The future

On one of the afternoon after the home visit, my GP said he would nip back home for a while to get some soup, so I followed. My jaw dropped when I saw his house. It was the perfect house really. Big and beautiful in a guarded community in the middle of a breathtaking countryside. The kitchen looked like Gordan Ramsay house's kitchen on television. I was just quietly admiring all the bits that I could get a glimpse of while drinking my soup. I can see why they say that doctors who have reached the peak of their career are be the top 2% of the wealthiest of the nation. I have been to quite a few people's houses (mostly ordinary people) while I am here and I have never been to one like this before. I think he deserves it because he works very hard (7am until over 8pm everyday) and cares for his patient very much. He and the other GP supervising me both told me on separate occasions to treat my patients like how I would like my own parents and my own children be treated, and I guess that was what made them so successful.

I didn't choose medicine because of the money that I would earn. I hope you are not rolling your eyes because this is the truth. My GP asked how much would I earn as a doctor in Malaysia, and I said I have no idea, and that is still the honest answer. Prior to this I have NEVER had any idea of a big house and posh cars and expensive hobbies as a result of being a doctor, and now, ashamedly I am thinking about it and I think it'd be nice to have all these to look forward to as I progress further in my career. At this stage, life is hard for me and all of my fellow medical student friends. Most of us are living independent of our parents for the first time in life with quite limited money to spare. The basics are all we can afford, I don't even wander over to the luxurious range corner of the store. Free lunch in hospitals tends to make us very happy because then we don't take to spare that precious £3 on food. In addition to all these, I feel I am not like many other people. I get only the allowance from my scholarship with no supplementary income from my parents (because I don't need it unlike my friends who are rich and are always overspending). Last year I was pickpocket and I was so devastated because there was about £350 inside. Doesn't sound much but that would have been all I'd spend in a month. I am brought up to spend on only what is absolutely necessary, and I'm glad. I don't have 10 shoes or make up accessories or night out dresses like most other girls. I don't feel that I need them. So I feel quite inferior after seeing my GP's house, feel like we are a world apart, and I just cannot see myself like that in 20 years or however long time.

Just another surprise that my GP commented that my English is much better than the other two Malaysian students he's had previously who drove a Volvo and obviously not needed a grant (scholarship he meant). I told it as a really nice complement!

Something to like about eh...

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I just downed three mug full of expresso strong coffee and swallowed 5 chocolate digestive biscuits. Am very very HYPER now. Have to get off my chair to star jump every few minutes.

Am about to write an email to explain why I am have been such a lazy procrastinator. I am ashamed of myself. Hope that person won't be too angry at me...

Continue working!!!

Just broke my favourite pink bowl when cooking. Is that bad? Hope they still sell it at BMS because I really really love the bowl. :( Don't ask me why I am cooking at this hour.

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Challenge me!

When I went to a facilitation training session 2 weeks ago, we were asked to list things that we do well + why do we do well and also things we don't do well + why. It was an interesting exercise, I learnt quite a lot about myself in just two hours.

One of points raised in the discussion was rather interesting. Many people felt that many a times, they are not able to do things to their maximum potential because they haven't been challenged. I know, I know. Medical students are supposed to be all self sufficient and self motivating and self challenging. But sometimes we just come to a point where we don't know which way is forward.

I think this has happened to me in my fifth year. I thought this year started badly with an unstimulating placement in the specialist cancer hospital. I wouldn't even call it a placement because I was hardly ever in. I spent less then 20 hrs in total in that hospital over the four weeks placement. We were not working under a named firm. We were not even allowed to take self initiative and turn up to clinics or wards - we were to strictly follow the time table. We had plenty of lectures and seminars - hardly challenging sitting on my arse for most of the time in the hospital. My only non-lecture based activities on my time table were a clinic and a bedside teaching. That's it. Two half a day of patient contact over the four weeks period.

