靠岸

It seems to me that with every milestone comes this false assurance of having...arrived. Graduated? Congratulations! Residency? Congratulations! Engaged? Congratulations! I say false assurance because as much as there is much safety in finding firm ground beneath your feet, the truth is it is but the beginning of another set of challenges. Who is to say that graduation will not see me killing my first patient? Behind the glitz and glamour of residency, how many actually drop and burn out? Engagement is certainly no golden ticket to a happily ever after.

Keep your feet on the ground.

Post Mortem

Almost seemed like the end would never come. But it did.

So my MBBS ended on a sour note. The Paediatric short cases were...shaky. I can only blame my lack of practice! I was all ready to score with a super zhnged developmental assessment kit but instead was asked to listen to a 4 year old boy's heart and feel a 12 year old boy's tummy. ))): ?Ventricular septal defect and beta Thalessemia with a weak hand??

But I guess you win some you lose some. Medical long cases went well, and I was very pleased with myself for having wormed my way out of a tricky situation where the patient was very primed not to give away the diagnosis. I will remember his face of HORROR when he let loose some precious information that gave the game away. I also met the truly awesome and dedicated father of a child with cerebral palsy. Adult medicine short cases were straightforward. Mitral regurgitation. Bronchiectasis and chronic liver disease. I only recognised Koh Dow Rhoon amongst my 6 examiners who asked me a physiology question! Nonetheless, Jansen Koh is the winz. ♥♥♥

I've had so many thoughts over the past 100 days that I need to share with those that come after us. Will need to assimilate everything and put it down on paper.

So it's over. I filled my past 2 days doing normal human things like cutting my hair, shopping with my mum and packing my room. I think my efficiency hasn't been so high in a while. Now my head is a lot lighter, both literally and metaphorically. :p Tomorrow I will be lunching with my grandmother, and working on the poster with KQ. I still need to help SJ pack and get started on writing the Nehemiah bible study.

We are leaving for New Zealand in a couple of days. I think planning for a holiday is always therapeutic for my inner detail devil. I do think I need to stop being such a micro manager. That said, now that the planning is done, really can't wait to just go and chillllll. YC recently whataspped me and reminded me of the awesome 2005 expedition. Seriously miss those times, dog biscuits, sandwiches and pavlova. ahh.

Wow, MBBS is really over. God is really faithful.

The People (2)

Adult Medical Long Case

Paediatrics Medical Long Case

The People

Surgical Long Case

Surgical Short Cases

Hit and run.

Some thoughts from today's Surgical Clinical examination experience.

The MBBS is truly a brutal exam. I honestly wonder what the patients feel at the end of the day, having been talked about by groups and groups of students and Professors in less than dignified language before their very eyes. What runs through their minds when they hear, "The patient has a SIGNIFICANT smoking history of 50 pack years!!!" I think I would feel very judged. What about those who had to have a digital rectal examination? In an examination venue like that, there is no privacy of any sort. I wonder what would possess anyone to sign up for something like that.

The short cases are no better. It's an entire morning of waiting, listening to people talk about the gigantic lump that is on your face, making you do stupid things like clench your teeth and look up while 10 other people in the room stare at you. Hernias, exposing your groin to groups and groups of 10 people. Hit and run. I think that's what it must feel like. And I don't even know their names. They were just...cases.

That is truly brutal.

Thank you Mr Yap. Sorry for waking you up from your sleep, having to cut you off multiple times, having to remove your clothing in a very very non-private environment, and calling you Mr Tay by accident. I'm sorry I forgot to ask about who you stayed with, and who would be taking care of you. I'm sorry for making your hip problem so apparent in front of so many people. I hope your pain gets better soon.

