My last day in ID

In 2012 as a fresh-faced House Officer, I encountered a young man with necrotizing fasciitis (a severe infection of the skin and soft tissue). It was a horrific encounter of a young man who deteriorated rapidly before my eyes, whose care was escalated quickly to the intensive care unit within 12 hours of admission. He eventually demised from an overwhelming infection. I remember sneaking into the ICU to spy on his progress. His fingers and toes were literally dropping off from gangrene. It turned out that he had acquired an infection in his blood stream caused by vibrio vulnificus, a bacteria found in uncooked seafood or infected waters. I ruminated over the case for several days, wondering if there was anything I could have done better. I then saved his case under a newly created patient list of “Interesting Patients”.

 Fast forward to 2014, and no other patient ever made in onto this list that I had created. As of 30 June 2014, I had a grand total of 1 patient on that list. (Well, I can think of 1 patient that I wound have like to have saved but didn’t have the chance to) Then I started ID. Off the top of my head, the most memorable patients that I encountered were a patient with vibrio sennensis bacteremia, ANCA-associated vasculitis that manifested in the form of pyrexia of unknown origin (later became full blown pulmonary haemorrhage), cryptococcal meningitis in a non-immunocompromised host, Lemierre's syndrome from a Klebsiella infection, rhinocerebral mucormycosis, fungal endopathalmitis, NTM prosthetic joint infection, PML (yay!), recurrent HSV requiring chronic suppressive therapy, primary CNS lymphoma with no mass, syphilitic gumma, and a handful of HIV infections. I had been warned to anticipate the weird and the wonderful prior to starting ID, nothing less indeed!

 Many other thoughts as I end this 3 months. Have encountered so many inspiring clinicians and beyond that educators, missionaries, public health advocates. And to top it off, I had to answer the questions posed blank into my unanticipating face, "what do you want to do with your life?" Tough question to answer, because the truth is I am sinful and selfish beyond what I can bear to admit.

Time to forge ahead. Dreadful CVM :(

 PS: Oh oh! First hand encounter with lues maligna!

ID and the world

I'm enjoying my current posting as I had expected! I always have a problem of unmet expectations. When someone tells me that Movie X is superb and I need to catch it, it always turns out substandard. The converse is true as well, that when I am told that Item Z fails to impress, it usually surpasses my dampened expectations. I have been told so much about an ID posting, from friends who have gone through it, as well as having been trained as a HO under two excellent ID physicians from day 1 of housemanship. Nonetheless, it has been an enjoyable 2 months and there is such great impetus to learn and become better. I had toyed with the idea of swopping this posting out for Haematology, but am glad that I didn't! Top that off with the Ebola outbreak in West Africa - I guess I didn't quite anticipate that when I wrote down "outbreak management" on my learning objectives form.

It's great now with major exam out of the way I can truly slow down to enjoy the posting and smell the roses. Having discovered that I had some money left lying around in my training fund, I finally got down to signing up for the Medicine Review Course, one that I have been telling myself to attend since medical school days but have procrastinated till now. No better time to attend than to attend when it is being organized by DL himself from IIDE TTSH :P The most compelling lecture was delivered by Prof S himself on the approach to hyponatriemia. Such a simple lecture topic, one would think, but delivered with such eloquence, clarity and humility.

As doctors become more senior, they develop their own reputation. Dr A? Oh she's the awesome one. She is damn smart and damn scary also. Dr K? He's the one who holds everyone to high standards, including himself. Prof Z? He is terrible, only know how to be a referrologist! I guess HOMOs are not spared either. Make a silly impression during your formative years and you will forever be banished. Certainly not uncommon for word to spread around oh that HO, cannot even manage hyperkalemia! or something judgemental like that. The workplace is an unforgiving one. Nonetheless, it should spur us on toward becoming better, and recover what may be left of a reputation that may have been damaged by a moment of ignorance.

Having said that though, life is so much more than work. One of the doctors who was previously from the ID department, currently working with Médecins Sans Frontières in Geneva, returned for a visit and gave us a talk on the work that she does with planning and executing healthcare access in developing countries. With so much development in healthcare and also outbreak management (think Ebola!), could not help but feel a tingling sense of exciting as I watched videos and heard her talk. Puts into perspective the kind of work and impact that people can have with good foresight and passion.

Alvin recently shared this on Facebook,

Doctors spend a lot of time focused on the future, 

planning it, working toward it. 

But at some point you start to realize your life is happening now. 

Not after med school, not after residency, right now. 

This is it. It’s here. Blink and you’ll miss it.

Don't miss it.

#mrbrownfan

Trust Mrs CO Lee to such an awesome person like Mr Brown. The best teachers raise the best kids. :) Mozzie wipeout everyone! Before I start ID posting please!