It is often said that life is full of guilty pleasures. I’m sure you can think of some classic ones: the tub of Ben & Jerry’s ice cream, that collection of 90s pop music or some ridiculously long Starbucks order you can get (uncyclopedia reliably informs me that it’s a Double Ristretto Venti Half-Soy Nonfat Decaf Organic Chocolate Brownie Iced Vanilla Double-Shot Gingerbread Frappuccino Extra Hot With Foam Whipped Cream Upside Down Double Blended, One Sweet’N Low and One Nutrasweet, and Ice). However for me, the guiltiest of all pleasures, especially for a university student, is the simple act of doing absolutely nothing of any value whatsoever and ashamedly it’s something I have recently experienced, and one I’m sure most of you will have experienced especially in the long summer holidays.

Taking a break and having ‘chillax’ time is good, and in fact very necessary especially after a long 10 weeks at a hospital that I have to commute a total of 50 miles every day for. Added to that the additional pressures of performing in 2 concerts, editing 3 issues of a newspaper, giving a tutorial to second year medics, marking keen A-level students’ BMAT essays and the numerous 21st birthday parties that comes with the 3rd year of university it is no surprise that you can feel a bit burnt out. A huge sense of relief comes after getting ‘signed off’ by your consultant for your first hospital attachment and mentally and physically, you are ready for holidays. Then you find out that you have 3 more weeks of lectures left…oh dear. The good news is that there is a weekend between the end of firms and the start of lectures: perfect time just to ‘take a chill-pill’ and have some good old relaxing time.

Now, having been on the insane warp-speed driven conveyor belt that is a medical student’s life, it is quite a surreal feeling to step off the belt and walk at normal speed for once. You are so used to everything going at such as fast and furious pace that the sudden slowness of a day off literally hits you like a door that you’ve just ran into, expecting it to open but only to find that it opens the other way (something I definitely…err…haven’t done before). Once you’ve recovered, you become an stationary observer, witnessing all the other people rushing about and trying to stay on the conveyor belt. To start with, you stand there and look back at the conveyor belt with some satisfaction. The satisfaction that comes with being on, surviving and being able to jump off the belt all in one piece. The satisfactory feeling gradually subsides, only to be replaced by a sense of envy. You start to miss the rush, the pace and the frenzy of life on the belt. You secretly wished you were back on the belt, although you are grateful that you’ve managed to escape it. Suddenly, an internal battle starts within your mind of whether or not to rejoin the belt: you really do NEED the rest but it looks like so much fun there! Finally, a massive wave of regret hits you. You DO really want to throw yourself back into the life that you’ve escaped from. In fact you actually feel guilty at having left it in the first place and what’s even worse is that the people who’ve stayed on the belt have move that little bit ahead of you, and you have to work even harder to catch them up. You feel even more regret at taking the time off especially since university students are at the very peak of their human condition, both mentally and physically. It is such a shame to see this time wasted on a day of doing absolutely nothing at all.

Everyone gets those days where you literally answer everything, both mentally and verbally with ‘cba’. It is a standard part of the classic ‘allow/CBA’ culture that is a student’s life (see blog post ‘Allowing it’ http://www2.imperial.ac.uk/blog/studentblogs/ken/2011/07/12/allowing-it/).The regret of having been so unproductive is clearly evident the day after, where an additional layer of madness is added to an already manic day through you trying to make up for the day before. The regret is even worse when your day was intended to be productive but in fact ends up with an Youtubing binge. However, the guilt is dampened when it comes with a day of intentional rest. Breaks are good and it is a pleasure to be enjoyed, albeit guiltily. Just remember that after the rest, the relaxation and the recuperation, in the words of President Bartlet on the ‘West Wing’: “Breaks over” (http://www.youtube.com/watch?v=KZvgSgpjkWU).

In the run up to Christmas, my housemates and I are attempting to cook a full Christmas dinner. Even though the four of us are…satisfactory cooks, we’ve never actually done a full roast dinner before. Making the old student favourite of spag-bol, maybe a bit of stir-fry and the occasional shepherd’s pie seems pretty simple now, and I don’t even need to look at a recipe for them. However, the full roast, and not any old roast but a full-on Christmas roast, is literally (as my friend Rahul likes to say), the ‘next level’.

