Tuesday, December 25

Merry Christmas!

I've just spent about five hours in front of the television on Christmas eve. I know this sounds sad but I've really enjoyed myself! I sang along with the Christmas music show and watched very interesting movies. The Pirates of the Caribbean: the Curse of the Black Pearl was amazing! I love Jack Sparrow and Will Turner! Such great actors. I have to admit that I haven't actually seen any of the pirates of the Caribbean series before because I was put off by the scary looking creature on the poster (Devy Jones being the most scary)... But it was alright watching it on tele, I could switch to another channel when I couldn't bear it. Also watch Gordon Ramsay's show - which was quite sickening. A chef chopped off the head from a wriggling eel, took its heart out and made a guest swallow the beating heart! And Gordon also took his son out for hunting trip and later cook the animal he killed. I appreciate the need for freshness of the food, yet I don't think there's a need to go that far. His son looked just about primary school age and he's definitely not supposed to be getting excited about watching his father shoot down a bird and later cook it and say it's yummy.

Anyway I've finally come up with revision plan. There is too much to learn, coupled with too little time plus an extremely low motivation to study = the perfect recipe for disaster. Luckily the exam this time isn't really going to affect my academic standing. Hopefully I'll be able to follow my revision plan until exam time. Then I'll be fine. I hope. Merry Christmas!

Sunday, December 16

Panic

I panic very easily. When I'm asked to do a job that I'm not very familiar with, I would start palpitating, going over instructions over and over and be slow and clumsy in what I do. In my first week, in an endocrine/surgical clinic, a doctor asked me to send a request card for MIBG in gamma camera and get a date for the scan- I was like ?!?!? and why did he send the other two students to take the history and I got picked for the job which I haven't got a clue about? And it must have been my unlucky day - the technician wouldn't accept the card because it wasn't clearly written enough and I spent some time arguing with him. He was mean... saying 'if you are confident that it's MIBG then write it down yourself and countersign it, or else I won't take it', and I had to bring the card back so the doctor can add the few letters into the card. It was for a patient with pheochromocytoma, and when I came back, the doctor talked about the condition. 'Pheochromocytoma is a catecholamine-secreting tumour, and catecholamine is hormones for fight-and-flight response, like just now when I asked you to send the request card the catecholamine level in your body must have shot up.' Nice one doctor, now I will remember what catecholamine is and what MIBG is for a long time.

Whenever a consultant talks to me, I get palpitation anyway. In the renal ward rounds last two months, whenever the consultant (particularly Janet) said something to me, I would jump. It's not just things like 'tell me about myeloma', but also simply stuff like 'tell me about his fluid balance' or 'fetch me his drug chart'. Sometimes I get surprises like 'why don't you type up the clinical notes' or 'order an ecg for this gentleman'. There I was, standing quietly behind the entourage of doctors hoping to be invisible, and statements like these made me feel extremely alarmed. I usually would simply go 'what? can you say that again?', hyperventilating. I recall her saying 'don't panic!' to me for quite a few times already. I don't know why I reacted like that. Maybe its just I have expected to play no role as a lowly student. However Janet was different in that she tried to include everyone and make me feel like part of the team. Anyway I spent most of my ward rounds being on my feet. I got used to it, and it became rather fun after a while.

Presenting history is often a horrible experience. We had a bedside teaching session with Prof Carlson last week and I presented a patient's history. It was my first time presenting in weeks. (My groupmates have managed to turn the clinical debrief meant for us to practise presenting history into spoonfeeding teaching session). I knew it wasn't the most coherant one I've presented, but the professor had just too much to critisised - in front of the patient and my groupmates. I usually take critism in a very positive way. But for the first time, I actually thought that was too much to take and I felt a little embarassed, holding my head down half the time.
'How did you know he had reflux? Did he used the word? What do you mean by bit of weight loss? How much is a bit? How can you tell if you don't ask? You must always ask about any complications with regards to previous surgeries. You can't just say all the symptoms in random orders.' etc etc
But it wasn't his fault. He must have been expecting more from a medical student 11th week into her clinical training. It was just me being stupid.

