My best placement ever as a medical student was a four week attachment to the A&E department at Blackburn in my third year and I have since looked forward to returning to this hospital. Enthusiastic and motivated students get a lot out of this hospital as the staff are ever willing to allow students to get involved. Over the years, I have met many senior students who spoke highly of this hospital in delivering high quality fifth year placement, and I thought I have to see what the fuss is all about for myself.
It was an 8 week placement - 4 weeks of GP and 4 weeks of general surgery. I thoroughly enjoyed both. I have written about my GP placement - on being given responsibilities that I've never been entrusted before and being challenged. The two GPs supervising were very competent and hardworking doctors but not without a life, and I aspire to be like them. It has revived my interest for general practice and now I can just about imagine myself enjoying GP as a job for the rest of my life.
The hospital placement was equally satisfying, even with my deep-seated dislike for surgery. I got stressed out when clerking in new patients because I wanted to do them properly fully, not like my previous clerkings which had always stopped at 'history and examination' and neglected the impression and management plan, putting in cannula and taking blood, arranging imaging, reviewing the results, writing up drug chart and presenting it to a senior doctor. I have finally understood and experience the need to PRIORITISE (like cooking for my family, really!) Seriously, I was stressed out, but the doctors were very encouraging and kept said I was doing well. I also had a go at presenting patient at a shift handover (which was a station examined in last year's finals) which involved lots of palpitation and butterfly in the stomach. When not on-call, I helped look after the patients perioperatively. On the second last day of my placement, I surprised myself by actually enjoying a day in theatre. I saw gallstones in real life, assisted the surgeons and the anaesthetists and properly examine a hernia.
There is always a few patients that every doctor remembers forever. For me, there were three this time. I was the first to see them and I diagnosed all of them correctly: they all had cancer, the scans confirmed it. While I couldn't resist the excitement of being the one to have elicited the important symptoms and signs on the history and examination to bring such important diagnosis to light, the people looking after them and I know that there is nothing to be happy about because there's basically no cure as their diseases were far too advance. They could well be dying as we speak. Which is why, I think, I will remember them forever.
The most unusual feature of all is the structured teachings that we received while on placement in Blackburn. There is weekly orthopaedic, surgical and radiology teachings as well as lectures on various specialties and practical clinical skills sessions for revision (not that I attend all of them or that they were on every week). On every Tuesdays, about 10 hospital and community tutors come together for our bedside teaching, PBL session and student grandround. The tutors knew us by our names, something that, as Manchester students, we are not accustomed. There was this award for a member in every PBL group for being, not the brightest but the one who contributes the most and did all the work (akin to the man-of-the-match title), and I received the award for my group! I knew they created this just for a laugh. But still, it's nice to be recognized and I'm really proud of my contribution! So that was the Blackburn tale. It's a shame that I won't be returning after the exam. Suffice to say, if I pass my exams, I have Blackburn to thank.
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Tuesday, December 29
Saturday, December 19
I read this very moving article in the theatre coffee room. Have a look. It's a long one, but I wish it had been longer.
Necessary Angels - National Geographic December 2008
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Necessary Angels - National Geographic December 2008
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Friday, December 11
Bones, stones, groans and psychic moans
Since my secondary school days, at the beginning of each day, I will decide if a day is going to be a good or a bad day. If it is going to be a good day, I'll be as productive as possible and make risky decisions. If it is going to be a bad day, I will keep my head down and let the day would pass uneventfully. I decided that last Wedsnesday was a bad day on the morning ward round. I knew the theory of the hernia orifices inside out. But when the consultant asked me explain and draw it on a piece of paper, I confused myself (between the mid-point of the inguinal canal and the midinguinal point) and consequently made a fool of myself in front of the entire surgical team. All day everyone from house officer to registrar was teasing me by saying 'so have you learn the hernia orifices?'
Just when I thought of leaving the unit, this lady comes along for me to clerk in. She presented with a week of lethargy, general malaise, constipation and left sided abdominal pain, and the GP sent her in because he was worried of her very high (>100) WCC. On examination, I found a mass on the left abdomen and in the rectum. As well as the physical signs, I thought she was withdrawn with a general apathy and was slow to answer questions. I thought something was really wrong, along the line of haemotology or GI malignancy. The registrar reviewed her and agreed with my findings. He told everyone that he was impressed that I managed to pick up the signs as they are quite subtle. To add to the excitement, the lab later on phoned urgently to inform us that this lady's calcium was 3.9 (sky high!). This is a medical emergency that surgeons are not used to dealing with, so they double checked using the internet. We then realised that this lady has essentially presented with symptoms and signs of hypercalcaemia, well, not really bones and stones but certainly groans and psychic moans! How exciting! Never thought a line like this in the bible of medicine (Oxford Handbook of Clinical Medicine) actually occurs in real life!
Since I am discussing this, I'd also like to talk about the nurses. Some junior doctors recently told me that nurses are stupid. And I thought what a very rude thing to say, not least because most of them are much more experienced than us when we just qualify. Now I can kind of understand what they mean. When this lady come in with a WCC of >100, the nurse wrote in her admission notes ?sigmoid abscess (I don't know on what basis because there wasn't a GP letter, maybe based on her left abdo pain and high WCC?). She said to me that she is septic and we need to get her onto the septic care bundle (a set of tick box protocol for patients with suspected sepsis). That was even before I had a chance to assess this lady. She shoved that form to me and asked me to take blood for lactate and blood culture as dictated by the form. After seeing the lady, I looked at the obs and the blood result, and along with the clinical picture, I thought sepsis was unlikely. When I expressed my opinion to the nurse, she patronizingly said 'It doesn't matter love, I've checked with the registrar'. Well, she's conveniently not informed the registrar that the lady is apyrexial and was haemodynamically stable with no sign of sepsis whatsoever and her main worrying symptom was the general malaise. I was bullied by this nurse into sticking multiple needles into this poor lady to fulfill these septic bundle tickboxes. When I then went on to present the case to the registrar, and he agreed that this lady was not septic and doesn't need to go down the sepsis bundle route. I wish I could smirk at this nurse and said 'I told you so' to her. Nurses doing the doctor's job is currently a big debate among the medical and nursing community. I personally think doctoring (ie decisions on diagnosis and management) is best left to doctors for many reasons, one being diagnosis and treatment is not as easy as ticking boxes.
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Just when I thought of leaving the unit, this lady comes along for me to clerk in. She presented with a week of lethargy, general malaise, constipation and left sided abdominal pain, and the GP sent her in because he was worried of her very high (>100) WCC. On examination, I found a mass on the left abdomen and in the rectum. As well as the physical signs, I thought she was withdrawn with a general apathy and was slow to answer questions. I thought something was really wrong, along the line of haemotology or GI malignancy. The registrar reviewed her and agreed with my findings. He told everyone that he was impressed that I managed to pick up the signs as they are quite subtle. To add to the excitement, the lab later on phoned urgently to inform us that this lady's calcium was 3.9 (sky high!). This is a medical emergency that surgeons are not used to dealing with, so they double checked using the internet. We then realised that this lady has essentially presented with symptoms and signs of hypercalcaemia, well, not really bones and stones but certainly groans and psychic moans! How exciting! Never thought a line like this in the bible of medicine (Oxford Handbook of Clinical Medicine) actually occurs in real life!
Since I am discussing this, I'd also like to talk about the nurses. Some junior doctors recently told me that nurses are stupid. And I thought what a very rude thing to say, not least because most of them are much more experienced than us when we just qualify. Now I can kind of understand what they mean. When this lady come in with a WCC of >100, the nurse wrote in her admission notes ?sigmoid abscess (I don't know on what basis because there wasn't a GP letter, maybe based on her left abdo pain and high WCC?). She said to me that she is septic and we need to get her onto the septic care bundle (a set of tick box protocol for patients with suspected sepsis). That was even before I had a chance to assess this lady. She shoved that form to me and asked me to take blood for lactate and blood culture as dictated by the form. After seeing the lady, I looked at the obs and the blood result, and along with the clinical picture, I thought sepsis was unlikely. When I expressed my opinion to the nurse, she patronizingly said 'It doesn't matter love, I've checked with the registrar'. Well, she's conveniently not informed the registrar that the lady is apyrexial and was haemodynamically stable with no sign of sepsis whatsoever and her main worrying symptom was the general malaise. I was bullied by this nurse into sticking multiple needles into this poor lady to fulfill these septic bundle tickboxes. When I then went on to present the case to the registrar, and he agreed that this lady was not septic and doesn't need to go down the sepsis bundle route. I wish I could smirk at this nurse and said 'I told you so' to her. Nurses doing the doctor's job is currently a big debate among the medical and nursing community. I personally think doctoring (ie decisions on diagnosis and management) is best left to doctors for many reasons, one being diagnosis and treatment is not as easy as ticking boxes.
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Saturday, November 21
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 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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Sunday, November 8
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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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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Wednesday, November 4
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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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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Friday, October 23
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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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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Saturday, October 17
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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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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Tuesday, October 13
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.
. . . . .
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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. . . . .
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!!!
. . . . .
Saturday, October 10
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.
. . . . .
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.
. . . . .
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.
. . . . .
. . . . .
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.
. . . . .
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.
. . . . .
Wednesday, September 30
Back in action
Aunty visited late this month. I'm not usually glad to see her but today I am. This marks the end of my the low mood, low confidence, low motivation and generally low in everything for weeks.
Busying myself with clinical work has definitely made me happier. I'm on my second day in geriatric medicine. I am really enjoying it. My consultant is very enthusiastic to teach, my SHO has been very accommodating and the nurses are really friendly. Communication is difficult with old people as half the time I am talking to confused or deaf people, but they are manageable challenges.
Yesterday, I examined a lady who was quite ill. I think I have built a good rapport with her even with her advanced dementia. She has a lovely smile. Yesterday I was quite worried about her being unusually drowsy. But today she was much more alert. During ward round, I said hello and smiled at her. And she held her hand out towards me and looked at me like a child wanting sweets... But my body language in response was terrible! I hesitated and did not go ahead to receive her hand and she was left holding her hand out for about 10 seconds before the nurse took her hands, and then she said to the nurse 'don't leave me' repeatedly... Ohhh... I felt so bad. I just wasn't sure what to do for at that moment because I don't want to look rude interrupting the consultant's ward round. So to all medical student or anyone looking after patients in any way, never be like me.
In the afternoon, I went on another ward round by prof, another consultant geriatrician. This ward was duller, most patients were medically fit but remained in the ward with 'pending social issues'. Things went a little more interesting with a lady with advanced dementia who had unexplained depressed level of consciousness and refusing to eat or drink since two weeks ago and was 'dumped' to prof with the recommendation: 'for palliation only', which I wasn't entirely comfortable about, not least because it seemed no one had really looked into any reversible cause for her presentation. Possibilities like extradural haematoma, post-surgical bleed, depression are amenable to treatment and I felt we shouldn't give up just yet. Plus she wasn't drowsy all the time as the notes and nurses reported. I went to her bedside myself, offered her a glass of water and she took sips herself! I usually keep my opinion to myself but because I really don't want to go back home today burdened by another guilt, I asked prof if he would consider any reversible causes. He rambled (ie I didn't understand what he was saying), but in essence he wasn't comfortable with giving up on this lady as well just yet, so the plan was for the nursing staff to actively encourage food and drinking with charting for the next 3 days. I hate to think that the nurses would secretly be thinking that she's really on her way already, but I have a feeling they well may. I am not saying that they are lazy or unprofessional, but I just know from experience that preconception and prejudice can really influence how much effort you would put in with a patient. So I think I'm going to pop upstairs just to check on her for the rest of the week. In addition, at prof's request I am currently studying hypo- and hypernatraemia management using this lady as a case.
At the end of the round, we walked passed a side room and prof showed us the lady who had been on the care of the dying pathway. He commented on the irregular breathing, saying that she may well 'on her last minutes now'. We then literally watched her took three more breaths, and then she stopped. She has died. I have never seen a person die in front of me like this before. It was weird. I wasn't really upset because I didn't know her. But one minute she was alive, and the next she was gone. I left feeling weird, I still feel it now. The SHO and I then went in to confirmed her death. It was also the first time I have heard a doctor announcing the time of death of a person for real. I have now witnessed the process of a person both arriving and departing this world. Very, very humbling.
I like the person I am now. I am thinking and I am motivated to learn. I feel driven to read because otherwise I would not be of any help to my patients. Lets hope this will sustain.
.
.
Busying myself with clinical work has definitely made me happier. I'm on my second day in geriatric medicine. I am really enjoying it. My consultant is very enthusiastic to teach, my SHO has been very accommodating and the nurses are really friendly. Communication is difficult with old people as half the time I am talking to confused or deaf people, but they are manageable challenges.
Yesterday, I examined a lady who was quite ill. I think I have built a good rapport with her even with her advanced dementia. She has a lovely smile. Yesterday I was quite worried about her being unusually drowsy. But today she was much more alert. During ward round, I said hello and smiled at her. And she held her hand out towards me and looked at me like a child wanting sweets... But my body language in response was terrible! I hesitated and did not go ahead to receive her hand and she was left holding her hand out for about 10 seconds before the nurse took her hands, and then she said to the nurse 'don't leave me' repeatedly... Ohhh... I felt so bad. I just wasn't sure what to do for at that moment because I don't want to look rude interrupting the consultant's ward round. So to all medical student or anyone looking after patients in any way, never be like me.
