Thursday, December 24, 2009

Lately...

Sorry about the absence - guess I never really left, I was still sheepishly reading all your posts.. but had nothing much to say myself. All is well, I promise. Returned from Fiji 10 days ago, where I spent 3 weeks at the CWM Hospital on a purely optional "elective" rotation. Words cannot adequately portray my gratitude to the patients and doctors who so humbly accommodated me during my time there. It is always with mixed feelings that I undertake placements in communities where I take away much much more than what I give in return. I am yet to reconcile with this morally-questionable predicament and am resting slightly with the hope that one day I can return as a qualified hot-shot and offer my services voluntarily (or at a substantially lower wage than I would be earning here anyway).

That aside, a reflection or two regarding my experiences. In light of my sway towards anaesthetics as a speciality, I decided to hang out with the dopers for a fair portion of my time. Having more faith in my abilities than I do myself, my supervisors allowed me to do spinal and regional blocks on pretty much anyone who walked through the OT doors. I also got lots of pratice in cannulating, intubating and inserting LMAs. There was a lot of in-between teaching and general chit-chat as well, which I loved because I got a chance to ask about anaesthetics as a specialty and exchange details about our differing health-care systems. The experience was great for all the obvious reasons, but particularly so in helping me realise that I don't think I'm very well suited to a career in anaesthetics. The challenges are still challenging, don't get me wrong - I've haven't mastered the Art by any means, I guess some part of me is just looking for something else. That's the real value of these experiences - among other things - crossing potential specialties off the list, sort of. I have an official anaesthetics terms in 4th year (if I make it that far!!) which will span for 8 weeks, so hopefully that will shed more light either way... but for better or worse, I'm quite content to be going into my clinical years a little less set on the path I want to pursue. The rest of my time in Fiji was spent scrubbing in on surgeries (mainly gen surg, plastics and obs/gynae). Obs/gynae is starting to grow on me - interesting mixture of medicine and surgery, but still, I'm not setting it in stone like I did anaesthetics! Anyway, Fiji has given me a lot to think about and despite my ethical dilemma, I'm not ruling out another placement there next year.

Back on the home-front, I have two exams awaiting me in about 4 weeks' time (haven't been given the precise dates yet). I'm doing a bit of study here and there, but just waiting for the new year to really get into it. I feel like I'm in limbo land, it's pretty scary because with the exam date being so close to the start of semester date, I don't know if I'll even be offered a supplementary exam if, Heaven forbid, I should fail. Of course I'm having slight regrets now about not just getting them out of the way at the time.. but, sunny-side up, my brain might be slightly less rusty than everyone elses' going into third year. Maybe.. hopefully :-S

M.C. everyone - hope you have a beautiful day with your family+friends tomorrow!

Sunday, October 25, 2009

More on life and its ironies

My mum is well. She is in her fourth day of an intensive physio and occupational therapy program at a rehab hospital. She is enjoying the sessions and has made some new friends who have helped her see things in a new perspective, especially her room-mate: a thirty-something year old woman who has just been diagnosed with MS. In a sad (yet slightly ironic) twist of fate, another event that has provoked much reflection among the family has been the death of one of the doctors who was looking after my mum during her time in hospital. A cardiologist, he died of a sudden heart attack last weekend - his wife sent a letter to all his patients informing us of what had happened. For some reason, it feels a little close to home for me. I do feel very sorry for her loss too, and sad that he was not able to be helped: in the way that he has helped so many others. C'est la vie..

And now I bore you with the logistics of my life. I have decided to take up the University's gracious offer of deferring my exams. Sort of. I actually have four exams - two written and two prac exams. I am going to do the prac exams next week with the rest of my cohort and am deferring the written ones, which are going to be held again at the end of January (!). I told my PBL group and couldn't believe the hostile reaction of one of my group members - she felt so personally threatened by the prospect of someone having that extra time to study! I felt like saying to her "oh grow up child, I'm not asking for you permission!". Le sigh. I'm still undecided as to what to do with the research project, but will probably contact the supervisor soon to decline it I think. As for Fiji, my dad suggested that I go for two weeks rather than four, straight after exams.. just to get away from things, if anything. I like the idea of compromise, but I don't want to tempt fate and leave because I feel like something may happen while I'm gone. Guess I'll give it a few more days before deciding for sure.

Don't know how to end this post, usually I'll add some lyrics, but there are no songs for my mood this evening. So instead, something a bit more sinister, that I feel captures a bit of my paranoia and cautiousness (it's a bit long, but fans of Alice in Wonderland will appreciate it):

'O Oysters, come and walk with us!'
The Walrus did beseech.
'A pleasant walk, a pleasant talk,
Along the briny beach:
We cannot do with more than four,
To give a hand to each.

The eldest Oyster looked at him,
But never a word he said:
The eldest Oyster winked his eye,
And shook his heavy head --
Meaning to say he did not choose
To leave the oyster bed.

But four young Oysters hurried up,
All eager for the treat:
Their coats were brushed, their faces washed,
Their shoes were clean and neat --
And this was odd, because, you know,
Thay hadn't any feet.

Four other Oysters followed them,
And yet another four;
And think and fast they came at last,
And more, and more, and more --
All hopping through the frothy waves,
And scrambling to the shore.

The Walrus and the Carpenter
Walked on a mile or so,
And the they rested on a rock
Conveniently low:
And all the little Oysters stood
And waited in a row.

"The time has come,' the Walrus said,
"To talk of many things:
Of shoes -- and ships -- and sealing wax --
Of cabbages -- and kings --
And why the sea is boiling hot --
And whether pigs have wings.'

'But wait a bit,' the Oysters cried,
'Before we have our chat;
For some of us are out of breath,
And all of us are fat!'
'No hurry!' said the Carpenter.
They thanked him much for that.

'A loaf of bread,' the Walrus said,
'Is what we chiefly need:
Pepper and vinegar besides
Are very good indeed --
Now, if you're ready, Oysters dear,
We can begin to feed.'

'But not on us!' the Oysters cried,
Turning a little blue,
'After such kindness, that would be
A dismal thing to do!'
'The night is fine,' the Walrus said,
'Do you admire the view?

'It was so kind of you to come!
And you are very nice!'
The Carpenter said nothing but
'Cut us another slice.
I wish you were not quite so deaf --
I've had to ask you twice!'

'It seems a shame,' the Walrus said,
"To play them such a trick,
After we've brought them out so far,
And made them trot so quick!'
The Carpenter said nothing but
"The butter's spread to thick!'

'I weep for you,' the Walrus said;
'I deeply sympathize.'
With sobs and tears he sorted out
Those of the largest size,
Holding his pocket handkerchief
Before his streaming eyes.

'O Oyster,' said the Carpenter,
'You've had a pleasant run!
Shall we be trotting home again?'
But answer came there none --
And this was scarcely odd, because
They'd eaten every one."

~ "The Walrus and the Carpenter", C.S. Lewis

Monday, October 12, 2009

Above everything, I am...

A daughter? A sister? A distant relative? A best friend? A casual buddy? A medical student? A member of PBL study Group E? A first aid officer? An employee at a pharmacy? A research assistant? A traveller? A random member of society who has made a commitment to serve?

I'm not really sure right now, but my situation demands that I make a decision soon.

Last week, my mum had another stroke. She was taken to the hospital, where, amongst other things, an MRI was ordered. She never made it to the MRI though because out of no where, she started to feel an uncomfortable crushing tightness in her chest, before throwing up, and then suddenly losing consciousness. An ECG and some blood tests indicated a STEMI -- an angiogram further revealed an occluded left descending coronary artery. Two stents were put in, followed by a recovery period in ICU, where she had two episodes of tonic-clonic seizures that night.

We have a saying in Islam: "Alhamdulillah". It literally means "Thank God", but in actual fact the sayer is implying "Thank God, for and in spite of, everything". Alhamdulillah for the blessings and the misfortunes. Alhamdulillah she is still alive. We use this term to accept that which we've been granted and affirm our belief in there being greater wisdom in what happens to us, beyond that which we can foresee.

More imminently and practically (for yours truly, selfishly), I have my end of year exams in three weeks' time; after which, I have a month-long elective in Fiji, completely organised and paid for... then a very exciting research project that I was going to participate in and co-publish which, again, took a lot of time and energy to organise... and then, well you get the point. I won't lie - I'm greedy - I want to have my cake and eat it too. But, in light of the circumstances, this is becoming a seemingly impossible ambition. Furthermore, the University has kindly granted me the opportunity to defer my exams until a more suitable time. On the one hand, I just want to attempt these exams and get whatever mark I'm given, at the risk of failing altogether - but this will leave me with ample time in my holiday break to slot my various activities in. On the other hand, oh to not have to worry about exams for a little while later and just be able to concentrate on being with my family is such a wonderful relief - even if it means having to cancel my plans for Fiji and research in the holidays, as I will be studying for my deferred exams! The answer seems obvious, but that's the conundrum - what IS the right answer?!