I do realised that consultants are not always there to bite. Most of them are amusing and have a bit of personality. The first thing surgical firm lead said to us at the introductory session was 'you all look like mugheads'... how eccentric was that? He has been really cool and I like him. And just last week a charming consultant told me 'your english is really good, if you haven't been telling me I would have thought that you were raised in England' Hahahahaaaa!!!!! Though thats not the first time I get compliment like this, I was still extremely overjoyed!

Finally, I am pleased to announce that I have been allocated an A&E SSC to do. (SSC = student selected component. 4 weeks clinical attachment of whatever speciality we want and we can put in 8 choices). I'm really looking forward to the attachment! It will no doubt bring up my catecholamine level but I think that will be what I want. Hope it'll be exciting!

Saturday, December 8

Sexual harassment at work

I've never thought that I would ever be harassed... Not that it happened for many times.

The first time was a week for I return to KL for summer holiday this year, worked at a psychiatric ward. This elderly male patient, A, kept smiling at me, and wouldn't it be rude if I just look away? I smiled back every time. And then over one or two hours his smile went funny, more friendly. Later on while I was standing nearby, he suddenly walked towards me and hugged me very tightly and kissed my cheek. Before I could react, another male staff noticed and saved me. Did you know what the staff said to A? "That was very bad you naugthy man." Anyway it didn't mind eventhough the permanent staff insisted that I fill in an incident reporting form.

The next one was a patient that I've met twice after my summer holiday. He suffered from alcoholic liver disease, I suspect with encephalopathy. The first time I met him, he was really agitated, half the time trying to climb out of bed. From breakfast through to lunchtime, he was asking me to have sex with him, with him holding his penis and being naked, crying 'come on, lets get on with it' - o dear - and I was alone with him in a side room doing one-to-one care. But I knew he was not capable of doing any harm as being sick he didn't have the strength. The next time I worked on the ward it was three or four weeks on. He wasn't as confused but I also noticed that he's lost a huge muscle bulk on his legs, which was really sad - but who wouldn't be after being forced to stay in bed for three weeks continuously? Yet the sexual disinhibition was still there in that he still refused to get dressed, kept holding his penis and asking me to have sex with him. Strictly speaking, this doesn't really count as sexual harassment since he was clearly confused, yet he did leave me frightened for a moment.

And today, about patient C, it was almost certainly outright harassment. The ward was really short of staff and I was rushing around like a headless chicken trying finishing my morning washing. So I was quite clumsy, knocking over things, spilling drinks and kept apologizing to patients.
When I went to patient C behind the curtains to help him have a wash, he said 'stop apologizing, you've done nothing wrong'. That was nice of him, I thought. 'OK,' I said.
'Tell me what have you completed today?'. Trying to boast my self confidence? No need for that - no time to waste. 'Not much,' I replied.
'Don't understand what you mean,' he said. And then he started putting his hands around my waist and then rubbing it down my bum. I walked away out of his reach right away. Then got back to business, getting him to sit up and have a wash.
I know I should have been stern in telling him off. But I just can't do that. I can do a lot of things but telling people off and rejecting people are not my strong points. I could have told one of the staff there but I was occupied to the last minute before I finish my shift. So I'll just let it go for this time.

I am legally entitled to complaint since sexual harassment constitutes any unwelcomed behaviour of a sexual nature. Fortunately on these occasions there weren't any harm done and hence I've didn't want any formal complaint. I just need to think if I am confronted with worse situations in the future what can I do.

