Breaking bad news…brought to you by the SPIKES protocol

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Let me just say that I am truly sorry, little comic me. There has been a lot happening, but that still isn’t an excuse for how you have been treated. I can only apologise and tell you that I am here now and hopefully we can sort everything out for you and your comic companions there. I’ve also made sure we shall not be disturbed, so that all my attention is on you.
Before we get started, do you want anything? Something to drink, like a cup of tea or coffee?

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To make sure that I haven’t missed anything, do you mind if I just ask you to tell me everything that has been going on right from the very beginning?

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So, I believe that there were also numerous family problems in the last year: 2 people admitted to hospital for life-threatening illness, an elderly family member being physically abused by other relatives, two people dying, one person having a full psychiatric event (mental breakdown), 3 people entering clinically severe depression…
And of course…our own deteriorating physical and mental health…

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That’s the dream. But getting back to the now, what would you like from this session?

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Before we go any further, let me just clarify something for you:
We made it into 4th year.

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Yes…we made it into 4th year without having to retake any exams. Somehow, despite everything we made it through and am now doing 4th year rotations…more specifically oncology, haematology and palliative care. How do you feel?

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It’s ok to feel confused. Normally, I think you’re right, I should be happy. But I spent the summer and the past 2 months of 4th year recovering…recovering from the apocalyptic fallout of everything else, which is still happening.

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…and let’s wrap this up before you completely lose yourself in this fantasy.
I should also point out that I no longer wear glasses, I don’t have much hair left on my head and I spend so much time in the library doing my research project, that I barely take out my stethoscope…

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The plan is that I shall keep blogging as much as I can…as long as you keep making it look interesting. And that’s the end of this blog post that HOPEFULLY mirrors the SPIKES protocol…

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…look it up (>.<).



It’s been a rough few months…
So rough that I would consider them as being some of the worst months I’ve ever had to endure…heh, which is impressive given my track record for ridiculously bad ‘amazing’ life experiences.

Jean-Martin Charcot.jpgRudolf Virchow NLM3.jpgRelated image
Free long island iced tea to anyone who gets this question right: who are these respectable looking gentlemen? …obviously, you’ll have to come and find me if you actually want the iced tea.

But I digress…Do I want to talk about how rough the past few months have been?
No…and in remembrance of Charcot and Virchow, I present to you my reasons in the form of a triad:
1) No energy.
2) No desire.
3) No time…as I am somehow dragging myself through that glorious wonderful time of the year that is known as ‘I hate life’ exams season…I should REALLY stop procrastinating and get back to doing some actual revision…maybe…in a minute…

You know things are rough when the only person who you feel like you can talk to is the comic version of yourself:


…I dare any of you to say that I am not crazy or clinically insane now.

“I want to help people…” (-.-)

…it’s become one of phrases that is beautiful and heartwarming to hear from people, yet will immediately cause a groan of hatred and anger from medical school interview panels.


It’s quite sad really that such a noble sentiment is viewed by medics in such a negative way. But if you had to read hundreds thousands just too many personal statements which all contain that phrase (many of which will be rejected), then I can understand how subconsciously you would link “I want to help people…” with the thought “that’s not good enough to get into med school“. Good old Pavlovian classical conditioning: you CAN teach old dogs interviewers new tricks…

(WARNING: Next part involves a great deal of philosophical and serious ethical questions…continue at your own peril.)

Today, as I was waiting for a bus, I saw a dalmatian (let’s call them Rolly…^o^) tethered up to a post nearby, whining and barking a lot towards a specific direction. On quick inspection of Rolly, I couldn’t see any wounds or any signs of a physical ailment…but the whining especially made me want to approach it and see what was going on to upset this dog so much. I can say with pride a LARGE AMOUNT of pride that I had already taken a few steps towards the dog before I stopped myself…


This dog is clearly distressed…what if it misinterprets attacks me? (I doubted the inter-species value of my super amazing med school communication skills training…)

Then my bus arrived and I decided that Rolly had attracted enough public attention that am sure someone would have gotten involved if their owner did not return. So I left for my communication venepuncture skills session.

The point is that young naive me would have approached that dalmatian WITHOUT HESITATION…which makes me ask “Was I right to hesitate and walk away?”

Am I a coward and a hypocrite? My hesitation arguably shows weakness and undermines the sentiment of wanting to help. I also should not have assumed that someone else would take care of the situation…and on hindsight, I should have stayed and made sure that the owner returned soon for Rolly…I felt so relieved to find that Rolly was not there on my way back home.

