shadows

Today was a day in hell.

 

I woke up wondering whether I should stay at home today to mug for end of posting test on Friday. Somehow I decided that I would go to hospital anyway cuz I was feeling hardworking. That was a decision that would prove so wrong.

 

It is anaesthesia posting now at Hospital X off Alexandra Road. I’ve been separated from my CG and doing it at Hospital X with another guy.

 

I was late for school and because it is anaesthesia posting, you can never be late cuz most of the stuff are done before the surgery, and if you are late, there’s nothing left to learn. So I actually took a cab to rush down to Hospital X off Alexandra Road to meet the tutor of the day.

 

Little do I know that although the schedule states I have to be there at 830am, the actual listing for the patient is to come to operating room at 0900. I stoned from 830 to 9am heavily regretting my decision to cab. And worse still stoned from 0900 to 0915 cuz the anaesthetist is late. But I didn’t really blame them cuz it was my bad to take taxi.

 

After waiting for like 45 mins doing nothing except pacing around an empty operating room, she finally came I said hi to her and told her I’m M4 attached to her for the day in anaesthesia. She didn’t even look at me and said, “ok go observe how they do the spinal anaesthesia.” And then trodded off to do her own stuff. Well she wasn’t particularly busy, and she didn’t bother to explain to me the steps of what the other anaesthetist was doing. Inside I was like wtf already cuz I know she’s the type that isn’t going to bother to teach.

 

So basically for the next 1 hour I just stood around doing nothing much and felt like an absolute pest with all the “excuse me” and “you’re in the way” etc, with her basically ignoring that I’m there, until finally she came over and shouted “Student, come!” She told me to hold the mask for the next patient while she started inducing with volatile anaesthesia. And all the time she’s barking “student, hold it tighter huh I can smell the gas!” then she suddenly said “student, pass me the bag” I was like, huh? And I looked around and the Ambu bag wasn’t around. She incredulously exclaimed, “he dunno what’s the bag!” I am like huh wtf, it’s my 2^nd day here I don’t know the position of where you keep your stuff you know? And the bag was like BEHIND me, how was I supposed to see it?

 

And then she asked me to try to intubate. I’m like ok, it’s the 2^nd time I get to intubate in a real person though I tired it many many times on manikins, so I took the laryngoscope and looked inside. Then she started screaming like “Don’t plaster your face so close to his face, don’t smell the patient’s breath!” Then when I insert the tube I was trying to aim for vocal cords and she’s like screaming “Don’t slide in and out, go in in one swift motion” I then realize the ETT has no stylet and is so flimsy that I cant bend it, my fingers went down a little to get closer to the tip to get more control and then she screamed, “hold the ETT higher!”

 

I am like. Fuck. I don’t do this everyday like you do, and if you want me to go in in ONE motion and looking so far away and holding the ETT so high up with no fucking stylet, why don’t you just do it yourself, because I can’t do it while trying so hard to accommodate to YOUR style. If you want me to do it, why don’t you just let me do it my way and only intervene if things are really wrong, and not intervene just to suit your whims and fancies?

 

And of course it was a failed intubation, and she screamed and took the tube back out and said, “do you know where you went” I am like “esophagus (duh, of course since you wanted me to go in in one swift motion)” She cried a loud “Ya!” and continued, “That’s how patients die!” I’m like. Right. As if she has never intubated the esophagus before in her life.

 

Then she strode off to do her stuff and ignored me. Meanwhile a kind registra told me to come over and was like “dun let her put you off. There’s nothing to feel bad about in a failed intubation, it’s very common” then he took me for “tutorial” and ask me questions and I clarified stuff, fortunately I managed to learn some stuff from him today.

 

And then the China nurse called for time out, which is to read out the patient’s name and NRIC and name of operation. You see, hospital X off Alexandra Road has had 4 operations with the wrong side or wrong name this year alone. Wrong side means instead of chopping off your right leg, they chop off your left leg instead. Wrong patient means instead of taking out Mr XYZ’s cancerous testicle, they take out your “cancerous testicle” instead.

 

I was like laughing under my breath when she tried to pronounce the name of operation which was laproscopic cholecystectomy with choleangiography into “lar-probe-scold-pick chole-shit-heck-tomy with chole-ant-chio-graphy” I am like thinking no wonder they so many wrong operations.

 

1 hour into the surgery.. I was filled with boredem. The kind anaesthetist I followed was doing nothing much except recording vitals and replacing bags of fluids. I looked into the screen of the surgery, and WHOA it was the most bloody laproscopic surgery I ever saw. And the surgeon also didn’t bother to suction and he’s like still looking for gallbladder! But it was a difficult case after all cuz of all the adhesions of previous surgery. But he’s like flipping lumps of tissue out to reveal things underneath with his blade which he treated more like a chopstick to lift things off, so of course wherever he touched it bled la. The anaesthesia MO also shaking head and whispered “he anyhow cut one.” Then the surgeon shouted “sian la What a lousy case!” Finally he called for help and when help arrived he said to the guy that came to help him “actually I can do it one la but it will take forever” By then it was 2hrs into the surgery and I was thinking, “yeah right”

 

By then I was cold, shivering (the OTs are super cold), supremely bored and tired, and super hungry cuz it was like 2.30pm and I have not eaten lunch yet. After help came they progressed faster and went on to do the cholangiogram. We had to hide behind the lead shields everytime they pressed the pedal to do the Xray. Then we settled down after that for quite a while, and I was still shivering and hungry and bored.

 

Then suddenly my tutor that I’m supposed to follow came in and look look. Then she suddenly screamed “EH THE XRAY MACHINE STILL ON LEH!” Everyone was like wtf!!! And then we ran to behind the lead shield. Everyone was hiding except the surgeon who had lead suit on already. They screamed for the radiographer who was in charge of the machine, who also somehow was in the other room. When she came in, she was like, “still on meh?” then she stood next to the machine still trying to put on her thyroid shield, I’m thinking, “what a cockster, turn off machine can liao lor, put on shield for what” Then the lights for the machine came off when she lifted off a lead suit resting on top of the machine, then the said “aiyah suit on the machine press the button la, why you all not vigilant one” My eyeballs rolled out of their sockets when she said that.

 

The bloody machine, from the time the cholangiogram was taken, until the time which they found out that it was still “zapping”, had been working for at least 5 minutes, with all of us and the patient, with no shields and whatever except the surgeon, in its field of zapping for 5 continuous minutes.  (according to her it was 5 minutes, but I’m sure it was longer than that.)

 

Now, if you have worked in hospital before, you would know that everytime they take an Xray which lasts 1 second, everyone runs to behind a shield or behind a wall, because these radiation are accumulative.

 

Now, each XRay typically lasts only 1 second, and 5 minutes of continuous Xrays is almost like taking 300 Xrays! Each Xray is 5millirem radiation and the annual limit for public is 100millirem which is 20 Xrays.

 

In that short span of 5minutes, we all, together with the patient, took the damage of 15 years worth of radiation. I wanted to take out the radiographer-nurse’s ovaries and dap with corn flour and fry with pig oil.

 

The younger you are, the more time you’ll have to accumulate additional genetic mutations and more time for the original mutations to act, hence radiation exposure at a young age is deemed most hazardous. And yes, I am the youngest there.

 

Yes, This is what hospital X off Alexandra Road’s nurses, surgeons and radiographers are like.

 

After that I was really exploding already with this fucked up place with lousy teaching  egoistic surgeons and irresponsible radiographers. So I decided to just stand up and tell the anaesthetist that maybe I should leave. I went to find my “tutor”- in “” cuz actually she didn’t tutor me on anything, who then said “actually you can leave long ago, there’s nothing left for you to do already”

I am like fuck you ok! You are in charge of me and you knew very well there’s nothing I can do already and didn’t even bother to tell me when you thought I could go off until I bothered to come ask you. And if she did I wouldn’t need to really endure so many hours with my hunger and cold and boredom and 15 years of radiation. I wanted to open her mouth there and then and intubate her with a dinner fork and bag-valve-mask her with Bygon. Instead I simply turned around without saying another word and walked off back to the other anaesthetist and thanked him for having taught me stuff.