In the afternoon, I went on another ward round by prof, another consultant geriatrician. This ward was duller, most patients were medically fit but remained in the ward with 'pending social issues'. Things went a little more interesting with a lady with advanced dementia who had unexplained depressed level of consciousness and refusing to eat or drink since two weeks ago and was 'dumped' to prof with the recommendation: 'for palliation only', which I wasn't entirely comfortable about, not least because it seemed no one had really looked into any reversible cause for her presentation. Possibilities like extradural haematoma, post-surgical bleed, depression are amenable to treatment and I felt we shouldn't give up just yet. Plus she wasn't drowsy all the time as the notes and nurses reported. I went to her bedside myself, offered her a glass of water and she took sips herself! I usually keep my opinion to myself but because I really don't want to go back home today burdened by another guilt, I asked prof if he would consider any reversible causes. He rambled (ie I didn't understand what he was saying), but in essence he wasn't comfortable with giving up on this lady as well just yet, so the plan was for the nursing staff to actively encourage food and drinking with charting for the next 3 days. I hate to think that the nurses would secretly be thinking that she's really on her way already, but I have a feeling they well may. I am not saying that they are lazy or unprofessional, but I just know from experience that preconception and prejudice can really influence how much effort you would put in with a patient. So I think I'm going to pop upstairs just to check on her for the rest of the week. In addition, at prof's request I am currently studying hypo- and hypernatraemia management using this lady as a case.
At the end of the round, we walked passed a side room and prof showed us the lady who had been on the care of the dying pathway. He commented on the irregular breathing, saying that she may well 'on her last minutes now'. We then literally watched her took three more breaths, and then she stopped. She has died. I have never seen a person die in front of me like this before. It was weird. I wasn't really upset because I didn't know her. But one minute she was alive, and the next she was gone. I left feeling weird, I still feel it now. The SHO and I then went in to confirmed her death. It was also the first time I have heard a doctor announcing the time of death of a person for real. I have now witnessed the process of a person both arriving and departing this world. Very, very humbling.
I like the person I am now. I am thinking and I am motivated to learn. I feel driven to read because otherwise I would not be of any help to my patients. Lets hope this will sustain.
.
.
Sunday, September 27
Cervical cancer vaccine
Government considers extending cervical cancer vaccination to adults
KOTA KINABALU: The government will consider expanding the free human papillomavirus (HPV) immunisation programme to include protection against cervical cancer for adults.
However, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that providing the vaccine free to adult women would depend on whether her ministry had sufficient funds.
From next year, the government will immunise all 13-year-olds in a programme that is expected to cost about RM150mil a year.
“The decision to provide the vaccine free for 13-year-olds was made because cervical cancer accounted for the second highest number of cancer cases among women in Malaysia, after breast cancer.
“If there is a need, the ministry will extend free jabs for others,” she told reporters at the her Hari Raya open house in Kg Pengalat Besar in Papar yesterday.
She said the vaccine has been found to be more effective when given to younger people compared to those in the 40s.
On Friday, Health Minister Datuk Seri Liow Tiong Lai announced that some 300,000 13-year-olds would be given free HPV immunisation jabs.
The vaccine is available in the country and costs about RM1,200 for three doses at private hospitals although the government was negotiating with the suppliers to reduce the price to about RM500.
I wish this Very Important Person would consult the expert and think before she make such popularity-enhancing statement, for when the public finds out the truth, would make her look stupid anyway (not that people like this would ever admit to it). The HPV vaccination is 'more effective when given to younger people compared to those in the 40s' because the vaccination doesn't work on women that's already have sex, i.e. those who are not virgin. This is because the Human Papilloma Virus (HPV) which causes cancerous changes on the cervix is very easily sexually transmitted. A senior doctor once told me even using condom will not prevent it from being transmitted, as it's one of those naturally occurring opportunistic microorganism which usually doesn't cause much trouble other than wanting to find a nice warm host. Once a lady have had sex, she already has this virus, although I have to emphasize that it doesn't turn cancerous in the big big majority of women. A woman only puts herself at high risk of cancer if she has multiple partners, doesn't use regular protection, smokes etc, you get the picture. HPV vaccine prevents the virus from infesting the cervix, but if they are there already, the vaccine is useless.
I'm not surprised that the introduction of this vaccine has not sparked a debate like it did in the UK. When the HPV vaccine was introduced in the UK, much information on HPV and cervical cancer were disseminated in order for parents and teenagers to make informed decisions. I was examined on counselling a worried parent in my fourth year gynae exam. UK parents were worried that endorsing this vaccine means condoning sex among teenage girls. I can only imagine what a ferocious issue the Islamic politicians would blow this into if they have been clever enough to find out. Cross our fingers they won't because if we just give it a second thought, we'd realize that it is just like any innocent vaccination we've ever had. It's there to protect the girls against cervical cancer in the future, nothing to do with the choice of sex lives they want to lead.
Take home message for politicians from the right, left, top and bottom wings who want to make the lime light: Whatever you say won't make me like you more because I frankly don't believe any of you anymore these days. Please check your facts first, don't waste the precious taxpayer money, don't give people false hope.
KOTA KINABALU: The government will consider expanding the free human papillomavirus (HPV) immunisation programme to include protection against cervical cancer for adults.
However, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that providing the vaccine free to adult women would depend on whether her ministry had sufficient funds.
From next year, the government will immunise all 13-year-olds in a programme that is expected to cost about RM150mil a year.
“The decision to provide the vaccine free for 13-year-olds was made because cervical cancer accounted for the second highest number of cancer cases among women in Malaysia, after breast cancer.
“If there is a need, the ministry will extend free jabs for others,” she told reporters at the her Hari Raya open house in Kg Pengalat Besar in Papar yesterday.
She said the vaccine has been found to be more effective when given to younger people compared to those in the 40s.
On Friday, Health Minister Datuk Seri Liow Tiong Lai announced that some 300,000 13-year-olds would be given free HPV immunisation jabs.
The vaccine is available in the country and costs about RM1,200 for three doses at private hospitals although the government was negotiating with the suppliers to reduce the price to about RM500.
I wish this Very Important Person would consult the expert and think before she make such popularity-enhancing statement, for when the public finds out the truth, would make her look stupid anyway (not that people like this would ever admit to it). The HPV vaccination is 'more effective when given to younger people compared to those in the 40s' because the vaccination doesn't work on women that's already have sex, i.e. those who are not virgin. This is because the Human Papilloma Virus (HPV) which causes cancerous changes on the cervix is very easily sexually transmitted. A senior doctor once told me even using condom will not prevent it from being transmitted, as it's one of those naturally occurring opportunistic microorganism which usually doesn't cause much trouble other than wanting to find a nice warm host. Once a lady have had sex, she already has this virus, although I have to emphasize that it doesn't turn cancerous in the big big majority of women. A woman only puts herself at high risk of cancer if she has multiple partners, doesn't use regular protection, smokes etc, you get the picture. HPV vaccine prevents the virus from infesting the cervix, but if they are there already, the vaccine is useless.
I'm not surprised that the introduction of this vaccine has not sparked a debate like it did in the UK. When the HPV vaccine was introduced in the UK, much information on HPV and cervical cancer were disseminated in order for parents and teenagers to make informed decisions. I was examined on counselling a worried parent in my fourth year gynae exam. UK parents were worried that endorsing this vaccine means condoning sex among teenage girls. I can only imagine what a ferocious issue the Islamic politicians would blow this into if they have been clever enough to find out. Cross our fingers they won't because if we just give it a second thought, we'd realize that it is just like any innocent vaccination we've ever had. It's there to protect the girls against cervical cancer in the future, nothing to do with the choice of sex lives they want to lead.
Take home message for politicians from the right, left, top and bottom wings who want to make the lime light: Whatever you say won't make me like you more because I frankly don't believe any of you anymore these days. Please check your facts first, don't waste the precious taxpayer money, don't give people false hope.
.
When will political stupidness end in Malaysia?
.
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Saturday, September 12
Charmed
Did you realise that charming people are such rare breed? I met one. It was the consultant in the clinic. Actually his most charismatic moment was when he did the introductory lecture last week. I remembered that I was still so busy talking to my friend when he was already ready to start and he looked at me, and I instantly fell silent... I don't know how he did it, it was as if he was able to connect to each and every one in the audience by his powerful eye contact. Very enthusiastic as well. This morning's clinic has been a bliss. Then we had another lecture with him after the clinic. Again I was really drawn in. Then there was an interactive exercise bit, and I couldn't believe that I sticked up my hand instantly after he asked 'who wants to do the first question' because while the mic was on the way to me I realized that I didn't actually know the answer... It's as if my right hand was acting from a remote control command, not from my brain. Nevermind. Didn't have time to panic. Albeit that extremely stressful situation (time pressure, all attention on me including the most charming person in the auditorium and my voice was to be amplified - I can never be comfortable with microphones etc) a bit of quick thinking I managed save myself from embarassment by giving the right answers. Maybe that's why he is a consultant at such a young age.
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Friday, September 4
I wish
that if i'm rubbish, people would just spit it out at me. I wish they would not keep on saying that it's fantastic and it's excellent and and it's a job well done and all that shit, when in fact it's just a pile of truly dispensible shit. Then I may not think all along that I'm such a star as they described and be so disappointed and so sore in my heart and to be feeling so ridiculous and humiliated when the final judgement comes.
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Thursday, September 3
Monday, August 31
5th year resolution
Tomorrow I will be a final year medical student. As I mentioned in my previous post, 3rd year was an unhappy year so I made action plans in order to make 4th year less miserable one, and 4th year was BRILLIANT! Now I think in a way it is nice to have had a bad year because I was able to make changes and look forward to a better year. With my 4th year being so full of moments of euphoria, I'm not sure what I should do to match that up in my 5th year. There is only one specific thing that I really want to improve: my interpersonal skills. I want to learn how to be a 'nice' person. It's difficult to sum up a 'nice' person in a few words. I don't even know what it is exactly, but I know that talking to some people makes me feel equal, listened to and comfortable. I aspire to be like these 'nice' person and I know I'm not to some people. I am the kind of person who avoids my weakness at all cost, but I think this ego of mine and the lack of empathy to people surrounding me are holding me back. There is definitely room for improvement and I want to be the best person I can be. I hope being 'nicer' can make me happier. I strive on 3 'S' from now on - Sympatique, Souriant et Sincerite (copied from a French movie Mon meilleur ami [My Best Friend]).
But I still feel a bit like driving aimlessly without specific goals for my 5th year. Any advice? Help...
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But I still feel a bit like driving aimlessly without specific goals for my 5th year. Any advice? Help...
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Sunday, August 30
Chorus
Joining the chorus was one of the best thing I have done in university. I only joined this year for several reasons. Third year wasn't a particularly happy year for me and I spent a lot of time reflecting on why this had occurred. One of my action plans was to participate in activities where I can get away from medics and meet some non-medics. Watching 'Last choir standing' and 'Maestro' over the summer holiday also re-ignited my enthusiasm for music. So I decided that I'd join this choir.
Rehearsal was always interactive and fun. It was handy to be sitting beside a music student during the first rehearsal as she had spare pencil to lend me. We were supposed to bring pencils to mark things in the score, just like piano lessons. First rehearsal was intimidating I have to admit. First of all, I've never seen a choir with that many people in it: there must have been 300 of us in the hall! The chorus is a non-auditioning choir and it's easy to assume that this translates as 'no experience required'. Incorrect. After the warm up, the conductor told us the page number to open, cued the pianist, and when the bars for vocal parts arrived, everyone just started singing! It appeared that we do need to know how to read notes, rhythms, time and key signatures, markings, italian terms etc. The pieces was quite long, so half of the rehearsals in the year consisted of sight-singing. Our conductor wanted us to do everything right at the first go, everything included not only the notes (i.e. the sound and words) but also the dynamics, expressions, diction etc. How demanding! Even in my grade 7 piano exam sight reading I had to completely ignored the expressions because my concentration was fully occupied in getting the notes and timing right. But I also loved the rehearsals because of this. It's challenging, but I knew I have the knowledge to do it right if I try hard enough. It was just wonderful to be engaging my brain in non-medical stuff, as though my brain have been straving of some vital nutrients that stimulation from medically related exercises cannot provide.
We performed two pieces, one for the Christmas concert and another one for the end of year concert. I fell in love with the first one, Elijah by Mendelsohn, from the first time we sang. It's a typical classical period music and I love classical period stuff. It's vibrant, yet still confine to certain rules and structures, rendering it predictable, makes sense to sing and easy to understand. On the other hand, the War Requiem by Britten took a while for me to see how the sound fitted togather to make any sense. I felt that it was not my cup of tea to begin with, but later on I came to understand how the theme of peace in Wilfred Owen poem was interwoven in the mass for the dead (Requiem) to make the whole song a messege/warning from mourning and deceased people to the world, and suddenly everything became very moving and meaningful.
Concerts were very exciting to prepare. I would always remember how I felt the first time we rehearsed with the orchestra. It was too overwhelming. The orchestra were so magnificent that I felt compelled to sing to the best of my ability to contribute to the grandiosity of the sound. Now I know that the pleasure of watching a concert can never ever be compared with that of performing. I was bursting with sense of pride along with the other singers and musicians when the conductor led us to stand and receive applause from the audience, especially on the second night of the Elijah concert when a few friends came along.