But then again, you could argue that if I stopped for every person who signalled that they needed help, then I’ll never finish med school…better off volunteering for multiple charities than finishing med school.
Someone once suggested the following thought to me:
“Everyone needs help and if you start making yourself responsible for ALL of them, then it’s a slippery slope. You can’t help everyone all the time…

Let’s have a look at the individual whose words I just paraphrased:


…getting back to the issue of Rolly:
There is no absolutely right or wrong answer here to my question of “Was I right to hesitate and walk away?”ignore those many ignorant close-minded people who insist that there is one.
All I know is that young naive me is definitely sad over my actions…and that makes me sad. I want to say that if it happened again, then I’ll definitely do things differently…

P.S: On my way home today, saw an elderly homeless gentleman (I call him Cain and he wanders around my neighbourhood a lot, not bothering or troubling anyone) sitting quietly staring out to sea, but obviously a little cold. Without hesitation, I walked to the McDonald’s 5 mins away and grabbed a burger and a coffee…won’t bother with the rest of the story because it is irrelevant…but young naive me smiled again…(^.^)

P.P.S: When I got home today and turned on the tv, the first thing I saw was an advert asking for donations to supply water to people in Africa…I changed the channel…(>.<).
This is going to be hard…

Freud’s answer to everything: “Your mum…”

Thanks to the legendary Robin Williams for that quote. You are sorely missed, good sir.

Today, I saw was a 16 year old male patient who was suffering with mild depression. He had the 3 major symptoms: low mood, felt no pleasure doing anything (anhedonia) and lack of energy
As the consultation continued, it was obvious that he’d been dragged to see us by his older brother and he was getting annoyed at being asked questions. Eventually, it got to a point where the two brothers just started arguing amongst themselves. I looked towards the Community Psychiatric Nurse who was supervising the session and he gestured to me to just stay where I was and keep quiet…apparently the brothers fight like this a lot and it’s their way of releasing stress and discussing problems.
At one point, the older brother asked “Why are you being such an a******?”
And the response was “YOUR MUM…”


Now…firstly, am pretty sure that he should have said “our mum…”
Secondly, it turns out that the actual biological mother of the 2 brothers had started a relationship with a new boyfriend and the younger brother really did not take well to this…hence the reason for his bad mood was indeed the actions of his mum.
Third and finally, it must have made Freud proud to hear someone say that his mother was the cause of his problems in a psychiatric consultation…

As you may have gathered, I am currently on my cardiology psychiatry placement…and it is weird to say the least.
Now…that’s not because I am surrounded by people who others may consider as ‘crazy’ or ‘mad’, but because I’ve had and still suffer from mental illness (namely depression)…and because I consider myself to be COMPLETELY and UTTERLY INSANE; so it is indescribably strange that those psychiatric patients that I have seen think that I am a sane and normally functional individual.


For the record, I am not psychotic:
1) I do not have auditory hallucinations (aka voices talking to me)…unless you count those voices inside my head…one of them is Old Omega (the sensible grown up)…oh and there’s little Alpha (the one who justs want to have fun) and Mu (the one who keeps the other two in line)…
2) I do not have thought broadcasting issues (my thoughts are not being inserted inside my head from elsewhere or being taken away and seen by others…shush little Alpha).
3) I do not believe that my body is being controlled by something other than me…Old Omega disagrees with me.
4) I do not have delusional perception…Mu tells me that that the pencil I dropped was a sign from the mighty Unicorn to go and insult the Flying Spaghetti monster with the following message: YOUR MUM!!!

Image result for flying spaghetti monster


The Beast evolves…


Can’t talk about ‘Beast’ without paying homage to one of the best cartoon shows I’ve watched as a child: X-Men: The Animated Series…second only to Batman: The Animated Series…so much nostalgia…(^.^)

So, as I was walking into the hospital for teaching today, I was suddenly stopped by someone I used to know from secondary school. This particular individual was out walking with his girlfriend. Now, I am quite blind, deaf, oblivious when I am walking…I will acknowledge obstacles and drop kick them into space move to avoid them. But beyond that, I can easily ignore people without realising and it’s an AMAZING annoying skill. Anyways, this guy stood right in my way and shouted loud enough for the entire road to hear:

Adrenaline flooded my system and my sympathetic nervous system went into overdrive. I could feel my pupils dilating, surveying the surroundings and analysing this couple. My heart thrashed about in my chest, making sure oxygenated blood was reaching every part of my being. My breaths became deeper, the alveoli grabbing every oxygen molecule they could reach. The muscles in my arms and legs subconsciously tensed, ready for some verbal and physical onslaught…it had been a long time since anyone had called me ‘Beast’.

