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!!!!!
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Sunday, June 7
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.
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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.
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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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