Round 2

10th of March. Clinical OSCEs, a test of communication and basic skills. (1) It was by no means the work of chance that led me to mug videos on incentive spirometry that morning itself. Just vomited out what those teaching videos had on recording to Mr Raj, and tried to zhng by adding on abdominal coughing. (2) Moving on, I would have totally buanged the GXM station, if Prof Kenneth Mak hadn't saved me by dropping youaregoingtofailandiamtellingyouwhatotdo hints :s I hadn't even realized my error until later when everyone was going through answers and it then occurred to me what grace I had been given. (3) I gave my HIV patient THE secret number. At least I said I would, as though it was the most normal thing in the world. well, it seemed like that to me while I was sitting in the HIV clinic last time! Oh well, I hope I don't get marked down for being indiscrete. (4) Medicines medicine medicines. I missed the amitryptiline overdose! It looked a little weird. I said I would check. (5) Got owned by Prof Glycated Haemoglobin DDD: was doing perfectly fine with open fractures until he started quizzing me about statistics and operative options. (6) Blue letters, memos. No time, everything was just...spinal. (7) Angry mother, angry daughter of patient and sad wife of patient with Alzheimer's dementia were neither too furious nor depressed...I think? :p

The medical papers have been less than encouraging. At about question 70 (out of 160) of the MCQ paper, I seriously reconsidered my career choice in Internal Medicine. Now everything looks very familiar...I just don't know which belongs where and what. I hate to imagine the day I decide to order Bactrim for a patient on Methotraxate because I didn't know/forgot the interactions. Injustice.

Today's MEQ was a different sort of heartbreak. Instant feedback is not good for one's mental well being. On discovering that Verapamil actually reduces proteinuria (who knew?!), my brain momentarily hung and I had to reread the next question like 3 times before moving on. Oh well. I guess I will discharge my ?SLE patients earlier next time!

So I had a self declared break tonight. Went to SJ's for dinner and went looking for something in a mall. Bracing self for the next wave, what matters most.

Clonorchis Sinensis Opisthorchis Viverrini

Alas! I have become so lazy, succumbing to just reblogging things. This is becoming an uncharacteristic webpage full of fancy and forgettable things! Oh dear.

I remember the days of O and A Levels, reaching home by noon just in time for a home cooked bowl of mee sua with meatballs and fish, crashing into bed for a nap and then waking up for quick last minute revision. I spent a great deal of time detailing each paper on a blogpost, putting into webspace memories such big academic milestones in my life. I guess as time passes, each examination becomes yet another one, and no longer has this omg effect on me. Still, I feel compelled to follow in this habit of reflecting and documenting this bit of my life.

So I started my count down quite a while back, and stumbled upon a very apt wallpaper when I felt very "inspired" one day and went to Google Images to search for "bleh". It has remained as my wall paper since the beginning of the awesome 2012! So began a long slow journey of ploughing through a tremendous amount of material, trying to fit it into the big picture of this whole doctoring business.

So Tuesday the 6th of March came. Paper 1, Surgical Essays. I did the paper from back to front, starting from what I was most confident to the least. Aortic dissection. Lois certainly has the ?gift of prophecy heh. Obstetrics was a blob of haziness, though cannot be more than thankful that it wasn't a Gynae question. Foot drop?! I re-read the question again just to make sure I wasn't sitting for a Neurology examination. It certainly impresses me though, that The People do take time to think of questions that test the nuances of medicine that we as professional muggers always miss. Medicine is broad and beautiful that way.

On the night before the first paper, my brother asked me, "so how many essay questions are there?" "Four in total", I replied. "Is there an option to choose which questions to answer?""No leh." "Yeah I thought so. Doctors certainly cannot choose their patients.". How very true.

Paper 2 was the Surgical OSSE and I totally buanged the slide with the imperforate hymen. All that shot into my mind in that last intense 15 minutes of the exam was Mayer-Rokitansky-Kuster-Hauser Syndrome and so my answer was a very brilliant "Blind ended vagina". No further questions please. A pity there were no questions on contraception or bone tumours. ): Thoughts of "wasted studying" crossed my mind, but was reminded that I'm studying not to pass an exam, but to become a good doctor.