Above everything, I am... confused and unsure of what to do.

Monday, September 28, 2009

Life happens when you least expect it

Or so the saying goes...

Two weeks ago my mum had a stroke. My mum is a healthy 47 year old, non-smoker, non-drinker, health-food junkie, exercise-doer. As far as risk factors are concerned she has none. But her's wasn't a typical stroke - it was caused by a spontaneous internal carotid artery dissection, which affected the right side of her brain and manifested in speech disturbances and left upper body weakness. Just like that, so unannounced. One minute we were making plans for what to do on the weekend; come the weekend, we found ourselves confused and bewildered around a bed in the stroke unit of our local hospital. I've been meaning to blog for a while but I've just been so damn busy between hospital visits; my petty attempts to keep up with uni work; contribute what I can towards housework; answer the bloody phone with people (mostly family and friends from overseas) wanting to know what happened; etc, etc. And amongst all the kerfuffle, incredulously, my friends are demanding to know why I can't go out for dinner, attend the Med Ball, come to their farewell party, watch a movie, grab a coffee, reply to their text messages, phone calls, emails, blah, blah.. which makes me think, have I been all-consumed by this and wallowing too much in self-pity? Genuine empathy is a really hard thing to feel because, quite simply, unless you're there and it's happened to you - you don't know what it's like. And so I ask myself with this newly-found insight: is it reasonable to even expect it? People have such short attention spans anyway (either that or they weren't listening to you in the first place) - why even bother trying to explain things when they're going to miss the point anyway. Anyway, enough pulling my hair out.

From an educational point of view, this experience has been a combination of terribly interesting and terribly frightening. When the neurologist told my parents and I the diagnosis, my parents responded as though she'd announced "oh it's just a cold" whereas I gasped in horror. Morbid as this is, sometimes I think, "OmG just die already - get it over and done with and that way I don't have to spend the rest of my life worrying about all the terrible things that can happen to you!!". Clearly I'm a little tired and world-weary. But alas, life goes on. And, perhaps, that's the point that I'm missing, with everyone's reactions around me? Bah humbug!

Wednesday, September 9, 2009

Irked

Today, I spent the morning on prac at the morgue. I went in with no feelings of apprehension or fear, but came out somewhat irked and paranoid. It wasn't the sights or the stench or that sense of death in the air; it was the case report at the end of each dissection table that told the story of how each body came to be. Suicide was the order of the day today - a cocktail of drugs and alcohol. Not pretty. Not pretty at all. I'm hazarding a guess in saying this, but I think if anyone was half-heartedly contemplating suicide; a trip to the morgue would potentially sway them otherwise (probably not the case for someone who'd already made up their mind though). From an educational point of view: a totally surreal and priceless way to learn anatomy. I stayed behind when my classmates left, to watch the autopsy of a neonate - the organs were tiny but eerily pristine and perfect. Kind of like microanatomy. Again though, its story was so sad - I wish I could share it with you. Such a fine line between life and death - I never realised how fine it was until today. Two days ago this person was alive; today they are not. The weirdest feeling perhaps, was that of walking out into the sparkling daylight at the end of the prac and seeing live people walking down the street. Anyway, I need to go have a long shower - the scent of death has permeated my skin.

Monday, August 24, 2009

The Greener Grass

Haven't blogged in a little while - sorry about that. Last week I found out that a few of my friends who had applied for med this year had been unsuccessful in obtaining interviews. I was quite shocked at this outcome for two people in particular - I was *so* sure that both would not only get interviews, but also be offered places straight away. I guess it's difficult to expect that the faith you have in someone else's potential will be transferred to a grueling selection committee. Still, I was *so* sure...

In light of these events, "gratitude" has been the order of my day recently. Anyone who's been through the medical school application process will attest to the ruthlessness of the high-stakes-all-or-none nature of the process. The more it means to you, the more stressful it is. We all jump into the pool, all too aware that we may be spat out again, just like that. Difficult thing to realise though is the implications and actual reality of being rejected; if you're lucky enough to be invited to stay in the water from your first application. I'm trying really hard to convey a sense of empathy and understanding to these friends who weren't accepted this time 'round - but I feel like I'm failing miserably. Standing on the greener grass makes every word I say sound less and less genuine or convincing. Not sure what else I can do?

I reflect back on this time, two years ago - when under the same moons of this Holy Month (it's currently Ramadan in the Islamic calendar) - I prayed and prayed that I would be accepted into the program if God in His wisdom knew that it was the right path for me to take; and for strength to accept a rejection if it was not. On being accepted into the program of course, all the prayers were by and large forgotten - it was I who achieved this, not some Divine Being. As the months went on, I started to take for granted how fortunate I was to be accepted first time 'round. But now I feel like I'm starting to regain some of that initial gratitude that I felt and paying due recognition to the Help that I received. At the same time, two years in, I've also come to realise that first-time acceptance isn't necessarily a great thing to have happpen, particularly if you've come straight out of high-school --> undergrad --> med school. I'm envious beyong words at those students with PhDs; 10 years nursing experience in a humanitarian aid-work setting; 15 years experience as parents; 5 years experience as teachers; the list is endless. I get pretty defensive when it's assumed that I have no "life experience" - because that's not entirely true either - but really, nothing is official or noteworthy. So yeah, all in all, I've come to remember how lucky I am that I was accepted first time 'round; but also realise the value of having an extra year or two or ten, while you are accepted, to do something amazing with your life... until you're finally asked to jump into the pool and stay :-)

Monday, August 3, 2009

10, 9, 8....

The count-down begins: we only have 10 more PBL weeks left for this year (out of 32). Oh my! I can't believe it's August already either :-O This month I farewell my beloved neuro block and welcome (half-heartedly) the upcoming musculoskeletal block. If I have one ambition, it's to remember the carpal bones without a bloody accompanying acronym!! I also hope we learn how to stabilise #ed limbs with a plaster cast - I've always wanted to learn that! One thing we learnt how to do during neuro block, which I thought was tres cool, was lumbar punctures :-S In my nerdy-neuro-obsessed mind, there's something creepy about gaining access to such a well-guarded area... as a body-fluid, CSF is so sacred; I feel like we shouldn't ever see it (and if we do it's either urgent - or ominous if it's coming out of the nose/ears post-head injury). *Shudder*.

Over the past week or so, I've reinitiated attempts to fulfill my New Year's resolutions - to exercise more and eat healthier foods. I was going very well until about April when, after my sister's wedding, I saw no need to try to fit into a size 8 dress. Now I'm back into it, for fitness and fun, more than anything else really. For now I'm just going to the gym and doing my own thing - treadmill, bike, cross-trainer - because whilst I like the idea of enrolling in an organised sport program, I think I'm too competitive to enjoy anything like that on its own merit :-S

What else has been happening? Not much really. I wish I had an exciting story to share with you about an epic adventure or the like. I guess I'm just quite content with the impeding end to what's been a long and mentally-draining year. If all goes well, it's my final year of full-time theoretical/didactic studies and I'm really looking forward to being in a practical learning environment. Closer to then, I guess I have a few exciting things coming up this month, with the City2Surf next Sunday (which I'm going to be on St John's First Aid duty for); completing the various first aid and life-support courses that I wrote about as part of my St John's training throughout this month; my sister's birthday on the 19th; and the beginning of the holy Islamic month of fasting, Ramadan, which will start on the 21st or 22nd (depending on the moon).

Anyway, hope the week is a good one! :-D

Friday, July 31, 2009

Control

Over the past few days I've been reassessing my approach to life and to what extent I feel I have command over the 24 hours that I have each day to use. Unfortunately, for some reason or another, it seems to me that things are heading in the way of the 2nd Law of Thermodynamics - in essence, that my life is becoming increasingly disorganised. There isn't one particular thing that I can use to illustrate this point; because it really is a combination of factors that are contributing to this down-ward spiral. When it comes down to it; the failure that I see on my part is lack of self-discipline. I've become quite accustomed to not having to account for the way that I'm spending my time (particularly since leaving high school all those years ago) and in particular, to the fact that I don't really owe anyone anything, as far as dedication of time spent. But of course, with this privilege, comes responsibility. So I want to start being a bit more responsible about how I'm spending my time.