Then I moved geriatric medicine in my usual teaching hospital. I am glad to say that because they were always short of medical staff and that there wasn't a house officer in the ward, I was usually the acting junior doctor. I still had to use my initiative quite often - constantly asking if there was a job I can do. Gradually they just give me jobs without me asking and I get things done without being told. Being involved in their continuing care, I knew every single patient in the ward well and felt quite happy making clinical judgement, ordering investigations, making referrals and to give information to patients and relatives. I knew that those jobs were well within my capabilities as I have been doing them since my fourth year. I guess working in a team is my strength and trying to build a good working relationship with my colleague just wasn't going to be a challenge at all. So in summary, extremely satisfying placement but perhaps not stimulating enough.

Now in GP land, I am having a great time with the doctors. The two GPs supervising me are fantastic teachers. I am finally feeling challenged by having to see my own patients. I have no problem doing the history, examination and diagnosis, but have never really ventured into informing patients about my diagnosis and management plan (mainly because I don't feel confident enough. Silly yee yen!), and now I am forced into doing that. I mean, if a consultant ask me quesions like 'What do you think the diagnosis is' or 'What is your management plan', I'd never ever say 'I don't know' because that'd make me look very stupid. A wrong answer is better than no answer. However, I am not so sure with patients, so on my first week I just resorted to saying 'I'm not sure, see what the doctor says' to everyone I see. But then I found that I have been right most of the time. So why not just discuss my thoughts with the patients? And I find that quite difficult. If all they need is prescription, that's easy. But if not, for example if they need lifestyle change, then I've got to explain things from how does the illness arise to how lifestyle changes can ease the problem. It's something that you'd think I ought to know, but I'm not very good at it. So I'm glad that I've found something to challenge myself for the remaining two weeks.

(This bit is not important)
Finally, I'd just like to moan about sitting in with nurses. In general, I don't think fifth year students need 'sitting in' with practice nurse anymore. Sitting in with the GPs is fine because there are clinical problems to solve and a high expectation is expected of me that I should be as capable and knowledgeable as a qualified doctor. On the other hand, nurse doesn't. The practice nurse that I am asked to sit in with is the friendly and lovely. But she just thinks I don't know anything. She talks about obesity and hypertension being a major problem in the community, and then showed me the immunisation schedule. (Great. Actually I am in my fifth year and I know and have already been examined on these before...) And she's never offered to let me do anything (and to be fair I haven't really asked except for today I asked if I could do a smear, she asked 'Have you been trained?' and later the answer to my question was no). But then you'd think even if I haven't been formally taught these skills, shouldn't it be her responsibility to teach and let me observe then try doing it under supervision? I dread sessions with her as they are just so boring. They are mainly just chronic disease review which consists of filling in template questionnaires. So she asks the patients the same questions off the computer and perform the same tests/examinations, followed by the same advice on smoking, diet and exercise. It can't get more ROUTINE than this. Talking about challenge - this is plain zero challenge. I might as well be in the library reading. Which is why, this Friday as there is no GP in the surgery to supervise me, I have asked to have a day off being I don't think it's worth the time sitting in with the nurses. I don't do day off normally. But I think I just have to take change of my own education and stop doing things that are not beneficial to myself. I hope I don't see anymore of this 17th century practice of passive 'observation' teaching. Sorry, I'm feeling irked.

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Good old gossip girl

I caught two old ladies with dementia gossiping about me while I was in the ward round.

Lady 1: (pointing towards me) 'That lady, do you know her?'
Lady 2: 'She the student'
Lady 1: 'She will be a good doctor'
Lady 2: 'Yes, she's always got a smile on her face'

My registrar: 'See even demented old ladies think you are going to be a good doctor, so you definitely will be a good doctor'

Why are these demented ladies suddenly so clever?

