he liked me very much the first couple of times I was at AH. However, since I have returned as a fellow he has been dead nice to me. He commented that I have become a lot better than when I was last at AH as a registrar. He has also said that he was pleased with my attention to detail. He still nitpicks at my work and sometimes “big-brothers” my anaesthetic charts (i.e. he would go to recovery and check on the quality of my anaesthetic record keeping for patients I have just delivered to recovery)… but he tells me that it is simply because “good is not good enough” and we need to aim for “perfection.” When I was chatting to some people about maybe taking on another fellowship after AH, SRob commented “don’t put ideas in her head… we have a department to run!” (basically saying that he was expecting that I would apply and contribute as a consultant at AH). And then there was that text that I shared above. When I last worked with him in MRI, he basically left me to see and sort the patients while he went to sit in a separate office within the MRI suite (this never happens!)– to me, that said a lot about how much he trusted me. And then there was feedback from the MRI staff that “he really likes you, and he thinks you are good.” All really lovely feedback. Besides SRob, there is also RishDi… who sat me down and told me that “every one of the fellows who wants a substantive job here next year will most likely be able to get a job (if you don’t f*ck up in the meantime).” With one of the fellows going to work in RMCH, and the another being a pre-CCT fellow… my conclusion was that RishDi was basically telling Hobbo and I that we are liked and people want us in the department. Most recently, I also got a message from my Ed supervisor saying that “you have a glowing consultant’s feedback.” All this feedback is so important to me. I want to write them all down so that I will remember them and let them prop me up in times when self-doubt fills my mind yet again… (which it often does).

 

 

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Moving forward into a new era

I really resent myself for not writing for ages and then having to catch up on a load of updates… Here we go anyway…

Great set of nights

  • Experienced one of my best sets of nights on 4th-8th June. Lovely CT1 (good looking, competent, teachable, easy to talk to). Friendly and highly competent ODPs. Great scrub nurses.
  • We had food every night! I brought in some blondies on the 1st night shift. The consultant who was in on the 2nd night bought us pizzas. My SHO brought sweeties in the 3rd night. And we had a massive party on the final night– one of the ODPs specially went to get a load of cakes/ cupcakes for me (to say thank you for the blondies), one of the scrub nurses brought in home-cooked Chicken Adobo for the team on my cheeky request, and I brought in some home-made cinnamon rolls!
  • The nights were not too busy… just enough work to keep us busy but not bogged down.

Last shifts

  • My last accompanied list was with A. Houston. A good ol’ elective open AAA to be more precise! Managed to get the thoracic epidural in and it worked a treat for the patient! It was a lovely last list to be on…. I’ve always enjoyed working with A. Houston. He’s really relaxed, very cautious, easy to chat to, and looks pretty too!
  • My last night shift ended on the morning of 6th July 2018. It had been quite a lot busier earlier on in the week (think: 3 consecutive renal transplants on 1 night!), but that last shift was sweet. Slept most of the night and managed to have a normal Friday day time!
  • My very last shift was on 12th July 2018. Not an amazing on call long day to be fair. I can’t really remember too much, except that my very last patient was a severe COPD patient who had fallen and sustained a flail segment of fractured ribs and some bleeding. I waited 2 hours for the “blue light” ambulance to come and take us (anaesthetic escort) to the major trauma centre… only to have the paramedics arrive at 1920h… 10 minutes before the shift changeover… thankfully, they were happy to wait 10 minutes so I could handover and not need to make the trip out way past my finish time!

Resigning

  • So, as I approach the end of my specialist training, I have to send a letter of resignation to my employers… I have to admit that it was one of the strangest and scariest things I have had to do in a while. Resigning from a job and a programme that I have comfortably settled into for the last 7 years! I procrastinated and procrastinated but eventually penned something down. I have no idea how to write a letter of resignation, so this was my short and sweet email to the employer:

Applying to be entered on the specialist register

  • So, I did that today. Applied to the GMC to be entered onto the specialist register. Once on the register I can work as a consultant anaesthetist. Eeks! Paid £420 for this privilege.

I got published!

  • In the college bulletin this month. It felt great! Most of the messages have been congratulatory. Very pleased.

Brush lettering

  • I’ve been going a little over the top with my brush lettering expenses recently. I just want all the colours! My wallet sustained some serious damage when I went back to Singapore recently… especially since discovering a shop called Overjoyed on Short Street (right next to Rochor MRT station).
  • So far, I’ve purchased a couple of sets of Tombow dual brush pens (and other assorted pens from various brands), a range of embossing equipment (heat gun, embossing fluid and embossing powder), a light box, and all manner of smooth paper! I also purchased a bottle of masking fluid to experiment with… can’t wait to break into that and have a go too!
  • I’ve been practicing a lot recently whilst on holiday, and even started an instagram account to document my brush lettering journey. Quite honestly, I’ve accumulated so much paper that I really need to stop being a garang guni and start throwing things out. The social media account should hopefully allow me to keep digital records and also engage with other creators online!
  • I have in fact developed a bit of a curriculum for myself:
    • Basic word form drills (Kaitlin style, Modern style, flowy style…)
    • Lettering connections
    • Blending
    • Bouncy lettering
    • Flourishing
    • Learn to draw watercolour floral wreaths
    • Play: Masking fluid, embossing, foiling
    • More word forms/ font types (e.g. Spencerian, copperplate… traditional types)
  • At present, I am concurrently practicing bouncing and flourishing… It has been a lot of fun and I can’t wait to have more time and motivation to progress even more! The aim is hopefully to be able to open an Etsy shop selling my pieces online in the future.

Visiting Singapore

  • Really physically and emotionally burnt out recently, so this recent trip home was a necessity, despite the fact that I could only be home for about 9 days (because I needed to be back for my visa appointment, before the start of the new job with the new employer).
  • Managed to see KX for the first time in years! He needed me to return the army jacket that he gave to me about 14 years ago. It was nice to see him– the guy that had been the centre of my few real-life idol-drama moments (think rushing from the army camp, hopping on the sky train and running across the airport terminal to find me, hug me and say goodbye before I left for the UK. Also think: signing a “contract” that we would get married if we both remained single at age 32). Well, the contract is void now as KX is a happily married man who recently welcomed his third son. He’s knee-deep into being a family doctor and happy working in the polyclinics. It was really lovely to meet up with him again- so many years have past and so much has changed. Yet, he seems to be still exactly the same.
  • The newly renovated house is so nice! Some things didn’t turn out as good as it could have been but I would say it was an overall success and I’m very pleased with it! The house is so much brighter and cleaner, and despite the persistent presence of many boxes the house doesn’t look so cramped with crap. I love the new kitchen and the new rain shower in the bathroom! We went shopping for furniture and curtains when I was at home– it was stressful but necessary.
  • Bought a load of skin care. Totally obsessing over K-beauty recently… especially the brand COSRX. Now, I have a healthy stock of cleansers, toners, scrubs, masks, essences and creams. And I only have one face. Here’s trusting that I’ll be able to use up the products before they go past their expiry dates!
  • Spiculated nodule. Fuck you. Please be gone. Please. Dear Lord, please take it away. Please help me to trust you. “Do not be anxious about anything, but in everything, by prayer and petition, present your requests to God. And the peace of God that transcends all understanding will guard your hearts and minds in Christ Jesus.”