But as social norms dictate, I smiled and acknowledged this individual. Ran through the pleasantries of asking how he was, what he was up to, paid some attention when he introduced his girlfriend standing beside him (what? I am a single guy. As cliched as it is, we do pay attention if a girl suddenly graces our vision), listened to what his future plans were…blah blah blah, etc.
NOTICE WELL that throughout all of this, he NEVER asked me how I was, what I was doing, etc (-.-).


Then, his girlfriend said the following, in a really chavvy accent:
“That’s a weird first name to have…Beast…your parents must not have liked you very much.”

Before I could even begin to register the insult in my head (I am quite slow, if you hadn’t already guessed by now), the guy immediately proceeded to correct her:
“No no no, that’s not his real name. That’s the nickname we had for him.”

At this point, he seemed to completely ignore the fact that I WAS STANDING RIGHT THERE next to them. He then explained the history behind the nickname of ‘Beast’:
He had these features that just reminded us of a beast, like being stupid, ugly, hairy, fat, naive, weak and really animalistic”. (In his defence, I did and still do yawn like a lion and tilt my head like a dog when I don’t understand something…should probably work on stopping that.)


As he said this, a revelation ran through my mind:
” I AM A BEAST!!!” I am loyal, protective, strong, intuitive…I had evolved beyond the characteristics that they had labelled me with. I had become something better, something that I could be proud of. And I couldn’t care less what these two ******* *******s thought.


I am Beast and don’t **** with me.

…what? Oh, you want to know what happened to the guy and his girlfriend? I tore them to shreds with my claws…or at least that’s how I am choosing to end this story (^.^).

…can’t get ‘Gladiator’ out of my head… (>.<)

are you not entertained

…is what I want to scream to the heavens and to hell and everything in between…

I have just found out that, by literally the thinnest margin, I have failed 3rd year and have to retake the year.
What makes it especially bitter is that I only failed 1 exam and failed it by technicality…
I achieved well above the pass mark, but one of the conditions of passing is to not fail more than 4 questions/stations. I failed 5…
However, a fail by technicality is irrelevant, because a “fail IS STILL A FAIL…and if you want to keep your place in this course, then you’re going to have to prove it to us” as one of the teaching staff, who has never met me, said.

So…after all the hard work, effort and stress of the past year, I once again have nothing to show for it.


I shall win this test

…ok, ok, am done with the gladiator memes…I promise…(>.>).

Anyways, there was a real serious point behind all that meme abuse…
I just can’t remember what it was….(>.<)
Oh, wait!! Yes I do…heh, and you thought you’d be getting away having read a short blog post…

Once again, I could have walked away and chosen another to do something else…but if I do, then it’ll only be after it has been proved that I just don’t have it in me to do medicine. I shall make it through this 3rd year of a medicine course…for the 3rd time (>.<)

I shall have my revenge

They tell me that it is not shameful to walk away and choose something else to do instead of medicine…but in a world where we are constantly told that WE CAN DO ANYTHING WE WANT TO DO, ESPECIALLY IF WE PUT OUR MINDS TO IT, to walk away would be to say that I did not give medicine everything I had, which would be a lie.

Furthermore, people tend to have a weird perception of failure. If X personally fails at something, then usually X attributes that to an external factor (I wasn’t able to perform at my best due to…whatever). If Y fails at something, then X will usually attributes that to an internal factor (Y just wasn’t good enough to do it…). I’d like to believe that people are more understanding and empathetic, but experience tells me otherwise.

In any case, whilst I could have worked harder over the past year, I still failed by the thinnest of margins. So I believe that I do have it in me to pass this year…I refuse to turn away and yield.

Resilience week 4 image

And if I fail…then I can continue to showcase my ability to spectacularly fail at everything (which is still an impressive skill to have) (^.^).

Cosplaying…well, roleplaying.

First of all, let’s get the my opinion over the EU referendum held here in the UK out of the way. I did vote. I voted to remain in the EU, and I don’t regret my decision at all. I am disappointed by the people result, but it’s a democracy. Like the lectures they give us on patient capacity: “If a patient shows that they can understand information regarding a decision, retain that information, analyse the pros and cons of that information and communicate that decision to others”, then even if you think they are acting irresponsibly, it is their RIGHT to do so. As for me, I shall do my best to make this decision to leave the EU work…by leaving the country.


Next on the agenda:
I have just come out of an exam and I can safely say that I have NO IDEA when it is, what is going on, where I am or how I got there…just to make it a full house of question words, may as well add that I don’t know how many times this has happened or who I am (^.^).
Maybe I am going crazy and developing psychotic symptoms…anyone want to do an MSE on me?