And I left, the monsterous place, which is Hospital X off Alexandra Road

okay I’m prolly the last one to update on Sunday’s FA Com, anyway here’s my version of it.

Woke up at like 4:30 am on Sunday to prepare. Must bring like 10 million stuff including cloth to iron uniform on, chicken essence, panadol extra (Willis every single competition also will fever one), even brought antihistamine in case they cold or flu. I made sure i didnt bring any books. No books from 11:59pm on saturday onwards.

Then i went for my run, which was my way of freshening up. When I came back its time to change into the officer Tee and get to school

MSHS is spooky at 6am anyway when I was there they were already eating Macs happily. It is almost as if today wasnt com at all. I could sense some anxiety from Jingwei and joson but willis and Wl were like crapping non stop. Luckily Kahmeng had tuition with sec 3s (yes at 6am in the morning) so we werent too lonely with just a few of us.

I got them to do one last round of CPR (somehow its like the everybody-must-do-CPR thing would just come out for sure again.) while I ironed their uniform again.

Bus came, and we got our hands together and did the Maris routine of JIAYOU! before we boarded the bus. we got to Guanyyang before we knew it. Joson was like super nervous can. We went to recee the TOC routes then change into uniform in the staff toilet. Wahaha they barred Kevin from entering cuz he’s the only non Staff sergeant. diaos

Uniform inspection was about seeing WL estatic face when they drew AA1. They were like yes yes yes yes! We had a discussion a day before that the number of the team more or less indicates the final position, last yr they were AA3 and they were 4th, so they wanted AA1 this yr. And the last time we won AC we were AC1 also. Sigh superstitious.

Anyway HSC took AC9 and they stood next to our team and walter took a photo with the 2 teams standing side by side. Zone 10 for the kilL!

After that saw my senior who was M5 and now house officer. She was our Zone com judge for short case and she’s damn screwed up with her judging. When I saw here I was like omg luckily I taught them the 6Ps for tight bandage, wonder what she’ll ask this time again. Luckily she went over to AC and i was like PHEW! True enough that siao zar bor gave like quite nonsensical marks for AC.

And soon com started. WITH LONG CASE. it is like what i told them la. They said they wanted AA1 and i told them they would have to do long case 1st, with the judges not warmed up and casualties at their bitchiest and most insane. The problem with doing 1st is not just that. Even if u got best long case i doubt the judge will let the 1st team get highest and the whole day have 9 other teams with lower scores. Sure will be tempted to give at least one team later higher marks one lor.

Anyway their case was ok although willis seemed overwhelmed at first.After a while everyone was in the mood. But they got cut at 8th minute. I was like wth and i can see willis was like wth also. Later on he told me he thought the judges thought it was so bad they wanted him to restart the whole case, like training.  lol. but it was ok la i have nothing much to complain about.

Next was short case. Was quite happy with it except they cant push away the darn table and dunno wad jingwei doing making all the passerbys fa-zhan at the side and stand for eternity throughout case. And like when the judge debrief them said they must diagnose vasovagal syncope instead of fainting. ZZ another judge that likes medical terms.

During case they used the blanket and pulled it open during thorough body check and used it to block spectators for casualty privacy. However they conveniently slapped it in front of the HSCS supporters who were watching. its like…. In-Your-Face, Bitch. LOL Hiranto eyes almost popped out. Think they thought the team did it deliberately. Nvm they will understand next yr. And then the yr after that everyone would be copying it. ZZ

Next was FD, and I was quite unhappy with it because Willis Zao-sia and he even samura-ed once. And WL was like dreaming and lagged twice. One bangs only came occastionally. And JW’s drill bordered on the famous toufu drill, pioneered and perfected by Andrew. And I thought I heard teddy bear commands when they backfaced the judge. Overall I thought it was average only and it was a fair price to pay for concentrating all on FA the day before.

Then i saw Zone 7 drill and thought it was pretty good. That of course made me more depressed.

Then came TOC. Woa. How do i put it. It was extremely… grotesque? They took 10 million years and I didnt agree with the method. I was watching until I foam in the mouth can. And Walter was like quite upset also. Their flexible splint was like some blob of blanket and they spent like 1 day trying to load the casualty into ambulance cuz the thing jammed. ZZ all in all it was a catastrophe.

I remembered telling walter they better get best long case, or it will be game over. Sigh. we clapped nevertheless.

After lunch was uneventful waiting and looking at other zone10 teams. AC team was not bad at long case. They have a rather different style from us though.

Before we know it we were waiting for prize presentation. Haha I spent the whole time playing with Weber the bunny that Walter’s team gave us 4 yrs ago. We turned it into recovery position and made a cervical collar for it. Diaos we were super bored. Think the hsc ppl next to us think we are some sot sot psycho. All the number 1s lined up staring at us also. We also keep snapping shots of Dexian during his scandalous rendezvous on stage. LOL.

And then came prize presentation . It was NC first. Anyway they lost by a mark. The hsc ppl quite sian diao.

Then was AC. Our ZC on stage screamed YESSSSSSSS!!! and clenched her fist in like a MUAHAHAHA-YES-WE-WIN-manner when they announced best leader, and yes it was only best leader. A bit malu.. lol. Anyway Ac bulldozed through everything. Good.

Then was NA. they like got best FA, and we didnt expect them to win but when they did everyone was pretty shocked. lol

Then was AA. Woa my heart almost stopped. The way they announced this yr can cushion the impact though. And We didnt get best leader as expected. Judges don’t particularly like teddy bears even if they are cute. Anyway ours ain’t cute at all.

When they announced CPR i was like, they better get best CPR. Anyway they did but they tied with Zone 8. Tieing with another team is almost like losing, esp when it’s zone 8. I was like quite sian. And then was long case.

They were 1st runner up. I tell u I really got cardiac arrest. Like must bang into wall kind. I looked at walter and shake head. Game over.

Then short case. 1st runner up again. Melt already.

When they announced the champ for short case I was like muttering "split split split!!!" not zone 6 again can liaos. Then it was zone 8. Woa a gush of relief washed over me. Our cadets all clapped for screamed YES and clapped insanely for Zone 8 when they announced. They didnt do it to spite ppl but they were just extremely relieved. And jeremy took a photo and told us we only missed SC by 1 mark. Suddenly got a hint of hope..

Then TOC. And GUESS WHAT THEY GOT 1st runner up AGAIN! Muahaha I screamed Keh-Long!! whoo hoo! Omg how in the world that kind of shitty TOC can get 1st runner up I dunoo.

And FD, 1st runner up agaiN!! LOL i was like, the judges are blind is it!! Yes!

By then the results are clear. But i was blocking everything out, must hear with my own ears.

When they won, how should i say, just seeing them jump up and down was enough. Sometimes, trainers like us live for months waiting for this moment.

Good job guys! Thanks for bringing Maris Stella St John back on it’s feet. It’s time to celebrate and keep our humility.

Next yr Zone Com will be a mighty 4 way battle again. Actually I really think we should thank the rest of Zone 10. With an insane level of competition at Zone 10 every yr (with like 4 different corps of National-Champion level fighting for just 1 throphy per category) and keeping us on our toes. This yr’s Zone com has already been insane but Next yr’s Zone com will be the most intense the world of St John has ever seen, with HSC and MSH adult teams retiring. We’ll work harder, and Bankai.

JiayoU! =)

Normally I dun comment on these sort of thing. But it irks me enough to compel me to lap it up. There have been some reports lately on aesthetic medicine practiced by GPs. The argument put forth was that some of these procedures are not evidence-based, and that it is hence unethical to offer them.