Visa

  • After coming back from Singapore, I have since attended my visa appointment on 27/7/18 at the premium service centre in Solihull (heck, these appointments are so hard to come by. There is a centre in my city but there were NO appointments FOR EVER). For £2999, I managed to get my visa application approved on the same day. Freaking expensive, but I guess it was worth it not having to surrender my passport and freedom to travel for 6 months! Just glad that these visa application sagas are now over and done with…

Neville

  • Sorry Neville, but I managed to scratch your butt (side actually) at the multi-storey car-park again. I hate multi-storey car parks! That was where you sustained your first and only other injury as well! I was trying to make a tight turn around the ramps and didn’t give myself enough space to turn (also, I was going in the opposite direction so I felt hurried to complete the turn before other cars came along). My heart aches for you Neville! Sorry!

A quick catch-up

In the wink of an eye, it is now April.

Where has all the time gone since I last blogged?

There are a few things I want to tell you, so here we go with catching up…

27th February 2017. GD finally enlisted into the army. After all the agonising, he is finally gone. In the weeks and months leading up to his enlistment, I have found it crazy how disproportionate his fans’ grief is as they lament and bemoan the fact that they will lose their idol for the next 2 years. They weep and bid farewell as if this man is dying, never to return again. The negativity and sadness from the entertainment news were really weighing me down, which actually made me wish that he would just go quickly. Go quickly and return quickly- that’s my policy. In the meantime, while GD is gone, I am motivated to use these 2 years as a time target for my own health and fitness journey. When he is discharged on 27th Nov 2019, I want to be a new me. A beautiful girl unashamed to go and see my favourite artist in real life. If I have reached my own goals when he returns, I will go to his comeback concert. New GD, be prepared to meet the new me (in 2 years).

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Speaking of my health and fitness journey…. So, after Christmas and New Year, I bloated up SO BAD.  Despite being convinced that I did not overindulge over the holidays, the weighing scales did not lie. I had piled on the pounds. All my hard work had gone down the drain… and I was back to square one yet again. I saw a picture of myself on Chinese New Years day (when eating Hotpot with Laura) and was *shook* (pardon the grammar… this is a new young generation term). My face was so round… my arms so thick. I hated that picture, and hated myself for it. I was starting to feel really despondent. 2 years of exercise hasn’t done anything, 2 rounds of BBG hasn’t done anything, slimming world worked for all of 2 weeks, reducing my chocolate/ coke/ cake/ cookie intake hasn’t done anything, healthy-eating/ meal prep hasn’t done anything… nothing has worked! One day at work, I was randomly chatting to one of my juniors about my (lack of) weight loss… which was when she suggested using myfitnesspal to help me track calories. Now, I have never tried calorie counting before so this is a brand new adventure for me. I was initially worried about the math and work that this was going to involve… now, I am 6 weeks in and the app has worked a treat! The ability to add calories to your daily count simply by scanning the barcode of the food you eat has made this seemingly tedious chore much more of a breeze than you would expect! I think I am starting to see some result… I have certainly had at least 2 people come up to me in the last week commenting that I have lost weight. Some days I am immensely motivated to keep within my calorie budget, other days I really just want to give up. Yet, I have to keep reminding myself that “Rome wasn’t built in a day. You didn’t get fat overnight” and “good things are worth waiting for.” Let’s see what happens in the coming weeks and months! I am excited to see what changes my body will undergo! In the mean time, God please keep my food cravings at bay!

Badminton and body pump. After 2 rounds of BBG, I gave up BBG on week 7 round 3. Why? Because it was getting really really boring. The exercises still hurt, but it was so boring and my body was starting to resent going to the gym in anticipation of the pain. And so, as a way to spice up my exercise life, I engaged SH to play badminton with me every Saturday morning. We bought some cheap rackets and shuttlecocks on amazon and starting playing at the university sports hall. We are amateurs, so we play without any rules or boundaries. Our aim is to keep a rally going for as long as is possible. So far, it has been a tonne of fun. The cardiovascular exercise of running around chasing a shuttlecock has been awesome. The times when we manage to really keep a rally going has been exhilarating. It has been so much fun being able to play with a friend and our friendship has certainly deepened as a result. SH and I have actually made these Saturday mornings into “Play and Pray” sessions. We play badminton, catch-up a bit on life, and then pray for each other for the coming week. I love both bits of this P&P and look forward to it every week! On top of spicing up my cardiovascular exercise with badminton, I have also started going to body pump classes to help me with my strength training. After 2 years in the gym feeling too scared to step into a class (there is a constant worry about not being able to keep up, feeling embarrassed, and not being to escape!), I finally bit the bullet and went on 27th January. Bodypump has been great! It is nice to exercise with 20+ other people, led by an instructor who knows how to train and motivate, and to lift to some really good groovey music! Admittedly, these low load high rep exercises really kill my muscles… but when I have overcome them and as I walk away with jelly legs, I am filled with a sense of pride that “I did it!”