Implications? Dedicating more time spent exercising, hanging out with the family, getting into healthier eating and sleeping habits.

I'm control-freak by nature... I feel like things are slipping. Let's see what I can do to stop that :-S

Tuesday, July 21, 2009

Much ado about nothing

Sorry about the lack of updates - to be honest, I've been staring at the screen for almost an hour and for the first time, she who has a bone to pick about everything, has nothing to report :-S I guess I'll write a bit about what been happening in my life, though I warn you that it won't be anything exciting...

So, we are still within our Neuro block at uni and as far as I'm concerned, we can stay here forever. For the first time all year, I understand the concepts and I have the answers. I can do the physical examinations and interpret the signs and symptoms. I know the Circle of Willis, the difference between Broca's and Wernicke's Areas, the MOA of the major antiepileptic drugs and how to calculate the GCS. These aren't particularly hard concepts or bits of information to commit to memory; but I guess the pace of information processing required in studying medicine is often so hectic and overwhelming that it's such a relief to be confident with the basics. This also holds particular value in my eyes because I'm the kind of student who believes in knowing the fundamentals or the "bread and butter", if you like; and not much more.

Today we learnt about something called "pseudoseizures" (we are studying epilepsy this week). For those who don't know what they are, here is a pretty good article on them. Captain Atopic wrote about them earlier in the year and I agree with him completely: pseudoseizures are NOT funny! I have to admit though, I'm a bit confused about the extent of consciousness and deliberation involved? Regardless, most sources point out that they may still be of some clinical/diagnostic value - in the same way that other "weird" or anti-social acts can trigger warning bells about underlying psychosocial issues. Still, it's just such an extreme measure to take!

What else? I think I'm finally on the other side of the long and drawn out messy ending to my friendship/relationship with FMH. God, it's taken over 6 months!! I'm just so blasĂ© about the whole thing now and am actually REALLY glad it's over. When I reflect on things now, I'm amazed (read: utterly disappointed in myself!) by the trance I was under with him. It's so debilitating! I don't wish to use this blog for defamation - but he was *so* selfish to take advantage of my sentiments in the ways he did. I've learnt so much from the experience though and if I can get this message across to at least one person, then nothing would have happened in vain. My message is this: love and life are full of compromises - fair enough - but don't ever compromise who you truly are or your raison d'ĂȘtre (reason for being) for someone else (this includes not making anyone your reason for being). Even if your ambitions in life aren't giving you fulfillment, I urge you to search deeper within yourself for answers before relying on others to give your life a sense of worth. And that's all I have to say about that.

Anyways, moving right along... I'm going to the Spring Seminar on Emergency Medicine in Broome, this October. Anyone else going? I'm really excited as this will be my first real med conference :-D I hope it's not too advanced for me, but I think the experience will be worth it all the same. Plus, I'll get to check out what the other side of this beautiful country looks like. On the second day of the conference, there are a few workshops on offer: I signed up for paediatric resuscitation, regional anaesthesia, ophthalmology and some other resuscitation one where they are supposedly going to cover difficult airways and umbilical vein catheterisation :-S I'm sure I'll update more on it later.

Well, I think that's as much as I can write about my life for one evening. Ooh, one last thing - apparently IMET released intern (match) offers for some students yesterday. I hope that all my final year virtual buddies get their top preferences! It must be such a stressful time :-S Good luck!

Friday, July 17, 2009

The five people you trust the most from med school

The other day, whilst attending an interesting lecture about Schizophrenia, I looked around the room at my class-mates and contemplated the idea that these people would be looking after patients one day and - Heaven forbid - it may even be myself who is under one of their care. As I furthered chewed through this (somewhat disturbing) thought, I came to the conclusion that there are only about 5 people amongst my cohort whom I would ever want treating me or my family. These people are neither the smartest nor the closest to me in friendship - but I saw unique qualities in them that I could only hope to emulate myself one day.

1. C - the ex-anaesthetics nurse.
Placid as a lake. Reassuring. The epitome of calmness.

2. M - the ex-physiotherapist.
Sharp and astute. Professional. Logical. Oh so very humble.

3. R - the father of two, and ex-science teacher.
Sagacious. Organised. Street-smart and savy... and because there are somethings only a parent can appreciate.

4. N - the goth, and ex-forensic scientist.
Original. Passionate. Fashionably sensitive, outside the square thinker.

5. P - the ex-computer programmer.
Deep. Discreet. Impeccably reliable and trust-worthy.


Above all, the five people I would trust the most from med school are honest, tolerant and sincere. They respect issues of confidentiality and are particularly professional in their conduct.

They are people you would want looking after you too...

Tuesday, July 14, 2009

"Yeah it's bad for you, but see how good it can look!"

I came across this awesome website last week called "Fancy Fast Food", which just had me drooling! It's a food blog specialising in extreme makeovers of fast foods - with recipes and photographs included!

Oh it's just perfectly ingenious, don't you think?! Global financial crisis affecting you much? Never fear - you can still whip up a culinary masterpiece at the cost of a Bic Mac Meal. Michelin star-worthy, I'd say!


Pictured here is a sure-winner with the whole family - the McSteak & Potatoes dish (aka spruced-up Bic Mac meal).

Sunday, July 12, 2009

Of blood, brains and glory!


My overall experiences of med school thus far have been pretty low key, somewhat tedious and, for lack of better words, quite boring. It's certainly not due to being so exceptionally talented that I find the content insulting to my intelligence - nay, almost the opposite! It's that a lot of the time I'm completely lost, either failing to comprehend the basics of what is presented to us or failing to see what the point of it is. Add to that our pathetic excuse for a clinical program (no hospital placements at all till 3rd year!!) and what you have is a med student soldiering on from week to week, head down, shoulders hunched... sometimes walking, often tripping... reaching for the light beyond the seemingly endless tunnel that is the pre-clinical component of the course. Excuse, the cynicism, it gets better.

Then, rather unexpectedly, you are granted a week of mercy - a week where uni is interesting, things actually make sense to you, and people - real people!! - are placed bravely under your care... and you allow yourself to quickly bathe in the glory of life as an active and diligent knowledge-seeking member of society. Perfectly aware, of course, of the transient nature of this phenomenon.

This week, with the start of neuro block, was my week.

I studied Neuroscience in my undergrad degree. I know the brain inside out and the other way 'round. From the minute biochemical neurotransmitters to the gross anatomical structures; I have devoted many hours trying to unravel, for my personal interest, the mysteries inherent within. I've done research on neurodegenerative diseases - I've found no answers for the betterment of humanity, but have answered *so* many of my burning questions.

I love the brain - I don't think I'll ever cease to be fascinated by it. The brain to the body; is the sun to the solar system. It is the only organ that cannot (as yet! :-S) be viably removed and/or replaced by a mechanical, electronic, or allogeneic substitute. Death, medico-legally, means having irreplaceable loss of brain function as indicated by a persistent flat electroencephalogram. Culturally and mythologically speaking, the brain is believed to house the soul and essence of self.

My highlight of the week was definitely dissecting a whole brain (with a perfectly intact arterial system!) out of my cadaver's cranium. I don't yet have any achievements at med school to be proud of - but, if I may so humbly point out just this once, that my partner and I were the only people to do so during our anatomy session (admittedly no one else did, not because they couldn't, but because they weren't interested in doing so when all they needed to do was look at a plastic model). Other thrills included being lectured on Parkinson's Disease by one of Australia's finest neurologists (who'd invited a PD patient to come with him to demonstrate the cardinal signs of the disease), and testing the good ol' cranial nerves during our clinical skills session.

My week was topped off with a St John's first aid duty at one of the most violent amateur rugby matches I have ever seen. Broken noses, dislocated shoulders/fingers/knees, concussions, sprains and strains. Oh my! I've had a very sheltered life :-S There were two games happening simultaneously on the oval and it was chaos! One thing I reflected on in hindsight was that I feel like I'm becoming a bit sloppy with formalities - I was forgetting to do simple things like gain explicit consent and explain what I was doing to the casualty. I think it's because we do so much clinical work in simulated environments at my uni, so it's easy to omit these essential details without dire consequences. Still, it's totally unacceptable to just jump in and ask someone "what happened?" without even exchanging names, for example :-S Anyway, I'm going to sign up for the 4-day new members' workshops run by my division in August - they'll cover everything from Senior First Aid, Advanced First Aid and Advanced Life Support. The SFA will mostly be a refresher, but the AFA and ALS will be completely new for me. Looking forward to learning something in the way of organisation and fluency in multi-tasking - and hopefully putting an end to this sloppiness!