Well first of all, I dun understand why that argument is valid if all other non-proven or partially-proven alternative therapy like TCM, chiropractice etc are still allowed. Secondly, aesthetic medicine has been in the primary health care for so long, why is it only now that people from the

Academy

of

Medicine

and

College

of

Family Physicians

bring up that they discourage these certain procedures. But surely, please, don’t tell me they were ignorant of these modalities happening in GP clinics all along. It is so rampant for goodness sake! Every doctor in

Singapore

knows at least 2 or 3 GP friends/ seniors/ lecturers/juniors cause many come from that one faculty of medicine and that 65% of all drs per batch become GPs. If you have 5 friends in med school, 3 would eventually be GPs. It is impossible for these people not to know that the trend has been there all along!

Yet, the funny thing is, no one commented that some of these procedures were “snake oil” or “unethical” UNTIL some big card from MOH started the controversy by mentioning it in the papers. Then when reporters ask, many of the “cards” interviewed felt that “oh ya, its unethical indeed..” or “yes it’s unproven at best” It has just become something convenient to jump on the band wagon and say the POLITICALLY CORRECT thing when NO ONE said anything all along. Now, it is like, if you want to show that you are a honourable ethical doctor on moral high grounds, you should slam aesthetic medicine as much as you can now. Oops. I forgot you knew these procedures existed all along. If it is so unethical and SO puts patients at risk, wouldn’t your highly moralistic and ethical faculties have prompted you into urgent action much earlier? Or is it some BIG card from MOH first remarked on it, and hence NOW you have a SUDDEN BOOST in your ethical faculties?

And honestly I really do feel that unproven modalities are unethical only if you DID NOT explain to the patient that it is unproven.. The thing is, people have informed choices. IF you propose a treatment that is unproven, and you do not come clean with the patient, and you just want to earn $$ as a result, fair enough, you are unethical. But if you propose a treatment that is unproven, explain everything to the patient (including the fact that evidence is lacking on its side) and he or she still prefers this (because of cost, lack of other options, etc) why is it unethical to work on patient’s informed preference?

It is insane really to think that all medicine has to be practiced on the grounds of evidence. I don’t deny that MOST of it has to be so. But it cannot generalize to every aspect of medicine. Sometimes, robotic rules do not apply. Take for example, THEY DO TEACH US that in palliative medicine, all the patients who are terminally ill, you do not blast them with cocktail chemotherapy drugs when obviously it is almost impossible to be cured of a cancer that has spreaded EVERYWHERE. When patients are dying, you simply do not make them suffer more in exchange for little curative effect. We just give drugs to relieve pain and breathlessness and wait for time to let them go as peacefully as possible. This is an example of an area of medicine that is counter-intuitive to the medical establishment’s “heal and cure EVERY patient” and “your primary job as a doctor is to prevent people from dying and SAVE LIVES”

Note that in terminal illness it is a balance between quality of life and quantity of life. Lets say you have 3 years to live by quality of life 2/10.  Multiply that you have 6. But if you have 1 year to live but quality of life 10/10, multiply that u have 10.

Now, name me a journal article as evidence that palliative care does improve this multiple of both factors. Who knows you are cutting too much quantity to improve on quality (by ceasing chemo and treating symptoms) and vice-versa?

You see, how to prove something like that? There’s no such evidence!! But every1 still do palliative care!

In the end, common sense applies more than cold hard evidence.

They say carboxytherapy is unproven, and it is unethical to offer them. What if Mr X, a 31 year old Chinese gentleman, comes in, obese. He says he cant afford lap band and liposauction. His whole family is fat and has familial hypercholesterolemia. He works from

8am

to

9pm

everyday like a dog to support his family. Lately he has martial problems and has low self esteem.

You tell him, since you cannot afford lipo, the only option is to exercise and diet to reduce weight. You advice him to try to reduce his stress levels.

Oh please.

As if he didn’t already know that, doctor.

If he could do it why would he be seeing you now, smart alek? People dun grow fat overnight.

Diet and exercise are good things, but human nature is such that people want to see instant results. In this situation, I offer carboxytherapy, but warn him it is unproven. I explain that he may spend the bucks and end up with no results and some more added bruises and side effects. He agrees to it, and says “I rather have a chance of slimming rather than have no chance of slimming by doing diet and exercise which I have already tried. I cannot stand people laughing at me in the workplace, day in day out, EVERYDAY, ANY LONGER”

I perform the procedure, AM I UNETHICAL?

Evidence based medicine is good, but life and people and disease are such fluid complex things that management by a doctor cannot be confined to the narrow domains of flat yes or no proven by evidence. If it was indeed so, there is no need for doctors, only drug and MC churning machines.

In the papers today, we were told to remember our oaths. For goodness sake, the oath is that we should serve the patients’ best interests. In the end it is more important for patients to be happy than you being happy with all your self-congratulatory, self-righteous thoughts that all your treatment are proven effective.

Because, that way, we are not treating them, we are actually treating ourselves.

So spare us the hypocrisy of your suggestion of our hypocrisy.

2007 is ending soon, and as I had written exactly one year ago, I said I needed a bracer (dota speak, if u have no idea, nevermind) to tide tru this year. Well, it didn’t take me long to realize that I needed much more than that. This year I died so many times that a skeleton king with ageis would feed. I think all the mere mortals in med fac did, let’s not talk about the holy pple. Anyway, it was a really rough year.

The year started out with a bacteria CA (omg that seemed like so long ago) that ate up my Hariraya, Xmas, birthday, and new year’s eve of 2006. And that followed by strings of CAs for COFM, pathology, genetics, neuroscience and so on that again ate up my Chinese New Yr. After that was incessant mugging for the 2^nd mbbs exam which I remembered them showing us a pic of penis with a lot of genital warts that look so creepy I felt like scrapping them off with a penknife. That and a lot of unexpected questions on syphilis diagnosis and things like that. As usual, they dun ever give medical students a break. Not even in the stinging cold, tense, oppressive exam hall.

After that was a short break which I got to carry out my

St John

duties. Training the teams this year was fulfilling but insane. 3 new teams to start off and so little time. If it wasn’t for Walter and the rest of the officers I would have been driven crazy. The results were not that bad. They came in 1^st, 2^nd, 3^rd although they lost one impt category. I guess when you have been tru so many years; you won’t allow a defeat to ruffle your feathers anymore. You simply soldier on with whatever remaining mettle and steel. We will never crumble that easily.

Before I knew it, foundation course had began, it was this crash course where they taught us how to clerk a patient (asking the correct qns, performing a physical exam properly) to arrive at a diagnosis. It’s called CSFC. I think, to a certain extent, CSFC had indirectly determined my learning attitude for the rest of the year.

I remembered feeling very disillusioned that time. Because it was the first time I think I really saw really ill patients. Really ill literally means dying. Things that you see in TV and books and that you mugged for in 2 years cumulates to what you see in front of you now. And I remembered at that time all my classmates were really eager to learn, and so was I, and somehow that enthusiasm turned ugly when people were really kiasu. In that hosp there were about 50+ of us, but there are only so many patients. Some of the patients were clerked like 6, 7 times in a day by different people. Can u imagine when u’re warded and everyday u have to see 7 people who ask exactly the same questions, and do exactly the same physical examination on you, 7 times a day. It was crazy.

I also saw during CSFC just how deeply medicine can erode you and turn you into something that you never thought you will become. Every day I follow my tutor in the clinics and wards, and it was the haunting mechanical robotic way that he practiced that really got to me. He did calls like 2 to 3 times a week, and he stayed till

5pm

the next day after calls. He worked so hard that he didn’t even look tired. He saw patients in clinics for followup without even looking at their faces, and dismissed them within minutes. He just went around doing his stuff like some medicine-churning surgical machine. There was no comfort, no warmth, no empathy, only cold, bloodless efficiency.

I remembered thinking, what happened all these years to degenerate him to this state? At the same time, I also thought about how much he must have sacrificed to work so hard. He looked like he was probably fit and good looking before and now he’s plump and balding. Which guy in his 30s would wanna be like that? And looking at his schedule everyday I had no idea what he could possibly do with his personal life.