Best registrar. I went to a MET call the other day with one of my SHOs. The patient had a low GCS and needed to be intubated on the ward and then transferred to CT scan before going to ITU. On arrival, I took charge of the situation and quickly made decisions as to what needed to be done for the patient. As usual, I asked for the names of the people I worked with and assigned jobs to them on a first name named-person basis. I tried to be methodical and calm, aiming to take control of what would otherwise be a chaotic situation. We vocalised our thoughts and plans and verbally went through our pre-intubation check-lists. The patient was eventually stabilised, secured and packaged before we set off on a little adventure around the various departments of the hospital. The patient took up a good part of 2 to 3 hours of my time. When I eventually returned to the theatre coffee room, I found my SHO was there having her lunch as well. This was when she said some really precious words to me, to the effect of “I just want to let you know that I think you are the best registrar that I have ever worked with. I really admire the way you handled the situation. You were so clear, and I could totally follow what your thought processes are– something that I struggle with some other registrars when I just don’t understand what they are thinking! I want to be just like you in the future.” It was such precious feedback! These words are something that I hold closely to my heart– to think that I am a role model to one of my juniors! All too often, I beat myself up over the things that I could have done better/ should have done/ shouldn’t have done… so much so that I forget that I can be quite good sometimes! Obviously, I am not going to let this get to my head… but I want this to stay in my head, to remain as a precious reminder that I am still deemed to be “fit-for-purpose” and to stop doubting myself and my competence so much!

I am done with being the organiser of the PFMs. After a year of really hard work at overhauling the format of the meetings, after multiple frustrating emails to and from the associate head of school, after being on the receiving end of non-stop moaning from the registrars, the PFMs have become a precious baby for me and V. And so, it was actually really hard to give it up…. to trust other people to carry on the good work that we have done. But it was necessary, since I finish training this summer and V will be off on maternity leave in February. Our last meeting was a roaring success. One of the speakers from London even sent an email to SM to commend me for my good work- what a wonderful way to end off this term of being PFM organiser!

It is Easter Sunday today! On a day like this, this song shouts out to me…

As my saviour hung nailed onto the tree, his love was poured out to set us free.

Man of sorrows Lamb of God
By His own betrayed
The sin of man and wrath of God
Has been on Jesus laid

Silent as He stood accused
Beaten mocked and scorned
Bowing to the Father’s will
He took a crown of thorns

Oh that rugged cross
My salvation
Where Your love poured out over me
Now my soul cries out
Hallelujah
Praise and honour unto Thee

Sent of heaven God’s own Son
To purchase and redeem
And reconcile the very ones
Who nailed Him to that tree

Oh that rugged cross
My salvation
Where Your love poured out over me
Now my soul cries out
Hallelujah
Praise and honour unto Thee

Now my debt is paid
It is paid in full
By the precious blood
That my Jesus spilled

Now the curse of sin
Has no hold on me
Whom the Son sets free
Oh is free indeed

Now my debt is paid
It is paid in full
By the precious blood
That my Jesus spilled

Now the curse of sin
Has no hold on me
Whom the Son sets free
Oh is free indeed

Oh that rugged cross
My salvation
Where Your love poured out over me
Now my soul cries out
Hallelujah
Praise and honour unto Thee

See the stone is rolled away
Behold the empty tomb
Hallelujah God be praised
He’s risen from the grave

Oh that rugged cross
My salvation
Where Your love poured out over me
Now my soul cries out
Hallelujah
Praise and honour unto Thee

Praise and honour unto Thee

The story so far…

I cannot believe that it is May 2017 already and I have not posted a single blog since my birthday last year! So much has happened, yet if I really sat down and wrote out the details of the last half a year, I am going to be here typing for the next 6 hours and this post is going to be incredibly long and tedious to read. So here’s what happened in a snapshot…

Life

Baking

So, I have somehow developed a keen interest in baking over the last few months. Since about Christmas time, I have been baking like a mad woman. When I am at home alone, in the quiet of the evening or nighttime, enveloped by the cosy warmth emanating from the oven, pottering around the kitchen and concentrating on making something awesome… I find this process extremely therapeutic. When I am baking, I forget about the stresses of the work day- the missed cannulas, the difficult intubations, the failed regional blocks… all these failures are wiped out of my mind as I get into my “flow.” All I can think of is the math calculations as I adjust my ingredient amounts, all I can hear is the whirring of my mixer, all I can feel is the heat from the oven, and all I can smell is the delicious sweetness of the sugar and butter and flour being whipped together into batter. At the end of each baking experiment, I am also presented with the satisfaction and reward of a dozen stunning cupcakes, or a scrumptious tray of cookies. I have truly fallen in love with baking!

Cooking is an art, but baking is a science. Indeed, the process of baking marries up my love for food and for science. I am so curious to find out what chemical reactions are going on as I add water to flour, or sugar to the batter, or what happens when the air bubbles in my batter expand within and escape out of the cake’s gluten structure under heated conditions. I find all of this fascinating, and have gone so far as to purchase a textbook on “how baking works.” So far, I have read about 4 chapters of it and I am being enlightened with each page I turn. I am reading about heat transfer, and the properties of the different materials used in bakeware. I am learning about which ingredients are tenderisers or tougheners, which ones are moisturisers and driers. I am enlightened about what happens to each of the ingredients at the molecular level as you mix them, or heat them, and cool them. I’ll admit that I have not really done much reading outside of medicine… and this (text)book has been a real pleasure to get back into leisurely reading with.

I think my baking escapades have also been made much more pleasurable and successful since using recipes from youtube celebrity baker cupcakejemma. Her recipes are so unbelievably incredible. It also helps that I have a very willing cake/ sweet-treats eater friend who always welcomes my attempts to feed him cake. I now try and find any and every reason to bake him cake, knowing that he will eat it (and I can just have one or two only instead of getting fat from eating all my own baked goods).

Fitness

So, whilst in one aspect of my life I am baking away with highly calorific butter and sugar and flour, another aspect of my life has been focussed on getting rid of said calories. Oh how life contradicts itself in so many ways! I have been spending a lot of time in the gym with Emma doing squats, deadlifts, chest presses and lunges… all in the hopes of building some muscle that will burn calories even when I rest. I have to say that my progress has been incredibly slow… potentially to the point of being non-existent. I am so frustrated as I have been working so so so hard and yet am hardly seeing any result at all. After all, I have ramped my physical activity up by at least 80% compared to the days before I joined the gym– when all I did was to consume cake, chocolate, cookies and coke… and when the most exercise I ever did was to go shopping for new clothes in the department store.

