The papers were fair, I suppose, even if not quite what I expected. A larger number of questions that were new to the question bank and not repeated from previous years. A much smaller number of questions that were directly related to immediate management – I was prepared, based on the pattern of questions that have been asked in the past, to spend half of my exam time talking about ABCs, and I don’t think I mentioned them once. A wildly disproportionate amount of neurology, I thought. A few bits and pieces that seemed to have come from the second year curriculum. There was one question about stroke that I had to work out backwards from first principles, and that part was reasonably manageable except that it went on to ask about which articles of the Human Rights Act applied to this patient’s case. I’ve learned a lot of medicine in five years, and I learned on Wednesday and Thursday that when I don’t know a particular bit of medicine then I can usually make a vaguely sensible guess based on the things that I do know and the things that are half-remembered from three years ago. I also learned that the thing that I cannot make up is articles of the Human Rights Act.

I got so little work done between papers that I may as well have not bothered. I sat with my notes for a few hours – literally, ‘sat with’, apparently hoping that something might go in by osmosis. The format of the written papers is such that anything that could have been in the second paper could also have been in the first paper, and so, technically, I was already as prepared as I was ever going to be. And in the end, the things that I wasn’t sure about on the second paper weren’t things that I would have ever thought to look at on Wednesday night, no matter how much work I’d done.

Overall, it could have been better but it could also have been a lot worse. I’m not prepared at the present time to say which way I think it’s gone for me, and I can’t do anything now but wait for the results in a few weeks. I got home from the second paper on Thursday and collapsed into bed for several hours, and then took yesterday to sort out a few of the real life things that have been sadly neglected over the last few weeks – grocery shopping, house cleaning, and putting an end to my rapidly accumulating fines at both the hospital and university libraries.

Today, OSCE revision has begun in earnest. In many ways, this is the harder part and, in my opinion, certainly the scarier part.

It doesn’t seem to have properly sunk in yet, even after having done those first exams, that this, this thing that I’m doing right now, really is it.

Providing that I survive the next three weeks, of course.

I’ll write about the written papers after tomorrow’s, but one down and for now suffice it to say that I’m just about still standing.

I have done, probably, everything that I can do, by now.

Five years.

And it all comes down to this.

For the last few days, I’ve had a verse from Hebrews rattling around in my mind: “Therefore, since we are surrounded by so great a cloud of witnesses, let us throw off every weight and the sin that clings so closely, and let us run with perseverance the race that is set before us.”

In other words, let’s go and kick some ass.

I am also, finally, a registered student. The fact that that has taken until this point in the academic year is a long and complicated story that involves a computer error with my funding body in England (which took my address in Glasgow and my parents’ address in Newcastle and merged them to create a mailing address for me that may exist on some other planet but certainly not on this planet), an ongoing piece of computer-related stupidity with my university in Scotland (which does not recognise some of the more obscure funding bodies as valid ones; these obscure funding bodies include, for example, NHS England and Her Majesty’s Armed Forces and all of the Northern Irish education board), and their inability to commmunicate with each other. It has taken a great deal of standing in long queues and shouting at various people and, at one point earlier in the year, being threatened with not being allowed to complete my degree, but it is finally sorted and not a moment too soon.

And with that, the only thing standing in my way is the really scary part.

The written papers are on Wednesday and Thursday. My plan is to come home from the second paper and topple into bed, and to have the rest of Thursday off before diving into work for the clinical exams that come next. We are known at Glasgow for having the biggest and longest-lasting OSCE of any medical school in the country, with fifty stations spread over four days. This is a source of unbridled terror for those of us who have to sit it and horrified fascination for our colleagues at other medical schools and, for some reason, a source of demented pride for the faculty. The first OSCE is in psychiatry and obs/gyn on Monday 27th, which seems like a terribly random combination of specialties to throw together but, as a person who gets awful stage fright before OSCEs, it is a little bit of a comfort to be starting with one that is solely based on my most recent rotations.  It is followed on the Wednesday with the bulk of the medicine and surgery stations, which  I’ll be taking in the same ward that I dinged bells on for PACES last year. It is worth noting at this point that, due to my medical education having ended with the rotations that it has done, I haven’t used my stethoscope for three months and so much of next weekend will be taken up with remembering which end goes in my ears. I get a break after that until the following Tuesday, which is a short and stressful paediatrics exam. That will be quickly followed on the Wednesday by a random hodgepodge of things that either didn’t quite fit into the other exams or require equipment that is only available in the medical school building. By lunchtime on Wednesday March 7th, I shall be a free woman.

The other thing that happens on Wednesday, on the day of the first written paper, is that the UKFPO will at last tell me where I’m actually working next year — conditional, of course, on my getting through the next few weeks in one piece. So, there’s that too.