***

I'll leave you with a link to a youtube video of "Candy" - one the most delicious songs I've heard this year. The voice is that of Scottish artist Paolo Nutini - he sings in his native accent, with a soulfully mellow voice that is mature well-beyond his young years. Another favourite song is "Million Faces". Check him out!

Wednesday, July 8, 2009

Sometimes, I really hate change

We would stand in the wind
We were free like water
Flowing down
Under the warmth of the sun
Now it's cold and we're scared
And we've both been shaken
Hey, look at us
Man, this doesn't need to be the end

Just let me hold you while you're falling apart
Just let me hold you and we'll both fall down

Fall on me tell me everything you want me to be
Forever with you
Forever in me
Ever the same
Call on me
I'll be there for you and you'll be there for me
Forever it's you
Forever in me
Ever the same

~ Rob Thomas, "Ever the Same"

Tuesday, July 7, 2009

Review: Doctor's Diaries

A few day's ago I came across the website of a TV series called "Doctors' Diaries". It's basically a documentary series that follows the lives of seven Harvard Medical School students - their journey through med school and their personal/professional lives post-graduation. It took 21 years to produce and makes for very interesting viewing (the series hasn't aired here in Australia yet so I just watched the 10 minute summary of each doctor's journey online through the website).

These short previews alone made me laugh, cry, cringe and sometimes just nod my head in recognition or sigh in resignation of the reality. The transformation over the years for some of the doctors was remarkable; but I particularly liked seeing how most of them stayed true to their guiding principles and used their skills in medicine in the ways that their younger selves had envisioned they would. Another thing that also stood out for me was how they all had relationship issues, falling under one of three categories:
- never got married or partnered-up;
- married but divorced and (for some) re-married; or
- married quite late in life.

I'll spare you all a relationship rant for today, but let's just say I'm close to losing what little faith I had in the idea of doctors maintaining a healthy work-life balance :-/ Regardless, most of the doctors seemed very happy and at peace with where their journeys had taken them; and I'd say the sweet out-did the sour. Overall, a refreshing and honest insight into an intriguing world that surprises even those of us in it. Well worth watching (if you only watch a couple of clips, watch Jay Bonnar and Jane Liebschutzs' stories - the part where Jay is an intern and trying to elicit a history off a guy with leg numbness is hilarious!!).

Saturday, July 4, 2009

Crazy - Confronting - Considerate

Crazy: is politically incorrect and far from the truth. This is real, this is raw.

Confronting: are just how real it actually is; the mysteries that shroud it; how it affects those who have it; and the fairly poor prognosis.

Considerate: are the modern medical practices and reactions to it, particularly (amongst others) the act of scheduling a patient in the interest of protecting them from "harm to reputation".


And thus I was left feeling, after my first formal block of education in Psychiatry.

Tuesday, June 30, 2009

Stranded

I woke up this morning feeling a bit unwell. I still went to uni though because it was my turn to present the grand rounds for our last case and didn't want my snazzy powerpoint presentation to go to waste. However, by the end of the day I felt way out of it (physically and mentally) and so took a chance to have a rest on the train ride home. Now, the train I normally catch home in the evenings is an express train that continues up to the Central Coast and Newcastle, which means it travels for long stretches between each stop; my stop is usually the second one - beyond that, I have no knowledge of where the train goes to.

I don't know how it happened, but I woke up to find the train almost empty, pulling into a station that I had never heard of. If I felt sick before getting on the train, it was nothing compared to how I now felt. I was so tired and overwhelmed that I couldn't even muster the energy to get out of my seat and find out where on earth I was. So I just started crying. I know it's stupid - for God's sake, I've travelled overseas alone and been in way trickier situations! But I really just felt so exhausted and defeated. And some days, you really just want to be in the comfort of your own abode.

Anyway, two hours later I finally made it home. Le sigh!

(If you are wondering about the point of this story, allow me to share some insight about a long-standing dream of mine: to own a car and finally stop being at the mercy of the public transport system)/

Sunday, June 28, 2009

Back...

...to the old smoke - tall buildings, traffic lights, crowds, chaos, family... oh my, it's only been two weeks but I think I'm going to have adjustment issues :-S

We have to fill out an evaluation form after each placement we do and one of the questions is "How has the experience impacted on your ambitions to practice rurally?" . For me, the experience has been revolutionary. Born and bred in major cities, here and overseas, I've never ventured off the beaten track. I had a lot of misconceptions about life in a small country town, socially and vocationally with regards to working there as a doctor - all of which have been dispelled by this experience. I was expecting the people to be a bit conservative and wary of strangers (not just from the city, but essentially from half-way across the world!) coming in to their town without the promise that they'd give something back. This was certainly not the reception I received; and I'm not sure if it's because Mudgee has a higher flow of tourists than other rural areas, but the people were extremely friendly, accommodating and welcoming. They also practiced good olde fashioned manners, which is a rare sight here: tipping their hats or greeting you as you walked down the street; holding the door open for you to pass; inviting you home for dinner after knowing you for only a few days; insisting that they pay for your coffee every morning!! I also really appreciated the wider spaces, fewer crowds and slower pace of life, much more than I envisioned I would. And of course, everyone really does know everyone elses' business - which may be good or bad, depending on what business of your's they know :-P.

From a medical practice perspective, the main differences that stood out for me were the greater responsibilities placed on GPs and nurses to hold up the health-care system and look after everyone's needs as much as they can. With the exception of regular visitors, they don't always have the luxury of passing the care of someone onto a specialist; so they manage a lot of cases in their clinics or the ED, that a specialist would otherwise take care of in the city. At the same time, the situation isn't as remote as I imagined it would be - for serious cases, care in Dubbo or Sydney is just a referral flight away (and the costs are covered of course). Also, because of the visiting specialists, there is access to a specialist if you really needed to see one in a non-emergency situation, every now and then (which is about the same access you would have if you lived in the city because it takes forever - read: weeks or months - to get an appointment with one in the city anyway!).

Overall, an extremely positive experience for me and I can't wait to return next year. Long-term, if I went into general practice, I wouldn't practice it anywhere but in a rural setting. Anyway, enough ranting from me. I'll let you decide: take a trip and see for youself!

Friday, June 26, 2009

Mudgee, Day 12 - One Last Drink


Last day in Mudgee :-( Dr P was going to be away today so I organised beforehand to spend my last day doing vampiring in the pathology room. I really think with some skills, it's just a matter of getting 50 or so under your belt, before you can rest easy and say, "I can do it" (note - 50 was just an arbitrary number that I've pulled out of nowhere but I'm sure there's been research done showing how many times are ideal). One thing I did notice today though (that I hadn't noticed before), is that I get nervous if the patient is nervous; and I'm consequently more likely to miss :-S They have a bed in the pathology room for people who look like they're "fainters" - I tended to just put anyone who was nervous on there because it relaxed them a bit. I don't know; it probably seems a bit excessive but I guess whatever is comfortable - for the patient and yourself - is ideal, right?

Anyway, off to pack my bags and have one last bubble bath in my killer spa tub. I can't really sleep because if I do then I won't wake up in time for my 6.30am bus, so I'm going to see the break of dawn in Mudgee watching DVDs. I'm down to my very last DVD; my all-time favourite movie, "Sleepless in Seattle". Shameful, I know :-P

* PS - needless to point out, but because some of you give me less credit for common-sense and ethics than you think I may have: YES, the patient's permission was granted to take and publish this photo.

Thursday, June 25, 2009

Mudgee, Day 11 - Happy Bowel Day

A visiting surgeon from Orange came to town today to cover a general surgery list, and Dr J (one of the GP/anaesthetists) agreed to having me tag-along and watch for the day. As it turned out, the surgeon himself was really keen to teach and because most of the procedures were scopes (there was also a lap chole and hernia repair), he had the aid of a screen to guide us through what he was doing, tutorial-style. He also asked questions which, naturally, presented prime opportunity for me display my knowledge (bah! or rather lack thereof!!); so, just in case anyone had a doubt in their mind, let me reaffirm the fact that I really, utterly, hopelessly know nothing :-S But alas, I keep swimming because I live in the hope that oneday I'll be able to stop writing about how little I know (and then you can assume that I've started knowing). Enough about that/...