Perhaps I really do have to work much harder on my diet. Rumour has it that weight loss is 20% exercise and 80% diet, so I may need to rethink my intake! However, this is also part of the reason for my aggravation because my diet has improved by leaps and bounds since my cake and coke days.  Now, I definitely give a lot more thought into what I put into my body. I hardly drink any coke at all these days, and I do not buy chocolate bars anymore. I still eat cake and cookies but I am quite a lot more watchful over how much I do actually have. So, with clean(er) eating and a heck of a lot more exercise, why am I still not shaping up nicely as I would really like? Do I really have to go cold turkey and eat bland food that I do not enjoy for the rest of my life? I am so disappointed because even my clothes do not feel any looser than they did before I started this “healthy living” thing a year ago. I am not giving up though… like I said before, Rome was not built in a day, and I did not get fat overnight. I am going to have to keep working at this body… try different activities, different diets… and hopefully someday I will reap the results that I desire. To me, strong is the new skinny. I want to be lean, toned and strong…

J, go and try out a new workout programme, a new gym class, yoga, dance, swimming… it may be scary to go at first, especially when you are on your own and you fear looking like a real clown amidst the experts. But please, just start.

I have been taking fitness inspiration from a celebrity personal trainer on instagram. Her name is Kayla Itsines. She does not advocate the whole “I wish I have your body” mentality- and I agree…. yet, she is SO stunningly beautiful that I cannot help but look at her and think “goals!” I guess you can say she is my fitspiration? Seeing her so beautiful and strong really motivates me to keep working on my own body.


Closer to home, Jamie Teo (Miss Singapore 2001 and former TV personality) has been a real inspiration and motivation to me too. She posts her home workout videos regularly and you can clearly see that her body has been well sculpted by all that exercise! She is so beautiful!

My final other source of inspiration comes from a man. He is none other than the 22 year old Australian Olympic swimmer Cameron McEvoy! This man is really like a machine. Somehow, he has managed to balance being a swimming champion with academia as he pursues his dream of becoming a physicist. I love seeing how he works out so hard both in the gym and at the pool to be in the best physical shape for the swimming championships. Yet, he alternates his posts from the pool with geeky posts of complex mathematical equations, or how he is reading up on the work of physics greats such as Richard Feynman. I love that someone is actually able to be so dedicated BOTH to sport and to science- something that is so difficult to do when both disciplines demand 100% dedication from 100% of you. To see someone being able to achieve/ or at least work to achieve such a feat is a real inspiration to me. And it helps that he looks really cute too.

Work

Prizes

So, the last time I went to Edinburgh in November, I had actually gone to attend the Patient Safety Conference where I presented a poster on my Ultrasound Screen cover project. I am extremely happy to say that I won the first prize for my poster! When I was there, I was able to explain the ideas behind my project to the other delegates and quite a few consultants from other hospitals around the country were asking me about how they can get hold of one of my screens. I am now desperately trying to get the hospital’s innovation team to help me further develop my product. Hopefully, we will eventually be able to sell the intellectual property to a commercial company so they can manufacture it in bulk in industry (compared to my homemade craft project of a prototype at present). I am excited as to what can possibly become of this little project– after all, the entire idea and concept had come completely from God as an answer to my prayers. I am extremely grateful to what the Lord has blessed me with and I really want to take this forward- to the rest of the UK and even beyond!

Oh by the way, when I was at the conference, I also had a chance to meet and even speak to Princess Anne (daughter of Queen Elizabeth and sister to Prince Charles). She is the patron of our Royal College and was in Scotland for St Andrew’s day anyway. And so, she came to attend our event. It was immensely exciting because I have never ever seen royalty up close and personal before. As trainees with posters to present, we were given the opportunity to speak to the Princess when she came to view our posters. We all had a short briefing before her arrival whereby we were taught to address her as “Your royal highness” at the first instance (and to curtsy as we said it) followed by “mam” (not mOm) thereafter. Frankly, I was so nervous about seeing her and speaking to her. I was worried that I would call her “Your majesty”– which is wrong as it refers to the queen. Also, I had no idea how to curtsy in a pair of trousers and so I just bobbed when I saw her. When I eventually got chatting to her, I actually found that she is very human. And a very nice one too. She was very friendly and seemed to genuinely take interest in what work I had done (though I honestly do not think she really understood what the heck I was doing).

Oh, one interesting thing happened too. After the adrenaline rush of having spoken to the Princess, and after speaking to quite a few other delegates about my work as I stood in front of my poster presenting it, I decided that I was parched. I found an opportune moment when I could leave my poster to get a drink. I had my eyes set on a jug of tea that was on a table about 4 meters away from me. In order for me to get to the tea, I had to walk behind Princess Anne (who was mingling/chatting to some other important people) on one side and a group of female doctors on the other side. I calculated my steps and moved swiftly towards hydration. However, just as I was walking behind the Princess, a female doctor from the other side took a step back towards me, effectively trying to squash me. In my haste to avoid her, I accidentally took a step towards the Princess and basically kicked her heel. Can you imagine the horror on my face as she turned around to find out who her “assailant” was. I was so shocked that all I could manage was “I am so sorry, so so sorry.” Oh man! But what a story for me to tell in the years to come– that I have kicked royalty in the heel in this lifetime!

In February, I took my project to present at the LSA trainee’s prize competition as well. It is something that I have been determined to do for the last few years but never really had anything that was “competition material.” This time, I submitted my entry and was determined to win the beautiful Jackson-Rees medal. I knew that the work was good and that I had worked hard on it. That night was going to be the night for me to present it orally and do it some justice! I practiced my oral presentation over and over again. I needed to sound enthusiastic and convicted by my own work. I needed to to be engaging and charismatic. I needed to keep my words understandable despite the fast pace that I had to go at to get everything I needed to say in. Yet on that night, I was SO nervous. When I walked into the lecture theatre, I saw DG to whom I admitted that I had so many butterflies in my stomach that it felt like I was sitting yet another exam. DG being DG told me not to be silly and to remember the 3Cs! I was 3rd in the line of 4 presenters. I think I eventually did a reasonable job of presenting my project. I was asked a load of questions, some of which I really struggled to piece of coherent answer for. I was desperate for a win. And yet I lost. I was 2nd place- still considered a win to most people especially since there is still an associated cash prize. However, I really really really wanted the shiny medal. I was disappointed. And then I was cross. Why? Because the 1st prize winner (an arrogant junior of mine) came over to me and said “I’m sorry I beat you.” Like, seriously? Anyway, now that the emotions of the night have all settled down, I am ultimately still very grateful to God. 2nd prize is still a prize. God is still good to me. And in the hilarious words of my wise mother “Don’t be disappointed. Sometime 2nd is better than 1st. Like singing competitions, 2nd prize winner always 发展得比冠军还要好 later. Remember it’s just a prize. So be happy that 你榜上有名,还有钱拿。你好强啊。一人之下,万人之上?。恭喜恭喜。”

Paediatrics

Now back in the children’s hospital. Loving it most days as the little children are so cute and beautiful. Even with the crying, screaming and protesting, all is forgiven when they are asleep and adorable like little angels. All is forgiven when you can have little cuddles with them in the recovery room. Children are so innocent and beautiful.