I shudder to think that he started out like one of us, eager, empathetic, only to degenerate over the years, enslaved by medicine but stuck at where he was. I can’t decide whether he was an uncompassionate mindless ghoul or a heroic self-sacrificing senior. I respect him and condemn him at the same time. And I wondered if he offered a peek into my bleak colourless future.

There were redeeming times, of course. I remembered my very 1^st night call with another medical tutor in the ICU. And the very first patient we saw was this trembling guy on the ICU bed. He was having rigors non-stop. He had a high fever, probably from septicemia. The thing that I really remembered was the fear I saw in his eyes. Real, cold, intense, gripping fear. He was trembling so bad from the cold that he just kept repeating “Cold! Cold!!” Me, a medical student, staff nurses, assistant nurses, the MO and my tutor who’s a registrar were all there. It was amazing because every1 just worked so seamlessly. The MO reported that the O2 sat was low and my tutor was puzzled because the sepsis should be from the gut, not lungs. He ascultated and found nothing. They had to draw blood and do an ABG. The MO did it and the assistant nurse helped to clear the sharps. The staff nurse added another blanket for the poor guy, and my tutor asked for the mat thing (what is it called?) that you can put on the bed for him to lie on, which can generate heat. Me, of course, was redundant as usual in the link, doing nothing except standing around and patting him on the shoulder and talking to him to hopefully make him feel ?better ?harrassed, and of course, answer questions that my tutor randomly threw at me.

But I was really awed by the way every1 just fell into place so nicely, and I saw the teamwork and how every1 was aligned with the same objectives and I thought, wow, the allied health professionals were really a force to behold. Already the guy was feeling better. And I am glad I could be part of that team next time. Not just that- it showed me that small things like blankets and mats matter just as much as definitive treatment do. I felt that they really cared for this guy who was trembling real bad. They could have just chucked him away with antibiotics that will treat him anyway. But they really stuck by him all along the way. These were the things that they dun teach us in medical school.

He was about 20, my age. And I thought, this guy could be me. I could be lying there. While impressed with the work that every1 were doing, I was also perturbed by the fear that he was experiencing. Rescue came in the form of visiting parents. We went out to give them some quiet time together. I looked at them afar for a while. His mum held his hands and his dad stood at the end of the bed. The typical Asian family- the mum comforts and the dad is supposedly more cool but is equally anxious as well. But the atmosphere really changed. He looked at his mum really intently, and she was stroking his head. They weren’t even speaking. If I can look into his eyes again I think I would surely see his fear melting. It’s very drama I know. It’s like those soap opera on channel 8. But it was really touching. And I thought, diseases remind you of what really matters most in the end, of who and what you hold dear to most. I bet that few seconds when the 3 of them were together in that ICU cubicle, many things were held at infinity, unspoken but felt and treasured forever.

It was a brief 10 minutes inside there. But I emerged from that cubicle feeling like I leveled up.

There was also this uncle I met in the wards. He refused to talk to anyone, and shooed me away even before I was within his 3m radius. But there was something about his shooing that made me feel that I should go talk to him all the more. It was that kind of shooing that said he actually wanted you to listen (yes I have a lot of experience getting rejected) He was going on about, DUN TALK TO ME, I AM AN OLD MAN THAT NO ONE WANTS. Etc

So being bold enuf then I took a chair and sat there, trying to work my charm so that he wont chase me away outright.. When I sat down I promised not to ask him about his medical problems but he can tell me any problems he has and I would just listen. He started vomiting out all his family problems. I just sat there like a receiving vessel and did what they taught us to do, which was to reflect back his feelings. Truly he was wrought with social problems aplenty. It was a really sad situation. But I think what he was really sad about was that no one visited him at all. From then on I made a point to try to find him everyday. Wow you should see his face when I enter the ward, it’s like Voom, his whole face lit up. He even smiled!!! And I was happy because he was happy, and also because, you see, as med students, most of the time we dun feel appreciated and people make it a point to make us feel like a nuisance. At that time, I felt like I was actually allowed to feel useful.

Everyday when I saw him, I actually talk to him things I normally didnt get to tell other pple. Like “that MO thinks I’m a retard. He looks down on med students like us” and “I got scolded today by my tutor” and “I got scolded by nurses. It’s not my fault that I dunno right?!” and things like that that even my lesser friends would think that I’m simply whining, but he would actually grin and listen and occasionally actually console me. LISTEN to this ok, a patient actually consoling me, a med student, what more could I ask for? He even tried to teach me stuff, like showing me his AV fistula and telling me it’s for dialysis and so on and how it works (though I didn’t know what he said was correct at that time). I was really touched when he tried doing that then.

When I ended posting there I went back during break once to see him and tell him that that might be the last time I would be seeing him. He had no home so I cant get his contacts. He was going to a nursing home, but didn’t know which one yet. I gave him my contacts but he has never called. I wished I can still see him now. Till the end I still didn’t know exactly what his med problems were. But it was a friendship that was forged under the most unusual circumstances, that was cherished, that was lost, that is still treasured.

That and my hilarious 1st scrubbing experience I gushed about in a previous whiney entry.

CSFC was a virgin experience of the roller coaster ride that is medicine, the tainted dreams, reality checks, lost naivety, mixed emotions, reinforced passion, intricate thoughts, extraordinary bonds, transient friendships and endless melancholy that ensnared us while it reared its face for us to decide whether it is beautiful or ugly or both, and finally to look at it straight in its face anyway, and take it for what it is.

Med posting is over and boy I guess I learnt loads but could have learnt more if I was more hardworking. Just couldn’t get myself to read up after reaching home at

7pm

almost everyday.

The end of posting test on sat was horrendous. We had an MCQ paper, 1 long case and 2 short cases each. Long case is just coming up with diagnosis and investigations via history taking. Short case is physical examination and diagnosis. Each patient was paid $50 for every candidate that checked him/her. It was rather real cuz there is no simulation, so what he has is really what he has. And we do it alone of course. I find it cheesy that they call the FA cases in SJ Coms short and long cases too. But they do that in teams. Well.

MCQ was like, LOL all repeated from past yr questions, which my group sat down and came to a consensus to the answers for each question beforehand already. The new questions, some are tricky but do-able.

Long case was on a man with shortness of breath and bloated abdomen and swollen limbs for 3 months before coming hosp. He is well now of cuz. It was quite funny cuz the moment I sat down he told me the diagnosis right away “I had water in my lungs, they used some medicine to get rid of the water” I did a write up on fluid overload in chronic renal failure be4, so it was ok. In fact I was so 100% certain it must be fluid overload I forgot to ask him whether he had orthopnoea and PND, which the judges grilled me on later. The bad thing was when I asked him for med history he just told me diabetes and renal failure despite repeated qn and gave me a whole bag of drugs, where I saw atenolol and simvastatin -__- I forgot to ask him about how long his hypertension was diagnosed as a result. Grilled. After 15mins I presented and after uttering the 1^st sentence they judge started firing me chains and chains of questions. I was quite confident so it was ok handling them. He asked some tricky questions like why I bothered to ask for giddiness when he sits up and what would I want to check for in abdomen examination in light of his hypertension.

Short Case Was Horrendous.

All the things that I hated/ feared/ most noob at came out.

First station was to perform a cardio exam. When I saw 2 judges I already minor freak out cuz they look familiar and they are so stern. And I sort of assumed the beds are already 45 deg before I started. So I forgot to put it up, only doing so after doing collapsing pulse. The collapsing pulse was suspicious, but I haven’t really felt a real waterhammer pulse before to confidently say it was collapsing. The JVP looked suspicious, but I judged that it really isn’t one and is more prob a carotid pulsation. The apex beat was not palpable so I turned him to the side and I thought it was displaced. I found it odd that the apex started slamming once I turned him.

