Taking your breath away

So I thought I'd write a little about this posting that I'm doing. Started Respiratory Medicine in January this year in a department with a reputation. A good one certainly, filled with the guardians of the ICUs, the healers of the most sick and also the scariests to call on call :p Was thrown into the deep end on Day 1, rounding in the NIVU (non invasive ventilation unit) where I had to familiarize myself with the machines and the room was a symphony of wheezing, pressure resistance and coughing altogether when all the beds were full. Thankful for seniors who were firm but approachable, and also for morning tea (something that I had grown used to back in NCC).

Put in my first chest tube 2 weeks into the posting and had to tell that same auntie that she had cancer. Learning to put in the arterial lines saved my ass on last nights call when the NIVU went from 25% to 100% full in 3 hours flat. To BIPAP or not to BIPAP? In medicine there is always a bit of white, a bit of black and a whole ocean of gray in between. The challenge of a training physician today really is to learn what is right, not what is convenient or commonplace.

My mind has wandered off to something else so I shall end this post abruptly with a picture of something yummy. Happy 1st month Adele, daughter of N and J! (talk about growing up and friends having babies...)

Green Grass

The grass is truly always greener on the otherside! Just when I braced myself for a terribad June, I have found myself in a newfound low. Incredible, I really miss Dr K (and the air con). I can so totally imagine CS rolling her eyes now hehe. Good times, very good times. :)

First Call

Just so I don't forget, I was on HO2 Gen Med call on the 3rd of May.

Tea Session

Everyone had been talking about all these residency "tea sessions" to which they had been cordially invited to, described as an interactive session to meet the faculty and clarify doubts. The more unassuming candidates were often surprised with having to participate in awkwardly disguised group interviews or in your face one-on-one discussions revolving around the candidate's curriculum vitae.

So when I signed up for the NHG Internal Medicine open house a few weeks back, I had some impression that it might end up as such, and made a mental note to prepare for an interview beforehand. At the same time, I also knew at the back of my head that it was very unlike Prof K to send out an invitation for something which was not. It was just not...her style. Nonetheless, it was something that I knew I needed to anticipate and prepare for.

Procrastination got the better of me until last night when I realized that I hadn't thought through it at all! In light of my sleepiness and the allure of my warm bed, I decided to trust my instincts, and put my faith in the integrity of Prof K. If she says its an open house, it must be just an open house. I went to bed, and headed out for the open house this morning - completely unprepared.

When I reached TTSH in the morning, I was once again bombarded by horror stories of how tea sessions morphed into grilling sessions and scrutiny of research papers. When my friend started grilling me mock interview questions which I hadn't prepared for, I felt completely unprepared and defeated. I didn't even bring a copy of my CV!

2pm came. It was slightly awkward in the beginning, when everyone was standing around having lunch while waiting for the program to begin. Everyone was expecting some sort of breaking into groups, waiting areas, and interview panels. Then...Prof K made an announcement.

Hi everyone! The program will begin shortly! Will you kindly make your way into the conference room? You should have been given a table number already, please sit accordingly.

Doom. Table numbers? Interview groups? I thought that was the end. Going for an interview unprepared is a terrible terrible thing to do.

We all settled into our tables. And as my mind was running through how I would answer standard interview questions, Prof K came up again to make an announcement.

Ok everyone, thank you for joining us today! Today's session will be completely informal and is purely for you to ask questions and clarify any doubts. Please make yourself as comfortable as possible, and if there are any questions, the faculty will be around to answer your queries. Please go ahead!

Really?

And the session went on as described in the email. A meet-the-people session, to meet the program directors and core faculty members. No frills, no loaded questions, no empty promises, no contrived answers and a very cute Dr L. It was an honest discussion on the limitations of the residency matching system, and how best to improve one's chances without violating MOHH regulations. Dr L made everyone feel very comfortable and it really reminded me of the feeling I had when during one of Prof Low's MBBS revision lectures and someone had arrived late midway and walked in midway into the lecture hall. He was greated by Prof Low's very warm "Welcome home!" Such love.

Just some thoughts for today. (:

Yummy and a haircut

After three rotations through TTSH, finally got to enjoy the 50% off at Starbucks every end of the month! The previous few times we were either having tutorial or the queue was just too long. Normally it takes place on the last Friday, but don't know why it happened today. Just as well, since I think no one knew it was on today and hence the queue was really short! Took the opportunity to try their new Espresso and Cream Chip Frap :D it was quite yummy, with a stronger coffee aroma and bits of cookies/chips floating around the icy goodness. Tons of calories omg!


I also got a haircut! It was an expensive haircut, saved only for times when I feel more courageous to do something to my fringe (as opposed to a regular trimming). Shall not spend so much money on hair cuts anymore. I'm becoming bankrupt. Here's a photo. The haircut auntie said my parting like was dead when she tried to cut my fringe because she couldn't get the short part to follow in the same direction. Seriously, she said "你的线死了". -_-The green blob is there to protect my identity and save myself the embarassment of being called a zi-pai-ing ah lian. :p oops.