Overall, it was a very relaxing and interesting session in theatres; particularly since I'd had a bit of exposure to GI diagnostical & surgical procedures last year when I went to Fiji - and also because we just finished doing the GI block at uni :-P Mind you, I spent most of the time close to Dr J's side while he shared some of his insights about anaesthetics. Speaking of which, it was actually pretty weird because in all of the scopes that were done today with a mild propofol sedation, all the patients came 'round at some point during the procedure and started writhing countinuously until more anaesthetic was given - is that normal? Why not maintain the sedation throughout, rather than allowing it to start wearing off before administering a new dose? Hmmm...so, I got a chance to practice inserting IV cannulas as well which, I'm discovering, is a damn-lot harder in real life than on those plastic arms :-S Luckily I only missed once; but I'm still working on getting a smooth technique thing happening here. Once I go back to uni next week, I should probably try to spend more time practising cannulations in the clinical skills lab and working on my "flicking" skills :-P

Anyway (and I just had to add this...), in the evening the Drs took me out for dinner and I had an amazing hot chocolate fondant with mixed berry ice cream for dessert. It was *so* delicious!!


***

Oh, and another thing I wanted to mention: this afternoon, results came out for the mid-yearly exam that I sat two weeks' ago (the one that I was passively shit-scared about failing). Well, somehow - through some means that defy logic and are beyond my grasp of comprehension - I passed (overall and every domain)! Phew! I live one more day then, yeah?

Wednesday, June 24, 2009

Mudgee, Day 10 - Flying solo in Cas

I spent the day in hospital today, doing cas duty with Dr P. Although I've mostly been happy to just tag along and observe (because as per my previous post, I don't really know anything yet), Dr P insisted that the best way to learn is to swim out on your own. So throughout the day, he assigned me to patients and told me that he was going to leave me entirely responsible for taking their history, examining them, asking him to order any tests/investigations that I thought would be useful, and then forming a management plan. He said that he would let me go as far as I could within reason before intervening if he thought I was on the right track, but otherwise trust whatever choices I made. Argh (but of course it was mostly pretend because he reviewed all the patients again briefly and wrote notes in their folders ;-)!

The idea was probably scarier than the reality because, as I came to realise, he only assigned me patients who (based on the triage nurse's initial assessment) he deemed non-serious or life-threatening. This was completely fine by me of course, as the opportunity to do something like this on a real patient (read: not my perfectly healthy family or fellow med students!) with real signs and symptoms was amazingly invaluable! I was able to continue the whole way without him intervening at all for a few patients (female with an U+LRTI; male with gastro+nausea; female with syncope; kid with fever); but he also stepped in with a few patients who had red flag symptoms that he picked up when I reported the findings of the Hx and Ex back to him. In a few instances, he told me to go back and ask one or two questions that he thought may be significant and which turned out to change the most probable diagnosis altogether. While most diagnoses are based a combination of information derived from the Hx, Ex and Ix; it's scary to think that in some instances, one or two extra/different things swerve the likelihood towards something else. Like this one guy who presented with abdominal pain in his LIF. When I examined him I noticed that he had a scar in his RUQ (from a cholecystectomy) so I immediately took anything gallbladder-related off my list; in fact, I took the liver off my list all together as well and didn't bother to check for jaundice in the sclera because the pain was on the polar opposite end (you can see where I'm going with this right?!). Anyway, suspecting that his symptoms were just a flare up of the diverticulitis he was diagnosed with 3 weeks ago, I asked Dr P to write an order for blood tests, to which he added LFTs. When the results came back, his Bilirubin, GGT and ALP where all elevated so Dr P asked me to go back and ask about the colour of his urine and stools (which I'd completely omitted from the history (!)). Urine darker and stools paler than usual. Anyway, long-story short: it turned out that in addition to the flare-up of his diverticulitis, he also had a common bile duct obstruction.

Another day, another lesson learnt. I really know nothing... but I'm learning.

Tuesday, June 23, 2009

Mudgee, Day 9 - Diversity

There is an unfortunate misconception that general practice is not as exciting as other medical specialities; with the phrase "coughs, colds, tears & smears" used to depict what are perceived to be the most common presentations to GPs. This time last year, I had just completed the first of my series of GP placements, as part of the first year clinical program, in a busy inner-city GP clinic - and to my disappointment "coughs, colds, tears & smears" were indeed the order of the day :-S Enter GP in the rural setting and oh boy - the difference is remarkable...

I spent today sitting-in on consultations with the good Dr P in the hope of absorbing via osmosis a thing, or two, or ten of his multitudinous praiseworthy skills and habits. I was treated, in return, with a day full of peculiar presentations that I thought only existed in textbooks. Shingles, intussusception of the small bowel, neurosarcoidosis, Barrett's oesophagus, excessive bruising with denial of trauma (leukamia... or physical/sexual abuse, perhaps?), polymyalgia rheumatica, colovesicular fistula... Whao! Inevitably, the more experienced medical students/doctors/nurses out there are rolling their eyes at me a-la-"been there, done that!", but seriously, I'm just overwhelmed by the diversity.

Two truths were thus confirmed for me today:
1. I know nothing.
2. Rural GP really demands that you know your thing.

Seriously. Le sigh.

Monday, June 22, 2009

Mudgee, Day 8 - A Dose of Anaesthetics


At some point during the past year and a half year of my medical training, I fell in love with anaesthetics. I think the attraction is due to a combination of the common scientific territory that it shares with my undergrad major (neuroscience); the largely controlled nature of the field ("control-freak" here!!); the fact that it has changed surgery in a way that only the invention of antibiotics can rival; and the quirky combination of theory and prac work involved. So it was without hesitation that I took up the opportunity to hang out with the anaesthetics team during today's dental surgery list at the hospital. The procedures (mostly extractions) were done by a visiting dentist who comes up from Bathurst to Mudgee once a month; while the anaesthetist was a local GP-anaesthetist (Dr L) from the team of five at the medical centre.


All up, there were five procedures - three children and two adults - done under a GA. I was hoping to get a chance to intubate but when it came to it, I didn't feel comfortable practising something I didn't know very well on children (and unfortunately the adults had class III and IV airways, so again, not ideal for practising on!!). But no big deal - there'll be plenty of opportunities to practice in due time. I still got to cannulate and take bloods off patients before their procedures; plus I was assigned to "check-lung-sounds-are-present-and-equal-post-ETT-insertion" duty :-P


They say that anaesthetics is like flying a plane - smoooth execution of take-off and landing are crucial and make up the majority of the anaesthetist's role. Part of the take-off involves calming the patient down and reassuring them - no easy task in adults, let alone children. Luckily I'd gotten some insider tips from my good friend Andre who is an anaesthetics nurse, particularly in the way of making the induction like an adventure for the kiddies: "Hey kid, would you like to go into outer-space?" *Cue overhead lights* "Whao! Your rocket is ready! Just put on this astronaut (gas) mask and off we go counting down for lift off - ten! nine! eight! seven! six!...". They're asleep before five! Pretty neat stuff, yeah? Of course the landing is somewhat trickier :-S People tend to get quite irritable and aggitated after a GA - they'll try to sit up and some trash about wildy. This is where it helps to have strong and sturdy assistants around (particularly if, like me, you're not so yourself)... or else start working on upper body strength if you're planning on going into anaesthetics cos you sure as hell will need it!

Throughout the day Dr L gave me little tutes on the drugs he was using. My favourite is Suxamethonium because you can actually see it working it's way up the body via fasciculations that travel from the toes to the eyelids. Light sedation with Ketamine is also pretty interesting, especially if you have any conversations with the person during the procedure and then ask them what you talked about after the K has worn off. Twisted ;-P What's your favourite?

Sunday, June 21, 2009

Mudgee, Days 6 & 7 - Weekend Road-Trip

My parents came to visit me for the weekend after I couldn't stop raving to them on the phone every night about how gorgeous my little country town is! We went for a drive around the region into neighbouring townships - up to Gulgong, then down south to Lue, Rylstone and Kandos. I'm somewhat perplexed now as to why people choose to flock en masse in coastal cities leaving vasts of endless spaces inland largely uninhabited. Seriously? Country NSW is breath-takingly beautiful and relaxing; the winding roads, open fields, rolling hills... I'm going to feel a bit claustrophobic when I re-integrate back to the city in a week's time :-S Here are some pics from our trip:


















Oh, and my weekend wasn't totally med-free. Dr P called me at 11pm on Saturday night, telling me that he was going to do an emergency Caesar if I wanted to watch? I think I'm some sort of Caesar magnet - everytime I'm due to watch an NVD it turns into a Caesar. In between this placement and my overseas one last year, I've seen 10 Caesars to 1 NVD (well, to be honest I was on a surgical rotation last year and only ducked in to labour ward for an afternoon in the hope of seeing at least 1 NVD :-P). Anyway, it was still beautiful to watch last night, especially when the dad started crying. Awww *warm and fuzzy!*.

