First quarter

Almost cannot believe that it is mid April already. Seriously feel as though my youth and energy is slipping through my hands.

Ended my last posting in Neuro quietly, and escaped for a getaway in Shanghai before my final three months in Residency. Most people give a look of horror as I share with them my final posting before I (supposedly) turn Registrar - MICU/MICU/ED. Three months packed with fun-filled excitement, resuscitations, invasive procedures as well as 没天没夜 . All's well so far, still getting used to the bloody cold MICU.

Neurology was a fantastic rotation (have I said this before?). I was told that people who enjoyed Infectious Diseases would enjoy things like Neurology, and it's true! (Although Dr M would fiercely disagree!) A big part of it is also largely the department that nurtures a logical and systemic approach to illness, and demands no less than wholehearted advocacy for patient. Thankful for seniors and mentors who go out of their way to impart wisdom to lowly beings like myself, teaching neuroanatomy even at 1AM on call. A cardiologist once remarked as I crossed paths with her in the lift, "Neurology deals with hopelessness. There is little to cure." I can almost hear Prof U retort with real life examples of his patients who were once condemned to maxward and limitation of care but now have come far and long with excellent functional recovery. Press on, he tells his patients with every once of confidence. And it's true! The pessimist in me often feels that I'd rather be dead than in a state like that, but Neurologists like these inspire hope and confidence for the future.

End march brought SJ and I to Shanghai, a destination that SJ has always been keen on visiting. It never piqued my interest before, but since flights there were cheaper than to over-visited Japan (literally everyone is in Japan!), we booked anyway. The Chinese are truly a confusing bunch. On one hand, I was thoroughly impressed by the amazing architecture and technological advancement that they had at their fingertips - The Bund skyline was breathtaking and a visit to the Shanghai world financial centre's top floor via lightning speed lifts was highly impressive. On the other hand, there are people selling mangosteens by the roadside next to these modern skyscrapers, and people wearing oddly-matched clothing next to high end fashion streets. Nonetheless, the Chinese people are definitely up and coming, and the West seriously needs to play up their game if they want to match up.

西湖, Hangzhou

The Bund

Chilling in the Sofitel Shanghai Hyland club lounge, finger food all day and free flow wine during happy hour!

Shopping :p

Thrombectomy

People are clearly mistaken when they say that Neurology is not life saving.

On my last call I saw how sharp decisiveness and prompt action transformed a NIHSS from 22 to 1! Incredible :D

You've survived, what next?

Six weeks into Neurology, I can see how Death could be far more enticing than Life. A burst aneurysm, classically described as an ironically beautiful starfish shaped hyperintensity on the plain CT brain scan, leaves one helpless at the hands of the Neurosurgeon. Depending on the time at which you arrive at the doorstep of the Emergency Department, you may be subject to a decompression craniectomy in which the surgeon takes out a part of your skull to allow the brain to swell beyond its usual enclosed brain space. A tube is then put into your lungs to help you breath, medications are used to support your blood pressure, while you get at least 4 different tubes put into your veins and orifices.

So you've survived. What next? 

A week later someone, because recovery is slow is any severe brain insult, there begins talk of putting in a tracheostomy - essentially a hole at the front of your neck through which a shorter tube is put to help you breathe. One cannot stay intubated through the mouth forever, and hence the tracheostomy remains the only better alternative. No one can predict what kind of brain recovery you will make. Whatever damage has been done, is done. Any form of intervention done at this stage remains to damage control and not to reverse any of the cell death that has occurred.

So you've survived, what next?

I've seen too many large MCA infarcts and massive posterior circulation strokes come through the doors of NNI in these past 6 weeks. "Surgery is life saving, but not brain saving", my stroke consultant would say. A life is saved, but saved only never to be able to talk, to walk or to meaningfully live as one would have before the stroke.

We all live, only to die another day.

So when we talk about medicine saving lives, I really wonder if that is what we should be doing. I cannot tell if this is my jaded-3-year-doctoring-self talking, or if modern medicine has failed to convince me that the lives we save are worth saving.  Prof U would say "Don't be demoralized! When people get demoralized they start talking about things like max ward et cetera. We must do all we can."

Specializations like medical oncology and cardiology are popular and sexy because to the layman, people die from cancer and from heart attacks. The poor Neurologist is jeered at for having little brain saving to do. They journey with the 23 year old with multiple sclerosis who cannot walk through the prime of her life, the 40 year old who discovers that he has dystrophic myotonia, a genetic disorder that causes his muscles to weaken. To add fuel to fire, he discovers that this disease has been passed on to all of his offspring. These people don't die, they live on.

Perhaps what people don't realize is that the things that don't kill you, could be far worse than dying. 

Pseudoseizures

Short notes before bedtime

Pseudoseizures 

Placebo effect

Living is over rated 

Cancer is over rated

Short lists but watching your back

Learning! 

Clearly post call. Good night. 

Post call ramblings

Twenty two days into January! Enjoying this new rotation very much. Busy, but thoughtful and challenging. Started off with NICU and now in the Acute Stroke Unit. Tubed my first patient (finally) and am getting the hang of "putting in lines". I had the chance to rotate with R who was a great partner and also someone with much experience and knowledge to learn from. Participated in the first Prof U tutorial (did not put paces school of horror to shame!)  and now can sit back to relax a little. Even at this point in my training, learning how to be faithful in little things before going on to bigger things.

Some things that I've been trying to procrastinate on deciding have sprung up in recent times. I have never been good at saying no. Praying for wisdom and peace in this decision making process.

SJ is at reservist exercise tonight so I am husbandless for now. He didn't leave without cooking a pot of chicken curry,  teriyaki salmon and chyesim for dinner. I shall continue to shamelessly be the wife that cannot cook :D

Neurology

(After the usual 10 minute morning round)

Me: So, the plan for today is that we will...is there anything else I can do for you?

Patient: Yes doctor...could you please help me scratch my nose?