Star Wars fashion

Orthopaedics is a very clean specialty. Right from meeting the patient, down to working him up, treating him and then managing him, everything is neat and fuss free. Clinical examination does not require the donning of masks or gloves, and the patient doesn't even need to undress excessively (as it usually is for other specialities). Look, feel, move. Apart from a little more force and some occasionally awkward manuveurs, its all about mechanics - knowing where the pivot is, where the force is coming from, the nature of the force and how it is transmitted. Surgeries are done in tip top sterility, in dramatic Star Wars fashion total exhaust gowns. More significantly, there is hardly any or no emotional burden in this field of work. No one is dying, no one is looking for a listening ear. The surgeon is direct, succinct yet professional - This is the problem and this is what I can do for you. This is the reason why this has happened. You can take some time to think about it before you make the decision, any questions? If its not osteoarthritis of the knee then its rotator cuff tear - a little pain here, there, still bearable, just annoying. If its too loose? tighten it; too tight? loosen it. Fix it, mend it, straighten it. ah heck it, just replace it.

Trauma, on the other hand, is another ball game altogether.

I spoke to my CMPS patient today because he was readmitted for gangrene. after speaking to him, i suddenly remembered the days where we spent hours clerking patients, just talking to them and listening to their stories. We left TTSH at 6pm after a long day, just as the sun was setting. Haven't had this awesome Gen Med feeling in a while. I miss them.

haha!

In continuation from the previous post...

Funny is the man who turns up for his own funeral!
BBC: Brazil man appears at own funeral

More randomly, I suspect I did not dislike Surgery as much as I thought I did. I suspect it was an apparent dislike, and not a true dislike, and it was probably more associated with the place than the subject. Orthopedic surgery has been enjoyable thus far (: Then again, maybe it's the place too :p my 2 more major postings in medical student heaven - thank God! (:

Strange CG mate 2

So on the 1st day of our Orthopedics posting, we are told that for the scheduled night duties, we are strongly encouraged to spend the night in the hospital, all the way till post-call the next day.

Our consultant says, don't worry, you can always ask for a duty room. We get at least 2 rooms for medical students. The current SIP students will use one, and you can have the other one.

Then, Kq (on night duty with me) looks at me and says, "Glori...we get to share a room...*pervy look*"

I fear for my life.

Spot Diagnosis

The disciples had forgotten to bring bread, except for one loaf they had with them in the boat. "Be careful," Jesus warned them. "Watch out for the yeast of the Pharisees and that of Herod." They discussed this with one another and said, "It is because we have no bread."

Aware of their discussion, Jesus asked them: "Why are you talking about having no bread? Do you still not see or understand? Are your hearts hardened? Do you have eyes but fail to see, and ears but fail to hear? And don't you remember? When I broke the five loaves for the five thousand, how many basketfuls of pieces did you pick up?"

"Twelve," they replied.

"And when I broke the seven loaves for the four thousand, how many basketfuls of pieces did you pick up?"

They answered, "Seven."

He said to them, "Do you still not understand?"

- Mark 8, The Yeast of the Pharisees and Herod

The Magic of Medicine

this week was rough. i started out thinking to myself, look i've got 4 more weeks to end-of-posting-test, time to buck up and not be stupid anymore. chiong where possible. i was just close to printing out a big sheet of paper which said THINK. DON'T BE STUPID, because that was how i'd been feeling through the past 6 weeks. day in day out i did my thing - go see the patients, attend my tutorials, practice, present and come back to study through what i've seen. by thursday i was tired and sleepy, but still trying to chiong and staying till 7pm on friday.

friday was a scary day. we had a tutorial with Dr Suresh and had a pseudo mock test which Z and M underwent whilst the rest of us watched. i thought they did ok, at least that's pretty much what i would have done in their circumstances. but guess what, the comments we got were "you're just close to passing" and "you already did xxx and if you just did xxx you would have failed immediately". demoralized x10000. EOPT = major fail.

but then K told me something whilst on the car back on friday, which i think ought to be shared with all those who are going to pee in their pants from EOPT syndrome. if i may rephrase it - "you know, i think if i did something so terrible during EOPT that the examiners decide to fail me, then i think i'd rather fail now and keep retaking till i get it right, lest i do it again next time and end up killing someone." i thought it was particularly insightful because it captured the essence of our exam, to prepare us for compentency as doctors and not just to get through an academic level.

Dr Suresh talked to us about the real world during our tutorial. the real world where real people function under real circumstances, not like in our exam where the patients are primed, told what to say and we are so eagerly trying to rehearse and prepare ourselves for the ideal patient with the perfect signs and symptoms. in the real world, patients lie, they come with 1 out of 25 signs, they are in denial, they don't take the correct medicines. in the real world, people die.

we had a fantastic geriatrics tutorial with Dr Lim WS on thursday. he told us about being doctors with a heart, and he quoted Edward Livingston Trudeau's "To cure sometimes, to relieve often, to comfort always". and whilst it doesn't come as anything mindblowing or new to us, i always find it inspiring when people who have been in the profession for so long can still hold true to such beliefs. they always tell us about how doctors become jaded and angsty from the workload, how the profession is unrewarding and demands more than you can give. but coming from The Wise Sages, it's an equivalent of a been there, done that.

Medicine is magical, and slowly but surely things are falling into place. right now we have but a pile of jigsaw puzzles thrown at our feet, and we slowly pick up the pieces to put them where they belong. the good physician first looks for the obvious abnormal looking corner pieces, then work from the peripheries towards the centre, finally hitting the heart of the puzzle where you should already have an idea of what the clinical picture is like. everything fits, the picture is complete and the puzzle solved. but that is not the end of the story, because we deal with humans, not cardboard. there is the dimension of thought and emotions that we have only just begun to discover...

press on friends! be real :)