Friday, June 19, 2009

Mudgee, Day 5 - Things happen at night in small towns too


Exhausted! Dr P and I were on cas-duty in the ED this evening after spending the day taking "walk-in" consultations at the medical centre. I just got home and I'm *so* exhausted! Let's recap what happened (again I'm conscious that it's a small town so in this instance while I am going to write about what happened, I'll change any obvious identifying features):

5.30pm: arrive at cas - Dr P asks me to interview and examine a patient who suffered a workplace injury to his right hand, then heads off to maternity ward to attend to a case that I'm not involved in. Middle-aged man, with an obviously deformity in his right hand just proximal to the 4th MCP joint (and causing the right knuckle to become inverted). Complaining of pain and weakness, but on examination his motor strength, range of mobility and sensation are normal. DDx: sprain, strain, soft tissue injury, fracture? Report back to Dr P who has returned from maternity. Orders an X-ray which reveals a spiral/oblique fracture to his 4th MC. Can't really do much in the way of "fixing" these kinds of fractures with a cast (I guess the intrinsic muscles, tendons and fascial sheaths of the hand have an inbuilt stabilising "cast" within them) so we bandage it up for him and ask him to return if the pain get significantly worse over the next few days.

6.00pm: attend to an elderly woman with colicky pain in her RUQ who is febrile and has been vomiting all day. Suspected cholecystitis - confirmed by an ultrasound (which shows multiple gallstones in the bile duct) and something in her blood-test (maybe a raised wbc count, GGT and alk phosphate levels?). Call Dubbo Base Hospital to get a surgical consult - surgeon advises to "wait it out" before considering a cholecystectomy. Inform patient and send her up to the wards.

6.30pm: Dr P attends to a patient with abdominal pain and sends me to see an elderly man with "flu-like" symptoms. Take a respiratory history and examination - patient is in obvious respiratory distress and his lungs sound pretty crappy (crackly, wheezy, gunky). Pneumonia, swine-flu (!), LRTI, bronchitis? Report back to Dr P who orders a CXR, which reveals diffuse interstitial lung opacities consistent with pulmonary fibrosis. Oh, and he had some LRTI.

7.00pm: Start talking about whether to send aforementioned man up to the ward where he could potentially infect other people but never finish discussion because a code is called to maternity. Dr P bolts, I bolt after him then realise it's probably for his special-case patient so I stop, turn around and walk back to the ED. As I walk in I look down and realise there are a couple of spots of blood on the floor. My eyes quickly follow a short trail around the corner to a man collapsed on the ground, drenched in blood. Lots of blood. Everywhere. Lots and lots of blood everywhere. On his pants, on his top, all down his back, all over his face and covering the entire back of his head. He's semi-conscious. All of a sudden, the nurses see him too and about five people simultaneously find the nearest pair of gloves and run up to him. We discover pretty quickly that he's bleeding from the back of his head (occipital region) - puncture wound that's severed a major artery completely. God Almighty - the head is such a bleeder! I stick my finger in the wound while the others find guaze/padding. We somehow manage to get him on a bed with my hand now applying pressure through thick padding directly onto the wound. It's futile - I can feel the bleeder throbbing and the pad saturated with blood. Warm, free-flowing blood is unnatural and creepy. One of the nurses tries to cannulate him and misses, once, twice, seven times!! He's lost so much blood his peripheral vessels are shutting down. His BP is ~ 85/40 and skin is icy cold. She eventually gets in and starts a free-flowing bag of saline. At some stage someone realises that because Dr P is attending a code in maternity, we don't actually have a doctor with us (!), so Dr J (a GP-anaesthetist) who is the second doctor on-call gets called in. He puts in another line (also misses a few times!), then orders an x-ray to clear his C-Spine because we find out that the mechanism of injury is a fall on the head. C-spine cleared, pupils equal and responsive to light, patient semi-alert (can squeeze hands and move toes) - patient positioned laterally and I can finally release my hand of its compressive role. Dr J inspects as best as he can with blood still gushing out of the wound then implants his pinky firmly into the bleeder while he sorts out what to do next. Many attempts are made to stop the bleeding - all in vain though :-S Finally tries to settle things down by stitching everything he can latch onto the needle together, both edges of the wound, and prays to whomever it is he believes in that the patient doesn't develop a massive epicranial haematoma. Does the trick (or so it appears)... bandage and clean him up (realise that he looks quite handsome without the veil of blood all over his face!). Keep him in overnight in the ED. Someone finally gets a chance to sit down and suss out what actually happened - find out, amongst other things, that he DROVE HIMSELF TO THE HOSPITAL!! Oh. Dear. Lord.

8.30pm: find Dr P and watch him attend two teenagers who had a head-on collision whilst playing foodball, leaving each with a pretty impressive cut - the first above his right eye, the second on his left cheek. The former gets stitches, the latter gets glue.

9.00pm: three patients in a row attend complaining of abdominal pain and episodes of vomiting. I'm told by Dr P that, being a Friday night, the key task is to rule out the worse case scenario (ie - need for surgery) because then arrangements can be made for transfers to Dubbo or Sydney ASAP.
- First patient: 10 year old girl complaining of pain over McBurney's point, has obvious guarding, but nil tenderness, rigidity, rebound tenderness or loss of appetite - appendicitis therefore unlikely. Is shit-scared of needles and thinks that I'm hiding one in my pocket that I'm going to pull out surreptitiously and jab her with - I assure her that I have no such intentions. Send her home and asked to return if worse.
- Second patient: 18 year old girl complaining of nausea and a generally-distributed cramping pain. "Any chance you might be pregnant?" - "Nope, I have an Implanon". Patient suspects it might be from a dodgy sausage roll. Good enough to leave it at that. I give her an IM gluteal shot of Maxalon and Buscopan and she's discharged. Asked to return if worse.
- Third patient: 3 year old girl - was febrile and vomiting earlier in the day but currently asymptomatic. Mum seems frustrated that her kid is now perfectly fine and happy when a few hours' ago she wasn't. Dr P tells her she did the right thing by acting on instinct and that kids have a tendency to oscillate symptom-wise when they're ill. Panadol, sent home, asked to return if worse.

10.00pm: Monitor Mr Head-Bleeder for an hour, taking his blood pressure manually on a regular basis because the damn machine isn't working properly. Dr P attends to his case in maternity. Chat to the nurses about working in a small rural town hospital - highs, lows, in-betweens? All are, for the most part, very happy and feel supported by the system. They tell me about the recently-released management guidelines that are designed to assist them in situations when a doctor is absent. Main complaints are about locum staff covering 24 or 48 hour weekend shifts - "they're rude, inconsiderate, unattentive, inefficient and clearly doing it for the money" (apparently they get over $5000 to cover a weekend - shit, no wonder NSWHealth is in debt!!). They give me pointers about how to get on the nurses' good side, which I note down very carefully.

11.00pm: since the ED is clear and there is no one waiting to be seen, Dr P and I decide to call it a night and retire to our respective abodes. Technically-speaking we're still on-call but we don't have to be at the hospital if we're not needed. I'm so totally exhausted even though the night is still young. I'm shaking from the thrill of having spent my first evening in an ED - I think I've found another favourite niche of medicine.

Above all, I'm rather impressed that things happen at night in small towns too...

Thursday, June 18, 2009

Mudgee, Day 4 - Your Doctor May Love/Hate You

This is sort of beyond the topic of rural medicine, but in light of some of observations that I've made over the last few days, I wanted to comment a bit about doctors' personalities. There's a scene in Moulin Rouge where Satine makes a remark with regards to her profession along the lines of, "I'm paid to make men believe what they want to believe". Now, far from comparing doctors to courtesans, I feel like in some ways we do that as well.

This has mostly stemmed from observing the behaviour of my mentor, Dr P - who is an absolute darling with his patients (and to be fair, with everyone around him). During their time whilst under his care, he makes every patient feel - then and there - like they're the most important thing to him in the world. Regardless of how trivial their presenting complaint is, he has no limits on the amount of energy and care he expends on each person individually. As a habitual "eye-roller" myself, this has managed to concurrently kill me and also give me an enormous amount of respect for his ability to sustain such a consistently high level of compassion.