Being in the chorus had truly revived my interest in music again. I am going to continue singing with the chorus and when I go back home, I will continue learning piano until grade 8 or diploma. I endeavour to learn as much about music while I'm on the western side of the globe and start a group, perhaps involving children and charity, things that I'm passionate about. I really really really enjoyed this and I'd love to share this with others especially those not privileged enough to know music.
.
Rehearsal was always interactive and fun. It was handy to be sitting beside a music student during the first rehearsal as she had spare pencil to lend me. We were supposed to bring pencils to mark things in the score, just like piano lessons. First rehearsal was intimidating I have to admit. First of all, I've never seen a choir with that many people in it: there must have been 300 of us in the hall! The chorus is a non-auditioning choir and it's easy to assume that this translates as 'no experience required'. Incorrect. After the warm up, the conductor told us the page number to open, cued the pianist, and when the bars for vocal parts arrived, everyone just started singing! It appeared that we do need to know how to read notes, rhythms, time and key signatures, markings, italian terms etc. The pieces was quite long, so half of the rehearsals in the year consisted of sight-singing. Our conductor wanted us to do everything right at the first go, everything included not only the notes (i.e. the sound and words) but also the dynamics, expressions, diction etc. How demanding! Even in my grade 7 piano exam sight reading I had to completely ignored the expressions because my concentration was fully occupied in getting the notes and timing right. But I also loved the rehearsals because of this. It's challenging, but I knew I have the knowledge to do it right if I try hard enough. It was just wonderful to be engaging my brain in non-medical stuff, as though my brain have been straving of some vital nutrients that stimulation from medically related exercises cannot provide.
We performed two pieces, one for the Christmas concert and another one for the end of year concert. I fell in love with the first one, Elijah by Mendelsohn, from the first time we sang. It's a typical classical period music and I love classical period stuff. It's vibrant, yet still confine to certain rules and structures, rendering it predictable, makes sense to sing and easy to understand. On the other hand, the War Requiem by Britten took a while for me to see how the sound fitted togather to make any sense. I felt that it was not my cup of tea to begin with, but later on I came to understand how the theme of peace in Wilfred Owen poem was interwoven in the mass for the dead (Requiem) to make the whole song a messege/warning from mourning and deceased people to the world, and suddenly everything became very moving and meaningful.
Concerts were very exciting to prepare. I would always remember how I felt the first time we rehearsed with the orchestra. It was too overwhelming. The orchestra were so magnificent that I felt compelled to sing to the best of my ability to contribute to the grandiosity of the sound. Now I know that the pleasure of watching a concert can never ever be compared with that of performing. I was bursting with sense of pride along with the other singers and musicians when the conductor led us to stand and receive applause from the audience, especially on the second night of the Elijah concert when a few friends came along.
Being in the chorus had truly revived my interest in music again. I am going to continue singing with the chorus and when I go back home, I will continue learning piano until grade 8 or diploma. I endeavour to learn as much about music while I'm on the western side of the globe and start a group, perhaps involving children and charity, things that I'm passionate about. I really really really enjoyed this and I'd love to share this with others especially those not privileged enough to know music.
.
Saturday, July 25
Project option
The fourth year draws to an end with the completion of the 11 weeks project option period. Before I started the PO I was sceptical about it being something 'enjoyable'. I thought 11 weeks is a long time for such a small piece of work, and I would have loads of free time to persue my own things. Turns out quite the opposite really.
I must admitted that I have been extremely lucky to have found an extremely supportive supervisor who gathered a great team for me to work with (to be honest, they were so helpful that I felt like the only child). We started planning about 6 months beforehand and had numerous meetings before the start of the PO, and I started data collection on day 1 itself which is great and unusual for many students. I started feeling bored on the second day I started my data collection (staring at the computer all day!) and I asked if I could go onto the ward to do some practical things, and the answer was yes, of course! (or else, with my nature of favouring actions, I might as well be rotten) I spend my Friday on the ward and the odd days in the week observing speech and language therapist, videofluoroscopy etc.
As a result, I got to know almost the most people in the hospital that look after stroke patients. The research people, the acute and rehabilitation doctors and nurses as well as some of the therapists. My supervisor encouraged me to talk to many people, and I think was the best advice that I've ever received from the entire PO period. If I have been stuck in the office, I would not have been able to write so much on the 'Discussion' section about the practical difficulties of the screening test I was investigating. Who says research has to be for unsociable geeks only? Equally rewarding was that my findings have provided useful information for the clinical changes that will be implemented.
I also quite enjoyed the process of research. The unclarity of the objective frustrates me: I wasn't sure from the beginning that the way I collect the data was the best method to answer the research question, but I didn't know how to convey the doubt, until I went to see a statistician, and he just said it was a flawed way to answer the question, so we changed our research question, and I was much more comfortable since then. Research does made me think a lot, constantly I was thinking of critically appraising work of others and myself, which was quite taxing.
The doctors were too nice and I was given the opportunity to do loads of things (including written my first complete drug kardex in addition to many others like clerking in patients, bloods etc etc). I'd like to think that I have been a helpful member of the team. I feel quite sorry to leave (but yesterday I learnt that the junior doctors will also be moving on to other rotations soon after I leave, so I don't feel too bad now). But I don't think I'm completely finished with the stroke team yet. Still has this potential publication pending (although, now when I look at the way I've analysed my data again, I kind of feel it will not passed the peer review because it's just far from perfection), and I hope to be part of the discussion group as to how best to improve this screening test. And hope my abstract for the stroke forum gets accepted so I can go to Glasgow in December!
.
I must admitted that I have been extremely lucky to have found an extremely supportive supervisor who gathered a great team for me to work with (to be honest, they were so helpful that I felt like the only child). We started planning about 6 months beforehand and had numerous meetings before the start of the PO, and I started data collection on day 1 itself which is great and unusual for many students. I started feeling bored on the second day I started my data collection (staring at the computer all day!) and I asked if I could go onto the ward to do some practical things, and the answer was yes, of course! (or else, with my nature of favouring actions, I might as well be rotten) I spend my Friday on the ward and the odd days in the week observing speech and language therapist, videofluoroscopy etc.
As a result, I got to know almost the most people in the hospital that look after stroke patients. The research people, the acute and rehabilitation doctors and nurses as well as some of the therapists. My supervisor encouraged me to talk to many people, and I think was the best advice that I've ever received from the entire PO period. If I have been stuck in the office, I would not have been able to write so much on the 'Discussion' section about the practical difficulties of the screening test I was investigating. Who says research has to be for unsociable geeks only? Equally rewarding was that my findings have provided useful information for the clinical changes that will be implemented.
I also quite enjoyed the process of research. The unclarity of the objective frustrates me: I wasn't sure from the beginning that the way I collect the data was the best method to answer the research question, but I didn't know how to convey the doubt, until I went to see a statistician, and he just said it was a flawed way to answer the question, so we changed our research question, and I was much more comfortable since then. Research does made me think a lot, constantly I was thinking of critically appraising work of others and myself, which was quite taxing.
The doctors were too nice and I was given the opportunity to do loads of things (including written my first complete drug kardex in addition to many others like clerking in patients, bloods etc etc). I'd like to think that I have been a helpful member of the team. I feel quite sorry to leave (but yesterday I learnt that the junior doctors will also be moving on to other rotations soon after I leave, so I don't feel too bad now). But I don't think I'm completely finished with the stroke team yet. Still has this potential publication pending (although, now when I look at the way I've analysed my data again, I kind of feel it will not passed the peer review because it's just far from perfection), and I hope to be part of the discussion group as to how best to improve this screening test. And hope my abstract for the stroke forum gets accepted so I can go to Glasgow in December!
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Wednesday, July 8
I'm worried...
because I can't seem to stop eating.
because I can't seem to stop messing around with facebook and wikipaedia and blogs, anything but not my report.
because I can't stop itching, which is a sign that I'm stressed
because I can't bloody concentrate on what I'm supposed to be doing, which is my report!!!
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because I can't seem to stop messing around with facebook and wikipaedia and blogs, anything but not my report.
because I can't stop itching, which is a sign that I'm stressed
because I can't bloody concentrate on what I'm supposed to be doing, which is my report!!!
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Tuesday, July 7
Me
This is supposed to be me. The artist is of course my artistically gifted sister Yee Leng. I love it!
Wednesday, July 1
On foreign maids
I am writing in response to your report: “Maid’s day off: Most against idea, govt wants more feedback” (The Star, 18th June 2009). I am quite disappointed with the results of the poll.
My background is in medicine and we are constantly reminded to treat others as we would like to be treated. But it doesn’t matter whether you work in healthcare or not, this principle should apply to everyone we encounter. How would you feel if you have to live in the place you work everyday with no day-off at all? We all appreciate our days off on Saturdays and Sundays, do foreign maids not need them too? If this is not good enough for us, why is it an acceptable practice for foreign maids?
It is nice to learn that some employers take their maid out for shopping, but would be apprehensive about letting them go out on their own fearing that they would ‘mix with bad hats’. My goodness, if I was a teenager and my parents were to use that as an excuse to not let me go out, I would be so annoyed, wouldn’t you? May I remind you that maids are fully grown adults? Who are we to assume that they lack the judgment to choose their companies? Outright cruelty with foreign maids may be rare, subtle restrictions in freedom like these can be enough to be mentally draining for anyone, I would imagine.
I would even go as far as to suggest that we stop calling them ‘maid’. They are not here for employers to slave around. They are helpers who are here to assist with our daily chores. Poor and uneducated many of them may be, they still deserve the same rights and respect as with everyone else.
Gandhi once said “The measure of a country's greatness should be based on how well it cares for its most vulnerable populations”. Foreign maids often cannot advocate for themselves and their jobs are lowly regarded. It does appear that some are taking advantage of this to exploit them further. We must take action to protect those who cannot fend for themselves, and I think the cabinet is doing the right thing to consider a mandatory day off in a week for all maids. Treat others as you would like to be treated. If not, it might be your right that would be denied one day.
.
My background is in medicine and we are constantly reminded to treat others as we would like to be treated. But it doesn’t matter whether you work in healthcare or not, this principle should apply to everyone we encounter. How would you feel if you have to live in the place you work everyday with no day-off at all? We all appreciate our days off on Saturdays and Sundays, do foreign maids not need them too? If this is not good enough for us, why is it an acceptable practice for foreign maids?
It is nice to learn that some employers take their maid out for shopping, but would be apprehensive about letting them go out on their own fearing that they would ‘mix with bad hats’. My goodness, if I was a teenager and my parents were to use that as an excuse to not let me go out, I would be so annoyed, wouldn’t you? May I remind you that maids are fully grown adults? Who are we to assume that they lack the judgment to choose their companies? Outright cruelty with foreign maids may be rare, subtle restrictions in freedom like these can be enough to be mentally draining for anyone, I would imagine.
I would even go as far as to suggest that we stop calling them ‘maid’. They are not here for employers to slave around. They are helpers who are here to assist with our daily chores. Poor and uneducated many of them may be, they still deserve the same rights and respect as with everyone else.
Gandhi once said “The measure of a country's greatness should be based on how well it cares for its most vulnerable populations”. Foreign maids often cannot advocate for themselves and their jobs are lowly regarded. It does appear that some are taking advantage of this to exploit them further. We must take action to protect those who cannot fend for themselves, and I think the cabinet is doing the right thing to consider a mandatory day off in a week for all maids. Treat others as you would like to be treated. If not, it might be your right that would be denied one day.
.
Thursday, June 25
My first ever referral
'Mr D is bleeding tears. Can you come and have a look?' the nurse said with some panic in her voice. Me eyes went wide opened, and my first thought: Exorcist!
Nah... it didn't look like that at all. We had a look and the nurses pressured the SHO to get him seen by an ophthalmologist. It was a very busy day and I was asked to make the referral. I foolishly agreed.
Firstly I needed to know who to call as my hospital has no ophthalmology service. We have an eye team from a DGH 10 miles away who runs an outpatient clinic here, but then just last week I heard another doctor arguing on the phone as they would not accept in-patient referral from our hospital. At the back of my mind, I remembered when I have had my placement at the eye hospital (the tertiary eye referral centre in Manchester) I was repeatedly told by a keen registrar about an interesting case from my hospital. I wonder if they would that a referral from us? So I googled and found their phone number. I just tried my luck and asked if they cover in-patient referral from my hospital, and they do! The nurse passed on the phone to the on-call registrar.
That was when my palpitations began. You might think, what is so difficult about making a phone call? Well, doctor to doctor conversation follows a specific format and I have seen many miscommunication happened over the phone. You'll be surprise if I tell you how many times I've seen people getting really pissed off and having a fit on the phone. I'm just terrified to be reminded of that. I think my SHO assumed that I know how to do it and pretty much just said to me 'Can you do the ophthalmology referral to Mr D?' and left. So before I called, I read Mr D's notes and checked the eye complaint several times. Then, I remembered a registrar who grumbled 'these SHOs are referral patients to us without even seeing the patients themselves first'. So I thought I ought to quickly take a history and examine Mr D's eyes before I proceed.
