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Angelique Flowers was dying of cancer just before her 31st birthday. She recorded this message for the Australian Prime Minister and asked Exit International to publicise it after her death. She died on Aug 19 2008.

I’m reviewing laws around end of life care, and was reminded of this case from a few months ago. I had a heated argument with a friend of mine over the matter.
It is a topic I am very interested in, and will continue to mull over.
In med school, you can see in people the optimism of science, the primacy of survival. Death is losing, and losing is anathema to these people.
But my thought was that, death is not always bad, there is a dignity in knowing when it is time to move on.

from Angelique’s video:
“I don’t believe in stoicism. I freely admit to not being a brave soul who grins and bears the pain and soldiers on

I deeply admire people who rise above the adversity and their suffering. But I haven’t grown from my illness or become a better person from its torments. All I want after 16 years of painful Crohn’s disease and now cancer is to die a pain-free peaceful death.

“Because euthanasia was banned in Australia I am denied this right …

“We finally have in Kevin Rudd a prime minister who is a person as well as a politician. A man who had the conscience to say sorry to our indigenous people, the integrity to ratify the Kyoto Protocol.

“I beg the Labor Government to continue beating with the heart it has shown and to ensure euthanasia is made legal once again.

“The law wouldn’t let a dog suffer the agony I’m going through before an inevitable death. It would be put down. Yet under the law, my life is worth less than a dog’s.”

Blood Pressure Control in the Kidney
Pressure Control in Kidney

Calcium and PTH
Calciuim & PTH

Pathophysiology of Chronic Kidney Disease
Pathophysiology of Chronic Kidney Disease

tachy

Haven’t had one of these for a while, but today it came back. not fun. 2hrs of 120bpm, clammy, nausea,
bah
feel better now, but drained as these things used to do.

On another note, I won the blood donation race today, 5min 53 sec for 470ml
we’re having a rematch in 3months, see if we can break 5min

Hey, a bit of good news
I managed to score in the top 3 of my class for cardio (132ppl), which, if I may indulge, pretty good for an ex-dancer/visual artist who has done no science since high school biology. And this is against phd’s, physio’s, medical scientists etc. Like smart people. And I had lost a good deal of the semester directing the Med Revue and pitching for a large commission with the Museum.

So yeah, maybe I can do this.
I feel pretty good about it, makes me feel a bit more confident and capable in myself.
yay!!!

Very related to the previous post
an article in the NY times about burnout in medical schools

read it

So when do you know?

In dance, there are benchmarks, you can see your self in the mirror, on video, you can tell. Or at least, other people can certainly tell. I know when I teach or audition people, I have a pretty good idea of their chances of being a dancer. I have friends who play a game when they examine (they are RAD examiners) on entry, and after the first exercise, they write down your score, put it away and see how close they were at the end of the exam.
You just Know.

But in this medicine thing, you just don’t know. Even if you consider medicine largely one of being a ‘health mechanic’, there are those mechanics who are Talented (to nick Isabelle Carmody’s habit of capitalising the word in the Obernewtyn chronicles. If you dont know what I mean, you should check it out). Who seem to be born to it, the same as a dancer is born to dance, or how any vocation seems to choose its members.
I mean you have exams which are non graded passes, and which don’t really seem to reflect the sort of doctor you may be, or if you are indeed, Talented.
We have had precious little clinical experience, no hands on sort of thing – so we have no idea on our aptitude there either.
(Though amusingly, we had a PBL tutor who told 3 of my friends that they were unsuited to medicine for entirely stupid reasons. eg, one of them, a nurse, said that she found the science difficult, to which he answered that perhaps she could consider ditching medicine and going back to nursing and getting a phd in nursing. Prick.)
Anyways, back to my ramble, how do we know that we are on the right path?
I envy those who have an unshakeable belief in medicine, it would make things simple. focussed.
I can’t help but have doubts.

I had a talk the other day to a proper graduated Dr, who is aiming for otho surgery. I mentioned that I was eyeing of plastics and reconstruction, or some other surgery. He suggested that I needed 4 or 5 good papers published, international conferences, volunteer work, preferably a Masters of Clinical Education, and 10 references to even get an interview.
However, I have no idea if plastics/reconstruction is really for me, its just a rough hunch and something this thing told me, but I have to pretty much gun for it now.
I suppose I can always gun for it, it won’t hurt to have all that for whatever specialty, but dammit its going to make the next few years hurt.

I may have overcomitted 2009 already – currently I’m going to be doing some research in microcirculation, research/development of anatomy teaching using interactive 3d, a commission with the South Australia Museum, a dance performance with the Adelaide Symphony Orchestra. Oh and that medschool thing. I’m also on 2 committees, and probably need to rack up some more volunteer work.
it should make it an interesting year though.

Oh and this being the end of the year, i revisited that medical specialty thing as mentioned and, with my own thoughts, i thought i’d update my list. refer here for the beginning of year thoughts.

So my main ones are still
*surgery – plastics/reconstruction
interesting work, varied cases, suits my attention to detail, dexterity and aesthetics. can also work with kids.
stupendous amount of work… no life

*paediatrics
like working with kids
fairly studendous amount of work

*GP – nice lifestyle. time to have family, make art.

which is fairly consistent. a surprise. I do quite like cardio, it is an interesting field…

anyways, i hope that soon i’ll know. Or maybe I won’t, but hopefully I can feel better about not knowing.

photo of the day:

Dad


So i managed to pass the last mega block of exams, cardio, resp and renal! huzzah. It was tough cause i directed Med Revue throughout that and was also involved in various other committees and stuff
Now the end is in sight, one more lot of exams and then glorious holidays
However these holidays are probably going to turn out not so holiday-ish due to an astonishing number of things I plan to do – John Flynn placement, short animated film with a string quartet, some design work, research.
Now if only I could work out how to say no. But these are great opportunities and I think i ought to take them while they present themselves.
I’m supposed to get into some sort of shape so I can perform next year as well which should be interesting seeing I haven’t performed for neigh on 2 years by then

Nothing else that interesting seems to happen, it’s all just uni things.
I’m still humbled by the incredible grace of some patients to allow a bumblie like me to fumble around them for an hour. I had one lovely gentleman who raised his blood pressure to unhealthy levels due to his eagerness to ‘help’ me. I couldn’t keep him down, he kept popping up and down and twisting and turning in his enthusiasm.

anyway, pic of the day :

baby

canon 40d with canon 70-200mm 2.8 IS lens at ISO 3200
1/40 f2.8 175mm

our med school soccer game, with our Brazilian import showing how it’s done
soccer
canon 40d with canon 70-200mm 2.8 IS lens at ISO 400
1250 f5 200mm

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