Moreover, however, the cynic in me has started to question the extent of his seemingly endless attention-giving spurges. I mean, he looks after at least 20-30 different people on any given day - and each person is left feeling like, "wow , this person really is genuinely and unconditionally concerned about me and only me!" - so that's a damn lot of people who feel supposedly uniquely loved by their doc. Now, I'll assume that because Dr P is by and large a normal guy, his display of such affections for his patients is mostly just him doing his job very well. So, call me naive in asking this - but does the general public know that it's all really a part of the job?

I don't have my own GP (I just go see the "next available person", who is usually a locum, at my local medical centre when - if - I ever need anything), so thankfully I've never believed that I'm anyone's whole world in a medical context. However, I won't deny that the idea of unrequitted concern and attention by a respectable member of society is very appealing and certainly a trap that I could fall into (now don't y'all start thinking I'm deprived, a-la-Freud), but seriously, you get what I'm saying right? Anyway, my point is - despite the appearance of genuine concern for you and only you - truth is, your doctor "cares about" hundreds of other people and you only have a very minute slice of their love pie. Go find attention elsewhere. *Rolls eyes...*

Okay, that was my random BS post for the week... I told you I have a lot to learn in the domains of compassion and humanity.

***

Onto what I got upto in the town of Mudge. So today, the good Dr P set me up in a consultation room to interview and examine patients on my own; outline DDx, Ix and a Mx plan; before presenting back to him. It was actually a lot of fun despite the fact that I had to shamefully display my lack of talent or abilities to all involved :-S I saw some pretty cool stuff though - people in rural towns get sick too, who woulda thought?! Ha! Then in the evening, Dr P invited me over to his place for dinner with his family which was quite delightful. Which reminds me, can I point out that being a rural GP is by no means the family friendly "life-style" option that I envisioned it to be? Dr P leaves home at about 8am every morning and does not return before 7pm - sometimes later. It's pretty intense because there are only about 10 doctors between his practice and the other medical centre in the area that look after GP consultations during the day and share hospital shifts at other times with additional roles as obs/gyn, anaesthetics and ED physicians. There is a MASS shortage of doctors (especially female doctors, of which there are currently none working in the the medical centre that I'm at) and it takes about a month to make an appointment to see your GP (they have "walk-ins" but you have to wait for hours and you're seen by who-ever is on walk-in duty for that day so there's little in the way of consistency there). Also a lot medical investigations like MRIs and EEGs have to be done in external hospitals with these facilities (usually in Dubbo or Sydney) - which is inevitably frustrating for the patients when these tests are ordered (and I would hazard a guess that most people would be tempted to just not get them done if it means having to travel for a couple of hours out of town). So, yeah, just some interesting thoughts... I'm on-duty in "cas" with Dr P tomorrow - it's a Friday night so it should be interesting, yeah?

Wednesday, June 17, 2009

Mudgee, Day 3 - Venepuncture Heaven

Today I died and went to venepuncture heaven (aka the pathology clinic). One of the first things I learnt in med school was how to take blood - I've practised countless times on fake arms, friends' arms and familys' arms; but by jolly, the thrill has yet to wear off! I guess the biggest difference in today's session (as opposed to previous venepuncture stints) was that I spent the entire day doing it, in the spirit of "practice makes perfect".

Venepuncture isn't a particularly difficult skill to acquire by any means; but the anatomical variations are enough to spice up the procedure and keep you in a hypervigilant state. It was particularly interesting, from an educational point of view, to be exposed to such a wide array of antecubital fossae - from the knotted and jumpy veins hiding underneath the thin, wrinkled skin of Mrs Senior-Citizen; to the deeeep, non-palpable veins lurking underneath the too-thick subcut layer of Mr Morbidly-Obese. I know it's hard to guage improvement with these skills because of the variable presentations, but I feel so much more confident now with getting harder veins; deciding on what to do next on realising I've missed the vein; as well as the pre- and post- set-ups. These aren't particularly challenging tasks either, but it takes a bit of practice to develop a systematic way of going about a multi-tasked procedure without looking:
a) Awkward
b) Figedity
c) Like a complete idiot who has no idea what they're doing
d) All of the above
I don't know, it's hard to describe; I mean, it's just venepuncture right?! But I'm starting to feel a bit like a significant portion of successful procedural medical work involves coordinated and efficient execution of tasks; done, of course, with as much confidence as your situation permits. It's not what you can do - but how smoothly you can do it. This is where practice comes in.

Anyway, the day also saw me do some deltoid IM injections (immunisations galore!), give desensitisation therapy antigens, and take out lots of sutures :-S Again, the "practice makes perfect" rule applies here. On the whole, another invaluable day of exposure and practice - it's going to be really hard for me to go back to doing BS theorical learning when semester two resumes in a couple of weeks.

So, off to make dinner and then watch some DVDs. Oh and in case you were wondering, I missed two veins today (out of about fifteen). I'm getting there...

Tuesday, June 16, 2009

Mudgee, Day 2 - Theatre Day

So, everyday Tuesday is "Theatre Day" at the medical centre. What this involves is the doctors taking it in turns to use the day surgery room to perform various procedures, including draining cysts/abcesses, putting in and taking out Implanons, biopsies, doing skin grafts, etc; but of course, being in an Australia setting - and a rural one at that - most procedures involve excising suspected BCCs and SCCs (basal and squamous cell carcinomas). I spent practically the whole day in the theatre, and was obligingly accommodated for by all the doctors during their procedures. Most of them operated on the "see one, do one, teach one" principle; and so they demonstrated to me how a certain procedure was done before letting me have a go. Again, very confronting (I really don't like being thrown in the deep end!!) - but seriously, pure gold in terms of experience. I was very impressed with how despite there being only one room, the system was very efficient and practical - most procedures took only 15 minutes so quite a few cases were done throughout the day (and I wasn't fobbed off to stand in the corner for the entire day either).

Later on in the afternoon. Dr P and I went down to the hospital to check on a little bub born three days ago who wasn't sucking or feeding; had vomited the expressed breast milk that was given to him via an NGT; and was more or less sleeping like a sloth since birth (read: totally lethargic and somewhat unresponsive to the world around him). In brief, he was having a pretty rough start. We spent a good half hour or so setting up a drip to administer IV fluid therapy (the poor little poppet didn't even whince while he was being cannulated even though he was jabbed like a pin cushion before it was in). Then the doctor decided it would be best to transfer him to a big tertiary hospital in Dubbo or Sydney, so the rest of the evening was spent working out the logistics of that - calling different hospitals, organising an ambulance to drive mum and bub to Mudgee airport for the helicopter ride to the tert hospital, preparing bub for the flight, writing out discharge forms, etc. There was so much to get done, and so many people working at different ends to try to get this baby looked after - but really, the whole affair was pulled off quite smoothly and they made it out of Mudgee before I'd even left the hospital!

I guess what I learnt today is that some things have a quick fix solution; others don't. So, unlike the worlds of business and commerce, medical practice cannot always operate according to a cost-benefit system; where the greater your input, the better the outcome. And I don't know if it's just the emotional factors (being a tiny little munchkin and all), but I found myself thinking that the hours spent helping just that one patient had just as much value (if not more), than crunching (in production-line style) through a full day of consultations, caseloads and procedures

Monday, June 15, 2009

Mudgee, Day 1 - Welcome to Mudgee

You know that the school of life is out to teach you a lesson or two when you discover, just 10 minutes before it's due to leave, that the train that was supposed to take you to your rural town for your placement has been cancelled... And you find yourself stranded at Central Station with an excessive amount of heavy luggage... And your pride won't allow you to call your parents to ask if they can please rescue you... And it's dusk... And cold... Oh, and did I mention that your destination is about 5 (public transport) hours away?

You realise however, that you have indeed learnt life-skills over the years and that you are more resourceful than you imagined, when - one train and two bus rides later - you manage to still make it there before midnight.

And so began my first John Flynn rural placement...

***

So where am I exactly? I'm in Mudgee, a town in central New South Wales, about 260km north-west of Sydney. Mudgee has a population of ~ 9000 people and the district is famous for its fine wine (oh the irony of a strict non-drinker being sent to such a place!); gourmet food; and fresh rural produce including cattle, sheep, wheat, olives, fruit, tomatoes, corn, honey and dairy products.

I'm staying at this gorgeous hotel in the "city centre" called the Cobb & Co Court Boutique Hotel, which is deliciously cosy and comfortable. The town itself is very quaint and organised, with typical country town qualities that I could definitely get used to: no traffic (and therefore no traffic lights!), wider roads, close proximity of destinations, no apartment blocks or high-rise buildings, kitsch cafes and quirky little shops. Each house is neatly set on half-acre block of land, with a well-trimmed garden and a white-picket fence: think Lego-land.