NOW FINALLY…the point of this post:
What did I get out of my third week of this resilience course? Well, we were given a Belbin questionnaire. It claims that there are 9 types of team working behaviour and based on your responses and is able to give you a score for each of the roles. In doing so, it provides you with a description of what kind of worker you are and what your strengths are if you are working in a team…
In our group, everyone had high scores around one or two behaviours that they were masters of. And because everyone had a different focus, it explained why our group worked well together…well, until you notice my results.
I found that I was literally: ‘a master of none, but a jack of all trades’. I had relatively low scores in all behaviours.

swiss army med

So…I am a master of NOTHING…well that sucks. After 14 27 years of being alive on this Earth, all my hardwork and effort and accummulation of ‘skills’ have made me the equivalent of a used stethoscope in a new set of operating theatre surgical tools. In a world where everything is becoming more and more specialised, my initial reaction to being a ‘jack of all trades’ was to scream “well that’s a bit s***” was not a favourable one.

But like most things in life, it’s all about money, fame, glory, perspective.
If I am honest, I have always loved the romantic Victorian/Edwardian era image of a doctor being a medic, a scientist, a philosopher, a poet, a raging alcoholic, etc. And it occurred to me that I could be seen as one version of a modern day equivalent. First and formost, I am a medic, then a scientist; I dabble in philosophy and psychiatry and even do a spot of poetry and spend far too much time doodling cartoon images (I even spent the last 5 mins of my exam doodling on a bit of scrap paper)…no comment about the raging alcoholism.

But coming back specifically to the Belbin questionnaire, what it pointed out was that I am adaptable. Yes, I am a master of none. BUT that doesn’t mean that I am worthless. It means that I can cosplay whilst other people can’t. I can dress up in a multitude of different costumes and roles depending on what is needed.

Resilience week 3 image

I can be a king and lead a group if required. I can be a knight and rush in to rescue people who need emotional support. I can be a dramaqueen and work alone. I can be a bishop and emit some degree of calm spiritualism in this mad chaotic world. I can be a rook and protect and guard those around me. I can be a pawn and work with other minions to achieve whatever goal our evil overlord desires.
(If you don’t understand the chess piece metaphor that is underpinning the above picture and my last paragraph…then…well, I don’t know. Go learn how to play chess? I apologise for being obscure…actually, no I don’t.)

Besides, there’s nothing wrong with being an old GP in a room of new young hospital consultants. We need more GP’s anyways…


Self-analysis…free from bias since NEVER.

So…week 2 of my course misadventures into resilience and mindfulness.

I say ‘misadventures’ because I really do just stumble around blindly and aimlessly most of the time, physically, mentally, spiritually, [insert more ‘-ally’ adverbs here]. The other day, I managed to walk into a lamp post…the worst thing being that the lamp post was completely in my line of vision as I walked towards it…

Resilience week 2-1

If you don’t understand the numbers in the picture, google the code “ICD-10 W22.02XA“…yes, it is a lame medicine joke/reference and no, I am NOT going to apologise for it.

Don’t ask what was going on in my mind…my brain was obviously registering the sensory input from my eyes, but I cannot remember, AT ALL, what I was thinking about…actually, I lie; I was daydreaming about what it would be like to be superhuman – have a photographic memory and enhanced senses, like amazing hearing and vision…kind of ironic really.

ANYWAYS, I digress.
Our tutor asked us to state some traits that we attribute to ourselves. This is essentially what was going on in my mind:

Resilience week 2 image

As you can see, my mind is clearly deranged…a set of scales with sides that are DEFINITELY UNBALANCED, adorned with my face, a bucket with a hole on one side and an extravagant aquarium on the other…complete with what I assume are fish…oh, and the fish seem to have no eyes or side fins. Evolution/my imagination has not been kind to these fish…

The point was that I focus heavily on my negatives and hang onto them. If there are positives to myself, I largely ignore them. If I am forced to acknowledge a positive, then I’ll do so for a brief second before I let that positive go free and far away.

I don’t think it’s wrong to focus on your negatives; it allows you to identify flaws or problems with yourself. Armed with that information, you can change yourself for the better…

BUT, my mistake is to ignore my positives…which don’t exist. If you only consider the negative aspects of yourself, then you will lose yourself in them and become depressed by them. It’s like walking around in the dark without a torch – you will get lost eventually.

…unless you have amazing super enhanced night vision…if so, then you’re fine (^.^).

1st of 8 weeks of Resilience.