The on call registrar was not too bad actually. He said hello, and then just let me present the patient for 2 minutes without interruption. Then he gave his ophthalmology opinion and recommendations. He said he's very busy but will try to come over and see the patient. I thanked him and hang up. Relief! Apart from my stress induced slurred speech (had to say chloromphenicol for three times before I get it right) it was not as bad as I expected. The only thing I got told off was that I didn't check his visual acuity (I did, just not using a snellen chart!). I documented almost every word that was exchanged - probably not a usual practice but I just want to be extra extra careful.
As always whenever I'm involved in patient care, I learn by leaps and bounds. For a start, I am twice as alert. I double check, no actually, I triple check everything. What for? Well, to make sure that I don't look too stupid, but more importantly people supervising me will often trust my words and judgement, and plan their management from what I have told them. If I've made up something in the history for example, the diagnosis and management will be based on those false information. They say we shouldn't bring patient issues home, but I always go home with nagging questions in my head. Have I done everything right? Or more importantly have I done anything wrong that could have harmed the patient? And to follow on, what would I do differently next time? Every single involvement with patient care is indeed a huge learning curve for me.
So for today, in hindsight, I could have done much better. Especially because I've just done an ophthalmology placement, I should have been able to get a better history, do a more thorough examination of the eye and come up with a more accurate diagnosis. I just forgot to take a moment to gather these thoughts. And I forgot that the receiving specialty doctors always want to know 'what do you think it is?'. The registrar must have thought that this is such a crappy referral. Today's experience also further reiterates to me that surviving as a junior doctor is all about communication, resourcefulness and being a little thick-skinned. It was a valuable learning experience for me. Definitely will be better next time.
.
Nah... it didn't look like that at all. We had a look and the nurses pressured the SHO to get him seen by an ophthalmologist. It was a very busy day and I was asked to make the referral. I foolishly agreed.
Firstly I needed to know who to call as my hospital has no ophthalmology service. We have an eye team from a DGH 10 miles away who runs an outpatient clinic here, but then just last week I heard another doctor arguing on the phone as they would not accept in-patient referral from our hospital. At the back of my mind, I remembered when I have had my placement at the eye hospital (the tertiary eye referral centre in Manchester) I was repeatedly told by a keen registrar about an interesting case from my hospital. I wonder if they would that a referral from us? So I googled and found their phone number. I just tried my luck and asked if they cover in-patient referral from my hospital, and they do! The nurse passed on the phone to the on-call registrar.
That was when my palpitations began. You might think, what is so difficult about making a phone call? Well, doctor to doctor conversation follows a specific format and I have seen many miscommunication happened over the phone. You'll be surprise if I tell you how many times I've seen people getting really pissed off and having a fit on the phone. I'm just terrified to be reminded of that. I think my SHO assumed that I know how to do it and pretty much just said to me 'Can you do the ophthalmology referral to Mr D?' and left. So before I called, I read Mr D's notes and checked the eye complaint several times. Then, I remembered a registrar who grumbled 'these SHOs are referral patients to us without even seeing the patients themselves first'. So I thought I ought to quickly take a history and examine Mr D's eyes before I proceed.
The on call registrar was not too bad actually. He said hello, and then just let me present the patient for 2 minutes without interruption. Then he gave his ophthalmology opinion and recommendations. He said he's very busy but will try to come over and see the patient. I thanked him and hang up. Relief! Apart from my stress induced slurred speech (had to say chloromphenicol for three times before I get it right) it was not as bad as I expected. The only thing I got told off was that I didn't check his visual acuity (I did, just not using a snellen chart!). I documented almost every word that was exchanged - probably not a usual practice but I just want to be extra extra careful.
As always whenever I'm involved in patient care, I learn by leaps and bounds. For a start, I am twice as alert. I double check, no actually, I triple check everything. What for? Well, to make sure that I don't look too stupid, but more importantly people supervising me will often trust my words and judgement, and plan their management from what I have told them. If I've made up something in the history for example, the diagnosis and management will be based on those false information. They say we shouldn't bring patient issues home, but I always go home with nagging questions in my head. Have I done everything right? Or more importantly have I done anything wrong that could have harmed the patient? And to follow on, what would I do differently next time? Every single involvement with patient care is indeed a huge learning curve for me.
So for today, in hindsight, I could have done much better. Especially because I've just done an ophthalmology placement, I should have been able to get a better history, do a more thorough examination of the eye and come up with a more accurate diagnosis. I just forgot to take a moment to gather these thoughts. And I forgot that the receiving specialty doctors always want to know 'what do you think it is?'. The registrar must have thought that this is such a crappy referral. Today's experience also further reiterates to me that surviving as a junior doctor is all about communication, resourcefulness and being a little thick-skinned. It was a valuable learning experience for me. Definitely will be better next time.
.
Friday, June 19
Free thoughts
*****
Occasionally when I walk pass student flats and smell food that I know and I like, I would crave for it uncontrollably. Such happened about a month ago. It was the chicken dish that women in confinement eat. I love confinement food. They taste spicy and appetizing. So I asked mummy for the recipe. Apparently it requires wine, so for the first time in my life, I bought a (small) bottle of wine from the supermarket. I cooked the chicken dish - not great, and I am not keen to try again soon. What should I do with the rest of the wine left? Two days ago, I poured a quarter of a glass to drink with my dinner. I felt awful after that! Terrible headache, felt sleepy, and absolutely couldn't concentrate on my reading (of some journal articles, not surprising!). I think I even have a little hangover on the day after. Why? I fear this may well be a psychological response, since (based on my knowledge of medicine) to make me feel that awful from 30mL of wine is physiologically impossible. I am very pressed for time this week, so not going anywhere near it.
*****
I wonder if one of my friends has got bipolar disorder. I have not really seen the manic side of her yet, but occasionally she does dresses very fancy. And yesterday she wore really really colourful make ups. And I know she has suffered from severe depression before. I will be looking out for some more manic features.
*****
I dislike being dragged along into management meetings, or even just hearing senior doctors talking about management. I feel like a child in a room full of adults discussing and arguing over adult matters and I really shouldn't be in here.
*****
I had a great dream last night.
*****
This week is extremely busy. I have just realised that as late minute person I am in a lifelong race against time and I have always won so far.
.
Occasionally when I walk pass student flats and smell food that I know and I like, I would crave for it uncontrollably. Such happened about a month ago. It was the chicken dish that women in confinement eat. I love confinement food. They taste spicy and appetizing. So I asked mummy for the recipe. Apparently it requires wine, so for the first time in my life, I bought a (small) bottle of wine from the supermarket. I cooked the chicken dish - not great, and I am not keen to try again soon. What should I do with the rest of the wine left? Two days ago, I poured a quarter of a glass to drink with my dinner. I felt awful after that! Terrible headache, felt sleepy, and absolutely couldn't concentrate on my reading (of some journal articles, not surprising!). I think I even have a little hangover on the day after. Why? I fear this may well be a psychological response, since (based on my knowledge of medicine) to make me feel that awful from 30mL of wine is physiologically impossible. I am very pressed for time this week, so not going anywhere near it.
*****
I wonder if one of my friends has got bipolar disorder. I have not really seen the manic side of her yet, but occasionally she does dresses very fancy. And yesterday she wore really really colourful make ups. And I know she has suffered from severe depression before. I will be looking out for some more manic features.
*****
I dislike being dragged along into management meetings, or even just hearing senior doctors talking about management. I feel like a child in a room full of adults discussing and arguing over adult matters and I really shouldn't be in here.
*****
I had a great dream last night.
*****
This week is extremely busy. I have just realised that as late minute person I am in a lifelong race against time and I have always won so far.
.
Sunday, June 14
Friday, June 12
Patients
I was out with some friends yesterday and they asked if I've ever thought about not wanting to do medicine. I said no, not since I've started anyway. And they were surprised, and asked why. 'The patients.' I answered. Will tell you about this two patients I've seen this week.
A elderly patient in the stroke ward. Very sweet, seen shuffling up and down the ward with his zimmer frame. Reminded me of my grandfather (a gong - father side). Had that face of him. His hands... thin, covered with tight but inelastic skin, protruding veins. Was trying so hard to convince us that he can manage to be discharged back to home, almost made me laugh... A gong would never had been so articulate. He had always been a very soft spoken person ever since I'd known him. He passed away a few years ago. Seeing this old man talk, I had tears at the corner of my eyes.
A consultant doctor admitted with a big bleeding stroke needing surgical evacuation. Although personally I never ever do it, there is always a risk of being patronised and treated like an institutionalized person when you are in hospital. Now he can't move the right side of his body, have trouble swallowing and is only allowed puree food, and have short term memory loss. I could just imagine that a month ago he could have been resuscitating patients, teaching junior doctors, being asked 'consultant opinion' about patients ; and now he needs people to wipe his bum and get out of bed using a hoist... If I'm lucky enough, I'd probably have the privillage to enjoy a fast and painless death. But I know that most of us would possibly end up like this one day. I know this ever since I started working as an auxillary nurse. Just had never really thought of it in this context before. People that I really respect and look up to, almost infalliable in my eyes, can actually be bedridden and lose all the dignity we spend all our lives building.
.
A elderly patient in the stroke ward. Very sweet, seen shuffling up and down the ward with his zimmer frame. Reminded me of my grandfather (a gong - father side). Had that face of him. His hands... thin, covered with tight but inelastic skin, protruding veins. Was trying so hard to convince us that he can manage to be discharged back to home, almost made me laugh... A gong would never had been so articulate. He had always been a very soft spoken person ever since I'd known him. He passed away a few years ago. Seeing this old man talk, I had tears at the corner of my eyes.
A consultant doctor admitted with a big bleeding stroke needing surgical evacuation. Although personally I never ever do it, there is always a risk of being patronised and treated like an institutionalized person when you are in hospital. Now he can't move the right side of his body, have trouble swallowing and is only allowed puree food, and have short term memory loss. I could just imagine that a month ago he could have been resuscitating patients, teaching junior doctors, being asked 'consultant opinion' about patients ; and now he needs people to wipe his bum and get out of bed using a hoist... If I'm lucky enough, I'd probably have the privillage to enjoy a fast and painless death. But I know that most of us would possibly end up like this one day. I know this ever since I started working as an auxillary nurse. Just had never really thought of it in this context before. People that I really respect and look up to, almost infalliable in my eyes, can actually be bedridden and lose all the dignity we spend all our lives building.
.
Sunday, June 7
Pushing the boundary - Part 2
I saw Mr G in the ward round last week. He was sitting out on a chair. Eyes wide opened, alert. ABCDE was perfect. Could even whisper a full sentence 'when do you think I can get back to normal'! He's now all ready for rehabilitation. So happy for him!!!!!
.
.
Friday, May 29
Pushing the boundary
This is medical post. I saw an exciting procedure done on a stroke patient today which yet again steered me into the reflective mood.
Mr G is a previously fit and well 50 year old father of two who was admitted with stroke last week. It affected his vision, speech, swallowing, right arm and leg. He took a turn for the worse yesterday. He had another big stroke affecting the brainstem and he completely lost his airway and slipped into a coma.
His brain CT and MRI were pretty horrific to watch too. First of all let me explain the relevant basic of neuroanatomy. The brainstem controls our consciousness, breathing, heart rate – absolutely fundamental for survival. When the brainstem is gone, that’s when you call a person ‘brain dead’. The make up of our bodies naturally makes sure that the brainstem is constantly well supplied with oxygen and nutrient by having two arteries on each sides of the brainstem. They are also interconnected to one another (communicating), so that if one is blocked for any reason, the other one can compensate for the supply.
On Mr G’s brain, one of the arteries is completely occluded beyond salvage. The other artery had a section of significant narrowing (stenosis) and was almost completely blocked. The supply of the whole of the brainstem and indeed the back of the brain were hanging on just by a thread size hole for that tiny amount of oxygenated blood to flow through. If this pinhole is blocked, Mr G would die.
So the idea was to put a stent into the nearly-blocked artery to open up the narrowing. Stenting is routinely done for vessels on the heart muscles (coronary arteries) but not so much for the brain arteries. I’m not sure why. Maybe because there is too much at stake. The intrusion to the diseased and perhaps fragile vessel could rupture the arterial wall resulting in a disastrous bleed into the brain. Debris (like fat/atheroma which sticks on the wall of the arteries that cause the narrowing in the first place) could dislodge and travel upwards to occlude the vessel further ahead. But on balance, if we don’t press ahead, more clots (emboli) are likely to just take its course to occlude the tight narrow vessel – the catch is that we cannot guarantee that it will happen.
Seeing the procedure itself just made me realize so many other factors to weigh up. My hospital is the tertiary referral centre for neurosciences services in Manchester. We have unrivalled expertise of the different neuro sub-specialties. Even so, since this procedure has never been performed before here, a radiologist from the neighbouring teaching hospital (MRI) had to bring in some stents they normally use for coronary vessels. The procedure is done under direct x-ray screening. In total Mr G must have been subjected to about an hour worth of radiation on two planes.