My mentor (Dr P) is a GP who, as with most rural GPs, also has training in obstetrics/gyn. Along with a team of five other doctors (as well as nursing and allied health workers), he works at one of the the local medical practices and the district hospital. Originally a Sydney-sider, he moved to Mudgee about 5 years ago for the greater opportunities that rural practice offers GPs to diversify and undertake procedural work.

I started the day by joining Dr P on his quick morning round at the hospital. The doctors at the medical practice have a rotating 24 hour "cas" (ie, casualty department or ED) roster at the hospital - and, of course, whomever they admit while on duty becomes their patient for the duration of the patient's hospital stay. Dr P saw the three patients whom he had admitted the previous day; before we scooted off to the medical practice for his consultations. Because Mudgee is such a small place, it's going to be very hard for me to write about what I saw without disclosing potentially-traceable private information :-| I think I can safely write though that the casemix of patients were very different to what I'd seen on my Inner Sydney GP placements last year. Whereas "tears and smears" were the dominant presentations in the latter; a lot of today's consultations were more acute and serious (some even requiring immediate hospital transfers and admissions). Prac-wise, I was asked to do various examinations and then report back to him; a task that I found concurrently challenging and extremely useful. These opportunities present rare moments where I feel like I may have actually learnt something in the last one and a half years. But I still have such a long way to go, and not just in terms of medical knowledge. Case in point: my mentor is the epitome of the compassionate and considerate listener; he is very giving of himself and, rather than rolling his eyes at those patients who (it seems to me) just come in for a chat or to complain about something trivial, he treats everyone like their's is the most important case to him in the world. I could definitely take a leaf from his book.

Anyway, tonight Dr P is on-call (from home) for all obstetric cases at the hospital and, because I took up his offer to contact me and pick me up on his way to hospital if anything comes up, I'm sort of "on-call" too . He's expecting one birth this week, but he thinks she may hold out till tomorrow. Personally, I have secret hopes for him to get called in tonight (I keep checking my phone every two minutes and am even considering wearing my scrubs to bed :-P)... we'll see.

I'll leave you with some photos of where I'm staying and the surrounding area:









Thursday, June 11, 2009

P!nk

I just came back from doing a first aid duty at the P!nk concert. I'd heard feedback from members who'd covered the weekend concerts that it had gotten pretty rowdy towards the end; but, being a weeknight and all, I thought the crowds would behave themselves tonight. Well, let's just say that the good people of Sydney proved me wrong and demonstrated quite passionately that a weeknight is no barrier to getting pissed off your head and committing associated acts of general stupidity. But hey, I should probably allude indifference at this stage for the sake of upholding the golden rule of working in health-care: we don't judge here (*rolls eyes*).

Anyway, it actually wasn't too bad (and really, from an educational point of view, one person's misfortune is another person's treasure :-P). We had a few mosh-pit nasties - mainly sprained ankles, crowd-induced heat exhaustion (probably precipitated by dehydration from the alcohol), and intoxications of varying degrees/aetiologies. A lady with a sprain injury asked us if we could take her to the first-aid room to x-ray her ankle so as to make sure it wasn't broken (seriously?!)... I asked her how much alcohol she'd thus far consumed. We haven't set up a portable ED for you here woman! Seriously?! One of the teams had to deal with an attendant who fell down a flight of stairs as she was leaving the venue and knocked her head hard on landing. Apparently she was pretty out of it but they couldn't tell whether it was from alcohol or a potential head injury. Not cool :-/ I wish people would look after themselves a bit more sometimes (ha! The defining public health issue of our times, eh?). Le sigh.

All-in-all, it was a pretty busy and interesting night. Ooh, and as for the concert itself - amaaazing!! Probably not to everyone's taste, but I'm a big fan of P!nk so I really enjoyed it. I even managed to capture a few shots ;-P







Wednesday, June 10, 2009

So much to do, so little time

Now that I'm on the other side of my hideous mid-yearly exam, I can start doing/thinking about other things. Unfortunately my brain is so full to the brim (nay, overflowing!) with mental to-do lists that I've been tossing and turning for the past hour trying to fall asleep, but to no avail. I need to off-load.


St John's First Aid duties and shifts at work:
  • Wednesday 10/6 (1830-2300) - "Pink Concert" First Aid (FA) duty
  • Thursday 11/6 (1600-2100) - Shift at work
  • Friday 12/6 (0830-1530) - "SACS Fun Day" FA duty - CANCELLED
  • Friday 12/6 (1800-2100) - "Fire Water" FA duty
  • Saturday 13/6 (0830-1730) - Shift at work
  • Sunday 14/6 (0930-1500) - "MS Walk/Run" FA duty


Social and family stuff (not many on this one!):
  • Wednesday 10/6 (1330-?) - Lunch with Raidah
  • Return calls and reply to long overdue emails, sms and facebook messages :-S
  • Try to spend at least a few hours with the 'rents, sis and bro-in-law :-/


The varsity list (sadly, it's never truly holiday time):
  • Finish off CCS notes (--> week 17)
  • Print BSC notes for past 17 weeks including anatomy to take to Mudgee (don't ask...)
  • Do week 17 and 18 group LOs and submit online
  • Prepare week 17 grand-rounds presentation
  • Write up past 5 weeks' worth of reflections for professional portfolio and update clinical skills log-book


Preparation for Mudgee:
  • Pack bag --> clothes/toiletries, steth, scrubs, varisty work, lap-top, camera, dvds and books
  • Practice clinical examinations/skills that I may need in Mudgee: taking/writing/summarising a Hx, antenatal examinations, injections, suturing, cannulations, intubations
  • Withdraw some $$$ from the bank to take with
  • Buy some sustenance food (ie chocolate) for long train ride to Mudgee
  • Get a present for my mentor (any ideas??)


Miscellaneous:
  • Clean room
  • Apply for a credit card
  • Call Centrelink
  • Sleep, if there's time left-over :-P

(Indicates they've been done, yo!)

Tuesday, June 9, 2009

Nobody knows

I get a bit frustrated sometimes when people make assumptions about the medical profession, and associated lifestyle, which I suspect aren't necessarily true. "Suspect", I write, because as a 2nd year student I personally know very little (yet!) about what's actually involved. However, some truths that I have come to observe, for example, include the fact that it's really not a very glamorous job, nor does it necessarily lend to a particularly comfortable lifestyle, despite the money that may (or may not) be involved, etc, etc. In brief, I feel like people on the outside rarely appreciate the demands and realities of the profession. Big deal, yes? Well, not really... because earlier on this evening, I came to realise quite an ironic twist to this phenomenon (which is probably already obvious to the well-organised mind): how much do we know about other peoples' professions?

So, my best friend Jess has just started teaching this year. First year out of uni, she's landed a full-time job as a kindergarten teacher at a well-established school. Now I don't know about you, but the image that's conjured in my mind when I think of teaching kindergarten is that of having a jolly-good time finger-painting and story-reading to a group of cute and innocent, rosy-cheeked, 5-year olds (let's add rainbows and bunny rabbits in the backdrop for good measure). Right? WRONG!! What she described to me tonight over dessert and coffee, was nothing short of trying to tame rascals in a juvenile detention centre. She has this child in her class with demonic tendencies who frequently breaks into violent outbursts and starts to throw things at the other children and my poor friend. Then there's the kid who likes to sit under the desk for reasons only God will ever know; and of course, being sheep, other kids follow suit and rebel accordingly in their own wicked way(s). Play-ground duty --> more like zoo-keeping duty!! Put those aside, the real challenge of course, is trying to deal with the bureaucracy of the place; with an unsupportive principal and his humble side-kick ass/principal, who turn a blind eye, tell her to pull herself together and do her job :-O

They don't know what we do; but then again, we don't know what they do either.

Monday, June 8, 2009

What would you do?

So while I fix my blog, I thought I would share this thought-provoking (albeit random) quote that I stumbled upon while I was flicking through one of my cousin's photo albums on fb. I believe it was taken at the University of British Columbia in Canada:



Simple as it is, it really moved me, no actually - scared me - when I first read it. I'm a massive control freak - I spend a lot of time finding out exactly what happened, what's happening and what's about to happen. But this... this... this just challenged me in such a peculiar way. I have an exam tomorrow and I know there are going to be a lot of questions that I won't know how to answer. But all that is just trivial compared to this question. I really don't know how to answer this one. What would you do?