Having taken some time to mull about this immense challenge, it is actually a lot less daunting than it sounds. Taking it to the next level is in fact a natural process of learning and a by-product of ‘growing up’. I came to university having cooked nothing more than a fry-up and boiled some rice (yes I’m THAT Asian!). When faced with making my first proper meal in halls, I was a bit scared, to say the least. Of course I took the standard necessary safety precautions before cooking my first meal, namely: making sure no-one was in the kitchen, making sure I was only cooking for myself and making sure that I had a pizza ready to shove in the oven in case anything goes wrong. Cooking for yourself is a lot less pressurised, not least because it relieves you of a responsibility that you are in charge of someone else’s meal but it also means you are saved from further embarrassment in that if you do inevitably mess it up, no-one else needs to know! 2 and a half years later, I can’t believe why I was so scared of making such a simple meal such as spag-bol. In those years of trying and failing, my cooking skills have slowly developed and now, I’m even confident enough (just about!) to actually not be afraid of the responsibility of cooking for other people. Therefore in 2 weeks time, it’s comforting to know that at least this attempt at a Christmas dinner won’t be as bad as if I made it 2 years ago (although this time, the 4 of us are cooking for other people as well…so no pressure then!).

Reaching for the next level not only applies to cooking, but to almost everything else. It is only by trying for, failing, then repeating until you eventually succeed that you can actually achieve the next level. In other words, this whole process can be aptly described by the phrase ‘man up!’. Now manning up usually applies to ‘downing’ some form of alcoholic concoction but it is also a great mantra for approaching medicine. If someone asks you to take blood, or put in a cannula, or to hold a clamp in surgery, there are several processes that occur in your mind. ‘Wow I’m being asked to do something!’, ‘I have stuff to do!’, ‘I feel useful!’, ‘I’m being recognised as a person rather than a spare part’, ‘Oh crap! I have never done one before’. These thoughts come in quick succession, and it’s product is the classic ‘eerrrrr’ noise that medical students tend to make. The turning point of the process come immediately after the noise: you either man up, do the cannula, fail, then learn how to do it correctly so at least your next response won’t be ‘I’ve never done one before’ but it will be ‘I’ve TRIED to do one’, or you don’t man up, in which case you will always be the one who has ‘never done that before’.

Building on knowledge is an extremely important part of learning, and that comes with the strength to step into the unknown. I’ve already written about stepping literally into the unknown in the ‘Inferior’ blog post (http://www2.imperial.ac.uk/blog/studentblogs/ken/2011/01/16/inferior/) However, you can also step into the unknown in familiar territory, and that can seem even more daunting at times because you can no longer fall back on the ‘I have never’ cushion. My friend Geraint is taking a giant leap into the foray of conducting, the ‘next level’ of musicianship. An absolute brilliant pianist and singer, he has decided to take up the baton of ICSM orchestra. Conducting may seem a lot easier than learning and playing an instrument but believe me it is a lot more difficult (I have never seen someone with so much visible stress as Geraint has shown in one particular rehearsal, admittedly it didn’t help that most of the orchestra were hungover!). It is even more difficult when you are both an accomplished musician yourself and are conducting fellow accomplished musicians because you AND they KNOW if it isn’t going well. If it hopefully all goes well on Thursday in the ICSM autumn orchestra concert, then it is another success at climbing to the upper echelons and I recommend you all come to watch the concert. It might inspire you to try and climb to the next level. Once you reach the next level, it is again another immense high (http://www2.imperial.ac.uk/blog/studentblogs/ken/2011/03/04/searching-for-a-high/) and you can look below and be proud of your achievements and look up and aspire to be even better.

You learn through your mistakes. This is the motto that carries people, especially children, through their lives. It is often said with the intention of comfort, in a situation that is anything but comfortable.

Some mistakes are easy to cover up and music and acting are two classic examples. Being ‘behind the scenes’ and being in the audience can alter you perceptions massively. I recently saw ‘Hamlet’ being performed by Michael Sheen, which was absolutely amazing. However, Michael and the rest of the cast could have thought it was a dreadful performance, but since the audience don’t actually know what is ‘good’ for this particular performance, they can hide it pretty well. Additionally, anyone who is unlucky enough to sit next to me at orchestra/choir will know that I frequently miss entries, play out of tune and time. However, with 10 other people around you playing roughly the same tune, it’s easy to hide it from the rest of the orchestra, and even easier to hide it from the audience.

Now mistakes in music and acting, as my violin teacher pointed out to me, are relatively minor. All that will happen is you will be immensely embarrassed, your self-confidence will drop, the audience will feel awkward and you will probably want to curl up into a ball and wish it all went away. A maximum of one day later, people will forget about it, you’ll have moved on to learning the next piece and everything will be fine. If you make a mistake in medicine, especially surgery, then the consequences are disastrous (not to put off/add pressure to any prospective medics/surgeons/patients!) I was watching a pretty cool neck surgery where the surgeon was dissecting out a tumour which had grown around the carotid artery. Now if you don’t know that much anatomy, then the carotid artery is the big artery with a massive pulse in your neck that supplies blood to your brain. The surgeon was dissecting perilously close to that artery in the calmest way possible. Meanwhile I was absolutely ‘bricking it’ thinking: ‘if his hand slips/tremors just once, the carotid is gone and this guy is probably dead’. Thankfully that didn’t happen and the surgeon left a anatomy-textbook-diagram-worthy dissection of the tumour around the artery and perfectly exposed the carotid, which was a brilliant sight to see, especially for anatomy teaching.