In order to put the stent in the best position, a guidewire needed to go over the area of stenosis. They tried once, the wire stays at the proximal bend and would not advance further. They looked for a stiffer wire, and the radiologist tried pushing it in, again it wouldn’t budge. By then, Mr G has already been subjected to two hours worth of anesthetic (don’t forget that this is a patient who has just suffered a very serious stroke). There isn’t a wire stiffer than this in stock. This is so frustrating! At this point, I wondered if they are going to just abandon the procedure. So the visiting radiologist from MRI suggested two wires: one as the main guidewire and another one as a buddy wire just to help stiffen the main one. And so the team of radiologists deliberated for a while. I heard the radiologist from MRI said ‘by the way this is an untouched territory, we have no idea what is going to happen’. So the team went ahead, and the guidewires finally passed through. Carefully they deployed the stent, opened it up and we finally saw what we went there for. There was much more blood flow running through that previously stenosed area, and we saw much more perfusion distally lighting up as dark stuff on the x-ray. So it was a success. I later learnt that this stent-in-the-brain procedure is only the second one to be done in this country. Well done to the radiologists!
However this is not the end of the story. Radiological success is one thing, the clinical picture is another. Will Mr G wake up? Will he start breathing on his own? Will he ever be strong enough to undergo physio and be a functional man again? Some area of the brainstem has obviously been deprived of oxygen and nutrient for some hours, and whether we have done this procedure in time for the fresh blood to replenish and revive these dying neurons, no one has the answer. I guess this is the time the doctors would be telling the relatives that we just have to wait and see. Still, I am hopeful. From what I have seen today and all my experience in medicine, I can tell you that when doctors say that 'we will do everything we can', they mean it.
.
Mr G is a previously fit and well 50 year old father of two who was admitted with stroke last week. It affected his vision, speech, swallowing, right arm and leg. He took a turn for the worse yesterday. He had another big stroke affecting the brainstem and he completely lost his airway and slipped into a coma.
His brain CT and MRI were pretty horrific to watch too. First of all let me explain the relevant basic of neuroanatomy. The brainstem controls our consciousness, breathing, heart rate – absolutely fundamental for survival. When the brainstem is gone, that’s when you call a person ‘brain dead’. The make up of our bodies naturally makes sure that the brainstem is constantly well supplied with oxygen and nutrient by having two arteries on each sides of the brainstem. They are also interconnected to one another (communicating), so that if one is blocked for any reason, the other one can compensate for the supply.
On Mr G’s brain, one of the arteries is completely occluded beyond salvage. The other artery had a section of significant narrowing (stenosis) and was almost completely blocked. The supply of the whole of the brainstem and indeed the back of the brain were hanging on just by a thread size hole for that tiny amount of oxygenated blood to flow through. If this pinhole is blocked, Mr G would die.
So the idea was to put a stent into the nearly-blocked artery to open up the narrowing. Stenting is routinely done for vessels on the heart muscles (coronary arteries) but not so much for the brain arteries. I’m not sure why. Maybe because there is too much at stake. The intrusion to the diseased and perhaps fragile vessel could rupture the arterial wall resulting in a disastrous bleed into the brain. Debris (like fat/atheroma which sticks on the wall of the arteries that cause the narrowing in the first place) could dislodge and travel upwards to occlude the vessel further ahead. But on balance, if we don’t press ahead, more clots (emboli) are likely to just take its course to occlude the tight narrow vessel – the catch is that we cannot guarantee that it will happen.
Seeing the procedure itself just made me realize so many other factors to weigh up. My hospital is the tertiary referral centre for neurosciences services in Manchester. We have unrivalled expertise of the different neuro sub-specialties. Even so, since this procedure has never been performed before here, a radiologist from the neighbouring teaching hospital (MRI) had to bring in some stents they normally use for coronary vessels. The procedure is done under direct x-ray screening. In total Mr G must have been subjected to about an hour worth of radiation on two planes.
In order to put the stent in the best position, a guidewire needed to go over the area of stenosis. They tried once, the wire stays at the proximal bend and would not advance further. They looked for a stiffer wire, and the radiologist tried pushing it in, again it wouldn’t budge. By then, Mr G has already been subjected to two hours worth of anesthetic (don’t forget that this is a patient who has just suffered a very serious stroke). There isn’t a wire stiffer than this in stock. This is so frustrating! At this point, I wondered if they are going to just abandon the procedure. So the visiting radiologist from MRI suggested two wires: one as the main guidewire and another one as a buddy wire just to help stiffen the main one. And so the team of radiologists deliberated for a while. I heard the radiologist from MRI said ‘by the way this is an untouched territory, we have no idea what is going to happen’. So the team went ahead, and the guidewires finally passed through. Carefully they deployed the stent, opened it up and we finally saw what we went there for. There was much more blood flow running through that previously stenosed area, and we saw much more perfusion distally lighting up as dark stuff on the x-ray. So it was a success. I later learnt that this stent-in-the-brain procedure is only the second one to be done in this country. Well done to the radiologists!
However this is not the end of the story. Radiological success is one thing, the clinical picture is another. Will Mr G wake up? Will he start breathing on his own? Will he ever be strong enough to undergo physio and be a functional man again? Some area of the brainstem has obviously been deprived of oxygen and nutrient for some hours, and whether we have done this procedure in time for the fresh blood to replenish and revive these dying neurons, no one has the answer. I guess this is the time the doctors would be telling the relatives that we just have to wait and see. Still, I am hopeful. From what I have seen today and all my experience in medicine, I can tell you that when doctors say that 'we will do everything we can', they mean it.
.
Thursday, May 28
Crisis of confidence
What I'd like to talk about today is based on a malaysian girl who always comes to me before her OSCE exam to get advice and to practise. She is a year below me currently preparing for her end of third year exam. And whenever she comes, we would end up in a lengthy chat on language, confidence etc etc.
She's a malay malaysian, brought up in a malay community and secondarily educated in a boarding school exclusively for malay people. Like me, she is studying medicine here courtesy of a generous scholarship funded by the taxpayers' money. These scholarships have traditionally been awarded to high achievers in the public examinations. There is a fixed view that excellence in exam equals potential, nothing else counts. It doesn't take a genius to find this hypothesis significantly flawed.
She lamented about the old issues. She feels that her PBL mates laugh at her and talk behind her back, that her voice is not powerful enough to overcome her colleagues' in PBL eventhough she has all the knowledge in her head or that her PBL mates frequently interrupt her. In conclusion she feels like an outsider. If I was someone responsible for her education, I'd be at least slightly worried because this is her third year as a student in Manchester and in my opinion should have been fairly comfortable with fitting in.
But in actual fact many oversea students feel this way. I know lots of people who completely shy away from any contact with non-malaysian other than attendance at compulsory group work. They cope by sticking to the other lost malaysians and remain in their own comfort zone speaking their native language, practising their own customs and cultures. With no new experience, these students might as well have studied at home and relieve our country RM1million per person. These are the sort of comments I often find going through the 'letter to editor' section in Malaysian newspapers, and I have to agree.
Many British students have never experience speaking in a second language with a group of native speakers. My impression is that they underestimate the strength it takes to say something, let alone comfortably contribute as an equal member of the group. I remember in my first ever PBL session, I made a joke and I was so afraid that people won't laugh (and I distinctly remember telling myself over and over again 'It doesn't matter if I made a fool of myself. It doesn't matter!'), but they actually burst out laughing - and I was just so chuffed and euphoric. They laughed at my joke! Couldn't believe it! Communicating in a good standard of English is one thing, and I believe we can all do that after all those stringent medical school admission criteria; but fitting in with the local students is another thing and it requires more than good English. We need to be hanging out with them, understand their jokes and show bits of our personalities. As non British, we are extremely conscious that our facial feature, the way we dress, our accents mark us out as being different. People may well be oblivious to these, but some of us are so self aware that it hinders them from reaching out. Until we lose this inhibition, we are not likely to get further away from our comfort zone.
Fortunately for me I am well pass that stage a long time ago. I now see the British society just like any society that I know of. There are good people and bad people and many in between; there are the rich and powerful and the poor and lowly and many who belong to the 'middle class'. And to communicate with any of them, I do need reasonable proficiency in english, but most of all I need to be myself, rather than holding back because I feel inferior that my english is not as good is theirs. If whatever I say comes from my true self, the conversation always turns out alright. The sincerity of human race cuts across different languages, cultures and nations. Sometimes it is these concepts and social skills that the high scorers fail to grasp.
That brings me back to the issue of confidence when speaking in english to a group of native speaker. A supportive environment helps (for example, friends who appreciate that I don't want to drink alcohol and would compromise by a nightout at a restaurant instead). But at the end of the day it is down to herself. I advised the girl to just be a little thick skinned and start to reach out to people. Doesn’t matter if they respond by being horrible and nasty – there are rotton apples everywhere. Unless she gets to know people on a personal level and let other people know her, there's unlikely going to be any genuine flow of conversation and she is just going to carry on feeling miserable.
To learn medicine, we can’t afford not to be able to talk naturally. Half of medicine really is just talking. Does it make sense?
More entries to come. Reminder to myself. * Chorus * Ophthalmology * Project option.
.
She's a malay malaysian, brought up in a malay community and secondarily educated in a boarding school exclusively for malay people. Like me, she is studying medicine here courtesy of a generous scholarship funded by the taxpayers' money. These scholarships have traditionally been awarded to high achievers in the public examinations. There is a fixed view that excellence in exam equals potential, nothing else counts. It doesn't take a genius to find this hypothesis significantly flawed.
She lamented about the old issues. She feels that her PBL mates laugh at her and talk behind her back, that her voice is not powerful enough to overcome her colleagues' in PBL eventhough she has all the knowledge in her head or that her PBL mates frequently interrupt her. In conclusion she feels like an outsider. If I was someone responsible for her education, I'd be at least slightly worried because this is her third year as a student in Manchester and in my opinion should have been fairly comfortable with fitting in.
But in actual fact many oversea students feel this way. I know lots of people who completely shy away from any contact with non-malaysian other than attendance at compulsory group work. They cope by sticking to the other lost malaysians and remain in their own comfort zone speaking their native language, practising their own customs and cultures. With no new experience, these students might as well have studied at home and relieve our country RM1million per person. These are the sort of comments I often find going through the 'letter to editor' section in Malaysian newspapers, and I have to agree.
Many British students have never experience speaking in a second language with a group of native speakers. My impression is that they underestimate the strength it takes to say something, let alone comfortably contribute as an equal member of the group. I remember in my first ever PBL session, I made a joke and I was so afraid that people won't laugh (and I distinctly remember telling myself over and over again 'It doesn't matter if I made a fool of myself. It doesn't matter!'), but they actually burst out laughing - and I was just so chuffed and euphoric. They laughed at my joke! Couldn't believe it! Communicating in a good standard of English is one thing, and I believe we can all do that after all those stringent medical school admission criteria; but fitting in with the local students is another thing and it requires more than good English. We need to be hanging out with them, understand their jokes and show bits of our personalities. As non British, we are extremely conscious that our facial feature, the way we dress, our accents mark us out as being different. People may well be oblivious to these, but some of us are so self aware that it hinders them from reaching out. Until we lose this inhibition, we are not likely to get further away from our comfort zone.
Fortunately for me I am well pass that stage a long time ago. I now see the British society just like any society that I know of. There are good people and bad people and many in between; there are the rich and powerful and the poor and lowly and many who belong to the 'middle class'. And to communicate with any of them, I do need reasonable proficiency in english, but most of all I need to be myself, rather than holding back because I feel inferior that my english is not as good is theirs. If whatever I say comes from my true self, the conversation always turns out alright. The sincerity of human race cuts across different languages, cultures and nations. Sometimes it is these concepts and social skills that the high scorers fail to grasp.
That brings me back to the issue of confidence when speaking in english to a group of native speaker. A supportive environment helps (for example, friends who appreciate that I don't want to drink alcohol and would compromise by a nightout at a restaurant instead). But at the end of the day it is down to herself. I advised the girl to just be a little thick skinned and start to reach out to people. Doesn’t matter if they respond by being horrible and nasty – there are rotton apples everywhere. Unless she gets to know people on a personal level and let other people know her, there's unlikely going to be any genuine flow of conversation and she is just going to carry on feeling miserable.
To learn medicine, we can’t afford not to be able to talk naturally. Half of medicine really is just talking. Does it make sense?
More entries to come. Reminder to myself. * Chorus * Ophthalmology * Project option.
.
Monday, May 4
When my room is messy
When my room is messy, I'm most probably:
-Stressed
-Not sleeping well OR sleeping too much
-Not eating well
-Procrastinating
-Depressed OR frustrated OR feelingless
-Generally not very efficient
Just to give you an impression of how messy my room is at the moment, on the floor I see:
-Books
-Papers
-An umbrella
-A handbag
-A pair of socks
-A saucepan
-A paperbag
-Two biscuit wraps
-A pair of jeans
-A stethoscope
I'm Stressed. I Hate Essay Writing.
HAPPY BIRTHDAY 20th WAN CHENG!!!
.
-Stressed
-Not sleeping well OR sleeping too much
-Not eating well
-Procrastinating
-Depressed OR frustrated OR feelingless
-Generally not very efficient
Just to give you an impression of how messy my room is at the moment, on the floor I see:
-Books
-Papers
-An umbrella
-A handbag
-A pair of socks
-A saucepan
-A paperbag
-Two biscuit wraps
-A pair of jeans
-A stethoscope
I'm Stressed. I Hate Essay Writing.
HAPPY BIRTHDAY 20th WAN CHENG!!!