Wednesday, December 5

Chinese school

I would like to comment based on my personal experience regarding the article in The Star http://thestar.com.my/columnists/story.asp?file=/2007/12/4/columnists/vkchin/19629191&sec=VKChin. I went to a chinese primary school in Kuala Lumpur. As the author has rightly said, by the time a girl finishes her education in a chinese primary school, there is no doubt that she would have been caned at least once. I remember I was so glad to be out of the chinese school system after standard six. I used to really hate chinese school because it was dictatic. We were not allowed to keep long hair and we spent a lot of time lining up being lectured. Academic wise, teachers often expected less than perfection, certainly from my class (which is the top class of the year). I was caned because of careless mistakes in maths (eg 7 x 3= 22), selecting the wrong answer in MCQ when we were specifically asked to revise for the topic, getting a C for essay practise and on many other silly occasions. I hated chinese calligraphy and hence have always got either a C or a D for that. Plus chinese school teachers are very harsh in grading, only one or two in the class would get an A in a typical essay writing practise (It was really not us who was stupid - almost the whole class got an A in the end-of-year national standardised exams UPSR). You have no idea how meticulous my teacher was - I spent so much time drawing box-like margins on every pages in my exercise books just because she wanted it that way.

Students would get caning for trivial things like forgetting to bring book or PE shirt. There were several times in which my sisters and I, on separate occasions, forgot to bring a file or book or even a piece of paper that we panicked and phoned mum to bring it for us. And mummy did actually travelled for 30minutes to deliver us our stuff. It seemed so ridiculous when I think back.

Another thing notoriously famous among chinese schools are the heavy bags. In standard six, we had to bring, on top of many textbooks, workbooks and exercise books, two big heavy dictionaries in Malay and Chinese language. My school bag normally weighed 30kg, that's excluding the pile of exercise books on my left hand and an extra small bag of files on my right hand. I actually developed a bit of kyphosis in primary school because of these heavy bags. Hence my bag felt like feather when I went to secondary school.

It was very difficult to shine and develop your full potential while in a chinese school. Only the very best 3-5 people gets the opportunities represent the school for bigger competitions. We hardly get to volunteer to participate in competitions, especially in my class, my teachers would usually just call the same 3-4 people to compete in story telling, public speaking and singing competitions without even asking if anyone else is interested. I was quite pissed off with that on several occasion - although I did not have much hidden talent to reveal, I'd like to be presented the opportunity to prove myself.


It is only fair that I think about the benefits of having a primary education in a chinese school. It gave me a very strong foundation in chinese language - I can tell you for a fact that my proficiency in chinese language was excellent (that was 10 years ago unfortunately). The drilling in mathematics built solid base of arithmancy for secondary and tertiary education - any ex-chinese school students always have an edge over other students when they are compared in later education. And I had fun playing snare drum for the school band in standard 4-6. It was quite enjoyable being one of the school pianists playing the school song in weekly assembly and in singing competitions and performances.

So should caning be allowed in chinese school? No. I think it is time for chinese school to revert to the national recommendation about caning student, which is something like caning is only to be done for serious offense, action to be taken by the disciplinary teacher or the principle with witness present etc. But I know chinese school is changing for the better, in terms of allowing students more freedom to participate in activities, certainly from what my youngest sister said about my former school. We know that operant conditioning works on mice, but there must be better, more civilised ways of making a point to children.

Saturday, December 1

Shock

Shock 1:
Surgical house officer on-call was called to see a 60 year old lady who had profuse PR/PV bleeding and I was following him around for the day. That was quite an experience. I know I have another 3 years before qualifying, but the thought of being expected to do something to prevent the patient in front of me from dying is just scary. 'So what are you going to do when a lady presents like this?' 'umm... find out the cause of the bleeding, or um.. take a history, give some fluids maybe..' WRONG! I must have read about management of hypovolaemic shock for at least 10 times yet I couldn't give confident answer. It's really alarming to recall how badly I hesitated while the lady's BP dropped by the minute. And it was also really impressive to see the house officer managing the situation so calmly. Bags of fluids and bloods going into the lady via three cannulas, blood pressure checked frequently, oxygen mask on, ECG, ABG, urgent bloods test ordered, reviewing results and sending more sample and prescribing more fluids and bloods, calling anaesthetists and seniors, writing clinical notes, assessing patient, talking to relative, asking nurses for help, teaching me, briefing the registrar - how could anyone ever manage so much at a time? Anyway the lady was sent to theatre as an emergency to have an endoscopy and colonoscopy for further management. I hope she is alright now. I have definitely learnt from this experience, and hopefully when I see another one of these shocks, I won't be as hesitant.