The real danger came during auscultation. At first I could hardly hear anything at all, and I thought, this must be one of those guys with congestive heart failure. After a while, the murmur came tru. And I realized, all heart murmurs almost sound the same. I thought I heard it in the mitral area but it got louder in the tricuspid. It doesn’t radiate into the axilla (I was hoping it would cuz I am better at mitral regurgitation) and failing to hear that I already minor panic again. Then I hoped it radiated to the carotids, which again it didn’t, and ejection systolic murmur is my 2^nd best. It doesn’t radiate equally in all direction, so its not a ventricle septal defect either. By then I am already jittery cuz actually I am only proficient in these 3 and I always always thought they dun bother setting diastolic murmur for year 3 exams, and I dun expect myself to be able to pick up those yet either.

I timed it and I thought it was systolic. (or maybe subconsciously I wanted it to be systolic too badly) I heard it better when I leaned him forward. And I really heard it best on the tricuspid area. So I thought it must be tricuspid regurgitation. When I presented I was 50% confident. But the look of the judge face tells me it was screwed up. He asked me whether it radiates, I said no. And he asked me when I heard it best, and after thinking in detail, I actually said S2. wad an idiot right, you tell them u hear a pansystolic murmur and u heard it better at second sound. Wad an idiot, I felt like slapping myself.

To my horror later all my friends said it was pansysolic also. And one said it was ejection systolic, to the much frowning of the judges. The last guy said it was diastolic murmur pulmonary regurgitation which the judges were semi-happy with. After thinking we all figured it must be aortic regurgitation early diastolic murmur. And I really hate myself. Wad an idiot, of cuz it must be AR right? Heard best when leaned forward? Tricuspid area? Weird collapsing pulse? Displaced apex beat? I guessed my downfall is timing it wrongly.

SC2 was neurology. Whoa. The lady had drooping face on one side, but ptosis on another!! After doing CN3 I realized it wasn’t ptosis. It was a lower motor neuron cranial nerve 7 palsy. I sort of missed out some steps, like feeling masseters, jaw jerks, and testing for hemianopia and Rhinne’s and Weber’s tests. I shld have done them, cuz I finished my exam so quickly and left the judges so much time to ask me questions. It sucked! I told them my diagnosis and they were ok with it, but they keep grilling me up and down about the causes.

“What causes 7^th nerve lesions?”

Zonked out and blanked out— “erm Bell’s palsy?”

“Tell me about Bell’s Palsy”

In my head I m thinking Arghhh. Thinking doesn’t reveal much. “Its an isolated lesion sparing the other nerves.”

“Ok so, What causes it?” I zonked out. Ok I completely didn’t mug this.

“Infection?”

“What type of infection?”

“Neuritis?”

“Neuritis?! What type of bacteria or virus cause 7^th nerve neuritis?”

MELTING- Erm actually I am not very sure (my friend later exclaimed when I told about this. HE screamed, “BELL’S PALSY IS IDIOPATHIC!!!!!”)

“So you are not very sure huh… So what causes 7^th nerve lesions?”

“IS it post infectious?” I know I am dead once those left my lips. Its vestibular neuritis I confused with.

His face wasn’t very pleasant looking.

“You thought it was post infectious?”

“yah.” Molten like volcano already.

He was so sad and he was thinking about other things to ask.

I thought for a while and then suddenly yr 1 anatomy sort of flowed back to me. At least part of it. So I suddenly gushed.

“Oh 7^th nerve travels from the cranium and pierces the parotid gland before reaching the face.”

Immediately both of them nodded.

“So for her lower motor neuron lesion it can be a partotid gland tumor, parotid gland malignancy involving the nerve, parotid gland surgery with damage to the nerve, parotid gland enlargement, parotid gland trauma, parotidomegaly due to duct blockage and alcohol-,” I gushed. I said it as if my dear parotid glands are my life saving buoyant in the middle of Alantic ocean and I am floating to north pole. While I said it, their faces ranged form the “finally-you-can-say-something” face at first followed by the “happy-you-can-answer” face followed by “ok-ok” face followed by the -____- face.

I beamed after finishing.

Then he asked,

“Ok what are the OTHER causes besides those to do with the parotid gland?

@__@

“Ok, nevermind, what is the common type of cerebellopontine angle tumor?”

“Common type of cerebellopontine angle tumor??!??!?!?!” I sort of repeated after him. I was so defeated I actually laughed right in front of him, bitterly sadly and funnily like, omg you actually asked me that. Just let me die can.

(I learnt later that it was acoustic neuroma.)

“Ok nevermind, what other nerves travel close to 7^th nerve?” After much struggle and getting it wrong at first I said the 8^th. HE was like “YESH! THE EIGHTH!!!” It was like as if he held his breath for so long and finally exhaled. It was a mixture of exclamation, relief and didactic at the same time. Like, ok good job you FINALLY got the answer so you better remember it.

I realized later that there are at least 1 million causes of 7^th nerve palsy. 1 of my friends gushed out the answers. And the reason for the tumor thing was cuz the tumor can compress both 7^th and 8^th nerve, so must always examine 8^th nerve carefully also whenever there is 7^th palsy. I guess all my batch mates all knew it like way before I did. Well, I hated doing cranial nerve exam. But there’s no excuse.

How I hoped I got like an enlarged liver, or a VSD, or a COPD or respi exam instead. Sigh. But better now than have these horrors at finals.

I heard later that my CG mates got those exactly, just all those I wanted. Omg. But in other hospitals, it was INSANE. They actually can get one station on psoriatic arthritis and another on gouty arthritis. They get systemic lupus for long case. And there were polycystic kidneys to ballot and SYRINGOMYELIA and ACROMEGALY. Can you believe it. Never in my dreams I thought they would actually make us do diastolic murmurs and things like syringomyelia at m3. If I melt doing CN7, I absolutely CAN DIE doing acromegaly cuz I never study that and never seen one before. I will just stone there and like, erm examine what?

The lesson is that it doesn’t matter which year you are. Dun assume they are kinder when you are not m4 or m5, they are ruthless in every exam. Actually I should know that by now. That day I was looking at my 1^st year physiology exams and they actually have a question on Obstructive jaundice! And another on- HEAR THIS- Artial fibrillation causing Budd Chiari Syndrome due to secondary embolism. Its insane!

So as u all can see, dun ask me for downgrade next time. I wun be able to pick up anything wrong with you to downgrade. =(    =(   

Be warned. This is a giant rambling.

I must be the most blur most cock most noob most sway med student in the world. Seriously. It is a miracle I haven walk out and get struck by lightning yet.

My first scrub in into the operation theatre was like a dive into hell. It was like those those theatres you see on Tv, except much bigger and with more sci-fi feeling. There is perfect 10 rumbling at the background when the surgeons operate. I remember hearing Avril Lavgine’s Girlfriend on 987fm while the registra was removing an inflamed ascending colon.

We didn’t know how to scrub in, and the tutor dumped us to a staff nurse and leave her to “teach” us. She told us to wash hands. Ok, so I did. After washing merrily till the 9^th out of the 10 standard step, she suddenly appeared beside me and said, “Your hands MUST be higher than your hands when you wash so that the dirty water dun flow downwards to the hand!” I was like. Hm. Ok ok. So have to rewash from 1^st step again lor.

Wash wash wash. Ok so now wash finish. Hands up. Take towel and wipe. Wipe wipe wipe, hands, den wrists, den forearm, den a last swipe up to the wrists again. Then suddenly I can hear the rapid indrawing of the nurse’s breath— “No No Nooo!!!! when you wipe down cannot wipe up again. Forearm is not as clean as hand!!!” I was like O_O! ok so I go wash again again, right back from step 1. .

washed finish. Wiped carefully. The nurse’s so happy that I can finally finish! Oh. Everything is perfect. Nice. Finally can go in.

Den I throw away the sterile towel. You know those metal dustbins with a lid on the top that your foot press a catch below so that the lid opens. So I throw the towel. Den my foot release too soon. And my hand got Kiap-ed by the mouth of the dust bin.

You can see the nurse face turn yellow and jaundiced. I think I can imagine a trail of frothy red blood coming from the sides of her mouth.