Also, who does not love to go to a workplace where there are colourful murals on the walls? Who does not enjoy blowing and popping bubbles as part of the job plan? Who complains about being able to play with toys whilst waiting for their “clients” to arrive?

The children’s hospital has been a really good place to work in… not just because of the children and the toys, but also because of the staff. In my opinion, you have to have a soft and gentle side to be able to work with children. And so paediatric surgeons are really some of the nicest surgeons I have ever worked with. Of course, some of them can still be arrogant and difficult… but compared to the egos and rudeness I have witnessed in adult tertiary centres, they are really quite mild. I love that in this hospital, people value me as part of their teams. I get addressed by surgeons, TCAs, ODPs and scrub nurses by my first name! This is something that does not often happen because people do not usually make an effort to remember the name of a passing anaesthetic registrar, and especially not if you have a name as uncommon as mine!

Nevertheless, I say goodbye to theatres for 6 weeks as I go and join the PICU/transfer team for a bit. I am admittedly very nervous about this as the pathologies in paediatric ICU are very different from that in adult units. The complex cardiac patients terrify me the most as I do not even know how blood is flowing within their congenitally abnormal hearts! Also, I am still unfamiliar with considering infusions in terms of mcg/kg/min… something that we never do in adult practice where everything is usually a standard mixture and adjusted in ml/hr! There is much to see and learn in the coming month and a half. I just want to pray to the Lord for good teaching and learning, and much safety as I go into an environment that I am completely unfamiliar with and uncomfortable in.

Church

A very powerful sermon from Mark 15: 1-15, 25-39. I am completely shaken by this.

You can be the crowd. Jesus is a very compelling figure. People have all sorts of objections to Christianity, yet when it comes to the actual person of Jesus, all sorts of people who hate the church still think that he is the best example of humanity that we have. He has unlimited power, and he uses this to help people– Everytime he does something terribly powerful and scary, we see him next caring for someone, talking to someone, healing someone, forgiving someone. Yet, He is uncompromising in his claims– that everyone who has ever lived should respect his authority, that we have to be fully accountable to Him. He says that we will do nothing more important than deal personally with him. As a result, many feel that “He is awkward for me” and “I do not like him making these claims– I need to get rid of him.”

What crime has he committed? They could not name the crime. Yet they shouted all the louder “crucify him!”


You can’t be Jesus. Barabbas was supposed to be the one crucified. It should have been him- the normal guy, the everyday criminal. However, Jesus died in his place instead. Yet, it was not a straight swap of one peasant for another. Jesus was different. 3 hrs of darkness at noontime on the day of his death– something not normal, and which is a sign of God’s anger. As Jesus hung on the cross, he cried “my God, my God, why has thou forsaken me?”– a cry of religious heartbreak not likely to be heard from hardened criminals. On the other side of the city, a large thick curtain rips from top to bottom the moment Jesus dies. THERE IS SOMETHING VERY DIFFERENT ABOUT JESUS. The death He died, only He could die. Jesus has terrifyingly limitless power and authority– heck, he controls evil with just His words! Yet, this king over everything chooses death– the one who committed no crime took the anger and separation from God in our place. “He saved others, but he cannot save himself?” What nonsense. He did not save himself, so that he can save others. And so at that moment, the curtain is ripped– from top to bottom, as if God has reached down, so that all the warning signs that remind us of our uncleanness has been ripped down by Him.


You can be Barabbas. The son of God died for you Barabbas! He took your place. Was Barabbas relieved? Was he thankful? How did he respond/ soul search? Did he live a better life afterwards? We do not know anything else about Barabbas. It was unimportant how bad Barabbas had been. It was unimportant if he went on to do something great. The only important thing about him was that Jesus died for him. And there is just one word to describe him: Released.

For the non-believer: Do you feel held back thinking that you can never be good enough to be a Christian? Do you think “I am too different and too distant?” Remember that Jesus never said “earn this.” Jesus’ offer to Barabbas is the same offer to you. “Release.” YOU CAN BE BARABBAS.  Having witnessed how horrible a price it is to pay for your sins, do you really want to insist on paying for your own uncleanness? Do you really want to say “Put me back in the cell and punish me please?” YOU CAN BE BARABBAS, so why would you not be? Let Jesus pay for you. The curtain is ripped. You can walk in and begin a life of knowing God and being made clean.

For the Christian: do you judge your friends? Do you think that some people are beyond salvation? Do you doubt that you can invite ANYBODY into this relationship? Even when you have witnessed that the first person to believe is the centurion who hammered the very nails into Jesus? Jesus died to rip the curtain in two. Please stop sewing the curtain back up. Stop holding back Jesus’ offer to people who do not fit the “profile.”

Thoughts on the drive home from work

I spent about an hour and a half this morning hand ventilating a little baby with a Mapleson F circuit (only 3kg, ex-prem, chronic lung disease, for PDA ligation).

Consequently, I spent an hour and a half breathing in unscavenged waste gases from the circuit with 3% sevoflurane and a fresh gas flow of 6 litres.

I reckon my own end tidal sevoflurane levels were probably about 0.5 by the end of it and I felt incredibly tired as I drove home from work.

Just thinking: If we advise our patients not to operate heavy machinery for 24hrs post GA, perhaps I really shouldn’t be driving after practically giving myself half an anaesthetic?

Mm…

p.s. My right hand has also probably suffered repetitive strain injury from all that bag squeezing… *sigh, occupational health hazards eh?

Grumpiest doctor

In the last 2 days, about 3 of my colleagues have commented that I am the grumpiest doctor they know. One of them even went so far as to say that “she doesn’t even enjoy what she is doing.”

They claim to have made their comments in jest, but these comments really jolted me into reflection.

Am I really such an unhappy doctor?