Shock 2:
My winning entry for the Shine award 2007 was published in the Student BMA news. Caught me by COMPLETE SURPRISE - can't say that it's a pleasant one though. Why couldn't someone have the courtesy to inform me about it before they actually publish it? I'm not mad or anything... it's just really not funny to suddenly come across my name and my essay on a medical student newspaper circulated countrywide.

Indiscrimately positive

Once a friend told me that I have the tendency to always think that everything is good. Every PBL group has been pleasant. All my tutor have been fine. All the medical specialities are interesting. BBGS, UTP, KMB and Manchester have all been amazing. Where I am living now is not the most expensive accommodation, but it's fine and I have no complaint. My family is the best in the world. All is well.

Unfortunately this doesn't agree with everybody.

Ok, this entry, so contradictory to the title, is a rant about my current PBL group. Since the beginning to the term but more so recently, I always find myself disagreeing with the rest of the group. They always have lots of complaint. Whenever they have just a little bit of free time to chat, they would complain. They talked about how the renal doctors were unapproachable, how the podiatry and hospice placements were boring, how teaching were not held on time etc, and very often I had to disagree with them all. However, I still wanted to be accepted by the group and hence very often I've just kept quiet (especially when they were giving feedback at the end of the renal firm). Also, whenever our clinical teachers were late for teaching, a few in our group would always suggest that we leave or make excuses to delay or cancel the teaching rather than making some effort to make our time worthwhile. To be honest, I have come to a point that I just can't to tolerate this anymore. Before this I would sometimes have gone away with them wasting away two hours sitting in the crush hall. Call me a boring person but I really hate wasting time just sitting around chatting when it could be used for more productive things like sitting in a clinic or clerking patients or practising skills. In the past two years I was involved in so many voluntary work not because I want to enhance my CV, but because I genuinely enjoy keeping myself occupied doing meaningful things. My groupmates are just the exact opposite. My clinical partner actually said to me that she enjoyed standing around doing nothing while we were on-call yesterday rather than taking blood. For the last few weeks she's been complaining that we don't get to practise the skill (which is not true by the way), and now when the opportunity arise she's not bothered, how obscure is that?

In this firm, we get lots of teaching sessions, which are overrated by my groupmates. I have no idea why but my groupmates love to be spoonfed. They were continually saying to the other doctors 'this firm is so much better than the renal firm, we've learn more in a week here than we had for eight weeks in renal', and I sometimes just had to say something to the contrary because I have thoroughly enjoyed and have learnt as much in the renal firm. The people in my group always speaks as though they represented the view of everyone, and my view always happen to be completely the opposite of the supposed majority view. Sigh... this is so difficult isn't it? A few girls in the group had started to avoid talking to me, don't really know why but I assumed it's because I enjoyed the renal and community block while they didn't. Is it my fault that I went to the trouble of learning things and making myself useful? Is it my fault that no one wants to take my offer when I ask them if they want to go to the ward? Is it my fault that I've seen and examined more patients than the rest of them? Is it my fault that they are not positive enough to look at the brighter side and cease learning opportunities?

I know I can be overly keen at times, which is why I have made it a point to not be at hospital after 5pm and I shall be engaged with extra curricular activities. Over the last two weeks I've been thinking that I really want to get along with my groupmates. But, maybe it's my fault or maybe it's their, we just disagree all the time (while I kept quiet most of the time). I have tried to reason with them, yet they just kept making excuses. Most of them are 1-3 years younger than me. I remember doing silly things just two or three years ago, it's amazing how much I grew just over the last few years after leaving home. Maybe it's just part of their process of maturation. I will be bitched behind my back but I don't care. I am not prepared succumb to behaving like them, turning up just to compulsory teaching, clerk the minimum number of patient and engage in discussion just to ensure that the teacher sees it and not mark us down. My ultimate purpose of studying medicine is to learn to become a competent doctor and I will do anything to achieve that.

p/s - Latest venupuncture stats: 7 successes 3 failures. Getting better!