So I rewash AGAIN again again. By the time I finish and gown up and glove on and so on. I went in, FINALLY SCRUBBED UP. The surgeon was doing… Erm…. Stiching up -___-… So ok. Tutor ask me to help the MO hold the clench thing. Den I walk in, watch watch a while. Think he was doing simple continuous stitch, but it was too fast for me to catch and I forgot how to stitch already. I put my hands down and accidentally touch the table linen below.

My tutor saw and like @_O “that is not sterile. You cant help to stitch…………” after a long pause he said “you have to UNSCRUB”

-____-@

So I scrubbed for 30 mins went in and didn’t last 3 mins. LOL Ivan looking at me was like quite ROFL also

So I went outside. Unscrub. What is unscrub??? So I took out gloves, gown, shower cap, mask.. unscub ma. Unscrub right? Everything extra take out ma. Den like stand there for a while. Den like the nurse came in and like O-O You cannot take off cap and mask when you are near OT. Now you cant get out, the sister will catch you. Ask your friend go down bring a mask and cap to get it on again.

Urghhh it was so disasterous I think I made history as a menace. Diaos. But seriously I didn’t know a thing before I went in. But anyway.

Talk about OSCE, which is this end of posting exam we had. We were supposed to take blood from a dummy arm. He has fake blood in his “veins”. It was a vacutainer method. So I fix the needle. The lid wouldn’t come off. Examiner say change another. Changed. Fix needle. Lid wouldn’t come off. Examiner say never mind, change again. Again lid cannot come off. 4^th time try, ok lid finally came off. Ok so now I warily poked the veins. No blood. Take out, poke again. No blood. So he ask, what are possible reasons? I crap a bit, den he said, ok. Now dispose the needle and the dispose sharps. I use the yellow container, the thing wouldnt come off. So he said, never mind, just throw it away. So I throw into the blue basket bin. He was like… “Nooooo!! Throw it into the ????” I didn’t catch. So I dunno did wad. Bacically I cyclically dumped things between the sharps box and the kidney dish and the blue bin interchangeably until he like so pek chek he like “OK. JUST leave the things here and MOVE to the other station” So I ok okok and just left. I think if I stayed a bit longer he will get a myocardial infarct

So after OSCE was hols. We planned a night cycling trip. I was like, just bring some FA supplies, yourself bat. Screw the extra clothing and poncho. Even if rain, you want to wear poncho meh??

SO We started at 1800, with cool weather and all. Cycled from East Coast out to Katong and then Geylang. We ate dinner, which was the exorbitant, kill-pple-start-fire beef kway tiao that taste more like beef mixed in peppered viscous gel and paste that cost an astronomical $5. Then went next door for the beancurd and you tiao. V nice. We started off again.

Cycled off to national stadium then to Suntec and Esplanade and then to Raffles place and then to the harbour front vivo city and then in to the

Labrador

park. It was

9pm

already. Go explore the park for a while. Then, the sky turned dark and cloudy and it started to rain. It started as like, some sparse drops kissing your scalp until it decides to eat it whole. It poured like mad while we waited in a lonely dim lit shelter with our bikes.

When it finally stopped at 2230 with us a bit morale down, we started in the drizzle that was friendly at first. When the skies found out we started riding it became stronger and stronger. We rode to Mac Ritchie and then to

Holland

village by

midnight

. When we are wet, drenched, tired, cold, hungry and Jack with some back pain. We went to NYDC to eat a pizza and baked ourselves with the air conditioner outlet (the one with the fan blowing hot air) outside. We then planned the next route to Jalan Kayu and finally set off.

By then we are well rested, dry, happy to go and well planned on the next route and looking forward to eating the prata there. So we set off. It has stopped raining.

15 mins after we set off. It started to RAIN. -____-! And this is the not big not small rain that you dun stop but will kill you as you go along type that was so pissing off and irritating and bloody annoying and pissifying that you wana kick the clouds in the balls for their random pissing. ARGHHH!!!!

SO we cycled anyway. For the next 2 hours. Guess what?

After crossing a road, the distance between me and the rest started to get further and further and it became harder and harder to control the bike. And I was like, what’s wrong sia? It is so slow now, the bike. And at one point for a long stretch I dun see them in front at all, they are far far far far ahead. I even got down and pushed the bike along and ran. (faster)

When I finally saw them, I was like, the bike’s wrong. They took a look and pointed to the flat front tyre. We wheeled the casualty into the petrol station and the rubber cushion of the tyre came out and made a star sign across the wheel. It cant even turn now. SO I have to CARRY it. When We FINALLY reached the station, we saw this….

This..

This…

Soab knnccb THUMB TACK inside the WHEEL. WTH SERIOUSLY THE ROAD SO BIG I CAN ACTUALLY KENNA SUCH A SMALL THUMBTACK LIKE WTF SIA HOW SWAY IS THAT. The probability is like 1/1000000 we chose that road and we turn at that exact spot and when we turn there, the 2 didn’t kena but ONLY I did . The TYRE OF A BICYCLE IS SO NARROW NOT LIKE CAR and must kena SUCH A SMALL THUMBTACK ALONG A RANDOM ROAD THAT NO ONE ELSE KENA. Woa lan eh.

We tried to resuscitate the bike with the pump and all but it keep on going back to pnuemothorax until we gave up.

We surrendered and went to eat prata. Rain has already stopped. TD ate tissue prata and onion prata and garlic prata. I ate banana prata. Like goring pisang lol. We slack there for 2h until 0500 thought got no

midnight

charge den take cab down back to east coast wait till 8 to return bike.

So happily took cab. And then reach at 0530… and realize there is

midnight

charge. Coasting $22 per cab

Nevermind. We locked the bikes near macs and we intended to walk around. Weather was cool. No rain. But we ended outside the shop and sat on the bench until we fell asleep. We all like damn chui le. Sleep for a while, den like, howcome the surroundings more and more cold huh???

IT WAS RAINING AGAIN. With the bikes locked so far away we are like &#$@%$%, have to run there again! We unlocked the bikes in rain, and for me, CARRY the bloody bike in rain lol for the final time. Even return bike also must torture us one last time!

So school started yesterday at NUH. I left home at around 0750, way before my bro. After 40 mins travel by mRT finally reach bus stop for 95. waited for a while. 95 came. Very crowded. A whole lot of us tried to squeeze in. Then like squeeze until, I am the last, and the last person who squeezed in was on the last step and the door closed. AND I WAS THE ONLY PERSON LEFT BEHIND THAT COULDN’T SQUEEZE IN. So waited for 95. no 95. it was like 0850 already. I gona be late. So I took bus 198. and drop at the industrial area and walk to NUH. It was hot and sunny. I sort of half ran. It is terrible to be late on first day. I jay walked across 2 roads. And I sweated like hell of a pig.

Ran. Ran Ran. NEar the entrance of NUH, I looked at my watch 0858. happy to be early. Then suddenly I heard a bus coming from behind me and speeded to the stop in front. It was a bloody bus 95. I am serious -______-!!!!!!!!!!!!

So I reached at the nick of time and sat down in the seminar room. Flipped the pages of the introduction and time table and saw my name under a column. It was a night call schedule. And mine is on 26/6. Isnt that tml? So I have night call on the 2^nd day? -_-

Today I came in the morning to do ward work. We started clerking cases. We did 2 cases. The first was having widespread abdominal pain. I was like “what causes widespread ab pain? Peritonitis?” but his history is not compatible with that. It was so like ??? until when we read case notes, we realized he didn’t tell us so many stuff. And he has ST elevation which was like a silent heart attack. They wrote impression as Brugada syndrome. What the hell is Brugada syndrome? (my colleague says its some disease they say the thai workers die of in their sleep in the newspapers) There are many strange diseases but this is just like alien la. In so many hosp end up here and so many wards must be in mine and out of so many beds we go interview that one. So we have no idea what it was and we flipped some books. No mention. We went to a 2^nd case. It was an old uncle who presented with intermittent cluadication until we asked where is the pain. He said knee cap. Where got pple get claudication at knee cap one? Ask his past med history he said no nothing, but he smokes and drinks.