At this stage of my training, perhaps I am. I am still re-living the nightmare of 1 month ago on a daily basis- every time I think I feel a little bit better, something else happens to put me right back into my place of misery. Adding to that, I have an educational supervisor from hell- she demands me to do this and that, then buggers off into the fog and provides no guidance or support whatsoever for me to achieve all these lofty plans that I have no interest in. Thirdly, there has been little teaching and learning where I am working at now. To be fair, there have been half-hearted attempts at teaching. I always have a great desire to ask questions, to explore thoughts, to learn new skills; but when the teachers appear disinterested, my enthusiasm runs dry. Fourthly, the patients I have been seeing recently have been sick as dogs. When I have been to review these patients on the wards or in A&E, I have so regularly found myself thinking “sh*t, they look like they are going to arrest on me anytime soon.” I have had to scoop and run with so many of these critically unwell patients, many of whom I then spend the entire day with as my “private patient” trying to resuscitate and stabilise on the ITU. Transferring someone to CT scan with pH 6.9, unrecordably high lactate, on 40ml/hr of adrenaline and a systolic BP of 80? Check. Jumping onto a patients bed to intubate a morbidly obese Down’s syndrome patient with a difficult airway during a cardiac arrest? Check. Hugely difficult to ventilate patients post intubation? Check check check. Anaesthetising a grey and clammy patient at a remote site that I’ve never even been to for an interventional radiological procedure requiring awkward positioning? Check. Having to place invasive lines in massively coagulopathic patients with platelets less than 10 or INR more than 10? Check. My sphincters have never been clenched so much in the space of 2 months, and my adrenal glands have been so plump from all the adrenaline needed to help me fight or flight through these massively stressful situations.

Finally, the junior doctors in this country have been/ are being shafted by the government. They are proposing new contracts that will remove safeguards against overworking doctors. They want “social hours” of working to extend from 7am to 10pm Monday to Saturday (i.e. no recompense for obviously antisocial working- seriously, who values their 9pm Saturday evenings the same way as 9am on a Tuesday morning?). Doctors are essentially doomed to a 30% pay cut under their proposals, whilst the people in authority have recently given themselves a 10% pay rise so that they are “paid the right rate for the right job.” And? Does this same rule not apply to us? What is the right rate for being at work 3 out of 4 weekends in a month? For having lunch at 6pm or missing meals altogether? For being vomitted or even spat on? For having to examine bits of people’s anatomy that will make your stomach turn? For enduring the melange of odours that the body is capable of producing? For all the difficult decisions that need to be made? For having to face death every single day? What is the right rate for having to study for extremely difficult professional exams in our own time? For having to pay thousands of pounds to sit said exams? For needing to pay for medical defence, college registrations, professional development courses? What is the right rate for sacrificing such a large part of my own personal and family life so that I can look after you?

So yes, I am miserable. I am depressed and demoralised. This is not what I signed up for when I was 18 years old and fresh out of junior college.

But I know I need to smile more. Other people do not need to be at the receiving end of my misery.

Come on, J. You were not like this before. You don’t have to become like that now.

Never

If I ever had any kids,

I will never let them go into medicine.

NEVER.

NEVER EVER.

Success is sweet because the sacrifice has been so great

The week leading up to the final viva examination were awfully horrible days. I had taken annual leave to revise at home; but after 4 months of solid revision, I seemed to have completely and utterly run out of steam. I would get up at about 10am everyday, faff around for about 2-3 hours on youtube before finally forcing myself to sit down and stare at the books. The procrastination got so out of hand that I ended up having to eject myself from the house and its distractions to study at the nearest cafe. Nevertheless, the first couple of hours were always the least productive, and it would take me another 2-3 hours to learn the first topic of the day. My revision momentum would build up so painfully slowly, and I would only feel as if I was starting to get into the rhythm of things at about 7 or 8pm at night. The “real revision” then goes on till about 3 or 4 am in the morning before I decide that I have done enough for the day and probably deserved to go to bed.

Once in bed, I would proceed to “quickly” run through everything I learnt that day in my mind. The process was often not as quick as I had expected it to be, and regularly led to tangents whereby I would try and remember other things that I had learnt the day, week, or even month before. Going to sleep was never a conscious decision, and I was almost always led to dreamland only when the machinery that is my brain would “hang” mid-thought. Sometimes I would fall asleep, then suddenly jolt awake and begin to run through how I would anaesthetise a phaeochromocytoma, or a patient with chronic renal failure, or someone with hypertrophic cardiomyopathy (just checking if I had forgotten).

It was really a rough time that I thoroughly did not enjoy. The more I revised, the more things seemed to crop up that needed looking up. Learning about oxygen was never just about the gas itself. It would lead on to how oxygen is distilled from air, how it is stored, how it is transferred from the pipeline through the anaesthetic machine and to the patient, how it is measured. That would then lead on to a question on the oxygen cascade and oxygen carriage in blood. Which then brings us to the topic of indications for long term oxygen therapy, or hyperbaric oxygen therapy, and the effects of oxygen toxicity. Now, that is only on the topic of oxygen. Imagine expounding on every single other topic that is in the curriculum in the same way. My mind was completely and utterly saturated.

I remember evenings when I would feel so overwhelmed and anxious that my palpitations would kick off again. I remember the uncomfortable churning in my stomach as I struggled to cope with the knowledge of my lack of knowledge. I remember the one night when I prayed to God and sobbed my eyes out. It was all getting too much. I was physically, emotionally and mentally drained. My stamina was running out, but somehow I had to keep it all together. I must not peak too early, nor should I sink into a state of despair prematurely. I had to keep myself together and pace myself to reach peak form on the 24th of June.

Hobbo and I became a revision pair before the exam as well. Thanks to the wonders of technology, we could viva each other almost every evening via Skype. We tried to work through the past questions on the Coventry Final FRCA website, and sought to ask each other the harder & more unexpected questions that have previously come up. Somehow, we had to practice how to talk AROUND things that we knew nothing about. We had to dig deep into working things out from first principles, and learn to deliver an answer we are unsure of with an overwhelming confidence. I found that one of the hardest things to do.

I took the train down to London the day before the exam. En route, I worked through the College questions from the College guidebook. I managed 2 long cases, 2 short cases and 2 science questions… and then headache struck. The same headache I had when I was on the train down to London for my Primary viva 2 years ago. The headache that required me to close all my books and bury my head into folded arms on the table.

I eventually arrived in London and checked into my usual exam hotel at Studios2let. I revised a little more. I then headed off to Nandos for the usual pre-exam dinner, and as usual looked through R.Craig’s statistics notes as I ate. I must have gone through these exact same motions at least 3-4 times in the last 4 years. Anyway, I continued to do some more revision on one of the art installations outside Euston station that evening, and it was only after I had convinced myself that I could remember the Van Hoff’s equation for osmotic pressure that I decided it was time to head back to the hotel. More attempts at last minute cramming ensued, but I could simply put no more into my brain that day. I was completely spent, and all I was achieving was placing myself in a state of panic. I made the conscious decision to stop. Shower. Sleep.