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Unusual cause of diarrhoea

I think this lucky gentleman is one of those that I will remember forever. He presented to hospital with diarrhoea. I was the first to see him in our ward. I took a history from him - he lied all the way (ok, I'm being too harsh, he has dementia and was actually two years behind us as he was telling me stories of his life two years back...). I felt a mass on his abdomen arising from the pelvis which was dull on percussion and diagnosed urinary retention, the diagnosis confirmed by bladder scan and treated by urethral catheterisation. Such a brilliant diagnosis! It made me feel so elated for several days. Diarrhoea then settled, no particular cause was found. In the interim he also developed conjunctivitis and coryzal (cold) symptoms. We were going to send him back to his nursing home when the nursing staff reported some rash. It didn't bother him at all, in fact he looked so much more alert and alive. One day after on yesterday's ward round, we saw the rash again and it has spread all over his body. (Maculopapular, blanching, discrete at first then coalescing). It looks like a rash from drug reaction, but he has not been started on any new drug. The only other differential diagnosis would be measles. They actually really look like measles. We then had a look into his mouth - there were white spots all over particularly the buccal mucosa. Medical students - what are these spots called?

If you are a medic, I hope you can sense our excitement by now! Medical staff who are not immunised and might be pregnant were told to stay off - which was a bit too late I think because the disease is most contagious before the rash appears. Another thing was that he was next to another patient who is immunocompromised on chemotherapy. He was isolated in a side room after that. When typing up the notes, I had to tell the geriatricians how to spell 'Koplik' as it was really not something that they expect to encounter in their specialty.

Extremely exciting stuff!

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Bus

I'm getting stressed every single morning over the Oxford Road buses. Basically these buses have to stick to their own scheduele but then they arrive at my stop early. So getting from where I am to the city centre can take 10 minutes or 30 minutes, depending on my luck. If I'm lucky and the bus is in a hurry, it would zoom pass the stops very quickly, jump the red light, overtake the traffic etc. But if I'm unlucky, it would be stood stationary at my stop for a further 10 minutes, then drive at a speed of 5 km/hr and wait for another 5 minutes at every single stops. And the connecting bus to my hospital: it's suppose to run every 15 minutes, but it has a habit of skipping one or two of them. I've had to wait for half an hour with no bus, and then have 3 buses turning up togather. STUPID!!!! So I would arrive at hospital either 30 minues early or 30 minutes late... silly isn't it? I really hate these buses!!! I'm all for saving the environment but not at the expense of my mental health. Can't wait to drive my own car.

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Any strangers who talk to me in the bus out of the blue are bad unless and until proven otherwise. Unfortunately it happens quite a lot. I just don't understand. What makes people think that they have a right to talk to me and ask me all about what course am I doing, where do I come from, where do I live and sometimes what is my religion! Yesterday, a chinese guy in his 40s was sitting in front of me when he started turning around and asking me questions in chinese. I answered out of politeness. But he then immediately said my chinese was 'bu biao jun' (not accurate), how untactful! I also often find that when people from china need assistance, they would just spot a chinese face on the street, talking away in chinese and just assume that you'd help. Like I said, to me, strangers who approach me are bad until proven otherwise, so I'd normally pretend not being able to speak in chinese, that's usually enough to put them off. Haha!!!

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Free thoughts

It ought to be, but full confidentiality almost impossible when you are in hospital. We draw the curtains around, but they are not sound proof. I was just on the computer reading some patient notes when I overheard a pastor talking to one of the patients. It touched me. She has a terminal cancer and she has been low in mood and been angry at everyone ever since I first met her. She asked the pastor 'do you think I will live?'. The pastor said he doesn't know but everyone dies. The pastor then said a prayer with her. He blessed her and all the patients in this hospital, and all the doctors and all the nurses and every who have been looking after her. I'm not a Christian and I'm not particularly religious but it made me choke, it was very moving that our efforts are being appreciated and people remember us in their prayers. The student nurse who was also there and I looked at each other, I think we share the same feeling.

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He is recovering from a really bad chest infection. Part of the examination requires looking into the sputum pot. It was very unusual this morning. It is very watery light brown, not sputum like at all. We just wonder if he has been pouring the yakult probiotic drink into the sputum pot.

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Another death in the ward. Elderly patient with metastatic cancer. I did not expect him to go so quickly but obviously I haven't been experienced enough to anticipate death. We were treating him for his heart failure and chest infection, and I remember he smiled at me everytime I looked at him even with him being so poorly. Nice people like this shouldn't die.

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