Check the files. He has HISTORY of diabetes (which he denied) and hyperlipid and does not smoke nor drinks. So the whole thing is messed up. Its like, ok so maybe he is a bit confused. Went to a 3^rd patient. Lump on the back with coughing blood. Took history. Check file. It wrote “Tachybrady syndrome” WTH is tachybrady syndrome La!!!!!! AGAIn so ulu pandang not in the books. *^$&&#@$^@ Se riously I never heard it in my life. It was like the whole place no 1 decent patient sobs sobs I like so dui you know 1 patient take how long to clerk la sigh woa piang.

At lunch time we heard that the briefing at 1600- 1700 is cancelled (great la wth I have night call today have to wait till 8pm. So from 4 to 8 do what) and changed to 0800 am tml (zzz I night call till

12am

leh still have to wake up early)

So when lessons ended at 4 I went to skive around till 8 when call starts. It was 4 hours of painful waiting and time wasting. At 1945 I called the dr on call. I met him and he was like, “I am new also, so you go eat dinner and wait for me to take my own history. Go and rest, if you want to go home its ok. If you really want then wait for me while I finish doing my own history taking” I am like        F-______-U       WTH. So I go inside student lounge to wait for his call when he finish which is when I started to type this blog. I waited for him for 2 hours ++ already and its 2222 NOW EXACTLY and I just called him and he said “its ok, you can just go home” WOA LAN EH I CANT BELIEVE IT MAN WTFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF

Zhi jie sha le wo ba

http://www.truefriendtest.com/friendtest/587051

So bored!! did this to entertain myself ROFL

My last post was be4 07 and I told myself I wouldn’t update this place anymore. But oh well. Can’t help it esp when you need to let loose some steam. Bah

Clinical skill foundation course has began and we’re all dispatched all over. I sort of miss some of my frens.. I hardly ever see them now except for the Monday NUS lectures. Anyway well, all these time from yr 1 to 2 when we went tru shit bashing tru books I kept telling myself that all these will take a new dimension when clinicals begin when things like “edema” and “dengue fever” wont be just a word or 2 on a page or piece of paper, coming out of a pen, but something superimposed on a living flesh with thoughts and ideas.

My 1^st day in SGH started at 7 sharp. There was some morbidity meeting among the surgeons. So they presented the cases. The atmosphere was super stiff and the tension was high. It was like “how did this patient die” kind of meeting. We sat there a bit diaos cuz half the time we couldn’t undertstand wad they were saying. As to why it was pretty tense, well, its like a fire and shield kind of mtg.

The rest of e day was ok except times when I was mad at myself at making silly mistakes and saying wrong things like “any last words before I leave?” The patient will look up and ask “What do you mean by last words?” (He did a lap band surgery) Actually I meant “Do you have anything left to say before I go off?” and I quickly twisted it by saying “oh I mean last words before you are discharged.” Den smile. Smiling makes everything ok

And silly mistakes like “Are you married? Do you have kids?” Of all pple I should know better than asking this stupid nonsense. You nvr ask whether pple are married or not. Last time I did that a man cried (I remember it was my 1^st time in the wards at Year 1 PDCP) and this time I offened another. Apparently it was probably a sore spot for her. Z

Out of the 5 tutors we saw over the days 5 out of 5 demanded we learn hokkien and Cantonese and malay and etc etc. Its was tough as hell. In the sgh orthopedic and cardiac wards no one speaks English. Most pple spoke only Mandarin or dialect. Melt. I tried learning hokkien from my mum.

I tried to say “is the food here nice to eat?” in hokkien “beng chai hou jia boh?”.. instead I said “bang sai hou jia boh” (the shit here nice to eat?) -___-!! Luckily I practiced in front of my mum. Or else. I think I will get a bed in the ward.

2^nd day was hell. I forgot to bring my lab coat. But that didn’t really matter. It was a disillusioning and disgusting day. It was one of those days when you stop in the tracks of your life and wondered what exactly you are doing with it.

Surgical tutorial at 0730 was about some m4s teaching us all the various tubes coming in and out of a bowel cancer patient. He has like, 10? lines running in and out of him. Intranasal oxygen, self controlled morphine, fecal drain, pulse oxymitter, ecg etc etc I dun remember the exact names. He was conscious and pretty alert. The medical students in my CG formed a fortress around his bed in every direction 360 degs. (well I suppose it is a rat race and it may come out for the exams HA HA HA.) The m4s fiddled with the tubes and tut us which is which. All of us pointing and fiddling with the tubes. HE is conscious damn it. Who likes to have so many tubes coming in and out of ya body?

He has a small segment of small bowel exposed due to the nature of the surgery. It was protected with some hard plastic cover. We asked what it was, the m4 den like unbutton his shirt and carelessly just exposed his abdomen (the man seems quite disturbed) and poked it with his pen. The fortress of students leaned over in interest.

I mean, he didn’t say it. But a person who need morphine to control pain and has so many tubes, Known he has bowel cancer, just gone tru surgery, has some herniated small bowel, and a whole group of fucken students crowding around him. I mean, what the hell do u still want? I dun think it was our CG’s fault becuz we were just following instructions. You know wad I m saying.

And in the 1000 surgical tutorial it got worse. The dr started teaching us how to do taking history (fair enuf) but he started on the differentials thing and how to do a case summary thing. He made a M4 do a case summary for us. It affected me because, we are here for clinical foundation course. THE PURPOSE WAS TO LEARN TO COMMUNICATE to patients and empathize with them and asking the correct qns. He even went on to teach us abdominal examination (during which they told this old uncle they were going to do the exam but didn’t tell him it involved exposing part of his gentials.)

I complained to a good friend about it. He agreed that the pt was treated badly. But he said probably the m4s are just desensitized after seeing too many pts. Another person was like, he is just m4, he aint even a doc yet. Desensitized?? DESENSITIZED wad shit?!

The medicine tutorial at 11 was about this rheumatologist doing the same, teaching cardiac examination, and expecting us to give differential diagnosis for things like chest pain. Number 1, it is not like the past where patho was taught at yr 2. We couldn’t come up with them and he was quite upset. OF COURSE we do not know the differentials, that’s why we are med students in elementary clinics in the first place. I mean, what do you expect?

I think I cant blame the tutors cuz they basically meant well, even though they sort of expected us to turn into drs overnight. They still meant well. At least they bothered. In that sense, they are already good. And I am grateful. But when Friday ended I really really really was ???????? For the first time since med sch I asked myself whether I was better off doing chem engine or something. This wasn’t what I had in mind. It wasn’t about the stress. It wasn’t about the exhaustion. But How can this be what I have in mind when everyone is like brushing the communication and empathy aside, everyone’s just racing to do a per rectal exam on a single person, everyone is racing to jab a cardiac’s pat’s pedal edema to see like “oh it is really pitting” everyone dun even remember what csfc was about communication and empathy, everyone’s is interested in the academic details and passing the long and short cases. The clinicians do not appear to think that it is important to practice communication first before teaching something more academic, more tangible and more respectful like cardiac exam, something we will learn anyway later. I mean, what is this all about? Communication is not important? Empathy is not important? A correct list of differentials is important? Giving a good case summary is important? Why dun they just train some examining and diagnostic robots instead?

The truth is it seems very easy to just bypass and neglect the communication training and just jump straight into the clinical training. The thing is, pple think it just isn’t tangible and cant really be taught and therefore unimportant. It is not as technical as an exam but the thing is, the 1 month set aside is not to reflect the difficulty but to ACCORD IT RESPECT. And I can’t understand, what is so complicated about this that pple cant understand?

Now I shall end here and read up on cardio, abdominal and neuro exam. For a communication module. I really dun mind reading and mugging all these. We are all going to become very clinically competent and efficient drs out of this training. I mean, how can we not be when we learn with such fervor and drive and insatiable thirst? Nevermind what we came here for in the first place.

I always have sumthing to write. Den when I come here, it gets lost.