The alarm clock rang. It was a signal to war. I got up and showered, packed, and prayed. As I cried out to the Lord, I could feel my teeth chattering, my hands trembling, my muscles stiffening up. Adrenaline and anxiety surged through me. The nausea I felt that morning made having breakfast a rather difficult and drawn out affair. I had no appetite to eat at all, but I knew I had to force this brain food down my gullet. Breakfast was followed by a long, slow walk to Red Lion Square with my luggage in tow. I did not feel good that morning- my head was not clear. I felt fuzzy. I knew I was not in top form. Had I gone past my peak? I contemplated this as I made my way to the college… and then something caught my eye. A passer-by emerged from a shop wearing a T-shirt emblazoned with the phrase “Success is certain.” That proved to be my motivation for the day, and I regarded that as a sign from God.

More palpitations, tachycardia, shortness-of-breath, and queasiness later, we were finally led to our exam. The morning exam was the clinical vivas. My long case was on an obese man with hypertension and a history of alcohol excess presenting for elective knee replacement. He was found to have an ejection systolic murmur and left ventricular hypertrophy on his ECG. I prepared my case as though he had aortic stenosis, only to be given an echocardiogram and cardiac MRI result during the exam itself saying that the valves were normal! So scrap aortic stenosis! Summon all knowledge on HOCM, on the spot! That was the route the exam went down instead.

My first clinical short case was on sepsis- fairly straightforward in my opinion.

The 2nd started with “What is Crohn’s disease? How does it present and how is it treated?” My heart sank- medicine! Flippin’ medicine! I’m trying to sit an anaesthetic exam here! Leave medicine to the medics! Anyway, I summoned everything I could remember about Crohn’s from my med school finals as a 4th year medical student 8 years ago. It was slightly painful. Thankfully, we moved away from general medicine and swiftly onto sedation practices for gastroscopies and colonoscopies. Not my hottest topic considering that I last looked up sedation guidelines 2 years ago- but it wasn’t terrible.

The final short case was on retained placenta. Great- I cover the maternity on-call ALL THE TIME so I should be hot on this. “What are your concerns pre-operatively?” I started with “the patient still has the physiological changes of pregnancy…” Nope, they didn’t want to hear that. “Bleeding.” What else? “Infection?” What else? I ran out of things to say. “How quickly does she need to come to theatre?” “Immediately if she is bleeding and haemodynamically unstable. As soon as is practically possible if she is stable- excessive delays should be avoided.” Not the answer they were looking for. “Within 75min?” They didn’t look happy. The examiner took me all over the place with this question, and kept coming back to “what are your other concerns?” I was so frustrated as I simply did not know what she was looking for. Thankfully, the final bell rang just in time to save me from the misery she was putting me through.

I left the morning exam feeling intensely dissatisfied. The exam just kept replaying in my mind, and the more I thought about it, the worse my performance appeared to be. I was convinced they had both given me a 0 for that last short case. That means I lost at least 4 marks just on that question alone. Assuming that I scored full marks for the other questions (which I was not sure I had), that gave me a budget of 4 marks to lose in the afternoon’s science exam- my weakest area, the very area that led to my failure the last time. That means I am likely to fail. Fail. Fail. Fail. I imagined having to undergo the hell that is revision and exams a 3rd time. I thought about how upsetting it would be to have to scrap my 30th birthday plans so as to revise for the December re-sit. I was miserable (even when eating lunch from my favourite Japanese fast food restaurant in London: Wasabi!).

After lunch, I went back to the college and sat in the lecture theatre for about an hour or so whilst waiting for the afternoon exam to start. I tried to put some last minute information into my (still fuzzy) brain. There were a couple of other candidates around me that afternoon, everyone desperately trying to keep it all together. Eventually, it all got a little bit too much. I needed to have a breath of fresh air, so I went outside to Red Lion Square and sat on one of the park benches there. I stopped myself from thinking about work, concentrating instead on how lovely and sunny it was, and how comfortable it was to feel the light breeze in my hair. Now and again a moment of panic would strike, and I would calm myself down by thinking of that “success is certain” sign I saw in the morning. Nick had also sent me a message that afternoon “Good luck Dr T! Keep going, you can do it!” YES I CAN. Keep the 3Cs J. Remember the story of the broken pencil. You are the worst judge of your own performance. Forget the morning, concentrate on the afternoon!

A gruelling 3 hours of waiting later, I went back to sit my afternoon exam. After putting my bag back into the locker, I thought “I should just quickly glance at the anatomy of the facial nerve…” Nevertheless, I struggled to find the appropriate page in my textbook… so I thought “oh screw it, I can’t be that unlucky.”

My anatomy viva started with “In which situations do we have to monitor cranial nerve function?” Flippin’ heck, I knew what they were going to follow up that question with. I kept my composure and started going on about monitoring facial nerve function in ENT surgery, 3rd and 6th nerve function in raised ICP, brainstem death testing, Guillan Barre Syndrome…” Then the question came “describe the anatomy of the facial nerve.” Great, I know nothing about it. I made some crap up on the spot, and even said that it exited the base of skull via the foramen magnum???!! (what an idiot). I was just about to lose it when I remembered some advice I received via email- move on! There are marks to be scored in later questions, don’t dwell on what you don’t know. So move on I did. We talked about the cranial nerves tested in each aspect of brainstem death testing, how recurrent laryngeal nerve function is monitored… we talked about loads of stuff, and even though I have never really encountered this question in my exam prep, I was surprised by how much I actually did know.

Then, the rest of the exam flew past and I knew I nailed the science. I was so thankful to God that nothing unexpected came up. We talked about the physiology of moving from the supine to lateral position in thoracic surgery, and causes of hypoxia in one lung ventilation. My pharmacology question was on drugs for diabetes and the treatment of DKA. I offered them 2 classification systems for insulin. How they are made (bovine, porcine or recombinant DNA), or how long their effects last (rapid, short, intermediate, long). They caught onto it and said “ok, so tell me about how insulin is made from recombinant DNA.” I had no idea, so I threw in any DNA-related jargon I knew. “I’m not entirely sure, but I assume that we hold the genetic code for insulin, and using codon-anticodon triplet matching, amino acids can be lined up in the correct order for expression of the insulin polypeptide.” Completely made that up, no idea if it is even true, but at least I think I sounded confident. They then wanted me to dig further into my knowledge as a foundation doctor from years ago and tell them about the times to peak effect and duration of action of each class of insulin. I wasn’t too hot on that, but could give vague timings based on memory. Finally, the physics question was on the safety features of vapourisers. I like the vapouriser topic, so didn’t struggle too much. I even offered to draw them a picture of the desflurane vapouriser! They asked about the effects of altitude on the functioning of vapourisers- something that I still cannot get my head around till this day, but I said what I knew (partial pressure unchanged, concentration decreased) and left it at that… I caught myself just before I went on to expound on my lack of knowledge.