So, as part of our course, we get a module where we spend 2-3 hours every week, for a period of 8 weeks studying/exploring an area of medicine that we find interesting.

Whilst other people assessed the interaction between genetics and the environment, took part in NHS audits, assisted independent research trials, I spent the 2 hours a week doing:
hard work mindfulness and resilience.

…yes, I was looking for an easy way out and I scored BIG TIME (^.^). NO ENERGY-DRAINING, TIME-DESTROYING, HAPPINESS-DRAINING WORK FOR ME!!!!!!
An opportunity to spend time doing absolutely nothing and making stuff up on the spot to address the ‘wishy-washy’ concepts that are associated with mindfulness.

The above paragraph did sum up part of my decision to choose to focus on mindfulness; BUT there is more to mindfulness than giving yourself a defensable excuse to procrastinate and use ‘fluffy, flowery, emotional’ language.

Part of the reason I chose it was because I knew that it is now time of year when deadlines, sign offs and exams are maliciously creeping nearer. And knowing how unlucky I tend to be, I knew that other things will crop up that shall add to that stress and potentially push me over the edge of my sanity. Choosing something that would help me to deal with all these stresses rather than adding to them was a key reason for doing this module.
As it happened, our first 2 hours of mindfulness was to focused on reminding ourselves of how to let go of all the problems that are plaguing us and to just give ourselves some time to be free from them.

Resilience week 1 image

YOU’RE AN IDIOT!!! You could have spent those 2 hours actually getting work and revision done instead of procrastinating and doing NOTHING!!!”

I can understand why you could view those 2 hours as a waste of time…because you’re right, I COULD have gotten some more work done, I COULD have done some more revision, I COULD have gone shopping…blahblahblah, etc.

But with all the stresses on me, if I didn’t take that time out, I would have BURNT OUT…and that’s a fact. If you can manage all the stresses that I had on me without spending those 2 hours on the beach, then infinite GOLD STARS to you. Let me know where you’d like me to post those gold stars…(-.-)

And yes, you could view it as me being lazy and procrastinating…and again I agree that I was procrastinating. But it was the lesser of two evils: procrastinate and lose a little revision time or over-extend myself and lose everything I have worked for this year.

For the record, we spent those 2 hours at the beach relaxing…‘FAB’ is the word I would use to describe the experience…and the name of the ice cream I had (^.^).


(I did also have a ‘BEAST’ice cream…you can look that up yourselves…recommended for chocoholics like yours truly.)

A part of me is disappointed that I couldn’t keep working and needed to waste those two hours…and I have to accept that. Another part of me is also disappointed that this is essentially an excuse for not working. If I were stronger, maybe I wouldn’t have needed those two hours and maybe I wouldn’t be ashamed of my wasted time…

Or maybe if I were stronger, I’d just beat the **** out of those parts of me for being close minded, for not looking at the bigger picture and for being ****s (>.>).


….if there is one phrase that accurately sums up the state of my life over the past 6 months, it would be: “the best-laid plans o’ mice an’ men gang aft agley…”
Or for those who are not familiar with the language of that Scottish poet Robert Burns: ‘no matter how much you prepare or plan for something, there will ALWAYS be something that can completely and utterly ruin it.’

For example, let’s take a look at the very thing that you are currently reading:
The aim of this blog was to detail all the experiences and thoughts that I would have whilst going through my third year of a medicine university course…KABOOM!!! BANG!!! CRASH!!! SMASH!!! BLAST!!!


Those are the sounds of epic explosions of failure, heh. And rightly so…after all, I haven’t typed anything for 6 months on here.

Things generally haven’t worked out well…but when you wake up somewhere with no idea where, when, how and why you got there, then is only one thing you can do:
Well…that’s one option, but it’s probably wiser to figure out what happened the night before that led you to your current predicament (you can tell that this happens to me a lot…*cough*).

To be honest, like the poor mouse of Burn’s poem, I didn’t foresee serious problems at home that would distract me from one of the most important years in my medical career, as well as other commitments, like keeping this blog up to date.

BUT…those are just excuses, regardless of how relevant they are. And it’s not as if I have been idle. I have been drawing cartoons over the past 8 weeks, so I’ll post those up in the next couple of days as there are stories behind them.

…I love how committed I am to making this blog less empty when the follower list for it is even worse (^.^). But it’s the principle that matters…and the fact that if I don’t, I might have nightmares about an angry Scottish poet for not doing so…(>.<)
(FYI I do not mean to offend anyone with the dialect in the drawing…I evidently need to spend more time with Scottish people…).