When concentration wanders off...

This blog post came out of a conversation on twitter about the difficulty of motivating yourself / getting work done when your concentration is bad for whatever reason (fatigue, anxiety, distraction etc). This is either going to make me sound hideously preachy, or militarily organised. I am neither. These are the techniques that I have learned over years of brainfog and depression, for actually managing to get anything done. In this way I am having quite a productive day despite the fact that my sensory processing today is simulating being wrapped in cotton wool underwater.

They give me a framework in which I don't need heroic amounts of motivation to battle through the fog. They might seem intense at first, but structure has really helped me, so it's worth a try. If you've got someone to help you hold yourself accountable for what you get up to over the day, all the better.

The very first thing on the list is to give yourself the best basis for concentration. As far as you are able get plenty of rest, eat enough and healthily, get some fresh air in your lungs, manage pain and anxiety etc. We are not machines, and as such to stay active our body and brain needs varied stimulation (why not switch between cleaning the bathroom and studying infectious disease for the ultimately engaging Saturday morning?) and regular periods of rest (every 90 minutes for me) and re-fueling (leave your desk to eat lunch and you combine the two).

Also identify your primary distractions, and deal with them. For example, when I'm writing a blog post, my natural inclination is to hop between tabs to twitter or my blog reader, where I inevitably forget was I was doing in the first place. To manage this, I have this open in a separate browser window, and every 10 minutes I give myself 5 minutes of browsing time, with an alarm that goes off at the end to remind me to start again. I find silence causes me to wander off into my brainbox, and I can't resist the urge to sing along to music, so I am writing this to a background of radio 4. If your distractions are worries, or anxieties, try taking 5 minutes to write them all down before you start work, as a symbol for setting them aside.

Realise that different days / moods suit different tasks. Today's brainfog means that anything creative / requiring sustained thought is out, but practical target-driven tasks are fine (email this question to such-and-such, book cinema tickets, write blog post from these notes, bullet point mobility issues for DLA application).

Make a to-do list, split into topics (such as current placement / revision / audit). Separate any big jobs into sub-tasks (such as write essay plan / draft introduction / run journal search). Assign each task to the category now, soon or sometime (I do this by highlighting each category in a different colour). Write a date/time to complete for everything in the 'now' category, and write a date/time to review the list.

Don't let this take any longer than 10 minutes. You can always add things later.

If you have a period of time (say an afternoon) and you have several tasks on the list for that time, there are a couple of ways to approach things.

Think about balance between activities - sometimes it's easy to group similar activities together, like getting several phonecalls out of the way in one go, but sometimes you need to break things up - so writing an essay in half an hour bursts interspersed with 10 minutes of cleaning the bathroom

Are you particularly dreading anything on the list? if it's a short activity (e.g. a phonecall) do it first. Then give yourself a reward - a piece of chocolate, or 15 minutes rocking out to the Beatles. If it's a longer activity (like cleaning the flat or writing an essay) spend 10 minutes assembling everything you need, then 20 minutes doing something else on the list. Then come back to it and spend 20 minutes doing an overview (writing an essay plan or doing a quick tidy round of the whole flat) and 10 minutes doing something else on the list.

Take a break, make a cup of tea, and then spend an hour getting as much done as you can (imagine you only have an hour to do the whole thing). If you find yourself getting too bogged down - spending ages tidying one little drawer, or over-policing and re-editing one particular sentence - take a deep breath, move to a different room / paragraph and keep going. You can come back to the detail later.

I know that it sounds brutal, and impossible, but getting into the habit of finishing the big picture first makes tasks seem so much less daunting.

If it's an essay, aim to have a general draft of the essay done within the hour, even if some paragraphs are only sentences or bullet points. Then work out how much time you have left to work on it, and split that time up between each paragraph / section, filling in the detail. Again, if you get too bogged down, stop and come up for air.

If you get to the end of the time period, and you haven't finished the tasks on your list, don't panic. Think about the now/soon/sometime model, decide when to do it, and then mentally set the task aside until then. Use this as a learning experience - it will help you to be more realistic about what is possible to get done in a given length of time. If you are constantly running out of time for the tasks you have to get done, you need to have a serious think about whether you have taken on too much.

Remember, it's always better to tell people early on that you won't get something done, rather than in a panic at the last minute - this goes for uni deadlines, jobs lists on placement, cooking dinner for your flatmates.

For studying, rather than writing, I use a slightly different technique. This is much more personal, and depends a lot on what you're learning, and how you best absorb / remember information. I'll write about that a bit tomorrow maybe.

T'will all be alright

With term starting tomorrow, I am starting to panic a little bit about how I'm going to cope. My mobility is worse, and worsening, since my last placement and both of the hospitals I'm placed at this year year are huge. My fatigue is slightly more under control these days (hooray!) but I'm really worried about uni setting it back, especially because finals are at the worst possible time of year for me, fatigue wise.

So here is a a post to myself - a post about how to take care of myself, of ways to make myself feel better.