I was thinking somewhat lately. 2006 is over, 2007 is approaching. Overall 2006 hasn’t been a fantastic year for me, on all fronts. The first 4 months have been a disaster studying for the 1^st professionals, which was so frustrating and much worse than Alvls. In the end, I didn’t do as well as I wanted. In SJ, we met several stumbling blocks also, whether is it com, a new terrible TIC and the first encounter with Justin Mai and folks. At home, it’s the 1^st year sis got married and wasn’t at home, and bro is like drifting away this yr also. Mum developed an episode of mania later in the year. Her fibromyalgia seems to have worsened.

All and all it was a rough road. Always wonder why people wish things like “happy new year! May all your dreams and wishes come true!” First, it is hopelessly cliché. Second, it is insincere because u cant be bothered to write something different. Third, I think it doesn’t make sense to wish for a happy new year because it’s not entirely within your control, but you can control things like “have a lot of fun” etc

But its not all that bad either, my niece came out to say hi this nov. And dad’s medical conditions are all pretty well controlled, not many accidents while he was on the roads either. Plus got to know quite a few new frens like Gabriel and Lian Kiat also, all whom I didn’t quite know until 2^nd half of 2006 lol.

And I began listening to ayumi this year! Muhahaha recently upgraded to fan status cuz I begin to like hang her posters and stuff in my room (my bro came in and shouted, “Siao Ah!” and my dad was like “No! she is the descendant of Japanese murderers!” He wasn’t joking when he said that u know. Lol he still living in world war 2. I was like “den u also hang Chairman Mao’s poster lor” My dad actually has a little red book. Omg sometimes I think of it, he is so funny.

And this year had been a lot of fun on dota, which before 2006 I was utterly hopeless in. And arcade drums! Muhahaha. You can say these are kiddo stuff and whatsoever. You dunno how much I owe the dota and drum creators. They piece together my sanity at all stages of the year. Without them and my friends, seriously, I duno what will become of me. Seriously.

So if I say 2006 was grueling, 2007 is going to be tormenting. Already the winds of change are blowing this December and the stress is building. The 6 hour corps retreat which ended past

midnight

is a prelude into the corps in 2007. And the bacteria CA in Jan which pple are preparing for is like a tiny glimpse into how terrible it will be to mug for the Second professional exams in April.

2007 for the corps is going to be make-or-break, and I will need to rally alongside it. I am just praying hard the upcoming officers in 07 will be of great help.

Next year in school is going to be hell and heaven also. Beyond the professionals in April clinicals will start, and stethoscopes and tappers will come in instead of just pen and paper. This is when the med course truly begins.

At home, I am starting to have a better idea of what to do with mum’s illnesses by coordinating the 2 different specialists. If despite all me and bros efforts it is still not done by end of next year, it will be really hopeless.

It will the cross roads for me on all fronts as student, SJofficer and son. I think 07 will be the toughest year yet, since I was born. I am feeling all apprehensive, optimistic and guarded at the same time.

Ironically, I will turn 21 next Dec. It is like a uniformgroup/ army rites of passage thing, like you go through a very siong camp or course and awarded with a title/ rank at the end. My gawd.

Brace myself!

(need bracers. Circlet of Nobility + Gauntlets of Strength. +6+3+3)

Thus far this is my most siong Christmas season yet. Or should I just say that it is unfortunate that all things come together at the most inopportune times.

Not to mention the 6 hour grueling corps retreat that left a ton, literally a ton, of things to be done, and fast. On top of that I am busy mugging the rheumatoid diseases in time for my mum’s next consultation. And there’s a ton of bacteria to mug for CA in 2.5 weeks time.

I am using this post to vomit out all the confusion and thoughts I have about mum’s fibromyalgia. Readers beware.

I always find it very perplexing that she almost indefinitely feels better when I rub ointment using her TCM yellow medicated oil. Inside the little bottle there is this plant root thingy. And in times when all the medication dun seem to work, somehow rubbing the oil always manage to ease the pain, albeit only for 1-2 days. (Every rubbing session is worse than PT. I always end up sweating silly after that. Have to use a lot of force and it must be repetitive and prolonged. Wahahaha its good exercise)

What I find very perplexing is that any med student know that there are 3 levels of regulation of pain, one at the peripheral level, at the spinal level and one at supraspinal level. (things like soldiers in war dun feel much pain during battle itself but when they are removed from battle the pain gets severe. It is not psychological, there is supraspinal regulation.) In my readings about fibrromyalgia, it seems there is no peripheral mechanism to the pain, no inflammation, and most of the pain is the result of downregulation at the spinal and supraspinal levels. So rubbing oil is definitely a peripheral treatment right? I mean the oil doesn’t like diffuse all the way to the spine and brain, and yet it does alleviate pain. But if it alleviates pain, why doesn’t the selective COX 2 inhibitors like celecoxib given by the rheumatologist seem to work? Dun these work as peripheral analgesics also?

Den why do they prescribe NSAIDS in the first place if the pain is not a tissue inflammation? I read the rheumatology books and they say they do it for the analgesic property of NSAIDs. But all along I was taught NSAID only work as analgesics cuz they inhibit prostaglandin and TXA production which in turn downregualte threshold of pain. IF you have no inflammation, how to get high levels peripheral prostaglandins? If there is already no high prostaglandin, giving NSAID shouldn’t help because the idea of NSAID is to alleviate pain from overproduction of prostagald? Until now I still can’t figure it out. Maybe there is something about nsaids that I dun know.

Den I thought, maybe it isn’t the oil itself that alleviates the pain, but the rubbing that does it along the enkephalin pathway, (people rubbing their arms when they are pinched, because the rubbing stimulate touch neurons which inhibit pain neurons at spinal cord) And I followed her to a TCM sinseh who gave her acupuncture, and I thought it does seem so, because the needles only enter at where she feels pain, but these are sites at the periphery, and acupuncture from what I heard, acts also trough the gating mechanism, which is enkephalin thingy between the primary afferent and secondary afferent in spinothalamic tract.

So if she can feel better using this pathway, shouldn’t the opiods like codeine and hydroxycodeine work also, cuz they work on the same receptors as the enkephalin? (is it?)

To make it worse, the pain can actually travel. It can be concentrated here in the morning, there in the afternoon, which I learnt later is migratory pain in fibromyalgia. Den if you press on one point that she feels painful, she can have referred pain and suanness somewhere down (which the TCM practicioner elicited and I tried later) And I was like thinking, is this really fibromyalgia or is it myofascial pain syndrome? Cuz the referred pain thingy belongs more to the later in my readings. Come to think of it, the rheumatologist didn’t conduct any test, she sort of like, come in already, oh, must be fibromyalgia.

And the pain changes with the weather. It gets worse during rainy seasons, which is, erm, these few days. (the text wrote fibromalgia changes with the weather) This morning she woke up with unbearable pain, and the worst thing is, the weather it is so bad that all her pain for whatever reason comes back. It is not just fibromyalgia alone, it is tooth ache, tummy ache, leg pain.

It used to be like, when she has both tooth ache and fibromyalgia pain at the same time, I will give her this mystery pill which I tell her will solve the tooth ache but not the leg pain (it is actually paracetamol. But if she knows it is paracetamol she wont eat it.) But today, I did the same thing and it doesn’t even solve the tooth ache. It seems she has this global universal upregulation of pain everywhere in her body in rainy weather that is probably supraspinal regulated and paracetamol and NSAIDs can do nothing about. And the tooth ache isn’t part of fibro in the 1^st place!!!

So I read that they found that in patients with fibromyalgia there is bilateral lowered perfusion of hemithalami and lower cerebral perfusion of right head of caudate nuclei of brain which are all responsible for pain sensation (is this why her pain is worse on her left leg than the right?) And thinking about it, the rainy season thingy probably translates to lower temperature, which in turn is probably something to do with the hypothalamus. I wont be surprised if it is another of those weird neural circuits linking all of them together.

It is so mind-boggling!!!!!

And I haven started mugging for the bacteria CA which is less than 3 weeks tym… ZZZ