.
Sunday, April 19
Medics Ski Trip 2009!!!
On the second or third day of my trip while chilling out in my apartment with my friends I suddenly had an overwhelming sense of deja-vu, which must had been a dream I had a few years back. It was a weird dream of living together with 7 other crazy second year medics whom I’ve not known before up on the mountains in France. How impossible is that? - I never thought it would ever happen in this real life. But this was what exactly happened during the 9 days ski trip.
Start from the beginning.
Day 0
Had Paeds, Obs+Gynae OSCEs for the last two days, still trying to normalize my life. Went to hire a ski jacket and sallopette, and bought socks, gloves and food supply for the week.
Day 1
Good Friday. I packed light, and turned up at the meeting point. Got our trip hoodies, T-shirt and hat – I loved them! Coach was late and we were left soaking in the rain. I did not booked the holiday with anyone in particular but knew a few people. They were with their gangs of friends. I started introducing myself to new people and chatted away.
Started the 24 hours coach journey. Sat beside me was a fourth year medic from Preston. Made our way to Dover, across the English Channel then to Calais.
Day 2
Stopped by a few service stations and a supermarche in France. Gauged my proficiency in French = beginner level at best. In the order from best to worst: Reading > Writing > Speaking > Listening.
Finally reached Tignes, part of the French Alps. Stayed in an apartment of 8 people (4 girls and 4 boys), all of the others being second year medics. They are really nice people. They drank a lot and made lots of mess, but would always clean up at some point. The boys especially were quite domesticated.
Got my skis, ski boots and poles; lift pass, insurance card. The night ended with a pajamas socials in a pub.
Day 3
First ski lesson. I was rubbish. Can’t even manage to stand on a slope, let alone walk or ski. The group was quite big, with about 25 people. We had to take turn to ski down a baby slope. The instructors were funny. But I genuinely thought I was so bad at it and was half contemplating not to attend lesson the next day.
In the afternoon, I went to La Rosset with some intermediate skiers. I didn’t want to go up the slope at first because it looked scary. I practiced snowplough at the bottom of the slope instead. After about an hour I was really bored and went on the chairlift. Looking down the slope, I so scared that my legs were shivering and I was hyperventilating. I started skiing down, lost control and fell. I didn’t mind falling; falling on the snow was actually quite nice. It was the awkward position of my landing, having to stand up steadily on a slope and sometimes reaching for my poles which has flung several meters away which frustrated me. So I skied, fell and got up about 5 times on that slope, and at the end of the slope I was able to sort of control my ski. I was rather pleased with myself but I wasn’t going up that slope again, not today at least.
Only after I went back home that I discovered that it was a blue slope!
(nb: Green slope = beginner, Blue = Moderate, Red = Difficult, Black = Very difficult)
One of my flatmate Stuart injured his left shoulder badly and had to go back to England for surgery. What a shame… I felt that I must be more cautious not to let accident happen especially since I was a beginner.
Day 4
Got a new instructor, her name is Nadine I think. We went back to the baby slope were we learned to snowplough yesterday. I was still falling over, but began to get the hang of it by the end of the lesson.
Did not ski this afternoon as my face was burning. It was hot, painful and there were even blisters coming out of my cheeks. I just took the free bus and roam around the resort.
Day 5
The morning did not start well for me. I kept on falling even on flat surface as it was so icy. The snowplough I learnt on the previous days didn’t work. I fell getting off the chairlift and couldn’t get up. I must have fallen about 10 times in the first hour of the lesson. However, once we have started on the new beginner slope Le Lavachet, skiing started to become enjoyable and fun. We followed Nadine in a trail spiraling around the slope. After about three runs, Nadine brought us to another run Bollin. I overheard her saying something like ‘I think we can do it…’. Didn’t think much about it and just trailed behind her down the slope. A few girls proclaimed excitedly ‘Can’t believe we just skied down a blue slope without falling!’ – REALLY? I shared their excitement.
In the afternoon, I just practiced on Lavachet a couple more times with Karlie, my flatmate who is also a beginner, before going to try Bollin again. I think due to the fact that I now realized that it is actually a blue run and also because it was the end of the day and the slope was getting really bumpy, I fell down twice (whereas I did not fall at all the previous time). While sat on the slope, one of the passing ski instructors in her red suit asked ‘Ca va?’ to which I replied ‘Ca va bien merci’. I know this is stupid but I was really thrilled that I had this very brief conversation in French… (I’m so stupid I know…)
Tonight’s social theme is neon rave. I wore a bright pink-red top. I witnessed a lethal drinking games created by the second year medics called the ‘Ring of Tignes’. The game basically involves each player drawing a poker card in turn. Every card is attached to a ‘rule’. For example Queen = everyone goes out of the room, 3 = Bitch card, King = Make a new rule etc; with players having to ‘consume’ his or her drinks every time a rule is broken. So glad I was given a choice to opt out. It was indeed rather funny to watch. Several people had to shout ‘YOU MAY TAKE OUR LAND, BUT YOU WILL NEVER TAKE OUR FREEDOM!’ at the balcony in various accents, Mikey had to lick Owen’s nipple each time a player swears (Yucks), and Helen who was ‘the bitch’ for most of the night had to sniff some boys’ underpants (Super-yucks).
Day 6
We warmed up by doing three runs on the green part of Bollin. Nadine made us to tricks like skiing on one leg, jumping and touching our toes while going down the slope, which was really fun. Then when the ground was not too icy, we did a couple of runs on the blue parts of Bollin. I did not fall at all!
In the afternoon, I revisited La Rosset with Karlie. We both loved the slope. I saw the slope so differently compared my first day on the skis – it was now wide, not-congested and easy. We tackled the slope easily and practiced on it numerous times.
After that Karlie had to go back. It was only 3:30 pm and I was tempted to venture on a new slope called Freese. I misread the map and thought it was a green slope. It was a long ride on the chair lift and when I glimpsed at the slope, I was nearly shitting my pants that I wanted to U-turn and go back on the chairlift. I had never been on such a long way off the starting point before, it was bringing me across to another mountain and where it was much more deserted and temperature was much cooler; it was even snowing a little. I finally braced myself to start skiing. I was constantly concentrating to ‘Take it slow – Snowplough – BIG SNOWPLOUGH – Bend your knees’. It turned out to be blue run all the way, some tricky steep parts and with it being at the evening most parts were quite bumpy. It was at least 5 times longer than any of the runs I had ever done by then. My legs were so tired after every stretch of slope and I was sweating so much out of fear I had to stop and rest. Finally, I managed the whole run in 45 minutes and only fell twice. I was quite proud of myself. However I was not longing to return to the same slope in a hurry.
Day 7
Nadine must have read my mind, she decided that we will do Fresse for today’s lesson. On the chair lift, I was thinking back on yesterday and how much I will dread this run, then I began to realize that today will be much worse. It was snowing much more heavily than yesterday, wind was stronger and temperature was much lower. We were initially moaning on the chairlift but after a point the wind and snow was hitting us so hard and painfully on our faces that we went completely silent. Visibility was poor. I only had a pair of sunglasses on, no goggles – honestly when we started skiing I could only see Nadine’s Ecole du Ski Francais red suit and jackets in other colours trailing behind her. A few people fell at the beginning. But once we got into the rhythm, we just carry on skiing and before we know it, we have finished and went up the same chairlift again to repeat the similar run. This time people were saying that this was an easy run. I’m glad that she insisted that we do it even in this extreme weather.
My other housemates and I came back for lunch early today because the weather was getting worse. Even the best skiers in the house said no one should be skiing in this weather and most chairlifts were closed, we stayed in and amused ourselves by laughing at the stupid birds caught in the blizzards. But I really wanted to ski today. So when the storm settled a little, I went out to ski again. With the uncertain weather, I just skied on the slopes I was comfortable with.
Tonight’s social theme is Scrubs, and I saw another round of the ‘Ring of Tignes’ game. The game escalated. They drank much more. Two boys had one of their eye brows completely shaved. One girl flashed her breast and two boys flashed their penis at the balcony.
Day 8
Today has to be the climax of the week skiing wise. Only 3 out of the 14 people turned up for lesson, mainly due to excessive consumption of alcohol on the night before. I was with Laura, a 15 year old girl and Tom, a father of two. Nadine brought us to some amazing slopes that we have not been before. We took 6 different chairlifts (and hence made full use of the expensive lift pass included in the package which I paid for), skied on 7 slopes across 3 mountains. All the conditions were ideal. It was snowing just a little with some gentle sunshine, snow was slightly powdery but without the bumps. We were able to ski quietly with not many people on the slopes zooming pass us. The views were breathtaking and we could sometimes see clouds beneath us. We also learnt to parallel turn today, which is a more advance ski skill to snowploughing. Due to the fact that they are blue slopes and that we were only starting to parallel turn, it was slightly challenging as we needed to concentrate, but still did not stop us from totally enjoying ourselves. I also picked up lots of speed today. Because there were only three of us we get personal feedback, and didn’t have to wait for other people too often. It was a perfect day. Not realizing that it was my last day, at the end of the lesson Nadine said ‘I’ll see you tomorrow?’, and reluctantly I answered ‘I’m going home today’. She’s been amazing, I’m not sure if I would have enjoyed this trip as much without her as my ski teacher. We bid farewell to each other.
I spent the rest of the day doing more blue slopes before returning my ski equipments in the evening. After that I went back to pack and tidy up the apartment.
Coach was late again and this time we waited in the snow. Started the 24 hour return journey. Didn’t sleep well at all during the journey eventhough I was occupying two seats. My seat partner injured her knee during the week and had to fly home early.
Day 9
Watched DVD Troy on the way and learnt about Achilles. Arrived at Manchester safe and sound, feeling wanting to carry on skiing for another week.
PS One take home message for me: Falling down, learning to get up and getting out of my comfort zone is essential to progressing to the next level.
.
Start from the beginning.
Day 0
Had Paeds, Obs+Gynae OSCEs for the last two days, still trying to normalize my life. Went to hire a ski jacket and sallopette, and bought socks, gloves and food supply for the week.
Day 1
Good Friday. I packed light, and turned up at the meeting point. Got our trip hoodies, T-shirt and hat – I loved them! Coach was late and we were left soaking in the rain. I did not booked the holiday with anyone in particular but knew a few people. They were with their gangs of friends. I started introducing myself to new people and chatted away.
Started the 24 hours coach journey. Sat beside me was a fourth year medic from Preston. Made our way to Dover, across the English Channel then to Calais.
Day 2
Stopped by a few service stations and a supermarche in France. Gauged my proficiency in French = beginner level at best. In the order from best to worst: Reading > Writing > Speaking > Listening.
Finally reached Tignes, part of the French Alps. Stayed in an apartment of 8 people (4 girls and 4 boys), all of the others being second year medics. They are really nice people. They drank a lot and made lots of mess, but would always clean up at some point. The boys especially were quite domesticated.
Got my skis, ski boots and poles; lift pass, insurance card. The night ended with a pajamas socials in a pub.
Day 3
First ski lesson. I was rubbish. Can’t even manage to stand on a slope, let alone walk or ski. The group was quite big, with about 25 people. We had to take turn to ski down a baby slope. The instructors were funny. But I genuinely thought I was so bad at it and was half contemplating not to attend lesson the next day.
In the afternoon, I went to La Rosset with some intermediate skiers. I didn’t want to go up the slope at first because it looked scary. I practiced snowplough at the bottom of the slope instead. After about an hour I was really bored and went on the chairlift. Looking down the slope, I so scared that my legs were shivering and I was hyperventilating. I started skiing down, lost control and fell. I didn’t mind falling; falling on the snow was actually quite nice. It was the awkward position of my landing, having to stand up steadily on a slope and sometimes reaching for my poles which has flung several meters away which frustrated me. So I skied, fell and got up about 5 times on that slope, and at the end of the slope I was able to sort of control my ski. I was rather pleased with myself but I wasn’t going up that slope again, not today at least.
Only after I went back home that I discovered that it was a blue slope!
(nb: Green slope = beginner, Blue = Moderate, Red = Difficult, Black = Very difficult)
One of my flatmate Stuart injured his left shoulder badly and had to go back to England for surgery. What a shame… I felt that I must be more cautious not to let accident happen especially since I was a beginner.
Day 4
Got a new instructor, her name is Nadine I think. We went back to the baby slope were we learned to snowplough yesterday. I was still falling over, but began to get the hang of it by the end of the lesson.
Did not ski this afternoon as my face was burning. It was hot, painful and there were even blisters coming out of my cheeks. I just took the free bus and roam around the resort.
Day 5
The morning did not start well for me. I kept on falling even on flat surface as it was so icy. The snowplough I learnt on the previous days didn’t work. I fell getting off the chairlift and couldn’t get up. I must have fallen about 10 times in the first hour of the lesson. However, once we have started on the new beginner slope Le Lavachet, skiing started to become enjoyable and fun. We followed Nadine in a trail spiraling around the slope. After about three runs, Nadine brought us to another run Bollin. I overheard her saying something like ‘I think we can do it…’. Didn’t think much about it and just trailed behind her down the slope. A few girls proclaimed excitedly ‘Can’t believe we just skied down a blue slope without falling!’ – REALLY? I shared their excitement.