1) Take care of the lovely mrs. Have plenty of not medic-medic or carer-caree time. Tell her often that everything will be fine. Play with daft cat often.
2) Sleep. Stop work at a sensible time, journal before bedtime, be fastidious about night-time pain management, have catch-up naps naps at the weekend.
3) Drink cherry and cinnamon tea, cointreau hot chocolate and mulled cider. Plenty of water, and salt.
4) Be sensible with my energy. Pace as much as possible without becoming a hermit. Don't feel guilty about the cleaner. Be assertive about my access needs on placement. Take it slow and steady.
5) Read something non-medical - funny, easy, familiar. Listen to an audio book snuggled under a blanket. Sing along to Sgt Pepper. Watch BBCThree nonsense and silly films.
6) Phone lovely people. Go for walks (/wheels) and talks with the mrs. Have people to stay, go to visit notsofaraway best friend. Give plenty of hugs.
7) Don't get cold! Wheat bag, big fluffy dressing gown, electric blanket, woolie socks, hot water bottle, nights in front of the fire.
8) Remember all the reasons I love medicine. Revise in ways that keep it interesting. Don't go near the library in the medical school, and avoid talking about revision with anyone else. It is not worth the inevitable panic.
9) Eat proper food what is warm and has veggies in. Plenty of mashed potato and daal and plum crumble. And porridge for breakfast.
10) If things get bad - rest, cut back, get help. Don't let it build up. Talk. Keep the med school in the loop.

The bottom line is that my health is important. I would rather be well and fail than to burn out passing, so I need to act like it, and not let guilt, or panic or the fact that other people still think they're invincible convince me not to. It could all go really quite pear-shaped otherwise, when it very much needs to all be alright in the end.

Written exams : the basics

To celebrate this being the first time in in 16 years that I have had no summer exams (other than an optional mock exam today), here is my exam survival guide. I hope you might find something useful hidden in the depths of it =)

The beginning of the year, or as early as possible :
1) Sit down with someone in the disability service +/- the medical school, and discuss any adaptations you might need. Remember to plan for your worst day. They will be able to tell you what kinds of adaptations they've made for other students. (For example, using a scribe, having rest breaks, or sitting the exam in a separate room)

Before that meeting it would be helpful to think back on previous exams, or to do a past paper in as close to exam conditions as possible, to find any problem areas.

2) Don't let anyone give you the excuse "but when you're working you won't (get extra time, for example)". You might want to say "yes, but it is not your responsibility to make adaptations for me in the work place". This is more relevant for clinical exams, and I'll discuss that another time. It's a tricky one.

Don't let anyone feel like you are gaining an unfair advantage. These are adaptations you need to minimise the impact of your impairment on your exam performance.

The month of the exam :
3) Practice using any unfamiliar adaptations, such as working with a scribe.

4) Learn a quick relaxation technique, and practice is, in case you have a blind panic on seeing the first question (been there, my friend). Some examples are lying flat on the floor and counting slowly to 100, contracting and relaxing muscles working from the feet up, and reciting a funny poem or singing all the way through your favourite song in your head.

The picture shows a window sill, on which are placed a
pile of books, and a big ball of wool with knitting needles
sticking out of it. Outside the window is a lamp-post.

The week of the exam :
5) Make like a marathon runner and tone down your study. Prioritise rest, good meals, stress busting (cinema, craft, coffee with friends, gentle exercise) and some gentle "dotting the Ts" revision. Get your sleep pattern in sync so it's not an effort to be up in time for a morning exam.

The day before the exam:
6) Make sure you know where and when the exam is, and how you're getting there. I get my Dad to phone the morning of every exam to make sure I'm up (not what you might call a morning person...) Give yourself the best chance of sleeping well by using good sleep hygiene (riciculous phrase!) +/- a wee dram.

7) Make sure you've packed the following in 1+ clear plastic bags :
- pens, pencils, rubbers etc
- uni ID badge if needed
- cushions, splints etc
- regular medication and any PRN you might need
- bottle of water (that you can open) and snacks (unwrapped and folded in kitchen roll so you don't rustle)
- lucky charm or something that makes you smile

The morning of the exam :
8) Wake up in time to have a proper breakfast and a drink and leave in plenty of time. Don't look at any work longer than 1 side of A4.

During the exam :
9) Take at least one 5 minute toilet break (if you don't have rest breaks) to stretch your legs, run through a relaxation technique and/or refresh with a snack. I tend to do this after my first plough through, at the switch between types of questions, or if I get a bit freaked out.

10) Think about variety to reduce over-straining any muscles / joints, and to keep your brain engaged. Switch pens regularly so you don't get the dread exam hand cramp, change sitting position (or switch between between sitting / standing / lying down if that is helpful for you) and consider not doing all questions of one type in a block, but rather doing half of one and then starting the other.

What pre-exam routines do you have? Have your med school been helpful in terms of exam arrangements?