That was a literally millimetres margin of error. Even tiny mistakes can make a huge difference not only in surgery, but in music as well when even one note played wrong is noticed. I remember a particularly funny advert where a mathematician had gone to the toilet and his mate decided it would be funny to change a ‘-’ into a ‘+’ sign in a ridiculously long equation the poor guy had written. Imagine if the guy had come back and not realised the change and carried on with a solution. In fact continuing on with a mistake is one of the most dangerous and embarrassing things you could do. At a recent tutorial I gave, there was a typo in one of my lecture slides. Someone in the audience pointed out that the information was wrong. I, nor the rest of the audience, recognised that this was a simple typo so I proceeded to try and explain why the wrong answer was correct, in a typical I’m-the-teacher-hence-anything-contradicting-my-slides-is-wrong fashion. All I succeeded in doing was to confuse everyone, including myself, even more and thus it became counterproductive as student-led tutorials are meant to SIMPLIFY things! All because of a simple typo that I later found when I went home.

In a world where mistakes are common, it’s easy to avoid the big mistakes. It is just as important, maybe more so to look out for the little mistakes that can lead to massive consequences.

It’s not uncommon to see students stay awake for insanely long periods of time, especially when out partying and enjoying themselves. Especially for medical students, this ability is essential, and I often like to think of my ridiculously late bed-times (normal people would regard the hour as waking up time) as good practice for the inevitable sleep-deprived nature of being a doctor. I would have liked to think that my surprising alertness when doing an on-call this week (yes I am being keen!) had something to do with my early university lifestyles. It is most likely to do with the fact that humans actually have a phenomenal capacity to achieve great things, especially with the correct motivation.

Marathon runners often complain about hitting ‘the wall’, authors often complain about ‘writer’s block’, and students just generally complain, although mainly about revision and exams. I remember that when cramming for exams, I thought my brain had reached a saturation point whereby literally no more information be squeezed in and at any moment, other bits of information would precipitate out. However, the wall would be broken, the mind unblocked and somehow, the information would continue to dissolve into the brain. This realisation often comes at the end of what you are trying to do and on reflection you can’t really believe, or remember how you had managed to achieve that. My particular wonder, which will make me sound extremely keen, is that at the start of my first year, I do what every medical student does and I buy a massive door-stopper of a text book called Gray’s Anatomy. Interestingly, one of my friends thought that the anatomy book was named AFTER the TV show Grey’s Anatomy and not the other way around! Anyway come to the end of second year and I have realised that I have read every page of the door-stopper and managed to retain most of that information as well. If you had told me that was going to happen when I first buy the book then I would have literally LOL’d! It’s amazing how long-term accumulation of knowledge does wonders for your study.

Surely all of that knowledge would disappear after a few years? Well it may do, but again to my surprise, I have managed to hold on to most of that knowledge, for now (yes some of the finer details did in fact escape, in front of my consultant, when he grilled me on the origin and path of the oculomotor nerve). It all comes back to the capacity of humans: we are actually surprisingly good at remembering things, especially repetitive things. Revision for the notoriously difficult second year medicine exams had me reciting the entire pharmocology course essential drugs list day in and day out, much like practicing a musical piece over and over again to the annoyance of your housemates, parents, neighbours, neighbours’ dogs, the garden shrubbery etc. That amount of repetitive drone does wonders for exams, but to my surprise it also did wonders half a year later when you encounter the same drugs list, but in a patient’s charts and your mind start reeling off the receptors, pharmacology and side effects of the drug. Again I will draw the musical comparison, where pieces that I’ve played 3 or 4 years ago are still fresh. Half a year is a relatively short period of time so it remains to be seen what a long hiatus does to the memory since in my finals exams in 3 years time, they may ask questions relating to my first year knowledge. Although if music is anything to go by, then it is a lot more reassuring as my friend Jennie proudly exclaimed that she can still ‘nail’ an virtuosic flute piece after 2 years of negligence.

From the ability to stay up late to the amazing functions of memory, the boundaries of what is humanly possible is constantly being stretched. If you can still learn some bits of information whilst extremely tired and hungover, just imagine how much better you can become if you were in a half-decent state. When applied in the correct manner, humans have a phenomenal ability to achieve great things and even make an impact on the world. Indeed Margaret Mead once said to ‘never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.’