I came away from the science exam feeling rather good. However, the dark cloud from the morning continued to loom over me as I sat in the Square Pig pub with Hobbo and Matt. The both of them were convinced they had failed. Honestly, they were so sad and angry. Hobbo had a different set of questions to mine and I can honestly say that he had a really bad set of questions. Apparently he had to tell them about the exact cytokines and local mediators and how their concentration changes in the presence of pulmonary hypertension (what??!). But the worst question has got to be “Tell me about Alzheimer’s disease and the drugs used to treat it” Are you for real?! An entire pharmacology viva on drugs for Alzheimer’s?? I’m not even sure that is in the curriculum. We have certainly not seen it in any of the anaesthetic textbooks. Hobbo said that he tried to direct his viva to talking about drugs for Parkinsons or drugs for depression, but they would have none of it. His examiner literally had to lead him to every answer “if they are very agitated what do you think they will need?” “If I told you that they are low in acetylcholine what do you think they may be on?” I felt sorry for him for having such bad luck.

1715hr eventually came, and it was time for us to return to the college for our results. I remember standing right outside the college’s glass doors panicking. I muttered under my breath “please let me see my candidate number on the grid, please let me see my number…” I paced up and down and back and forth feeling almost sick from the anxiety. Matt was worried sick too, and eventually came and put his head on my shoulders. That was when I whispered to him “shall we pray?” Matt nodded.

I’ve always known that Matt is a Christian, but we have hardly ever said much about Christianity or our faith to each other. That day though, I felt the overwhelming need to pray with him and for him. We have been through a heck of a lot of hell together for this exam. So there we stood, outside the door of the Royal College of Anaesthetists, heads bowed to our Lord and Saviour. 2 desperately anxious anaesthetists begging the Lord for peace.

And peace was bestowed. Almost instantaneously, I felt so much better. Through prayer, we were reminded that everything is in God’s hands. We need not fear nor tremble, for the Lord is sovereign over it all. That was possibly one of the most precious moments I experienced on that horrible day- the reminder that GOD IS IN CONTROL.

We eventually went inside to collect the “Success grid.” I peeled away from the others with my little sheet. I closed my eyes and took a couple of deep breaths. This was the moment of truth. Slowly, ever so slowly, I worked my way from the bottom of the grid upwards, scanning constantly for my candidate number…

AND I FOUND IT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Final SOE pass

I passed! I passed! I passed!

I turned around and saw Hobbo peering over at me. The moment I saw him, my face just crumpled up and I started sobbing and sobbing and sobbing. After trying to hold it together for the last few months, after all the fears and frustration, after all the sacrifices I have made, suddenly I have received relief. Hobbo hugged me. “Did you pass?” I nodded, and he held me even more tightly. With tears rolling down my cheeks, I looked up at him and asked “did you?” And YES HE DID!!! I was elated!! The Hobster and I have worked so so so so hard together. Right from the very start when we were building the structure of propofol from styrofoam balls and sticks, to our days revising for the primary viva exam at the women’s hospital, to the times spent working through final MCQ/SBA/SAQ questions with study gambling, through all the courses we attended together, failing the final viva exam last December, to the evening skype viva revision sessions we did together in the last few months… now we have both passed! Together! On the same day! Freedom is offered! I thanked the Hobbo for being my revision partner, and he said to me that “I couldn’t have done it without you either.” Such precious words.

We turned around to find Matt, and he had passed too! Group hug! We are now fellows of the Royal College of Anaesthetists. We are post FRCA. No more exams thank you very much. The thought of it, no more exams! This is all too good to be true. We are so elated. So joyous. So relieved. So thankful. Matt pulled me apart and said “let’s thank God together.” So there we stood, this time INSIDE the Royal College, as fellows, praising God and thanking Him for His goodness to us. Through the tough times when I was hospitalized with palpitations, and Matt needing a gastroscopy due to exam-anxiety related reflux, God has been faithful and led us through it all to this point. The point of relief. We are so thankful.

The people from the college then called out our names and candidate numbers so that we could form orderly rows. We listened to a retiring examiner give her speech to the newly appointed fellows (whoop! whoop!) and then proceeded to this strange college tradition whereby the successful candidates would go and shake the hands of all the examiners that day (they were all stood in a line). We were then offered the legendary glass of wine- the one that we’ve heard talked about so many times, the glass of wine of success. Not the finest of wines out there, but certainly the most expensive glass I have ever paid for– £2700 worth in exam fees alone (primary & final exams). That’s not even counting the money spent on books, courses, train tickets, hotel fees. Or my mental health and social life. That day, I had a change in mood… and it was only then that I realised how miserable I have been for the last 4 years. I had become so used to feeling so miserable that it seemed like the normal way to feel! Every single year had consisted of 3-4 months of exam prep, exam, rest for 2 months. Start revising for the next test again, exam, rest. And the cycle repeats. Now the cycle is broken. Thank God.

We were all so excited that evening. Matt was so excited that he even went on to (accidentally) smash his most expensive glass of wine onto the floor (silly thing)… but that did not put a damper on our spirits. We just could not help but address each other as Dr_____, FRCA. Whoop Whoop! It was a pleasure to sign in the register of the Royal College of Anaesthetists. Yes, my name is finally in the book. It is in the book! In the book! Whoop whoop! I was drunk on happiness and relief.

We took a tonne of photos that evening. Eventually, when we had savoured our time in the “pass room,” it was time to head back home. As we headed towards Euston station, we agreed that we will allow ourselves to relish in pride and maybe a little bit of arrogance that day and perhaps even the day after before getting back to reality (and humility of course). Because who are we? WE ARE CHAMPIONS!!!! There were so many smiles and laughter abounded that evening. Even our Burger King dinner at the train station tasted like it was manna from the heavens. This time, I wasn’t taking the train of shame back home- I was on the train for champions!

What a day to remember, and I probably will not forget this for a very long time to come.

Hallelujah, praise the Lord.