In the meantime, I can be found on the top floor of the medical school library, buried underneath a folder of past papers, dressed in reindeer socks and a series of fetching hoodies, and holding on to my coffee as though it holds the answers to life, the universe, the exam questions, and everything.

O&G has a lot less to do with babies than everyone thinks it does.

I grant that this is partly because obstetrics only accounts for half of the specialty, while the rest of it concerns  itself with prolapse and smears and weird bleeding and, I suppose, the prevention of babies. It is, however, also partly because although obstetricians are terribly interested in potential babies and in safely getting those potential babies to the outside world, that’s pretty much where that interest ends. Children? Well, those are someone else’s department.

But this is a five week rotation and I felt I ought at some point during that time to see a ‘normal’ delivery. Not only because I’m supposed to. Not only because I think it would be fairly appalling to graduate from medical school without having a least made an attempt. Rather, because when the inevitable day comes that I’m flying home from somewhere warm and beach-esque and they ask if there’s a doctor on board, nobody will be too appalled when I admit that I cannot perform a coronary bypass at three thousand feet (or at all), but they will be if I’m forced to confess that I have never seen a baby delivered before and have no idea where to begin.

It was with that thought that I went off to labour ward and found myself a friendly midwife and an understanding set of parents-to-be who weren’t remotely fazed by the prospect of having a medical student sit in the corner for the next several hours. The mum had already been in labour for the better part of a day when I got there, hadn’t slept or eaten in more hours than I care to imagine, wasn’t using pain relief, and announced cheerfully between mouthfuls of Entonox that she had long since given up on the idea of being embarrassed about anything pregnancy related. For the next six hours, she chatted to me about all manner of things and occasionally paused to have a contraction before picking up the conversation right where she had left it. And once she reached the stage of what they call active labour, she gritted her teeth and got right down to it and pushed that baby on out with barely a whimper.

It’s not to say that it didn’t look like hard work. I was vaguely horrified by the whole thing, especially when the doctor brought out the episiotomy scissors, and I’m beginning to feel that evolution should surely by now have reached a point where storks really do bring them. I have never been through the childbirthing process myself and have no particular wish to do so, but I suspect that I wouldn’t handle it with an ounce of the grace and stoicism that this woman did.

And suddenly there was a baby and a new mum and dad and even I got a bit teary.

Incidentally, I learned at this point that if the inevitable day does come when I’m on the plane, the only thing I’ll really have to do is catch.

O&G isn’t as much about babies as everyone thinks it is, but it is a little bit about babies and the part that is is a wonderfully happy thing in a way that so much of medicine tends to not be. And although I think that most of the things that I do and see as a medical student are a privilege, there is something of an extra special privilege in being there at the very start of a new life and I was very proud to have been there for this one.

Welcome to Planet Earth, little one.

If you want to join in, you will need a webcam and a free Google+ account with the St Mary’s Cathedral daily prayer page added to your circles. The liturgy and instructions are available here: Online Evening Prayer – Week C.

So, you can imagine the reaction when I announced last week that I was spending my day with plastic vaginas.

I suppose there are a limited number of fields in which the training involves probing fake disembodied body parts.

In the midst of all this business of trying to cram five years worth of medical knowledge into my head, I am also doing an obs and gyn rotation. I haven’t had obs and gyn before, unless you count the five weeks I once spent learning exclusively about vulval carcinoma. So, part of my first week was taken up with being taught how to do the relevant examinations — on plastic vaginas.

There are all sorts of plastic models available. There are pregnant abdomens with foetuses that can change position. There are heads that can have a whole variety of pathology slides hidden inside their eyes. There is a plastic arm from which blood can be taken and into which cannulas inserted. In one of my local hospitals, there is an acute care training facility with an entire plastic person who actually talks.

Of course, it’s extraordinarily difficult to do a proper fundoscopy on eyes that don’t move even when you ask politely and extraordinarily difficult to miss a vein when the plastic arm is dotted with literally hundreds of trackmarks, the pregnant abdomen doesn’t feel much like a real pregnant abdomen at all, and I nearly jumped out of my skin the first time SimMan talked to me. Still, there is a point to it all, which is that although hospital patients are extraordinarily kind and usually quite happy for legions of medical students to listen to their heart murmur and feel for their spleen and have a go with the tendon hammer, even the kindest and most understanding patient would rather not have a PR done for anything other than the very best of clinical reasons and neither would you. This is where the simulated stuff comes in.

Well, I say that. I had a patient last year who won the award for Most Understanding Patient In The Universe, who was getting a routine cervical smear and immediately agreed, at the request of the nurse, to let the medical student repeat the speculum examination ‘for practice’. It was all I could do to stop myself from saying, “Seriously?!”