In the afternoon, I just practiced on Lavachet a couple more times with Karlie, my flatmate who is also a beginner, before going to try Bollin again. I think due to the fact that I now realized that it is actually a blue run and also because it was the end of the day and the slope was getting really bumpy, I fell down twice (whereas I did not fall at all the previous time). While sat on the slope, one of the passing ski instructors in her red suit asked ‘Ca va?’ to which I replied ‘Ca va bien merci’. I know this is stupid but I was really thrilled that I had this very brief conversation in French… (I’m so stupid I know…)
Tonight’s social theme is neon rave. I wore a bright pink-red top. I witnessed a lethal drinking games created by the second year medics called the ‘Ring of Tignes’. The game basically involves each player drawing a poker card in turn. Every card is attached to a ‘rule’. For example Queen = everyone goes out of the room, 3 = Bitch card, King = Make a new rule etc; with players having to ‘consume’ his or her drinks every time a rule is broken. So glad I was given a choice to opt out. It was indeed rather funny to watch. Several people had to shout ‘YOU MAY TAKE OUR LAND, BUT YOU WILL NEVER TAKE OUR FREEDOM!’ at the balcony in various accents, Mikey had to lick Owen’s nipple each time a player swears (Yucks), and Helen who was ‘the bitch’ for most of the night had to sniff some boys’ underpants (Super-yucks).
Day 6
We warmed up by doing three runs on the green part of Bollin. Nadine made us to tricks like skiing on one leg, jumping and touching our toes while going down the slope, which was really fun. Then when the ground was not too icy, we did a couple of runs on the blue parts of Bollin. I did not fall at all!
In the afternoon, I revisited La Rosset with Karlie. We both loved the slope. I saw the slope so differently compared my first day on the skis – it was now wide, not-congested and easy. We tackled the slope easily and practiced on it numerous times.
After that Karlie had to go back. It was only 3:30 pm and I was tempted to venture on a new slope called Freese. I misread the map and thought it was a green slope. It was a long ride on the chair lift and when I glimpsed at the slope, I was nearly shitting my pants that I wanted to U-turn and go back on the chairlift. I had never been on such a long way off the starting point before, it was bringing me across to another mountain and where it was much more deserted and temperature was much cooler; it was even snowing a little. I finally braced myself to start skiing. I was constantly concentrating to ‘Take it slow – Snowplough – BIG SNOWPLOUGH – Bend your knees’. It turned out to be blue run all the way, some tricky steep parts and with it being at the evening most parts were quite bumpy. It was at least 5 times longer than any of the runs I had ever done by then. My legs were so tired after every stretch of slope and I was sweating so much out of fear I had to stop and rest. Finally, I managed the whole run in 45 minutes and only fell twice. I was quite proud of myself. However I was not longing to return to the same slope in a hurry.
Day 7
Nadine must have read my mind, she decided that we will do Fresse for today’s lesson. On the chair lift, I was thinking back on yesterday and how much I will dread this run, then I began to realize that today will be much worse. It was snowing much more heavily than yesterday, wind was stronger and temperature was much lower. We were initially moaning on the chairlift but after a point the wind and snow was hitting us so hard and painfully on our faces that we went completely silent. Visibility was poor. I only had a pair of sunglasses on, no goggles – honestly when we started skiing I could only see Nadine’s Ecole du Ski Francais red suit and jackets in other colours trailing behind her. A few people fell at the beginning. But once we got into the rhythm, we just carry on skiing and before we know it, we have finished and went up the same chairlift again to repeat the similar run. This time people were saying that this was an easy run. I’m glad that she insisted that we do it even in this extreme weather.
My other housemates and I came back for lunch early today because the weather was getting worse. Even the best skiers in the house said no one should be skiing in this weather and most chairlifts were closed, we stayed in and amused ourselves by laughing at the stupid birds caught in the blizzards. But I really wanted to ski today. So when the storm settled a little, I went out to ski again. With the uncertain weather, I just skied on the slopes I was comfortable with.
Tonight’s social theme is Scrubs, and I saw another round of the ‘Ring of Tignes’ game. The game escalated. They drank much more. Two boys had one of their eye brows completely shaved. One girl flashed her breast and two boys flashed their penis at the balcony.
Day 8
Today has to be the climax of the week skiing wise. Only 3 out of the 14 people turned up for lesson, mainly due to excessive consumption of alcohol on the night before. I was with Laura, a 15 year old girl and Tom, a father of two. Nadine brought us to some amazing slopes that we have not been before. We took 6 different chairlifts (and hence made full use of the expensive lift pass included in the package which I paid for), skied on 7 slopes across 3 mountains. All the conditions were ideal. It was snowing just a little with some gentle sunshine, snow was slightly powdery but without the bumps. We were able to ski quietly with not many people on the slopes zooming pass us. The views were breathtaking and we could sometimes see clouds beneath us. We also learnt to parallel turn today, which is a more advance ski skill to snowploughing. Due to the fact that they are blue slopes and that we were only starting to parallel turn, it was slightly challenging as we needed to concentrate, but still did not stop us from totally enjoying ourselves. I also picked up lots of speed today. Because there were only three of us we get personal feedback, and didn’t have to wait for other people too often. It was a perfect day. Not realizing that it was my last day, at the end of the lesson Nadine said ‘I’ll see you tomorrow?’, and reluctantly I answered ‘I’m going home today’. She’s been amazing, I’m not sure if I would have enjoyed this trip as much without her as my ski teacher. We bid farewell to each other.
I spent the rest of the day doing more blue slopes before returning my ski equipments in the evening. After that I went back to pack and tidy up the apartment.
Coach was late again and this time we waited in the snow. Started the 24 hour return journey. Didn’t sleep well at all during the journey eventhough I was occupying two seats. My seat partner injured her knee during the week and had to fly home early.
Day 9
Watched DVD Troy on the way and learnt about Achilles. Arrived at Manchester safe and sound, feeling wanting to carry on skiing for another week.
PS One take home message for me: Falling down, learning to get up and getting out of my comfort zone is essential to progressing to the next level.
.
Monday, March 30
Workshop
Last weekend, I was one of the volunteers to help out in the Global Health Conference attended by about 400 medical students from all over the UK. My personal highlight of the weekend was the workshop that I delivered.
Conducting a workshop is nothing new to me. I have, since my second year in medicine, been leading various workshops on training of generic skills like leadership, publicity, teamwork in medical student conferences; on teaching when I coordinated the after school club; on asylum seekers issues all the time since I'm too passionate about this; global health issues like the one on maternal and child health which I did at the start of term this year. I love workshops, right from the planning to the execution. The fact that it's meant to educational, fun and stimulating through learning by participation makes the design and planning so interesting. I usually start by getting my team to research around the topic, then pool our findings and see how we can fit the important bits in our workshop. Then comes my favourite part, which is putting our creative mind to the test and come up with ideas on how the message can be delivered, be it open discussion, debate, brain storming, games or puzzles. Ideally we aim to get the participants exercising both their bodies and their brains. Meticulous planning is necessary and time keeping is essential as people tend to become so engaged that they want to carry on talking and playing for longer than the allocated time.
This workshop is called 'In the Shoes of the Asylum Seekers'. It involves role play and participants acting as either asylum seeker or health care professional or ordinary English people. Every scenario is followed by discussion of issues that have come up during the act. The fact that two of my friends were able to help me out in facilitating the small group activities meant that the groups were kept small and every single participant were able to speak up. It went very well overall. Participants were engaged, and we received nice positive feedback. It was worth all my effort planning the workshop while juggling with the extremely hectic paediatrics placement and neglecting my exam happening next week. I'm too very happy!
Sunday, March 15
Managing constipation
Constipation is a very common problem for people of all ages. I met a 7 year old girl on Friday who impressed me with her unique way of managing her problem. Basically for her it started when she was about 3 years old, complicated by a slightly deformed rectum and anus. Nowadays what she does is to make sure that she poos 2-3x a day, and to describe her poo according to the stool chart.
The aim is to have a well formed but reasonably soft poo, i.e. type 3 or 4. If she has no poo for a day, or if poo has been hard (type 1 or 2) then she will tell mummy and mummy will add movicol (an osmotic laxative, makes poo softer) into her breakfast. And she will let mummy know if she has done a poo at school or not. So now at the age of 7 she is an expert in the stool chart and managing constipation. She now rarely needs any laxative at all because it's all been so regular now with the sensible use of movicol.
You might think this is so simple but this is the very first time I have heard about constipation being managed like this. Usually doctors prescribe laxative for a fixed length of time, and patient would take it blindly, without consideration about what is happening to their own bowel motions. So more often than not, they will come back to the doctor, either saying that constipation is still there, or that they are now having diarrhoea, either way relying the doctor to prescribe some more medication to sort out the problem. I must say this too often happens to the elderly patients. I am going to start recommending this little girl's method of managing constipation to other patients from now on.
.
The aim is to have a well formed but reasonably soft poo, i.e. type 3 or 4. If she has no poo for a day, or if poo has been hard (type 1 or 2) then she will tell mummy and mummy will add movicol (an osmotic laxative, makes poo softer) into her breakfast. And she will let mummy know if she has done a poo at school or not. So now at the age of 7 she is an expert in the stool chart and managing constipation. She now rarely needs any laxative at all because it's all been so regular now with the sensible use of movicol.You might think this is so simple but this is the very first time I have heard about constipation being managed like this. Usually doctors prescribe laxative for a fixed length of time, and patient would take it blindly, without consideration about what is happening to their own bowel motions. So more often than not, they will come back to the doctor, either saying that constipation is still there, or that they are now having diarrhoea, either way relying the doctor to prescribe some more medication to sort out the problem. I must say this too often happens to the elderly patients. I am going to start recommending this little girl's method of managing constipation to other patients from now on.
.
Sunday, March 1
Keep up
From very early on in the clinical training, we have been told that learning medicine (especially in Manchester) follows the principle of how much effort you put in is how much you get. This suits me well. Armed with unrivaled eagerness at the beginning of third year, I went to the wards everyday 9am - 5pm. But it didn’t take that long for me to realize that the principle only works in the ideal world, and we are not living in one. Sometimes there is no patient to see, other times doctors are too busy. It’s mentally and physically draining. Still, I persisted. And generally speaking I’d say the effort pays off.
I always envy the way nurses are trained. When nurses or midwives ask me what time would I be in a ward until, my answer ‘we can leave whenever we want’ often surprise them. Student nurses are included into the staff rota and are expected to work in shift and contribute to the nursing team. Medical students, on the other hand, are free to do what they want. Easily, I can get away with just going into hospital for half a day in a week for the compulsory PBL session. There were some rare occasions when I have demonstrated commitment and people started to treat me as part of the team (in Renal, A&E, O&G). It is satisfying to get to know the team well, work with them and gain their trust so they let me do things, like a little apprentice. But I often feel disheartened because my hard work is not rewarded. Sometimes no one even notices.
During obs and gynae things changed. Mr S’ registrar said she noticed that I have been turning up for every single theatre sessions, which is unusual for students. During my labour week, I got along quite well with a student midwife, Nancy. Nancy and I looked after a lady in labour and after that she said something really moving to me. She told me that the way I interacted with the family, building rapport and helping out, has changed her perception of medical students. She has never seen medical student being so involved with a lady’s care before. Another midwife Gill also commented that she was seeing me so much more than the other students. I don’t think she’d have allowed me to assist in delivering the baby boy had she not seen me being that keen.
I would always remember one of the greatest compliments I have ever had from a patient. At 7:30pm in the emergency admission unit, a patient told the consultant ‘She was here all day and she didn’t stop smiling’, and the consultant continued ‘Yes and she’s very intelligent as well.’ It could have gone on to hug and thank the patient for noticing.
I have been complaining a lot about being tired lately. My concerned friends would ask if I have to go to lecture a lot. I know they meant well, but I just want to scream at them. We don’t HAVE to do anything in medicine. It is just me wanting to make the best out of all the placements. So it’s my choice then I exhaust myself and I should stop moaning.
Freedom and hard work are devil combination. Why bother to wake up at 6am for the morning ward round when it is optional and I know that my friends most probably are taking a day off? A lot of conscience and self discipline are needed to make it work. I am a creature far from perfection. Coming to the end of my fourth year, my enthusiasm is wearing off. Determination, without rewards and positive reinforcement, can only last so long. I thank all the people who keep me going.
I always envy the way nurses are trained. When nurses or midwives ask me what time would I be in a ward until, my answer ‘we can leave whenever we want’ often surprise them. Student nurses are included into the staff rota and are expected to work in shift and contribute to the nursing team. Medical students, on the other hand, are free to do what they want. Easily, I can get away with just going into hospital for half a day in a week for the compulsory PBL session. There were some rare occasions when I have demonstrated commitment and people started to treat me as part of the team (in Renal, A&E, O&G). It is satisfying to get to know the team well, work with them and gain their trust so they let me do things, like a little apprentice. But I often feel disheartened because my hard work is not rewarded. Sometimes no one even notices.
During obs and gynae things changed. Mr S’ registrar said she noticed that I have been turning up for every single theatre sessions, which is unusual for students. During my labour week, I got along quite well with a student midwife, Nancy. Nancy and I looked after a lady in labour and after that she said something really moving to me. She told me that the way I interacted with the family, building rapport and helping out, has changed her perception of medical students. She has never seen medical student being so involved with a lady’s care before. Another midwife Gill also commented that she was seeing me so much more than the other students. I don’t think she’d have allowed me to assist in delivering the baby boy had she not seen me being that keen.