Paper 3 was a mind numbing 180 MCQs, with very obvious attempts to make life difficult. "The following statements are false EXCEPT" could really just be simplified into "Which of the following is TRUE". Nevertheless, Mr MacDonald's fate certainly tickled my toes in the midst of a very long 3 hour paper. Thankful that just hanging out in seminar rooms talking rubbish the day before saved my ass on some questions O:

I guess in all this, I will remember that studying in MD6 has been a great blessing. After all that years of complaining about not having a place of our own, we are certainly putting the new building to good use. The best part of exams has always been the company along the same journey. We are but barely starting, and was very encouraged by Lois' morning sharing onIndestructible Joy. Jesus was not gloomy, though He was a Saviour who shared in our sufferings. Counting down till the end, and in the processes experiencing His daily grace.

Best of MBBS 2011

From Seniors Accounts, Class of 2011

Me: Mdm, what medical problems do you have?
Pt: first, i had loss of appetite
Me: ok..................... can you tell me your other medical problems? (i was trying to get her to tell me her other co-morbids so i would have a rough guide on how much time to spend on each, but auntie didn’t get my drift)
Pt: then i had loss of weight
*oh crap... had sinking feeling already*
Me: oh as in, do you have diabetes, hypertension, hyperlipidemia, heart disease, asthma? any past surgeries?
Pt: none
*felt relieved. but not for long*
Pt: then both my hands numb, then leg swollen
*zomg* ?!??!?
Me: ok the leg swelling, one leg or both legs?
Pt: right leg more swollen than the left
*….........................*
Pt: then i had constipation, then shortness of breath, then felt tired, then after i went to see my gp, he told me to come hospital, and the doctors at the hospital said i was YELLOW
*zomgggg*

* * *

Then ask about management: scope done? What does it show and which part of the intestine involved? At this point the mother said small plus large intestine and I shouted out Crohns right?!? She finally admitted and I pat my own back mentally. I asked about steroids use and side effects of steroids. She also told me about sulfusalazine and 6mp! I really did not know what is 6mp. On hindsight, maybe I should have joked with her 6mp? the doctor gave u a 6mp camera issit. lame. It is mercaptopurine, an immunosuppressive drug used for IBD, non hodgkin lymphoma, psoriatic arthritis etc.

* * *

What are the differentials for acute kidney failure in this man? (he had been previously admitted for episodes possibly linked to either his CLD or DM nephropathy) I said Hepatorenal syndromes 1/2 and they seemed to be appeased. Know some impressive shit like Hepatorenal syndrome to tickle your examiner’s balls. They probably won’t know more about it than you do so can chillax and bask in the glory of your 7-syllable diagnosis.

* * *

15 year old chinese boy who looks like he is 10 years old. I was pretty surprised when told his age. Then I started to ask about presenting complaint. I was totally hoping for a asthma and was quite sure he is one with steroids toxicity plus plus. But my balls shrunk when mummy said he had diarrhea a few years ago. I really never thought I would get things like GE, functional abdominal pain or my worst nightmare IBD! I got one such case before in an EOPT and totally flunked it. And the day before I was furiously mugging paeds when i came across this topic and I said to myself, screw it, how likely is lightning going to strike twice? I guess the MBBS is really an astounding combination of all our previous karma and the idiosyncrasies of lady luck. I wished I had helped a few more old ladies cross the road. i muttered an audible obscenity which the boy caught and looked very pleased.

* * *

Then I proceeded to give him a tutorial on IBD when I realized the indian guy (examiner) was reading from a set of pre-prepared questions and points. That showed he probably did not know IBD very well. So I started my first menthols light of my life. On endoscopic visualisation UC involves certainly rectum, plus colon. It is a mucosal and submucosal thing and show crypt abcess, pseudo polyps , cobblestones and longitudinal fissures. the lesions are continuous. Crohn’s is transmural and has skip lesions and strictures and fistulas and bah bah bah. UC more likely to bleed and Crohn will show non-caseating granulomas. I spoke real fast so that he will hear the terms and even if I make a mistake he will not be so likely to catch it. Koh Pei Ling was looking amused and nodding furiously by this time which the Indian prof was frowning as he tried his best to coordinate his eyes and ears.