The patients who will agree to that kind of thing are rare (and with good reason, too) and I wouldn’t normally even ask. And yet we do need to learn how to do these things, just as we needed to learn how to listen for heart murmurs.

It goes a bit like this.

In the clinical skills department, a plastic groin which has tragically lost its torso and legs lies on a table. In an exam situation, we are told by the instruction card to treat it as though it is a real person. This can get a little farcical. “Hello,” I say to it. “I’m Beth. I’m a final year medical student. You are Plastic Groin #2, correct? I understand that you’re here for your smear. Have you had one done before?” At this point, I hope that one of the eight people watching me will take pity and start acting. I explain the procedure. I get consent. I give it some privacy to get undressed while I go to wash my hands and get a chaperone. I come back and ask it to pull its legs up to its bum and let its knees fall apart, and, perhaps unsurprisingly given that seems to have lost its motor cortex along with the torso and the legs, it never ever does. I ask it to cough, and it doesn’t do that either. I explain that I am going to insert the speculum, and I do so. I tell the spectators that the appearance is normal, which is a lie – even the very best plastic doesn’t look like a human mucous membrane of any sort. I take the smear. I pretend to put it into a histology pot. I explain that I am going to remove the speculum, and I do so. I say, “Thank you, Plastic Groin #2.” It never thanks me.

When I said that this was what I had spent my day doing, I was asked, slightly incredulously, if this is how the whole thing works – plastic one day, real life the next.

It is a bit weird, I suppose, when you consider it from the point of view of normal people, people who haven’t spent a few years becoming accustomed and slightly immune to the medical student brand of weird.

Nevertheless, I’m appreciative of the fact that I get to make mistakes in an environment when it doesn’t matter, because when it’s the first time, there’ll always be someone who’ll try to do a PR with two fingers (or without lubrication) or a testicle examination without gloves or pull a speculum out when it’s still open or use an otoscope in such a way that it would probably go straight through a real eardrum. I leave it to you to decide which of the above mistakes you think was the one that I made.

After I learned last month that I had been given some sort of job somewhere in Scotland, I was asked to choose ten of the fifty-three different programmes that are available for F1/F2 in Scotland and list them in order of preference. I was told that if I failed to be allocated a job amongst those ten, I would be contacted and asked to rank all the programmes in Scotland that still had places available. Today, I got an email from the Scottish foundation school  informing me that I had been allocated to one of my top ten programmes and that I needn’t worry about the second part.

I’ve not yet been told where I’ll be working. I won’t be told that until February. I’d like one of my top two – there is very little difference between them; both are in a DGH that I know and love, and both of them come with the possibility of rotating in my specialty of interest during F2. In the end, though, I applied to ten jobs, none of them on an island and all of them in hospitals that I like and all of them within commuting distance of Glasgow, and knowing which of those jobs I’ve been given is a great deal less important than knowing what I’ve learned today.

I get to keep my city.

I’m happy enough with just that.

I returned today — and when I say returned, I mean that I battled my way through the tornado. I ought to have arrived yesterday, but, as you may gather from the selection of storm photos on the BBC, my attempts were foiled by the Scottish weather. “Scotland is apparently closed for business,” I announced to my family when my suitcase and I unexpectedly reappeared at the front door. The friends who are familiar with me and my long history of transport-related disasters are suspicious that it was my attempt to get on a train that caused the weather, while others have suggested that I simply brought it with me. I am mostly grateful that the worst of the weather happened before I got on a train, rather than when I was stuck on the tracks in the Borders. In any case, I trundled into Glasgow early this afternoon to the blessedly familiar sight of a choppy river and a leaden sky. It’s good to be home.

Inevitably, coming home has kickstarted the exam fear and work recommences tomorrow.

For those of you who are keeping track, written exams start on February 15th and clinical finals finish on March 9th. A thousand more apologies for what will doubtless be my extreme absence, both from the blog and from much of my normal life, between now and then. I will start being a sane person again after that. Well, as sane as I ever get.

If you should happen to be looking for something to read in the meantime, I recommend Internal Optimist‘s blog. Internal Optimist is a fourth year medical student who has recently returned from his elective in Tanzania, and what he has written about his time there is very well worth a read.

I don’t often make New Year’s resolutions, but I have just the one this year. To graduate from medical school. The end is in sight, and, after nine long and mostly happy years, with one last hurdle and God willing, I will be a doctor in 2012.

I hope that in the year to come, some of your hopes and dreams may also be realised.

And there’s a hand, my trusty fiere,
And gie’s a hand o’ thine,
And we’ll tak a right gude-willy waught,
For auld lang syne.