I would always remember one of the greatest compliments I have ever had from a patient. At 7:30pm in the emergency admission unit, a patient told the consultant ‘She was here all day and she didn’t stop smiling’, and the consultant continued ‘Yes and she’s very intelligent as well.’ It could have gone on to hug and thank the patient for noticing.
I have been complaining a lot about being tired lately. My concerned friends would ask if I have to go to lecture a lot. I know they meant well, but I just want to scream at them. We don’t HAVE to do anything in medicine. It is just me wanting to make the best out of all the placements. So it’s my choice then I exhaust myself and I should stop moaning.
Freedom and hard work are devil combination. Why bother to wake up at 6am for the morning ward round when it is optional and I know that my friends most probably are taking a day off? A lot of conscience and self discipline are needed to make it work. I am a creature far from perfection. Coming to the end of my fourth year, my enthusiasm is wearing off. Determination, without rewards and positive reinforcement, can only last so long. I thank all the people who keep me going.
.
Saturday, February 7
Overwhelmed
I have been in front of the computer all day wasting time, playing games and surfing the internet. Sometimes, when there are just so much to do, I shut off and do nothing. I don't know why. Perhaps half expecting the work to go away, and half realising that I won't be able to do everything to the standard I want to and so just give up. I am really disappointed with myself whenever I am like that. But it's really difficult to pick myself up.
.
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Saturday, January 31
Reading
My first ever memory of learning to read was trying to follow the chinese characters of the children's sing-along music video. I remember my father being so impressed that my sister and I could read the lyrics of songs in the whole video by the second day since the video was purchased.
My parents are avid readers. Pa had a gigantic bookshelf in our living room upstairs. When I was young, I used to climb to the top of the shelf like a spider and see if there is any interesting books. Mummy reads lots of story books and pa always complained that she was passing on a bad habit of reading in the loo (especially while pooing) to us.
In pa's big bookshelf, there were two rows of adult fictions belonging to mummy which were of no interest to little children. But behind those books was where the gem where hidden - hundreds of copies of 'er tong le yuan' (lit = 'Children's playground', a children's magazine) which my father has kept from his childhood. My sister Yee Leng and I started picking a few copies every night to read on our bed before bedtime. We used to be reading those until 2 am. And mum wouldn't allow the lights to be on, so we read on our bed with the light from the wedged toilet door, I think that was when I started developing poor eyesight (but why does Yee Leng has perfect vision?).
I can't say for all my other sisters, but when I was young the place that I really look forward to going was the bookshop. Once in the bookshop, it can be hours before we come out. With both my parents engrossed with their own readings and the rest of us in our own favourite sections, it is usually one of us in hunger or with nature's call that prompt us that we have been in for too long.
I have never been too fond of library in schools. I used to be the sort of person who judge a book by its cover, and unfortunately the school library book cover were often not interesting enough to catch my attention. But I was almost ran wild the first time I went into the national library. We were supposed to be researching on our history project. Instead I brought piles of science books with nice colourful illustration and sat there reading them for ages. After secondary school, the first university (UTP) has an amazing library which kept the most up-to-date books with the most fancy covers. I was too bewilded and borrowed loads of books on flash, photoshop and webpage design which was my interest of that time. Then in Manchester, I was again surprised by the bigger and better library facilities provided. In my first and second year, I used to borrow up to the maximum quota of 20 books all the time (not always related to my course). Now, although I have calmed down a little (in terms of not always loaning 20 books from the main university library), I still borrow a few books from many different libraries (the public library and hospitals + departmental libraries) every now and then.
Again rubbing off my father, I am a fierce protector of my own books. All my new books have to be wrapped up in plastic covers. Apparently it's not a very popular thing to do in this part of the world - my friends asked me why do I laminate my books... Almost every school children do this in Malaysia. I would be very crossed if any pages are folded or if there are 'ears' on the cover page, I would be very crossed.
If I can be granted a wish, I would like all the books in the world and spend a lifetime reading. It tells me that who I meet, what I see and experience aren't the only things that exist in this world. There are so much more to discover. Reading imaginary fictions, it sometimes makes me wonder if weird things like alien and ghost are real, or even, if good values like the spirit of justice and kindness are in the human nature. Reading really broadens our minds. I would be very interested to find out what any of you think about reading. Have you been interested in reading? How has it affected you? What would you be without it?
My parents are avid readers. Pa had a gigantic bookshelf in our living room upstairs. When I was young, I used to climb to the top of the shelf like a spider and see if there is any interesting books. Mummy reads lots of story books and pa always complained that she was passing on a bad habit of reading in the loo (especially while pooing) to us.
In pa's big bookshelf, there were two rows of adult fictions belonging to mummy which were of no interest to little children. But behind those books was where the gem where hidden - hundreds of copies of 'er tong le yuan' (lit = 'Children's playground', a children's magazine) which my father has kept from his childhood. My sister Yee Leng and I started picking a few copies every night to read on our bed before bedtime. We used to be reading those until 2 am. And mum wouldn't allow the lights to be on, so we read on our bed with the light from the wedged toilet door, I think that was when I started developing poor eyesight (but why does Yee Leng has perfect vision?).
I can't say for all my other sisters, but when I was young the place that I really look forward to going was the bookshop. Once in the bookshop, it can be hours before we come out. With both my parents engrossed with their own readings and the rest of us in our own favourite sections, it is usually one of us in hunger or with nature's call that prompt us that we have been in for too long.
I have never been too fond of library in schools. I used to be the sort of person who judge a book by its cover, and unfortunately the school library book cover were often not interesting enough to catch my attention. But I was almost ran wild the first time I went into the national library. We were supposed to be researching on our history project. Instead I brought piles of science books with nice colourful illustration and sat there reading them for ages. After secondary school, the first university (UTP) has an amazing library which kept the most up-to-date books with the most fancy covers. I was too bewilded and borrowed loads of books on flash, photoshop and webpage design which was my interest of that time. Then in Manchester, I was again surprised by the bigger and better library facilities provided. In my first and second year, I used to borrow up to the maximum quota of 20 books all the time (not always related to my course). Now, although I have calmed down a little (in terms of not always loaning 20 books from the main university library), I still borrow a few books from many different libraries (the public library and hospitals + departmental libraries) every now and then.
Again rubbing off my father, I am a fierce protector of my own books. All my new books have to be wrapped up in plastic covers. Apparently it's not a very popular thing to do in this part of the world - my friends asked me why do I laminate my books... Almost every school children do this in Malaysia. I would be very crossed if any pages are folded or if there are 'ears' on the cover page, I would be very crossed.
If I can be granted a wish, I would like all the books in the world and spend a lifetime reading. It tells me that who I meet, what I see and experience aren't the only things that exist in this world. There are so much more to discover. Reading imaginary fictions, it sometimes makes me wonder if weird things like alien and ghost are real, or even, if good values like the spirit of justice and kindness are in the human nature. Reading really broadens our minds. I would be very interested to find out what any of you think about reading. Have you been interested in reading? How has it affected you? What would you be without it?
Pic 1: All started here: pa's gigantic bookshelf. Roughly 4m x 3m?
Pic 2: YL and my first bookshelf
Pic 3: Pa also loves collecting old newspaper. Imagine this x10 in my house. He has to collect cuttings of interesting news and features. I hope he has fully abandon this hobby and switch the more efficient internet now
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Tuesday, January 27
Obs and gynae
I am now on my fourth week out of seven in obs and gynae, and I better write something about it now while I feel positive about it. It is one of the better organised placement. Seven of us in a group are each allocated to one consultant. In my case I have two of them since they both only work part time in this hospital.
On a typical monday, I would spend the morning in the antenatal day case or early pregnancy unit. In the afternoon, we attend a tutorial and the postgraduate meeting while hoping to get some free food. I would then clerk in the theatre patients for the next day and hence go home quite late. Tuesday is theatre day, when I perform some PV exams. Wednesday, the GP day, starts unusually early at 0730, but I am usually home by noon. On Thursday I attend the hysteroscopy clinic in the morning and the Antenatal clinic in the afternoon. Friday morning tends to start with an MDT, followed by the gynae clinic and PBL. We also need to attend one off clinics like termination of pregnancy, GUM, breast, colposcopy, scan etc.
So far I am enjoying it more than I expect. I am surprisingly attracted to the surgical side of gynae, probably rubbing off from Mr S (see below). I am beginning to understand some of the surgical concepts like haemostasis and the different equipment used as well. Learning anatomy in theatre is confusing and so unlike reading a book, but I am getting more familiar with the pelvis every week. For example today, I learn to appreciate how curvy the sacrum actually is, that when you pour water into the pelvis for washout, it fills like a bowl. I don't think I would be doing Obs and gynae for the rest of my life. I can't really stand watching too many external genitalia for a long time, and to be honest, besides childbirth, there is nothing really exciting about the reproductive organs. (Well actually that's not true as tumours can grow to impressively big sizes).
Some personalities worth mentioning:
Mr S is one of the consultants I am allocated to. He is like a typical surgical (wants to Get Things Done, and becomes annoyed when there is delay or people messing about wasting time), only a really nice one. He has a great personality and sense of humour, and would introduce himself to anyone new working with him in theatre or in meeting. He is very tall, and is like a father to his team of juniors. He spoonfeeds me most of the time and doesn't ask me much questions to embarass me. Mr S is a gynaecologist subspecialising in surgical oncology, so I was not really exposed to a wide range of conditions. Theatre is getting quite dull - hysterectomy after hysterectomy after hysterestomy... But I can see why his job is so rewarding, as surgery means cure for many conditions, including some cancers.
Dr R is the second consultant I am attached to. I attend her hysteroscopy clinic once a week. She smiles all the time and is casual and friendly. She loves classical music and sometimes dances with the music on her chair. It really helps to be a female student as ladies are more likely to allow female to observe. I have only met her twice because she has been on holiday, but this is good because I am also a little bored of watching hysteroscopies.
The midwives in my hospital are amazing (I still have my favourites). I have never really felt left out, and I am always be given the opportunity to do stuff. Hence now I am now fairly good at measuring BP manually, taking blood and getting the gist of palpating a pregnant abdomen.
Dan is my PBL groupmate and he bakes a cake for every friday's PBL session, so our PBL discussions have been a delicious affair. Isn't it wonderful to have a groupmate like this?
3 and a half more weeks to go. Look forward to my labour week.
.
On a typical monday, I would spend the morning in the antenatal day case or early pregnancy unit. In the afternoon, we attend a tutorial and the postgraduate meeting while hoping to get some free food. I would then clerk in the theatre patients for the next day and hence go home quite late. Tuesday is theatre day, when I perform some PV exams. Wednesday, the GP day, starts unusually early at 0730, but I am usually home by noon. On Thursday I attend the hysteroscopy clinic in the morning and the Antenatal clinic in the afternoon. Friday morning tends to start with an MDT, followed by the gynae clinic and PBL. We also need to attend one off clinics like termination of pregnancy, GUM, breast, colposcopy, scan etc.
So far I am enjoying it more than I expect. I am surprisingly attracted to the surgical side of gynae, probably rubbing off from Mr S (see below). I am beginning to understand some of the surgical concepts like haemostasis and the different equipment used as well. Learning anatomy in theatre is confusing and so unlike reading a book, but I am getting more familiar with the pelvis every week. For example today, I learn to appreciate how curvy the sacrum actually is, that when you pour water into the pelvis for washout, it fills like a bowl. I don't think I would be doing Obs and gynae for the rest of my life. I can't really stand watching too many external genitalia for a long time, and to be honest, besides childbirth, there is nothing really exciting about the reproductive organs. (Well actually that's not true as tumours can grow to impressively big sizes).
Some personalities worth mentioning:
Mr S is one of the consultants I am allocated to. He is like a typical surgical (wants to Get Things Done, and becomes annoyed when there is delay or people messing about wasting time), only a really nice one. He has a great personality and sense of humour, and would introduce himself to anyone new working with him in theatre or in meeting. He is very tall, and is like a father to his team of juniors. He spoonfeeds me most of the time and doesn't ask me much questions to embarass me. Mr S is a gynaecologist subspecialising in surgical oncology, so I was not really exposed to a wide range of conditions. Theatre is getting quite dull - hysterectomy after hysterectomy after hysterestomy... But I can see why his job is so rewarding, as surgery means cure for many conditions, including some cancers.
Dr R is the second consultant I am attached to. I attend her hysteroscopy clinic once a week. She smiles all the time and is casual and friendly. She loves classical music and sometimes dances with the music on her chair. It really helps to be a female student as ladies are more likely to allow female to observe. I have only met her twice because she has been on holiday, but this is good because I am also a little bored of watching hysteroscopies.
The midwives in my hospital are amazing (I still have my favourites). I have never really felt left out, and I am always be given the opportunity to do stuff. Hence now I am now fairly good at measuring BP manually, taking blood and getting the gist of palpating a pregnant abdomen.
Dan is my PBL groupmate and he bakes a cake for every friday's PBL session, so our PBL discussions have been a delicious affair. Isn't it wonderful to have a groupmate like this?
3 and a half more weeks to go. Look forward to my labour week.
.
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