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.


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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.

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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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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?

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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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.


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Happy Chinese New Year!

May the year of Ox brings us all peace and prosperity!


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Happy Birthday To Me!

24th aniversary of me popping out of my mum's birth canal. For two birthdays, mum has been describing to me how, for the first time in her life, her water broke and a gush of warm water rushed through her thighs and legs. It's lovely to hear these things.

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